Cardiac metastasis in a patient with oral squamous cell carcinoma

A 55-year-old man initially presented with an undifferentiated, HPV-p16-negative squamous cell carcinoma (SCC) in the left tonsillar region (cT4a N0 M0), which was treated with a combination of radiotherapy and chemotherapy. Several months later, the patient developed osteoradionecrosis on the left side of the mandible as well as a second primary lesion at the left base of the tongue. Surgical resection and mandibular reconstruction with a free vascularised fibula flap was performed. Regional clinical and radiologic follow-up showed no signs of tumour recurrence. However, routine positron emission tomography (PET)-CT showed a hypermetabolic mass intracardially. MRI confirmed the presence of a mass intramurally in the left ventricle, highly indicative of metastasis. Cardiac metastasis following oral cancer is rare and usually asymptomatic. Therefore, it can be missed easily and is mostly described as a finding postmortem. Reporting these cases is important for contributing to the insight into the uncommon development of metastasis.

Metastatic Alveolar Soft Part Sarcoma to the Breast: A Case Report

Introduction/Objective Metastases to the breast are rare (less than 3% of all breast malignancies). In adults, malignant melanoma is the most common type of metastasis followed by carcinomas from various primary sites. Here, we describe a case of metastatic alveolar soft part sarcoma (ASPS) to the breast. Only a handful similar presentations are reported in the literature. Methods Here we describe the case of a 43-year-old female patient with a recent diagnosis of left base of tongue alveolar soft part sarcoma (in an outside hospital), presenting with a palpable mass in her left breast. Sonographic study of the left breast demonstrated a 1.4 cm oval hypoechoic mass with partially microlobulated margins at 1 o’clock. Results Histopathologic examination of the ultrasound guided core biopsy showed a “pink” neoplasm, composed of plump epithelioid tumor cells with an eosinophilic and granular cytoplasm, round to oval nuclei and conspicuous nucleoli. They are arranged in organoid nests separated by sinusoidal spaces. An immunohistochemical study shows the tumor cells to be negative for keratin AE1/AE3, keratin 7, keratin 5/6, GATA-3, Pax-8, estrogen receptor, HER2, p63, S100 and CD117. FISH test for TFE3 (Xp 11.23) is positive. PAS with diastase staining highlights the intracytoplasmic granules. Theses morphologic, clinical and molecular findings confirm the diagnosis of metastatic ASPS. Conclusion The differential diagnosis of “pink” tumors of the breast include primary tumors like secretory carcinoma and apocrine carcinoma and metastatic lesions of renal, thyroid, skin (melanoma), oral cavity and soft tissue. Although extremely rare, in the right clinical context, metastatic ASPS to the breast can occur and should be included in the differential diagnosis.

Design and Modeling of Semi Compliant Prosthetic Knee Joint

This paper presents the design phases and modeling of multi axial compliant prosthetic knee joint comprised of rigid and flexible members providing a better performance than traditional spring-loaded rigid multilink joints. Mechanism consists of monolithic compliant five bar incorporating large deflecting flexure hinges, two rigid body representing the upper and lower legs, translational spring and flexure joints simulating ankle motion. Dynamical modeling is studied by integrating pseudo rigid body modeling of small-length flexure hinge method and Lagrange equations under the assumption that link 2 (left base link) is fixed and link 3 is rotated quasi-statically at constant speed. Torsional stiffness of ankle springs is obtained by using MSC Adams simulations. Initial prototype is built by 3D printing the parts using polylactic acid (PLA) filament. Mechanism is potentially suitable for pediatric prosthetic knee systems due to its simple design, versatility and light weight.

Quistes pulmonares congénitos en recién nacido. A propósito de un caso

Congenital pulmonary malformations, especially congenital pulmonary cysts, are a heterogeneous group of alterations in lung development that can occur at different stages of embryogenesis, affecting the parenchyma, the arterial supply, the venous drainage or being a combination of them. A clinical case is presented where it analyzes the congenital pulmonary malformations in a newborn patient at the term of adequate weight for the gestational age, in the same as when entering the Neonatology service. To the radiological control in which an image of bubbles of air trapped in the left base is visualized, initial suspicion of diaphragmatic hernia, the same that is discarded at 24 hours, changing to a diagnosis of congenital pulmonary malformations. Congenital lung cysts.

Introduction

This introductory chapter discusses the unquestioned identification between “Zionism” as a national movement that sought to realize the Jewish nation's self-determination in Palestine, and “the Jewish nation-state,” which has no room for the national collective existence of any particular national group other than the Jews and which represents the ultimate and teleological realization of the Zionist project. The vast majority of those who support the two-state solution, who are known as the “Zionist left,” base their position on the need to avoid the formation of a binational state in which the Jewish demographic majority would be endangered. They argue that this is the way to rescue what they consider to be the political core of the Zionist idea: a mono-national state for the Jewish political collective.

Lessons from the Left in Lima: Susana Villarán and the Fleeting Return of Progressive Politics to City Hall

Amid a rightward shift in Latin America, how can the left gain ground in cities characterized by entrenched neoliberalism? The case of Susana Villarán, the progressive mayor who led Lima, Peru, from 2011 to 2014, illustrates the uphill battle facing the left. Villarán’s surprise election put a leftist in City Hall for the first time in 25 years. She confronted unrelenting opposition but defied expectations and beat back a recall election only to face a punishing defeat in her reelection bid. Weak policy-making capacity and a lack of party machinery forced her to expend all her political capital on the recall battle, leaving her with nothing to secure reelection. Her trajectory suggests an important lesson for progressives in cities where the left is weak: a headline-grabbing win by an individual leftist is no substitute for a robust left base. Absent the latter, simply electing a progressive mayor is likely to prove a fleeting victory. En medio de un movimiento hacia la derecha en América Latina, ¿cómo puede la izquierda ganar terreno en ciudades caracterizadas por un neoliberalismo atrincherado? El caso de Susana Villarán, la alcaldesa progresista que gobernó Lima, Perú, de 2011 a 2014, ilustra la batalla cuesta arriba que enfrenta la izquierda. La sorprendente victoria electoral de Villarán logró colocar a alguien de la izquierda en la alcaldía por primera vez en 25 años. Ella se enfrentó a una oposición implacable, pero desafió las expectativas y ganó una revocatoria solo para enfrentar una derrota contundente en su intento por la reelección. Dado la poca capacidad para crear políticas públicas y la ausencia de una maquinaria electoral partidista, se vio forzada a gastar todo su capital político en la batalla por la revocatoria, lo cual la dejó sin recursos para conseguir la reelección. Su trayectoria presenta una lección importante para los progresistas en ciudades donde la izquierda es débil: una victoria llamativa por parte de un individuo de la izquierda no funge como substituto para una base robusta de la izquierda. Lo anterior sugiere que cuando esta base se encuentra ausente, es probable que el simple acto de elegir un alcalde progresista sea una victoria efímera.

Malakoplakia of the prostate masquerading as locally advanced prostate cancer on mpMRI

A 66-year-old man was referred for urological evaluation for an abnormal digital rectal exam (cT2a, subtle nodule at left base, 121 cc prostate) and an elevated prostate specific antigen (PSA) of 8.0 ng/ml. Subsequent 12-core transrectal ultrasound (TRUS)- guided biopsy revealed Gleason 3+4 adenocarcinoma in seven of 12 cores, including all six cores on the right side and one core at the left apex. No extraprostatic extension was identified. Postbiopsy, the patient developed urinary retention requiring a catheter, as well as an Escherichia coli (E. coli) urinary tract infection (UTI) requiring hospitalization and intravenous antibiotics.

Case 13.14

25-year-old man with multiple episodes of pleuritic chest pain Short-axis SSFP image (Figure 13.14.1) reveals a small, predominantly inferior pericardial effusion, a small left pleural effusion, and left base atelectasis. Short-axis and horizontal long-axis LGE inversion recovery T1-weighted images (Figure 13.14.2...