Seyed Farshad Allameh
Vol 7 No 3 (2022): May-June
Synovial sarcoma is a malignant mesenchymal neoplasm which com- monly arises in the extremities of adults, in close association with joint capsules. Only a few cases of synovial sarcoma occurring in the abdominal wall have been reported. We report an extremely rare case of monophasic synovial sarcoma of abdominal wall in a 58-year-old woman who had presented with painless left ante- rior abdominal wall mass. The patient underwent excisional surgery. Histological and immunohistochemistry examinations revealed monophasic synovial sarcoma. Base on the diagnosis, the patient received chemoradiation.Primary synovial sarcoma is rarely found in the anterior abdominal wall. But, it should be included in the differential diagnosis.
In this case report, a man presenting with a rare symptom of appendix cancer is dis- cussed. Hematuria, which was the key diagnostic feature in this patient, has never been re- ported as a presenting feature of appendix cancer which may explain why this patient has been experiencing this symptom for months and yet have not get the proper di- agnosis. As we discussed in the case report, although appendiceal cancer is a potentially life-threatening issue, it is frequently missed in patients. Therefore, we believe report- ing this key symptom in this journal would help physicians to make a more accurate diagnosis in this matter.
CCTGA, also known as levo- or L-loop transposition (L-TGA), double discordance, or ventricular inversion, is a rare cardiovascular anomaly with inversion of the ventricles and great arteries. In this anomaly, the right atrium communicates with the morpho- logic left ventricle, which gives rise to the pulmonary artery, while the left atrium communicates with the morphologic right ventricle, which gives rise to the aorta. Thus, atrioventricular and ventriculoarterial discordance (double discordance) exist, and although the blood flows in the normal direction, it passes through the wrong ventricular chambers. It is a unique conotruncal anomaly, in which the four-chamber view is abnormal. It may be associated with other heart disorders. In most fetuses, TGA remains undiagnosed before birth. The diagnosis of TGA can be made by care- fully and appropriately evaluating the anatomic locations of cardiac chambers and the connections between the atria, ventricles, and great arteries with high-resolution ultrasound. Patients with isolated CTGA generally present later in life with signs and symptoms related to either arrhythmias or heart failure. TGA is rarely associated with chromosomal abnormality and amniocentesis is usually not undertaken. We report a case of CTGA detected at 18 week’s gestation on screening ultrasound.
The presented case is an 81- year-old woman who had experienced episodes of facial twitching without loss of consciousness and flu like symptoms for a few weeks prior to her admission. examinations were unremarkable except for left 3rd nerve and right 6th nerve palsy, right peripheral facial palsy and right -side hemiparesis. FH was positive for sarcoidosis. neuroimaging were in favor of PCNSL. Sarcoidosis and malignancy maybe etiologically related in at least 25% of cases. Coexis- tence of sarcoidosis and lymphoma have been reported previously. Our patient had two daughters with sarcoidosis and her chest CT scan showed multiple lymph nodes in medias- tinum. Unfortunately, due to the location and the technical restriction, biopsy of mediasti- nal lymph nodes was not performed for our patient and we could not differentiate whether it was reactive, paraneoplastic or granulomatous. We present this case as concurrence of lymphoma and sarcoidosis in a family, which could guide a new concern for the patient with granulomatous infiltrative disease for early diagnosis and familial screening.
Cavernous sinus hemangiomas (CSHs) are rare, benign, slow-growing neoplasms within the cavernous sinus. Laterally located to these lesions, the cranial nerves and carotid artery are subject to injury during removal of hemangiomas through a transcranial route. Therefore, for surgi- cal management of cavernous sinus hemangiomas a medial corridor granted through an endoscop- ic endonasal approach may be less traumatic to the neurovascular bundle. Case-1 describes a 23-year old male who presented with intermittent blurred vision and very mild ptosis on the right side for two years before admission. Fundoscopic exam, visual acuity and perimetry tests were normal. With intense enhancement after contrast administration, both brain MRI and CT scan demonstrated an extra-axial mass in the right cavernous sinus. Case-2 presents a 59-year-old male, a known case of renal oncocytoma who underwent nephrec- tomy a year before, with chief complain of moderate intermittent headaches. Imaging study of the brain by MRI revealed a sellar mass. Near-total resection for case-1 and gross total resection for case-2 were performed through the an extended endoscopic endonasal approach. We report two cases of near-total and gross total resection of CSHs via an extend- ed endoscopic endonasal approach substantiating advances in minimal access neurosurgery to the treatment of such grim lesions of an intricate vicinity of the skull base. At the same time, we focus to review extensively the growing yet heterogenous literature of the past twenty years on the broached topic. The evolution of extended endoscopic endonasal approach over the past two decades changes the dynamism of the surgical practices steeped in tradition and provides a safer alternate route for preserving cranial nerves of this anatomic region.
Double J stent or DJ stent, is a self-retaining ureteral stent mainly used to provide effective drainage of kidney into urinary baldder. However, because of widespread use, lack of patient education or due to lack of adherence to regular follow up, patients may end up with a forgotten DJ stent which can stay undiagnosed in the pelvi-ureteral system for years and cause a lot of complications before coming to attention. We present a unique case of repetitively neglected (forgotten) DJ stent in a 28-year-old male, who had the stent placed 11 years back as a part of Percutaneous Nephrolithotomy (PCNL) and now presented with encrusted DJ stent with large bladder calculus and calculus deposits along entire length of the stent. To our knowledge, this study reports the forgotten stent with the maximum stone burden available in literature.
Accessory navicular bone occurs due to failure of fusion of a secondary ossification center with the navicular. It is the second most common ossicle of the foot, with majority of them being identified incidentally on imaging studies. We report a case of 45-year-old female who presented with complaints of pain and localized redness over the medial aspect of the right foot which was aggravated on walking. This brief review aims to describe the pathophysiology, radiographic findings and management of Os naviculare syndrome. We also wish to highlight to the physicians that it must be suspected in patients with localized pain over the medial aspect of the midfoot without obvious trauma. The presence of accessory navicular should not be disregarded as an incidental radiological variant in a symptomatic patient.
A 20-year-old woman presented with left eye ptosis without any headache and pupillary dysfunctions. After the radiological examination, the oculomotor nerve compression was detected in the interpeduncular space by the posterior communicating artery (PCoA) with normal size and shape. The patient underwent frontotemporal craniotomy, and during the surgery, the nerve was detached from the PCoA. Immediately after surgery, all symptoms disappeared. Although oculomotor nerve palsy (ONP) owing to internal carotid-PCoA aneurysm is common, vascular compression due to a non- aneurysmal PCoA is very rare. To the extent of our knowledge, this is the first case in which a slightly displaced, otherwise normal, PCoA causes ONP without any pupillary involvement. After ruling out an aneurysmal artery, this should be considered as one of the possible causes of the ONP.
Hereditary hemochromatosis (HH) is a rare genetic disorder, causing systemic iron overload. High amounts of iron in the bloodstream gradually oversaturate the trans- ferrin which can cause sedimentation of iron in the pancreas, liver, heart, pituitary and joints, though it can establish multiorgan involvements. We present a case of TFR2 (type 3) HH who had minor α-thalassemia and uncontrolled diabetes mellitus, and discuss the clinical presentation and patient management. A 33-year-old man with type 3 HH and alpha-thalassemia trait, presented with uncon- trolled diabetes mellitus, skin hyperpigmentation and hypogonadism. The patient had high blood glucose ,despite the administration of 80 units of Glargine and 80 units of Aspart insulins per day, but after changing them into human insulins, his diabetes mellitus was surprisingly controlled with only 32 units of NPH and 18 units of Regular insulins. Furthermore, he was treated with testosterone (due to hypogonadism) and Deferasirox (due to iron overload).
Spontaneous pneumomediastinum has been reported in association with COVID-19. Pneumomediastinum could remain elusive until computed tomogra- phy is performed. Hence, we need to be vigilant even though it generally has a benign clinical course. We presented four confirmed COVID-19 cases with typical ground glass opacity on chest radiograph. All four had the computed tomography that re- vealed pneumomediastinum, pneumothorax and subcutaneous emphysema. Only one patient had pneumomediastinum after intubation. Pneumomediastinum is a devastating finding which should be picked up as early as possible and must be excluded in COVID patients whom deteriorate quickly, as adequate time may pass before any viable intervention can be done to expedite the patients’ recovery.
Tuberculosis, a preventable and curable disease caused by Mycobacterium tuberculosis, is the leading infectious cause of mortality worldwide. Organs commonly affected are lungs and extrapulmonary organs like lymph nodes, meninges, bones, genitourinary and gastrointestinal tract. Ileocaecal tuberculosis is the commonest form of the gastrointestinal tract. Disseminated infection can involve almost all organs in the body but isolated pancreatic tuberculosis is rarely reported in the literature. Hereby, we report a case of a young female presenting with abdominal pain and further evaluation with imaging revealed pancreatic mass raising suspicion of malignancy. Endoscopic ultrasound (EUS) guided FNAC of pancreatic mass surprisingly revealed necrotizing granulomatous lesions favoring tuberculosis. This was further supported by the complete resolution of the mass with Antituberculous Therapy (ATT). What is important: All pancreatic masses are not malignant. Infectious causes like tuberculosis should be considered in the differential diagnosis which is curable by medication. With a high index of suspicion and adequate workup, unnecessary invasive procedures can be avoided.
A 13-year-old girl presented with fever, nausea and projectile vomiting and altered sensorium. On physical examination, the meningeal signs were presented without focal neurological deficits and Grade Ⅱ papilledema was presented on fundus examination. The patient was found to be positive for Japanese encephalitis virus in cerebrospinal fluid. Focal neurological deficit in the form of right hemiparesis was noticed at day 6 of hospitalisation. Multiple lesions with minimal enhancement with perilesional edema were observed in cerebral cortex in contrast with enhanced magnetic resonance imaging of the brain, giving rise to starry sky appearance. No tests for neurotuberculosis were found positive. Serum IgG enzyme-linked immunosorbent assay test was negative for Cysticercosis, but magnetic resonance spectroscopy was suggestive of cysticercal meningitis. During treatment, she had intermittent episodes of nausea and vomiting with waxing and waning sensorium. Subsequently, it was planned to start Albendazole after steroids coverage and anticonvulsants but the patient did not improve and succumbed to her illness.
Seyed Farshad Allameh
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