Pituitary Stalk Lesions - Single Center Long Term Observation

Background & Methods: Pituitary stalk lesions (PSL) are various changes located in the pituitary infundibulum. The underlying pathology and exact diagnosis are difficult to establish due to their unique anatomical locus. A retrospective observational analysis of 60 adult patients (34W/26M) with pituitary lesions was performed. The mean age of diagnosis was 33.8 years (SD 23.7). The etiologies were divided into 3 groups (congenital, inflammatory, neoplastic), classified as exact, probable or unknown and characterized hormonally. Aim: To present the etiological spectrum of pituitary stalk lesions and their clinical and hormonal characteristics on the basis of long term observation in the pediatric/adult endocrinology departments of our university. Results: The most common causes of PSL were neoplasms (20/60, 33.3%, 14W/6M); congenital malformations were detected in 17/60 (28.3%, 6W/11M), while inflammatory etiology was found in 15/60 (25.0%, 9W/6M) of patients. The exact diagnosis was established in 26/60 (43.3%) cases (16 congenital malformations, 6 adenomas, 1 pituitary cancer, 1 craniopharyngioma, 1 germinoma and 1 lymphocytic hypophysitis [LH]). The probable cause was suggested in 26/60 patients (43.3%) - 10 with the suspicion of LH, 4 with histiocytosis, 3 with a metastatic tumor from a disseminated cancer, 3 craniopharyngiomas, 1 posterior pituitary lobe ectopy, 1 prolactinoma, 1 granular cell tumor, 2 adenomas and 1 pituicytoma. The origin of 8/60 PSL (13.3%) remains unknown. During hormonal assessment the most common insufficiency concerned the gonadal axis found in 29/60 (48.3%) of patients, followed by thyroid (26/60, 43.4%), somatotropic (21/60, 35.0%) and adrenal axis (20/60, 33.3%) insufficiencies. Hyperprolactinemia was detected in 20/60 (33.3%) of patients, while diabetes insipidus was confirmed in 15/60 (25%) of cases. 45 patients presented at least 1 hormonal deficit, some of them were transient. In clinical aspect, symptoms associated with hormonal deficits led to the initiation of diagnostic work-up in 29 patients (48.3%; including 15 patients (25.0%) with growth retardation). Neurological symptoms such as headaches, visual disturbances and seizures were seen in 13 patients (21.7%). Polydipsia and polyuria were the primary presentation in 11 cases (18.3%), while 5 cases (8.3%) had a clinical manifestation of hormone overproduction. Incidental diagnosis was seen in 2 female patients (3.3%). Conclusions: The diagnosis, management and treatment of the pituitary stalk lesions remains challenging. Difficulties in establishing the exact diagnosis might also be related to the non-specific, transient characteristics of the symptoms and hormonal insufficiencies. Long term observations might help better the understanding of the disease and result in improvement of management.

Rare paratesticular aggressive angiomyxoma mimicking an epididymal tumor in an 82-year-old man: Case report

Aggressive angiomyxoma (AAM) is a rare mesenchymal myxoid tumor, and most cases occur in the pelvic region or perineum of adult females. AAM is very rare in males. Most of these cases have been diagnosed in patients aged 30–60 years, and the tumors involved the pelvic cavity, scrotum, or spermatic cord. AAM can mimic inguinal hernia, hydrocele, or paratesticular neoplasm. Four male cases have been reported with paratesticular AAM mimicking a testicular/epididymal tumor, and to the best of our knowledge, this is the oldest patient in the literature. Because of its rarity, making an exact diagnosis before surgery is difficult. Herein, we present a case of AAM in an 82-year-old man and review the literature.

Mediastinal Lipoblastoma Causing Diaphragm Eventration - A Challenging Entity

Lipoblastoma is a rare benign neoplasm and its mediastinal location is even rarer. We report a boy with anterior upper mediastinal fat density mass extended to neck root with ipsilateral diaphragm eventration. Preoperative diagnosis was a lipomatous neoplasm. The exact diagnosis was established after complete excision via a cervical approach with complete recovery.

Differential Diagnosis of Nail Psoriasis and Onychomycoses: A Report Based on 40 Years of Specialised Nail Consultations

Ungual psoriasis and onychomycosis are common nail diseases. Despite their different aetiology and course, surprisingly they have much in common both clinically and histopathologically, rendering their distinction often very challenging. Because their treatments are fundamentally different, anti-inflammatory–immunosuppressive for psoriasis and anti-infective for onychomycoses, an exact diagnosis is crucial for their management. Psoriasis is the dermatosis with the most frequent nail involvement. Pits, ivory-coloured spots, salmon or oil spots, subungual hyperkeratosis, onycholysis, and splinter haemorrhages are the most common nail signs. Onychomycoses are thought to be the most frequent nail diseases. This statement is disputed for toenails, for which orthopaedic abnormalities are said to be even more frequent and mimic fungal nail infections.

Intussusception of the bowel in a child malrotation

Introduction. During treatment of intussusception, the greatest difficulties occur when the disease is combined with other disorders and malformations.Materials and methods. Clinical observation on treatment in a child with bowel intussusception and malformation is presented. The course of the disease was rather difficult for exact diagnosis. Control of conservative disinvagination was inconclusive. During a surgery, a malrotation was detected. This affected the diagnostic and therapeutic tactics. The second component of obstruction represented by the abdominal adhesive process was also found and removed.Results. The conducted surgery allowed to confirm the effectiveness of the given conservative treatment, detect the concurrent pathology and remove the mechanical obstruction.Conclusion. The presented observation clearly demonstrates difficulties in exact diagnosis and control of conservative disinvaginaton when intestinal invagination is combined with congenital malrotation. As a result, the outcome of conservative disinvaginaton could be significantly controlled, commissure or the second component of invagination was removed and an exact diagnosis was made.

A Novel Intelligent Scan Assistant System for Early Pregnancy Diagnosis by Ultrasound: Clinical Decision Support System Evaluation Study (Preprint)

BACKGROUND Early pregnancy ultrasound scans are usually performed by nonexpert examiners in obstetrics/gynecology (OB/GYN) emergency departments. Establishing the precise diagnosis of pregnancy location is key for appropriate management of early pregnancies, and experts are usually able to locate a pregnancy in the first scan. A decision-support system based on a semantic, expert-validated knowledge base may improve the diagnostic performance of nonexpert examiners for early pregnancy transvaginal ultrasound. OBJECTIVE This study aims to evaluate a novel Intelligent Scan Assistant System for early pregnancy ultrasound to diagnose the pregnancy location and determine the image quality. METHODS Two trainees performed virtual transvaginal ultrasound examinations of early pregnancy cases with and without the system. The ultrasound images and reports were blindly reviewed by two experts using scoring methods. A diagnosis of pregnancy location and ultrasound image quality were compared between scans performed with and without the system. RESULTS Each trainee performed a virtual vaginal examination for all 32 cases with and without use of the system. The analysis of the 128 resulting scans showed higher quality of the images (quality score: +23%; P<.001), less images per scan (4.6 vs 6.3 [without the CDSS]; P<.001), and higher confidence in reporting conclusions (trust score: +20%; P<.001) with use of the system. Further, use of the system cost an additional 8 minutes per scan. We observed a correct diagnosis of pregnancy location in 39 (61%) and 52 (81%) of 64 scans in the nonassisted mode and assisted mode, respectively. Additionally, an exact diagnosis (with precise ectopic location) was made in 30 (47%) and 49 (73%) of the 64 scans without and with use of the system, respectively. These differences in diagnostic performance (+20% for correct location diagnosis and +30% for exact diagnosis) were both statistically significant (P=.002 and P<.001, respectively). CONCLUSIONS The Intelligent Scan Assistant System is based on an expert-validated knowledge base and demonstrates significant improvement in early pregnancy scanning, both in diagnostic performance (pregnancy location and precise diagnosis) and scan quality (selection of images, confidence, and image quality).

Listeria Infections of the Eye

The bacterium Listeria monocytogenes resides originally in the environment. Infections of the eye have been induced experimentally; for example, in rabbits and guinea pigs. Natural ocular infections occur in various animals; in most instances, they are induced exogenously; for example, by contaminated silage affecting primarily the conjunctiva, cornea, or the anterior chamber. Sporadic infections as well as outbreaks have been described. In humans, besides exogenous infections, endogenous infections also occur, inducing mainly endophthalmitis. Since an exact diagnosis of the causative agent is often delayed, specific therapy starts too late, so that the outcome is often poor. The antibiotics of primary choice would be ampicillin or a quinolone such as moxifloxacin or levofloxacin. The role of fosfomycin for therapy of ocular infections is discussed.

Osteoid Osteoma of the Radial Styloid Resembling de Quervain's Disease

We describe a case of osteoid osteoma in the radial styloid of a 37-year old man mimicking de Quervain's disease. The exact diagnosis was made with CT examination and confirmed by histological evaluation of the tumour. The lesion was removed by curettage and symptoms were resolved rapidly thereafter. There was no sign of recurrence at one year follow-up.