Left parathyroid adenoma with features of brown tumor, incidental finding: a case report

Primary hyperparathyroidism (PHPT) occurs in a setting of excessive parathyroid hormone (PTH) secretion with an autonomous parathyroid gland which resulting in hypercalcemia. Cases of parathyroid adenoma are rare, PTH is a chief regulator of calcium homeostasis in the human body. PHPT could be caused by solitary adenomas, hyperplasia, multiple adenomas and carcinomas. A 35-year-old female who came in with complaints of left hip pain past 1 month which aggravated since 1 week, with previous medical history of hyperthyroidism. Laboratory and biochemical findings suggested features of PHPT. She underwent left parathyroid excision with subtotal thyroidectomy. Histopathology analysis revealed features of parathyroid adenoma with eosinophilic to clear cytoplasm, few foci with oxyphilic nodules. Patient showed significant fall in PTH levels after tumor excision and is being discharged 5th day after surgery. PHPT occurs at any age, but it is most commonly seen in people over the age of 50 years and postmenopausal women. The current presentation of PHPT shifts from the classical symptomatic form to the asymptomatic form. parathyroidectomy is still the treatment of choice for both symptomatic and asymptomatic forms. Parathyroid adenoma has an excellent prognosis with surgical treatment.

P093 Algodystrophy in children: a case report

Background Algodystrophy is an entity very often unrecognized by pediatricians. The evolution is readily dragging and disabling in the absence of early and coordinated care. The Objective: Based on a case observed in a 10-year-old boy, the authors recall the main characteristics of the syndrome, guiding the practitioner to make the diagnosis, and implement appropriate and early therapy. Observation A 10-year-old boy with no previous medical history, presenting with neuropathic-like pain in the wrist and the hand that started a month ago without any triggers. Clinical exam noted functional impotence, a whole limb tremor, hyperesthesia as well as allodynia. The patient's hand is swollen and warm with a claw-like appearance. The rest of the body exam is normal. The laboratory markers and x-rays of the whole limb are normal. Bone scintigraphy confirms the diagnosis of wrist algodystrophy. The treatment combining corticosteroids, functional rehabilitation, and psychotherapy allowed a favorable outcome with no sequelae. Conclusion The diagnosis of algodystrophy remains too often unrecognized, and its management is sometimes inadequate. Early diagnosis and treatment improve the prognosis.

Pink plaque on the hypogastrium

Bowen’s disease is a type of intraepidermal squamous cell carcinoma usually affecting the elderly and occurring on sun-exposed areas, such as the face, scalp, and limbs. The development of Bowen’s disease in other locations such as the abdomen is rare. In these cases, dermoscopy proves to be a helpful tool in making the diagnosis [1]. A 65-year-old male with no previous medical history presented himself with a nonhealing asymptomatic lesion on the abdomen slowly growing for the last ten years. A dermatological examination revealed a 6-cm well-limited erythematous plaque on the hypogastrium with peripheral pigmentation (Fig. 1). Dermoscopy found central keratin as well as white shiny structures, including white shiny lines, white shiny areas, and rosettes (Fig. 2) as well as brown linear globules and dots on the periphery and looped vessels (Fig. 3). Bowen’s disease was the most likely diagnosis, which was confirmed by histopathology. The patient underwent surgery for excision of the lesion with 5-mm margins.

Keloid-like dermatofibroma

Dermatofibroma is a common benign skin tumor, mainly occurring in young to middle-aged females. It is frequently localized in the lower extremities. A typical dermatofibroma usually presents itself as a single firm papule or nodule, of variable color, bluish, brownish, or pinkish. Its clinical, dermoscopic, and histological features usually allow easy diagnosis [1]. However, it is possible to observe some variations of these typical features. Keloid-like dermatofibroma is one of these atypical presentations rarely reported in the literature [2]. A 40-year-old patient with no previous medical history presented to our dermatology department with a lumbosacral lesion evolving for several months. A physical examination revealed a firm, well-demarcated, asymptomatic erythematous nodule, 5 × 12 mm in size, localized in the lumbosacral area (Fig. 1). The patient denied any trauma preceding the onset of the lesion. There was no personal or familial history of keloidal scars. A dermoscopic examination revealed erythema, telangiectatic vessels, a shiny white streak, and a brownish-yellow pigmentation (Fig. 2). A biopsy was performed. A histological examination revealed an atrophic epidermis. The dermis contained a fibroblastic proliferation of low cell density haphazardly arranged, located on a fibromatous background (Figs. 3 and 4). Dermatofibroma with a keloidal presentation was the diagnosis.

SP4.2.9 Investigation of patients with qFIT >400µg/g during the initial stages of the COVID-19 pandemic

Background During the initial stages of the COVID-19 pandemic non-emergency endoscopy was suspended as per BSG recommendations, resulting in altered pathways for investigation of suspected malignancies. In our unit, patients referred via suspected colorectal cancer (CRC) pathways with a quantitative faecal immunochemical test (qFIT) >400 µg/g were offered CT imaging in the first instance. Methods We accessed our electronic records to retrospectively identify patients referred with a qFIT >400 µg/g between March and May 2020. Patient demographics, previous medical history, and referral details were recorded. Primary outcome was incidence of new CRC diagnosis. Results 21 patients were included. Median follow-up was 218 days, and median time from referral to CT was 17 days. 3 (14.3%) patients had new cancer diagnoses;2 CRC and 1 lung. 42.8% of patients had normal investigations, or benign colorectal pathology. 95.2% patients went on to have an endoscopy; low risk polyps (28.6%), high risk polyps (4.8%) and IBD (9.6%) were identified. 57.1% of patients were discharged following endoscopy, with the remaining 42.9% needing further management which included referral to other specialties and repeat scopes. Discussion and conclusion CT scanning did not reduce the need for subsequent endoscopy, but aided in prioritising patients for subsequent investigation. There were no cases of CRC identified endoscopically which were not identified by CT imaging. In conclusion, CT is a viable alternative to endoscopy when restrictions are placed on endoscopy services.

MPO-ANCA-Positive Hypertrophic Pachymeningitis With Elevated Serum IgG4: A Case Report and Literature Review.

Background: We report a case of serum myeloperoxidase (MPO)-anti-neutrophil cytoplasmic antibody (ANCA)-positive hypertrophic pachymeningitis with elevated serum immunoglobulin G (IgG)4.Case presentation: He was a 67-year-old man who appeared headache and hearing loss 7 years ago. He was treated with methylprednisolone and mycophenolate when he was diagnosed with hypertrophic pachymeningitis 2 years ago. He went to the hospital this time because of fatigue and appetite, the results of his blood tests indicated a progressive increase in creatinine and an increase in MPO and IgG4. His kidney biopsy revealed very few infiltrating IgG4-positive cells. Instead, fibrinoid necrosis of arterioles was observed. Considering the clinical process and these findings, the disease was considered more likely to be ANCA-associated hypertrophic pachymeningitis with elevated serum IgG4 level.Conclusions: Our case highlights the importance of the pathological examination and the medical history. Pathological examination and previous medical history play an essential role in the diagnosis of the disease. Only when the disease is correctly diagnosed can it be further treated effectively and get a better prognosis.Data Sources: Data were collected from the patient’s electronic medical records and the hospital laboratory medicine database.

Functional Olfactory Neuroblastoma Inducing Symptomatic SIADH

Olfactory neuroblastoma (ONB) is a rare malignancy of the sinonasal cavity, originating from neuroepithelial olfactory cells. Olfactory neuroblastoma can be difficult to diagnose due to its anatomic position and variable symptomatic presentation, leading to diagnosis at a more advanced stage. Here, we present the case of a 35-year-old man with no previous medical history who had a bicycle accident secondary to syncope. He was found to be hyponatremic and suspected to have syndrome of inappropriate antidiuretic hormone secretion (SIADH). In the workup of SIADH, a brain magnetic resonance imaging revealed a mass in the left middle meatus. The lesion secreted inappropriate amounts of ADH, resulting in symptomatic paraneoplastic SIADH. This ultimately led to the early recognition and successful resection of this rare ONB. The patient has remained disease-free for over 5 years. This case is a fortunate example of a functional malignancy of the sinonasal tract that was discovered early and successfully treated as a result of symptomatic SIADH.

Rare PHEX variant with insidious presentation leads to a delayed diagnosis of X-linked hypophosphatemia

A 7-year-old girl without a significant previous medical history was diagnosed with X-linked hypophosphatemic rickets (XLHR) due to a rare, most likely pathogenic, PHEX gene variant after a 4-year delayed diagnosis due to mild clinical presentation. At 2 years of age, her intoeing and femoral bowing were attributed to physiologic bowing and borderline vitamin D sufficiency, despite phosphorus not being measured. Hypophosphatemia was eventually detected after incomplete improvement of bowing and leg length discrepancy with suboptimal linear growth. This rare PHEX variant (c.1949T>C, p.Leu650Pro) further supported the clinical diagnosis of XLHR. Treatment with burosumab (an anti-FGF23 monoclonal antibody) normalised phosphorus and alkaline phosphatase levels and improved her bowing. The diverse phenotypic presentation of this variant can result in delayed diagnosis and highlights the importance of prompt assessment of phosphorus levels in patients with skeletal deformities to ensure timely recognition and treatment.

Peduncular hallucinosis after a thalamic stroke

Peduncular hallucinosis is a rare form of hallucinations consisting of vivid and nonthreatening colourful visual hallucinations. It was first described by French neurologist Jean Lhermitte in 1922. It sometimes includes distorted images of animals and people. Peduncular hallucinosis has been described after vascular and infective lesions of the mesencephalon and thalamus.We present a case of peduncular hallucinosis after a right thalamic infarction. This is a case of a 75-year-old Caucasian man with a previous medical history of hypertension and hyperlipidaemia who presented as a transfer from an outside hospital with transient left facial palsy, upper and lower extremity weakness. His symptoms resolved on arrival. CTA head and neck revealed focal filling defect in the basilar artery and a right posterior cerebral artery (PCA) occlusion at its origin. MRI brain without contrast revealed a right thalamic infarct. The patient had vivid hallucinations including his wife sleeping on his hospital bed, seeing his favourite book on the table while he had left it at home, seeing his dogs and a TV show on his room television while it was off. He was easily redirectable, and the hallucinations resolved over 2 days without pharmacological intervention. In cases of thalamic, midbrain or peduncular infarctions, physicians should be cognizant of the possibility of peduncular hallucinosis and inquire about hallucinations. New onset hallucinations in a patient with no prior psychiatric history presenting with concerns for stroke should prompt physicians to strongly consider peduncular hallucinosis.