Year 2020, Volume 4 - Issue 5

Background: Giant cell arteritis (GCA) is an immunologic disorder affecting large and medium size vessels, especially focusing on the external branches of the aorta. The most commonly affected vessel is the temporal artery, and it usually presents with headache in elderly patients. The participation of other vessels, such as the aorta, can result in serious, life-threatening complications. Case presentation: We present the case of a patient admitted to our hospital, diagnosed with GCA and pericardial effusion, which is a rare combination, with only a few case reports in the literature. Conclusion: Pericardial effusion in the context of GCA is rare but it can be dangerous, and by presenting such a case, we want to underline the importance of checking for extracranial involvement when GCA is suspected.

Background: Horse shoe kidney is rare, rarer is urothelial carcinoma of renal pelvis in horse shoe kidney, but is more common than that in normal kidney. Radical nephroureterectomy with removal of a cuff of urinary bladder is the standard of treatment. Despite of complete surgery, there are loco-regional recurrences. Case Report: Presenting a case of 60-year male with gross hematuria of 2 months. On imaging found to have horse show kidney with right kidney upper pole mass, believing it to be renal cell carcinoma, nephrectomy was done. However, histopathology turned out to be low-grade urothelial carcinoma of pelvis. Patient had recurrence in left over ureteral stump and ureteric orifice after 10 months. Completion surgery followed by adjuvant intra-vesical bacille calmette guerin (BCG) was given and patient has no recurrence since past 2 years. Conclusion: Urothelial carcinoma of renal pelvis although rare, but it is three to four times more common than that in normal kidney due to chronic obstruction in horse shoe kidney. Due to multifocality of urothelial carcinoma of renal pelvis, gold standard treatment remains complete nephroureterectomy with removal of a cuff of urinary bladder. Post-operative locoregional recurrences are seen and judicious use of intravesical BCG, chemotherapy, and radiotherapy has shown to beneficial.

Background: Idiopathic normal pressure hydrocephalus (iNPH) is usually regarded as a disease characterized by gait and balance disturbance, cognitive dysfunction, and urinary symptoms. The pathophysiology of iNPH is still unknown, but the increased number of familial cases raises the suspicion of a genetic component. The C9ORF72 expansion is known to cause frontotemporal lobar degeneration and ALS, and its prevalence is found among Finnish iNPH patients. Case Presentation: We report an interesting case of a patient with possible iNPH who also developed ALS. Conclusion: Our case raises the theory of coexistence of gene-induced etiology. Key Message: Our case also raises the question of a genetic link between iNPH and ALS.

Background: Ectopic breast cancer is a rare entity and an important diagnostic and treatment challenge. Case Presentation: 46-year-old female with previous history of resection of ectopic axillary breast tissue who was referred to our Institution after a second resection following an increase in left axillary volume. Histology reported a ductal ectopic breast tissue carcinoma that invaded the deep layer of the dermis and was positive for estrogen and progesterone receptors and Human Epidermal growth factor Receptor-type 2. After being referred to our Institution, surgical margin re-excision and sentinel node biopsy were performed. The patient initiated hormone therapy and underwent adjuvant radiotherapy to the breast and axilla (50 Gy/25 fractions, in daily 2 Gy fractions with a 3D conformal radiation therapy technique) and boost with bolus to the axilla (to complete 60 Gy). She remains in follow-up, with no recurrence to date. Conclusion: A high index of suspicion is required for the timely diagnosis of this rare condition. Since there are no specific guidelines, treatment remains a challenge.

Background: Primary myelofibrosis is a rare myeloproliferative disorder that is occasionally associated with abdominal and hepatic complications, such as Budd–Chiari syndrome, nodular regenerative hyperplasia, portal vein thrombosis, and rarely portal hypertension, which is found in 7% of the cases. Case Presentation: We report a rare case of portal hypertension with chylous ascites in a 49-year-old male patient with primary myelofibrosis, who presented with a painless progressive distension of the abdomen for 1 month. His transjugular liver biopsy revealed extramedullary hematopoiesis with colonies of erythroid precursors, megakaryocytes, and numerous clusters of erythroid islands in the hepatic sinusoids. He was provided with a salt-restricted diet and diuretics with partial response and was scheduled for a transjugular intrahepatic portosystemic shunt. Conclusion: Extramedullary hematopoiesis should always be considered in patients with myeloproliferative disorders with a rare case of portal hypertension.

Background: Vitamin b12 deficiency is associated with wide spectrum of neurological manifestations Case Presentation: We are reporting a case of 63 years old male presented with history of unsteady gait and was found to have severely low level of vitamin B12, Total resolution of the symptoms occurred following parenteral vitamin B12 replacement therapy. Conclusion: This case report highlights one of the neurological presentations of vitamin B12 deficiency in a previously healthy individual.

Background: Suppurative leiomyoma (pyomyoma) is a rare complication of myoma. Pregnancy predisposes myoma for the acquisition of pyogenic infection. The expectant management of myoma is preferred during pregnancy, but pyomyoma mostly necessitates early surgical intervention to improve the maternal and fetal outcomes. A delayed diagnosis may result in lifethreatening complications. Case Presentation: We report a case of a 30-year-old female, second gravida presented to the emergency room at 33 weeks’ gestation with 10 days of abdominal pain, fever, and vomiting. Abdominal examination showed distended tensed uterus with fundal height corresponding to 36 weeks’ size Pyomyoma, which manifested as obstructive uropathy with acute kidney injury and managed successfully. The renal function test had a marked derangement with blood urea nitrogen being 76 mg/dl and serum creatinine of 2.6 mg/dl, with normal electrolytic values. Magnetic resonance imaging pelvis revealed an abdominopelvic mass of approximately 18 × 11 cm with peripheral T1 hyperintensity and diffusion restriction and bilateral hydroureteronephrosis with extension. Laparotomy showed an irregular ragged mass of approximately 16 × 10 cm extending from the posterior surface of the uterus to the right side broad ligament. It had friable degenerated tissues with purulent collection within it which was spontaneously draining suggestive of ruptured pyomyoma. Pyomyoma was enucleated, and the patient recovered well postoperatively. Conclusion: Pyomyoma should be strongly suspected in the cases of myoma with sepsis during pregnancy.

Background: Sarcomatoid carcinoma (SC) is a rare, aggressive, and heterogeneous subtype of non-small cell lung cancers. Once the cancer is diagnosed, surgical resection followed by chemotherapy or radiation is the general line of treatment based on the staging. Case Presentation: We report a case of a young female who presented with 1-week history of shortness of breath and found to have a mass in the lung. She was diagnosed with SC, but resection was not possible because of the cancer size. The patient’s clinical status deteriorated as the mass increased in size so rapidly that she died within 18 days of the first evaluation. Conclusion: Unlike other lung cancers, SC can show aggressive deterioration within a matter of days. When suspected, early evaluation and diagnosis are warranted for the timely treatment of SC.

Background: Splenic laceration is the most common injury following blunt abdominal trauma. The injury is characterized by the presence of parenchymal laceration; however, vascular lesions may also be seen such as pseudoaneurysms. Multiple pseudoaneurysms are rare complication. Delayed treatment is traditionally with splenectomy, however, small case series of the use of embolization have been described. Case Presentation: A 29-year-old female presented with left upper quadrant pain 22 days after a motor vehicle accident; she was hemodynamically stable. Computed tomography imaging with contrast enhancement demonstrated American Association Staging of Trauma grade IV splenic artery injury with multiple large splenic artery pseudoaneurysms. The patient proceeded to angiography and was treated with proximal coil embolization. Ultrasound demonstrated pseudoaneurysm thrombosis at 4 days and again at 6 weeks after treatment. Conclusion: This case demonstrates the success of splenic artery embolization in achieving non-operative management of blunt splenic injury in a sub-acute setting, even with the presence of multiple large splenic artery pseudoaneurysms.

Background: Globally, colorectal cancer is a substantial health burden. This case will discuss about challenges during management due to pregnancy. To the best of authors’ knowledge, very few cases of this type have been reported in the literature. Case Presentation: A 20-year-old married, pregnant female, second gravid and para 1 presented during her 34th week of gestation, with complaints of something coming out of the anus, bleeding per rectum, abdominal distension, and relative constipation for 8 months. Carcinoembryonic antigen was normal. CT scan and MRI showed circumferential mural thickening of length 7.5 cm involving anal canal and anorectal junction, associated with perilesional fat stranding. The neoadjuvant chemoradiotherapy was advised after c section. Conclusion: This case report highlights the fact that early detection and management of colorectal cancer during pregnancy can prevent morbidity and mortality.