Year 2022, Volume 6 - Issue 6

Background: Extramedullary plasmacytoma (EMP) of the thyroid is a rare neoplasm that may present either as a solitary plasmacell tumor or involvement of plasma cell myeloma (PCM). In this report, we present a unique case of PCM presented as a thyroid mass without previous history, and initially misinterpreted as medullary carcinoma on fine-needle aspiration cytology (FNAC). Case Presentation: A 77-year-old female presented with shortness of breath and palpitation. Ultrasonography-guided FNAC from the large thyroid mass revealed hypercellular smears composed of monomorphic plasmacytoid cells, focally binucleated, scattered diffusely. Subsequent histopathological examination and immunohistochemistry of thyroidectomy specimen showed infiltration of sheets of plasma cells and diagnosed as EMP. Histology of the bone marrow displayed Lambda positive neoplastic plasma cells. A combination of singly distributed cells and aggregates with plasmacytoid morphology on a proteinous background without clinical suspicion and previous history leads to misinterpretation of FNAC. Conclusion: Clinical correlation, immunocytochemistry, and complementary cytological approach including various preparation techniques of staining are crucial for avoiding diagnostic pitfalls and the patients' proper treatment.

Background: The therapy of patients with concomitant multiple sclerosis (MS) and ankylosing spondylitis (AS) is a challenge for clinicians. Secukinumab is effective in the treatment of MS. In the clinical case, we present, substantial clinical and radiological remission in the case of both autoimmune diseases was observed. Case Presentation: A male adult was diagnosed with relapsing-remitting MS. The patient complained of severe thoraco-lumbar pain. Magnetic resonance imaging (MRI) led to a diagnosis of AS. Considering that nonsteroidal anti-inflammatory drugs were ineffective and tumor necrosis factor-α blockers are contraindicated in patients with MS, secukinumab was prescribed. MRI 8 months after initiation of therapy provided clinical stability in consideration of the two autoimmune comorbidities. Conclusion: Secukinumab is an effective therapy for concomitant MS and AS.

Background: Being highly malignant, ovarian carcinoma mostly presents at an advanced stage at the time of diagnosis. The appendix could be a potential site for metastatic involvement by ovarian malignancy, however, this is a rare event. Though, its presence can upgrade the tumor to stage III. Case Presentation: We report a post-menopausal patient with abdominal mass and distension. Computed tomography scan showed bilateral adnexal lesions, an enlarged enhancing appendix, right hydroureteronephrosis, and ascites. On histopathological correlation, the adnexal lesions turned out to be moderate to poorly differentiated papillary adenocarcinoma with omental and appendiceal involvement by the pathologic process. The patient was then referred to the Oncology department. Conclusion: Clinical assessment of appendix or routine appendectomy as part of late-stage ovarian carcinoma management in older patients with omental involvement can lower the risk of appendiceal involvement with subsequent downstaging of the tumor.

Background: Cutaneous horn arising from the nasal vestibule is an extremely rare entity with only four published case reports to date. Although cutaneous horns are commonly benign, the risk of it harboring a malignant or pre-malignant process is about one in three. Verrucous carcinoma is a variant of squamous cell carcinoma (SCC) that typically presents in the oral cavity, and very rarely in the nasal cavity. Case Presentation: We report a 78-year-old female who presented with a rapidly enlarging right naris cutaneous horn of 5 months duration. Computed tomography scan showed a heterogeneously enhancing mass at the right anterior nasal cavity with no overt bone or cartilage destruction. Differential diagnoses included seborrheic keratosis, actinic keratosis, viral wart, and malignant tumors such as SCC. She underwent an excision biopsy and histology confirmed the diagnosis of a pT1 verrucous SCC. Conclusion: Due to the rarity of the site of the disease, management of sinonasal verrucous carcinoma is generally derived from management options of other subsites in the head and neck region. The preferred treatment modality is surgical excision, while primary radiotherapy is an emerging treatment alternative in poor surgical candidates.

Introduction: We describe here a case of a woman admitted to our Internal Medicine Unit for multifocal pneumonia. During the stay, she presented a few neurological symptoms: headache, nausea, emesis, photophobia, and gait disturbance. Methodology: Chest computed tomography (CT) detected multiple areas interpreted as septic emboli. Moreover, a left internal jugular thrombosis (LIJT) was incidentally reported. A CT-angiography showed the LIJT extension to cerebral sinuses. Ear, nose, and throat consultation revealed a left medium otitis. Anticoagulation with Fondaparinux was associated to antibiotic therapy with improvement in neurological symptoms that totally remitted over the next 2 weeks. Results: These findings confirmed the diagnosis of a Lemierre's Syndrome with thrombosis extension to cerebral sinuses. The genetic thrombophilic panel showed a heterozygosis for prothrombin gene G20210A mutation and the patient was discharged with Rivaroxaban for home continuation of anticoagulant therapy for at least 6 months. Conclusion: The prevalence of inherited thrombophilias in Lemierre's Syndrome is unknown and to our knowledge, this article is the first to identify a prothrombin gene G20210A mutation in a patient with Lemierre's Syndrome with thrombosis extension into the cerebral venous system. Exploring patients with Lemierre's Syndrome for underlying thrombophilia could clarify whether this promotes retrograde jugular vein thrombosis extension.