A rare case of peritoneal disseminated angiosarcoma 20 years after ovarian cancer diagnosis

Angiosarcoma is a rare form of sarcoma which may be either a primary tumor or it may result from previous irradiation because of another tumor. In this paper, we present a case of a female patient diagnosed as having peritoneal disseminated angiosarcoma 20 years after ovarian cancer treatment (surgery, chemotherapy and radiotherapy). The case was very atypical because of an extremely rare peritoneal location and disseminated nature of the changes. Based on the initial histological picture, poorly differentiated cancer metastasis was diagnosed, suggesting a recurrence of the ovarian cancer that had been diagnosed earlier. The time elapsed from the ovarian cancer diagnosis, history of the previous irradiation and concentration of tumor markers were the only additional clinical data provided to the pathologists, which ultimately contributed to a correct diagnosis. The case we present herein shows and emphasizes the importance of proper communication between a clinician and a pathologist, which is a prerequisite for a correct diagnosis and, consequently, for proper treatment of patients. It also confirms the high specificity of the HE4 (human epididymis protein 4) marker in the monitoring of ovarian cancer, which was within normal limits in spite of peritoneal tumor dissemination.

Congenital nasolacrimal duct mucocele--a case report

Congenital nasolacrimal duct mucocele (CNDM) is a very rare condition in newborns. Prolapse or expansion of the mucocele into the nose may lead to respiratory distress and difficulty in feeding. The triad of cystic medial canthal mass, dilatation of the nasolacrimal duct and a contiguous sub-mucosal nasal mass on computed tomography (CT) is indicative in the diagnosis of CNDM. The case of a five-week-old girl with infected CNDM is described. The authors aim to emphasize the very rare incidence of CNDM in Polish newborns, delayed diagnosis in the case described and the paramount importance of CT of the head for the correct diagnosis and treatment.

[Fixation of the crico-arythenoid joints in rheumatoid arthritis--preliminary report]

Rheumatoid arthritis (RA) is a systemic disease of connective tissue which affects joints lined with synovial membrane. Laryngeal joints also have such a structure. Among all reasons leading to their inflammation rheumatoid arthritis is mentioned on the first place. In larynx RA mostly affects cricoarythenoid joints (CA). RA of the CA joints is found in 27% to 78% suffering from RA. In the acute phase of the disease patients complain of burning and foreign body sensation in the throat, hoarseness, pain on speaking, voice fatigability, problems with swallowing. Chronic RA of the CA joints can lead to their fixation and dyspnoea, requiring emergency tracheotomy. According to the literature, this state occurs in 10% to 25% patients suffering from RA. A case of 75 years old woman is presented, who was admitted to our Clinic with severe inspiratory dyspnoea requiring tracheotomy. She was suffering from RA for 26 years. She complained of effort dyspnoea, problems with swallowing and tightness sensation in the throat for 4 years. Patient complained also about cervical spine pain, upper right extremity and knee joint periodic oedema. The patient was suffering from so severe lower extremities pain and rheumatoid changes in knee joints that she had to walk on crutches. Little hands' joints were deformed with significant ulnarisation. Videolaryngostroboscopic examination showed no movement in CA joints, paramedian position of the vocal folds and narrowing of the glottic rim to 1.5 mm. Phonatory mobility of the vocal folds was preserved. Electromiographic examination of the internal laryngeal muscles made a) during phonation--showed bilateral normal bioelectrical record from thyroarythenoid muscles, b) at rest--there was no denervation activity. In computerized tomography study no degenerative changes in CA joints were found. On the basis of clinical view and examinations results, there was considered that fixation in CA joints was due to degenerative changes, which were the result of their rheumatoid inflammation. It was emphasized that this subject has been mentioned only several times in laryngological and phoniatric handbooks and in few articles.