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Gouveia I, Xavier M, Silva J, Martins P. Malignant tumour in pregnancy: Ewing-like sarcoma of the gluteal region. BMJ Case Rep 2024; 17:e257493. [PMID: 38649246 PMCID: PMC11043757 DOI: 10.1136/bcr-2023-257493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Abstract
We report a case of an Ewing-like sarcoma of the gluteal region with ongoing growth during the second trimester of pregnancy and noted during the third trimester. This lesion was consequently studied to infer its malignant potential. Several examinations were conducted to characterise this lesion, such as ultrasound and MR, which showed signs of tumourous invasion of the deep tissues of the gluteal region.Given that the pregnancy was at the end of the third trimester, the decision was made to schedule the delivery at 37 weeks of gestation and treat the tumour afterwards to balance maternal and fetal health.This case illustrates the need for a detailed investigation and guidance by a multidisciplinary team to provide prenatal counselling regarding a malignant tumour during pregnancy.
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Affiliation(s)
- Inês Gouveia
- Gynecology, Centro Hospitalar de Vila Nova de Gaia Espinho EPE, Vila Nova de Gaia, Portugal
| | - Marta Xavier
- Gynecology, Centro Hospitalar de Vila Nova de Gaia Espinho EPE, Vila Nova de Gaia, Portugal
| | - Joana Silva
- Obstetrics & Ginecology, Centro Hospitalar de Vila Nova de Gaia Espinho EPE, Vila Nova de Gaia, Portugal
| | - Pedro Martins
- Cirurgia Geral, Instituto Português de Oncologia do Porto Francisco Gentil EPE, Porto, Portugal
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2
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Lai JK, Panasci L, Patey NG, Wang H. Placental metastasis from maternal NUT carcinoma: diagnostic pitfalls and challenges. BMJ Case Rep 2024; 17:e259538. [PMID: 38569728 PMCID: PMC10989104 DOI: 10.1136/bcr-2023-259538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Abstract
We report a young pregnant woman with large midline thoracic mass and markedly elevated serum alpha-fetoprotein (AFP) levels. Initially suspected as a germ cell tumour (GCT) due to age, site, and high AFP levels, a biopsy unveiled a high-grade malignant tumour characterised by undifferentiated monotonous cells. Although tumour cells exhibited positive AFP, the overall immunoprofile did not provide additional evidence to support GCT. Further work-up showed positive for NUT (nuclear protein in testis) immunostaining and the presence of BRD4-NUT1 fusion, confirming the diagnosis of NUT carcinoma. On radiology, there were extensive metastases to lungs, liver, vertebrae, and placenta. Despite aggressive chemotherapy, radiotherapy and immunotherapy, she did not respond to the therapies. Fortunately, her child was not affected by the carcinoma. This is the first case highlighting that thoracic lung primary NUT carcinoma can spread to the placenta and manifest with elevated serum AFP levels, potentially leading to misdiagnosis as GCT both clinically and pathologically.
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Affiliation(s)
- Jonathan K Lai
- Department of Pathology, McGill University Faculty of Medicine, Montreal, Quebec, Canada
- Department of Diagnostic and Molecular Pathology, McGill University Medical Centre, Montreal, Quebec, Canada
| | - Lawrence Panasci
- Department of Medical Oncology, Jewish General Hospital, Montreal, QC, Canada
| | - Natalie Gabrielle Patey
- Departement de Pathologie et du Centre de Recherche, CHU Sainte-Justine, Montreal, QC, Canada
| | - Hangjun Wang
- Department of Diagnostic and Molecular Pathology, Jewish General Hospital, McGill University Faculty of Medicine, Montreal, QC, Canada
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3
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Elsaid A, Egdell R, Singh V, Russell S. Interesting case of regional left ventricular hypertrophy. BMJ Case Rep 2024; 17:e257882. [PMID: 38490700 PMCID: PMC10946368 DOI: 10.1136/bcr-2023-257882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024] Open
Abstract
This is an account of an interesting case with an unusual cardiac presentation. He is a man in his 60s who presented with chest tightness to the accident and emergency unit. The initial thoughts were of acute coronary syndrome or acute aortic syndrome. The initial set of investigations was non-conclusive. His echocardiogram which was done during hospital admission showed asymmetric hypertrophy of the heart muscle. It was prudent to assess that new finding with an MRI scan. The patient presented to the hospital twice during the investigation and was treated for a lower respiratory tract infection. The MRI report showed an interventricular mass lesion extending to the right ventricular free wall with angiosarcoma being high up in the differential diagnosis. Going through the heart team discussion, the decision was to go for a transcatheter biopsy. The biopsy showed B-cell lymphoma. The treatment started and interestingly with satisfactory results.
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Affiliation(s)
- Ahmad Elsaid
- Cardiology, Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-under-Lyne, UK
| | - Robin Egdell
- East Cheshire NHS Trust, Macclesfield, Cheshire East, UK
| | - Vikram Singh
- East Cheshire NHS Trust, Macclesfield, Cheshire East, UK
| | - Stuart Russell
- East Cheshire NHS Trust, Macclesfield, Cheshire East, UK
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4
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Nonaka M, Ishida H, Manrai M, Takashima A. Tuberculous peritonitis diagnosed following laparoscopic examination for suspected advanced ovarian cancer. BMJ Case Rep 2024; 17:e257973. [PMID: 38429060 PMCID: PMC10910656 DOI: 10.1136/bcr-2023-257973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2024] [Indexed: 03/03/2024] Open
Abstract
Laparoscopy for intra-abdominal exploration and tissue sampling is useful in advanced ovarian cancers, in which it is presumed to be difficult to achieve complete tumour reduction in the initial surgery. This is a report of a case of suspected advanced ovarian cancer in a patient, who underwent laparoscopic screening and was later pathologically diagnosed with tuberculous peritonitis. A woman in her 50s visited her local doctor with constipation. Since imaging showed massive ascites she was referred for further evaluation. We initially suspected advanced ovarian cancer due to the presence of massive ascites and multiple peritoneal nodules. However, histopathological examination indicated that the nodules were tubercles, and the patient was subsequently diagnosed with tuberculous peritonitis. It is important to be aware that tuberculosis peritonitis can be misdiagnosed or mistaken for advanced ovarian cancer. Preoperative diagnosis of tuberculous peritonitis is often difficult. Tuberculous peritonitis should be considered if intraoperative findings show diffuse nodular disseminated lesions.
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Affiliation(s)
- Mizuki Nonaka
- Department of Obstetrics and Gynecology, Toho University Medical Center, Sakura, Japan
| | - Hiroaki Ishida
- Department of Obstetrics and Gynecology, Toho University Medical Center, Sakura, Japan
| | - Megumi Manrai
- Department of Obstetrics and Gynecology, Toho University Medical Center, Sakura, Japan
| | - Akiko Takashima
- Department of Obstetrics and Gynecology, Toho University Medical Center, Sakura, Japan
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5
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An KR, Marshall TC, Cusimano RJ. Vasculitic rash and cerebral emboli in an adolescent with left atrial myxoma. BMJ Case Rep 2024; 17:e258822. [PMID: 38417930 PMCID: PMC10900332 DOI: 10.1136/bcr-2023-258822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2024] Open
Abstract
A previously healthy woman in late adolescence presented to the emergency department with stroke-like symptoms following a two-month history of bilateral foot pain and oedema, accompanied by a macular rash and progressive lower extremity weakness. On further investigation, she was found to have multiple cerebral emboli and a left atrial myxoma fixed to the interatrial septum. The patient subsequently underwent urgent surgical excision of the myxoma. On follow-up, her cutaneous and neurological symptoms were significantly improved. This case suggests that, in the presence of a vasculitic rash without evident or obvious cause, cardiac myxoma should be included in the differential diagnosis.
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Affiliation(s)
- Kevin R An
- Division of Cardiac Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Terrel C Marshall
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Robert J Cusimano
- Division of Cardiac Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
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6
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Solis W, Youssef AM, Shaw R, Li Y. Spinal intramedullary uterine carcinosarcoma metastasis. BMJ Case Rep 2024; 17:e259268. [PMID: 38417940 PMCID: PMC10900381 DOI: 10.1136/bcr-2023-259268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2024] Open
Abstract
Intramedullary spinal cord metastases (ISCM) are a rare and challenging manifestation of metastatic cancer that have devastating impacts on the individual's neurological function, survival expectancy and overall quality of life. Given the rarity and poor prognosis, there is a lack of consensus in management. Uterine carcinosarcoma itself is a rare cancer, accounting for less than 3% of all uterine cancers. It carries a poor prognosis, with only one-third of patients surviving beyond 5 years. There are no previous reports of uterine carcinosarcoma metastases to the spinal cord. Here, we present the case of a woman in her late 70s with a uterine carcinosarcoma intramedullary metastasis that was refractory to radiotherapy treatment and responded favourably to surgical debulking.
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Affiliation(s)
- Waldo Solis
- Neurosurgery, Westmead Hospital, Westmead, New South Wales, Australia
| | - Andrew M Youssef
- Neurosurgery, Westmead Hospital, Westmead, New South Wales, Australia
- Anatomy and Histology, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Richard Shaw
- Neurosurgery, Westmead Hospital, Westmead, New South Wales, Australia
| | - Yingda Li
- Neurosurgery, Westmead Hospital, Westmead, New South Wales, Australia
- Anatomy and Histology, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
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7
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Sharma R, Khera S, Devnani B, Binit S. Primary soft tissue sarcoma breast with multiphenotypic differentiation. BMJ Case Rep 2024; 17:e255750. [PMID: 38388202 PMCID: PMC10884258 DOI: 10.1136/bcr-2023-255750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024] Open
Abstract
Primary soft tissue sarcomas of the breast are rare aggressive neoplasms. These often are misdiagnosed with other more common neoplasms like fibroepithelial malignancies, namely phyllodes tumour and metaplastic carcinoma. Being uncommon, chances of being misdiagnosed are higher leading to early mortality. A multidisciplinary team incorporating surgery, pathology, chemotherapy and radiotherapy is required to formulate an approach to primary soft tissue sarcoma. Generally, these tumours may show single or dual phenotype; we present one rare case report showing multiphenotypic differentiation.
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Affiliation(s)
- Rashim Sharma
- Pathology and Lab Medicine, All India Institute of Medical Sciences Jodhpur, Jodhpur, Rajasthan, India
| | - Sudeep Khera
- Pathology and Lab Medicine, All India Institute of Medical Sciences Jodhpur, Jodhpur, Rajasthan, India
| | - Bharti Devnani
- Radiotherapy, All India Institute of Medical Sciences Jodhpur, Jodhpur, Rajasthan, India
| | - Sureka Binit
- Diagnostic and Interventional Radiology, All India Institute of Medical Sciences Jodhpur, Jodhpur, Rajasthan, India
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8
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Casanova C, Madeira JIM, Pereira da Silva N, Antunes C. Post-radiation uterine rhabdomyosarcoma. BMJ Case Rep 2024; 17:e258853. [PMID: 38272523 PMCID: PMC10826475 DOI: 10.1136/bcr-2023-258853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024] Open
Affiliation(s)
- Clara Casanova
- Medical Imaging Department, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | | | - Nuno Pereira da Silva
- Medical Imaging Department, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | - Célia Antunes
- Medical Imaging Department, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
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9
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Grewal NKS, Maning J, Gordon LI, Akhter N. Checkpoint inhibitor myocarditis with preceding immunosuppression and tolerance of sequential anthracycline therapy. BMJ Case Rep 2024; 17:e257357. [PMID: 38199648 PMCID: PMC10806916 DOI: 10.1136/bcr-2023-257357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024] Open
Abstract
A man in his 50s with no known cardiac history and diffuse large B-cell lymphoma on nivolumab presented with acute dyspnoea and swelling. Physical examination revealed volume overload. Work-up noted new elevation of B-type natriuretic peptide and troponin, with new lateral T-wave inversions on ECG. He was admitted to cardiac intensive care for decompensated heart failure. Echocardiography showed ejection fraction 51% with diffuse hypokinesis and reduction of global longitudinal strain. Cardiac MRI demonstrated diffuse myocardial fibrosis with oedema suggesting acute injury. Endomyocardial biopsy revealed lymphocytic and macrophagic infiltrate with cardiomyocyte damage, compatible with immune checkpoint inhibitor (ICI) myocarditis. Immunotherapy was discontinued and he was treated with diuresis, steroids and initiation of goal-directed medical therapy for heart failure. He required additional treatment with anthracyclines. He was monitored with cardio-oncology follow-up after every cycle of anthracycline and tolerated a cumulative 312 mg/m2 therapy. The safety of anthracycline administration after ICI-myocarditis has not been described.
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Affiliation(s)
| | - Jennifer Maning
- Medicine (Cardiology), Northwestern Medicine, Chicago, Illinois, USA
| | - Leo I Gordon
- Hematology and Medical Oncology, Northwestern Medicine, Chicago, Illinois, USA
| | - Nausheen Akhter
- Medicine (Cardiology), Northwestern Medicine, Chicago, Illinois, USA
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10
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Goldberg A, Chen JN, Breaux J, Pope H. Spindly reason for a pulmonary embolism. BMJ Case Rep 2024; 17:e258084. [PMID: 38182162 PMCID: PMC10773297 DOI: 10.1136/bcr-2023-258084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2024] Open
Abstract
Pulmonary artery intimal sarcomas (PAISs) are rare, malignant tumours that arise from the intimal or intramural wall of the pulmonary artery and are often mistaken for pulmonary emboli. Diagnosis and treatment of this condition are difficult due to the lack of formal guidelines. Initiating treatment as soon as possible after diagnosis is essential for maximising survival. Here, we present the case of a patient with a PAIS that initially presented similar to pulmonary thromboembolic disease and was treated with a multimodal approach.
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Affiliation(s)
- Alec Goldberg
- Internal Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Jason N Chen
- Internal Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - John Breaux
- Cardiothoracic Surgery, Lakeview Regional Medical Center, Covington, Louisiana, USA
| | - Helen Pope
- Internal Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
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11
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Alzghoul H, Haider A, Mukhtar F, Khuddus N. Bing-Neel syndrome: a rare neurological complication of Waldenström macroglobulinaemia. BMJ Case Rep 2024; 17:e255268. [PMID: 38182164 PMCID: PMC10773308 DOI: 10.1136/bcr-2023-255268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2024] Open
Abstract
Bing-Neel syndrome (BNS) is a very rare manifestation of Waldenström macroglobulinaemia (WM), in which lymphoplasmacytic cells invade the central nervous system. The clinical presentation includes symptoms of headaches, visual floaters, neuropathy, seizures and gait abnormalities. Here, we describe an elderly woman, who presented with complaints of visual floaters, progressive neuropathy and cognitive changes. Workup including a bone marrow biopsy confirmed the diagnosis of WM. Shortly afterwards, the patient experienced a seizure leading to hospitalisation, which revealed a right frontal lobe lesion on brain MRI. A biopsy of the lesion showed a small B cell lymphoma positive for an MYD88 mutation, confirming BNS. The patient was initially treated with ibrutinib, before transitioning to zanubrutinib. However, she developed disease progression necessitating radiotherapy with lenalidomide and rituximab maintenance therapy, which achieved remission. This case sheds light on the diagnosis and management of a very rare complication of a rare disease.
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Affiliation(s)
- Hamza Alzghoul
- Internal Medicine, University of Central Florida College of Medicine, Gainesville, Florida, USA
- Internal Medicine, North Florida Regional Medical Center, Gainesville, Florida, USA
| | - Asad Haider
- Internal Medicine, University of Central Florida College of Medicine, Gainesville, Florida, USA
- Internal Medicine, North Florida Regional Medical Center, Gainesville, Florida, USA
| | - Faisal Mukhtar
- Department of Pathology, Immunology, and Laboratory Medicine, University of Florida, Gainesville, Florida, USA
| | - Nausheen Khuddus
- Ophthalmology, North Florida Regional Medical Center, Gainesville, Florida, USA
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12
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Naito M, Terasaki M, Ouchi N, Toyoshima M. Uterine carcinosarcoma showing immature teratoid-like differentiation. BMJ Case Rep 2023; 16:e257228. [PMID: 38154864 PMCID: PMC10759010 DOI: 10.1136/bcr-2023-257228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2023] Open
Abstract
A carcinosarcoma is a rare form of cancer characterised by the presence of both carcinomatous and sarcomatous components. Here, we present our experience with an extremely rare case of an uterine carcinosarcoma with immature teratoid-like differentiation. The patient was a woman in her 60s. She was referred for the evaluation of a uterine tumour. She underwent total abdominal hysterectomy with bilateral adnexectomy and received postoperative treatment with paclitaxel and carboplatin. On microscopic examination, the tumour had a heterogeneous appearance with a combination of carcinomatous and sarcomatous elements, and teratoid features. The tumour included immature squamous epithelial cells and immature epithelial glands, and focal atypical fused glands, which are consistent with endometrioid carcinoma, were identified in the endometrium. Pathological differentiation from extrarenal Wilms' tumour and teratocarcinosarcoma was challenging. The final pathological diagnosis was uterine carcinosarcoma with immature teratoid-like differentiation. At 14 months after the surgery, the patient has not experienced recurrence.
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Affiliation(s)
- Mio Naito
- Obstetrics and Gynecology, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Mika Terasaki
- Analytic Human Pathology, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Nozomi Ouchi
- Obstetrics and Gynecology, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Masafumi Toyoshima
- Obstetrics and Gynecology, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
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13
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Hannon M, Plant WD, Joyce C, Russell NE. Rare case of steroid cell tumour presenting as resistant hypertension in early pregnancy. BMJ Case Rep 2023; 16:e255716. [PMID: 38123321 DOI: 10.1136/bcr-2023-255716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
A woman 12 weeks and 3 days pregnant was referred to the emergency department with significant hypertension which, despite aggressive medical management, remained uncontrolled. Markedly elevated levels of renin and aldosterone beyond what is typical in early pregnancy were present, which together with the finding of a right ovarian cyst pointed to the possible diagnosis of an extrarenal reninoma.and the decision was made to perform a right-sided oophorectomy at 16 weeks gestation. Histology demonstrated a staining pattern most consistent with a steroid cell tumour leading to the diagnosis of refractory hypertension secondary to an ovarian steroid cell tumour. Post oophorectomy blood biochemistry rapidly returned to normal, and our patient's hypertension slowly resolved allowing for a large reduction in antihypertensive agent requirements and a successful pregnancy outcome.
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Affiliation(s)
- Maura Hannon
- Obstetrics and Gynacology, Cork University Maternity Hospital, Cork, Ireland
| | - William D Plant
- Department of Renal Medicine, Cork University Hospital, Cork, Cork, Ireland
- University College Cork College of Medicine and Health, Cork, Ireland
| | - Caroline Joyce
- Department of Biochemistry, Cork University Hospital, Cork, Ireland
| | - Noirin E Russell
- Obstetrics and Gynacology, Cork University Maternity Hospital, Cork, Ireland
- University College Cork College of Medicine and Health, Cork, Ireland
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14
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Sheokand S, Siwatch S, Kundu R, Saha PK. A rare case of infection and spontaneous rupture in ovarian mucinous cystadenoma. BMJ Case Rep 2023; 16:e253329. [PMID: 38114297 DOI: 10.1136/bcr-2022-253329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023] Open
Abstract
Ovarian cysts exhibit variable clinical presentations depending on their size, type and resulting sequelae. Rupture of ovarian cysts is infrequent, and cyst infections are even rarer. Here, we report an unusual case involving a young, non-pregnant woman who presented acutely with features of peritonitis and sepsis and was found to have a complex adnexal mass. Following a rigorous diagnostic evaluation, which included an urgent exploratory laparotomy and salpingo-oophorectomy, common diagnoses including tubo-ovarian abscess, endometriotic cyst and pelvic tuberculosis were ruled out. Instead, she was diagnosed with an ovarian mucinous cystadenoma that had become infected, possibly due to pelvic inflammatory disease, leading to spontaneous rupture. Such a presentation has rarely been reported, especially in a non-pregnant setting. Therefore, we emphasise the importance of considering this rare complication as a potential differential diagnosis in similar clinical presentations and discuss the management implications, including the importance of adequately treating pelvic inflammatory disease.
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Affiliation(s)
- Seema Sheokand
- Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, Punjab, India
| | - Sujata Siwatch
- Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, Punjab, India
| | - Reetu Kundu
- Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, Punjab, India
| | - Pradip Kumar Saha
- Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, Punjab, India
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15
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Fukai S, Maeda S, Chikazawa K, Rikiyama T. Strangulated bowel obstruction caused by vaginal perforation due to vaginal cancer in a patient with chronic uterine prolapse. BMJ Case Rep 2023; 16:e255815. [PMID: 38086574 PMCID: PMC10728924 DOI: 10.1136/bcr-2023-255815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 12/18/2023] Open
Abstract
A woman in her 90s with chronic uterine prolapse presented with abdominal pain and a vaginal mass. The patient had generalised peritonitis and a strangulated bowel obstruction originating from a perforated posterior vagina. We performed partial intestinal resection and a total hysterectomy, including excision of the perforation of the vaginal site and the adnexa. The patient died on postoperative day 8 due to worsening systemic sepsis. The pathological diagnosis revealed an invasive carcinoma in the perforated area of the vagina. Obstetric factors are the most frequent cause of female genital tract perforation, and chronic uterine prolapse is associated with this condition; however, vaginal cancer has never been reported as a cause of perforation. Therefore, close collaboration in gynaecology should be considered to investigate whether vaginal perforation and uterine prolapse are related to cancer.
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Affiliation(s)
- Shota Fukai
- Department of Urology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Shimpei Maeda
- Jichi Ika University Saitama Medical Center, Saitama, Japan
| | - Kenro Chikazawa
- Obstetrics and Gynecology, Jichi Medical University, Saitama Medical Center, Saitama-shi, Japan
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16
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Bidarmaghz B, Idrees M, Lee YY, Hodgkinson P. Large hepatocellular carcinoma treated with sequential SBRT and immunotherapy with anti-VEGF (Vascular Endothelial Growth Factor) therapy. BMJ Case Rep 2023; 16:e256931. [PMID: 38061854 PMCID: PMC10711845 DOI: 10.1136/bcr-2023-256931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2023] [Indexed: 12/18/2023] Open
Abstract
Managing large solitary hepatocellular carcinoma (HCC) remains challenging as guidelines recommend a palliative approach given the general poor prognosis without accounting for variations in the underlying tumour biology. Surgical resection provides significantly better survival than other modalities for HCC, but only a small proportion of patients with large tumours qualify for surgical resection. Recently, with technological advances in radiation therapy, stereotactic body radiation therapy (SBRT) has emerged as an alternative treatment option for HCC . In this paper, we present a patient who was diagnosed with a 13 cm HCC with vascular invasion. SBRT was delivered as a locoregional therapy followed by immunotherapy with the outcome of complete pathological response observed on right hemi-hepatectomy.
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Affiliation(s)
- Bardia Bidarmaghz
- Transplant, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Marwan Idrees
- Transplant, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Yoo Young Lee
- Radiation Oncology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Peter Hodgkinson
- Transplant, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
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17
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Matthews CN, Salman S, Mustafa SF, Misra D. Cardiogenic and obstructive shock: primary laryngeal synovial sarcoma with cardiac metastasis. BMJ Case Rep 2023; 16:e257431. [PMID: 38042527 PMCID: PMC10693874 DOI: 10.1136/bcr-2023-257431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2023] Open
Abstract
A man in his 20s with a history of laryngeal synovial sarcoma presented with dyspnoea. Imaging revealed a large right ventricular (RV) mass, which was resected, and histological analysis indicated synovial sarcoma recurrence. Within 1 month of RV mass resection, the tumour progressed with paratracheal metastasis. The lumen was nearly obliterated, and right ventricular outflow tract (RVOT) obstruction led to rapid deterioration with mixed cardiogenic and obstructive shock. We present a rare case of primary laryngeal synovial sarcoma metastasising to the heart.
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Affiliation(s)
- Christopher N Matthews
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sidra Salman
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Syed Farrukh Mustafa
- Mount Sinai Fuster Heart Hospital, Mount Sinai Health System, New York, New York, USA
| | - Deepika Misra
- Mount Sinai Fuster Heart Hospital, Mount Sinai Health System, New York, New York, USA
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18
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Dirani K, Marusca G, Wang J, Juzych D. Capecitabine-induced posterior reversible encephalopathy syndrome (PRES) in a patient with gastric adenocarcinoma. BMJ Case Rep 2023; 16:e252059. [PMID: 38035676 PMCID: PMC10689393 DOI: 10.1136/bcr-2022-252059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES) is characterised by encephalopathy, visual disturbances and seizures, accompanied by radiological parieto-occipital oedema. Immunosuppressive and immunomodulatory drugs are risk factors. While capecitabine-induced PRES cases are rare, this report details a young woman with advanced gastric adenocarcinoma on capecitabine. She exhibited symptoms of nausea, vomiting and abdominal pain before developing hypertension, drowsiness and a seizure. Brain MRI revealed parieto-occipital hyperintense areas indicative of PRES. Suspending capecitabine led to a gradually improved mental state. Prompt recognition and treatment of PRES offer reversibility, often achievable through dose reduction or discontinuation of the causative drug.
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Affiliation(s)
- Karim Dirani
- DMC, Detroit, Michigan, USA
- Ophthalmology, Kresge Eye Institute, Detroit, Michigan, USA
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19
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Shinde RV, Anne SA, Firdos AP, Muralidhar V. Twisted aggressive angiomyxoma of the vulva presenting as an emergency with severe pain and impending gangrene. BMJ Case Rep 2023; 16:e257870. [PMID: 37996144 PMCID: PMC10668135 DOI: 10.1136/bcr-2023-257870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023] Open
Affiliation(s)
- Ranoji V Shinde
- Obstetrics and Gynaecology, Chettinad Academy of Research and Education, Kanchipuram, Tamil Nadu, India
| | - Shreya A Anne
- Obstetrics and Gynaecology, Chettinad Academy of Research and Education, Kanchipuram, Tamil Nadu, India
| | - Alhaj P Firdos
- Obstetrics and Gynaecology, Chettinad Academy of Research and Education, Kanchipuram, Tamil Nadu, India
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20
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Khromchenko K, Aikman N, Sun X, ElSahwi K. Early-stage serous fallopian tube carcinoma. BMJ Case Rep 2023; 16:e255638. [PMID: 37996138 PMCID: PMC10668166 DOI: 10.1136/bcr-2023-255638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023] Open
Abstract
Primary fallopian tube carcinoma (PFTC) is a rare disease. Its location, close association with epithelial ovarian carcinoma, and lack of specific signs and symptoms make diagnosis challenging especially in its early stages. We report a postmenopausal patient who presented with a 2-month history of abdominopelvic pain with watery vaginal discharge. Imaging findings showed a 7 cm complex left adnexal mass. The patient underwent a robotic-assisted total laparoscopic hysterectomy and bilateral salpingo-oophorectomy and surgical staging. Findings were significant for stage IA serous fallopian tube carcinoma. PFTC is sometimes missed preoperatively and intraoperatively. Available literature review has focused on the clinical and imaging characteristics of PFTC to aid in timely disease diagnosis. Minimally invasive surgery is a viable option in the diagnosis and management of early-stage ovarian cancer due to improved visualisation of pelvic structures, decreased length of hospital stay, decreased estimated blood loss and lower postoperative complication rates compared with laparotomy.
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Affiliation(s)
- Keren Khromchenko
- Department of Obstetrics and Gynecology, Hackensack Meridian Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Noelle Aikman
- Department of Obstetrics and Gynecology, Hackensack Meridian Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Xiu Sun
- Department of Pathology, Hackensack Meridian Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Karim ElSahwi
- Division of Gynecologic Oncology, Hackensack Meridian Jersey Shore University Medical Center, Neptune, NJ, USA
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21
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Li Y, Stewart L, Tang S, McWhirter E. Pembrolizumab-induced immune-related sclerosing cholangitis. BMJ Case Rep 2023; 16:e256125. [PMID: 37914171 PMCID: PMC10626897 DOI: 10.1136/bcr-2023-256125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023] Open
Abstract
Immunotherapy is increasingly used to treat various types of cancer; however, it can often result in immune-related adverse events (irAEs). Immune-related sclerosing cholangitis (irSC) is a rare type of hepatic irAE that has been described only in a few cases, and much remains unknown about its optimal treatment. In this report, we describe the case of a man in his 70s who was diagnosed with metastatic melanoma and treated with pembrolizumab. He experienced multiple irAEs, including irSC, which did not respond to initial prednisone treatment (2 mg/kg daily dosing). However, subsequent treatment with ursodeoxycholic acid (UDCA) resulted in complete resolution of symptoms and normalisation of laboratory and radiographic abnormalities related to irSC. Our case suggests that steroids, which are traditionally used to treat irAEs, may be ineffective for irSC and that UDCA may be a better alternative. Clinicians should be aware of this rare irAE.
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Affiliation(s)
- Yuchen Li
- Medical Oncology, Juravinski Cancer Centre, Hamilton, Ontario, Canada
| | - Lori Stewart
- Diagnostic Imaging, Juravinski Hospital, Hamilton, Ontario, Canada
| | - Shangguo Tang
- Pathology, McMaster University Medical Centre, Hamilton, Ontario, Canada
| | - Elaine McWhirter
- Medical Oncology, Juravinski Cancer Centre, Hamilton, Ontario, Canada
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22
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Raffali MAAF, Boon Cong B, Muhammad SF, Che Hassan HH. Eosinophilic myocarditis mimicking acute coronary syndrome in a young man with T-lymphoblastic lymphoma and hypereosinophilia. BMJ Case Rep 2023; 16:e255396. [PMID: 37748814 PMCID: PMC10533657 DOI: 10.1136/bcr-2023-255396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023] Open
Abstract
A man in his 20s with underlying chemorefractory primary T-lymphoblastic lymphoma and hypereosinophilia developed acute chest pain in the ward after readmission for disease progression. ECG showed widespread ST depression and serum troponin was markedly elevated. Transthoracic echocardiography showed diffused thrombus deposition with preserved ejection fraction consistent with eosinophilic myocarditis. The patient ultimately succumbed to the disease, after complications with severe hospital-acquired pneumonia.
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Affiliation(s)
| | - Beh Boon Cong
- Department and Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Malaysia
| | - Syawal Faizal Muhammad
- Department and Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Malaysia
| | - Hamat Hamdi Che Hassan
- Department and Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Malaysia
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23
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Tolentino-de la Mora A, Verdugo-Carrión ZE, Vázquez-Castro RA, Vega-Barrientos R. Primary cardiac angiosarcoma presenting with haemoptysis. BMJ Case Rep 2023; 16:e256596. [PMID: 37734864 PMCID: PMC10514630 DOI: 10.1136/bcr-2023-256596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023] Open
Abstract
A male patient in his 30s presented to the emergency room with a 1-week history of dyspnoea that progressed to haemoptysis, having coughed up approximately 200 mL of blood on two occasions. On diagnostic investigation, a mediastinal tumour infiltrating the free wall of the right atrium and multiple pulmonary nodules were discovered. The first suspicion was a neoplasm of pulmonary origin, and a bronchoscopy was performed, histology reported a probable cardiac origin for the neoplasm. A subsequent biopsy confirmed the presence of a primary cardiac angiosarcoma. An extension CT scan revealed brain metastases. The patient received chemotherapy treatment, resulting in a partial response to date. This case is one of the few reported instances of cardiac neoplasm presenting with respiratory symptoms.
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24
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Panigrahi C, Tikare N, Das PK, Padhi S. Core-binding factor abnormalities involving chromosome 16 in acute myeloid leukaemia: prognostic and therapeutic implications. BMJ Case Rep 2023; 16:e252915. [PMID: 37591621 PMCID: PMC10441072 DOI: 10.1136/bcr-2022-252915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023] Open
Abstract
Core-binding factor (CBF) abnormality-associated myeloid neoplasms incorporate acute myeloid leukaemia (AML) (CBF-AML) with translocation t(8;21)(q22;q22.1) (AML1/ETO fusion) and inv(16)(p13.1q22) or translocation t(16;16)(p13.1;q22) (CBFB/MYH11 fusion) abnormalities which confer a favourable prognosis following cytarabine-based induction chemotherapy. Accumulating evidence from the molecular studies have stratified CBF-AML into favourable and unfavourable subgroups based on the associated cooperating mutations that impact the outcome. We describe a case of acute myelomonocytic leukaemia with abnormal eosinophils (M4Eo) in a woman in her 20s who was found to have CBFβ/MYH11 fusion along with mutated c-KIT (exon 17) and KRAS (exon 2) genes by next-generation sequencing. She had an aggressive clinical course following initiation of cytarabine-based induction chemotherapy. The underlying mutational landscape may significantly influence the biological behaviour of otherwise favourable risk of CBF-AML cases.
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Affiliation(s)
- Chinmayee Panigrahi
- Pathology and Lab Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Nakul Tikare
- Medical Oncology/Hematology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Prabodha Kumar Das
- Medical Oncology/Hematology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Somanath Padhi
- Pathology and Lab Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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25
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Tanaka T, Nii S, Yamaoka H, Fujimoto N. Severe cardiotoxicity induced by osimertinib in a patient with EGFR-mutated adenocarcinoma of the lung. BMJ Case Rep 2023; 16:e255245. [PMID: 37479487 PMCID: PMC10364154 DOI: 10.1136/bcr-2023-255245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2023] Open
Abstract
A man in his 70s was detected an infiltrative shadow on the right lung. A bronchoscopy confirmed the diagnosis of adenocarcinoma of the lung, classified as cT2bN2M0 stage IIIA, with a deletion mutation in EGFR exon 19. Weekly carboplatin plus paclitaxel was administered in combination with thoracic radiotherapy, followed by maintenance therapy with durvalumab for 1 year. Four months later, he was diagnosed with a recurrence of adenocarcinoma in the lung. He started treatment with osimertinib. Six months after initiating osimertinib, a chest CT revealed bilateral pleural effusion and expansion of the inferior vena cava. Eleven months later, he entered our emergency department with progressive dyspnoea. A chest CT showed bilateral massive pleural effusion and cardiac enlargement. He was diagnosed with osimertinib-induced cardiac failure. Osimertinib was discontinued, and echocardiology demonstrated a gradual improvement in cardiac function. It is necessary to take care of osimertinib-related cardiotoxicity.
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Affiliation(s)
- Takaaki Tanaka
- Medical Oncology, Okayama Rosai Hospital, Okayama, Japan
| | - Soma Nii
- Internal Medicine, Okayama Rosai Hospital, Okayama, Japan
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26
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Kucera C, Chappell N, Wang S. Severe thrombocytopenia after trastuzumab in a patient with HER2-positive serous endometrial cancer. BMJ Case Rep 2023; 16:16/6/e255181. [PMID: 37263678 DOI: 10.1136/bcr-2023-255181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
Trastuzumab is a humanised, monoclonal antibody that interferes with the human epidermal growth factor receptor 2 (HER2)/neu receptor and binds selectively to the HERB2 protein. It has been shown to prolong survival of patients with HER2-positive advanced uterine serous carcinoma.We report the case of a woman in her 70s with HER2-positive metastatic papillary serous endometrial adenocarcinoma, who experienced severe thrombocytopenia related to trastuzumab administration. One week after the first dose of carboplatin/paclitaxel/trastuzumab combination chemotherapy, the patient was admitted to the hospital with vaginal bleeding, melena, petechiae and platelet counts of 0×109/L. The patient was suspected to have a severe trastuzumab-induced thrombocytopenia. A rapid and complete recovery was observed after multiple platelet transfusions, high-dose IV corticosteroids and immunoglobulin.Among the 13 reported cases of trastuzumab-induced thrombocytopenia, this is the first case reported in the literature occurring in a patient with a gynecologic malignancy.
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Affiliation(s)
- Celia Kucera
- Department of Obstetrics and Gynecology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Nicole Chappell
- Department of Obstetrics and Gynecology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Stephanie Wang
- Department of Obstetrics and Gynecology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
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27
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Khalil G, Fiani D, Antaki F, Diab E. Primary gastric amyloidosis associated with linitis plastica and delayed progression to systemic amyloidosis and multiple myeloma. BMJ Case Rep 2023; 16:16/5/e252786. [PMID: 37247951 DOI: 10.1136/bcr-2022-252786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
We report the case of a woman in her 50s who underwent, 5 years prior, a total gastrectomy after neoadjuvant chemotherapy for diffuse-type gastric cancer diagnosed during a workup for isolated gastric primary light chain (AL) amyloidosis. At the time of diagnosis, immunoglobulins light chain measurements and bone marrow biopsy were performed to rule out multiple myeloma and came back normal. Three years later, the patient developed systemic amyloidosis involving the heart and the lungs, after which she developed multiple myeloma. Isolated amyloid deposits in the stomach are a rare finding. While AL amyloidosis is frequently found in concomitance with multiple myeloma, late progression of primary AL amyloidosis to systemic amyloidosis and multiple myeloma is uncommon.
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Affiliation(s)
- Georges Khalil
- Department of Internal Medicine, Saint John Hospital, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, Lebanon
| | - Dimitri Fiani
- Department of Internal Medicine, Universite Saint-Joseph Faculte de medecine, Beirut, Lebanon
| | - Fares Antaki
- Ophthalmology, Centre Hospitalier Universitaire de l'Universite de Montreal, Montreal, Quebec, Canada
| | - Ernest Diab
- Department of Hematology-Oncology, Universite Saint-Joseph Faculte de medecine, Beirut, Lebanon
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28
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Amin R, Wu CY, Lee JCS, Ananta MG. Metastatic signet-ring carcinoma to the uterus presenting as an endometrial polyp. BMJ Case Rep 2023; 16:16/5/e254190. [PMID: 37221007 DOI: 10.1136/bcr-2022-254190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
Primary signet-ring cell carcinoma of the uterus is rare and requires exclusion of possible metastatic tumour to the uterus. We report a case of a woman in her 70s who underwent hysteroscopy and a polypectomy for a polyp arising from the uterine wall. On histological examination, malignant cells with signet-ring cell morphology were found within the fragments of endometrial tissue. Immunohistochemical studies indicated a metastatic adenocarcinoma possibly from the gastrointestinal tract. Additional radiological investigations revealed a possible primary gastric tumour, which was further confirmed on subsequent biopsies. This case illustrates that gastric carcinomas can rarely metastasise to the endometrium and highlights the importance of clinical correlation in arriving at the final diagnosis.
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Affiliation(s)
- Ramzi Amin
- Department of Histopathology, KK Women's and Children's Hospital, Singapore
| | - Carly Yanlin Wu
- Department of Histopathology, KK Women's and Children's Hospital, Singapore
| | - Jill Cheng Sim Lee
- Department of Obstetric and Gynaecology, KK Women's and Children's Hospital, Singapore
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29
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Deshmukh P, Haldar K. Rare case of high-grade endometrial stromal sarcoma metastasising to inferior vena cava and right atrium. BMJ Case Rep 2023; 16:16/4/e251195. [PMID: 37076193 PMCID: PMC10124211 DOI: 10.1136/bcr-2022-251195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023] Open
Abstract
Endometrial stromal sarcomas (ESSs) are a rare form of uterine malignancy representing <10% of all uterine sarcomas and <1% of all primary malignant tumours of the uterus. Invasion of the vascular system by low-grade ESS has been reported in the literature. Here we report the first case of a high-grade ESS invading the pelvic and gonadal vein and extending through the inferior vena cava to the right atrium, the diagnostic challenges and multidisciplinary management of the case.
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Affiliation(s)
- Priyanka Deshmukh
- Department of Obstetrics and Gynaecology, Addenbrooke's Hospital, Cambridge, UK
| | - Krishnayan Haldar
- Department of Obstetrics and Gynaecology, Addenbrooke's Hospital, Cambridge, UK
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30
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Danley K, Fidler MJ, Sadaf A, Okwuosa TM. Unusual vasovagal-type autonomic dysfunction secondary to immune checkpoint inhibitor therapy. BMJ Case Rep 2023; 16:16/2/e251034. [PMID: 36805877 PMCID: PMC10016300 DOI: 10.1136/bcr-2022-251034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
We present the case of a patient with oral squamous cell carcinoma treated with the programmed death ligand inhibitor, pembrolizumab, an immune checkpoint inhibitor. She subsequently developed vasovagal-type autonomic dysfunction thought to be secondary to the pembrolizumab. The patient's vasovagal symptoms resolved with the initiation of oral glucocorticoids.
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Affiliation(s)
- Kelsey Danley
- Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Mary Jo Fidler
- Oncology, Rush University Medical Center, Chicago, Illinois, USA
| | - Aliyah Sadaf
- Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Tochukwu M Okwuosa
- Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
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31
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Tan SF, Abbas SOA, Mayooran N, Naik SK. Primary undifferentiated high-grade pleomorphic cardiac sarcoma in the left atrium with atypical presentation. BMJ Case Rep 2023; 16:16/1/e252198. [PMID: 36690394 PMCID: PMC9872464 DOI: 10.1136/bcr-2022-252198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
A woman in her 60s had 4 months of malaise, fatigue, dyspnoea, night sweats and grade 3 clubbing. She had a pansystolic murmur and signs of congestive heart failure. Multimodal imaging with a transthoracic echocardiogram, transoesophageal echocardiogram and CT was carried out to diagnose and reconstruct the mass for surgical planning. A 2×2.8 cm circular dense mass was found in the left atrium with vegetations on the mitral valve. Positron emission tomography and cardiac MRI confirmed the mass's hypermetabolic activity and malignant features. Mitral valve replacement and surgical resection were performed. She was diagnosed with grade 3 undifferentiated cardiac sarcoma and referred to the sarcoma multidisciplinary team for further management given sarcoma's rarity and complexity. The poor prognosis of sarcoma was evident as her symptoms recurred 2 months postoperatively.
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Affiliation(s)
- Sue Fen Tan
- Cardiac surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
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32
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Anandathirtha K, Shabnam Z, Manjeera L, Ramesh N. Xanthogranulomatous endometritis with unilateral salpingo-oophoritis in a postmenopausal woman masquerading as a malignancy. BMJ Case Rep 2023; 16:16/1/e247341. [PMID: 36657821 PMCID: PMC9853125 DOI: 10.1136/bcr-2021-247341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Xanthogranulomatous endometritis (XGE) is a rare pathological entity which is characterised by sheets of foamy histiocytes and lymphoplasmacytic infiltrates. This condition can mimic endometrial carcinoma. We report a case, clinically suspected as carcinoma of the endometrium/ovary, which was diagnosed as XGE with left salpingo-oophoritis on histopathology.
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Affiliation(s)
- Kavya Anandathirtha
- Obstetrics and Gynaecology, Kasturba Medical College, Mangalore, Karnataka, India
| | - Zulfiya Shabnam
- Obstetrics and Gynaecology, KS Hegde Medical Academy, Mangalore, Karnataka, India
| | - Lakshmi Manjeera
- Obstetrics and Gynaecology, KS Hegde Medical Academy, Mangalore, Karnataka, India
| | - Nikita Ramesh
- Obstetrics and Gynaecology, KS Hegde Medical Academy, Mangalore, Karnataka, India
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33
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Eslinger L, Ahmed T, Lodhi SH, Ahmed T. Chronic dysphagia as a presenting complaint for primary mediastinal diffuse large B-cell lymphoma. BMJ Case Rep 2023; 16:16/1/e253357. [PMID: 36634994 PMCID: PMC9843212 DOI: 10.1136/bcr-2022-253357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Diffuse large B-cell lymphoma (DLBCL) is the most common lymphoid malignancy in adults. It manifests a variable presentation, depending on the tissue in which it arises. Rarely, it can present as dysphagia to solid and liquid foods in primary oesophageal lymphoma with or without B symptoms. We present a case of a 66-year-old man who presented with 3 months of progressive dysphagia with only a mild associated weight loss. This was later found to be caused by DLBCL of the mediastinum causing external compression of the patient's distal oesophagus and gastric cardia. He was treated with one cycle of standard-of-care chemotherapy and subsequently discharged with outpatient follow-up. We emphasise the importance of ruling out life-threatening conditions such as lymphoma in patients who present with dysphagia, as well as the high variability in presentation of DLBCL.
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Affiliation(s)
- Logan Eslinger
- University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Taimoor Ahmed
- Department of Internal Medicine, University of Kentucky Medical Center, Lexington, Kentucky, USA
| | - Samra Haroon Lodhi
- Department of Internal Medicine, University of Kentucky Medical Center, Lexington, Kentucky, USA
| | - Taha Ahmed
- Department of Internal Medicine, University of Kentucky Medical Center, Lexington, Kentucky, USA
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34
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Soman B, Dias MC, Rizvi SAJ, Kardos A. Myasthenia gravis, myositis and myocarditis: a fatal triad of immune-related adverse effect of immune checkpoint inhibitor treatment. BMJ Case Rep 2022; 15:15/12/e251966. [PMID: 36593626 PMCID: PMC9743272 DOI: 10.1136/bcr-2022-251966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Pembrolizumab, a humanised monoclonal antibody and immune checkpoint inhibitor (ICI) that blocks programmed death receptor 1 and its ligands, is an effective immunotherapy for malignancies such as melanoma, lung, head and neck, cancers, and Hodgkin's lymphoma. It has an overall response rate between 73% and 83%, with complete response rate of 27%-30%. It is well tolerated with minor side effects in 70% of cases characterised by fatigue, rash, pruritus and diarrhoea. In rare cases, more serious and life-threatening complications can occur at a rate of 0.3%-1.3%. We report a case of a woman in her 70s with non-small-cell lung cancer treated with ICI. She presented to the emergency department with left-sided ptosis and muscle weakness 3 weeks of her first dose of pembrolizumab infusion as a treatment plan of her cancer. She was diagnosed with myasthenia gravis, myocarditis and myositis as ICI-induced immune-related adverse effects resistant to medical intervention. We wish to raise awareness of the triad of life-threatening complication of ICI therapy that accounts for 30%-50% of fatal complications.
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Affiliation(s)
- Biji Soman
- Department of Cardiology, Milton Keynes University Hospital, Milton Keynes, UK
| | - Maria Cecilia Dias
- Department of Oncology, Milton Keynes University Hospital, Milton Keynes, UK
| | - Syed Azhar J Rizvi
- Department of Oncology, Milton Keynes University Hospital, Milton Keynes, UK
| | - Attila Kardos
- Department of Cardiology, Milton Keynes University Hospital, Milton Keynes, UK .,Faculty of Medicine and Health Sciences, The University of Buckingham, Buckingham, UK
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35
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Javaid A, Khandait H, Ong CK. Left atrial myxoma with coronary artery disease. BMJ Case Rep 2022; 15:e252905. [PMID: 36316054 PMCID: PMC9628531 DOI: 10.1136/bcr-2022-252905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
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36
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Ehtesham M, Shabbir MA. Myxomatous tumours of the right atrium in a patient with recurring myasthenia gravis exacerbations. BMJ Case Rep 2022; 15:15/5/e250457. [PMID: 35606044 DOI: 10.1136/bcr-2022-250457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Moiz Ehtesham
- Internal Medicine, Albany Medical Center Hospital, Albany, New York, USA
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Bounds L, McGrath F, Taubert M. Hypercalcaemia to hypocalcaemia: tetany as a side effect of intravenous bisphosphonate treatment. BMJ Case Rep 2022; 15:e249141. [PMID: 35487644 PMCID: PMC9058685 DOI: 10.1136/bcr-2022-249141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2022] [Indexed: 11/04/2022] Open
Abstract
A woman in her 40s with advanced bladder cancer was admitted to hospital with hypercalcaemia of malignancy. Initially, she presented with non-specific symptoms of malaise, fatigue and general deterioration. She was treated with intravenous fluids and zoledronic acid in order to bring her calcium levels down, but subsequently developed significant hypocalcaemia. This manifested as tetany in the hands in the form of bilateral carpopedal spasm. She also reported perioral paraesthesia. Bloods during her admission revealed deranged electrolytes, and her vitamin D level was on the lower scale of normal (25 nmol/L). The patient's symptoms improved with electrolyte replacement and oral baclofen for her symptomatically distressing wrist and hand muscle spasms. This case report is a reminder that bisphosphonates can cause significant hypocalcaemia with symptoms of tetany, even when they are given for initial hypercalcaemia. Baclofen worked well to improve symptoms.
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Affiliation(s)
- Lauren Bounds
- Palliative Care Department, Velindre University NHS Trust, Cardiff, UK
| | - Felix McGrath
- Palliative Care Department, Velindre University NHS Trust, Cardiff, UK
| | - Mark Taubert
- Palliative Care Department, Velindre University NHS Trust, Cardiff, UK
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Abstract
A 25-year-old pregnant woman reported suffering from an aggressive giant cell tumour of the distal humerus extending into the elbow joint. The successful management required a careful evaluation of the various treatment options due to her pregnancy. Surgical excision of the mass was performed. The residual bone defect was reconstructed with an elbow mega-prosthesis. The patient made a pain-free recovery with a good range of motion and delivered the baby at term with no complications.
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Affiliation(s)
- Raju Vaishya
- Orthopaedic & Joint Replacement Surgery, Indraprastha Apollo Hospital, New Delhi, Delhi, India
| | - Abhishek Vaish
- Orthopaedic & Joint Replacement Surgery, Indraprastha Apollo Hospital, New Delhi, Delhi, India
| | - Nishant Pawar
- Orthopaedic & Joint Replacement Surgery, Indraprastha Apollo Hospital, New Delhi, Delhi, India
| | - Pankaj Baweja
- Pathology, Indraprastha Apollo Hospital, New Delhi, Delhi, India
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Affiliation(s)
- Tony Chen
- Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA
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Freitas DMM, Ramos RL, Serpa Pinto L, Ribeiro R. Primary pericardial mesothelioma and asbestos exposure: a rare fatal disease. BMJ Case Rep 2017; 2017:bcr-2017-219949. [PMID: 28500034 DOI: 10.1136/bcr-2017-219949] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
| | - Raquel L Ramos
- Internal Medicine, Hospital Geral de Santo Antonio SA, Porto, Portugal
| | - Luísa Serpa Pinto
- Internal Medicine, Hospital Geral de Santo Antonio SA, Porto, Portugal
| | - Rosa Ribeiro
- Internal Medicine, Hospital Geral de Santo Antonio SA, Porto, Portugal
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Affiliation(s)
- Aymen Albaghdadi
- Internal Medicine, Texas Tech University Health Sciences Center Foster School of Medicine, El Paso, Texas, USA
| | - Mohamed Teleb
- Department of Cardiology, Texas Tech University Health Sciences Center Foster School of Medicine, El Paso, Texas, USA
| | - Chunyen Liu
- William Beaumont Army Medical Center, El Paso, Texas, USA
| | - Harsh Agrawal
- Department of Cardiology, Texas Tech University Health Sciences Center Foster School of Medicine, El Paso, Texas, USA
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Abstract
An asymptomatic 18-year-old black woman was found to have an incidental finding of third-degree atrioventricular (AV) block on a routine ECG. 2-Dimensional transthoracic echocardiography showed a heterogeneous mass in the region of the peri-membranous septum in the AV node area. A cardiac MRI showed a well-defined cystic mass arising from the right side of the interatrial septal wall. An MRI compatible permanent pacemaker was implanted with plans to monitor the tumour with non-invasive imaging. Cystic tumour of the AV node is a rare primary cardiac tumour. It is known as the smallest and most common primary cardiac tumour that can cause sudden death. All previous six cases of living patients with cystic tumour of the AV node reported in the literature were females and symptomatic. We present a rare case of a patient with cystic tumour of the AV node, and we highlight the treatment dilemmas for this condition.
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Affiliation(s)
- Wael Abuzeid
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Abstract
An asymptomatic 18-year-old black woman was found to have an incidental finding of third-degree atrioventricular (AV) block on a routine ECG. 2-Dimensional transthoracic echocardiography showed a heterogeneous mass in the region of the peri-membranous septum in the AV node area. A cardiac MRI showed a well-defined cystic mass arising from the right side of the interatrial septal wall. An MRI compatible permanent pacemaker was implanted with plans to monitor the tumour with non-invasive imaging. Cystic tumour of the AV node is a rare primary cardiac tumour. It is known as the smallest and most common primary cardiac tumour that can cause sudden death. All previous six cases of living patients with cystic tumour of the AV node reported in the literature were females and symptomatic. We present a rare case of a patient with cystic tumour of the AV node, and we highlight the treatment dilemmas for this condition.
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Affiliation(s)
- Wael Abuzeid
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Lima PC, Teixeira J, Aires GN, Andrade LDA. Endocervical gastric-type adenocarcinoma, an unrelated HPV tumour: difficulties in screening and diagnosis. BMJ Case Rep 2017; 2017:bcr-2017-219724. [PMID: 28404551 DOI: 10.1136/bcr-2017-219724] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Gastric-type adenocarcinoma of the cervix (GAS) is an uncommon and aggressive tumour unrelated to human papillomavirus (HPV) infection with distinctive histological and immunohistochemical characteristics. GAS may be associated with lobular endocervical glandular hyperplasia (LEGH), another unusual lesion. We report a case of a 59-year-old woman with screening cytology 'AGC-Neo' and cervical conisation exhibiting cervical intraepithelial neoplasia grade 1, extensive LEGH and canal sampling with abundant mucinous cells. Based on the possible association between LEGH and GAS, a total hysterectomy was performed. The histological diagnosis revealed a morphological gradient of lesions: LEGH, minimal deviation adenocarcinoma and GAS with lymphatic invasion. Immunohistochemistry revealed strong MUC6 expression and no p16 staining. After pelvic radiotherapy, the patient continues follow-up evaluation. The diagnostic difficulties of GAS and its relationship with LEGH are discussed. This rare tumour is important because it is poorly symptomatic and potentially aggressive. In addition, the methods for cancer control related to HPV do not affect this tumour.
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Affiliation(s)
- Priscila Carneiro Lima
- Tocoginecology, Universidade Estadual de Campinas Faculdade de Ciencias Medicas, Campinas, Brazil
| | - Julio Teixeira
- Tocoginecology, Universidade Estadual de Campinas Faculdade de Ciencias Medicas, Campinas, Brazil
| | - Guilherme Nogueira Aires
- Tocoginecology, Universidade Estadual de Campinas Faculdade de Ciencias Medicas, Campinas, Brazil
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