scholarly journals Melanoma metastasis to a nonfunctioning pituitary macroadenoma: illustrative case

2021 ◽  
Vol 1 (23) ◽  
Author(s):  
Krista Lamorie-Foote ◽  
Shivani D. Rangwala ◽  
Alexandra Kammen ◽  
Esteban Gnass ◽  
Daniel R. Kramer ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Stage Iv ◽  
Collision Tumor ◽  
Laboratory Evaluation ◽  
Illustrative Case ◽  
Melanoma Metastasis ◽  
Pituitary Macroadenoma ◽  
Endoscopic Endonasal ◽  
Cancer History ◽  
Sellar Lesions

BACKGROUND Metastases to the central nervous system are often multiple in number and typically favor the gray-white matter junction. Collision tumors, defined as the coexistence of two morphologically different tumors, such as metastases to a known pituitary adenoma (PA), are exceedingly rare. Only a few reported cases of metastases to a PA exist in the literature. OBSERVATIONS The authors present the case of a 64-year-old man with a known history of stage IV metastatic melanoma who was found to have hypermetabolic activity in the sellar region on surveillance positron emission tomography. On laboratory evaluation, he had clear evidence of pituitary axis dysfunction without diabetes insipidus. Subsequent magnetic resonance imaging showed a 2.4-cm sellar mass with features of a pituitary macroadenoma and internal hemorrhage, although no clinical symptoms of apoplexy were noted. He underwent a transsphenoidal endoscopic endonasal approach for resection of the sellar lesion. Final pathology showed a collision tumor with melanoma cells intermixed with PA cells. LESSONS Histological analysis verified the rare presence of a collision tumor of a melanoma metastasis to a nonfunctional pituitary macroadenoma. Metastasis to a preexisting PA, although rare, should be considered in the differential diagnosis in patients with sellar lesions and a known cancer history.

Skin Cancer History Boosts Melanoma Metastasis Risk

2010 ◽  
Vol 41 (5) ◽  
pp. 27
Author(s):  
BRUCE JANCIN
Keyword(s):  
Skin Cancer ◽  
Melanoma Metastasis ◽  
Cancer History

scholarly journals Cannabinoid Hyperemesis Syndrome: A Case Report of an Underdiagnosed Condition

2020 ◽  
pp. 1-5
Author(s):  
João Machado Nogueira ◽  
Inês Fonseca ◽  
Marco Duarte
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Diagnostic Tests ◽  
Clinical Symptoms ◽  
Definitive Diagnosis ◽  
Hot Water ◽  
Illustrative Case ◽  
Raising Awareness ◽  
Detailed Medical History ◽  
Cannabinoid Hyperemesis Syndrome

Cannabinoid hyperemesis syndrome (CHS) is characterized by episodic bursts of nausea, vomiting and abdominal pain, affecting chronic cannabis users. The clinical picture mimics an acute abdomen, usually leading to multiple assessments in the emergency department. Several complementary diagnostic examinations are performed with non-specific results, making differential diagnosis puzzling. We present a case of a 42-year-old man, who has been admitted multiple times to the emergency department in the last 3 months for abdominal pain, nausea and vomiting, without triggering factors and improving only with hot water baths. He was evaluated by different specialties, the various complementary diagnostic tests performed showed no significant results, and no definitive diagnosis was obtained. Treatment resulted only in a partial and transient resolution of symptoms. A more detailed medical history revealed cannabis use for more than 5 years, with a recent increase in the amount consumed. After psychoeducation, explaining the risks associated with consumption and its relationship with the clinical symptoms, which resulted in complete suspension of cannabis, there have been no new symptomatic episodes since then. We present an illustrative case of a poorly reported clinical entity despite having a probable significant prevalence, raising awareness in order that clinicians identify and properly manage these cases.

scholarly journals Iatrogenic cerebrospinal fluid leak after repeated nasal swab tests for COVID-19: illustrative case

2021 ◽  
Vol 2 (17) ◽  
Author(s):  
Johnson Ku ◽  
Chieh-Yi Chen ◽  
Jason Ku ◽  
Hsuan-Kan Chang ◽  
Jau-Ching Wu ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Nasal Cavity ◽  
Nasal Swab ◽  
Cerebrospinal Fluid Leak ◽  
Cribriform Plate ◽  
Csf Leak ◽  
Illustrative Case ◽  
Endoscopic Endonasal ◽  
Csf Rhinorrhea ◽  
Csf Leakage

BACKGROUND Nasal swab tests are one of the most essential tools for screening coronavirus disease 2019 (COVID-19). The authors report a rare case of iatrogenic cerebrospinal fluid (CSF) leak from the anterior skull base after repeated nasal swab tests for COVID-19, which was treated with endoscopic endonasal repair. OBSERVATIONS A 41-year-old man presented with clear continuous rhinorrhea through his left nostril for 5 days after repeated nasal swabbing for COVID-19. There were no obvious risk factors for spontaneous CSF leak. Computed tomography cisternography showed contrast accumulation in the left olfactory fossa and along the left nasal cavity. Such findings aligned with a preliminary diagnosis of CSF leakage through the left cribriform plate. Magnetic resonance imaging confirmed the presence of a CSF fistula between his left cribriform plate and superior nasal concha. The patient underwent endoscopic endonasal repair. CSF rhinorrhea ceased after the surgery, and no recurrence was noted during the 12-week postoperative follow-up period. LESSONS Although rare, iatrogenic CSF leakage can be a serious complication following COVID-19 nasal swab tests, especially when infection may cause significant neurological sequelae. Healthcare providers should become familiar with nasal cavity anatomy and be well trained in performing nasal swab tests.

Collision Tumor: Importance of the new auxiliary tools for diagnosis (An illustrative case report)

2011 ◽  
Vol 17 (7) ◽  
Author(s):  
Nuno Menezes ◽  
Guedes Rita ◽  
Leite Inês ◽  
Varela Paulo ◽  
Baptista Armando
Keyword(s):  
Case Report ◽  
Collision Tumor ◽  
Illustrative Case

scholarly journals Calcified Prolactinoma of the Pituitary Gland: Illustrative Case Reports Highlighting Medical versus Surgical Intervention

2019 ◽  
Vol 81 (01) ◽  
pp. 022-029
Author(s):  
Sherwin Tavakol ◽  
Asma Hasan ◽  
Michelle A. Wedemeyer ◽  
Joshua Bakhsheshian ◽  
Chia-Shang J. Liu ◽  
...  
Keyword(s):  
Pituitary Gland ◽  
Pituitary Adenomas ◽  
Standard Treatment ◽  
Tumor Response ◽  
Surgical Intervention ◽  
Case Reports ◽  
Illustrative Case ◽  
Tumor Shrinkage ◽  
Endoscopic Endonasal ◽  
Diffuse Calcification

AbstractThe presence of calcification is uncommon in pituitary adenomas, and often lends support to other diagnoses including craniopharyngioma. The majority of calcified pituitary adenomas are prolactin-secreting tumors. We report two patients with calcified macroprolactinomas, one that was treated medically with a biochemical response and partial tumor response, and one that was treated successfully via an endoscopic endonasal transsphenoidal approach. Suspected calcified prolactinomas can be initially managed medically as per standard treatment for typical prolactinomas; however, the presence of diffuse calcification may hinder tumor shrinkage. Tumors that are refractory to medical treatment can be safely managed with surgery.

Endocrine Active Pituitary Tumor

2018 ◽  
Author(s):  
Amol Raheja ◽  
William T. Couldwell
Keyword(s):  
Pituitary Tumor ◽  
Index Case ◽  
Current Evidence ◽  
Illustrative Case ◽  
Complication Management ◽  
Pituitary Macroadenoma ◽  
Review Of Literature ◽  
Management Options ◽  
Surgical Options ◽  
Pros And Cons

This chapter presents an illustrative case demonstrating the principles of diagnosis and management in endocrine active pituitary tumor. The index case involves a 30-year-old male patient who presented with phenotypic markers of acromegaly. On radiological and endocrinological evaluation, growth hormone–secreting pituitary macroadenoma was identified. The philosophy of decision-making and management paradigm is discussed to demonstrate the pros and cons of medical, radiation, and surgical options. Technical nuances of the surgical procedure and its complication management are stressed. A brief review of literature is included to elaborate on the current evidence, including outcomes for the various management options for such tumors, with special emphasis on multimodality management.

scholarly journals Outcomes of solitary dilated breast ducts in symptomatic and asymptomatic patients

2020 ◽  
Vol 93 (1109) ◽  
pp. 20191039
Author(s):  
Sadia Choudhery ◽  
Curtis Simmons ◽  
Genevieve A. Woodard ◽  
Asha A. Bhatt ◽  
Tara L. Anderson ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Clinical Symptoms ◽  
Nipple Discharge ◽  
Maximum Diameter ◽  
Density Maximum ◽  
Cancer History ◽  
Bloody Nipple Discharge ◽  
Peripheral Location ◽  
Asymptomatic Patients ◽  
Lactating Females

Objective: The purpose of this study is to assess the outcomes of symptomatic and asymptomatic solitary dilated ducts detected on mammography, ultrasound, and MRI. Methods: All cases of isolated solitary dilated ducts between January 1, 2009 and December 31, 2016 in non-lactating females were reviewed. Clinical data, including patient’s age, breast cancer history, and pathology results were collected. Imaging was reviewed, and indication for the exam, breast density, maximum diameter of the dilated duct on ultrasound, presence of an intraductal mass, presence of intraductal vascularity, presence of intraductal echogenicity, and subareolar or peripheral location of the dilated duct were recorded. Results: 87 cases of solitary dilated ducts were assessed in this study, of which 3 were malignant, resulting in a positive predictive value of 3.5% (3/87). No malignancy was identified in asymptomatic screening patients. The three malignant cases were seen in patients presenting with a palpable lump (n = 1) or bloody nipple discharge (n = 2). There was a statistically significant association observed between the dilated duct diameter (p = 0.049) and presence of intraductal vascularity (p = 0.0005) with presence of malignancy. Conclusion: Rate of malignancy is low in solitary dilated ducts, especially among asymptomatic patients. Patient’s presenting with clinical symptoms, larger dilated duct diameters, and/or intraductal vascularity may require additional evaluation including biopsy to exclude malignancy. Advances in knowledge: Clinical and imaging factors can assist in better identifying patients with solitary dilated ducts who should undergo biopsy.

scholarly journals Presentation and outcomes in surgically and conservatively managed pediatric Rathke cleft cysts

2018 ◽  
Vol 21 (3) ◽  
pp. 308-314 ◽  
Author(s):  
Matthew J. Shepard ◽  
Mohamed A. Elzoghby ◽  
Erin N. Kiehna ◽  
Spencer C. Payne ◽  
John A. Jane
Keyword(s):  
Visual Field ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Study Patient ◽  
Endoscopic Endonasal ◽  
Diagnostic Uncertainty ◽  
Conservative Group ◽  
Sellar Lesions ◽  
Operative Notes ◽  
Cyst Fenestration

OBJECTIVERathke cleft cysts (RCCs) are sellar lesions that are commonly encountered in adults but infrequently diagnosed in the pediatric population. As a result, the optimal management of pediatric RCCs remains a subject of controversy. Only 2 prior surgical series have been published on pediatric RCCs and no study has compared the presentation and outcomes of surgically versus conservatively managed cases. The authors therefore performed a comparative analysis of pediatric cases of RCC in which patients were treated with surgery or managed in a conservative manner.METHODSAll cases involving pediatric patients diagnosed with an RCC at the University of Virginia between 2000 and 2016 were included in this study. Patient medical records, operative notes, and neuroimaging findings were reviewed. Patients who developed visual field deficits, radiographic evidence of chiasmal compression, or medically refractory headaches were considered candidates for surgical intervention. All patients who were selected for surgery underwent an endoscopic endonasal approach with cyst fenestration.RESULTSA total of 24 pediatric patients were diagnosed with an RCC over a 16-year period. Seven patients ultimately underwent transsphenoidal cyst fenestration, and 17 were managed conservatively. The patients’ age at diagnosis, cyst size, and pituitary function at the time of RCC diagnosis were similar in the conservatively and surgically managed cohorts. At diagnosis, 19 of 24 patients endorsed headaches that led to neuroimaging. All patients in the surgical cohort endorsed severe headaches at diagnosis compared with 71% in the conservative group. For the 7 patients treated with surgery, complete cyst evacuation was achieved in 86% of cases. Transient postoperative endocrinopathy occurred in 4 (57%) of 7 surgically treated individuals and resolved in all cases. In the conservative cohort, 1 patient developed a delayed pituitary-related endocrinopathy. Headache resolution occurred in 5 (71%) of the 7 patients who underwent surgery and 7 (58%) of the 12 who were treated without surgery. Cyst recurrence was documented in 1 individual in the surgical cohort who underwent a subtotal cyst fenestration that ultimately required re-intervention. In the conservative cohort, spontaneous cyst shrinkage occurred in 35% of patients with a median time to regression of 23.5 months.CONCLUSIONSPediatric RCCs are benign sellar lesions that often present with headaches. While cyst fenestration mitigates headaches in most patients, the majority of conservatively managed pediatric patients with RCCs will have spontaneous headache resolution. Furthermore, spontaneous RCC regression occurs in a substantial number of individuals. Thus, in the absence of optic compression, visual field deficit, or diagnostic uncertainty, many pediatric cases of RCC can be managed conservatively.

Complete surgical resection of residual melanoma metastasis and survival in stage IV patients following high-dose IL-2 therapy

2008 ◽  
Vol 26 (15_suppl) ◽  
pp. 20000-20000
Author(s):  
B. Taback ◽  
J. Honeyman ◽  
C. Liu ◽  
G. DeRaffele ◽  
H. L. Kaufman
Keyword(s):  
Surgical Resection ◽  
Stage Iv ◽  
High Dose ◽  
Melanoma Metastasis ◽  
Complete Surgical Resection

Effect of ipilimumab at 10 mg/kg on disease control in patients (pts) with M1c-stage melanoma in relation to baseline lactate dehydrogenase (LDH) levels

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 9041-9041
Author(s):  
M. Smylie ◽  
S. Francis ◽  
B. Neyns ◽  
M. Maio ◽  
D. Minor ◽  
...  
Keyword(s):  
Disease Control ◽  
Phase Ii ◽  
Cytotoxic T Lymphocyte ◽  
Stage Iv ◽  
Tumor Burden ◽  
Clinical Activity ◽  
Melanoma Metastasis ◽  
Phase Ii Studies ◽  
Similar Disease ◽  
To Receive

9041 Background: Ipilimumab, a fully human, anti-cytotoxic T-lymphocyte antigen-4 monoclonal antibody, enhances antitumor immunity. Ipilimumab is clinically active in advanced melanoma, with a 1-year survival rate of ∼50% in Phase II studies (Wolchok et al. CRI-CVC annual meeting 2008. Oral presentation). Serum LDH level is an independent prognostic factor for malignant melanoma, and is strongly predictive of reduced survival in stage IV disease (Bedikian et al. J Clin Oncol. 2006;24:4738–4745.). This analysis evaluated the association between baseline LDH levels and disease control (stable or reduced measurable tumor burden) in previously treated pts with M1c-stage melanoma (metastasis to vital organs other than the lungs) who received ipilimumab in 2 recently completed Phase II studies (CA184008 and 022). Methods: Ipilimumab at 10 mg/kg was given every 3 weeks (Q3W) × 4; eligible pts could continue to receive ipilimumab Q12W beginning at Week 24. In study 022, pts were randomized to receive ipilimumab induction dosing at 0.3, 3.0, or 10 mg/kg Q3W × 4; study 008 was a single- arm trial of ipilimumab at 10 mg/kg. Disease control data were pooled from the 2 Phase II studies for pts treated with ipilimumab at 10 mg/kg and stratified by normal and elevated (>1× upper normal limit [UNL]) LDH levels. Elevated LDH was not capped. Results: For 227 pts treated at 10 mg/kg, 123 had M1c-stage disease: 42 had normal LDH and 81 had LDH >1 × UNL (of which 32 had LDH 2 × UNL). Among these 123 pts, 17/81 (21.0%) [95% CI 12.7–31.5] with elevated LDH levels experienced disease control, whereas 12/42 (28.6%) [95% CI 15.7–44.6] with LDH levels at or below the UNL experienced disease control. Conclusions: Our data show that ipilimumab exerts similar disease control in pts with normal and elevated LDH levels. Ipilimumab therefore appears to have clinical activity in the form of disease control in pts with a very poor prognosis, i.e., M1c-stage melanoma and elevated LDH levels. [Table: see text]

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