pISSN: 2538-2683
eISSN: 2538-2691
Editor-in-Chief:
Shahin Akhondzadeh
Editor-in-charge:
Seyed Farshad Allameh
Current Issue
Vol 10 No 5 (2025): September - October
Case Report(s)
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Electroconvulsive therapy (ECT) is known as a treatment method for psychological disorders. This method, like any other treatment, has disadvantages that could threaten the patient’s life. During the process, some changes occur in the autonomic systems of the body. The aim of this study is to introduce a rare case of asystole during electroconvulsive therapy. The patient was a 48-year-old man with a history of bipolar disorder and a candidate for ECT. There were no problems in cardiac examinations. In the postictal phase of the seizure, the heart rate was not detectable. Cardiopulmonary resuscitation was started immediately with chest compressions, and airway management was performed by the anesthesiologist. The patient’s cardiac rhythm converted to a sinus rhythm following five minutes of chest compressions. The ECG wave appeared, and the pulse oximeter was able to show SpO₂ and the heart rate. Meanwhile, the patient’s airway was secured, and he was delivered to recovery with a blood pressure of 119.66 mm Hg and a heart rate of 105 beats/min. By retrieving the patient’s consciousness and hemodynamic stability, he was transferred to the ICU for treatment and diagnostic procedures.
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A 57-year-old female patient presented with acute onset of pain and bluish discoloration of the right hand. Physical examination revealed a cold, cyanotic right hand with absent radial, ulnar, and brachial pulses. Laboratory evaluation showed no pathological abnormalities, and there was no history of chronic disease or recent surgical intervention. Urgent CT angiography of the thorax and upper extremity demonstrated an aberrant right subclavian artery consistent with Adachi and Williams Classification Type G, with complete luminal occlusion caused by a 25-mm thrombus. Additional thrombotic occlusion of the distal axillary and proximal brachial arteries was also identified. This rare presentation highlights aberrant right subclavian artery thrombosis as an important cause of acute upper extremity ischemia and underscores the need to consider both congenital vascular variants and alternative thrombotic etiologies in the differential diagnosis of acute arterial occlusion.
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Retinoblastoma is the most common intraocular malignancy in children, typically diagnosed before the age of five. Delayed or incorrect diagnosis can lead to extraocular metastasis or intracranial extension. In older children, the presentation may be atypical and mimic conditions such as endophthalmitis, Coats disease, or uveitis, which can make the diagnosis challenging. Here we present a case of unilateral retinoblastoma that was misdiagnosed multiple times, ultimately resulting in intracranial extension and patient death. An 8-year-old boy with a 7-month history of progressive unilateral proptosis and vision loss was referred for ophthalmologic consultation. He had been misdiagnosed three separate times with uveitis, Coats disease, and optic pathway glioma. Before the correct diagnosis was made, he underwent ventriculoperitoneal (VP) shunt
placement for obstructive hydrocephalus. On examination, chemosis, anterior staphyloma, and xanthocoria were noted. The anterior chamber was completely filled with an intraocular mass. Intraocular pressure was 35 mmHg. A previously performed computed tomography (CT) scan showed an intraocular mass with calcification. B-scan ultrasonography revealed a slightly hyperechoic infiltrative mass with fine calcifications. Magnetic resonance imaging (MRI) demonstrated intracranial extension. Cerebrospinal fluid (CSF) cytology was negative for tumor cells. Systemic chemotherapy was initiated immediately, but the patient passed away 3 months later. Successful management of retinoblastoma requires a high index of suspicion to enable early diagnosis. Manifestation after 5 years of age may appear atypical, and mimickers such as endophthalmitis, Coats disease, or uveitis can easily mislead the physician, result in unnecessary interventions, and delay early treatment. -
A lipoma is the most frequently occurring benign tumor of adipose tissue. Its prevalence in the head and neck region is approximately 15–20%, while in the oral cavity, it accounts for only 1–4% of all benign tumors. The occurrence of tongue lipomas represents just 0.3% of all tongue tumors. The buccal mucosa is the most
common location for lipomas in the oral cavity, making tongue lipomas quite rare. In the oral cavity, these lesions typically present as slow-growing with a distinctive yellow hue and a soft texture. This condition mainly affects adults, and surgical removal is the preferred treatment method. A 56-year-old man presented with a mass on the right lateral side of his tongue that he had had for the past 12 years. Over the last 2 years, he experienced challenges with speech and eating due to the tumor’s gradual growth. Upon clinical evaluation,
a yellowish superficial lesion was observed, measuring 5 cm at its largest diameter, protruding from the surface of the tongue. The tumor was surgically removed, leading to the restoration of normal tongue function, and histopathological analysis confirmed that it was a simple lipoma. When a slow-growing, painless, and well-defined lesion appears on the tongue, one should consider lipomas despite their rarity. Surgical removal of a lipoma is recommended to provide symptom relief and to rule out the possibility of related malignancy. -
The splenic vessels, including the splenic artery and vein, normally run along the superior and posterior aspects of the pancreas, but their intrapancreatic courses can vary. Such variations may pose challenges during abdominal surgeries, including distal pancreatectomy, splenectomy, and pancreatic transplantation.
A formalin-fixed female cadaver, aged 54 years at death, was examined during routine educational dissection. The upper abdominal cavity was explored, with particular attention to the pancreas, spleen, splenic artery, and splenic vein. Vascular structures were stained using acrylic-based staining agents to visualize the blood vessels. Splenomegaly was noted based on gross anatomical assessment, and findings were documented through descriptive notes and digital photography. The cadaver exhibited a markedly enlarged spleen. The splenic artery followed an atypical intrapancreatic course, traversing the pancreatic parenchyma in a tortuous, deeper trajectory instead of the classical suprapancreatic pathway. The splenic vein was partially embedded within the posterior pancreas, deviating from its usual extrapancreatic route. Additionally, the inferior mesenteric vein drained directly into the superior mesenteric vein, contrary to its common confluence with the splenic vein.
This case highlights a rare anatomical variation of the splenic vascular pathways associated with splenomegaly. Awareness of such deviations is crucial for surgeons, anatomists, and radiologists to prevent intraoperative
complications and ensure accurate imaging interpretation. Individualized anatomical assessment during clinical and educational procedures is emphasized, contributing valuable insight to anatomical and surgical
literature. -
The incidence of multiple primary malignancies (MPMs) has risen in clinical practice; however, cases involving three or more primary cancers remain rare. A 56-year-old postmenopausal female with a significant familial cancer history developed four primary malignancies: papillary renal cell carcinoma, endometrial stromal sarcoma, colon adenocarcinoma, and invasive ductal carcinoma of the breast. The patient passed away after one year of receiving palliative treatment for her metastatic breast cancer. This study reviews 33 cases of MPMs, primarily involving breast, colon, and uterine cancers, mostly in women over 60. Genetic predisposition plays a significant role, with 35.5% having hereditary cancer syndromes. This report emphasizes the importance of considering new masses in cancer patients as potential new malignancies. Early detection using
fluorodeoxyglucose positron emission tomography (FDG-PET), implementing genetic testing, and timely cancer screenings in high-risk families significantly improve patient outcomes and management. -
Hour-glass stomach, a rare anatomical variant characterized by a narrowed gastric segment, presents with significant clinical challenges, including postprandial pain, nausea, vomiting, and malnutrition. This report details two cases of hour-glass stomach and their surgical management. The first case involved a 58-year-old female presenting with persistent esophageal reflux and dyspepsia, initially treated with laparoscopic
sleeve gastrectomy, subsequently revised to a Roux-en-Y gastrojejunostomy due to delayed gastric emptying. The second case was a 28-year-old male who presented with a hiatal hernia, abdominal pain, and vomiting, and who underwent a combined laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass in a single procedure. Both patients were diagnosed using radiographic imaging with water-soluble contrast. The surgical approach, combining sleeve gastrectomy to address the anatomical narrowing and Roux-en-Y bypass to improve gastric emptying, resulted in symptom resolution and no recurrence at 2-month follow-up. This case series highlights the efficacy of this surgical strategy in managing hour-glass stomach and emphasizes the
importance of radiographic imaging for diagnosis and postoperative assessment. Further studies with larger patient cohorts are needed to establish standardized treatment protocols and long-term outcomes. -
Acute lymphocytic leukemia (ALL) is a prevalent cancer in pediatrics. The cutaneous manifestation known as leukemia cutis is an unusual presentation of ALL, and patients with this manifestation have a poor prognosis. In this report, we present a 3-yearold boy who was referred to our clinic with cutaneous manifestations of ALL and responded well to treatment. A 3-year-old male patient was referred to our clinic for swelling in the left posterior thoracic region. The child’s parents reported an observable bulging in the abdominal area. Ultrasonography revealed splenomegaly and a hypoechoic mass measuring 11 mm × 8 mm in the anterior superior cortex of the right kidney. Laboratory studies indicated leukocytosis. Imaging findings suggested potential metastatic liver involvement, with a less probable diagnosis of secondary non-Hodgkin lymphoma
(NHL). Bone marrow aspiration (BMA) and biopsy of the thoracic lesion were performed. The BMA confirmed a diagnosis of acute pre-B cell lymphoblastic leukemia (ALL), and the cutaneous biopsy indicated infiltration by leukemic cells. The patient was initiated on a standard treatment regimen, to which he responded well. Leukemia cutis is rare in children and may present as unresponsive swelling. Pediatricians should consider it when standard treatments fail. -
Body packing (ingesting drug-filled packets) is a well-known method of drug smuggling, especially among prisoners. It carries significant risks, including packet rupture, bowel obstruction, and life-threatening gastrointestinal bleeding. We present a 37-year-old male prisoner with a known history of peptic ulcer disease
who presented with severe epigastric pain, coffee-ground vomiting, and hematochezia. Abdominal X-ray revealed multiple foreign objects consistent with drug packets. Due to ongoing bleeding and the rupture of one packet during removal, the patient underwent emergency surgical intervention. This case highlights the importance of early imaging, multidisciplinary management, and the need for surgical readiness in body packers with active bleeding. -
Hyperuricemia is commonly associated with hematological malignancies and high cell-turnover states. In megaloblastic anemia, ineffective erythropoiesis can increase purine breakdown, but severe hyperuricemia as an initial presentation—especially in children—is rare and may mimic malignancy. A 10-year-old girl with Down syndrome presented with failure to thrive, severe pancytopenia, hepatosplenomegaly, and marked hyperuricemia, raising strong suspicion of acute leukemia. Bone marrow examination revealed megaloblastic hematopoiesis without excess blasts. Treatment with vitamin B12 and folate led to rapid hematological recovery and normalization of uric acid levels. Megaloblastic anemia should be considered in children presenting with severe hyperuricemia and cytopenias, even when malignancy is suspected. Early diagnosis allows prompt, curative therapy and avoids unnecessary aggressive interventions.
