Intravenous leiomyomatosis involved cor dextrum: A review of diagnosis and management with an illustrative case

Intravenous leiomyomatosis (IVL) is a benign disease that originates in the uterus and is characterized by aggressive intravenous growth that can extend to the inferior vena cava and even involve the intracardiac cavity. This extension of the IVL into the right heart is known as intracardiac leiomyomatosis (ICL). The clinical incidence of this disease is extremely low, and the characteristics of atypical aggressive growth lead to diagnostic dilemmas. Thus, studies on this disease have profound clinical significance. Here, we report a case of intracardiac leiomyomatosis and review the relevant literature. A 46-year-old female patient presented with exertive chest tightness and shortness of breath with an onset of approximately half a month. The patient underwent uterine myomectomy in 2018 and recovered well after surgery. On preoperative echocardiography, a hypoechoic mass was detected in the right atrium, which was diagnosed as a leiomyoma. Cardiac magnetic resonance imaging (MRI) revealed a T2-weighted mixed high-signal mass with partial cystic changes that extended from the inferior vena cava into the right atrioventricular cavity, occupying most of the atrial cavity and was misdiagnosed as an atrial mucinous tumor. The patient underwent cardiac tumor resection, tricuspid valvuloplasty, and lower-extremity vascular exploration under general anesthesia with extracorporeal circulation. The final pathological diagnosis was ICL. This is an illustrative analysis of various aspects of the disease, including pathology, etiology, clinical symptoms, imaging diagnosis, and treatment modalities.

Signet-ring cell carcinoma of the caecum: A case report

Colorectal cancer (CRC) ranks as the third most prevalent cancer globally, with adenocarcinomas being the most frequent type. Signet ring cell carcinoma (SRCC) is a very rare subtype of adenocarcinoma, it commonly occurs in the stomach. However, other digestive localizations are possible including the colon, rectum, and gallbladder. Herein, we report a rare case of a metastatic caecal SRCC in a young male patient, presented to our department for abdominal diffuse pain and distention evolving for 3 months, associated with remarkable weight loss and asthenia. The clinical examination revealed abundant ascites and abdominal tenderness. Laboratory tests showed an elevated C-reactive protein at 35 mg/l (normal value: <6 mg/l), a microcytic hypochromic anemia at 11.2 g/dl (normal value for a man > 13 g/dl), increased carcinoembryonic antigen (CEA) levels, as well as CA 19-9 and CA-125.The abdominal scan showed irregular and asymmetrical thickening with peripheral speculation of the caecum measuring 2.1 cm *5.8 cm. Additionally, adjacent adenopathies, abundant ascites, and peritoneal carcinomatosis were observed to be associated with suspicious bilateral pulmonary nodules and micronodules. The colonoscopy identified a bulging ulcerative tumor of the ileocecal valve extended to the ileum. Further histologic examination confirmed the presence of signet-ring cell carcinoma. The patient was referred to the medical oncology department to initiate palliative chemotherapy following a multidisciplinary consultation meeting. We can underline that SRCC of the caecum is a rare entity with a bad prognosis. Usually, the diagnosis is made at late stages due to the lack of obvious symptoms earlier.

Liver hydatidosis disease with portal vein invasion: Report of a rare case and review of literature

Hydatid disease is a zoonosis caused by Echinococcus granulosus. Humans are aberrant intermediate hosts and following the infection, the parasite may infest any organ of the body, with the liver and lungs being the most involved organs. Portal vein involvement by hydatid cyst disease is extremely rare with only seven cases published to our knowledge. We present a 62-year-old Persian male with an incidental liver cyst. His laboratory tests were in normal ranges. The ultrasonography (US), computed tomography (CT) and magnetic resonance imaging (MRI) findings show hydatid disease of the liver with distal portal vein involvement and collateral venous formations. The patient is being followed and has not gone under surgery yet. It possesses a propensity to invade multiple organ systems, notably the liver and lungs. Hydatid disease is imposing a significant burden on healthcare systems specifically in developing countries. Manifestations of the disease are often non-specific, while a subset of the infected population remains asymptomatic. Portal vein invasion and obstruction is a rare complication, and it is important to distinguish it from vein thrombosis, as the management of these entities requires different approaches.

Cerebral venous sinus thrombosis with hemorrhagic infarct: A rare presentation in a risk-defying male patient

Cerebral venous sinus thrombosis (CVST) is a rare but critical cerebrovascular condition characterized by clot formation in cerebral veins or sinuses. We present a case of a 30-year-old male with CVST, an atypical presentation of right-sided weakness and sudden loss of consciousness. While CVST typically manifests as severe headaches and neurological deficits, our patient's unique symptoms pose diagnostic challenges. Advanced imaging techniques, including MRI with venography, played a pivotal role in confirming the diagnosis. Treatment involved anticoagulation therapy and resulted in a favorable outcome. This case highlights the importance of considering CVST in patients with unusual neurological symptoms and the crucial role of early diagnosis and intervention. Advances in diagnostic modalities and treatment options have significantly improved outcomes in CVST patients, emphasizing the need for timely recognition and management.

Complete metabolic response after Partially Ablative Radiotherapy (PAR) for bulky retroperitoneal liposarcoma: A case report

In the management of symptomatic inoperable retroperitoneal sarcomas (RPS), palliative radiotherapy (RT) is a potential treatment option. However, the efficacy of low doses used in palliative RT is limited in these radioresistant tumors. Therefore, exploring dose escalation strategies targeting specific regions of the tumor may enhance the therapeutic effect of RT in relieving or preventing symptoms. In this case report, we present the case of an 87-year-old patient with rapidly growing undifferentiated liposarcoma in the retroperitoneum, where surgical and systemic therapies were ruled out due to age and comorbidities. RT was administered using volumetric modulated arc therapy, delivering 20 Gy in 4 fractions twice daily to the macroscopic tumor and 40 Gy in 4 fractions twice daily (simultaneous integrated boost) to the central part of the tumor (Gross Tumor Volume minus 2 cm). An 18F-FDG-PET-CT scan performed after RT demonstrated a complete metabolic response throughout the entire tumor mass. Although the patient eventually succumbed to metastatic spread to the bone, liver, and lung after 9 months, no local disease progression or pain/obstructive symptoms were observed. This case highlights the technical and clinical feasibility of delivering ablative doses of RT to the central region of the tumor and suggests the potential for achieving a complete metabolic response and durable tumor control.

A case report

Leiomyosarcoma (LMS) is a rare malignant tumor originating from smooth muscle cells. Primary leiomyosarcomas arising from vessels' walls are extremely rare (2%), with LMS of inferior vena cava being the most frequent subtype. We present the case of a 45-year-old man with a past medical history of resected leiomyosarcoma of the right calf, presenting with a follow-up CT showing a retroperitoneal mass arising from the inferior vena cava, which proved to be IVC leiomyosarcoma at histopathology. The patient underwent surgical resection of the mass with prosthetic reconstruction of the IVC. Three days after surgery he developed complete thrombosis of IVC graft which persisted at 3-months follow-up imaging and was treated with pharmacological therapy. Although there are many references reporting the association between LMS of the inferior vena cava and postoperative deep vein thrombosis, to our knowledge there are no reports currently available regarding complete thrombosis of IVC vascular graft after surgical resection of IVC LMS.

Case report of rare primary gastric large B-cell lymphoma

Gastric large B-cell lymphoma is rare and can be challenging to diagnose due to its nonspecific presentation. Primary gastric large B-cell lymphoma is rare, especially compared to systemic disease with gastric involvement. In this case, an 85-year-old female was brought to the ER with abdominal pain, as well as a history of nausea, constipation, and weight loss. CT imaging showed thickening of the anterior wall of the stomach accompanied by inflammatory changes. Esophagogastroduodenoscopy revealed a 7-8 cm "half circumferential necrotic" ulcer suggestive of malignancy. Biopsy confirmed this to be gastric large B-cell lymphoma. Subsequent PET-CT showed no metastasis. This case illustrates the value of imaging in diagnosing this unusual condition.

Significance of expeditious diagnosis and treatment following menarche in obstructed hemivagina and ipsilateral renal agenesis syndrome: A case report

Obstructed hemivagina and ipsilateral renal agenesis syndrome is a rare complex of structural abnormalities of female urogenital tract. Moreover, delayed treatment of this condition can reportedly lead to pelvic infection, endometriosis, and infertility. We present a rare case of obstructed hemivagina and ipsilateral renal agenesis syndrome wherein appropriate treatment was initiated early due to the identification of left renal agenesis. A 14-year-old girl visited the gynecology department due to worsening left lower abdominal pain after menarche. She was diagnosed with renal dysplasia in the pediatric department at the ages of 3 and 9 years, and it was recommended that she visits the gynecology department right after menarche. She experienced her first menarche at the age of 14 years. Imaging studies revealed uterine didelphys with occlusion of the left vagina and formation of hematocolpos. Additionally, hematomas were observed in the left uterine cavity and the left fallopian tube; left renal agenesis was confirmed. Based on these findings, we diagnosed this patient with obstructed hemivagina and ipsilateral renal agenesis syndrome and performed a surgical incision and excision of the closed left vaginal wall, resulting in the disappearance of the hematocolpos. Approximately 2 years postoperatively, the patient has remained recurrence-free. Early diagnosis and treatment are crucial for preserving fertility in patients with obstructed hemivagina and ipsilateral renal agenesis syndrome, and early referral to the obstetrics and gynecology department is recommended if renal dysplasia is detected during childhood.

Postpartum chylothorax: Two case reports and literature review

Postpartum chylothorax is an infrequent complication of delivery that is sometimes overlooked. We presented 2 cases of chylothorax in primiparous women who developed chest tightness and breath shortness after vaginal birth, probably due to increased pressure in the thoracic ducts during labor. Lymphography with iodine oil revealed leakage at the T4 level of the thoracic duct in 1 patient but not in the other. Only trace amounts of iodized oil were deposited in the thoracic cavity. There was a significant decrease in postoperative drainage. However, the treatment did not yield the anticipated curative effect in either case. Eight incidences of postpartum chylothorax were identified in the reviewed literature. Patients with refractory chylothorax may benefit greatly from lymphography since it can detect structural changes and determine whether there is a leaking in the thoracic duct. Lymphography-guided therapy for chylothorax with a verified leak has the potential to be both effective and safe. Lymphangiography can serve as a useful tool in selecting the optimal surgical strategy.

Epilepsy Surgery for Cognitive Improvement in Epileptic Encephalopathy

Epileptic encephalopathies are defined by the presence of frequent epileptiform activity that causes neurodevelopmental slowing or regression. Here, we review evidence that epilepsy surgery improves neurodevelopment in children with epileptic encephalopathies. We describe an example patient with epileptic encephalopathy without drug refractory seizures, who underwent successful diagnostic and therapeutic surgeries. In patients with epileptic encephalopathy, cognitive improvement alone is a sufficient indication to recommend surgical intervention in experienced centers.

Pseudotumoral hemicerebellitis in a young male sailor with complete recovery after steroid therapy

Pseudotumoral hemicerebellitis is a rare presentation of acute cerebellitis, which involves the inflammation of a single cerebellar hemisphere and most commonly affects children. It mimics a tumor on imaging, hence given the name. In this report, we present a case of pseudotumoral hemicerebellitis in a 30-year-old male who presented to the emergency room (ER) with complaints of vertigo, vomiting, and a headache.

Solitary plasmacytoma of mandible: A case report

Solitary plasmacytoma is a rare malignant tumor, presenting less than 5% of all plasma cell proliferation. Bone forms are the most frequent, affecting particularly the axial bone skeleton, mandibular localization is extremely rare. Diagnosis is based on the presence of a localized plasma cell tumor without signs of a disseminated form. We report a case of 65 years old female patient with solitary bone plasmacytoma of mandible, who has undergone surgical treatment without adjuvant therapy, with a good clinical and radiological outcomes at 12 months follow-up.

Paranasal sinus angiosarcoma with facial paralysis as a novel manifestation: a case report and literature review

BACKGROUND

Paranasal sinus angiosarcoma is an uncommon malignancy, with only a few reported cases worldwide. Although it exhibits multiple symptoms, facial paralysis has not been previously documented as a noticeable presentation.

CASE PRESENTATION

In this case, we report a 40-year-old male who presented with facial numbness and pain for one month, weakness of his facial muscles for 15 days, and recurrent right epistaxis for 1 year. He had a history of nasal inflammatory polyps with chronic sinusitis. Computed tomography and magnetic resonance imaging showed space-occupying lesions in the right nasal cavity and maxillary sinus, with bone destruction occurring in the sinus wall and turbinate. This patient then underwent endoscopic surgery. According to the histopathological and immunohistochemical results, he was eventually diagnosed with paranasal sinus angiosarcoma in April 2021. To date, this patient has not initiated any radiotherapy or chemotherapy and has survived with lymphatic metastasis for at least 3 years.

CONCLUSIONS

This manuscript suggests that paranasal sinus angiosarcoma can present with facial paralysis. Moreover, pathological and immunohistochemical tests are still vital for diagnosing paranasal sinus angiosarcoma and differential diagnosis. Additionally, regular follow-up is crucial for patients with paranasal sinus angiosarcoma, enabling monitoring of recurrence, metastasis, and recovery while contributing valuable clinical data to understanding this rare disease and associated research endeavours.

Nintedanib-associated enterocolitis with intractable diarrhea: a case report

Revised idiopathic pulmonary fibrosis treatment guidelines were published in 2015, and nintedanib was conditionally recommended. Although diarrhea is reported to be a common major adverse event associated with nintedanib, there have been few reports on detailed endoscopic findings of nintedanib-associated enterocolitis. A 74-year-old woman was diagnosed with idiopathic pulmonary fibrosis 4 years ago in May. She was started on nintedanib (300 mg). Three months later, hepatic dysfunction was observed; therefore, the drug was temporarily discontinued and then resumed at a dose reduction of 200 mg. Five months later, the patient developed diarrhea, and the dose was reduced to 150 mg. However, no effect was noted; hence, colonoscopy was performed. Various inflammatory lesions, such as erythema and erosions, were observed continuously at the rectum, which resembled ulcerative colitis. No improvement was observed 2 months after follow-up colonoscopy, and nintedanib-related enterocolitis was suspected. The dose was further reduced to 100 mg. Since the endoscopic findings of nintedanib-associated enterocolitis are similar to those of ulcerative colitis, it is critical to consider patients with diarrhea who are taking nintedanib as having associated enterocolitis and attempt to reduce or discontinue the drug if diarrhea does not improve with antidiarrheal agents.

Necrotizing fasciitis wound after debridement could be successfully treated with negative-pressure wound therapy with instillation and dwelling: A case report

Background

Necrotizing fasciitis (NF) is associated with a high mortality rate. Adequate incision and drainage and repeated debridement are necessary for NF management. After drainage, daily local irrigation should be performed.

Case presentation

A 72-year-old male patient complained of left lower quadrant pain. Computed tomography revealed a 7 cm mass in the descending colon, with retroperitoneal penetration. Hence, he underwent emergency surgery. The left abdomen was widely incised, and a transverse colostomy was performed for local wound control. Daily debridement of necrotic tissue and wound irrigation were continued. On postoperative day 48, the wound was extensive and complex and obtained a positive bacterial culture. Subsequently, we began a negative-pressure wound therapy with instillation and dwelling (NPWTi-d), which was very effective for extensive and complicated wounds with infection. Thereafter, a split-thickness skin was grafted, and the skin graft survived well. Ultimately, the wound successfully closed.

Conclusions

NPWT is contraindicated for infected wounds, and an infection control period is required. However, NPWTi-d enables early initiation of wound care despite the presence of infection. Therefore, NPWTi-d is effective for extensive and complicated wounds with infection after NF debridement.

Non-operative management strategy for blunt pulmonary artery pseudoaneurysm: A case report

Traumatic pulmonary artery pseudoaneurysms (PAP) are rare findings and are often associated with penetrating trauma to the chest. We present a case of a pulmonary artery pseudoaneurysm following blunt trauma. A 49-year-old man presented after a motor vehicle collision. Contrast enhanced computed tomography scans of the neck, chest, abdomen, and pelvis were obtained demonstrating a proximal right pulmonary artery pseudoaneurysm, small volume hemopericardium, left first rib fracture, and focal non-flow limiting dissection of left subclavian artery. For the management of right PAP, we adopted a non-operative management strategy with an esmolol infusion for strict heart rate and blood pressure control. An echocardiogram was obtained the next day revealing no cardiac tamponade. Angiography of the chest was done after 24 h which showed stable appearance of the right PAP and hemopericardium. Patient was discharged home on hospital day 11.

A large common hepatic artery pseudo aneurysm: A case report

INTRODUCTION & IMPORTANCE

The Hepatic Artery Aneurysms (HAAs) are rare and asymptomatic with a high rate of rupture. The management is mandatory and depends on the size and the location of the aneurysm.

CASE PRESENTATION

We reported a case of 50 years old male, admitted to sharp epigastric pain. Radiological investigations confirmed a common hepatic artery aneurysm. We indicated an open surgery to repair the aneurysm, the postoperative course finished without any complications.

CLINICAL DISCUSSION & CONCLUSION

HAAs are considered the second most common type of splanchnic aneurysms. Although from the rare occurrence, HAAs have a high rate of rupture. Open repair of the HAAs remains the treatment of choice of degenerative HAAs, to preserve the arterial flow to the liver.

"Growth plate fracture of the proximal tibia in a young adult with an unfused growth plate: A case report"

INTRODUCTION

Tibial plateau fractures are recognized as one of the most challenging orthopedic injuries, especially when encountered in adults with unfused growth plates. The rarity of such cases makes them significant for study and discussion.

IMPORTANCE

The presence of an open growth plate in adult patients can significantly influence both treatment decisions and outcomes. Understanding these unique cases is vital, as they offer insights into managing similar future cases and advancing orthopedic care.

CASE PRESENTATION

A 23-year-old male, following a car accident, presented with a closed knee injury. Radiographic evaluations, including a hand X-ray to determine skeletal age, were employed. The findings confirmed a Salter and Harris type 4 fracture of the proximal tibia and indicated a skeletal age of approximately 15 years ±6 months. Treatment involved open reduction and internal fixation, specifically tailored to account for the patient's preserved growth plate.

CLINICAL DISCUSSION

Managing such fractures necessitates a specialized approach, ensuring the growth plate is not jeopardized during treatment. The patient's age, combined with the presence of an unfused growth plate, added complexity to the treatment plan. The emphasis on accurate classification of the fracture, the selected surgical technique, and post-operative care played a pivotal role in the successful recovery.

CONCLUSION

This case underscores the importance of a holistic, multidisciplinary approach in managing rare orthopedic presentations. Ensuring the preservation of growth potential while achieving functional recovery is paramount. Such cases enrich the orthopedic literature, guiding future treatments and interventions.

Posterior reversible encephalopathy syndrome in postpartum patients with gestational hypertension: A case report emphasizing early recognition and management

Posterior reversible encephalopathy syndrome (PRES) is a rare neuroradiological condition causing headaches, altered mental status, seizures, visual disturbances, and focal deficits. It is often associated with preeclampsia and eclampsia in pregnancy, but can also occur in patients with other medical conditions, such as hypertension, autoimmune diseases, renal dysfunction etc. This case report highlights the importance of recognizing PRES in postpartum patients with hypertension and the need for prompt diagnosis and management to prevent potential complications. A 30-year-old woman with gestational hypertension underwent scheduled induction of labor. After a successful delivery, she experienced a sudden headache but no other neurological symptoms. Imaging showed bilateral frontoparietal white matter edema, consistent with PRES. She was closely monitored, treated with analgesics, and improved within a week. The case highlights the rarity of PRES in postpartum patients without preeclampsia or eclampsia. It underscores the importance of considering PRES as a possible diagnosis in postpartum patients with hypertension, even in the absence of typical risk factors. Prompt control of blood pressure and careful monitoring are essential to ensure a positive outcome, as PRES can lead to life-threatening complications if not managed appropriately. The study highlights the importance of heightened awareness of PRES in postpartum patients with gestational hypertension. Early detection and timely management can improve prognosis, even in atypical cases. Healthcare professionals should be vigilant in assessing hypertension patients to diagnose and manage PRES, preventing neurological sequelae. Further research is needed to better understand PRES pathophysiology and risk factors in postpartum patients.

Multidisciplinary perioperative management in dilatation and evacuation for a giant hydatidiform mole: A case report

Gestational trophoblastic disease (GTD) is an abnormal pregnancy caused by the placenta, which can potentially metastasise. Suction evacuation is recommended for diagnosis and treatment, and dilatation and evacuation (D&E) is usually performed under intravenous anaesthesia due to the short operation time and minimal blood loss. We refer to the guidelines produced by the Japan Society of Obstetrics and Gynaecology (JSOG), and acknowledge that practices vary globally. However, to the best of our knowledge, there is no evidence on perioperative management and arrangements in D&E required for managing giant hydatidiform moles, such as preventing massive haemorrhage, respiratory dysfunction with a pathogenesis like ovarian hyperstimulation syndrome (OHSS), or intensive care needs. This case report describes perioperative considerations for managing a giant hydatidiform mole using D&E in a uterus enlarged to the third-trimester pregnancy size. A 28-year-old multiparous woman was clinically diagnosed with a hydatidiform mole after a spontaneous miscarriage due to abnormal genital bleeding, systemic oedema, and abdominal distention. Ultrasound and computed tomography showed a ballooning uterus with a third-trimester pregnancy size, a robust intrauterine mass, and ascites. Serum hCG levels were extremely high (>3,000,000 mIU/mL), confirming the clinical diagnosis of a hydatidiform mole. Emergency D&E was safely performed under multidisciplinary perioperative management, with careful preparation and support. This is a rare experience-based case report and valuable documentation detailing multidisciplinary perioperative management under general anaesthesia. To the best of our knowledge, this is the first report describing the considerations, details, and innovations required in the perioperative management of giant hydatidiform moles using D&E.

A rare concurrent incidence of adult-onset acute disseminated encephalomyelitis and antiphospholipid antibody syndrome: A case report

INTRODUCTION

Acute disseminated encephalomyelitis (ADEM) is a demyelinating immune-mediated condition of the central nervous system, whereas antiphospholipid antibody syndrome (APLA) is an autoimmune disorder accompanied by thrombosis and pregnancy-related problems. We present a unique case of a 30-year-old female with ADEM coexisting with APLA, highlighting the importance of early identification and specialized care.

PRESENTATION OF CASE

We present a case of a 30-year-old woman with a history of hypertension, multiple miscarriages, and non-compliance with medication, who presented with altered consciousness and weakness in all four limbs. Laboratory tests revealed positive anti-cardiolipin and lupus anticoagulant antibodies, confirming APLA. A neurological examination revealed increased limb tone, heightened reflexes, and extensor plantar responses. MRI revealed confluent white matter lesions that were consistent with ADEM. The patient received prompt treatment with intravenous methylprednisolone and then received oral prednisone, leading to a rapid improvement in neurological status.

DISCUSSION

The intricate interaction between ADEM and APLA remains enigmatic. The plausible connection between "molecular mimicry" and weakened blood-brain barrier, substantiated by antiphospholipid antibodies, may help explain their concurrent occurrence.

CONCLUSION

This case highlights the significance of early diagnosis and management of the rare and complex coexistence of ADEM and APLA to attain optimal outcomes, as well as the significance of careful examination for simultaneous autoimmune markers in individuals presenting with neurological disturbances.

Conservative surgical management of surface osteosarcoma using 3D printing technology: An unusual case report and literature review

INTRODUCTION AND IMPORTANCE

Surface osteosarcoma, a rare variant of osteosarcoma, poses unique challenges in diagnosis and treatment. This report discusses the application of 3D printing technology in the surgical management of a complex case involving a 27-year-old female patient with surface osteosarcoma in the proximal tibia.

CASE PRESENTATION

A 27-year-old female patient presented with a progressively growing mass on her right knee, initially misdiagnosed as a benign bone tumor. Over five years, the lesion expanded from a well-corticated metaphyseal-epiphyseal outgrowth on the proximal tibia to involve the anterior tibial tuberosity. Radiological and histological evaluations confirmed well-differentiated paraosteal surface osteosarcoma. A multidisciplinary team opted for a conservative surgical approach, including resection of the anterior tibial tuberosity and patellar tendon. Precision was enhanced through 3D printing technology, which provided custom cutting guides. The reconstruction involved non-vascularized peroneus and iliac crest bone grafts.

CLINICAL DISCUSSION

Accurate differentiation from benign lesions presents challenges. Achieving surgical resection with clear margins is pivotal for favourable outcomes, particularly in young patients. Chemotherapy yields limited benefits in low-grade surface osteosarcomas. Functional prognosis hinges on effective post-resection reconstruction. 3D printing technology facilitates meticulous surgical planning and guidance, enhancing the success of conservative surgical interventions.

CONCLUSION

This case underscores the significance of a multidisciplinary approach, accurate diagnosis, and the integration of 3D printing technology in managing surface osteosarcomas. Conservative surgical resection, guided by precise planning and reconstruction, is critical for preserving functionality. Continued research and the adoption of innovative techniques hold promise for improving the quality of life and functional outcomes of individuals grappling with musculoskeletal tumors.

Congenital infantile hypertrophic pyloric stenosis in preterm dizygotic twins infants diagnosed early: A case report

INTRODUCTION AND IMPORTANCE

The association in the occurrence of hypertrophic pyloric stenosis (HPS) is 0.25 % to 0.44 % between monozygotic twins and 0.05 % to 0.10 % in dizygotic twins. A combination of genetic and environmental factors may have contributed to the occurrence of HPS. In view of the few related cases reported recently, we present two dizygotic twins who were diagnosed with HPS.

CASE PRESENTATION

This report describes a rare case of congenital infantile hypertrophic pyloric stenosis in preterm dizygotic twins diagnosed early, in which the first case presented with severe clinical features and managed surgically while the second presented with moderate features and hence managed non-operatively with atropine for 14 days. At 6 months of age, both twins continued to tolerate feeds, demonstrated satisfactory weight gain and had achieved appropriate developmental milestones. The postoperative course was uneventful in the twin A.

CLINICAL DISCUSSION

Congenital HPS in premature twins remains an underdiagnosed pathology due to its clinical picture mimicking digestive intolerance to feeds. The mean age at diagnosis is about 38 days, and only 0.4 % of all children suffering from HPS show symptoms in the first 3 days of life. Symptom relief is achieved after a classic pyloromyotomy is performed by a more preferable laparoscopic technique or using the open surgical technique.

CONCLUSION

If one of the dizygotic twins has HPS, the other baby should be evaluated for the same diagnosis as early as possible, to ensure timely management. HPS with moderate clinical features can be treated with atropine for 14 days while severe HPS should be treated by pyloromyotomy.

Eccrine spiradenoma of nose: Surgical case report

INTRODUCTION AND IMPORTANCE

Eccrine spiradenoma is a benign tumor of the eccrine sweat glands, preferentially affecting the scalp, face and trunk. Few cases are described in the literature, it is a fairly rare pathology.

PRESENTATION OF THE CASE

We present the case of a 64-year-old man who consulted for an ulcerative and nodular lesion of the left side of the nose for 5 years. He was treated in our department (excision and reconstruction). Pathological examination revealed a benign eccrine spiradenoma.

CLINICAL DISCUSSION

Eccrine spiradenoma is a relatively rare benign adnexal tumor. His diagnosis is based on histopathological examination. His treatment is surgical. In case of incomplete excision of the tumor, the risk of recurrence is always possible. The risk of malignant transformation exists, particularly for tumors with a long duration of evolution.

CONCLUSION

Benign eccrine spiradenoma is a rare adnexal tumor, but it is important to know about it. The main risk is malignant transformation.

Hemoadsorption and continuous venovenous hemodiafiltration in the management of paraquat poisoning during pregnancy: A case report

We describe the case of a mother in the second trimester of pregnancy with severe paraquat poisoning who ended her pregnancy at term and a healthy newborn. Management was initiated after 34 h of paraquat administration with the HA-230 hemoadsorption cartridge, followed by continuous venovenous hemodiafiltration for 120 h, in addition to cyclophosphamide and methylprednisolone. There was no evidence of adverse effects associated with treatment or extracorporeal therapy, and maternal and fetal well-being was maintained during the 26 days of hospitalization and at the end of pregnancy. This case treated with hemoadsorption and hemodiafiltration for paraquat poisoning during pregnancy is one of the few procedures reported in the literature and can be used as a guide for the management of subsequent cases.

The Alexis Laparoscopic System as Minimally Invasive Surgical Technique in Operative Management of Huge Cystic Ovarian Tumors in Children and Young Adolescents: A Case Report

BACKGROUND

The use of the Alexis wound protector-retractor (AWPR) could further improve the laparoscopic techniques for safely removing huge ovarian tumors in children.

CASE

A 15-year-old patient presented to our emergency department with a history of weeks of persistent abdominal pain. Clinical examination and magnetic resonance imaging demonstrated a 25 × 21 × 21 cm cystic mass arising from the left ovary. An en block unilateral oophorectomy and salpingectomy with the use of a medium-sized AWPR was performed without complications. The patient was discharged on the second postoperative day.

CONCLUSION

The AWPR is a safe and effective tool in treating such children and adolescents with huge ovarian tumors, preserving fertility, minimizing the postoperative pain and hospital stay, and providing an excellent cosmetic outcome.

Recurrent severe anemia associated with a jejunal arteriovenous malformation in pregnancy: A case report

Background

Small intestinal arteriovenous (AV) malformations may cause gastrointestinal hemorrhage, occasionally leading to anemia; however, they are rarely seen in pregnancy. This report presents a case of a pregnant woman who had recurrent severe anemia that was attributed to a small hemorrhagic intestinal arteriovenous malformation.

Case Presentation

A 24-year-old pregnant woman (gravida 2, para 1) presented with a low hemoglobin concentration (3.6 g/dL) in her first pregnancy and underwent an emergency cesarean section at 36 weeks due to non-reassuring fetal status. In her second pregnancy, she was hospitalized at 30 weeks with epigastric pain and nausea. A low hemoglobin level (6.6 g/dL) and scant fecal occult blood were revealed upon examination. She was referred to the hospital for further evaluation and pregnancy management. Recurrent blood transfusions were required; however, neither hematemesis nor obvious fecal hemorrhage was observed. At 31 weeks, a cesarean section was performed owing to persistent anemia. Postoperative small intestinal capsule endoscopy and flexible fiberoptic proximal small intestinal endoscopy revealed a suspected bleeding small intestinal arteriovenous malformation. The patient underwent partial resection of the small intestine on hospitalization day 16. Histopathological examination confirmed a small intestinal arteriovenous malformation. The patient had a good postoperative course and was discharged on hospitalization day 24.

Conclusions

Small intestinal arteriovenous malformations can bleed during pregnancy. They can go undetected if they spontaneously shrink postpartum. In severe anemia during pregnancy, hemorrhage from small intestinal arteriovenous malformations should be included in the differential diagnosis and promptly investigated even in the absence of gastrointestinal symptoms.

Spontaneous rupture of renal angiomyolipoma presenting with shock; a case report from Tanzania

INTRODUCTION AND IMPORTANCE

Renal angiomyolipoma (AML) are benign tumors, often incidentally diagnosed with rupture being the commonest complication and cause of mortality. These tumors are rare with a higher prevalence among patients with tuberous sclerosis and female predominance. Management is dependent on tumor size and whether or not the tumor has ruptured.

CASE PRESENTATION

32-year-old female presenting with sudden right flank pain with shock without history of prior trauma or surgeries. Underwent imaging revealing a suspected ruptured AML thus underwent emergent nephrectomy with admission to intensive care.

CLINICAL DISCUSSION

Wunderlich syndrome manifests as the Lenk triad, which includes acute flank pain, flank mass, and hypovolemic shock with signs of internal bleeding such as hematuria. It is a rare manifestation signifying spontaneous renal hemorrhage. Due to the instability of the patient had to undergo emergency laparotomy and nephrectomy.

CONCLUSION

Renal AML occur as a rare benign phenomenon which when ruptured are associated with high mortality rate if not treated promptly in a setting with specialized treatment and intensive unit care. We hope that through our experience patients presenting with Lenk's triad are identified early for adequate intervention.

A rare case of an isolated primary hydatid cyst in the uterus in a 7-year-old child: Case report and review of the literature

INTRODUCTION AND SIGNIFICANCE

Hydatidosis is one of the diseases caused by tapeworms that infect humans during their life cycle and still pose a major problem. A review of the medical literature has reported a few cases of serous cysts in the uterus. In most cases, pelvic cysts are asymptomatic and may sometimes cause compressive symptoms or complications when ruptured.

CASE PRESENTATION

We presented a case of a serous cyst of the uterus that was discovered through vague abdominal pain. The definitive diagnosis of the case was made during surgery when the cyst was opened, where it was removed and the cavity was closed completely.

CLINICAL DISCUSSION

The diagnosis of a serous cyst is based on a good clinical history, with the help of serological tests, in addition to radiological investigations that help to determine the number of cysts, their location, and their surroundings, in order to choose the appropriate therapeutic intervention according to the size of the cyst and its location, for the best patient care.

CONCLUSION

Hydatid cysts of the uterus are rare, but they should be included in the differential diagnosis of pelvic cysts to avoid the accidental rupture of the cyst during surgery and the occurrence of an allergic reaction that can sometimes be fatal.

Superior vena cava syndrome induced by lung hyperinflation in chronic obstructive pulmonary disease: a case report

BACKGROUND

Superior vena cava syndrome is rarely attributed to chronic obstructive pulmonary disease.

CASE PRESENTATION

We present the case of an 82-year-old Japanese man who experienced gradually progressive dyspnea on exertion. His physical examination revealed small vascular dilatations on his chest and upper abdominal skin characterized by blood flow from head to leg, indicating superior vena cava syndrome. Radiographic findings included lung hyperinflation with a drop-like heart on chest X-ray, and emphysematous changes on computed tomography. The superior vena cava appeared extremely narrow and slit-like, with no adjacent mass or giant bulla. Pulmonary function testing indicated a forced expiratory volume in 1 second of 0.82L (44.4% of predicted value) and a forced expiratory volume in 1 second/forced vital capacity of 31.29%. A diagnosis of chronic obstructive pulmonary disease was made. We discuss how longitudinal forces can narrow the superior vena cava, particularly when it protrudes toward the lung field due to its anatomical location in the upper mediastinum. The absence of mediastinal adipose tissue may render the superior vena cava susceptible to compression, resulting in a loss of its typical columnar structure. The protrusion of the superior vena cava toward the lung field may be a contributing factor to superior vena cava narrowing in chronic obstructive pulmonary disease.

CONCLUSION

This case represents the first reported instance of superior vena cava syndrome associated with chronic obstructive pulmonary disease, characterized by lung hyperinflation, in the absence of a giant bulla.

Effectiveness of a lower-abdominal incision in an extremely underweight patient with thin skin who underwent laparotomy during an upper abdominal surgery: A case report

INTRODUCTION

Although laparoscopic surgery is often difficult in patients with obesity, very few studies have investigated its difficulty in extremely underweight patients.

PRESENTATION OF CASE

We present the case of a 44-year-old nulliparous woman with an extremely low body weight who underwent laparoscopic adnexal surgery. She had undergone laparotomy for partial hepatectomy and was referred to our hospital 6 months later for an ovarian tumor. She weighed 25.5 kg and had a body mass index of 10.6 kg/m2. Abdominal magnetic resonance imaging revealed a relatively large rectus abdominis and a dilated bowel. An umbilical approach was considered dangerous because of the existing surgical scar. Thus, a small incision was made in the lower abdomen, and the first trocar was inserted under direct view. Laparoscopic resection of the right adnexa was performed; however, the operative time was longer than expected (96 min) because the dilated intestinal tract obstructed our view and the lower abdominal mini-incision approach with the EZ access device was used.

DISCUSSION

Underweight patients are reportedly at an increased risk of subcutaneous emphysema and initial trocar puncture injuries. We avoided these by approaching through a small, lower abdominal incision. We considered the unexpectedly rapid and deep trocar entry to be dangerous and expected a hand-assisted approach to be safer.

CONCLUSION

Our findings indicate that considerably difficulties are encountered during a laparoscopic surgery in extremely underweight patients with a history of laparotomy; thus, special care should be taken during such surgeries.

Unusual location of subungual melanoma surgically managed successfully: A rare case report from Syria

INTRODUCTION AND IMPORTANCE

Acral lentiginous melanoma (ALM), the least common subtype of cutaneous melanoma, poses challenges in early detection, resulting in low survival rates. Subungual melanoma (SUM), a rare form of ALM originating from the nail matrix, is less common on the hands than on the feet, accounting in the hands for only 0.3 % of all cutaneous melanomas. This makes the case of hand subungual melanoma that we are presenting very rare and significant.

CASE PRESENTATION

A 64-year-old woman presented with an asymptomatic subungual lesion on her left fifth finger. The lesion, ranging in color from brown to black, did not cause bleeding and exhibited a clear nail plate rupture. An incisional biopsy confirmed the diagnosis of subungual melanoma. The patient underwent a proximal interphalangeal (PIP) joint amputation and remains in good health. Regular CT scans and clinical examination have shown no recurrence.

CLINICAL DISCUSSION

Subungual melanoma, a rare subtype of acral lentiginous melanoma, comprises less than 1 % of all melanomas. While the Hallux and thumb are commonly affected, our case involved the little finger which is the rarest site of hand subungual melanoma. Occurrence ages are between 50 and 70. The Hutchinson sign, nail fold pigmentation, indicates poor prognosis in advanced stages, which was positive in our case. Recommended management is amputation at the level of the most distal unaffected joint.

CONCLUSION

Our aim is to raise healthcare professionals' awareness of early recognition and management of subungual melanoma. Early detection and treatment reduce metastasis risk and improve survival rates.

Multiple Foci of Basal Cell Carcinoma Arising in Rhinophyma: A Case Report and Literature Review

Background

Rhinophyma is a benign condition caused by the excessive growth of sebaceous glands in the nasal tissue, presenting with symptoms such as nasal hypertrophy, erythema, and papules. Cases of basal cell carcinoma in rhinophyma have been reported in literature, but its etiological role remains unclear. It is uncertain whether rhinophyma is predisposed to neoplasm development or if their coexistence is coincidental.

Material and Method

We conducted a literature survey to identify such cases reported over the years.

Results

We identified 22 studies reporting a total of 47 cases in the literature, all involving male patients. The most common pattern of occurrence was the rapid growth of a nodular formation within the context of rhinophyma.

Discussions and Conclusion

The elucidation of the association between basal cell carcinoma and rhinophyma remains challenging. The presence of multiple foci supports the theory that rhinophyma may play a role in their development, but larger studies are needed to establish a causal relationship.

PET FDG CT is useful for giant-cell arteritis with isolated cough

Giant cell arteritis (GCA) is a chronic vasculitis of large- and medium-sized vessels. The most frequent symptoms are temporal headaches, scalp tenderness, jaw claudication and polymyalgia rheumatica in 35% of patients. Atypical presentation with dry cough is very rare and could be isolated making the diagnosis difficult. Initial imaging including PET-CT could be helpful. Literature review yielded 13 case reports with available data and one case series which focused on cough and which were all be included in this study. Most of the cases included males (n = 8), with mostly isolated cough or associated to fever and weight loss. Ang