Year 2021, Volume 5 - Issue 2

Background: Factor XIII deficiency, which can be congenital or acquired, is a rare disorder. It can cause life-threatening bleeding. It cannot be diagnosed by usual hemostasis tests; only by specific screening tests. Case Presentation: We report the case of a young pregnant woman whom we discovered a paraneoplastic factor XIII deficiency with the underlying cause of colorectal cancer. Conclusion: A paraneoplastic context concerning hematologic malignancies as well as solid tumors must not be ignored. No other case of paraneoplastic factor XIII deficiency resulting from colorectal cancer is previously reported in the literature.

Background: Hepatoblastoma is a primary malignant tumor of the liver usually occurring in children, whereas it is very rare in adults, affecting males slightly more. Case Presentation: We report a case of a 20-year old female patient with a palpable liver mass and significantly elevated alphafetoprotein (AFP), Serum Glutamic Oxaloacetic Transaminase, and Serum Glutamic-Pyruvic Transaminase values. The microscopic examination revealed a mixed cell population of small cells with an oval-shaped nucleus and scant relatively basophilic cytoplasm co-existing with larger cells with eosinophilic or clear cytoplasm, round nuclei, arranged in trabeculae of six or more cells separated by thin fibrous septa. The immunohistochemical assessment of the tumor cells revealed positivity for AFP, Glypican-3, Glutamate Synthetase, polyclonal Carcinoembryonic antigen, Cytokeratin (CK8/18), and Epithelial Specific Antigen/Ep-CAM, membranous and focally nuclear positivity for b-catenin, focal positivity for CK19 and vimentin and faintly focal positivity for Sallike protein-4 and Cluster Differentiation 99. The cell proliferation rate Ki-67 was high, at about 85% and concerning the prognostic markers, there was a positive expression of Cyclin D1 at approximately 80% of the tumor cells, whereas c-myc was negative. These findings drove us to the diagnosis of hepatoblastoma, macrotrabecular subtype. Conclusion: Although the age, medical history, clinical findings, and the laboratory investigations of the patient suggested hepatocellular carcinoma, on the histological examination the mixed blastematous morphology of the tumor combined with the results of the immunohistochemical assay, lead to the diagnosis of hepatoblastoma.

Background: Hypersensitivity pneumonitis (HP) is a complex syndrome due to an inflammatory response of the lungs to many aerosolized antigens. HP can be divided into acute, subacute, and chronic phenotypes, which frequently overlap. Case presentation: We describe the case of a non-smoker man admitted to the hospital for flu-like symptoms who presented emphysema as an evolution of HP. The diagnosis of HP was proposed by a multidisciplinary team based on the clinical/functional data and CT findings; two chest CTs were compared: a CT was performed during the hospitalization of the patient and a CT had been performed 5 years before. The diagnosis was confirmed through a lung biopsy. Examining the patient history, a domestic exposition to pigeons and poultry was revealed. Conclusion: HP can lead to emphysema instead of fibrosis. This atypical evolution of HP should be known by clinicians and radiologists in order to suspect it and promptly start the correct diagnostic workup.

Background: Heterotopic pancreas is the presence of pancreatic tissue outside its normal location, mostly in the gastrointestinal tract. It is rare and most patients are asymptomatic adults. The presence of heterotopic pancreas in the umbilicus and the pediatric age group is even more rare. Case Presentation: An 18-month-old boy presented with clear umbilical discharge since birth. On examination, there was a swollen and inflamed umbilicus. Exploration and excision of the umbilical lesion were done. Histopathological examination of the lesion reported as umbilical sinus with the presence of heterotopic pancreas. He was discharged well with no complications seen on the follow-up review. Conclusions: Heterotopic pancreas is rare. Awareness of this condition is important in order for the patient to be managed accordingly.

Background: Lumbosacral radiculoplexopathy (LSRP) is a rare entity, with several etiologies described in the literature. Vascular lesions to the lower part of the aorta and the common iliac artery can cause LSRP of ischemic etiology. Clinical Presentation: A 66-year-old man with a previous history of peripheral obstructive arterial disease (POAD) requiring aortobifemoral and femoropopliteal procedures had a prolonged hospital stay due to various complications: stent infection and occlusion, aortoenteric fistula causing hemorrhagic shock, transmetatarsal amputation of the right foot. In this context, he underwent multiple endovascular procedures. At discharge, the patient presented flaccid paraparesis, distal bilateral hypoesthesia, saddle anesthesia and urinary and anal incontinence. Spinal cord infarction was excluded. An electromyographic study confirmed the diagnosis of bilateral LSRP of ischemic etiology. Conclusion: This case highlights the importance of including ischemic etiology as a differential diagnosis of peripheral nerve injuries, namely in patients with POAD.

Background: While the patients with coronavirus disease 2019 typically present with respiratory illness, some patients also report gastrointestinal symptoms such as diarrhea, vomiting, and abdominal pain. In this case study, four different cases with the progression of pulmonary computed tomography (CT) findings following the onset of gastrointestinal symptoms are presented. Case presentation: Case 1, A 37-year-old male patient presented with fever, cough, fatigue, muscle and joint pain. On the fifth day of treatment, gastrointestinal symptoms including anorexia, nausea and vomiting were observed. A follow-up chest CT revealed progression in pulmonary involvement. Case 2, A 46-year-old male patient presented with fever, shortness of breath, muscle and joint pain. On the fourth day of treatment, gastrointestinal symptoms including anorexia, nausea and vomiting were observed. A follow-up chest CT revealed progression of pulmonary findings in both lungs. Case 3, A 50-year-old male presented with no symptoms other than dry cough. On the fourth day of treatment, gastrointestinal symptoms including anorexia, nausea and vomiting were observed. A follow-up chest CT revealed bilateral peripherally ground-glass and consolidation areas. Case 4, A 34-year-old female patient presented with fever, cough, fatigue, muscle and joint pain. On the third day of the treatment, gastrointestinal symptoms including anorexia, nausea, vomiting and diarrhea were observed. A follow-up chest CT revealed bilateral progression of pulmonary findings. Conclusion: Many studies reported that patients with gastrointestinal symptoms have a more serious clinical course than patients without these symptoms. No study has yet been presented to the literature in which this clinical situation is supported by radiological findings.

Background: Second-trimester miscarriage can be managed by surgical or medical methods, which are generally safe. However, rare but life-threatening complications like rupture of the uterus might occur; which may present atypically. Case presentation: A 31-year-old multigravida woman with a history of prior four cesarean deliveries presented with a missed miscarriage at 16 weeks gestation. After proper counseling, she opted to proceed with medical management with misoprostol. Six hours after the fifth dose the patient started to complain of hematuria. Ultrasound scan showed an empty uterus with the fetus inside the urinary bladder. Laparotomy was done revealing a ruptured uterus at the site of the previous scar, with the fetus and placenta inside the urinary bladder. Conclusion: Second-trimester uterine rupture may have atypical presentation. High index of suspicion, guided by imaging techniques, is essential for early diagnosis to reduce maternal morbidity.

Background: Intramuscular myxomas are rare tumors of mesenchymal origin and are usually presented in skeletal or cardiac muscles. They are of gelatinous texture and tend to reach large dimensions. They usually present as a painless mass which grows significantly with time, but rarely causing symptoms as pain or pressure to nearby structures. Intramuscular myxomas are usually diagnosed with ultrasound, computed tomography scan or magnetic resonance imaging scan, but the definite diagnosis is acquired by the histology report of the excised mass. Case Presentation: We report a rare case of a large (4 x 4 cm) symptomatic myxoma of the left thigh in a 49-year-old female. Conclusion: Intramuscular myxomas are rare tumors of mesenchymal origin, which can reach large dimensions. Excision is advised, even in smaller-sized masses, in order to have a definite diagnosis.

Background: Ovarian leiomyoma is very rare and constitutes 0.5%-1% of ovarian benign masses. Although most adnexal masses are benign, primary purpose of the assessment is to eliminate any malignancies. The most important issue in the evaluation of ovarian masses is to differentiate between malignant and benign masses. Laparoscopy is an important diagnostic and minimally invasive method for these purposes. Case Presentation: In this paper, we present a case report on laparoscopic evaluation of a patient who was diagnosed with right ovarian spontaneous parasitic myoma and who did not have a history of uterine surgery. Conclusion: Uterine ovarian myoma is extremely rare and can be confused with malignant ovarian masses. Laparoscopy option should be considered as the primary approach in the management of masses with suspicious location and appearance and in the differentiation of benign and malignant.