Year 2020, Volume 4 - Issue 1

Background: Ovarian cancer has emerged as one of the most common malignancies affecting women in India. Despite optimal surgery and appropriate first-line chemotherapy, almost 70%–80% of patients with epithelial ovarian cancer will develop recurrence. Inguinal lymph node metastasis is a rare site of involvement in recurrent epithelial ovarian cancer. Case Presentation: Herein, we report the case of a 54-year-old female who presented to us with painless left inguinal lymphadenopathy. She gave history of being diagnosed with malignant ovarian cancer 2 years ago, for which she underwent debulking surgery. She received only one cycle of chemotherapy after which she defaulted. Cytological examination of the inguinal nodes revealed metastatic ovarian cancer. CA-125 levels were elevated despite the lack of any foci of metabolically active tissue on imaging. Conclusion: Inguinal lymphadenopathy is a rare presentation of recurrent ovarian cancer. Despite that, it is essential to examine the inguinal region in the follow up of all the cases of ovarian cancer. It is also necessary to consider ovarian cancer in the differential diagnosis for inguinal lymphadenopathy in a female patient.

Background: Biphasic pulmonary blastoma (BPB) is an uncommon and aggressive malignancy of the lung. Herein, we report a recurrent BPB in a young patient. Case Presentation: A 26-year-old female patient presented with respiratory distress and cough. Radiological workup illustrated well-circumscribed mass lesion (size ~ 6 cm) in the lateral basal segment of the lower lobe of the right lung, for which the patient underwent lobectomy. Histopathology revealed BPB. The patient was kept on close follow-up without any oncological intervention and remained disease-free for 3 years. Afterward, the patient presented with recurrent disease (i.e., a pulmonary oval nodule of size ~ 1.4 ×1.2 cm) and metastasis in the right renal region with infiltration into the right T12-LV1 and LV2 vertebrae. The patient was given three courses of multi-agent chemotherapy (i.e., ifosfamide, carboplatin, and etoposide), which resolved the pulmonary lesion only. Conclusion: Ultimately, our study indicates that BPB is an aggressive disease and demands multimodality treatment toward favorable prognosis.s.

Background: Amyloidosis is a tissue protein deposition. Urethral amyloidosis is rare. Clinical presentation includes hematuria, obstructive urinary symptoms, urethritis-like symptoms, urethral discharge, or a palpable penile/urethral mass. The diagnosis is made by urethro-cystoscopy and biopsy. Case Presentation: We report the case of a 38-year-old man with a medical history of recurrent urinary tract infections, urethral discharge, and a palpable bulbar urethral mass. Urethral biopsies confirmed the urethral amyloidosis. The treatment was endoscopic urethral dilatation. Conclusion: Urethral amyloidosis is a rare condition and a challenging diagnosis. Urethroscopy is the best method for diagnosis. Biopsies should be done to exclude malignancy.

Background: Osteomyelitis is an infection of the bone and presents itself in different forms of symptomatology. The infection may spread either from the blood or the adjoining soft tissue structures. Sometimes, the findings are so subtle that even clinical presentation does not match with the ongoing infectious process. Subperiosteal collection is one such finding that may not be evaluated in plain radiography. This may be misdiagnosed due to their resemblance with similar type of pathology such as Morel–Lavallee lesion. A cross-sectional imaging evaluation is must to find the diagnosis in these types of conditions. Case Presentation: We present a 14-year-old male with similar type of swelling in the right thigh which appeared after 2 weeks of the blunt injury. Plain radiography was normal. Ultrasound, computed tomography, and magnetic resonance imaging revealed it as a case of acute osteomyelitis with subperiosteal collection. The patient was treated with surgical drainage and broad-spectrum antibiotics. Conclusion: A cross-sectional imaging played a pivotal role in clinching the diagnosis of femoral osteomyelitis with subperiosteal collection. This also helped in the management and follow-up of the patient.

Background: It is well known that psychotic symptoms can occur as a result of seizure activity in the brain. This can easily be diagnosed in those with recognizable seizures by taking a careful history. However, in the absence of a typical seizure presentation, it is far more challenging to differentiate between an organic and primary psychosis. Case Presentation: We present the case of a 51-year-old female who had a 28-year history of treatment-resistant schizophrenia. She did not report or display any seizure activity, and an extensive investigation was unremarkable. The unusual nature of her psychopathology, which was predominantly visual hallucinations and somatic delusions, and the difficult to treat nature of her symptoms, prompted investigation with Electroencephalograph which demonstrated bilateral temporal lobe epileptic activity. Conclusion: Treatment with divalproex sodium and discontinuation of antipsychotic medication achieved an excellent response, where her visual hallucinations and somatic delusions were both remarkably ameliorated.

Background: The Nipah virus (NiV), known to exist in various fruit bats, is associated with one of the deadliest infections affecting human beings. The virus has caused outbreaks in Malaysia, Singapore, Philippines, Bangladesh, and the West Bengal state of India. Pigs were the intermediate hosts during the Malaysian and Singaporean outbreaks and horses in Philippines; while the Indian and Bangladesh outbreaks saw a bat to human followed by human-to-human transmission. The infection is characterized by rapidly progressive encephalitis and acute respiratory distress syndrome, carrying a very high mortality rate. Case Presentation: We present the case of a middle-aged male who presented with fever, vomiting and loose stools, and throat pain. His initial blood investigations were normal. He later developed diplopia, cerebellar symptoms, and segmental sweating. His blood, urine, and throat swab tested positive for NiV. He was started on antivirals but succumbed to death. Conclusion: NiV infection, in humans, presents with a wide spectrum of clinical manifestations, ranging from asymptomatic infection to acute respiratory infection and fatal encephalitis. It is transmitted to humans from animals, such as bats or pigs, or contaminated foods. This was our first experience with NiV; and probably one of the first reported cases from our region. Our experience showed the occurrence of cerebellar symptoms in NiV infection.

Background: Retinal migraine is a type of migraine with aura. It is a rare entity which presents as monocular symptoms, such as scotomas or blindness followed by headache phase of migraine. There are wide varieties of causes for monocular vision loss ranging from benign causes to very serious causes of blindness. Case Presentation: This is a case of 26-year-old female who presented with recurrent attacks of unilateral vision loss but it was not followed by headache which is a rare entity. On investigations, her complete blood picture, liver function tests, renal function tests, erythrocyte sedimentation rate, C-reactive protein, electrocardiography, echocardiography, anti-neutrophil antibody, carotid Doppler, and magnetic resonance imaging of brain were all normal. Conclusion: The diagnosis of retinal migraine was established and the patient was reassured and counseled in detail with the advice of follow-up.

Background: Synovial lipoma is a rare entity and needs high index of suspicion for accurate diagnosis. It is a condition that needs early intervention to prevent progressive joint effusion and degeneration. Case Presentation: This case report describes an adolescent patient with a rare unilateral presentation of synovial lipoma. A 17-year-old female presented with pain and swelling in her left knee from past 2 years. X-ray findings of left knee showed a soft tissue shadow. Left knee synovectomy was performed due to progression of disease. Grossly a single, yellowish, fatty soft tissue piece was received. Histologically, lesion chiefly consists of proliferating mature fat infiltrating the hypertrophic synovial villi. Conclusion: Based on histopathological findings, a diagnosis of synovial lipoma was established. In given clinical scenario, synovial lipoma may be included in differential diagnosis of refractory chronic joint effusion and knee pain with otherwise negative workup.

Background: Primary malignant melanoma (PMM) of the parotid is a very rare tumor. Herein, we report a case of PMM of the parotid with extensive metastasis. Case Presentation: A 25-year-old male patient presented with progressively enlarging firm nodule in the right parotid gland. The patient underwent total right parotidectomy. Histopathology revealed malignant melanoma of the parotid. Metastatic workup demonstrated lymphadenopathy in the ipsilateral cervical, epigasterium and para-aortic regions, metastatic spread in the liver, pancreas, and bones, and thereby, was not fit for any oncological intervention. Conclusion: This study indicates that PMM of the parotid is a rare and highly aggressive malignancy.

Background: Klinefelter-syndrome (KS) is recognized as 47, XXY or XXY, two or more X chromosome in males giving rise to a set of clinical signs and symptoms. These individuals are predisposed to certain malignancies. The association of Hodgkinlymphoma (HL) with KS is very rare and reported only in a single case in literature. Moreover, it is extremely rare to have Chronic- Demyelinating-Inflammatory-Polyneuropathy (CIDP) as initial presentation of HL. The association of CIDP in HL in a case of Klinefelter-syndrome has never reported together. Case Presentation: We report a case of 47-year old Indian male who presented with CIDP and was eventually diagnosed with Nodular sclerosis variant of HL. Karyotyping revealed KS. Institution of treatment of HL improved his neurological symptoms. However, administration of androgens was deferred till the completion of chemotherapy. Unfortunately, he could not tolerate Chemotherapy and died of Renal Failure during the fourth cycle. Conclusion: This case report depicts an extremely rare combination of CIDP, HL with KS. It also signifies that all CIDP cases should be evaluated for occult malignancy and if malignancy is found patient should undergo karyotyping for under-diagnosed chromosomal abnormalities such as KS as in this case.