Pub Date : 2013-03-01DOI: 10.13172/2052-0077-2-3-469
K. Vassiou, F. Kotrogianni, E. Lavdas, M. Vlychou, M. Fanariotis, D. Arvanitis, I. Fezoulidis
Introduction The tracheobronchial tree exhibits a wide range of variations. The purpose of this study is the investigation of the frequency and multidetector tomographic (MDCT) findings of anatomical variations of the main bronchi and of the lobar bronchi, as well as the detection of abnormal bronchi originated from the trachea, in subjects without severe bronchial pathology. Materials and methods About 872 consecutive patients who underwent thoracic MDCT examination were enrolled in the study. All MDCT data, including multiplanar reconstructions, maximum intensity projections and volume-rendered images, as well as virtual bronchoscopy, were evaluated for the detection of main bronchial variations. Various kinds of bronchial variations and anomalies, such as tracheal bronchus, accessory cardiac bronchus, bronchus hypoplasia and bronchial origin anomalies, were documented. Results In 872 subjects, the overall frequency of main bronchus variations is 2.52% (22/872). More specifically, tracheal bronchus were found in eight cases (0.9%), accessory cardiac bronchus was found in one case (0.1%), hypoplasia was found in one case (0.1%) and bronchial origin anomalies were found in 10 cases (1.14%). Conclusion The display of tracheobronchial variations is of clinical importance first because they are related to infections and, sometimes, malignancies and second in preoperative or in cases of bronchoscopic procedures. In our study, the commonest variation was the tracheal bronchus. MDCT and virtual bronchoscopy can depict tracheobronchial variations accurately and can be served as an alternative to bronchoscopy in certain cases of possible bronchial anomaly.
{"title":"Tracheobronchial variations evaluated by multidetector computed tomography and virtual bronchoscopy","authors":"K. Vassiou, F. Kotrogianni, E. Lavdas, M. Vlychou, M. Fanariotis, D. Arvanitis, I. Fezoulidis","doi":"10.13172/2052-0077-2-3-469","DOIUrl":"https://doi.org/10.13172/2052-0077-2-3-469","url":null,"abstract":"Introduction The tracheobronchial tree exhibits a wide range of variations. The purpose of this study is the investigation of the frequency and multidetector tomographic (MDCT) findings of anatomical variations of the main bronchi and of the lobar bronchi, as well as the detection of abnormal bronchi originated from the trachea, in subjects without severe bronchial pathology. Materials and methods About 872 consecutive patients who underwent thoracic MDCT examination were enrolled in the study. All MDCT data, including multiplanar reconstructions, maximum intensity projections and volume-rendered images, as well as virtual bronchoscopy, were evaluated for the detection of main bronchial variations. Various kinds of bronchial variations and anomalies, such as tracheal bronchus, accessory cardiac bronchus, bronchus hypoplasia and bronchial origin anomalies, were documented. Results In 872 subjects, the overall frequency of main bronchus variations is 2.52% (22/872). More specifically, tracheal bronchus were found in eight cases (0.9%), accessory cardiac bronchus was found in one case (0.1%), hypoplasia was found in one case (0.1%) and bronchial origin anomalies were found in 10 cases (1.14%). Conclusion The display of tracheobronchial variations is of clinical importance first because they are related to infections and, sometimes, malignancies and second in preoperative or in cases of bronchoscopic procedures. In our study, the commonest variation was the tracheal bronchus. MDCT and virtual bronchoscopy can depict tracheobronchial variations accurately and can be served as an alternative to bronchoscopy in certain cases of possible bronchial anomaly.","PeriodicalId":19393,"journal":{"name":"OA Case Reports","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2013-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79755420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-03-01DOI: 10.13172/2052-0077-2-3-468
G. Sayar, O. Karamustafalıoğlu, Eylem Özten
{"title":"Acute and maintenance transcranial magnetic stimulation (TMS) in a pregnant woman with major depression: A case report","authors":"G. Sayar, O. Karamustafalıoğlu, Eylem Özten","doi":"10.13172/2052-0077-2-3-468","DOIUrl":"https://doi.org/10.13172/2052-0077-2-3-468","url":null,"abstract":"","PeriodicalId":19393,"journal":{"name":"OA Case Reports","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2013-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84135343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-03-01DOI: 10.13172/2052-0077-2-3-467
S. Mujtaba, S. Kamholz
Abstract Introduction There are multiple causes of pericardial effusion, including drugs. Avonex® (interferon beta-1a) is an immunomodulator used for the treatment of multiple sclerosis. Adverse cardiac effects associated with the use of Avonex® are exceedingly rare. To date, only one case has been reported by the United States Food and Drug Administration, associating the use of Avonex® with the development of pericardial effusion. We report the second such case. Case report A 44-year-old woman with a history of multiple sclerosis, asthma and schizophrenia presented to the Emergency Department with increasing shortness of breath for 2 months, which had acutely worsened that morning, orthopnoea and an unintentional weight loss of 10 pounds over the last 6 months. On examination, the patient was found to be short of breath but haemodynamically stable. Notable findings included bilateral wheezing, jugular venous distension and pulsus paradoxus. An electrocardiogram showed a normal sinus rhythm without electrical alternans. Chest radiograph revealed cardiomegaly; a transthoracic echocardiogram showed a large pericardial effusion with evidence of increased pericardial pressure and impending cardiac tamponade. Additional history revealed that the patient had been started on Avonex® 30 mcg once weekly several months prior. A comprehensive work to exclude all potential causes of pericardial effusion, including connective tissue disorders and infectious aetiologies, proved unrevealing. Surgical drainage was performed. A cytological examination of the pericardial fluid revealed benign mesothelial cells; tissue examination confirmed focal mesothelial hyperplasia. A tuberculin skin test was negative. Computed tomographic scanning of the chest, abdomen and pelvis did not show any evidence of an occult malignancy. Conclusion The patient and her neurologist were alerted to the possibility of Avonex®induced pericardial effusion due to the lack of evidence for other aetiologies. Despite the relative dearth of data on Avonex®-related pericardial effusion, this diagnosis is one that merits consideration to prevent potential morbidity and mortality.
{"title":"A rare bird: Avonex ® -induced pericardial effusion","authors":"S. Mujtaba, S. Kamholz","doi":"10.13172/2052-0077-2-3-467","DOIUrl":"https://doi.org/10.13172/2052-0077-2-3-467","url":null,"abstract":"Abstract Introduction There are multiple causes of pericardial effusion, including drugs. Avonex® (interferon beta-1a) is an immunomodulator used for the treatment of multiple sclerosis. Adverse cardiac effects associated with the use of Avonex® are exceedingly rare. To date, only one case has been reported by the United States Food and Drug Administration, associating the use of Avonex® with the development of pericardial effusion. We report the second such case. Case report A 44-year-old woman with a history of multiple sclerosis, asthma and schizophrenia presented to the Emergency Department with increasing shortness of breath for 2 months, which had acutely worsened that morning, orthopnoea and an unintentional weight loss of 10 pounds over the last 6 months. On examination, the patient was found to be short of breath but haemodynamically stable. Notable findings included bilateral wheezing, jugular venous distension and pulsus paradoxus. An electrocardiogram showed a normal sinus rhythm without electrical alternans. Chest radiograph revealed cardiomegaly; a transthoracic echocardiogram showed a large pericardial effusion with evidence of increased pericardial pressure and impending cardiac tamponade. Additional history revealed that the patient had been started on Avonex® 30 mcg once weekly several months prior. A comprehensive work to exclude all potential causes of pericardial effusion, including connective tissue disorders and infectious aetiologies, proved unrevealing. Surgical drainage was performed. A cytological examination of the pericardial fluid revealed benign mesothelial cells; tissue examination confirmed focal mesothelial hyperplasia. A tuberculin skin test was negative. Computed tomographic scanning of the chest, abdomen and pelvis did not show any evidence of an occult malignancy. Conclusion The patient and her neurologist were alerted to the possibility of Avonex®induced pericardial effusion due to the lack of evidence for other aetiologies. Despite the relative dearth of data on Avonex®-related pericardial effusion, this diagnosis is one that merits consideration to prevent potential morbidity and mortality.","PeriodicalId":19393,"journal":{"name":"OA Case Reports","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2013-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74655858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-03-01DOI: 10.13172/2052-0077-2-3-509
A. Thakur, Js Thakur
Introduction Anticancer drugs have a number of side effects, including toxic effects on bone marrow, kidney, lymphoreticular tissue, mucosa and cochlea. Extravasational toxicity is a complication of anticancer drugs, unmentioned in the majority of clinical textbooks other than oncology, explaining why residents may be unaware of this preventable catastrophe. The objective of this paper is to review and present the clinical features and management of extravasation of these anticancer drugs so that first line staff get acquainted to this complication and its management. After reading this paper, residents and clinicians will be more vigilant in anticancer drug infusion and management of extravasation. Conclusion Once extravasation occurs, tis-sue injury is inevitable but can be reduced with the proper antidote. A trained member of staff should ad-minister this, preferably from the on-cology department only. Introduction As the incidence of cancer is increasing, cancer management has become a team effort consisting of family members, physicians, surgeons, radiations and medical oncologists, psychiatrists and physiotherapists. The objective of this team is to provide a cure or palliation with minimal side effects and quality of life to the patient. Radiation therapy has become target-orientated to avoid injury to normal tissue but now chemoradiation is the preferred modality. In spite of giving promising results, these anticancer drugs have a number of side effects, which include toxic effects on bone marrow, kidney, lymphoreticular tissue, mucosa and cochlea1. In India, the oncology department is overloaded with cancer patients; hence, anticancer drugs are being infused in the parent departments by nurses and residents. However, extravasational toxicity is one of the dreaded complications of anticancer drugs, which didnot find a place in the majority of clinical textbooks1–7 other than oncology, and hence many of the residents may be unaware of this preventable catastrophe8. The incidence of extravasations in adults is 0.1% to 6.5%9,10. Extravasation can occur in any centre and even in highly advanced oncology centres11, but these advanced centres have specially trained oncology-nursing staff. Commonly, chemotherapy is infused in clinical or parental departments of the patient, and work of infusion is left to a house surgeon or an intern, who may not have yet acquired a reasonable experience in venepuncture. Even the resident may not have adequate knowledge of the measures to be undertaken in case of extravasation due to absence of this complication and its management in the majority of clinical textbooks. The objective of this paper is to review and present the clinical features and management of extravasation of these anticancer drugs so that the first line staff (residents/nurses) gets acquainted to this complication and its management. Classification based on mode of
{"title":"Extravasational toxicity of anticancer chemotherapy and its management","authors":"A. Thakur, Js Thakur","doi":"10.13172/2052-0077-2-3-509","DOIUrl":"https://doi.org/10.13172/2052-0077-2-3-509","url":null,"abstract":"Introduction Anticancer drugs have a number of side effects, including toxic effects on bone marrow, kidney, lymphoreticular tissue, mucosa and cochlea. Extravasational toxicity is a complication of anticancer drugs, unmentioned in the majority of clinical textbooks other than oncology, explaining why residents may be unaware of this preventable catastrophe. The objective of this paper is to review and present the clinical features and management of extravasation of these anticancer drugs so that first line staff get acquainted to this complication and its management. After reading this paper, residents and clinicians will be more vigilant in anticancer drug infusion and management of extravasation. Conclusion Once extravasation occurs, tis-sue injury is inevitable but can be reduced with the proper antidote. A trained member of staff should ad-minister this, preferably from the on-cology department only. Introduction As the incidence of cancer is increasing, cancer management has become a team effort consisting of family members, physicians, surgeons, radiations and medical oncologists, psychiatrists and physiotherapists. The objective of this team is to provide a cure or palliation with minimal side effects and quality of life to the patient. Radiation therapy has become target-orientated to avoid injury to normal tissue but now chemoradiation is the preferred modality. In spite of giving promising results, these anticancer drugs have a number of side effects, which include toxic effects on bone marrow, kidney, lymphoreticular tissue, mucosa and cochlea1. In India, the oncology department is overloaded with cancer patients; hence, anticancer drugs are being infused in the parent departments by nurses and residents. However, extravasational toxicity is one of the dreaded complications of anticancer drugs, which didnot find a place in the majority of clinical textbooks1–7 other than oncology, and hence many of the residents may be unaware of this preventable catastrophe8. The incidence of extravasations in adults is 0.1% to 6.5%9,10. Extravasation can occur in any centre and even in highly advanced oncology centres11, but these advanced centres have specially trained oncology-nursing staff. Commonly, chemotherapy is infused in clinical or parental departments of the patient, and work of infusion is left to a house surgeon or an intern, who may not have yet acquired a reasonable experience in venepuncture. Even the resident may not have adequate knowledge of the measures to be undertaken in case of extravasation due to absence of this complication and its management in the majority of clinical textbooks. The objective of this paper is to review and present the clinical features and management of extravasation of these anticancer drugs so that the first line staff (residents/nurses) gets acquainted to this complication and its management. Classification based on mode of","PeriodicalId":19393,"journal":{"name":"OA Case Reports","volume":"33 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2013-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87343027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-03-01DOI: 10.13172/2052-0077-2-3-507
Ak Al-Hawary, A. Shalaby, A. Shebl, S. Khater, B. Wadie, Ea Abu Beih, M. El-baz
Introduction The coexistence of renal cell carcinoma and urothelial carcinoma of renal pelvis or ureter has rarely been described in literature. This paper discusses synchronous ipsilateral transitional cell and papillary renal cell carcinomas. Case report We present a case of a 69-year-old male who was admitted in Mansoura Urology and Nephrology Centre with a history of loin pain and occasional haematuria confirmed to be transitional cell carcinoma combined with papillary renal cell carcinoma. Conclusion In more than 31 years, this was the first reported case of synchronous renal tumour in Mansoura Urology and Nephrology Centre, Mansoura University, Egypt. Introduction Renal cell carcinoma (RCC) is the most common adult renal epithelial cancer, accounting for more than 90% of all renal malignancies1. Primary transitional cell carcinoma (TCC) of the renal pelvis or ureter is a relatively rare disease. It accounts for <1% of genitourinary neoplasms and 5%–7% of all urinary tract tumours2. The coexistence of RCC and TCC of renal pelvis or ureter is uncommon3. According to Choi et al4., 26 cases of synchronous renal carcinoma and TCC are reported in the literature. This paper discussed the first case of synchronous papillary RCC and pelvic TCC managed in Mansoura Urology and Nephrology Center. Case report A 69-year-old man presented with left loin pain and occasional total haematuria for 6 months prior to admission in the Urology and Nephrology Center. A palpable left renal mass was the main finding on his physical examination. Laboratory tests were unremarkable, except for the high serum creatinine (1.7 mg/ dl). Serum total prostatic specific antigen was also elevated (8.7 ng/ml). Transrectal ultrasound and biopsy confirmed benign prostate enlargement. An abdominal computerized tomography scan (CT) revealed a large renal mass, about 15 cm in diameter. This mass occupied most of the lower and middle zones of the left kidney and was compressing the descending colon and sigmoid colon. No enlarged hilar or regional lymphnodes were detected. The other kidney showed no abnormalities. On cystoscopy, there was no associated bladder tumour, and bone scan showed no evidence of metastasis. The patient had left radical nephrectomy via supracostal (above the eleventh rib) approach. On exploration, no visibly enlarged lymph nodes were detected. Liver surface was normal with no metastasis. There was a large renal mass attached to the transverse mesocolon and the descending colon was stretched and attached to the anterior surface of the kidney. Dissection of the kidney with its covering perirenal fascia was performed. Ligation of a single hilar renal artery was performed followed by the vein. The wound was closed in layers with suitable drain, and the post-operative period was uneventful. He was discharged in good condition 5 days after the surgery. No post-operative chemotherapy was administered. This patient will be followed up with abdominal CT, complete blood
{"title":"Synchronous ipsilateral transitional cell and papillary renal cell carcinomas","authors":"Ak Al-Hawary, A. Shalaby, A. Shebl, S. Khater, B. Wadie, Ea Abu Beih, M. El-baz","doi":"10.13172/2052-0077-2-3-507","DOIUrl":"https://doi.org/10.13172/2052-0077-2-3-507","url":null,"abstract":"Introduction The coexistence of renal cell carcinoma and urothelial carcinoma of renal pelvis or ureter has rarely been described in literature. This paper discusses synchronous ipsilateral transitional cell and papillary renal cell carcinomas. Case report We present a case of a 69-year-old male who was admitted in Mansoura Urology and Nephrology Centre with a history of loin pain and occasional haematuria confirmed to be transitional cell carcinoma combined with papillary renal cell carcinoma. Conclusion In more than 31 years, this was the first reported case of synchronous renal tumour in Mansoura Urology and Nephrology Centre, Mansoura University, Egypt. Introduction Renal cell carcinoma (RCC) is the most common adult renal epithelial cancer, accounting for more than 90% of all renal malignancies1. Primary transitional cell carcinoma (TCC) of the renal pelvis or ureter is a relatively rare disease. It accounts for <1% of genitourinary neoplasms and 5%–7% of all urinary tract tumours2. The coexistence of RCC and TCC of renal pelvis or ureter is uncommon3. According to Choi et al4., 26 cases of synchronous renal carcinoma and TCC are reported in the literature. This paper discussed the first case of synchronous papillary RCC and pelvic TCC managed in Mansoura Urology and Nephrology Center. Case report A 69-year-old man presented with left loin pain and occasional total haematuria for 6 months prior to admission in the Urology and Nephrology Center. A palpable left renal mass was the main finding on his physical examination. Laboratory tests were unremarkable, except for the high serum creatinine (1.7 mg/ dl). Serum total prostatic specific antigen was also elevated (8.7 ng/ml). Transrectal ultrasound and biopsy confirmed benign prostate enlargement. An abdominal computerized tomography scan (CT) revealed a large renal mass, about 15 cm in diameter. This mass occupied most of the lower and middle zones of the left kidney and was compressing the descending colon and sigmoid colon. No enlarged hilar or regional lymphnodes were detected. The other kidney showed no abnormalities. On cystoscopy, there was no associated bladder tumour, and bone scan showed no evidence of metastasis. The patient had left radical nephrectomy via supracostal (above the eleventh rib) approach. On exploration, no visibly enlarged lymph nodes were detected. Liver surface was normal with no metastasis. There was a large renal mass attached to the transverse mesocolon and the descending colon was stretched and attached to the anterior surface of the kidney. Dissection of the kidney with its covering perirenal fascia was performed. Ligation of a single hilar renal artery was performed followed by the vein. The wound was closed in layers with suitable drain, and the post-operative period was uneventful. He was discharged in good condition 5 days after the surgery. No post-operative chemotherapy was administered. This patient will be followed up with abdominal CT, complete blood ","PeriodicalId":19393,"journal":{"name":"OA Case Reports","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2013-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79009774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-02-01DOI: 10.13172/2052-0077-2-2-424
C. Meisenkothen, M. Finkelstein
Introduction During normal human embryonic development, the testes descend from the abdominal cavity to the scrotal sac. Passage occurs through the processus vaginalis, which arises as an outpouching of the parietal peritoneum at the beginning of the third month of gestation. After the testis descends into the scrotum (between 7 and 9 months of gestation), the processus vaginalis is normally obliterated. However, the processus vaginalis remains patent at birth in 20% of the population. Most boys born with a patent processus vaginalis remain asymptomatic throughout life, but incomplete closure of the processus vaginalis may lead to a variety of abnormalities. Complete patency may result in a communicating hydrocele or a congenital i nguinoscrotal hernia. A persistent processus vaginalis often closes during the first year of life, probably in response to the surge in serum testosterone that normally occurs at 1–2 months of age1. The tunica vaginalis is a mesotheliumlined sac that results from closure of the superior portion of the processus vaginalis. In the event that the processus vaginalis does not close completely, then the tunica vaginalis remains in communication with the peritoneal cavity. Mesothelioma of the tunica vaginalis is a rare tumour. In a study of incident cases of mesothelioma in the Netherlands, most of the mesotheliomas occurred in the pleura, where there were 119 (88%) against 15 (11%) in the peritoneum and two in the tunica vaginalis testis2. Marinaccio and colleagues3 reported on the incidence of extrapleural mesothelioma in the Italian National Mesothelioma Registry. Standardized incidence rates (Italy, 2004, per million inhabitants) were 2.1 cases for the peritoneal site and 0.2 cases for the tunica vaginalis testis. Mesothelioma of the tunica vaginalis represents only 0.09% (10 cases) of all mesothelioma deaths in the UK Health and Safety Executive Mesothelioma Register4. Mesothelioma of the tunica vaginalis has been associated with asbestos exposure. The first case report was published by Fligiel and Kaneko in 19765. The subject, a 68-year-old man, had worked for 40 years as a pipe insulator. Gorini and colleagues6 in Italy reported two cases of this tumour. A 67-year-old man had been occupationally exposed to asbestos for a 30-year period with a latency of 42 years. An 80-year-old man had been exposed to asbestos for 5 years with a latency of 52 years. Spiess and colleagues reported a retrospective clinicopathological and follow-up study of five patients with malignant mesothelioma of the tunica vaginalis treated at the M.D. Anderson Cancer Center in Houston, Texas, during a 25year period7. Asbestos exposure was identified in four of the five patients. In the Italian Registry Study3, 70% of subjects with mesothelioma of the tunica vaginalis had occupational or leisure-related exposure to asbestos. Mean latency (defined as the time elapsing between the beginning of exposure to asbestos and diagnosis) was estimated for cas
{"title":"Asbestos exposure and malignant mesothelioma of the tunica vaginalis testis: Case series and review of the literature","authors":"C. Meisenkothen, M. Finkelstein","doi":"10.13172/2052-0077-2-2-424","DOIUrl":"https://doi.org/10.13172/2052-0077-2-2-424","url":null,"abstract":"Introduction During normal human embryonic development, the testes descend from the abdominal cavity to the scrotal sac. Passage occurs through the processus vaginalis, which arises as an outpouching of the parietal peritoneum at the beginning of the third month of gestation. After the testis descends into the scrotum (between 7 and 9 months of gestation), the processus vaginalis is normally obliterated. However, the processus vaginalis remains patent at birth in 20% of the population. Most boys born with a patent processus vaginalis remain asymptomatic throughout life, but incomplete closure of the processus vaginalis may lead to a variety of abnormalities. Complete patency may result in a communicating hydrocele or a congenital i nguinoscrotal hernia. A persistent processus vaginalis often closes during the first year of life, probably in response to the surge in serum testosterone that normally occurs at 1–2 months of age1. The tunica vaginalis is a mesotheliumlined sac that results from closure of the superior portion of the processus vaginalis. In the event that the processus vaginalis does not close completely, then the tunica vaginalis remains in communication with the peritoneal cavity. Mesothelioma of the tunica vaginalis is a rare tumour. In a study of incident cases of mesothelioma in the Netherlands, most of the mesotheliomas occurred in the pleura, where there were 119 (88%) against 15 (11%) in the peritoneum and two in the tunica vaginalis testis2. Marinaccio and colleagues3 reported on the incidence of extrapleural mesothelioma in the Italian National Mesothelioma Registry. Standardized incidence rates (Italy, 2004, per million inhabitants) were 2.1 cases for the peritoneal site and 0.2 cases for the tunica vaginalis testis. Mesothelioma of the tunica vaginalis represents only 0.09% (10 cases) of all mesothelioma deaths in the UK Health and Safety Executive Mesothelioma Register4. Mesothelioma of the tunica vaginalis has been associated with asbestos exposure. The first case report was published by Fligiel and Kaneko in 19765. The subject, a 68-year-old man, had worked for 40 years as a pipe insulator. Gorini and colleagues6 in Italy reported two cases of this tumour. A 67-year-old man had been occupationally exposed to asbestos for a 30-year period with a latency of 42 years. An 80-year-old man had been exposed to asbestos for 5 years with a latency of 52 years. Spiess and colleagues reported a retrospective clinicopathological and follow-up study of five patients with malignant mesothelioma of the tunica vaginalis treated at the M.D. Anderson Cancer Center in Houston, Texas, during a 25year period7. Asbestos exposure was identified in four of the five patients. In the Italian Registry Study3, 70% of subjects with mesothelioma of the tunica vaginalis had occupational or leisure-related exposure to asbestos. Mean latency (defined as the time elapsing between the beginning of exposure to asbestos and diagnosis) was estimated for cas","PeriodicalId":19393,"journal":{"name":"OA Case Reports","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2013-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82255322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-02-01DOI: 10.13172/2052-0077-2-2-409
F. Longo, G. Musumeci, R. Parenti, G. Vecchio, G. Pizzicannella, G. Magro
Introduction We have reported a case of cellular fibrous histiocytoma occurring as a polypoid, dermal nodule in the arm of a 10-year old boy. The tumour was predominantly composed of spindleshaped cells with a mild degree of nuclear pleomorphism and showed unusual morphological features like central necrosis and epidermal ulceration. Apart from vimentin and CD10, surprisingly, neoplastic cells were diffusely stained with an epithelial membrane antigen. Although expression of the epithelial membrane antigen is absent in conventional fibrous histiocytomas, immunoreactivity for this marker has been reported in about 60% of dermal epithelioid cell fibrous histiocytomas. Case report A 10-year old boy presented to our observation with a non-painful, solitary, polypoid, cutaneous lesion; the lesion was focally ulcerated, measuring 1 cm in its greatest diameter, and located in the right arm. This is the first case of cellular fibrous histiocytoma, which exhibited diffused expression of the epithelial membrane antigen. The presence of tumour necrosis and epidermal ulceration, along with an aberrant expression of the epithelial membrane antigen, raised serious diagnostic problems, leading to a speculation regarding the presence of epithelioid sarcoma. Conclusion Immunohistochemical analyses, showing diffused nuclear INI1 (hSNF5/SMARCB1) expression and the absence of pancytokeratins, were extremely helpful in ruling out epithelioid sarcoma. Awareness of the possibility that dermal cellular fibrous histiocytoma may concurrently exhibit necrosis, epidermal ulceration and diffused expression of epithelial membrane antigen, is crucial to avoid a misdiagnosis of malignancy. Introduction Fibrous histiocytoma is a common fibro-histiocytic tumour which commonly occurs in the dermis and superficial subcutis (dermatofibroma). The diagnosis of dermatofibroma/fibrous histiocytoma is usually straightforward if the typical morphological features are present1–3. However, some diagnostic difficulties may arise when one is dealing with some unusual morphological variants, including cellular1,3,4, lipidised2,3, haemosiderotic3,4, aneurysmal1–4, keloidal3,4, granular cell2–4, palisading3,4, atrophic1–4, clear cell1–4, myxoid4, lichenoid3,4, balloon cell3,4, signet-ring cell3,4, with osteoclastlike giant cells4,5, with smooth muscle proliferation4, with prominent myofibroblastic proliferation4, with intracytoplasmic eosinophilic globules4, plexiform3,4, epithelioid1,3,4,6–8, atypical1–4,9,10 and lastly, combined variants11,12. Among these variants, cellular fibrous histiocytoma (CFH) may represent a diagnostic challenge because there is the risk of it being confused with other benign or malignant dermal tumours1,3, 4. CFH, first described by Calonje et al.13 as a distinct variant of fibrous histiocytoma, accounts to approximately 5% of cutaneous benign fibrous histiocytomas (dermatofibromas) . CFH generally presents in young to middle-aged adults as a slowly growing, solitary
{"title":"Aberrant epithelial membrane antigen expression in dermal cellular fibrous histiocytoma with central necrosis and epidermal ulceration: a potential mimicker of epithelioid sarcoma","authors":"F. Longo, G. Musumeci, R. Parenti, G. Vecchio, G. Pizzicannella, G. Magro","doi":"10.13172/2052-0077-2-2-409","DOIUrl":"https://doi.org/10.13172/2052-0077-2-2-409","url":null,"abstract":"Introduction We have reported a case of cellular fibrous histiocytoma occurring as a polypoid, dermal nodule in the arm of a 10-year old boy. The tumour was predominantly composed of spindleshaped cells with a mild degree of nuclear pleomorphism and showed unusual morphological features like central necrosis and epidermal ulceration. Apart from vimentin and CD10, surprisingly, neoplastic cells were diffusely stained with an epithelial membrane antigen. Although expression of the epithelial membrane antigen is absent in conventional fibrous histiocytomas, immunoreactivity for this marker has been reported in about 60% of dermal epithelioid cell fibrous histiocytomas. Case report A 10-year old boy presented to our observation with a non-painful, solitary, polypoid, cutaneous lesion; the lesion was focally ulcerated, measuring 1 cm in its greatest diameter, and located in the right arm. This is the first case of cellular fibrous histiocytoma, which exhibited diffused expression of the epithelial membrane antigen. The presence of tumour necrosis and epidermal ulceration, along with an aberrant expression of the epithelial membrane antigen, raised serious diagnostic problems, leading to a speculation regarding the presence of epithelioid sarcoma. Conclusion Immunohistochemical analyses, showing diffused nuclear INI1 (hSNF5/SMARCB1) expression and the absence of pancytokeratins, were extremely helpful in ruling out epithelioid sarcoma. Awareness of the possibility that dermal cellular fibrous histiocytoma may concurrently exhibit necrosis, epidermal ulceration and diffused expression of epithelial membrane antigen, is crucial to avoid a misdiagnosis of malignancy. Introduction Fibrous histiocytoma is a common fibro-histiocytic tumour which commonly occurs in the dermis and superficial subcutis (dermatofibroma). The diagnosis of dermatofibroma/fibrous histiocytoma is usually straightforward if the typical morphological features are present1–3. However, some diagnostic difficulties may arise when one is dealing with some unusual morphological variants, including cellular1,3,4, lipidised2,3, haemosiderotic3,4, aneurysmal1–4, keloidal3,4, granular cell2–4, palisading3,4, atrophic1–4, clear cell1–4, myxoid4, lichenoid3,4, balloon cell3,4, signet-ring cell3,4, with osteoclastlike giant cells4,5, with smooth muscle proliferation4, with prominent myofibroblastic proliferation4, with intracytoplasmic eosinophilic globules4, plexiform3,4, epithelioid1,3,4,6–8, atypical1–4,9,10 and lastly, combined variants11,12. Among these variants, cellular fibrous histiocytoma (CFH) may represent a diagnostic challenge because there is the risk of it being confused with other benign or malignant dermal tumours1,3, 4. CFH, first described by Calonje et al.13 as a distinct variant of fibrous histiocytoma, accounts to approximately 5% of cutaneous benign fibrous histiocytomas (dermatofibromas) . CFH generally presents in young to middle-aged adults as a slowly growing, solitary ","PeriodicalId":19393,"journal":{"name":"OA Case Reports","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2013-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82321920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-02-01DOI: 10.13172/2052-0077-2-2-426
A. Orsetti, P. Markiewicz, M. Epstein, Ojg Conceio, G. D'Ippolito, M. Ribeiro
Abstract Introduction Chromobacterium violaceum is a Gram-negative bacillus often found in soil and water of tropical and subtrop-ical regions. Human infection by this bacterium is rare; however, when it occurs, it is associated with high mor-tality rates if not diagnosed or treated correctly or early enough. A study car-ried out between 1971 and 2005 high-lighted that human infection by this microorganism could yield mortality rates between 60 % and 80%. Systemic clinical symptoms include sepsis and visceral abscesses in the liver. The combination of percutaneous drainage of abscesses and systemic antibiotic therapy remains the most common treatment. Currently, it is believed that diagnosis via computed tomography scan and ultrasound-guided aspira-tion must be done before beginning antibiotic therapy. We report a case of C. violaceum infection in Brazil in a pa-tient who had rapid evolution of signs and multiple liver abscesses. Treat-ment consisted of interventional ra- Ð need for surgical intervention.
{"title":"Liver abscesses by chromobacterium violaceum: a case report of a rare disease","authors":"A. Orsetti, P. Markiewicz, M. Epstein, Ojg Conceio, G. D'Ippolito, M. Ribeiro","doi":"10.13172/2052-0077-2-2-426","DOIUrl":"https://doi.org/10.13172/2052-0077-2-2-426","url":null,"abstract":"Abstract Introduction Chromobacterium violaceum is a Gram-negative bacillus often found in soil and water of tropical and subtrop-ical regions. Human infection by this bacterium is rare; however, when it occurs, it is associated with high mor-tality rates if not diagnosed or treated correctly or early enough. A study car-ried out between 1971 and 2005 high-lighted that human infection by this microorganism could yield mortality rates between 60 % and 80%. Systemic clinical symptoms include sepsis and visceral abscesses in the liver. The combination of percutaneous drainage of abscesses and systemic antibiotic therapy remains the most common treatment. Currently, it is believed that diagnosis via computed tomography scan and ultrasound-guided aspira-tion must be done before beginning antibiotic therapy. We report a case of C. violaceum infection in Brazil in a pa-tient who had rapid evolution of signs and multiple liver abscesses. Treat-ment consisted of interventional ra-\u0003\u0003 \u0003Ð \u0003\u0003\u0003need for surgical intervention.","PeriodicalId":19393,"journal":{"name":"OA Case Reports","volume":"86 2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2013-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83329835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-02-01DOI: 10.13172/2052-0077-2-2-416
V. Soldo, N. Cutura, S. Andjelić, M. Zamurović
Introduction Thrombocytopenia, or a low blood platelet count, is encountered in 7–8% of all pregnancies1. It is the second most common blood disorder in pregnancy2,3. The first blood disorder is anaemia3. Platelets are non-nucleated cells derived from megakaryocytes in the bone marrow and normally live in the peripheral circulation for as long as 10 days. Platelets play a critical initiating role in haemostatic system1,4. The normal range of platelets in non-pregnant women is 150 000– 400 000/μL. Average platelet count in pregnancy is decreased. Change in platelet count is due to haemodilution, increased platelet consumption and increased platelet aggregation driven by increased levels of thromboxane A2. Thrombocytopenia can be defined as platelet count less than 150 000/μL or platelet count below the 2.5th percentile for pregnant patients (116 000/μL)1. Classification of thrombocytopenia in pregnancy is arbitary and not necessarily clinically relevant. Mild thrombocytopenia is 100 000– 150 000/μL, moderate thrombocytopenia is 50 000–100 000/μL and severe thrombocytopenia is less than 50 000/μL. The pathophysiology of gestational thrombocytopenia (GT) is unknown. It usually develops in the third trimester, detected incidentally, pati ents are asymptomatic with no prepregnancy history of low platelets or abnormal bleeding, it is mild thrombocytopenia (counts more than 70 000/μL)5–9. GT accounts for almost threefourths of all cases of thrombocytopenia2,10. Mode of delivery is determined by obstetric/maternal indications. Platelet counts normalize within 2–12 weeks following delivery10–12. No pathological significance for the mother or foetus is noted. No risk for foetal haemorrhage or bleeding complications is observed13–17. A low platelet count can also be associated with preeclampsia, HELLP syndrome or idiopathic thrombocytopenic purpura (ITP)18–23. The differential diagnosis between mild ITP and GT is very difficult during pregnancy5,19. ITP accounts for only approximately one case of thrombocytopenia per 1000 pregnancies and 5% of cases of pregnancy-associated thrombocytopenia, it is the most common cause of significant thrombocytopenia in the first trimester24–27. Women with ITP often have a history of bleeding complications and have thrombocytopenia on a prepregnancy platelet count16,28. We present this rare case of GT in a pregnant 30-year-old woman.
{"title":"An unusual case of gestational thrombocytopenia: case report and review of the literature","authors":"V. Soldo, N. Cutura, S. Andjelić, M. Zamurović","doi":"10.13172/2052-0077-2-2-416","DOIUrl":"https://doi.org/10.13172/2052-0077-2-2-416","url":null,"abstract":"Introduction Thrombocytopenia, or a low blood platelet count, is encountered in 7–8% of all pregnancies1. It is the second most common blood disorder in pregnancy2,3. The first blood disorder is anaemia3. Platelets are non-nucleated cells derived from megakaryocytes in the bone marrow and normally live in the peripheral circulation for as long as 10 days. Platelets play a critical initiating role in haemostatic system1,4. The normal range of platelets in non-pregnant women is 150 000– 400 000/μL. Average platelet count in pregnancy is decreased. Change in platelet count is due to haemodilution, increased platelet consumption and increased platelet aggregation driven by increased levels of thromboxane A2. Thrombocytopenia can be defined as platelet count less than 150 000/μL or platelet count below the 2.5th percentile for pregnant patients (116 000/μL)1. Classification of thrombocytopenia in pregnancy is arbitary and not necessarily clinically relevant. Mild thrombocytopenia is 100 000– 150 000/μL, moderate thrombocytopenia is 50 000–100 000/μL and severe thrombocytopenia is less than 50 000/μL. The pathophysiology of gestational thrombocytopenia (GT) is unknown. It usually develops in the third trimester, detected incidentally, pati ents are asymptomatic with no prepregnancy history of low platelets or abnormal bleeding, it is mild thrombocytopenia (counts more than 70 000/μL)5–9. GT accounts for almost threefourths of all cases of thrombocytopenia2,10. Mode of delivery is determined by obstetric/maternal indications. Platelet counts normalize within 2–12 weeks following delivery10–12. No pathological significance for the mother or foetus is noted. No risk for foetal haemorrhage or bleeding complications is observed13–17. A low platelet count can also be associated with preeclampsia, HELLP syndrome or idiopathic thrombocytopenic purpura (ITP)18–23. The differential diagnosis between mild ITP and GT is very difficult during pregnancy5,19. ITP accounts for only approximately one case of thrombocytopenia per 1000 pregnancies and 5% of cases of pregnancy-associated thrombocytopenia, it is the most common cause of significant thrombocytopenia in the first trimester24–27. Women with ITP often have a history of bleeding complications and have thrombocytopenia on a prepregnancy platelet count16,28. We present this rare case of GT in a pregnant 30-year-old woman.","PeriodicalId":19393,"journal":{"name":"OA Case Reports","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2013-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90259531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-02-01DOI: 10.13172/2052-0077-2-2-466
A. Tsavari, K. Koulia, E. Skafida, D. Myoteri, A. Zisi, X. Grammatoglou, T. Vasilakaki
Abstract Introduction Primary extranodal lymphomas of the liver are notably rare. A proportion of cases are associated with infection with hepatitis C or B, HIV, EBV or primary biliary cirrhosis. We report the case of a 45-year-old man who presented with abdominal pain and weight loss. Case report Physical examination revealed an enlarged liver, but ascites, jaundice, splenomegaly and peripheral lymphadenopathy were absent. Laboratory studies showed elevated hepatic enzymes. Tumour markers CEA and AFP were normal. Abdominal computed tomography revealed multiple hypodense lesions in both lobes of the liver. Liver biopsy examination confirmed a diagnosis of non-Hodgkin’s anaplastic large-cell lymphoma of T phenotype. Immunohistochemically, the neoplastic cells were positive for CD43, CD4, CD2, CD3, CD30, CD5 and granzyme B and negative for CD20, CD79a, CD10, EBV, CD15, CEA, EMA, CD56, CD57 and ALK1. Bone marrow biopsy did not reveal lymphomatous involvement. The patient received combination chemotherapy, and he was alive 2 years after diagnosis. Conclusion Although primary lymphoma of liver is rare compared with secondary hepatic involvement by lymphoma, primary epithelial neoplasms and metastatic carcinoma, the diagnosis should be considered in certain clinical circumstances. The prognosis relates to the specific disease entity.
{"title":"Primary anaplastic large-cell lymphoma, ALK1 negative, of the liver: A case report","authors":"A. Tsavari, K. Koulia, E. Skafida, D. Myoteri, A. Zisi, X. Grammatoglou, T. Vasilakaki","doi":"10.13172/2052-0077-2-2-466","DOIUrl":"https://doi.org/10.13172/2052-0077-2-2-466","url":null,"abstract":"Abstract Introduction Primary extranodal lymphomas of the liver are notably rare. A proportion of cases are associated with infection with hepatitis C or B, HIV, EBV or primary biliary cirrhosis. We report the case of a 45-year-old man who presented with abdominal pain and weight loss. Case report Physical examination revealed an enlarged liver, but ascites, jaundice, splenomegaly and peripheral lymphadenopathy were absent. Laboratory studies showed elevated hepatic enzymes. Tumour markers CEA and AFP were normal. Abdominal computed tomography revealed multiple hypodense lesions in both lobes of the liver. Liver biopsy examination confirmed a diagnosis of non-Hodgkin’s anaplastic large-cell lymphoma of T phenotype. Immunohistochemically, the neoplastic cells were positive for CD43, CD4, CD2, CD3, CD30, CD5 and granzyme B and negative for CD20, CD79a, CD10, EBV, CD15, CEA, EMA, CD56, CD57 and ALK1. Bone marrow biopsy did not reveal lymphomatous involvement. The patient received combination chemotherapy, and he was alive 2 years after diagnosis. Conclusion Although primary lymphoma of liver is rare compared with secondary hepatic involvement by lymphoma, primary epithelial neoplasms and metastatic carcinoma, the diagnosis should be considered in certain clinical circumstances. The prognosis relates to the specific disease entity.","PeriodicalId":19393,"journal":{"name":"OA Case Reports","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2013-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74700693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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