Hand, foot and mouth disease associated with streptococcus infection in a child (clinical case)

In the presented clinical case, the combination of two pathogens (enterovirus and streptococcus) caused a severe and atypical course of the hand-foot-mouth syndrome in a child of primary school age. EVI from the first days of the disease represented by the typical localization of the primary elements of the rash and the characteristic intoxication syndrome was confirmed by the detection of enterovirus RNA in the feces. The course of the disease was undulating. In the first wave, skin rashes accompanied by soreness and itching corresponded to the classical EVI in terms of the nature of the elements, their localization and were combined with lesions of the epithelium of the oral mucosa. Starting from the 5th day of the disease, against the background of an increase in the severity of intoxication syndrome, bullous elements appeared on the skin of the extremities, an excess of the permissible values of antistreptolysin-O was found 12 times, and when sowing material from cracks in the corner of the mouth, Streptococcus pyogenes 106 KUO was isolated, which indicated a combination of the syndrome Hand-foot-mouth with streptococcal infection. Onychomadesis in the period of convalescence retrospectively testified to the dominant role of enterovirus in the presented clinical case.

RARE-58. CONGENITAL METASTATIC CHORDOMA OF THE CLIVUS

Chordomas are rare midline axial skeletal neoplasms that typically present in adults. They are infrequent in childhood with typical localization in the spheno-occipital skull base. They are derived from remnants of the embryonic notochord. We present the case of 4 months old girl, who was born with „blueberry muffin” syndrome and was first negatively diagnosed for neuroblastoma and leukemia (two negative skin biopsies were performed) was admitted with axial laxity. In imaging testes there was a tumor of the scull base, metastases in the lungs and kidneys (that were not seen at previous assessments) and a small lesion in the heart. The third biopsy of skin lesion was performed and pathological examination revealed a neoplasm composed of cords, clusters, and chains of multivacuolated cells embedded within a myxoid matrix and separated by fibrous septa. No atypical and dedifferentiated features were present. Mitotic activity was not observed. Neoplastic cells showed the typical cytoplasmic immunostaining for EMA, S100 and cytokeratin AE1/AE3, strong nuclear brachyury expression, and retention of nuclear INI-1 expression. The diagnosis of chordoma was established. Neoplastic tissue and blood samples were obtained for molecular analysis using next generation sequencing, including germline mutations assessment (are ongoing). Chemotherapy as for soft tissue sarcomas was undertaken. Currently a patient is on treatment with improvement of neurological status.

Differential Diagnosis of a Glenoid Cyst in Omarthrosis: Hemangioma of the Glenoid – Resection and Reconstruction Using Autologous Bone-Graft and Special Implant

Hemangiomas belong to the benign tumors, that can occur in any bone of the human body. The typical localization are the vertebral spine and the skull. There is no reported case of an intraarticular glenoidal hemangioma so far. The current paper presents a case of a 48-year-old female with joint pain that started 2 years before. The clinical manifestations included limited range of motion (ROM) and load dependent, non-load dependent and night pain. Roentgenogram and magnetic resonance imaging (MRI) of the left shoulder showed degenerative changes of the glenohumeral cartilage and a big (11.8mm x 10.3 mm) intraglenoidal mass affecting the joint line. The postoperative pathological diagnosis was that of a cavernous hemangioma. The aim of the present study was to present the imaging presentation of glenoidal hemangioma and to show therapeutic options in case of glenohumeral osteoarthritis (OA) with glenoidal bone loss due to hemangioma. In the present case no recurrence of the hemangioma and no complications of the implant in terms of loosening, infection or consisting were observed.

Five-Year Long-Term Followup of a Primary Lymph node Gastrinoma: Is a Pancreaticoduodenectomy Justified?

Background. Gastrinoma-positive lymph nodes and failed localization of the primary tumor during surgical exploration are described. Specialists suppose that these lymph nodes are metastases rather than a primary gastrinoma.Methods. Case report with a five-year long-term followup. A 60-year-old patient with an confirmed gastrinoma was treated in our department. All preoperative evaluations including somatostatin-receptor-scintigraphy and F-Dopa PET failed to localize the gastrinoma. Explorative laparotomy revealed a gastrinoma in two peripancreatic lymph nodes. Despite extensive intraoperative exploration, no primary gastrinoma could be detected in typical localization.Results. Over a period of 5 years, the patient's gastrin level stayed in the normal range and the patient seems to be completely cured.Conclusion. A prophylactic partial pancreatoduodenectomy is not indicated to avoid recurrence, since complete biochemical cure by local resection of the lymph node gastrinoma is possible.

Clinical and Roentgenologic Semiotics of Long Bone Pathologic Fractures

During 1965-2002 one thousand two hundred thirty patients with bone tumors and tumor-like diseases were treated at Astrakhan Medical Academy, Clinic of Traumatology and Orthopaedics. Out of them 163 (13.3%) patients had pathologic fractures. One hundred eight fractures were localized within long bones: humerus (61), femur (37), tibia (29), fibula (6), radius (5). Long bones fractures were commonly resulted from destructive lesions: solitary bone cyst - 48 cases, fibrous dysplasia - 26, giant cell tumor - 24, aneurismal bone cyst - 18, metaphyseal fibrous defect -11. Clinical and roentgenologic semiotics was studied and complex of roentgenologic signs of long bone pathologic fractures was systematized. Peculiarities of fractures (injury mechanism, typical localization of pathologic process, pattern of destruction focus) in various nosologic forms of primary disease were detected. The data obtained simplify diagnosis and allow trustworthy making prehistologic diagnosis as well as to choose optimum treatment tactics.

Plaučių chondrohamartomų diagnostika

Aba VitėnasVšĮ Vilniaus universiteto ligoninės "Santariškių klinikos"Centro filialas, Radiologijos skyrius,Žygimantų g. 3, LT–01102, VilniusEl. paštas [email protected] Įvadas / tikslas Plaučių disontogeniniai navikai – hamartomos – yra dažniausi iš visų periferinių nepiktybinių rutulinių plaučių darinių. Endobronchinė centrinė hamartoma (epistoma) pasitaiko labai retai. Kremzlinės struktūros plaučių hamartomos – chondrohamartomos ir osteochondrohamartomos – yra dažniausios. Darbo tikslas – apibūdinti plaučių hamartomas, sukonkretinti jų rentgenologinius diferencinės diagnostikos žymenis ir tuo remiantis – klasifikaciją. Ligoniai ir metodai Plaučių hamartomos buvo nustatytos 43 ligoniams – 16–78 metų 28 vyrams ir 15 moterų. Visiems ligoniams atliktas kompleksinis radiologinis tyrimas – polipozicinė rentgenoskopija, rentgenografija, tomografija, skaitmeninė fluorografija, kompiuterinė tomografija. Bronchoskopija ir biopsija padaryta 31 ligoniui. Buvo atliekami ir kiti tyrimai: ultragarsinis, funkciniai plaučių mėginiai, specifinės laboratorinės reakcijos diferencinei diagnostikai nuo plaučių tuberkuliozės, kolagenozės, echinokokozės, alergozės. Rezultatai 42 ligoniams diagnozuota periferinė ir vienam – centrinė hamartoma. Tipinė plaučių hamartomos lokalizacija – dešiniojo plaučio apatinė skiltis (21 ligonis, arba 49%). Centrinė endobronchinė hamartoma diagnozuota 42 metų ligoniui, ilgai sirgusiam lėtiniu bronchitu ir dažnai plaučių uždegimu. Operuota 30 ligonių. Devyni ligoniai iš 13 neoperuotųjų stebėti nuo 1 iki 14 metų. Periferinės hamartomos dažniausiai buvo besimptomės. 23 ligoniams hamartoma nustatyta atsitiktinai profilaktiškai tiriant plaučius dėl įvairių pilvo organų ligų arba atliekant fluorografinį tyrimą. Kitiems tirtiesiems hamartoma buvo diagnozuota sergant plaučių ligomis, tuberkulioze, alergoze, kolagenoze, įvairiais navikais. Dvylikai ligonių nepiktybinio plaučių naviko, arba hamartomos, diagnozė buvo tiksliai nustatyta poliklinikoje. Devyniems buvo įtartas pirminis vėžys arba metastazė, šešiems – specifinis infiltratas arba tuberkuloma, vienam – eozinofilinis infiltratas, vienam – echinokokas. Hamartoma 31 ligoniui buvo dešiniajame, 12 – kairiajame plautyje. Rentgenogramoje periferinė hamartoma buvo matoma apskritos formos ir ryškių kontūrų. Jos rentgenologinė struktūra buvo nevienoda. Šviesi (nekalcifikuota) hamartoma buvo matoma 14 ligonių. Kitiems 28 ligoniams diagnozuota kalcifikuota (inkrustuota arba tamsi) hamartoma, t. y. hamartochondroma (chondrohamartoma, osteochondrohamartoma). Išvados Nors plaučių hamartomos auga labai lėtai, pasitaiko labai greitai progresuojančių: 3 ligoniams, arba 7%, hamartomos per metus padidėjo iki 50%. Dažniausias jų variantas – hamartochondroma (chondrohamartoma). Piktybinių hamartomų nediagnozuota. Pagal neoplazinės kalcinozės laipsnį plaučių hamartomos radiologiškai skirstomos į tris variantus: šviesas, inkrustuotas ir tamsias. Radiologai gali diferencijuoti dažniausius plaučių hamartomų variantus, tarp jų chondrohamartomas ir osteochondrohamartomas. Reikšminiai žodžiai: disontogeniniai plaučių navikai, disembriomos, periferiniai plaučių navikai, hamartomos, hamartochondromos, neoplazinė kalcinozė, rentgenodiagnostika Diagnostics of pulmonary chondrohamartomas Aba Vitėnas Background / objective Hamartomas, as dysontogenic tumours, are most common among all peripheral non-malignant "spheral" pulmonary formations. Endobronchial central hamartoma is rare and is usually diagnosed as "epystoma" (bronchial obturator). Among peripheral hamartomas, tumours of cartilaginous structure (chondrohamartomas and ostheochondrohamartomas) are particularly common. The objective of the work was to describe pulmonary hamartomas and to concretize most common variations of hamartoma and their different radiological signs. Patients and methods Forty-three patients were diagnosed with pulmonary hamartoma (28 males and 15 females, 16–78 years old). In the hospital, clinical and laboratory tests were performed for all patients; complex radiological examination: polypositional X-ray radioscopy, radiography, tomography, digital fluorography, computed tomography. Thirty-one patients underwent bronchoscopy and biopsy, sonoscopy, functional lung tests, specific reactions. Results Forty-two patients had peripheral and one central hamartoma. The most typical localization of pulmonary hamartoma was the lower lobe of the right lung (21 patients, 49%). A central endobronchial hamartoma was diagnosed for a 42-year-old patient who had been ill for a long time with chronic bronchitis and frequent pneumonias. 30 pacients were operated one. From 13 non-operated patients, 9 were followed up in dynamics for 1–14 years. Peripheral hamartoma usually was asymptomatic. Twenty-three patients were diagnosed occasionaly during preventive pulmonary evaluation in case of different abdominal diseases or during fluorography. The others diagnosed as having hamartoma were ill with lung diseases, TBC, alergosis, collagenosis, different tumours. In out-patient settings, correct diagnosis of benign tumour or hamartoma was established for 12 patients, 9 were suspected as having cancer or metastases, 6 – specific infiltrate (tuberculoma), 1 – eosinophilic infiltrate and 1 – echinococcus; 31 patient had the tumour in the right, and 12 patients in the left lung. Radiologically, hamartoma is a spheric tumour with clear margins. As to the structure of the tumour, 14 patients had non-calcificated, "light" hamartoma, 28 had calcificated, "inlaid" and "hard" hamartochondroma. Thus, neoplastic calcinosis is characteristic of chondrohamartomas (osteochondrohamartomas) and occurs twice as often as hamartomas of other types. Conclusions Althought hamartomas grow very slowly, there were rapidly increasing ones: for 3 patients (7%) the volume of hamartoma increased by 50% in a year. The most common type was hamartochondroma (chondrohamartoma). There were no malignant hamartomas. Therefore radiologists can diagnose most common variations of hamartomas as "light", "inlaid" and "hard" ones. Keywords: dysontogenous pulmonary tumours, dysembriomas, peripheral pulmonary tumours, hamartomas, hamartochondromas, neoplastic calcinosis, radiological diagnostics