Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 5 2 2020 08 29 35 38 Najmeh Aletaha Department of Gastroenterology and Hepatology, Imam khomeini Hospital complex, Tehran University of Medical Sciences, Tehran, Iran. Marziyeh Ghalamkari Department of Hematology and Oncology, Imam khomeini Hospital complex, Tehran University of Medical Sciences, Tehran, Iran. Masoud Sotoudeh Digestive Oncology Research Center, Digestive Diseases Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Forough Alborzi Department of Gastroenterology and Hepatology, Imam khomeini Hospital complex, Tehran University of Medical Sciences, Tehran, Iran. Naser Ebrahimi Daryani Department of Gastroenterology and Hepatology, Imam khomeini Hospital complex, Tehran University of Medical Sciences, Tehran, Iran. 2019 07 07 2019 12 14 Stromal or mesenchymal neoplasms affecting the gastrointestinal tract are relatively rare lesions. A far less common group of Gastrointestinal (GI) mesenchymal tumors is leiomyoma. Surgery is the mainstay treatment for leiomyoma. Complete endoscopic resection of the tumor could be challenging due to its submucosal origin. In this study, we reported a case of a 48-year-old woman with leiomyoma of the cecum, i.e. treated by endoscopic resection. https://crcp.tums.ac.ir/index.php/crcp/article/view/279 https://crcp.tums.ac.ir/index.php/crcp/article/download/279/349

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 5 2 2020 08 29 39 42 Mahsa Abbaszadeh Department of Internal Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Mohammadreza Salehi Department of Infectious Diseases, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Shirkhoda Department of Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Sahar Karimpour Reyhan Department of Internal Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. 2019 09 10 2020 02 20 Tuberculosis (TB) could be presented with different manifestations. On many occasions, further evaluation in patients with the first diagnosis of the lung, pancreas, ovarian, or bladder cancer leads to the definite diagnosis of TB and the symptoms subside by treatment. Concerning the easy access to diagnostic tests and dramatic treatment responses, it is essential that physicians in endemic areas consider TB in patients with suspicious symptoms and in the differential diagnosis of malignancies, to diagnose the disease sooner and by simple and inexpensive tests; thus, avoiding imposing extra expenses to patients and the health system. We reported a 45 year-old female who was evaluated for abdominal pain, significant weight loss, and ascites for the past 4 months. The mediastinal and abdominopelvic Computed Tomography (CT) scan was performed in the initial evaluations of the patient. Accordingly, massive para-aortic and mediastinal lymphadenopathies and two thyroid nodules were detected. Furthermore, considering peritoneal thickening and moderate ascites, lymphoproliferative disorders were highly suggested as the diagnosis. The laboratory test data revealed bicytopenia, Erythrocyte Sedimentation Rate (ESR:57), and a high Cancer Antigen 125 (CA125). Unfortunately, the results of paracentesis were unavailable, though cytology was negative for malignancy. Due to anemia and weight loss, endoscopy and colonoscopy were performed twice in two different clinics, of which only gastritis was reported. Multiple abdominal and vaginal sonography was performed; these assessments suggested mild splenomegaly, mesenteric engorgement and thickening, multiple para-aortic and iliac adenopathies, as well as healthy uterus and ovaries. At the beginning of admission in Imam Khomeini Hospital, the patient denied any relevant medical history or family history. With further detailed questioning, we noticed a positive TB history in the patient’s grandmother, who lived with her. A Purified Protein Derivative (PPD) https://crcp.tums.ac.ir/index.php/crcp/article/view/301 https://crcp.tums.ac.ir/index.php/crcp/article/download/301/350

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 5 2 2020 08 29 43 46 Armen Malekiantaghi Department of Pediatrics, Pediatric Gastroenterology and Hepatology Research Center, Bahrami Children’s Hospital, Tehran University of Medical Sciences, Tehran, Iran Behzad Mohammadpour Ahranjani Department of Pediatrics, Bahrami Children’s Hospital, Tehran University of Medical Sciences, Tehran, Iran. Kambiz Eftekhari Department of Pediatrics, Pediatric Gastroenterology and Hepatology Research Center, Bahrami Children’s Hospital, Tehran University of Medical Sciences, Tehran, Iran. 2019 12 03 2020 02 20 Ingested Foreign Bodies (FB) frequently occur in pediatric patients. The most commonly ingested foreign bodies are coins, magnets, batteries, small toys, jewelry, buttons, and bones in decreasing order of frequency. A three-year-old boy referred to the emergency room with incidental ingestion of an ampoule of epinephrine. The radiography data demonstrated the location of the ingested ampoule in the stomach. The upper endoscopy was performed; however, the object had already passed through the pylorus. The following day, he passed the ampoule without complications. Our case was pretty unique because the most commonly ingested FBs in the pediatric population include coins followed by magnets, batteries, and so on. Asymptomatic patients having no dangerous FB could be observed until either presenting something abnormal or uneventfully passing the FB. https://crcp.tums.ac.ir/index.php/crcp/article/view/318 https://crcp.tums.ac.ir/index.php/crcp/article/download/318/351

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 5 2 2020 08 30 47 50 Marjan Mouodi Department of Pediatrics, Bahrami Children’s Hospital, Tehran University of Medical Sciences, Tehran, Iran. Soghra Rabizadeh Department of Pediatrics, Bahrami Children’s Hospital, Tehran University of Medical Sciences, Tehran, Iran. Hasan Jalaeikhoo AJA Cancer Research Center (ACRC), AJA University of Medical Sciences, Tehran, Iran. Manouchehr Nakhjavani Department of Pediatrics, Bahrami Children’s Hospital, Tehran University of Medical Sciences, Tehran, Iran. 2019 12 10 2020 02 20 Acute Lymphoblastic Leukemia (ALL) is a type of leukemia that generates from white blood cells in the bone marrow. ALL could present with different nonspecific symptoms. Hypercalcemia is a rare presentation in B-cell ALL. We reported a middle-aged man presented with hypercalcemia and osteolytic bone lesions without bone pain and a definitive diagnosis of B-cell ALL. https://crcp.tums.ac.ir/index.php/crcp/article/view/321 https://crcp.tums.ac.ir/index.php/crcp/article/download/321/352

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 5 2 2020 08 30 51 54 Ghazaleh Jamalipour Soufi Department of Radiology, Isfahan University of Medical Sciences, Isfahan, Iran. Siavash Iravani School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. 2019 12 29 2020 04 02 Pelizaeus-Merzbacher Disease (PMD), as a rare genetically x-linked leukodystrophy, is a disorder of proteolipid protein expression in myelin formation. This disorder is clinically presented by neurodevelopmental delay and abnormal pendular eye movements. The responsible gene for this disorder is the proteolipid protein gene (PLP1). Our case was a oneyear- old boy referred to the radiology department for evaluating the Central Nervous System (CNS) development by brain Magnetic Resonance Imaging (MRI). Clinically, he demonstrated neuro-developmental delay symptoms. The brain MRI results indicated a diffuse lack of normal white matter myelination. This case report should be considered about the possibility of PMD in the brain MRI of patients who present a diffuse arrest of normal white matter myelination. https://crcp.tums.ac.ir/index.php/crcp/article/view/324 https://crcp.tums.ac.ir/index.php/crcp/article/download/324/353

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 5 2 2020 08 30 55 57 EN Mohsen Esfandbod Department of Hematology-Oncology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Bahareh Shateri Amiri Department of Internal Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Reza Taslimi Department of Gastroenterology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. 2020 01 01 2020 04 02 Background: Multiple Endocrine Neoplasia type 2B (MEN2B) is an autosomal dominant disorder characterized by Medullary Thyroid Carcinoma (MTC) and pheochromocytoma. MTC occurs in almost all MEN2B patients. The tumor develops at an earlier age and is aggressive. Surgery is often not curative for this condition. Death from MTC occurred in 50% of patients with MEN2B. Thus, early diagnosis and prevention are crucial in this regard. Thyroidectomy, as early as the neonatal period, may be indicated in patients with MEN2B identified by genetic screening. Case Presentation: We reported a 24-year-old male presented to the emergency department with dyspnea for the past 3 months. There was a nodule 3*3 cm in the Right Lower Lobe (RLL) of the thyroid gland. Non-contrast Computer Tomography (CT) scan of the lung revealed multiple nodular lesions compatible with metastasis. The Fine Needle Aspiration (FNA) cytology of the thyroid nodule indicated that the features of medullary thyroid carcinoma were positive stains in Immunohistochemistry (IHC) for calcitonin. A diagnosis of pulmonary metastatic medullary thyroid carcinoma, as a presenting feature of MEN2B, was made. The patient was treated with Vandetanib. Conclusion: In the reported MEN2B patient, MTC occurred in the early stages of life and was multifocal. Thus, it is crucial to diagnose medullary thyroid cancer at the early stages of the disease. https://crcp.tums.ac.ir/index.php/crcp/article/view/325 https://crcp.tums.ac.ir/index.php/crcp/article/download/325/354

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 5 2 2020 08 30 58 62 EN Shokouh Shahrokhi Sabzevar Department of Medical Genetics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Farzaneh Mirzaei Department of Medical Genetics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Mohammad Hossein Tanipour Department of Medical Genetics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Atiyeh Eslahi Department of Medical Genetics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Mohammad Hasanzadeh Nazarabadi Department of Medical Genetics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. 2020 01 07 2020 04 02 Turner Syndrome (TS) is a chromosomal sex disorder, phenotypically characterized by short stature, webbed neck, cubitus valgus, and rarely with slight intellectual disability. A majority of TS patients (95%-98%) have infertility due to ovarian failure. Pregnancy in TS patients is an unusual case; however, pregnancy could rarely occur in mosaicism TS patients without any assistance. Pregnancy in such patients is associated with high risks of maternal mortality, spontaneous abortion, as well as the congenital and karyotype abnormalities of the fetus. A 30-year-old pregnant woman has referred to our genetics lab with a history of polyabortivity. Her menarche occurred at the age of 13 years and her menstruation was claimed to be in a regular cycle. The patient’s two first pregnancies resulted in stillbirth, whereas the third one was delivered through caesarian surgery, but spoiled after 8 days. Our case was characterized by mosaicism 45, X/45, XX, after referring as a multi-abortion case. The fourth pregnancy has happened at the age of 31 years and a healthy embryo with normal heart function was diagnosed by sonography in 17 weeks of gestation. The result of amniocentesis confirmed a healthy female embryo with 46, XX karyotype. Spontaneous pregnancy is regarded as a precarious situation terrifying by abortion or malignancy; also, chromosomal abnormalities, like trisomy 21 and TS, are prevalent in offspring. Therefore, it is strongly recommended to have cohort studies based on karyotype characterization to decrease the patient’s concerns as well as to follow more practical clinical approaches. https://crcp.tums.ac.ir/index.php/crcp/article/view/328 https://crcp.tums.ac.ir/index.php/crcp/article/download/328/355

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 5 2 2020 08 30 63 66 Mohammadreza Shalbafan Mental Health Research Center, Iran University of Medical Sciences, Tehran, Iran. Farzaneh Malekpour Mental Health Research Center, Iran University of Medical Sciences, Tehran, Iran. Pegah Asadi Mental Health Research Center, Iran University of Medical Sciences, Tehran, Iran. 2020 01 20 2020 04 02 Introduction: Bell`s palsy is a neurological condition manifests with acute unilateral neuropathy of 7th cranial nerve. The cause is not clear. However, some infections, immune system responses and ischemic causes are suggested as etiologies. We report 2 cases with Bell`s palsy whi>https://crcp.tums.ac.ir/index.php/crcp/article/view/410

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 6 4 2021 11 27 173 180 Ghazaleh Shaker Department of Pathology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Farid Azmoudeh Ardalan Department of Pathology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Mehdi Zeinalizadeh Department of Neurological Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. 2020 10 22 2020 12 13 Meningioma is a common primary tumor of the central nervous system and one of the most encountered brain tumors. Although classic histopathologic features of meningioma are relatively common and make its diagnosis straightforward, certain variants possess unusual histologic features causing diagnostic challenges. We reported three cases of clear cell meningioma, microcytic meningioma, and angiomatous meningioma report, variants with potential deceptive morphologies, and discuss their distinguishing morphologic features. https://crcp.tums.ac.ir/index.php/