Successful surgical treatment of desmoplastic small round cell tumor in a postmenopausal woman: A rare case report

INTRODUCTION AND IMPORTANCE

Desmoplastic small round cell tumor (DSRCT) is a type of soft tissue sarcoma that arises from mesenchymal cells and primarily affects young males.

CASE PRESENTATION

We present a case of a 58-year-old multiparous woman who presented with colic abdominal pain in the epigastric area and hypogastric area, along with dyspeptic complaints, nausea, constipation every 2-3 days, and a gradual increase of the size of the abdomen.

CLINICAL DISCUSSION

DSRCT is an uncommon and extremely aggressive tumor that occurs in the abdomen. It is typically associated with a grim prognosis and primarily affects young males aged 20 to 30. In our case, the patient underwent a surgical procedure to remove the entire tumor, without the need for chemotherapy or radiotherapy. This decision was made considering the absence of metastasis and cancerous cells in the ascites and the potential adverse effects of these treatments. Throughout a 12-month follow-up period, the patient's health condition improved, as indicated by weight gain.

CONCLUSION

This case report highlights the importance of considering DSRCT in the differential diagnosis of abdominal masses in postmenopausal women and emphasizes the potential for successful treatment through surgical intervention.

The diagnostic utility of heparin-binding protein among patients with bacterial infections: a systematic review and meta-analysis

BACKGROUND

Bacterial infections are considered a leading cause of hospitalization and death globally. There is still a need for a rapid and feasible biomarker for bacterial infections. Heparin-binding protein (HBP) was shown to be related to bacterial infections. The objective of the study is to investigate the diagnostic accuracy of HBP in bacterial infections.

METHODS

Articles were screened in PubMed, SCOPUS, Web of Science, and Cochrane to recognize eligible studies. We included studies investigating the diagnostic accuracy of HBP and reported the necessary data to construct 2 × 2 tables. A univariate analysis was conducted to determine the pooled sensitivity and specificity, and a bivariate diagnostic random-effects model was used to calculate the optimal cut-off point.

RESULTS

The analysis comprised sixteen studies in total. Plasma HBP showed a sensitivity of 0.90 (95% CI: [0.79, 0.96]) and a specificity of 0.87 (95% CI: [0.66, 0.96]) in diagnosing bacterial infections using blood samples. Pooling data from seven studies revealed that HBP in cerebrospinal fluid (CSF) has sensitivity and specificity of 96% (95% CI: [0.85, 0.99]), and 95% (95% CI: [0.89, 0.97]), respectively, for the diagnosis of bacterial meningitis. In urinary tract infections (UTI), urine-HBP was revealed to have a high diagnostic value in discriminating bacterial from non-bacterial UTI infection at a cut-off value of 32.868 ng/ml with sensitivity and specificity of 87%.

CONCLUSION

HBP has shown a high diagnostic accuracy of bacterial infections, including UTI and meningitis. Further studies are needed to determine its prognostic value and whether it could guide antibiotic therapy.

Amelanotic nodular melanoma misdiagnosed as a benign skin lesion: A rare case report from Syria

Introduction

and importance: Amelanotic melanoma is a rare and aggressive type of melanoma. It is often diagnosed late because of the lack of melanin in its cells, and this causes treatment delay and, eventually, poor prognosis.

Case presentation

We report a case of a 79-year-old female patient that presented to the dermatology clinic with an asymptomatic lesion on the medial heel of the right foot, with no medical history of previous melanoma or related skin cancer. To get the right diagnosis, an incisional biopsy was performed, and the sample was sent to the pathology laboratory. The sample was stained with S100 and HMB-45 stains, and both were positive. Also, no melanin pigmented cells were seen, so the diagnosis was amelanotic nodular melanoma. The patient was then referred to surgery. The lesion was successfully excised with 5cm safety margins, and the whole lesion was sent to the pathology laboratory to ensure that the edges are malignancy-free. After 18 months of follow-up, the patient is in good health.

Conclusion

Accurate and early diagnosis with appropriate clinical intervention can improve the prognosis and reduce mortality and morbidity rates.

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Amelanotic melanoma is typically misdiagnosed with other skin lesions with similar characteristics, especially those on the foot.

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Accurate diagnosis is often delayed, resulting in a poor prognosis which makes AM a challenging case.

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Early and accurate diagnosis of the lesion using histological and immunohistochemical examinations can improve the prognosis and maintain the patient's quality of life.

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Surgical excision of the lesion with appropriate margins of safety is the current approved treatment while other treatments are still being researched.

Activated pulmonary vascular neutrophils as early mediators of endotoxin-induced lung inflammation

Pulmonary vascular sequestration of leukocytes has been reported to increase in some models of lung injury, including that induced by gram-negative bacterial lipopolysaccharide (LPS). Neutrophils recruited to the lung likely participate in LPS-induced lung inflammation and associated injury, but the functional activities of these pulmonary vascular neutrophils have not been directly assessed. In the current study, cells were recovered by pulmonary vascular lavage (PVL) of isolated rat lungs, harvested 2 h after intravenous infusion of LPS (3 mg/kg) or saline in intact rats, at which time LPS-induced neutrophil recruitment to the lung could be appreciated histologically but not by airway lavage. Relative concentrations of leukocytes recovered from the pulmonary vasculature by PVL were compared with those present in circulating blood, normalizing for lavage dilution on the basis of erythrocyte counts. Excess neutrophils, lymphocytes, monocytes, and eosinophils were recovered from the pulmonary vasculature of controls, and LPS infusion increased recovery of neutrophils (most prominently), lymphocytes, and monocytes. Compared with cells recovered from controls, PVL neutrophils from LPS-infused animals were primed for increased zymosan-stimulated superoxide generation, determined by ferricytochrome C reduction, and were more adherent to nylon wool columns. Northern blots of extracted RNA demonstrated that LPS infusion also upregulated interleukin-1 beta (IL-1 beta) mRNA expression in PVL leukocyte samples, but not BAL or circulating blood samples. Ficoll-hypaque separation demonstrated that the LPS-induced IL-1 beta signal in PVL leukocytes was derived primarily from polymorphonuclear rather than mononuclear leukocytes. In conclusion, all circulating leukocyte populations are sequestered in rat lungs, and LPS increases pulmonary vascular sequestration of leukocytes, recruiting most prominently an activated pool of neutrophils that are more adherent, primed for increased oxygen radical production, and expressing increased IL-1 beta message. These findings suggest a more prominent role than previously appreciated for sequestered neutrophils in sepsis-induced lung inflammation.