Gastroparesis, Thymoma, and Asymptomatic Myasthenia: A Rare Clinical Scenario

Background: Paraneoplastic gastroparesis is a gastrointestinal syndrome that rarely precedes a tumor diagnosis. To increase awareness of this rare clinical entity, we present a case of severe gastroparesis, which was later proven to be associated with a thymoma. Case report: A 55-year old man had the sudden onset of severe abdominal cramps and abdominal distension, early satiety with postprandial nausea, acid regurgitation, belching, and flatulence. He lost about 20 pounds. The physical and imaging examination revealed stomach distension, gastroparesis, and the presence of a solid mass in the anterior mediastinum. Radical surgery was performed to remove the thymoma and, given the high value of Mib-1, the patient was submitted to postoperative chest radiation therapy. After thymectomy, a diagnosis of paraneoplastic myasthenia gravis with subacute autonomic failure was made. Conclusion: Autoimmune gastroparesis should be considered as a potential paraneoplastic syndrome in patients with thymoma, myasthenia gravis, and delayed gastric emptying in the absence of mechanical obstruction.

Graphene Oxide Catalyzed Synthesis of Fused Chromeno Spiro Pyrrolidine Oxindoles via Tandem Decarboxylation and 1,3-Dipolar Cycloaddition

A short and efficient multicomponent sequence for synthesizing fused novel polyheterocyclic chromeno spiro-pyrrolidine oxindoles via 1,3-dipolar cycloaddition reaction mediated by reactive azomethine ylides catalyzed by the Graphene Oxide (GO) is reported herein. This approach was utilized for synthesizing fused polyheterocyclic spiro-pyrrolothiazole and spiro-pyrrole oxindoles with yields ranging from good to excellent. A heterogeneous GO catalyst with an ultra-low catalytic loading of 0.05 wt% could proficiently catalyze the reaction without the formation of any side products and can also be visualized by the formation of solid mass in the reaction flask. The methodology is green in nature and the products were isolated by simple filtration without the use of any chromatographic techniques.

A Rare Case of Myoid Hamartoma Masquerading As Invasive Breast Carcinoma

Breast Myoid Hamartoma (MH) is a rare type of neoplasm with a poorly understood pathogenesis. Very few literatures have reported such disease with an unclear prognosis and malignant potentiality. Some isolated studies have shown that breast Myoid Hamartoma (MH) may be genetically related to other types of tumours with the involvement of HMGA2 gene. We reported a case of a 64-year-old post-menopausal lady with an underlying chronic idiopathic axonal polyneuropathy (CIAP) that was referred to our centre for a suspected right breast tumour. Clinical and imaging proved the disease to be malignant, however, core biopsy results showed otherwise. Ultrasound of the right breast showed a solid mass with a hypoechoic heterogeneous echotexture and posterior shadowing. A Mammogram highlighted a dense lesion in the right breast with radiolucent halo and macrocalcification. It was reported as BIRADS 4 category. Managing breast Myoid Hamartoma (MH) is proved to be of great challenge to clinicians as meticulous clinical acumen is needed to strategize a proper plan and management, most importantly, not to overlook the disease as the malignant transformation has been reported before.

Falcotentorial meningiomas: Optimal surgical planning and intraoperative challenges – case report

Meningiomas arising from the falcotentorial junction are rare, and the selection of the optimal surgical approach is essential. We report a 41-year-old man presented with progressive left paresis in the lower limbs. An MRI showed a solid mass inside the third ventricle in contact with the falcotentorial dural junction. The tumor was removed by the transtentorial/transfalcine occipital approach, performed with the patient in the three-quarter prone position. The tumor was devascularized from the tentorium, then debulked and finally dissected. The affected falx and tentorium were resected, but all of patent dural venous sinuses were preserved. The tumor was a subtotal resect. Choosing the surgical approach is essential for the safe and effective removal of an FTM and preoperative imaging analysis should identify the tumor’s anatomical relations and guide toward the least disruptive route that preserves the neurovascular structures. This article aims to report a successfully treated FTM.

Extended double sleeve lobectomy combined with thoracic wall resection to treat a huge lung cancer

A 58-year-old man came to our hospital with numbness of the left arm, fatigue, and fever. A huge solid mass with necrotic changes located in the left upper lobe was noted on the computed tomography scan. The tumor directly invaded the extrathoracic wall, the left main pulmonary artery, and the superior segment of the lower lobe. To avoid pneumonectomy, a combination of an extended double sleeve lobectomy and thoracic wall resection was performed. The postoperative course was uneventful. The patient has survived without any recurrence for 6 months postoperatively.

Pancreatic cyst-solid mass: tuberculosis

Question: A 29-year-old Chinese male was admitted to our department with a history of right upper quadrant pain for two months, anorexia, weight loss about 5 kg and without fever. The pain radiated to the back and it got worst lately. He didn’t have a history of tuberculosis. The sclera was mild icteric. Laboratory test results showed total bilirubin level increased to 58 umol/L (normal level <28 umol/L) and tumor markers were normal. Chest X-ray was normal. Abdominal contrastenhanced CT showed a 25 x 30 mm cyst-solid mass in the head of pancreas (Figure1. A) and the lesion was mild enhancement in arterial phase. Pancreatic tumor was considered. Endoscopic ultrasonography confirmed the mass with uneven echo in the pancreatic head and the boundary of the mass was not clear (Figure1. B). The lesion may invade the portal vein. As the patient was young and the operation was very traumatic, the patient refused surgery unless the lesion was proved to be a tumor.

Environment friendly concrete block made from Portland cement and aggregate replacement materials

This research work investigated the properties of concrete block made from Portland cement and aggregate replacement materials. Portland cement (PC) was replaced by fly ash (FA) at 10%, 20%, 30% and sand was replaced by bottom ash (BA) at 10% by weight. Water was used at 7% by weight of total solid mass. Binder : Sand : Stone dust ratio of 1 : 5 : 6, 1 : 4 : 5 and 1 : 3.5 : 4.5 were used. Compressive strength were tested after curing in air for 28 days. The results showed that compressive strength of 1 : 5 : 6 ratio was lower than others. Concrete block replaced PC by fly ash had lower compressive strength when amount of fly ash increased. Concrete block had lower compressive strength when replaced sand by bottom ash. As a result, the mixes with FA as PC replacement and BA as sand replacement at the ratio of 1 : 5 : 6 did not meet the requirement of Thai industrial standard. However, concrete block with PC replaced by fly ash at 10%, 20% and sand replaced by bottom ash at 10% of 1 : 3.5 : 4.5 ratio was higher than 1 : 5 : 6 ratio and this ratio meet the requirement of Thai industrial standard.

Giant urethral stone with diverticulum; a case report

Urethral calculi are rare and represent 1-2% of all urinary stone diseases. Rarely, calculus grows to large size and are labeled as a "giant urethral calculus". A 75-year-old male came to the OPD of Madinah Teaching Hospital Faisalabad with a chief complaint of suprapubic pain, penile pain, and hard mass on the left side of the scrotum and anterior perineum. The patient had a significant history of undergoing debridement for Meleney's and Fournier's gangrene, along with suprapubic cystostomy done about 1.5 years back. Physical examination revealed a solid mass with dimensions 6x7 cm on the left side of the scrotum and anterior perineum (left periurethral area). Open surgery was performed. A huge stone, 6x6cm, was removed. Diverticulae were excised, and urethroplasty was performed. A catheter was removed on the 21st postoperative with a satisfactory urinary stream.

Primary cavernous hemangioma of the glans penis with balanitis xerotica obliterans: a case report

The uniqueness of this case is in its rarity and divergent presentation. Here, we report a case of 61 years old diabetic male who presented with painless swelling on the glans penis for the past 6 months along with bleeding from the mass and difficulty to pass urine for 1 month. Examination revealed solid, mass arising from the tip of glans with non-retractile, indurated prepuce. No clinically palpable lymphadenopathy was present. Dorsal slit was performed and mass excised. Histopathology examination revealed cavernous hemangioma. Primary cavernous hemangioma of glans penis is very rare but challenging for urologists to diagnose and manage such cases.

Adult Extrarenal Teratoid Wilms’ Tumor: A Case Report

Background: A teratoid Wilms’ tumor (TWT) is a very rare histologic variant of the classical Wilms’ tumor. This tumor development outside kidneys is rare. Extrarenal TWT mainly occurs in children, and reports of adult-related cases are rare. Till now, only seven cases of extrarenal TWT have been reported, among which five cases occurred in children and another two cases was reported in adult. Methods: A retrospective analysis of the clinicopathological characteristics of a case of extrarenal teratoid Wilms’ tumors (TWT) admitted to our hospital and analysis and summary with literature. Results: The case was a 19-year-old woman that presenting with lower, painless abdominal discomfort, and an imaging of an ultrasound and MRI both showed a cystic-solid mass on the right ovary. The patient subsequently underwent a laparoscopic right ovarian cystectomy, The specimen is sent for pathological examination, microscopic examination showed typical morphological features of Wilms’ tumor and predominance of teratoid elements which comprising more than 50% of the tumor. The diagnosis was made as extrarenal TWT in right ovary. After 3 courses of chemotherapy, the patient remains without evidence of disease after twenty-six months of follow-up. Conclusion: Our case is the third reported case of adult extrarenal TWT occurring in ovarian. Careful histomorphological examination and extensive immunohistochemical studies will allow for accurate diagnosis, We reported this case in order to improve the clinicians and pathologist’s understanding of tumors.