OpenMed/multicare-articles huggingface dataset:
Case report: Squamous cell carcinoma and spindle cell sarcoma (SCS) arising in a mature cystic teratoma of the ovary
Authors: Xue-Qian Qian, Li-Li Chen, Chang-Kun Zhu, Ya-Xia Chen, Xiao-Yun Wan
Journal: Front Surg (2023)
Keywords: ca199, malignant transformation, mature teratoma, spindle cell sarcoma, squamous cell carcinoma
MeSH terms: Case Reports

Objective:
Malignant transformation of mature ovarian teratoma is a rare phenomenon, mainly occurring in postmenopausal period. Squamous cell carcinoma accounts for 80% of all malignant transformations. Sarcoma transformation is much less common and tends to imply a poorer prognosis and aggressiveness.
Case report:
We report a case of undifferentiated sarcoma with squamous cell carcinoma in a mature cystic teratoma of the ovary in a 36-year-old woman. The tumor shows epithelial and stromal components. This is a unique report of a benign teratoma of the ovary with malignant transformation, showing epithelial and sarcomatous components. This young woman presented with abdominal distension and a rapidly enlarging ovario-derived pelvic mass with a slightly elevated CA199 tumor marker of 115.9 U/ml. The woman underwent transabdominal excision of the left ovarian cyst on October 20, 2020. During the operation, rapid freezing pathological examination did not indicate malignancy. The postoperative paraffin pathology revealed undifferentiated sarcoma with squamous cell carcinoma (from mature cystic teratoma malignancy), and she finally received comprehensive staging surgery. Postoperative paraffin pathology showed no residual cancer in uterus and other tissues, and all lymph nodes were negative. The patient was finally diagnosed with ovarian malignant tumor IC1 stage (high-grade spindle cell sarcoma complicated with squamous cell carcinoma). Chemotherapy was completed three times after surgery, and no signs of recurrence were found after follow-up.
Conclusion:
The preoperative diagnosis and intraoperative rapid freezing examination of malignant transformation of mature teratoma of ovary are challenging.
Male breast cancer presenting as nipple discharge
Authors: A Farooq, K Horgan
Journal: Case Rep Surg (2011)
MeSH terms: Case Reports

Male breast cancer (MBC) is a rare disease and constitutes less than 1% of all breast carcinoma cases. Although MBC most often presents with a palpable mass, failure to recognise the significance of other symptoms may lead to a delay in diagnosis. Nipple discharge (ND) is a rare symptom in men, but it may herald an underlying malignancy. We present two cases of (MBC) presenting with ND and emphasise the importance of this clinical sign in suspecting underlying malignancy and an opportunity for early diagnosis. We also discuss the clinical significance of ND in men in relation to current literature.
A Conservative Approach to a Large Mycotic Pulmonary Pseudoaneurysm
Authors: Erin Torpey, Jenna Spears, Yousif Al-Saiegh, Mindi Roeser
Journal: Case Rep Pulmonol (2021)
MeSH terms: Case Reports

Pulmonary mycotic pseudoaneurysm is a rare complication of bacteremia with high associated mortality. We present a case of a large proximal pulmonary artery pseudoaneurysm as a result of methicillin-sensitive Staphylococcus aureus bacteremia, originating from a tunneled dialysis catheter infection. This case was ultimately managed conservatively with surveillance imaging and a prolonged intravenous antibiotic course, rather than with surgical or interventional management. To our knowledge, this is the first reported case of a mycotic pulmonary pseudoaneurysm due to septic embolization of an infected superior vena cava thrombus.
New Onset British Accent, Acute Behavioral Changes, and Seizures: A Unique Presentation of NMDAR Encephalitis
Authors: Mohankumar Kurukumbi, Tulsi S Shah, Jose A Castillo, Rahul U Nayak, Jahnnavi Madiraju
Journal: Case Rep Neurol Med (2019)
MeSH terms: Case Reports

The leading cause of autoimmune encephalitis is N-methyl-D-aspartate receptor (NMDAR) encephalitis. Symptoms can present as prominent behavioral abnormalities prompting inaccurate psychiatric diagnoses. Psychiatric features such as bizarre behavior, agitation, anxiety, delusions, and hallucinations are well noted in the current literature, but a manifestation of foreign accent syndrome has, to our knowledge, never been reported in cases of encephalitis. Once diagnosed, initiation of therapy can result in effective treatment. Here, we present a case of a 32-year-old female with new onset seizures and marked behavioral changes, such as speaking in a foreign accent, who was empirically treated for NMDAR encephalitis due to strong clinical suspicion, showed no improvement with first line therapy with IVIG and IV steroids, and finally had rapid resolution of symptoms with the early initiation of second line therapy of rituximab. In a young female presenting with nonspecific behavioral changes, NMDAR encephalitis should be on the differential and, although CSF antibodies are definitively diagnostic, there should be a low threshold to start empiric therapy and escalate to second line treatment.
Anti N-methyl-D-aspartate receptor (NMDAr) encephalitis during pregnancy: A case report
Authors: Fedele Dono, Giacomo Evangelista, Stefano Consoli, Giovanna Scorrano, Mirella Russo, Martina di Pietro, Marco Onofrj, Stefano L Sensi, Francesca Anzellotti
Journal: Epilepsy Behav Rep (2022)
Keywords: epilepsy, fetal outcome, lacosamide, maternal outcome, seizures
MeSH terms: Case Reports

Anti-N-methyl-D-aspartate receptor (NMDAr) antibody encephalitis is an autoimmune disorder characterized by reduced synaptic activity of the NMDAr due to circulating antibodies that target the NR1 subunit. Few cases of anti-NMDAR encephalitis during pregnancy have been described. The permeation of anti-NR1 antibodies through the placenta can be instrumental in the development of complications in newborns. We describe a case of a young woman suffering from anti-NMDAR encephalitis during the first trimester of pregnancy and focus on diagnostic and therapeutic management.
Gastrointestinal Cryptococcosis Associated with Intestinal Lymphangiectasia
Authors: Fernando Naranjo-Saltos, Alejandro Hallo, Carlos Hallo, Andres Mayancela, Alejandra Rojas
Journal: Case Rep Med (2020)
MeSH terms: Case Reports

Intestinal lymphangiectasia is a pathological dilation of enteric lymphatic vessels resulting in lymph leakage to the intestinal lumen. This chronic lymph leakage leads to a state of immunosuppression secondary to the loss of humoral and cellular components of the immune system and represents a potential risk factor for opportunistic infections. We report a case of protein-losing enteropathy in a seemingly immunocompetent patient. An intestinal histopathological study revealed the unusual association of lymphangiectasia and intestinal cryptococcosis. Although cryptococcal infection is common in immunocompromised patients, intestinal involvement is rarely reported. We found no reports on the association of intestinal cryptococcosis in patients with lymphangiectasia. This case report is the first to describe intestinal cryptococcosis associated with intestinal lymphangiectasia.
Misdiagnosis of Extensive Maxillofacial Infection and Its Relationship with Periodontal Problems and Hyperglycemia
Authors: Cristian Statkievicz, Leonardo P Faverani, Pedro Henrique Silva Gomes-Ferreira, Gabriel Ramalho-Ferreira, Idelmo Rangel Garcia-Junior
Journal: Case Rep Dent (2016)

Background. Complex dental infections can reach distant areas of the alveolar process, invading the secondary fascial spaces. Objectives. This case report aims to show a misdiagnosis of odontogenic infection and a great need for dentist in the hospital environment. Case Report. A male patient presented facial asymmetry and trismus, while the facial CT examination showed a hyperdense mass involving the left masseteric, pterygomandibular, and superficial temporal regions. The patient was then referred to oral oncology center by emergency physician with cancer suspicion. After 15 days, the patient returned to the same emergency room and was attended by the surgical and maxillofacial trauma team, presenting tachycardia, tachypnea, dysphagia, and trismus. During anamnesis, the patient reported being an uncontrolled diabetic. In intraoral exam, a poor oral condition and generalized periodontitis were observed. Results. Correct diagnosis of odontogenic infection was established and adequately treated. Conclusions. Symptomatology bland may mask the severity of an infection; every increase in volume associated with trismus, poor oral hygiene with or without hyperglycemia should be heavily investigated for the presence of an infectious process. It emphasizes the importance of a dentist working with the physician in emergency room.
Transient Vestibulopathy in Wallenberg's Syndrome: Pathologic Analysis
Authors: Jorge C Kattah, Ali S Saber Tehrani, Sigrun Roeber, Meena Gujrati, Sarah E Bach, David E Newman Toker, Ari M Blitz, Anja K E Horn
Journal: Front Neurol (2017)
Keywords: mri diffusion, head impulse test, lateral medullary infarction, pathology, transient ischemia
MeSH terms: Case Reports

Objective:
To report an unusual lateral medullary stroke (LMS) associated with transient unidirectional horizontal, nystagmus, and decreased horizontal vestibulo-ocular reflex (h-VOR) gain that mimicked a peripheral vestibulopathy. MRI suggested involvement of caudal medial vestibular nucleus (MVN); however, the rapid resolution of the nystagmus and improved h-VOR gain favored transient ischemia without infarction. Decreased h-VOR gain is expected with peripheral vestibular lesions within the labyrinth or superior vestibular nerve; less frequently lateral pontine strokes involving the vestibular root entry, the vestibular fascicle, or neurons within the MVN may be responsible. The h-VOR is typically normal in LMS.
Methods:
Clinicopathologic examination of a 61-year-old man with an acute vestibular syndrome (AVS) and left LMS who died 3 weeks after the stroke. Postmortem brainstem analysis was performed.
Results:
The stroke involved the lateral medulla and pontomedullary junction, near the MVN, sparing the cerebellum and pons. To explain transient vestibular findings there are two possible hypotheses; the first would be that the MVN survived the ischemic process and would be histologically intact, and the second that vestibular afferents in the horizontal semicircular canal were ischemic and recovered after the ischemic process. Neuropathological examination showed a left LMS whose extent matched that seen by imaging. Non-ocular motor signs correlated well with structures affected by the infarction. Neurons and glia within nearby MVN were spared, as predicted by the rapid normalization of the ocular motor signs. Although unlikely, the possibility of transient intralabyrinthine arteriolar ischemia cannot be excluded. Additionally, truncal lateropulsion was due to combined lateral vestibulospinal tract and lateral reticular nucleus infarction.
Conclusion:
LMS may rarely be associated with an AVS that either represents or mimics a peripheral vestibulopathy. To our knowledge, this is the first neuropathologic examination of the brainstem of an LMS associated with transient vestibular findings occurring in the context of an anterior/posterior (AICA/PICA) cerebellar arterial variant stroke.
Case Report: A Case of Adult Methylmalonic Acidemia With Bilateral Cerebellar Lesions Caused by a New Mutation in MMACHC Gene
Authors: Shengnan Wang, Xu Wang, Jianxin Xi, Wenzhuo Yang, Mingqin Zhu
Journal: Front Neurol (2022)
Keywords: mmachc, bilateral cerebellar lesions, c484g>a, cobalamin c deficiency, methylmalonic acidemia and homocysteinemia
MeSH terms: Case Reports

Methylmalonic acidemia is a severe heterogeneous disorder of methylmalonate and cobalamin (Cbl; vitamin B12) metabolism with poor prognosis. Around 90% of reported patients with methylmalonic acidemia (MMA) are severe infantile early onset, while cases with late-onset MMA have been rarely reported. Few reported late-onset MMA patients presented with atypical clinical symptoms, therefore, often misdiagnosed if without family history. Herein, we report a 29-year-old female who was admitted to our hospital due to symptoms manifested as encephalitis. The brain MRI showed symmetrical bilateral cerebellar lesions with Gd enhancement. Laboratory tests showed significantly elevated levels of homocysteine and methylmalonic acid. A genetic analysis identified a novel homozygous mutation (c.484G>A; p.Gly162 Arg) in the MMACHC gene. The patient was diagnosed with MMA, and her symptoms improved dramatically with intramuscular adenosine cobalamin treatment. In conclusion, for patients with symmetrical lesions in the brain, the possibility of metabolic diseases should be considered, detailed medical and family history should be collected, and metabolic screening tests as well as gene tests are necessary for correct diagnosis. The mutation diversity in MMACHC gene is an important factor leading to the heterogeneity of clinical manifestations of patients with MMA.
Severe Thrombocytopenia in a 30-Year-Old African American Male With Newly Diagnosed Sarcoidosis: A Case Report
Authors: Melisa Pasli, Katie K Lovell, Sai Swarupa R Vulasala, Marsha L Hairr, Revanth Reddy Bandaru, Mohammad Z Khalilullah, Leonard Johnson Jr
Journal: Cureus (2023)
Keywords: clinical hematology, immune thrombocytopenia (itp), itp management, sarcoidosis, thrombocytopenia
MeSH terms: Case Reports

Sarcoidosis is a multisystem inflammatory disorder characterized by the formation of non-caseating granulomas. Hematological manifestations such as thrombocytopenia are unusual presentations of the disease. Various theories have been proposed for the development of thrombocytopenia in patients with sarcoidosis such as decreased production in bone marrow caused by granuloma formation, hypersplenism, and immune thrombocytopenia (ITP). We present a case of a 30-year-old African American male with ITP secondary to sarcoidosis who presented with a sudden onset of buccal mucosa and mucocutaneous bleeding and was found to have severe thrombocytopenia with values reaching as low as 1000/uL without prior history of easy bruising or bleeding. Overall, our patient had dyspnea, mucocutaneous bleeding, and was found to have mediastinal and hilar adenopathy, isolated thrombocytopenia, no splenomegaly, and non-necrotizing granulomas in the lymph nodes. The patient received platelet transfusions without initial response and received intravenous immunoglobulin (IVIG), romiplostim, and steroids with subsequent improvement in the platelet count after sufficient administration of a treatment regimen of approximately one week. Confounding factors that resulted in diagnostic uncertainty of our patient presentation included travel history with prophylactic antimalarial medications, doxycycline usage, only slightly elevated Angiotensin-Converting Enzyme (ACE) levels, and imaging features concerning metastatic disease vs. lymphoma. The clinical diversity of sarcoidosis often leads to diagnostic uncertainty and treatment delays due to its resemblance to other more common disorders. This is a novel case report of the earliest temporal presentation of severe thrombocytopenia and sarcoidosis in an African American male reported in the literature.
Rectus sheath hematoma: three case reports
Authors: Selin Kapan, Ahmet N Turhan, Halil Alis, Mustafa U Kalayci, Sinan Hatipoglu, Hakan Yigitbas, Ersan Aygun
Journal: J Med Case Rep (2008)

Introduction:
Rectus sheath hematoma is an uncommon cause of acute abdominal pain. It is an accumulation of blood in the sheath of the rectus abdominis, secondary to rupture of an epigastric vessel or muscle tear. It could occur spontaneously or after trauma. They are usually located infraumblically and often misdiagnosed as acute abdomen, inflammatory diseases or tumours of the abdomen.
Case presentation:
We reported three cases of rectus sheath hematoma presenting with a mass in the abdomen and diagnosed by computerized tomography. The patients recovered uneventfully after bed rest, intravenous fluid replacement, blood transfusion and analgesic treatment.
Conclusion:
Rectus sheath hematoma is a rarely seen pathology often misdiagnosed as acute abdomen that may lead to unnecessary laparotomies. Computerized tomography must be chosen for definitive diagnosis since ultrasonography is subject to error due to misinterpretation of the images. Main therapy is conservative management.
Signet ring cell carcinoma and poorly differentiated adenocarcinoma in a gastric hyperplastic polyp with lymphatic invasion: A case report
Authors: Kazuya Takahashi, Shin Saito, Yuki Kaneko, Shiro Matsumoto, Hironori Yamaguchi, Joji Kitayama, Yoshinori Hosoya, Hirotoshi Kawata, Alan Kawarai Lefor, Naohiro Sata
Journal: Int J Surg Case Rep (2019)
Keywords: diffuse gastric adenocarcinoma, gastric hyperplastic polyp, helicobacter pylori, lymphatic invasion, malignant transformation

Introduction:
Gastric hyperplastic polyps are common stomach lesion and these polyps are generally benign. However, they can undergo malignant transformation. Most reported cases of malignant transformation of gastric hyperplastic polyps have been to well or moderately differentiated adenocarcinoma, and those transformed into poorly differentiated adenocarcinoma are extremely rare. No case has been reported that has changed to diffuse type adenocarcinoma with lymphatic invasion.
Presentation of case:
A 48-year-old woman presented with worsening anemia. A polyp was seen in the gastric cardia seven years prior to presentation. Helicobacter pylori infection was also found at that time. She underwent upper gastrointestinal endoscopy and biopsy of the polyp revealed signet ring cell carcinoma. Total gastrectomy was performed due to concern about possible invasion into the submucosal layer and there was no evidence of distant metastases. Histologic examination revealed both poorly differentiated adenocarcinoma and signet ring cell carcinoma surrounded by hyperplastic epithelium at the head of the polyp. Lymphatic invasion was also found, and malignant cells were limited to the mucosa.
Discussion:
Gastric hyperplastic polyps are commonly associated with chronic gastritis which is related to Helicobacter pylori infections. Gastric hyperplastic polyps are generally benign and rarely undergo malignant transformation to adenocarcinoma with differentiated histology. The gastric hyperplastic polyp in this patient transformed to poorly differentiated adenocarcinoma with lymphatic invasion.
Conclusion:
Even small polyps may become poorly differentiated adenocarcinoma with invasion, so close follow-up or endoscopic resection are recommended as well as eradication of Helico Pylori infection when appropriate.
Long-term survival with stable disease after multidisciplinary treatment for synchronous liver metastases from gastric cancer: A case report
Authors: Wenjun Shi, Junfeng Wang, Wenjing Zhang, Tao Shou
Journal: Int J Surg Case Rep (2019)
Keywords: case report, gastric cancer, liver metastases, long-term survival, treatment

Introduction:
The liver is one of the most common sites of hematogenous metastases of gastric cancer. The 5-year overall survival rate of synchronous liver metastases from gastric cancer was less than 27%. We report a rare case of patient with synchronous liver metastases from gastric cancer who experienced stable disease for 7 years and 3 months following multidisciplinary modalities.
The presentation of a case:
A 33-year-old woman was admitted to our institute because of abdominal pain lasting for a day. Haemoglobin level was 68 g/L. Computed tomography (CT) scan revealed hemoperitoneum, multiple round lesions within liver parenchyma. The pathological diagnosis was gastric cancer with liver metastases. Following multidisciplinary treatment, she experienced stable disease for7 years and 3 months. Currently, the patient remains alive with no recurrence.
Conclusion:
We report a rare case of patient with synchronous liver metastases from gastric cancer who experienced stable disease for 7 years and 3 months following multidisciplinary modalities. Future trials are required to prospectively investigate the established regimen of multidisciplinary treatment.
Acute Abdominal Pain as a Result of an Isolated Left Ovarian Vein Thrombosis
Authors: Abhay Setia, Farzin Adili, Karl Ludwig, Joerg Herold
Journal: Case Rep Med (2023)
MeSH terms: Case Reports

Ovarian vein thrombosis (OVT) is a rare thromboembolic condition. It involves the right ovarian vein in 70-80% of cases. The risk factors for the development of OVT are pregnancy or puerperium, hormone therapy with estrogen, recent surgery or hospitalization, malignancy, pelvic inflammatory diseases, thrombophilia and idiopathic OVT. We present a rare case of left OVT in a young, non-pregnant woman in her 30 s. A high degree of suspicion is necessitated in patients with the triad of young-middle-aged female, pain abdomen in lower quadrant and hematuria to diagnose OVT. Contrast enhanced computer tomography (CT-venography) is the diagnostic modality of choice. The patient was initially treated with low molecular weight heparin and then switched to direct oral anticoagulants. At 6-monthsfollow-up the patient was free from any symptoms.
Bartsocas-papas syndrome: unusual findings in the first reported egyptian family
Authors: E M Abdalla, H Morsy
Journal: Case Rep Genet (2011)
MeSH terms: Case Reports

Bartsocas-Papas syndrome (BPS) is an autosomal recessive syndrome with severe craniofacial, limb, and genital abnormalities. As of 2011, 24 published cases and families were registered in the Orphanet Report Series. Compared to other disorders characterized by pterygia, the condition is usually more severe and often lethal: most affected patients die in utero or shortly after birth. We report the first Egyptian family with Bartsocas-Papas syndrome comprising three cases; our proband who was a female infant with severe craniofacial and limb anomalies typical of Bartsocas-Papas syndrome, a similarly affected female fetus which died in utero at the 7th gestational month, and a 16-year-old mentally retarded uncle who presented with some of the typical features of Bartsocas-Papas syndrome, including syndactyly, thumb hypoplasia, and microphthalmia. This male patient actually did not present with pterygia, however, we find his clinical description noteworthy.
Microureteroscopy in Children: Two First Cases
Authors: Juan-Pablo Caballero-Romeu, Alberto Budia-Alba, Juan-Antonio Galan-Llopis, Maria-Dolores Montoya-Lirola, Pedro-José García-Tabar, Juan-Francisco Galiano-Baena, Nuria Albertos-Mira-Marcelí, Jeronimo Gonzalvez-Piñera
Journal: J Endourol Case Rep (2016)
MeSH terms: Case Reports

Background:
Urinary stones disease is becoming more common not only in adults but also in children. Most cases are resolved with extracorporeal shock wave lithotripsy, but miniaturization of endoscopes has increased the use of ureteroscopy in resolving ureteral stones, most notably in children.
Case presentation:
This presentation focuses on two cases of microureteroscopy. In both cases, the presence of lithiasis in the pelvic ureter was suspected to be the cause of ureter hydronephrosis, and a microureteroscopy was performed for treatment purposes. MicroPerc set 4.85F sheath was used to explore the pelvic ureter, thus avoiding the need to dilate the ureteral meatus or having to use the safety guide. Patients did not require a postoperative stent and were discharged within 24 hours of the procedure.
Conclusion:
Use of microureteroscopy proved satisfactory in the two cases of children and it allows diagnosis and treatment of ureteral pathology in pediatric patients.