Seyed Farshad Allameh
Vol 6 No 1 (2021): January-February
Breast cancer is the most common cause of cancer death in women of middle age (20-59) through last decade. In contrast Incidence rates for thyroid cancer may have begun to stabilize in recent years. Synchronous neoplasms of both thyroid and breast cancer are very rare in clinic. The current study presents a case of synchronous papillary thyroid carcinoma and breast ductal carcinoma in 37 years old woman. It is proposed that the mechanism of these synchronous primary tumors is associated with an interaction between the breast and thyroid hormonal responses. It is important to examine breast tissue in patients with thyroid carcinoma or vice versa. In our case although axillary sentinel lymph node was free from tumor, cervical lymph nodes were involved by breast carcinoma; showing importance of cervical examination in breast cancer patients.
Osteoid osteoma is a benign bone-forming tumor. Besides, it is small and painful, consisting of osteoid and woven bone, and surrounded by a thick layer of reactive bone formation. The tumor is self-limited or needs to be removed by surgery. This report describes a 16-year-old male with congenital deafness who presented with a right mandibular swelling initiated 2 years ago. The patient underwent excisional surgery. Histological examinations revealed a benign bone-forming tumor, compatible with osteoid osteoma. Radiologic and histologic correlation confirmed the diagnosis. Base on the diagnosis, the patient received no more treatment. After 4 years of close follow-up examinations, no recurrence was observed in the patient. Osteoid osteoma is often confused with numerous other entities in uncommon sites. Thus, imaging and histologic correlations are required. Proper diagnosis is necessary for further patient management in this respect.
Systemic Lupus Erythematous (SLE) is a chronic autoimmune disorder with a relapsing- remitting course. Besides, SLE most commonly occurs in child-bearing-age women. Due to protean manifestations, the diagnosis may be challenging; however, a high index of suspicion, i.e. achieved by experience and perceptivity is the key to a correct decision. Here, we present an SLE patient; her initial symptoms resembled a malignant process, but important elements guided us to the underlying autoimmune process. A 34-year-old woman presented with a uterine mass, deep vein thrombosis, and significant thrombocytopenia. Our first impression was malignant processes; however, considering her age with thrombosis and thrombocytopenia as the key components of her presentation, we suspected antiphospholipid syndrome and SLE. Her abdominal mass was a benign leiomyoma. We treated her with glucocorticoids and anticoagulants. Accordingly, after improving cytopenia, we discharged her and the follow-up examination result was satisfactory.
Non-Hodgkin’s B-cell lymphoma is a hematological condition with different types based on clinical presentation, pathological features, and therapeutic response, like Diffuse Large B-cell Lymphoma (DLBCL), follicular lymphoma, and Chronic Lymphocytic Leukemia (CLL). We report A 33-year-old male presented with a complaint of unilateral leg swelling, firstly supposed to be a Deep Vein Thrombosis (DVT); however, in multiple Doppler ultrasonography, DVT was ruled out. The patient’s precise history revealed a swollen mass in the left knee region for two months that slowly enlarged and was confirmed with a physical examination. Doppler ultrasonography of the lower extremities conducted in our center presented no sign of deep vein thrombosis; however, it demonstrated some complex conglomerate lymph nodes in the left inguinal compressing the ipsilateral femoral and iliac vein. It also revealed bulky adenopathy, with a 95×65 mm left knee mass. The performed biopsy reported the existence of malignant lymphoma, suggesting the existence of DLBCL. Consequently, he was referred to a hematology/oncology department for appropriate treatment. This unusual presentation of DLBCL and the importance of noticing an accurate history taking and physical examination, instead of conducting unnecessary paraclinical tests (several Doppler ultrasonography in this case), have led us to report this case.
Gitelman Syndrome (GS), also known as familial hypokalemia-hypomagnesemia, is a rare genetic disorder. GS presents with a specific defect in kidney function, that leads to hypokalemia, hypomagnesemia, metabolic alkalosis, and hypocalciuria. Here, we present a 30-year-old woman without a medical history. She experienced an episode of tonic-clonic seizure, generalized muscle weakness, and severe hyponatremia as the first presentation of GS. The interesting point of this case was her late-onset presentation and the long period of her disease diagnosis; thus, it highlights the importance of considering this diagnosis.
A Solitary Fibrous Tumor (SFT) is a soft tissue tumor that appears exceedingly rare in the parotid gland. The literature review suggested that approximately 12%-22% of these cases behave aggressively. Besides, only 4 cases of histological malignant parotid gland SFT are reported in the English literature. We presented a 65-year-old cigarette-smoker man with a fix and tender mass over the left parotid and submandibular areas. On physical examination, the marginal branch of the facial nerve was paralyzed. The left total parotidectomy and neck dissection levels 1 and 2 were performed with preoperative embolization procedure and adjuvant radiotherapy for the patient. The results of the follow-up examination were unremarkable after 11 months. In this case report, we aimed to increase awareness on SFTs, although rare, among clinicians and pathologists. Accordingly, it should be considered in the differential diagnosis of soft-tissue tumors in the major salivary glands for better management.
Carbohydrate Antigen 19-9 (CA19-9) is a tumor marker for the prognosis of colorectal and pancreatic cancers. The high level of this tumor marker in gastric cancer indicates the advanced stage and peritoneal metastasis of the tumor. We reported a case of gastric cancer with an extremely high serum level of CA19-9. We also measured the serum levels of carcinoembryonic antigen and Carbohydrate Antigen 125 in the reported case. Such tumor markers manifest the progression and poor prognosis of cancer. Computed tomography data indicated several lytic and sclerotic foci in the inferior thoracic, lumbar vertebrae, and the right iliac wing, along with invasion to lymph nodes and a right adnexal mass in the reported patient. Bone marrow biopsy results revealed that carcinoma cells were predominantly composed of signet ring cell carcinoma. The patient has expired before receiving any interventions for cancer.
Duodenal melanoma constitutes a very small number of gastrointestinal malignant melanomas. The small intestine is a common site for the metastatic spread of cutaneous melanomas; however, its metastatic involvement from a primary rectal melanoma origin has seldom been reported. We present the histopathologic features of an unusual case of primary rectal melanoma metastasizing to the duodenum.
Seyed Farshad Allameh
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