AME Case Reports最新文献

Background: Collision tumors of the gastrointestinal (GI) tract are thought to be uncommon, with those of the colon being rare with very few cases reported in current literature. There are three proposed theories regarding the etiology of collision tumors currently, including the "double primaries", the "biclonal malignant transformation", and the "tumor-to-tumor carcinogenesis" theories. Prognosis of collision tumors remains unclear. To our knowledge, this is the fifth case of a collision carcinoma involving the cecum and ileocecal valve and the first report of a collision carcinoma including both mucinous adenocarcinoma and neuroendocrine tumor of the cecum and the ileocecal valve. The aim of this paper is to explore the history of collision tumors and associated nomenclature, defined diagnostic criteria, and proposed theories for etiology in addition to patient presentation, approach to diagnosis, treatment options, and prognosis.

Case description: We present the case of an 83-year-old female who presented to the emergency room with a 4-month history of cramping abdominal pain associated with nausea, emesis, and decreased appetite with associated weight loss. Diagnostic imaging demonstrated a bowel obstruction secondary to a mass in the cecum and she underwent an exploratory laparotomy with right hemicolectomy. She was found to have a collision carcinoma of the cecum and ileocecal valve containing both mucinous adenocarcinoma and neuroendocrine tumor. Diagnosis was confirmed post-operatively with pathologic examination and immunohistochemical testing.

Conclusions: Diagnosing collision tumors upon patient presentation is exceedingly difficult as the symptoms are often identical to other neoplasms of the GI tract and vary based on location of the tumor. It is thought that the true prevalence of collision tumors is underestimated due to history of changing nomenclature, unclear diagnostic criteria, unreported cases, and unrecognized cases. Furthermore, new advances in immunohistochemical evaluation have allowed for better characterization of these neoplasms. With clarification regarding nomenclature, diagnostic criteria and expanding awareness, it is our hope that this leads to an increase in reported cases, allowing for an expanded discussion and resulting growth of literature and further studies. Further knowledge regarding the pathogenesis, treatment, and prognosis is needed.

Background: Cardiac resynchronization therapy (CRT) implantation has significantly improved quality of life and reduced overall mortality due to heart failure. The conventional method of CRT implantation is implanting a left ventricle (LV) lead into a side branch of the coronary sinus (CS) tributary to pace the epicardial surface and capture the LV. This is safe, and well tolerated with a high success rate. The rate of failure to place an LV lead has decreased over time, however, there are still challenging cases where a conventional CRT implant fails and alternative techniques are being considered, one such technique is trans-septal endocardial LV lead placement used to capture the LV, endocardially but its use is limited due to lack of evidence, practice uptake and clinical trials.

Case description: We present, a case report of a patient for whom we successfully used a trans-septal left ventricle (TSLV) endocardial lead implantation approach following a failed LV lead implant via the CS to get effective cardiac resynchronisation.

Conclusions: Post-TSLV lead implantation follow-up checks were normal with good electrical parameters and appropriate biventricular pacing. No post-procedural complications were reported, and echocardiographic parameters improved at follow-up. We believe, although, TSLV lead implant is more complex and often double operators are required, in selected patients, it can be a safe alternative following a failed traditional LV lead implant via the CS.

Background: Local anesthetic (LA) resistance is an exceedingly rare phenomenon. Incidence is unknown given the rarity of disease. Often, inadequate response to LA can be attributed to many factors including suboptimal dosing, maldistribution, or poor procedural technique. However, in the absence of these technical factors, true LA resistance can be attributed to mutations in the voltage gated sodium channel and is strongly associated with hypermobility conditions such as Ehlers Danlos and muscular dystrophies such as Emery-Dreifuss. There have also been reports describing LA resistance after scorpion bites, although the underlying mechanism for this type of resistance is unknown. We aim to present a case of suspected LA resistance in the setting of multiple failed LA delivery.

Case description: In this case report, we describe a patient with suspected LA resistance after failed intrathecal, perineural, intraarticular and subcutaneous delivery of LA. Our patient was unresponsive to three different LAs at varying doses.

Conclusions: Patients with failure to achieve adequate anesthesia with more than one route of LA administration should be evaluated for LA resistance. A thorough medical history and physical examination, along with a focus on identifying prior LA failure such as with dental procedures, and physical examination findings suggestive of connective tissue disorders may help establish the diagnosis with confirmatory genetic testing.

Background: Multiple myeloma (MM) relapse in the central nervous system (CNS) confers an adverse prognosis, usually occurring in a short period after stem cell transplant and with a short overall survival. Isolated CNS relapse is so rare that there is no current standard treatment.

Case description: We present a 59-year-old male with an isolated CNS MM relapse, who had received autologous stem-cell transplant (ASCT) and thalidomide maintenance 11 years prior. He returned to our clinic with cauda equina syndrome and a nuclear magnetic resonance (NMR) identified a spinal lesion, a lumbar puncture was performed and plasma cells were identified in his cerebrospinal fluid (CSF). He was initially treated with intrathecal (IT) chemotherapy with methotrexate and steroid + radiotherapy and plasma cells disappeared after a few bi-weekly doses. Later on, treatment with pomalidomide/dexamethasone was given for 12 cycles with good clinical response with 80% recovery of his motor function.

Conclusions: In this rare case of a very late CNS MM relapse, we demonstrate that IT chemotherapy complemented with a systemic pomalidomide-based treatment is safe and effective. This is particularly important in contexts where newer therapies such as bispecifics, chimeric antigen receptor-T (CAR-T) cells or even daratumumab or selinexor are not widely available. Further clinical experience in this particular scenario will be required to confirm this observation and define overall the best strategy for this rare group of patients.

Background: Orbital floor fractures typically manifest as eyeball mobility disorders with double vision (diplopia), enophthalmia, and infraorbital paresis. Surgical treatment of these fractures involves orbital floor reconstruction. The procedure involves freeing the trapped tissues from the lumen of the maxillary sinus and rebuilding the orbital floor. Technological progress in the field of three-dimensional (3D) printing allows physical prototyping of the implants to be used during the procedure.

Case description: A 43-year-old female patient presented to the hospital with diplopia, which first occurred after a fall from own height. Examinations, including a computed tomography (CT) confirmed the diagnosis of an orbital floor fracture. 3D printing was used to plan the surgical treatment of the patient. Based on preoperative CT, a 1:1 scale model was prepared by means of 3D printing to demonstrate the fractured orbital area. It was later used to pre-cut a Codubix prosthesis, which was subsequently used to reconstruct the fractured bone. The patient's postoperative course was uneventful. Instant improvement in diplopia was noted. A CT scan was performed on the 3^rd day after surgery. No herniation into the maxillary sinus was observed.

Conclusions: 3D printing seems to be a useful method that allows more thorough preparation for the surgery and also could potentially shorten its duration.

Background: The medial collateral ligament (MCL) is crucial for ensuring implant stability after unicompartmental knee arthroplasty (UKA). Intraoperative MCL lesions can cause valgus instability, affecting function and implant longevity, and thereby negatively impacting the patient's outcome. Every surgeon who performs UKA may encounter this complication in their daily practice. In this context, this case report presents a rescue technique. The existing literature does not specify a protocol for managing this complication. This article presents the first instance of accidental midsubstance section of the MCL during medial UKA, managed through primary suture and augmentation repair with a fascia lata (FL) autograft. The procedure was subsequently replicated step by step on an anatomical specimen.

Case description: A 54-year-old woman, previously successfully treated with right medial UKA, was referred to our clinic following an unsuccessful attempt at conservative treatment for osteoarthritis in the left knee. Scheduled for a left medial UKA, an inadvertent midsubstance transection of the deep part of the MCL was encountered during the procedure, resulting in valgus instability. The MCL was promptly repaired and reinforced using an ipsilateral FL augmentation autograft. Subsequent UKA surgery was successfully completed. Follow-up at one year revealed favorable post-operative outcomes, with symmetrical stability on stress radiographs and no indications of early loosening.

Conclusions: To our knowledge, this article represents the first documentation of the direct management for this rare yet severe complication. This case report could therefore inspire any surgeon facing this complication. The technique, grounded in biomechanical principles, ensures direct medial stability whilst allowing uninterrupted continuation of the initial procedure. Characterized by simplicity and reproducibility, the approach demonstrates favorable short-term outcomes. Because the results should be interpreted considering the limited impact of a case report, further prospective studies are essential to substantiate and strengthen these findings.

Background: Pancreatic cancer is characterized by chemoresistance. In recent years, more potential therapeutic molecular targets for pancreatic cancer have been developed, and thus increasing attention has been paid to precise chemotherapy to improve the prognosis of patients with advanced pancreatic cancer.

Case description: In this study, we reported two rare cases of advanced pancreatic cancer. One patient was diagnosed with retroperitoneal lymph node metastasis after radical resection of pancreatic ductal adenocarcinoma. The diagnosis of another patient was pancreatic ductal adenocarcinoma with liver metastasis. The whole genome sequencing of their tumor tissues detected both wild-type Kirsten rat sarcoma viral oncogene homolog (KRAS) and mutant breast cancer susceptibility gene (BRCA). And immunohistochemistry showed their tumor tissue was negative for epidermal growth factor receptor. We used the combined chemotherapy of gemcitabine (1,000 mg/m²) + oxaliplatin (135 mg/m²) + nimotuzumab (400 mg). After nine times of chemotherapy, the imaging examinations including positron emission tomography-computed tomography showed that both cases achieved complete remission. And there were no serious side effects during chemotherapy. Then, the patients were treated with oral olaparide (600 mg/day) for one year, and survived without tumor progress for more than 1.5 years.

Conclusions: These two cases achieved excellent effects of precise chemotherapy, which provided an important reference for the treatment of pancreatic cancer patients with wild KRAS and mutant BRCA.

Background: Camrelizumab has been widely used in the treatment of various cancers, it is important to determine the side-effect of this drug and the corresponding treatment strategy.

Case description: The current case report describes the clinic, diagnosis, treatment and prognosis of camrelizumab-related encephalitis. Camrelizumab was administrated to a 67-year-old man with squamous cell carcinoma (SCC), a form of non-small cell lung cancer (NSCLC). One month after the treatment, the patient showed typical encephalitis symptoms including systemic fatigue, numbness of extremities and walking instability. Furthermore, the total protein in cerebrospinal fluid (CSF) was significantly elevated (1,399 vs. normal range 120-600 mg/L). Importantly, magnetic resonance imaging showed there was no brain metastasis. The patient did not get better after two days of intravenous injection of thioctic acid (1.2 g) and cobamamide (1.5 mg) once daily. Therefore, this patient was diagnosed as camrelizumab-related encephalitis. Then, we put him on one-month regimen: oral taper corticoids (methylprednisolone, MP) at 500 mg (days 1-4), 120 mg (days 5-10) and 60 mg (days 11-15); MP was replaced with oral prednisone acetate at 30 mg (days 16-30). After the treatment, the total protein in CSF was decreased to 873 mg/L, and all of encephalitis-related symptom was completely lost. About one year after the onset of encephalitis, the patient showed no recurrence of neurological symptoms.

Conclusions: The present case proves the efficacy and safety of corticoids in the treatment of camrelizumab-related adverse effects.

Background: Chylothorax is an uncommon condition defined by the escape of lymphatic fluid into the pleural space originating from the thoracic duct.

Case description: Our case involves a male patient in his 60s who developed traumatic chylothorax after being involved in a bicycle collision. The total body computed tomography (CT) showed multiple fractures of the ribs and spine, including a fracture of the anterior column of the Th12 vertebra. The patient was placed under observation in the intensive care unit and because of the instability of the Th12 fracture operative stabilization was performed with a percutaneous dorsal pedicle screw-rod spondylodesis. One day postoperatively, the patient suffered from acute respiratory distress; vital signs and hemoglobin levels remained stable. CT angiography was performed showing a large amount of fluid in the right pleural cavity. A chest tube was placed and a total of 3 L of fluid was evacuated. The next day a chylous production of 2 to 3 L per 24 hours was observed. Initiation of nutritional management for the patient involved a medium-chain triglyceride (MCT) diet in conjunction with total parenteral nutrition (TPN) administration. Due to the ongoing chylous leakage, despite the MCT diet and TPN, the patient underwent video-assisted thoracic surgery (VATS); the thoracic duct was identified and clipped. In addition, a VATS chemical pleurodesis with talc was performed. The chylous drainage ceased and after a total of 8 weeks the MCT diet was stopped.

Conclusions: This case report encompasses relevant diagnostic evaluations and the array of medical treatments applicable to a chylothorax resulting from trauma.

Background: Extra-adrenal pheochromocytoma (paraganglioma) of the urinary bladder is a rare tumor, accounting for 0.05% of bladder tumors and less than 1% of all paragangliomas. In the genitourinary tract, paragangliomas are most commonly found in the bladder. These tumors have aggressive malignant potential, so complete surgical resection for localized disease is important. Paragangliomas may be non-functional or functional with catecholamine secretions. Although these tumors are rare and difficult to distinguish from urothelial carcinoma (UC), intraoperative manipulation of these tumors may lead to a catecholamine surge and intraoperative complications. Preoperative or early intraoperative recognition of this tumor would facilitate appropriate alpha blockade to minimize morbidity.

Case description: Herein we report a rare non-functional paraganglioma arising from the bladder of a 46-year-old male. This case is notable for the location of the mass, requiring a 70-degree cystoscopic lens for complete visualization near the bladder neck, and for the identification of a golden-yellow sessile mass during the resection. Upon visualization of this mass, the operation should be paused for close hemodynamic monitoring and assess for signs of hypertensive crisis prior to continuing without alpha blockade.

Conclusions: Suspected localized bladder paraganglioma cases should be optimized hemodynamically and managed surgically. Visualization of a sessile bladder mass on gross examination with golden-yellow tumor during the resection should prompt suspicion for a paraganglioma. Biochemical evaluation with serum or urine catecholamines, metanephrines, and normetanephrines should be performed to assess for tumor functionality.