Confluent and Reticulated Papillomatosis of Carteaud and Gougerot in a Young Nepali Male

Confluent and reticulated papillomatosis of Carteaud and Gougerot is a keratinization disorder with an infective aetiology. Patients present with hyperpigmented papules on the upper trunk and axillae that coalesce centrally and demonstrate reticulation peripherally. Diagnosis is based on clinical findings, characteristic histopathologic changes and response to therapy. We report a case of a young Nepali male who presented with gradual onset of asymptomatic raised dark brown lesions on his neck, trunk and axillae over the course of eight years. The condition was previously misdiagnosed as pityriasis versicolor and had received oral and topical antifungals. The diagnosis was revised to confluent and reticulated papillomatosis based on clinical and histopathological examination. He was subsequently started on oral minocycline 50 mg twice daily and nightly application of topical tretinoin 0.05% gel. There was complete resolution of all his lesions except for residual hyperpigmentation at the end of two months of therapy. There has been no relapse six months from the end of therapy. This is to our knowledge, the first case of confluent and reticulated papillomatosis reported from Nepal. Oral minocycline and topical tretinoin should be considered first line in the treatment of confluent and reticulated papillomatosis.

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Pre-operative diagnosis of ovarian ectopic pregnancy: a challenge to practicing clinician

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20190904 ◽

2019 ◽

Vol 8 (3) ◽

pp. 1193

Author(s):

Shalini Mahana Valecha ◽

Dolly Bashani ◽

Jaya Gedam ◽

Pandeeswari .

Keyword(s):

Ectopic Pregnancy ◽

Histopathological Examination ◽

Clinical Findings ◽

Uneventful Recovery ◽

Ultrasound Scan ◽

First Case ◽

Stromal Tissue ◽

Ectopic Pregnancies ◽

The Right ◽

Medical Advances

The first case of primary ovarian ectopic pregnancy was reported by St. Maurice in 1689. Primary ovarian ectopic pregnancy is rare entity, with incidence of around 3% of all ectopic pregnancies. The aim of present case report is to study the role of different modalities like clinical findings, biochemistry, sonography, surgery and histopathology in diagnosis of primary ovarian ectopic pregnancy. Authors present a case of a 24 years old female with history of 2 months amenorrhoea, per vaginal spotting and mild intermittent abdominal pain in RIF. Examination was unremarkable and serum βHCG was 2007.5IU/ml. An ultrasound scan showed an ectopic mass in the right adnexa suggestive of a tubal ectopic pregnancy and she underwent surgical management at our institute. At laparoscopy, both fallopian tubes were noted to be normal with an ectopic mass attached to the right ovary with a pedicle. With these unusual laparoscopic findings, possibilities of tubal miscarriage, ovarian pregnancy, or abdominal pregnancy were suspected. Ectopic mass was coagulated and cut through the pedicle with bipolar cautery and specimen was sent for HPE. Our patient made an uneventful recovery and no further medical management was indicated. The diagnosis of right ovarian ectopic pregnancy was finally confirmed by histopathological evidence of the presence of chorionic villi in a background of ovarian stromal tissue, in consideration with Spigelberg’s criteria. Present case highlights the importance of considering non-tubal ectopic pregnancies when making a diagnosis based on ultrasound scan. Pre-operative diagnosis of ovarian ectopic pregnancy still remains a challenge in spite of current medical advances. Despite the benefits and reliability of ultrasound scanning, there will still be situations where the definitive diagnosis can only be made at surgery. However, histopathological examination is confirmatory and always mandatory.

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Intestinal Heterotopic Pancreas Involved by Simultaneous PanIN-2 Lesion and Endocrine Microadenoma: a Unique Case

Journal of Gastrointestinal and Liver Diseases ◽

10.15403/jgld.2014.1121.262.pan ◽

2017 ◽

Vol 26 (2) ◽

pp. 199-202

Author(s):

Remus Cornea ◽

Sorina Taban ◽

Cristian Suciu ◽

Codruta Lazureanu ◽

Alis Dema

Keyword(s):

Histopathological Examination ◽

Intraepithelial Neoplasia ◽

Heterotopic Pancreas ◽

Pancreatic Intraepithelial Neoplasia ◽

Unique Case ◽

Intraductal Papillary Mucinous Neoplasms ◽

Pancreatic Endocrine Neoplasm ◽

First Case ◽

Mucinous Neoplasms

We hereby present the case of a 58-year-old male who underwent a total gastrectomy for gastric neoplasm. During the surgery, a tumor mass in the jejunum was identified, considered as metastasis, and resected. The histopathological examination of the jejunal lesion showed ectopic pancreas. In this area, two pathological distinct lesions were identified, one histologically compatible with pancreatic intraepithelial neoplasia (PanIN) type 2 lesion and the other with morphologic criteria for endocrine microadenoma. To our knowledge, this is the first case that evidences the presence of a concomitant premalignant exocrine lesion and benign endocrine lesion in a heterotopic pancreas (HP).Abbreviations: HP: heterotopic pancreas; IPMN: Intraductal Papillary Mucinous Neoplasms; PanIN: Pancreatic Intraepithelial Neoplasia; PEN: pancreatic endocrine neoplasm.

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Complete resolution of acute pancreatitis-induced chylous ascites following transhepatic portal vein stenting

BMJ Case Reports ◽

10.1136/bcr-2020-235986 ◽

2020 ◽

Vol 13 (12) ◽

pp. e235986

Author(s):

Alexander Tindale ◽

James Jackson ◽

Darina Kohoutova ◽

Panagiotis Vlavianos

Keyword(s):

Portal Vein ◽

Complete Resolution ◽

Chylous Ascites ◽

Biliary Pancreatitis ◽

Acute Biliary Pancreatitis ◽

Portal Vein Stenosis ◽

First Case ◽

Vein Stenosis ◽

Inflammatory Changes

We introduce a case of a 73-year-old man who developed intractable chylous ascites due to portal vein compression as a result of peripancreatic inflammatory changes after acute biliary pancreatitis. After stenting the portal vein stenosis, the chylous ascites improved from requiring weekly paracentesis to requiring no drainage within 4 months of the procedure and at the 15-month follow-up. To our knowledge, it is the first case reported in the literature where portal vein stenting has successfully been used to treat pancreatitis-induced chylous ascites.

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Primary stromal sarcoma of breast: A case report and literature review

Breast Disease ◽

10.3233/bd-201012 ◽

2021 ◽

pp. 1-7

Author(s):

Mohammad Al-Wiswasy ◽

Mahmoud Al-Balas ◽

Raith Al-Saffar ◽

Hamzeh Al-Balas

Keyword(s):

Malignant Tumors ◽

Histopathological Examination ◽

Prognostic Significance ◽

Total Duration ◽

Young Patients ◽

Soft Tissue Sarcomas ◽

Breast Mass ◽

Resection Margins ◽

Stromal Sarcoma ◽

First Case

INTRODUCTION: Primary breast sarcoma (PBS) was first described in 1887 as a rare heterogeneous neoplasm arising from the mesenchymal tissue of the mammary gland accounting for less than 5% of all body soft-tissue sarcomas and less than 0.1% of all malignant tumors of the breast. CASE PRESENTATION: A 31-year old lady presented with left breast mass which she felt four years before during which the mass increased in size from 1 to 6 cm in the largest diameter, diagnosed clinically as a benign fibroadenoma without any further cytological or histopathological confirmation. Histopathological examination of the excised breast mass reveals undifferentiated, primary stromal sarcoma of the breast (PSSB), which was followed by mastectomy three weeks later with reconstructive breast surgery with a total duration of follow-up of 3 years thereafter. This is the first case of PSSB reported in Jordan. DISCUSSION/CONCLUSION: PSSB is the generic term given to malignant breast tumors thought to arise from the specialized mesenchymal stroma of the breast but lacking an epithelial component with a phylloides pattern. PSSB is difficult to diagnose preoperatively due to its rarity and inadequate imaging methods to establish an exact diagnosis. The histology of the patient mass may be the leading factor for the management of these tumors. Even in very young patients, a progressively growing breast mass should alert the clinician to investigate for malignancy and verify the results by biopsy. Surgery with adequate resection margins represents the only potentially curative modality with prognostic significance. Adjuvant chemotherapy and radiotherapy are not very beneficial. The prognosis is dismal for patients with lymph node involvement and the size of the tumor has a lesser bearing on the outcome.

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Fetus in fetu: two case reports from North African country

Egyptian Pediatric Association Gazette ◽

10.1186/s43054-020-00049-5 ◽

2021 ◽

Vol 69 (1) ◽

Author(s):

Moutaz Ragab ◽

Omar Nagy Abdelhakeem ◽

Omar Mansour ◽

Mai Gad ◽

Hesham Anwar Hussein

Keyword(s):

Histopathological Examination ◽

Case Reports ◽

Abdominal Mass ◽

Mature Teratoma ◽

Surgical Techniques ◽

Rare Condition ◽

Mass Effect ◽

Fetus In Fetu ◽

Vascular Connection ◽

First Case

Abstract Background Fetus in fetu is a rare congenital anomaly. The exact etiology is unclear; one of the mostly accepted theories is the occurrence of an embryological insult occurring in a diamniotic monochorionic twin leading to asymmetrical division of the blastocyst mass. Commonly, they present in the infancy with clinical picture related to their mass effect. About 80% of cases are in the abdomen retroperitoneally. Case presentation We present two cases of this rare condition. The first case was for a 10-year-old girl that presented with anemia and abdominal mass, while the second case was for a 4-month-old boy that was diagnosed antenatally by ultrasound. Both cases had vertebrae, recognizable fetal organs, and skin coverage. Both had a distinct sac. The second case had a vascular connection with the host arising from the superior mesenteric artery. Both cases were intra-abdominal and showed normal levels of alpha-fetoprotein. Histopathological examination revealed elements from the three germ layers without any evidence of immature cells ruling out teratoma as a differential diagnosis. Conclusions Owing to its rarity, fetus in fetu requires a high degree of suspicion and meticulous surgical techniques to avoid either injury of the adjacent vital structures or bleeding from the main blood supply connection to the host. It should be differentiated from mature teratoma.

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Influence of Baseline Positron Emission Tomography in Metastatic Gastroesophageal Cancer on Survival and Response to Therapy

Oncology ◽

10.1159/000517842 ◽

2021 ◽

pp. 1-6

Author(s):

Ahmed Abdelhakeem ◽

Madhavi Patnana ◽

Xuemei Wang ◽

Jane E. Rogers ◽

Mariela Blum Murphy ◽

...

Keyword(s):

Positron Emission Tomography ◽

Response To Therapy ◽

Emission Tomography ◽

Gastroesophageal Cancer ◽

First Line ◽

First Line Therapy ◽

Line Therapy ◽

Positron Emission ◽

Pet Ct ◽

Metastatic Burden

Background: The value of baseline fluorodeoxyglucose-positron emission tomography-computed tomography (PET-CT) remains uncertain once gastroesophageal cancer is metastatic. We hypothesized that assessment of detailed PET-CT parameters (maximum standardized uptake value [SUVmax] and/or total lesion glycolysis [TLG]), and the extent of metastatic burden could aid prediction of probability of response or prognosticate. Methods: We retrospectively analyzed treatment-naive patients with stage 4 gastroesophageal cancer (December 2002–August 2017) who had initial PET-CT for cancer staging at MD Anderson Cancer Center. SUVmax and TLG were compared with treatment outcomes for the full cohort and subgroups based on metastatic burden (≤2 or >2 metastatic sites). Results: We identified 129 patients with metastatic gastroesophageal cancer who underwent PET-CT before first-line therapy. The median follow-up time was 61 months. The median overall survival (OS) was 18.5 months; the first progression-free survival (PFS) was 5.5 months. SUVmax or TLG of the primary tumor or of all metastases combined had no influence on OS or PFS, whether the number of metastases was ≤2 or >2. Overall response rates (ORRs) to first-line therapy were 48% and 45% for patients with ≤2 and >2 metastases, respectively (nonsignificant). ORR did not differ based on low or high values of SUVmax or TLG. Conclusions: This is the first assessment of a unique set of PET-CT data and its association with outcomes in metastatic gastroesophageal cancer. In our large cohort of patients, detailed analyses of PET-CT (by SUVmax and/or TLG) did not discriminate any parameters examined. Thus, baseline PET-CT in untreated metastatic gastroesophageal cancer patients has limited or no utility.

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Rosette-Forming Glioneuronal Tumor of the Fourth Ventricle: A Case of Relapse Treated with Proton Beam Therapy

Diagnostics ◽

10.3390/diagnostics11050903 ◽

2021 ◽

Vol 11 (5) ◽

pp. 903

Author(s):

Antonella Cacchione ◽

Angela Mastronuzzi ◽

Andrea Carai ◽

Giovanna Stefania Colafati ◽

Francesca Diomedi-Camassei ◽

...

Keyword(s):

Adjuvant Therapy ◽

Proton Beam ◽

Fourth Ventricle ◽

Histopathological Examination ◽

Local Level ◽

Proton Beam Therapy ◽

Disease Recurrence ◽

Glioneuronal Tumor ◽

First Case ◽

Cystic Component

Rosette-forming glioneuronal tumors (RGNTs) are rare, grade I, central nervous system (CNS) tumors typically localized to the fourth ventricle. We describe a 9-year-old girl with dizziness and occipital headache. A magnetic resonance imaging (MRI) revealed a large hypodense posterior fossa mass lesion in relation to the vermis, with cystic component. Surgical resection of the tumor was performed. A RGNT diagnosis was made at the histopathological examination. During follow-up, the patient experienced a first relapse, which was again surgically removed. Eight months after, MRI documented a second recurrence at the local level. She was a candidate for the proton beam therapy (PBT) program. Three years after the end of PBT, the patient had no evidence of disease recurrence. This report underlines that, although RGNTs are commonly associated with an indolent course, they may have the potential for aggressive behavior, suggesting the need for treatment in addition to surgery. Controversy exists in the literature regarding effective management of RGNTs. Chemotherapy and radiation are used as adjuvant therapy, but their efficacy management has not been adequately described in the literature. This is the first case report published in which PBT was proposed for adjuvant therapy in place of chemotherapy in RGNT relapse.

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FIRST CASE SERIES OF VENOUS SINUS STENTING IN IIH PATIENTS IN WALES

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2015-312379.25 ◽

2015 ◽

Vol 86 (11) ◽

pp. e4.113-e4

Author(s):

Gauhar Abbas Malik ◽

Yogish Joshi

Keyword(s):

Intracranial Hypertension ◽

Case Series ◽

Headache Disorder ◽

Venous Sinus ◽

First Line ◽

Venous Stenting ◽

First Case ◽

Sinus Stenosis

BackgroundIdiopathic Intracranial Hypertension (IIH), is defined by increased cerebral spinal fluid (CSF) pressure in the absence of other causes of intracranial hypertension. There has been recent interest in the role of intracranial venous sinus stenosis in IIH. The raised pressures in IIH are argued to worsen by the secondary appearance of the venous sinus stenosis.Objective5 patients have undergone endovascular pressure measurement in Wales and their clinical details including history, examination, initial management, neuroimaging pre- and post venous stenting, and follow-up (6–24 months) to provide the first case study of patients undergoing Venous sinus stenting in Wales.Methods5 patients with IIH refractory to first line treatments underwent venography and manometry and 4 patients underwent stenting of the venous sinuses after this procedure had shown a pressure gradient proximal to stenosis in the lateral sinuses.ResultsThree patients were rendered asymptomatic, two were improved including one patient unmasking a different headache disorder following treatment.ConclusionsStenting in venous stenosis provides a further treatment option to patients refractory to first line treatments with IIH. This case series highlights in selected cases treatment is promising with good outcomes.

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Spontaneous cervical surgical emphysema following childbirth

The Journal of Laryngology & Otology ◽

10.1017/s0022215107001089 ◽

2007 ◽

Vol 121 (12) ◽

Cited By ~ 1

Author(s):

S Mylvaganam ◽

C G L Hobbs

Keyword(s):

Case Report ◽

Complete Resolution ◽

Post Partum ◽

Neck Swelling ◽

First Case ◽

Increased Risk ◽

Surgical Emphysema

AbstractObjective:We report a case of post-partum surgical cervical emphysema, which is a rare but well recognised complication of labour. By reporting the first case in the ENT literature, we aim to raise awareness of this complication, particularly amongst trainees, to ensure that patients are managed most appropriately.Case report:A 36-year-old, primigravida woman developed neck swelling and odynophagia post-partum. Surgical cervical emphysema was palpated, with further examination excluding pneumomediastinum and pneumothorax. The patient was managed conservatively, with complete resolution of symptoms within a week.Conclusions:Surgical cervical emphysema, pneumothorax and pneumomediastinum are all well recognised post-partum complications. The vast majority of cases do not present with respiratory or cardiac compromise and can be appropriately managed conservatively, with expectation of resolution in a fortnight. There is no evidence that such patients are at increased risk during subsequent pregnancies.

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Exclusive Neurogenic Bladder and Fecal Incontinency in an Achondroplasic Child Successfully Treated with Lumbar Foraminal Decompression

Pediatric Neurosurgery ◽

10.1159/000517652 ◽

2021 ◽

pp. 1-6

Author(s):

Flavio Giordano ◽

Matteo Lenge ◽

Pierarturo Donati ◽

Lorenzo Mongardi ◽

Gianpiero Di Giacomo ◽

...

Keyword(s):

Fecal Incontinence ◽

Neurogenic Bladder ◽

Genetic Disorder ◽

Motor Impairment ◽

Foramen Magnum ◽

Clinical Findings ◽

Lumbar Stenosis ◽

Endochondral Bone ◽

Case Presentation ◽

First Case

Introduction: Achondroplasia is a genetic disorder characterized by defects in the development of endochondral bone resulting in skeletal abnormalities like stenosis of the foramen magnum and of the spine, shortened limb bones, and macrocephaly. Congenital spinal stenosis is frequent and due to premature fusion of the pedicles to the laminae. Case Presentation: We report a case of neurogenic bladder and fecal incontinence due to lumbar stenosis successfully treated with L1–L5 partial laminectomy and foraminotomy in a 7-year-old achondroplasic child. Discussion/Conclusion: To our knowledge, this is the first case report of exclusive neurogenic bladder and fecal incontinence in an achondroplasic child. Neurogenic bladder and fecal incontinence without motor impairment may be early and exclusive clinical findings of lumbar stenosis in children with achondroplasia.

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