OpenMed/multicare-articles huggingface dataset:
CASTLE Thyroid Tumor: A Case Report and Literature Review
Authors: Chris Lominska, Christopher Fleighton Estes, Prakash C Neupane, Y Shnayder, Mindi J TenNapel, Maura F O'Neil
Journal: Front Oncol (2017)
Keywords: castle, case report, radiation therapy, thyroid carcinoma, thyroid tumor
MeSH terms: Case Reports

Carcinoma showing thymus-like differentiation is a rare tumor of the thyroid gland, which is structurally similar to thymic tissue. Overall, it has a favorable prognosis. Radiotherapy has been shown to be an effective local treatment, but there have been reports of distant recurrence. It has been suggested that adding chemotherapy may decrease the risk of recurrence. Here, we present a case report of a patient with a large tumor and extrathyroidal extension. The patient was treated with surgery, radiotherapy, and cisplatin with acceptable toxicity. The patient is free of locally recurrent or distant disease at 3 years.
Perioperative Management and Preemptive ECMO Cannulation of a Parturient with Cystic Fibrosis Undergoing Cesarean Delivery
Authors: Thais Franklin Dos Santos, Andrea Rabassa, Oscar Aljure, Reine Zbeidy
Journal: Case Rep Anesthesiol (2020)
MeSH terms: Case Reports

Physiologic changes of pregnancy and cystic fibrosis pathology provide a unique set of circumstances. Pulmonary disease accounts for over 90% of the morbidity and mortality of patients with cystic fibrosis. These abnormalities create anesthetic challenges due to multiple organ systems being affected including the respiratory, gastrointestinal, cardiovascular, and genitourinary tracts, where patients present with chronic respiratory failure, pancreatic insufficiency, poor nutrition, and cardiac manifestations. We present the perianesthetic management of a parturient with cystic fibrosis who successfully underwent preterm cesarean delivery under neuraxial anesthesia with preemptive bilateral femoral venous sheaths placed for potential extracorporeal membrane oxygenation (ECMO) initiation.
Spinal Cord Diffuse Midline Glioma With Histone H3 K27M Mutation in a Pediatric Patient
Authors: Ran Cheng, Da-Peng Li, Nan Zhang, Ji-Yin Zhang, Di Zhang, Ting-Ting Liu, Jun Yang, Ming Ge
Journal: Front Surg (2021)
Keywords: h3k27 mutation, diffuse midline gliomas, pathology, pediatric neurosurgery, spinal cord tumors

Background: Diffuse midline glioma (DMG) with histone H3 K27M mutation is a recently identified entity documented in the 2016 World Health Organization (WHO) Classification of Tumors of the Central Nervous System. Spinal cord DMGs with H3 K27M-mutant are commonly reported in adults. Herein, we reported a pediatric patient with spinal cord H3 K27M-mutant DMG. Case Report: A 7-year-old girl with 1-month history of neck pain and 3-week history of progressive weakness in the right hand was presented. Spinal magnetic resonance imaging showed an intramedullary lesion with slight enhancement at the C2-7 levels. With intraoperative neuroelectrophysiological monitoring, the lesion was subtotally resected. Histopathological examination revealed a DMG with histone H3 K27M mutation corresponding to WHO grade IV. Postoperatively, the neck pain was relieved, and the upper-extremity weakness remained unchanged. Oral temozolomide was administrated for 7 months, and radiotherapy was performed for 22 courses. After an 18-month follow-up, no tumor recurrence was noted. Conclusion: Spinal cord H3 K27M-mutant DMGs are extremely rare in pediatric patients. Preoperative differential diagnosis is challenging, and surgical resection with postoperative chemoradiotherapy may be an effective treatment.
Disseminated Nocardiosis: A Successful Blind Strategy of Treatment in an HIV Infected Patient
Authors: Ana C Guerra, Dário Batista, Maria J Aleixo, Paulo Saraiva, Maria J Aguas
Journal: Case Rep Infect Dis (2015)

Background. Nocardiosis is a rare disease that mainly affects severely immunocompromised patients. Symptoms are nonspecific and microbiological isolation is difficult, hiding the diagnosis. Treatment should be guided by species and susceptibility testing. Findings. We report a clinical case of a disseminated nocardiosis in a patient with HIV and HVB infections. Interpretation. Diagnosis should be presumed early and microbiological conditions should be optimized, in order to identify the species and achieve antibiotic susceptibility testing. This is a very important step to choose an effective therapeutic regimen or alternative options.
Difficult to Treat Focal, Stiff Person Syndrome of the Left Upper Extremity
Authors: Nathan E Esplin, John W Stelzer, Timothy B Legare, Sayed K Ali
Journal: Case Rep Neurol Med (2017)
MeSH terms: Case Reports

Background:
Stiff person syndrome (SPS) is a rare neurologic disorder characterized by muscle rigidity. It is a disorder of reduced GABA activity leading to increased muscle tone and often painful spasms. It generally presents in the axial musculature but rarely can involve only one limb, typically a lower extremity. In rare cases it can be paraneoplastic which generally resolves on treatment of the underlying neoplasm.
Case report:
A 46-year-old male with a history of Hodgkin's Lymphoma in remission presented with left upper extremity pain secondary to a diagnosis of Stiff Person Syndrome limited to his left upper extremity. He had previously benefitted from plasmapheresis and was on diazepam and baclofen at home with relatively good control of his symptoms. SPS had previously been diagnosed with EMG and anti-GAD-65 antibody titers and was confirmed by an elevated anti-GAD-65 antibody titer. He was treated with plasmapheresis and maximum doses of medical treatment including botulinum toxin with only transient mild improvement in his symptoms.
Conclusion:
This case represents a case of a rare disease that was refractory to all known therapies. It outlines the need for further understanding of this disorder in order to provide better symptomatic treatment or potentially more definitive care.
Metastatic neuroendocrine pancreatic tumor - Case report
Authors: E C Radu, A I Saizu, R R Grigorescu, A E Croitoru, C Gheorghe
Journal: J Med Life (2018)
Keywords: cancer, neuroendocrine, pancreas
MeSH terms: Intestinal Neoplasms / pathology, Liver Neoplasms / secondary, Neuroendocrine Tumors / pathology, Pancreatic Neoplasms / pathology, Stomach Neoplasms / pathology, Case Reports, Cell Proliferation, Endoscopic Ultrasound-Guided Fine Needle Aspiration, Fatal Outcome, Humans, Immunohistochemistry, Liver Neoplasms / diagnostic imaging, Liver Neoplasms / pathology, Magnetic Resonance Imaging, Male, Middle Aged, Prognosis, Staining and Labeling, Tomography, X-Ray Computed, Gastro-enteropancreatic neuroendocrine tumor

Rationale.Pancreatic neuroendocrine tumors (NETs) are rare neoplasms that develop from the endocrine tissues of the pancreas. They have a better overall prognosis than pancreatic adenocarcinoma. However, all commonly used classification systems reflect a separation between more indolent, well-differentiated tumors and far more aggressive poorly differentiated types that behave clinically more like small-cell carcinoma of the lung. Objective.To present the case of a 62-year-old man with an aggressive pancreatic NET, with liver, splenic and bone metastases who underwent multidisciplinary treatment including several lines of chemotherapy, somatostatin analogs and radiotherapy. Methods and Results.The patient is a smoker and an occasional drinker, known with type two diabetes mellitus (DM), receiving insulin therapy. He was diagnosed by contrast-enhanced computed tomography (CT) in January 2015 with a locally invasive pancreatic body mass, intraabdominal adenopathies and liver nodules, suggestive of metastases. Histopathological diagnosis was obtained through liver biopsy: neuroendocrine tumor with a 10-15% Ki67 proliferation index. Palliative chemotherapy with oxaliplatin and capecitabine was started in March 2015. In June 2015, Sandostatin LAR was added. In March 2016, he had progressive disease. Subsequently, in September 2016, bone metastasis was found within the T10 vertebra. He underwent radiotherapy for multiple bone metastases in February 2017. Progressive disease was again found during a CT examination in May 2017. His performance status has gradually worsened since then and he died in July 2017. Discussion.As a group, well-differentiated gastroenteropancreatic NETs are generally indolent malignancies with prolonged natural history. Intermediate-grade NETs have a slightly worse prognosis than low-grade tumors. Abbreviations: NETs - neuroendocrine tumors, NEC - neuroendocrine carcinoma, CT - computed tomography, MRI - magnetic resonance imaging, DM - diabetes mellitus, WHO - World Health Organisation, HCV - hepatitis C virus, CEA - carcinoembryonic antigen, AFP - alpha-fetoprotein, 5-HIAA - 5-Hydroxyindoleacetic acid, IHC - immunohistochemistry, EUS - endoscopic ultrasonography, EUS FNA - endoscopic ultrasonography with fine needle aspiration, CgA - chromogranin A, PRRT - peptide receptor radioligand therapy.
Cytomegalovirus Colitis in Primary Hypogammaglobulinemia With Normal CD4+ T Cells: Deficiency of CMV-Specific CD8+ T Cells
Authors: Sudhanshu Agrawal, Amrita Khokhar, Sudhir Gupta
Journal: Front Immunol (2019)
Keywords: cd4 treg, cd8 teg, pd-1, t effector memory cells, cytotoxic t cells
MeSH terms: Agammaglobulinemia / complications, CD4-Positive T-Lymphocytes / immunology, CD8-Positive T-Lymphocytes / immunology, Colitis / virology, Cytomegalovirus / genetics, Cytomegalovirus Infections / complications, Cytomegalovirus Infections / diagnosis, Case Reports, Adult, Antiviral Agents / therapeutic use, CD4 Lymphocyte Count, Cytomegalovirus Infections / drug therapy, Cytomegalovirus Infections / virology, Humans, Immunocompromised Host, Male, Polymerase Chain Reaction, Treatment Outcome, Valganciclovir / therapeutic use, Antiviral Agents, Valganciclovir

CMV colitis has been reported in immunocompromized patients with severe deficiency of CD4+ T cells and T cell functions. In this study we present an extensive immunological analysis in a patient with primary hypogammaglobulinemia and CMV colitis who had normal numbers of CD3+T, CD4+T and CD8+T cells, and normal T cell proliferative responses to mitogens and recall antigens. Naïve (TN), central (TCM), and effector (TEM) memory subsets of CD4+ and CD8+ T cells, Granzyme+ and Perforin+ CD8+ T cells, PD-1+ T cells, CD4 Treg, CD8 Treg, and CMV tetramer specific CD8+ T cells were analyzed with specific antibodies and isotype controls using multicolor flow cytometry. CD8 TEM, Granzyme+ and Perforin+, and PD-1 CD8+T cells were increased, whereas CD8 TN and CD8 TCM cells were decreased in the patient as compared to controls. CMV tetramer+ CD8+ T cells were decreased in the patient. These data demonstrate that a deficiency of CMV-specific CD8+ T cells even in the presence of normal CD4+ T cell numbers and normal T cell functions may predispose patients with primary hypogammaglobulinemia to CMV colitis.
Mucin-Poor Mucinous Tubular and Spindle Cell Carcinoma of the Kidney Presented with Multiple Metastases Two Years after Nephrectomy: An Atypical Behaviour of a Rare, Indolent Tumour
Authors: I Sokolakis, C Kalogirou, L Frey, M Oelschläger, M Krebs, H Riedmiller, H Kübler, D Vergho
Journal: Case Rep Urol (2017)
MeSH terms: Case Reports

Background:
Mucinous tubular and spindle cell carcinoma (MTSCC) is a rare type of renal cell carcinoma, whose clinical behaviour and metastatic potential have not been fully elucidated to date. There are only a few metastatic cases in the literature, which all either featured sarcomatoid differentiation or were synchronously metastasised at diagnosis.
Case presentation:
We report a case of a 49-year-old male with end-stage kidney disease on dialysis, presenting with multiple osseous metastases of a mucin-poor variant of MTSCC of the kidney, without sarcomatoid differentiation, two years after bilateral nephrectomy for papillary renal cell carcinoma (RCC) at a curable stage. After retrospectively reexamining the initial nephrectomy specimens, the tumour of the right kidney was also diagnosed as a mucin-poor variant of MTSCC, while the tumour of the left kidney was confirmed as a papillary RCC.
Conclusions:
It is proposed that MTSCC can be associated with end-stage renal disease and that particularly the mucin-poor variant is easily confused with papillary renal cell carcinoma, as happened in this case. Although it is considered as a relatively indolent malign entity, it can metastasise even years after successful primary surgical treatment. This implies, besides accurate diagnosis, that MTSCC patients should be monitored closely in the follow-up period.
Novel Brentuximab Vedotin Combination Therapies Show Promising Activity in Highly Refractory CD30+ Non-Hodgkin Lymphoma: A Case Series and Review of the Literature
Authors: Wilfred Delacruz, Robert Setlik, Arash Hassantoufighi, Shyam Daya, Susannah Cooper, Dale Selby, Alexander Brown
Journal: Case Rep Oncol Med (2016)

Non-Hodgkin lymphomas (NHLs) are a heterogeneous group of hematologic malignancies which typically respond to standard first-line chemoimmunotherapy regimens. Unfortunately, patients with refractory NHL face a poor prognosis and represent an unmet need for improved therapeutics. We present two cases of refractory CD30+ NHL who responded to novel brentuximab vedotin- (BV-) based regimens. The first is a patient with stage IV anaplastic large cell lymphoma (ALCL) with cranial nerve involvement who failed front-line treatment with cyclophosphamide, doxorubicin, vincristine, etoposide, and prednisone (CHOEP) and second line cyclophosphamide, vincristine, doxorubicin, dexamethasone alternating with high-dose methotrexate (MTX), and cytarabine (hyperCVAD) with intrathecal- (IT-) MTX and IT-cytarabine, but responded when BV was substituted for vincristine (hyperCBAD). The second patient was a man with stage IV diffuse large B-cell lymphoma (DLBCL) with leptomeningeal involvement whose disease progressed during first-line rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) and progressed despite salvage therapy with rituximab, dexamethasone, cytarabine, and cisplatin (R-DHAP) in whom addition of BV to topotecan resulted in a significant response. This report describes the first successful salvage treatments of highly aggressive, double refractory CD30+ NHL using two unreported BV-based chemoimmunotherapy regimens. Both regimens appear effective and have manageable toxicities. Further clinical trials assessing novel BV combinations are warranted.
Intracardiac thrombus in Behçet's disease: a rare case in Morocco
Authors: Younes Amchich, Nezha Reguig, Abdelhalim Boucaid, Reda Belghoule, Adil Zegmout, Jamal Eddine Bourkadi
Journal: Pan Afr Med J (2020)
Keywords: behçet’s disease, hemoptysis, immunosuppressive agents, intracardiac thrombus, pulmonary embolism
MeSH terms: Behcet Syndrome / complications, Heart Ventricles / diagnostic imaging, Thrombosis / diagnostic imaging, Case Reports, Adolescent, Adrenal Cortex Hormones / administration & dosage, Behcet Syndrome / drug therapy, Cyclophosphamide / administration & dosage, Echocardiography, Heart Ventricles / pathology, Humans, Immunosuppressive Agents / administration & dosage, Male, Morocco, Thrombosis / drug therapy, Thrombosis / etiology, Adrenal Cortex Hormones, Immunosuppressive Agents, Cyclophosphamide

Behçet's syndrome is a systemic inflammatory disease generally presented with the triad of uveitis, oral and genital ulcers. However, it may present with gastrointestinal, central nervous system, skin and vascular disease manifestations. Intracardiac thrombus is a rare but serious complication of Behçet's disease. A 16-year-old man with Behçet's syndrome was hospitalized into our department with a history of cough, fever, chest pain, hemoptysis, and weight loss. Transthoracic echocardiography and chest scan revealed a right ventricular thrombus. After one month of treatment with cyclophosphamide, and corticosteroid the intracardiac thrombus has been resolved.
Peri-operative management of hysterostomy in a parturient with complete heart block, placenta accreta and intrauterine death
Authors: Vineya Rai, Ina I Shariffuddin, Yoo K Chan, Rajesh K Muniandy, Kang K Wong, Sukcharanjit Singh
Journal: BMC Anesthesiol (2014)
Keywords: complete heart block, hysterectomy, hysterostomy, pregnancy
MeSH terms: Fetal Death / etiology, Heart Block / complications, Hysterectomy / methods, Placenta Accreta / physiopathology, Case Reports, Research Support, Non-U.S. Gov't, Adult, Anesthesia, General / methods, Blood Loss, Surgical / prevention & control, Embolization, Therapeutic / methods, Female, Heart Block / congenital, Heart Block / surgery, Humans, Pacemaker, Artificial, Pregnancy, Pregnancy Complications, Cardiovascular / physiopathology, Pregnancy Complications, Cardiovascular / surgery

Background:
Complete heart block in pregnancy has serious implications particularly during the period of delivery. This is more so if the delivery is an operative one as the presence of heart block may produce haemodynamic instability in the intra operative period. We report a unique case of a pregnant mother with complete heart block undergoing hysterostomy, complicated by placenta accreta and intrauterine death.
Case presentation:
A 37 year old Malaysian Chinese parturient was admitted at 25 weeks gestation following a scan which suggested intrauterine death and placenta accreta. She was diagnosed to have congenital complete heart block after her first delivery eight years previously but a pacemaker was never inserted. These medical conditions make her extremely likely to experience massive bleeding and haemodynamic instability. Among the measures taken to optimise her pre-operatively were the insertion of a temporary intravenous pacemaker and embolization of the uterine arteries to minimize peri-operative blood loss. She successfully underwent surgery under general anesthesia, which was relatively uneventful and was discharged well on the fourth post-operative day.
Conclusion:
Congenital heart block in pregnancies in the presence of potential massive bleeding is best managed by a team, with meticulous pre-operative optimization. Suggested strategies would include insertion of a temporary pacemaker and embolization of the uterine arteries to reduce the risk of the patient getting into life threatening situations.
Combined Aortic Root Replacement and Heart Transplantation in a Patient with Dilated Cardiomyopathy and Aortic Root Aneurysm
Authors: B Baharestani, A Amin, B Ghadrdoost, M Behjati
Journal: Int J Organ Transplant Med (2018)
Keywords: aortic aneurysm, aortic root replacement, heart transplantation
MeSH terms: Case Reports

Concomitant replacement of the ascending aorta and heart transplantation are an infrequent procedure. This procedure was most often performed in patients with Marfan syndrome, however, it has its own technical difficulties. Hereby, we report on combined heart transplantation and aortic root replacement using donor's ascending aorta in a 25-year-old man diagnosed with dilated cardiomyopathy and ascending aorta aneurysm. This procedure was successful and beneficial to patients with aortopathy who are candidates for heart transplantation.
CT-guided minimally-invasive penile fracture repair
Authors: Cui Yan, Bing-Xue Liang, Hai-Bin Huang, Bi-Rong Liang, Zheng Zhou, Ling-Jun Wang, Zhong-Qi Yang, Shao-Xiang Xian
Journal: Int Braz J Urol (2019)
Keywords: penis, sutureless surgical procedures, tomography, x-ray computed
MeSH terms: Penile Diseases / surgery, Penis / injuries, Rupture / surgery, Case Reports, Adult, Humans, Male, Minimally Invasive Surgical Procedures, Penile Diseases / diagnostic imaging, Penis / diagnostic imaging, Penis / surgery, Rupture / diagnostic imaging, Tomography, X-Ray Computed

We present the case of a 28 year old patient with an incomplete tear of the tunica albuginea occurred after having sexual intercourse in the female superior position. The diagnostic assessment was performed first clinically, then with CT, owing to its high resolution, allowed to exactly detect the tear location leading to precise preoperative planning. After adequate diagnosis through imaging and proper planning, the patient was performed a selective minimally invasive surgical approach to repair the lesion. The patient had good erection with no angular deformity or plaque formation after a 3-month follow-up.
Canine cutaneous and renal glomerular vasculopathy in the Republic of Ireland: a description of three cases
Authors: Aimee Hope, Carlos Martinez, Joseph P Cassidy, Barbara Gallagher, Carmel T Mooney
Journal: Ir Vet J (2019)
Keywords: alabama rot, skin lesions with azotaemia, thrombotic microangiopathy
MeSH terms: Case Reports

Background:
Cutaneous and renal glomerular vasculopathy (CRGV) is a condition of unknown aetiology involving microvascular thrombosis. It has recently been described in over 160 dogs in the United Kingdom and usually has a grave prognosis. To date, this condition has not been described in dogs residing in the Republic of Ireland.
Case presentation:
Three dogs presented to University College Dublin Veterinary Hospital (UCDVH) for investigation of rapidly progressive skin lesions. All dogs were diagnosed with CRGV on post-mortem examination. All three dogs had azotaemia on presentation or rapidly developed azotaemia, and all were euthanased because of progression of clinical signs and likelihood of CRGV. One dog was affected by seizure-like episodes and had thrombotic microangiopathy evident within the cerebrum.
Conclusions:
CRGV occurs in dogs residing in the Republic of Ireland and is a differential for cases presenting with skin lesions and azotaemia. The histopathological lesions of CRGV can also affect the brain leading to neurological signs such as seizures. Owners and veterinarians should be aware that this condition can occur in dogs in Ireland.
Immunohistochemical features of multifocal melanoacanthoma in the hard palate: a case report
Authors: Luis Felipe das Chagas E Silva de Carvalho, Vitor Hugo Farina, Luiz Antonio Guimarães Cabral, Adriana Aigotti Haberbeck Brandão, Ricardo Della Coletta, Janete Dias Almeida
Journal: BMC Res Notes (2013)
MeSH terms: Acanthoma / metabolism, Mouth Neoplasms / metabolism, Palate, Hard / pathology, Case Reports, Acanthoma / pathology, Female, Humans, Immunohistochemistry, Middle Aged, Mouth Neoplasms / pathology

Background:
Melanoacanthoma (MA) has been described in the oral mucosa as a solitary lesion or, occasionally, as multiple lesions. MA mainly affects dark skinned patients and grows rapidly, showing a plane or slightly raised appearance and a brown to black color. The differential diagnosis includes oral nevi, amalgam tattoos, and melanomas. We report here the case of a 58-year-old black woman who presented multiple pigmented lesions on the hard palate.
Case presentation:
Based on the differential diagnosis of melanoma, a punch biopsy (4 mm in diameter) was performed. The material was fixed in 10% formalin, embedded in paraffin, and stained with hematoxylin-eosin or submitted to immunohistochemical analysis. Immunohistochemistry using antibodies against protein S-100, melan-A, HMB-45, MCM-2, MCM-5, Ki-67 and geminin was performed. Immunohistochemical analysis revealed strong cytoplasmic immunoreactivity of dendritic melanocytes for proteinS-100, HMB-45 and melan-A.Positive staining for proliferative markers (MCM-2, MCM-5, Ki-67) was only observed in basal and suprabasal epithelial cells, confirming the reactive etiology of the lesion. The diagnosis was oral Melanoacanthoma (MA).
Conclusion:
The patient has been followed up for 30 months and shows no clinical alterations. MA should be included in the differential diagnosis of pigmented lesions of the oral cavity.