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Significance of early diagnosis and treatment of adult late-onset Pompe disease on the effectiveness of enzyme replacement therapy in improving muscle strength and respiratory function: a case report. 成人晚发型庞贝氏症的早期诊断和治疗对酶替代疗法改善肌力和呼吸功能效果的意义:病例报告。
IF 0.9 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-08 DOI: 10.1186/s13256-024-04837-0
Moein Mir, Kianmehr Rouhani, Kiana Rouhani, Mohammadjavad Hassani, Mohammadrafi Damirchi, Sajjad Yazdansetad, Mehrdad Aghaei

Background: Pompe disease, a rare autosomal recessive disorder, is caused by mutations in the acid α-glucosidase gene. Pompe disease is a congenital metabolic disorder that affects all organs, particularly the striated muscle and nerve cells. Diagnosis is typically confirmed through enzyme assays that reveal reduced acid α-glucosidase activity. Enzyme replacement therapy utilizing human α-glucosidase is an available treatment option. Timely diagnosis and treatment in the early stages of the disease significantly impact the effectiveness of enzyme replacement therapy in enhancing patient condition. Here, we present a case of a patient with Pompe disease diagnosed 20 years after the onset of clinical symptoms.

Case presentation: A 38-year-old Iranian Baloch woman referred to our rheumatology clinic with progressive muscle weakness presents with a complex medical history. On mechanical ventilation for 12 years, she has endured fatigue and limb weakness since the age of 16, exacerbated following an abortion at 19. Despite undergoing corticosteroid and azathioprine therapies, the suspected diagnosis of inflammatory myopathy did not yield improvement. Hospitalization at 23 due to respiratory failure post-pregnancy led to her continued reliance on a ventilator. A dried blood spot test indicated reduced GAA enzyme activity, confirming a diagnosis of Pompe disease through genetic testing. Treatment with myozyme for 2 years demonstrated limited efficacy, as the patient experienced improved breathing but no significant overall improvement in limb-girdle muscular weakness. This case underscores the challenges and complexities involved in diagnosing and managing rare neuromuscular disorders like Pompe disease.

Conclusion: Early intervention with enzyme replacement therapy plays a crucial role in halting further muscle loss and disease progression in Pompe disease patients. It is important to note that treatment during advanced stages of the disease may not yield substantial benefits. Nevertheless, enzyme instability and denaturation due to temperature and neutral pH levels, along with limited delivery to disease-relevant tissues, can pose challenges in treatment. However, timely diagnosis of Pompe disease is paramount for its effective management and improved outcomes.

背景:庞贝氏症是一种罕见的常染色体隐性遗传疾病,由酸 α-葡萄糖苷酶基因突变引起。庞贝氏症是一种先天性代谢性疾病,影响所有器官,尤其是横纹肌和神经细胞。诊断通常是通过酶测定发现酸 α-葡萄糖苷酶活性降低。利用人体α-葡萄糖苷酶进行酶替代治疗是一种可行的治疗方法。疾病早期的及时诊断和治疗对酶替代疗法改善患者病情的效果有很大影响。在此,我们介绍了一例庞贝病患者,她在出现临床症状 20 年后才被确诊:一名 38 岁的伊朗俾路支妇女因进行性肌无力转诊至我们的风湿病诊所,病史复杂。她使用机械通气 12 年,自 16 岁起就出现疲劳和四肢无力,19 岁堕胎后病情加重。尽管接受了皮质类固醇和硫唑嘌呤治疗,但疑似炎症性肌病的诊断结果并未好转。23 岁时,她在怀孕后因呼吸衰竭住院,因此一直依赖呼吸机。干血斑检测显示 GAA 酶活性降低,通过基因检测确诊为庞贝氏症。使用肌酶治疗 2 年的疗效有限,患者的呼吸有所改善,但四肢肌肉无力的总体情况没有明显改善。本病例强调了诊断和管理庞贝氏症等罕见神经肌肉疾病所面临的挑战和复杂性:结论:酶替代疗法的早期干预在阻止庞贝病患者肌肉进一步萎缩和疾病进展方面发挥着至关重要的作用。值得注意的是,疾病晚期的治疗可能不会产生实质性的益处。然而,温度和中性 pH 值导致的酶不稳定性和变性,以及向疾病相关组织的有限输送,都会给治疗带来挑战。不过,及时诊断庞贝氏症对于有效治疗和改善预后至关重要。
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引用次数: 0
Giant pedunculated liver hydatid cyst causing inferior vena cava syndrome: a case report. 引起下腔静脉综合征的巨大梗阻性肝包虫囊肿:病例报告。
IF 0.9 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-07 DOI: 10.1186/s13256-024-04772-0
Abdi Tesemma, Miheret Adane, Kebebe Bekele, Bekam Debebe, Edoardo Rosso, Demisu Zenbaba, Degefa Gomora, Girma Beressa

Background: Hydatid disease is a zoonotic infection caused by the species Echinococcus that typically affects the liver. Most liver hydatid cysts are asymptomatic at first, but as the cyst grows larger, symptoms, such as compression effects, start to appear. Ultrasonography and computed tomography scans are the widely used diagnostic tools, and surgery is considered the mainstay of treatment.

Case presentation: We present an unusual case of a giant pedunculated hydatid cyst causing inferior vena cava syndrome in a 20-year-old male patient from the Oromo ethnic group from a rural area of the country. Abdominal ultrasound and computed tomography scan confirmed the diagnosis. Our patient underwent radical surgical resection of the cyst and had a good outcome.

Conclusion: Hydatid liver cyst diagnosis needs a high index of suspicion for echinococcal etiology when dealing with a giant liver cyst as it results in grave complications without any manifestations.

背景:包虫病是一种由棘球蚴引起的人畜共患传染病,通常会影响肝脏。大多数肝包虫囊肿起初没有症状,但随着囊肿的增大,开始出现压迫效应等症状。超声波和计算机断层扫描是广泛使用的诊断工具,手术被认为是治疗的主要手段:我们介绍了一例来自该国农村地区奥罗莫族的 20 岁男性患者,他的巨大有蒂包虫囊肿引起了下腔静脉综合征。腹部超声波和计算机断层扫描证实了诊断结果。我们的患者接受了囊肿根治性手术切除,结果良好:结论:在诊断巨大肝囊肿时,需要高度怀疑棘球蚴病的病因,因为它会在没有任何表现的情况下导致严重的并发症。
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引用次数: 0
Severe hydronephrosis complicated with primary aldosteronism: a case report and review of the literature. 严重肾积水并发原发性醛固酮增多症:病例报告和文献综述。
IF 0.9 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-06 DOI: 10.1186/s13256-024-04798-4
Jianjuan Sun, Qiurong Zeng, Longbing Lai, Mingjun Gu, Dingrong Liu, Guangxiu Wu, Chuan Peng, Shuming Yang, Qifu Li, Jiangang Lu

Background: Primary aldosteronism is characterized by high plasma aldosterone and low renin. The plasma aldosterone-to-renin ratio is recommended for screening. Severe hydronephrosis leads to renal parenchymal ischemia, resulting in increased renin secretion. Since nonsuppression of renin may cause a negative result in the aldosterone-to-renin ratio test, severe hydronephrosis and primary aldosteronism occurring simultaneously in a patient are challenging to diagnose.

Case presentation: A 54-year-old Chinese man of Han ethnicity was diagnosed with hypertension and severe hypokalemia (minimum 1.57 mmol/L) 13 years prior, and was also diagnosed with severe hydronephrosis due to congenital ureteral stenosis on the left side. His clinical features suggested primary aldosteronism, but the aldosterone-to-renin ratio result of the patient was negative every time he underwent the primary aldosteronism screening test. No further treatment for primary aldosteronism was performed, which led the patient to suffer from severe hypokalemia, such that he was taking 12-15 g/day potassium chloride orally to keep his blood potassium between 3.0 and 3.5 mmol/L (reference value, 3.5-5.5 mmol/L) for 13 years, and the patient needed to be hospitalized in the intensive care unit for rescue several times. At admission, although the aldosterone-to-renin ratio result of the patient was negative, we still did the saline stress test and captopril inhibition test, and the results showed that the plasma aldosterone level was not lower after the test than before the test. Adrenal enhanced computed tomography suggested an adenoma in the left adrenal gland, and the results of adrenal vein sampling suggested that the left side was the dominant side. Therefore, laparoscopic total resection of the left adrenal gland was performed, and 2 weeks later, the patient developed short-term renal function impairment and hyperkalemia, but his renal function and blood potassium returned to normal after treatment that included fluid rehydration. The patient's biochemical test results and clinical symptoms were completely normal after 1 year.

Conclusion: We suggest that for patients with a high suspicion of primary aldosteronism in the clinic, comprehensive analysis must be performed in combination with clinical characteristic assessments, such as severe hydronephrosis, if renin is within the normal range or if the aldosterone-to-renin ratio result is negative at screening and diagnostic tests, and adrenal vein sampling should be performed if necessary. It can help avoid misdiagnoses and contribute to the treatment of patients with severe hydronephrosis and primary aldosteronism.

背景:原发性醛固酮增多症的特点是血浆醛固酮高而肾素低。建议通过血浆醛固酮与肾素的比值进行筛查。严重肾积水会导致肾实质缺血,从而导致肾素分泌增加。由于肾素的非抑制性可能会导致醛固酮与肾素比值检测结果呈阴性,因此同时出现严重肾积水和原发性醛固酮增多症的患者很难诊断:一名 54 岁的中国汉族男子在 13 年前被诊断出患有高血压和严重低钾血症(最低 1.57 mmol/L),同时还被诊断出因左侧先天性输尿管狭窄而导致严重肾积水。他的临床特征表明他患有原发性醛固酮增多症,但每次接受原发性醛固酮增多症筛查时,醛固酮与肾素的比值结果都是阴性。由于没有对原发性醛固酮增多症进行进一步治疗,患者患上了严重的低钾血症,13 年来,他每天口服 12-15 克氯化钾,使血钾保持在 3.0 至 3.5 毫摩尔/升(参考值为 3.5 至 5.5 毫摩尔/升)之间,并多次入住重症监护室进行抢救。入院时,虽然患者的醛固酮-肾素比值结果为阴性,但我们还是为其做了生理盐水压力试验和卡托普利抑制试验,结果显示试验后血浆醛固酮水平并不比试验前低。肾上腺增强计算机断层扫描提示左侧肾上腺腺瘤,肾上腺静脉取样结果显示左侧为优势侧。因此,患者接受了腹腔镜下左侧肾上腺全切除术。两周后,患者出现了短期肾功能损害和高钾血症,但经过补液等治疗后,肾功能和血钾恢复正常。1 年后,患者的生化检查结果和临床症状完全正常:我们建议,对于临床高度怀疑原发性醛固酮增多症的患者,必须结合临床特征评估进行综合分析,如严重肾积水,如果肾素在正常范围内或筛查和诊断性检查中醛固酮与肾素比值结果为阴性,必要时应进行肾上腺静脉采样。这有助于避免误诊,并有助于治疗严重肾积水和原发性醛固酮增多症患者。
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引用次数: 0
Benign extracranial meningioma with pulmonary metastasis: a case report and review of literature. 良性颅外脑膜瘤伴肺部转移:病例报告和文献综述。
IF 0.9 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-05 DOI: 10.1186/s13256-024-04800-z
Jianing Cui, Xiaozhao Zou, Ying Han, Jing Jiang

Background: Meningiomas are common central nervous system tumors, predominantly intracranial, they rarely develop extracranially. Moreover, benign meningiomas seldom metastasize.

Case presentation: This article presents a case report of a 55-year-old Chinese male patient with a primary World Health Organization grade 1 meningioma originating from the petrous apex of the temporal bone, accompanied by pulmonary metastasis. Following two incomplete resections of the primary tumor, the patient underwent radiotherapy and has since maintained a stable condition.

Conclusion: The case report highlights the rare occurrence of pulmonary metastasis in a benign World Health Organization grade 1 meningioma originating from an extracranial site. It also illustrates the important role of radiotherapy in treating patients with meningioma. Additionally, a review of related literature is provided to gain insights for the diagnosis and treatment of the disease.

背景:脑膜瘤是常见的中枢神经系统肿瘤,主要发生在颅内,很少发生在颅外。此外,良性脑膜瘤很少发生转移:本文报告了一例 55 岁中国男性患者的病例,该患者患有原发性世界卫生组织 1 级脑膜瘤,起源于颞骨石状顶,并伴有肺转移。在两次不完全切除原发肿瘤后,患者接受了放疗,此后病情一直保持稳定:本病例报告强调了起源于颅外部位的世界卫生组织 1 级良性脑膜瘤发生肺转移的罕见情况。该病例还说明了放疗在治疗脑膜瘤患者中的重要作用。此外,报告还对相关文献进行了综述,以便为该疾病的诊断和治疗提供启示。
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引用次数: 0
A presentation of basal cell adenoma: a case report. 基底细胞腺瘤:病例报告。
IF 0.9 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-05 DOI: 10.1186/s13256-024-04692-z
Deviprasad Dosemane, Meera Niranjan Khadilkar, Nithya Chandy, Shikha Jayasheelan

Background: While statistically rare in comparison to other head and neck tumours, parotid gland swellings are often encountered in clinical practice where one of the primary goals of examination becomes distinction between benign and malignant lesions. Hallmarks of malignancy are characterized by a female preponderance, history of radiation exposure, a positive family history, and clinical features like heterogenous consistency, fixity to skin/underlying tissues and involvement of facial nerve.

Case presentation: Here we present a case of parotid swelling in a 72-year old gentleman from south India that had a curious amalgamation of both benign and malignant features.

Conclusions: While benign, the risk of malignant transformation and rare multicentric occurrence indicates a need to keep basal cell adenoma in mind in case of parotid swellings and their surgical management.

背景:虽然与其他头颈部肿瘤相比,腮腺肿物在统计数字上比较罕见,但在临床实践中经常会遇到,检查的主要目的之一就是区分良性和恶性病变。恶性肿瘤的特征是女性居多、有放射线暴露史、阳性家族史,以及异质性、与皮肤/下层组织固定、累及面神经等临床特征:我们在此介绍一例来自印度南部的 72 岁腮腺肿物病例,该病例同时具有良性和恶性特征:结论:腮腺肿物虽然是良性的,但其恶变的风险和罕见的多中心发生表明,在腮腺肿物及其手术治疗中需要牢记基底细胞腺瘤。
{"title":"A presentation of basal cell adenoma: a case report.","authors":"Deviprasad Dosemane, Meera Niranjan Khadilkar, Nithya Chandy, Shikha Jayasheelan","doi":"10.1186/s13256-024-04692-z","DOIUrl":"10.1186/s13256-024-04692-z","url":null,"abstract":"<p><strong>Background: </strong>While statistically rare in comparison to other head and neck tumours, parotid gland swellings are often encountered in clinical practice where one of the primary goals of examination becomes distinction between benign and malignant lesions. Hallmarks of malignancy are characterized by a female preponderance, history of radiation exposure, a positive family history, and clinical features like heterogenous consistency, fixity to skin/underlying tissues and involvement of facial nerve.</p><p><strong>Case presentation: </strong>Here we present a case of parotid swelling in a 72-year old gentleman from south India that had a curious amalgamation of both benign and malignant features.</p><p><strong>Conclusions: </strong>While benign, the risk of malignant transformation and rare multicentric occurrence indicates a need to keep basal cell adenoma in mind in case of parotid swellings and their surgical management.</p>","PeriodicalId":16236,"journal":{"name":"Journal of Medical Case Reports","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11452998/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142375567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Vascular complications during appendectomy: severe adhesion of the appendix to the right iliac artery: a case report. 阑尾切除术中的血管并发症:阑尾与右髂动脉严重粘连:病例报告。
IF 0.9 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-04 DOI: 10.1186/s13256-024-04794-8
Ahmad Hosseinzadeh, Hoora Rezaeibana, Mohammadreza Khosravi, Armin Sourani, Hadis Yazdanshenas, Reza Shahriarirad

Introduction: Appendicitis is a common cause of acute abdomen. Rarely, it may form adhesions to nearby structures, complicating surgeries, especially when involving vascular structures such as the internal iliac artery, potentially causing severe intraoperative hemorrhage.

Case presentation: A 65-year-old Middle Eastern male presented with abdominal pain and anorexia for 5 days. Examination and imaging confirmed acute appendicitis with complications. Additionally, a large pelvic mass was noted. During surgery, severe bleeding was encountered due to an adhesion between the appendix and the right internal iliac artery, managed by ligating the artery. The patient recovered well and was discharged in stable condition. Histopathology confirmed the diagnosis.

Conclusion: This case highlights a rare vascular complication of appendectomy due to abnormal adhesions between the appendix and the internal iliac artery, associated with a large pelvic mass. This study emphasizes the need for thorough preoperative evaluation and careful surgical planning in patients with unusual anatomical variations or specific underlying conditions such as neurofibromatosis. Early recognition and strategic management of vascular adhesions are essential to optimize patient outcomes in appendectomies complicated by such rare scenarios.

简介阑尾炎是急腹症的常见病因。罕见的是,阑尾炎可能会与附近的结构形成粘连,使手术复杂化,尤其是涉及髂内动脉等血管结构时,可能会导致严重的术中大出血:一名 65 岁的中东男性因腹痛和厌食 5 天前来就诊。检查和造影证实他患有急性阑尾炎,并伴有并发症。此外,还发现一个巨大的盆腔肿块。手术中,阑尾与右侧髂内动脉粘连导致大出血,通过结扎动脉进行了处理。患者恢复良好,病情稳定后出院。组织病理学确诊:本病例突显了阑尾切除术后因阑尾与髂内动脉异常粘连导致的罕见血管并发症,并伴有巨大的盆腔肿块。本研究强调,对于有异常解剖变异或特殊基础疾病(如神经纤维瘤病)的患者,需要进行全面的术前评估和仔细的手术规划。尽早识别血管粘连并进行策略性处理对于优化此类罕见情况下阑尾切除术并发症的患者预后至关重要。
{"title":"Vascular complications during appendectomy: severe adhesion of the appendix to the right iliac artery: a case report.","authors":"Ahmad Hosseinzadeh, Hoora Rezaeibana, Mohammadreza Khosravi, Armin Sourani, Hadis Yazdanshenas, Reza Shahriarirad","doi":"10.1186/s13256-024-04794-8","DOIUrl":"10.1186/s13256-024-04794-8","url":null,"abstract":"<p><strong>Introduction: </strong>Appendicitis is a common cause of acute abdomen. Rarely, it may form adhesions to nearby structures, complicating surgeries, especially when involving vascular structures such as the internal iliac artery, potentially causing severe intraoperative hemorrhage.</p><p><strong>Case presentation: </strong>A 65-year-old Middle Eastern male presented with abdominal pain and anorexia for 5 days. Examination and imaging confirmed acute appendicitis with complications. Additionally, a large pelvic mass was noted. During surgery, severe bleeding was encountered due to an adhesion between the appendix and the right internal iliac artery, managed by ligating the artery. The patient recovered well and was discharged in stable condition. Histopathology confirmed the diagnosis.</p><p><strong>Conclusion: </strong>This case highlights a rare vascular complication of appendectomy due to abnormal adhesions between the appendix and the internal iliac artery, associated with a large pelvic mass. This study emphasizes the need for thorough preoperative evaluation and careful surgical planning in patients with unusual anatomical variations or specific underlying conditions such as neurofibromatosis. Early recognition and strategic management of vascular adhesions are essential to optimize patient outcomes in appendectomies complicated by such rare scenarios.</p>","PeriodicalId":16236,"journal":{"name":"Journal of Medical Case Reports","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11450989/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142372064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Pericardial cyst unveiling: a case of unusual chest symptoms in a young woman with a family history of cancer: a case report and review of literature. 心包囊肿显露:一例有癌症家族史的年轻女性的异常胸部症状:病例报告和文献综述。
IF 0.9 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-03 DOI: 10.1186/s13256-024-04771-1
Parisa Adib-Hajbagheri, Mohsen Mirmohammadsadeghi, Mohammadhossien Paknahad, Mahdi Rafiyan

Background: Pericardial cysts, though rare and benign, can present with various clinical symptoms depending on their size and location in the body. The detection of these cysts typically relies on imaging studies for a conclusive diagnosis, with surgical removal being the definitive treatment.

Case presentation: This case report details the clinical journey of a 32-year-old Iranian woman with a family history of breast and lung cancer, who experienced left-sided chest pain. Utilizing a combination of clinical history review, mammography, echocardiography, and computed tomography, a precise diagnosis of a 10 cm × 3.5 cm pericardial cyst was achieved. The patient underwent median sternotomy for complete cyst excision.

Conclusions: While pericardial cysts are often asymptomatic and benign, they can lead to life-threatening complications. Hence, regular follow-up is advised, and in certain instances, minimally invasive interventions or surgery may be necessary.

背景:心包囊肿虽然罕见且为良性,但可根据其大小和在体内的位置表现出各种临床症状。这些囊肿的检测通常依赖于影像学检查来确诊,手术切除是最终的治疗方法:本病例报告详细描述了一名 32 岁伊朗妇女的临床过程,该妇女有乳腺癌和肺癌家族史,曾出现左侧胸痛。结合临床病史回顾、乳房 X 射线照相术、超声心动图和计算机断层扫描,患者被精确诊断为 10 厘米 × 3.5 厘米的心包囊肿。患者接受了胸骨正中切开术,完全切除了囊肿:虽然心包囊肿通常是无症状的良性囊肿,但也可能导致危及生命的并发症。因此,建议定期进行随访,在某些情况下,可能需要进行微创干预或手术。
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引用次数: 0
Conservative treatment in uterine perivascular epithelioid cell tumor of uncertain malignant potential: a case report. 恶性程度不确定的子宫血管周围上皮样细胞瘤的保守治疗:病例报告。
IF 0.9 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-02 DOI: 10.1186/s13256-024-04781-z
Ines Zemni, Ines Houissa, Nadia Boujelbene, Saida Sakhri, Imene Sassi, Tarek Ben Dhiab

Introduction: Perivascular epithelioid cell tumors are uncommon mesenchymal tumors. The genital tract is the most common extrarenal location. Preoperative diagnosis is rarely achieved owing to non-specific symptoms and imaging features. Consensus on treatment strategies remains elusive. Case presentation We report the case a 38 year-old north African woman with a primary sterility, who was diagnosed with a uterine Perivascular epithelioid cell tumor of uncertain malignant potential on a resection specimen of an intracavity polypoid mass. Immunohistochemistry confirmed the diagnosis and we opted for conservative surgery to preserve the patient's fertility desires.

Conclusion: Uterine perivascular epithelioid cell tumor is a rare entity that warrants consideration in the differential diagnosis of uterine tumors. Treatment modalities, follow-up protocols, and prognosis remain ambiguous. Given their unpredictable behavior, accurate diagnosis and long-term monitoring are imperative.

导言血管周围上皮样细胞瘤是一种不常见的间质肿瘤。生殖道是最常见的肾外部位。由于症状和影像学特征不具特异性,术前诊断极少。治疗策略仍未达成共识。病例介绍 我们报告的病例是一名 38 岁的原发性不育症北非女性,她在腔内息肉样肿块切除标本上被诊断为恶性可能性不确定的子宫血管周围上皮样细胞瘤。免疫组化确诊后,我们选择了保守手术,以保留患者的生育愿望:结论:子宫血管周围上皮样细胞瘤是一种罕见的肿瘤,值得在子宫肿瘤的鉴别诊断中加以考虑。治疗方式、随访方案和预后仍不明确。鉴于其行为难以预测,准确诊断和长期监测势在必行。
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引用次数: 0
Functional movement disorder similar to Parkinson's disease: a case report. 类似帕金森病的功能性运动障碍:病例报告。
IF 0.9 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-01 DOI: 10.1186/s13256-024-04767-x
Sarah Goudarzzadeh, Shayan Shekarabi, Mahnaz Abdi

Introduction: Functional neurological disorder challenges conventional medical understanding, presenting neurological symptoms without organic explanations. This report delves into the intricate interplay between psychological and physical manifestations, emphasizing the importance of timely diagnosis and intervention and its impact on a patient's mental health and quality of life.

Case presentation: A 40-year-old single Iranian man was admitted for the third time owing to exacerbation of mood symptoms, including depression, irritability, aggression, suicidal ideation, and movement and sensory problems. The patient's symptoms began with psychological stressors and family conflict, leading to muscle weakness and tremors in the left hand. Over a year, muscle weakness escalated, leading to slow movement, motor impairment in the lower limbs, and reliance on a cane for walking. The patient still exhibited symptoms, such as a mask-like face, stooped walking posture, and a relative improvement of symptoms periodically. At first, the patient was suspected of Parkinson's disease and was placed on levodopa and amantadine. However, the medication was discontinued owing to an unsatisfactory response and the lack of strong evidence in favor of neurological problems on frequent examinations and reviews. Despite multiple hospitalizations, the patient's symptoms remained unresolved. Finally, after years of investigations, based on specialists' recommendations, he was admitted to the psychosomatic ward for diagnostic evaluationele, and he was diagnosed with functional neurological disorder (psychogenic parkinsonism). He underwent pharmacotherapy, electroconvulsive therapy, and psychotherapy. He was discharged with partial improvement of symptoms, but showed periods of relapse and remission during the following years.

Conclusion: This case study illuminates functional neurological disorder complexities, emphasizing the need for a holistic diagnostic approach. Timely interventions, including psychological support, can alleviate symptoms, reduce healthcare costs, and improve the overall prognosis. The report contributes to evolving functional neurological disorder understanding in psychiatry and neurology. The report underscores early recognition, advocating for comprehensive interventions involving psychiatric support, cognitive-behavioral therapy, and patient psychoeducation.

简介功能性神经紊乱挑战了传统医学的认识,它表现出的神经症状无法用器质性病变来解释。本报告深入探讨了心理和生理表现之间错综复杂的相互作用,强调了及时诊断和干预的重要性及其对患者心理健康和生活质量的影响:一名 40 岁的伊朗单身男子因情绪症状加重(包括抑郁、易怒、攻击性、自杀念头以及运动和感官障碍)第三次入院。患者的症状始于心理压力和家庭冲突,导致左手肌肉无力和震颤。一年后,肌无力症状逐渐加重,导致行动迟缓、下肢运动障碍和依靠拐杖行走。患者仍表现出面具样面容、弯腰驼背的走路姿势等症状,但症状会周期性地相对改善。起初,患者被怀疑患有帕金森病,并开始服用左旋多巴和金刚烷胺。然而,由于疗效不理想,而且在频繁的检查和复查中也没有有力的证据证明患者存在神经系统问题,因此停止了用药。尽管多次住院治疗,但患者的症状仍然没有得到缓解。最后,经过多年的调查,根据专家的建议,他住进了精神病房进行诊断评估,并被诊断为功能性神经紊乱(精神性帕金森病)。他接受了药物治疗、电休克治疗和心理治疗。出院时,他的症状得到了部分改善,但在随后的几年里,症状时而复发,时而缓解:本病例研究揭示了功能性神经紊乱的复杂性,强调了综合诊断方法的必要性。包括心理支持在内的及时干预可以减轻症状、降低医疗成本并改善整体预后。该报告有助于精神病学和神经病学对功能性神经障碍性疾病的认识不断发展。报告强调早期识别,提倡采取综合干预措施,包括精神支持、认知行为疗法和患者心理教育。
{"title":"Functional movement disorder similar to Parkinson's disease: a case report.","authors":"Sarah Goudarzzadeh, Shayan Shekarabi, Mahnaz Abdi","doi":"10.1186/s13256-024-04767-x","DOIUrl":"10.1186/s13256-024-04767-x","url":null,"abstract":"<p><strong>Introduction: </strong>Functional neurological disorder challenges conventional medical understanding, presenting neurological symptoms without organic explanations. This report delves into the intricate interplay between psychological and physical manifestations, emphasizing the importance of timely diagnosis and intervention and its impact on a patient's mental health and quality of life.</p><p><strong>Case presentation: </strong>A 40-year-old single Iranian man was admitted for the third time owing to exacerbation of mood symptoms, including depression, irritability, aggression, suicidal ideation, and movement and sensory problems. The patient's symptoms began with psychological stressors and family conflict, leading to muscle weakness and tremors in the left hand. Over a year, muscle weakness escalated, leading to slow movement, motor impairment in the lower limbs, and reliance on a cane for walking. The patient still exhibited symptoms, such as a mask-like face, stooped walking posture, and a relative improvement of symptoms periodically. At first, the patient was suspected of Parkinson's disease and was placed on levodopa and amantadine. However, the medication was discontinued owing to an unsatisfactory response and the lack of strong evidence in favor of neurological problems on frequent examinations and reviews. Despite multiple hospitalizations, the patient's symptoms remained unresolved. Finally, after years of investigations, based on specialists' recommendations, he was admitted to the psychosomatic ward for diagnostic evaluationele, and he was diagnosed with functional neurological disorder (psychogenic parkinsonism). He underwent pharmacotherapy, electroconvulsive therapy, and psychotherapy. He was discharged with partial improvement of symptoms, but showed periods of relapse and remission during the following years.</p><p><strong>Conclusion: </strong>This case study illuminates functional neurological disorder complexities, emphasizing the need for a holistic diagnostic approach. Timely interventions, including psychological support, can alleviate symptoms, reduce healthcare costs, and improve the overall prognosis. The report contributes to evolving functional neurological disorder understanding in psychiatry and neurology. The report underscores early recognition, advocating for comprehensive interventions involving psychiatric support, cognitive-behavioral therapy, and patient psychoeducation.</p>","PeriodicalId":16236,"journal":{"name":"Journal of Medical Case Reports","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11443806/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Localized type tenosynovial giant cell tumor with metastases to lungs and pleura: a case report and literature review. 肺和胸膜转移的局部型腱鞘巨细胞瘤:病例报告和文献综述。
IF 0.9 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-09-30 DOI: 10.1186/s13256-024-04768-w
Afshan Ali Shaik, Manoj Kumar Panigrahi, Mahismita Patro, Vangapandu Sushmita, Pritinanda Mishra

Background: Tenosynovial giant cell tumor is a rare soft tissue tumor of the synovium of joint, bursae, or tendon sheath. It is divided into localized or diffuse types on the basis of the growth pattern. Localized tenosynovial giant cell tumors are usually benign and treated successfully by excision. Diffuse tenosynovial giant cell tumors, in contrast to localized type, can destroy bone and cartilage and are associated with frequent local recurrences and distant metastasis. Localized type tenosynovial giant cell tumors rarely metastasize to distant organs. Here, we report a case of localized tenosynovial giant cell tumor presenting with lung metastases and systematically review literature.

Case presentation: A 55-year-old Asian male presented with a dry cough, right-sided chest pain and progressive dyspnea for 1 month. At 18 months before this presentation, he had undergone excision of a painless swelling on his right index finger. The swelling recurred within 3 months of excision, and a biopsy was then suggestive of a giant cell tumor. Given the suspicion of a giant cell tumor, a wide excision of the lesion was performed and the excisional biopsy was consistent with a diagnosis of tenosynovial giant cell tumor, localized type. At admission to our hospital, the patient had tachypnoea and absent breath sounds on the right side. A chest radiograph showed a right-sided pleural effusion with a homogenous opacity in the left mid-zone. A contrast-enhanced computed tomography of the chest and abdomen showed right massive pleural effusion and bilateral multiple lobulated heterogeneously enhancing pleural-based masses with areas of internal calcification. Pleural fluid analysis revealed an exudate with no malignant cells on cytology. A lung biopsy showed osteoclast-like giant cells and mononuclear spindle cells with areas of hemorrhage and necrosis, suggesting tenosynovial giant cell tumor metastasis. A final diagnosis of localized type tenosynovial giant cell tumor of the right index finger with metastases to the lungs and pleura was made. The patient passed away after receiving three cycles of denosumab injection owing to progressive disease.

Conclusion: Lung metastasis is extremely rare in patients with localized tenosynovial giant cell tumor. The survival is usually poor in patients with lung metastasis. A close follow-up of patients with localized type tenosynovial giant cell tumor is necessary for early detection of pleuropulmonary complications.

背景:腱鞘巨细胞瘤腱鞘巨细胞瘤是一种罕见的关节滑膜、滑囊或腱鞘软组织肿瘤。根据生长方式可分为局部型和弥漫型。局部型腱鞘巨细胞瘤通常是良性的,切除治疗效果良好。弥漫型腱鞘巨细胞瘤与局部型腱鞘巨细胞瘤相反,可破坏骨和软骨,并经常出现局部复发和远处转移。局部型腱鞘巨细胞瘤很少向远处器官转移。在此,我们报告了一例出现肺转移的局部型腱鞘巨细胞瘤,并系统回顾了相关文献:一名 55 岁的亚洲男性因干咳、右侧胸痛和进行性呼吸困难就诊 1 个月。发病前 18 个月,他曾接受过右手食指无痛肿物切除术。肿物在切除后 3 个月内复发,活检结果提示为巨细胞瘤。鉴于怀疑是巨细胞瘤,医生对病灶进行了广泛切除,切除活检结果与腱鞘巨细胞瘤(局部型)的诊断一致。入院时,患者呼吸急促,右侧呼吸音消失。胸片显示右侧胸腔积液,左侧中区有同质不透明。胸部和腹部对比增强计算机断层扫描显示右侧大量胸腔积液和双侧多发分叶状异质性增强胸膜肿块,肿块内部有钙化区。胸腔积液分析显示有渗出物,细胞学检查未发现恶性细胞。肺活检显示破骨细胞样巨细胞和单核纺锤形细胞,有出血和坏死区域,提示腱鞘巨细胞瘤转移。最终诊断为右手食指局部型腱鞘巨细胞瘤,并向肺部和胸膜转移。患者在接受三个周期的地诺单抗注射后因病情进展而去世:结论:肺转移在局部腱鞘巨细胞瘤患者中极为罕见。结论:在局部腱鞘巨细胞瘤患者中,肺转移极为罕见,肺转移患者的生存率通常较低。有必要对局部型腱鞘巨细胞瘤患者进行密切随访,以便及早发现胸肺部并发症。
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Journal of Medical Case Reports
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