Giant uterine fibroid: a rare differential diagnosis for an abdominopelvic mass

Uterine leiomyomas also called as fibroid uterus are commonest tumors of the female genitourinary tract, however the occurrence of a giant uterine fibroid is rare. The giant uterine leiomyomas pose a great diagnostic as well as surgical challenge due to its size, vague nonspecific symptoms and the inadvertent injury to the adjacent organs during surgery. Here we would like to report a case of a 42 years female, known psychiatric patient with complaints of progressive abdominal distension for 5 years with rapid enlargement in the past 1 year with amenorrhea for 6 months and constipation for 2 months. Pre-operatively patient was diagnosed with ovarian malignancy and was proceeded with staging laparotomy where the mass was found to be arising from the uterus. Patient underwent total abdominal hysterectomy with bilateral salpingo oophorectomy and pathological examination revealed fibroid uterus with cystic degeneration. Post-operatively the patient recovered well and was discharged and on follow up examination was found to have returned to her normal life.

P12 Focal myositis—A case series of a rare cause of hip immobility and calf pseudotumor in children

Case report - Introduction Focal myositis is a rare immune-mediated pseudotumour of a single skeletal muscle group. Only around 200 cases have been described in the literature, so little is known about incidence, prevalence, patient management and outcomes. This differs and should not be confused with post-viral myalgia which bears neither the histological changes nor chronicity of focal myositis. Treatment options are centred on immunomodulation and in severe cases surgical management of contractures. Case report - Case description Case 1 A systemically well 7-year-old girl presented with 5-weeks of right calf tenderness and swelling following a short episode of pharyngitis and generalised maculopapular rash. There was no gait abnormality, focal neurology or restriction in activity aside from fatigability on walking distances. There were no skin rashes, joint involvement, eye changes or involvement of other muscles. She had a raised creatine kinase, plasma viscosity and lactate dehydrogenase. Her other blood results were normal including an extended autoimmune screen, immunoglobulins, complement levels, ASOT and titres of mycoplasma, EBV and CMV. MRI showed evidence of extensive inflammation of the gastrocnemius and soleus. A muscle biopsy showed heavy interstitial inflammatory cell infiltrate of predominantly lymphocytes, features of fibre necrosis including phagocytosis and hyalinisation with concurrent fibre regeneration. Case 2 A systemically well 14-year-old presented with 6-months of left-sided hip pain, weight loss and inability to weight-bear without crutches. On examination there was painful fixed limitation of the left hip to 45o on abduction and external rotation with bilateral mild swelling of the proximal interphalangeal (PIP) joints on both upper limbs. Otherwise, there was a full range of movement in all joints, with no rashes or other joint swelling or inflammation. Her blood tests were ANA positive 1:6000 and MRI of her hips demonstrated high T2 signal intensity in the left gluteus minimis and medius, obturator internus, obturator externus in keeping with myositis. Case report - Discussion Case 1 She was initially managed with physiotherapy and anti-inflammatory medications but then developed intermittent right calf pain, restriction in activity and tiptoe walking due to gastrocnemius contractures. She was commenced on an 8-week tapering course of oral steroids and is improving with weekly methotrexate. Case 2 She received a pulse of corticosteroids followed by a course of methotrexate. There was immediate improvement in her PIP joint swellings and within a few weeks she was able to walk without crutches for the first time in 6 months; a surveillance MRI confirmed complete radiographical resolution of myositis. Unfortunately, 18 months after her diagnosis, she had developed anterior uveitis of her left eye with posterior synechiae; this responded well to steroid and cyclopentolate eye drops. Case report - Key learning points We emphasise that clinicians should bear this rare differential diagnosis for in mind for consideration of early conservative management, assessment for uveitis, immunomodulation and possibly surgical correction to improve patient outcome.

Unilateral Giant Hydronephrosis Secondary to Ureteropelvic Junction Obstruction in a Middle-Aged Woman

Background. Giant hydronephrosis is a rare urologic problem defined as a collection of more than one liter of urine in the collecting system. The radiologic appearance may mimic benign cystic disease of the kidney. We report a case of giant hydronephrosis in a 32-year-old female who presented with progressive abdominal swelling of two-year duration, caused by ureteropelvic junction obstruction with more than nine liters of urine in the collecting system. Conclusion. Giant hydronephrosis is a rare differential diagnosis for cystic intra-abdominal mass in adults with progressively increasing abdominal swelling. CT and MRI are important in confirming the diagnosis by localizing the origin of the swelling. Management depends on the underlying cause and appearance of the diseased kidney.

Case report: Rare convexity meningeal chondroma mimicking a meningioma

Background: Intracranial chondromas account for 0.2–0.3% of all intracranial neoplastic lesions and less than a quarter arise in the convexity or falx. Despite its benign nature, exceedingly rare malignant transformations exist. The misdiagnosis with meningiomas is frequent and may be related with chondromas’ similar insidious clinical presentation and imaging features. Standalone surgery is advised and complete resection provides the definitive treatment. Case Description: A 44-year-old female presents with insidious headache, visual disturbances, and papilledema. The imaging studies were compatible with frontal parasagittal meningioma. Surgery revealed a meningeal based mass, mostly avascular and with a well-demarked surgical plane from the brain parenchyma. Complete resection with meningeal margins was achieved and the histopathologic examination revealed a chondroma. The patient symptoms subsided and no surgical complications existed. Conclusion: Intracranial convexity chondromas constitute a rare differential diagnosis for meningiomas. The present case reinforces the current scarce data and serves as reminder for clinicians diagnosing and treating intracranial tumors.

Opticopathy Caused by Endoprosthesis-Related Cobalt Intoxication

Cobalt intoxication is a rare cause of toxic opticopathy, and may be caused by metal endoprostheses. Since its clinical appearance is unspecific and the incidence low, diagnosis is challenging. Due to the dramatic consequences of delayed treatment, cobalt intoxication should be considered as a rare differential diagnosis of bilateral loss of vision in patients with appropriate history.

Primary vesical actinomycosis with changes of cystitis cystica presenting as bladder mass

Actinomycosis is a rare chronic granulomatous suppurative infection caused by Gram-positive bacteria. The occurrence of primary vesical actinomycosis is extremely rare and only a few cases have been reported. Pre-operative diagnosis of vesical actinomycosis is challenging as the clinical and radiological features usually point towards bladder malignancy. Therefore, in most cases, definitive diagnosis is usually made after histopathological examination of the involved tissue. A 60-year-old male presented with complaints of hematuria, burning micturition, irritative, and obstructive urinary symptoms for 15 days. USG revealed a large soft-tissue mass having a polypoidal intraluminal and extraluminal component and involving the right posterolateral urinary bladder wall. CT scan showed a large irregular soft-tissue mass with multiple cystic lesions involving the right lateral wall of the urinary bladder. Transurethral resection of bladder mass biopsy was performed and the histopathological examination showed bacterial colonies of Actinomyces with changes of cystitis cystica. The patient was treated with amoxicillin and potassium clavulanate for 3 months. Actinomycosis should be kept as a rare differential diagnosis in cases presenting as bladder mass. The diagnosis is most commonly made by histopathology and may need a repeat biopsy to arrive at the correct diagnosis. The patient should be treated by penicillin group of antibiotics for 2–3 months and followed up for years to detect any recurrence.

Antrochoanal Polyp: A Rare Differential Diagnosis of Adenoids

Introduction: Antrochoanal polyps are more prevalent in children than adults. Unilateral nasal obstruction and rhinorrhea are usually the features of the unilateral antrochoanal polyps. Bilateral nasal obstruction is also a feature of antrochoanal polyp if it is large and obstruct both choana. Giant antrochoanal polyp is rarely reported in the literature and as a case reports. Case Report: We reported a further case of giant left antrochoanal polyp in a 6-years-old boy presented with bilateral nasal obstruction, nasal and postnasal mucopurulent discharge, hypo-nasal speech, mouth breathing, snoring, and obstructive sleep apnea syndrome. These features are mostly consistent mostly with the diagnosis of the adenoids. Physical examination revealed a mass seen in the oropharynx behind the uvula. Further examination by nasal endoscopy, computerized tomography, and histopathological evaluation of the excised polyp have confirmed the diagnosis of an antrochoanal polyp. Conclusion: Although this entity is rarely seen in daily clinical practice, great care is needed to catch the diagnosis for early treatment to avoid unwanted complications.

Pelizaeus-Merzbacher Disease as a Rare Cause of Stridor in an Infant with Severe Reflux and Hypotonia

Stridor is high-pitched, noisy breathing that occurs as a result of a narrowed airflow. It is considered as a respiratory emergency in which if left untreated, may lead to death. The most common cause of stridor in paediatric is laryngomalacia (LM). Nevertheless, other causes of persistent stridor in infant have to be ruled out, in the case of failed surgical therapy. Here, we report a rare case of a three-month-old infant boy with persistent stridor since birth who had undergone aryepiglottoplasty for LM at day ten of life and was referred back to the hospital due to worsening of stridor with signs of respiratory distress and subsequently he was diagnosed with Pelizaeus-Merzbacher Disease (PMD). This is the first report to discuss on PMD as a rare differential diagnosis of stridor.