OpenMed/multicare-articles huggingface dataset:
Adaptive Tomotherapy for locally advanced unresectable pancreatic neuroendocrine tumor: Case report and literature review
Authors: Kuan-Yi Tu, Yen-Shuo Huang, Juntiong Lau, Hsin-Hua Lee
Journal: Front Oncol (2022)
Keywords: tomotherapy, abdomen, adaptive planning, case report, image-guided radiotherapy (igrt), neuroendocrine neoplasm (nen), pancreas, unresectable neuroendocrine tumor (net)
MeSH terms: Case Reports

Background:
Pancreatic neuroendocrine tumor (NET) is rare, and the majority presents late in their clinical course. Here, we present a huge locally advanced pancreatic NET having Hi-Art helical Tomotherapy that resulted in a 68% reduction in target volume during adaptive image-guided radiotherapy (IGRT).
Case summary:
A 63-year-old man without any history of systemic disease developed voiding difficulty for several months. Associated symptoms included poor appetite, nausea, distended abdomen, and body weight loss. Further magnetic resonance imaging showed a large multilobulated tumor in the left upper abdomen. Tumor biopsy revealed well-differentiated, grade 2, neuroendocrine tumor. Complete resection was unattainable. Therefore, Lanreotide was prescribed initially. However, tumor progression up to the greatest diameter of 18 cm was noted on computed tomography 5 months later. Thus, he stopped Lanreotide and commenced on concurrent chemoradiotherapy (CCRT). With a total dose of 70 Gy in 35 fractions, we generated two adaptive treatment plans during the whole course. Laparoscopic subtotal pancreatectomy with spleen preservation was performed after neoadjuvant CCRT. It has been more than 3 years after IGRT, and he remains cancer free and reports no side effects during regular follow-ups.
Conclusion:
Tomotherapy caused tumor size reduction and hence facilitated surgical possibility for this originally unresectable pancreatic NET. Neoadjuvant IGRT incorporated with adaptive treatment planning enhanced delivery accuracy. In this case of pancreatic NET resistant to Lanreotide, inter-fractional tumor regression from 1910 to 605 cc (68%) was documented.
Allergic Bronchopulmonary Aspergillosis with an Atypical Mass-Like Presentation
Authors: Mahmoud Ibrahim Mahmoud, Alaeldin Elfaki, Ziad A Alhaj, Abir Hamad Said
Journal: Case Rep Pulmonol (2022)
MeSH terms: Case Reports

Allergic bronchopulmonary aspergillosis is an uncommon condition characterized by airway hypersensitivity to Aspergillus fumigatus, resulting in worsening asthma control and bronchiectasis progression. It is associated with various radiological features. Here, we describe a 53-year-old lady with atypical CT chest finding as soft tissue density masses in both lungs evaluated initially as a lung tumour. The diagnosis was particularly challenging given the history of undiagnosed asthma. Nevertheless, bronchoscopy findings of mucus impaction and blood eosinophilia redirect the clinical thinking toward ABPA. Laboratory examination showed elevated total IgE, Aspergillus fumigatus IgE, and Aspergillus niger IgE. Shortly after treatments with systemic steroids, our patient showed a symptomatic improvement. Moreover, subsequent follow-up showed a resolution of the radiological opacities.
Needle-Knife Fistulotomy for the Rescue: An Unusual Cause of Iatrogenic Extrahepatic Biliary Obstruction
Authors: Laura L Ulmer, Lokesh K Jha, Neil Bhogal, Saurabh Kapur, Saurabh Chandan, Derrick Eichele, Ishfaq Bhat, Shailender Singh
Journal: Case Rep Gastrointest Med (2018)
MeSH terms: Case Reports

A 71-year-old male presented to our institution with cholestatic hepatitis after having recently undergone upper endoscopy for treatment of gastrointestinal bleeding. Further investigation with endoscopic retrograde cholangiopancreatography revealed a hemostatic clip on the ampulla of Vater. After initial attempts at cannulation of the common bile duct were unsuccessful, biliary decompression was achieved by use of needle-knife fistulotomy. A common bile duct stent was placed and the liver function tests improved prior to discharge.
Pylorus-preserving pancreatoduodenectomy for pancreatic head cancer after surgery for esophageal cancer with gastric tube reconstruction in a long-term survivor: A case report
Authors: Takashi Orii, Masaki Yoshimura, Hiroe Kitahara, Yukihiko Karasawa
Journal: Int J Surg Case Rep (2019)
Keywords: esophagectomy, gastric tube, gastroduodenal artery, pylorus-preserving pancreatoduodenectomy, right gastroepiploic artery

Introduction:
To maintain the blood circulation of the gastric tube in pylorus-preserving pancreatoduodenectomy (PPPD) for periampullary cancer after esophagectomy for esophageal cancer, it is necessary to preserve the gastroduodenal artery and its branch, the right gastroepiploic artery, which are usually resected for more convenient, complete, and effective lymph node dissection. Here we report the case of a patient with a postoperative survival period of more than 5 years.
Presentation of case:
A 79-year-old man, who underwent subtotal esophagectomy and gastric tube reconstruction 11 years ago, was diagnosed with pancreatic head cancer during routine examination 5 years after the esophageal surgery. After placement of a coronary artery stent for an arterial branch stenosis incidentally found during preoperative screening electrocardiogram, he underwent pancreatic surgery. As the tumor did not extend to the anterior surface of the pancreas and as there were no swollen lymph nodes in the area, the gastroduodenal artery, the gastroepiploic artery and vein could be preserved. Elective PPPD was conducted without incident, and good preoperative gastric tube circulation was maintained postoperatively. Reconstruction was performed according to the modified Child procedure with duct-to-mucosa stentless pancreaticojejunostomy. The postoperative course was uneventful and though it took the patient a long time to overcome the physical decline, he remains alive with no recurrent disease over 5 years post-operation.
Conclusion:
Although PPPD may be performed after esophagectomy with gastric tube reconstruction, it is still unclear how the risk of recurrence is affected. Therefore, the indications of this procedure should always be carefully considered.
Implant Prosthodontic Rehabilitation after Surgical Treatment for an Oropharyngeal Malignant Tumour Using Tantalum Dental Implants
Authors: Marko Vuletić, Ivica Pelivan, Dragana Gabrić
Journal: Case Rep Dent (2021)
MeSH terms: Case Reports

Oropharyngeal cancer (OPC) represents a significant portion of head and neck cancers. In most cases, it is localised in the soft palate, lingual and palatine tonsils, base of the tongue, and the surrounding tissues. Alcohol and tobacco exposure are well-known evidence-based risk factors for developing OPC; however, over the last decade, there has been a rapid increase in OPC linked to human papillomavirus (HPV). Dental implant therapy faces many challenges related to immediate and long-term success, and patients who are rehabilitated with implant prosthodontic therapy often have numerous comorbidities. Tantalum is a rare transitional metal element which has high corrosion resistance and is extremely inert. Porous tantalum trabecular metal (PTTM) has high volumetric porosity, a low modulus of elasticity, and very high friction. PTTM implant surface enhancement allows "osseoincorporation," which means the neovascularisation and formation of new bone directly onto the implant. A 65-year-old patient presented to the Department of Oral Surgery of Clinical Hospital Centre Zagreb after resection of the mandible due to OPC had oral rehabilitation. Three Zimmer Biomet Trabecular Metal™ implants (4.1 × 10 mm) were inserted in the area of lower left first incisor, lower left second premolar, and lower right second premolar, and after four months, a new upper partial denture and the bar-retained mandibular overdenture were made. Implant prosthodontic rehabilitation of head and neck cancer patients is usually challenging in terms of achieving an improvement in its main aim, quality of life; however, today it is a safe and reliable therapy. Although radiation therapy may negatively affect the patient's oral condition and influence the short- and long-term success of the implant, the presented case report showed that the excellent properties of PTTM-enhanced dental implants may give great basis for future comparative researches of using these implants in the treatment of oncologic patients.
Case Report: Combination of Pressure Guidewire and Optical Coherence Tomography-Guided Drug-Coated Balloon Revascularization for Renal Artery Fibromuscular Dysplasia
Authors: Yuxi Li, Xinyan Wen, Bo Zheng, Ming Chen, Wei Ma, Jianping Li
Journal: Front Cardiovasc Med (2022)
Keywords: drug-coated balloon, fibromuscular dysplasia, optical coherence tomography, pressure guidewire, secondary hypertension
MeSH terms: Case Reports

Fibromuscular dysplasia (FMD) is the second common cause of renovascular hypertension. With the advent of endovascular therapy, angiography has become a diagnostic gold standard for FMD. Optical coherence tomography (OCT) by reflecting in vivo histology may improve diagnostic and classification accuracy. Renal fractional flow reserve (rFFR), measured by pressure guidewire, may distinguish the patients who may benefit from revascularization by identifying physiologically significant stenoses. However, the role of usage of both OCT and rFFR is not well-studied. We herein report a 17-year-old male with renovascular hypertension due to FMD. Angioplasty of drug-coated balloon (DCB) guided by OCT and FFR favorably achieved blood pressure (BP) control. In conclusion, the utility of both OCT and FFR may be useful for the appropriate selection of patients with renal FMD.
Case Report: Retroperitoneal Sarcoma in Six Operations: Our Experience in Operative Management of Blood Vessels
Authors: Jinhui Guo, Fabo Qiu, Jie Zhao, Qiliang Lu, Wen Fu, Qiuran Xu, Dongsheng Huang
Journal: Front Oncol (2022)
Keywords: myxofibrosarcoma, recurrent, retroperitoneal dedifferentiated liposarcoma, rhabdomyosarcoma differentiation, vascular resection
MeSH terms: Case Reports

Here we introduce a case of retroperitoneal liposarcoma, which is characterized by repeated recurrences after surgery, and has undergone a total of 6 operations. The diameter of the tumor was about 26 cm at the time of the patient's diagnosis. The imaging examination revealed that the surrounding organs and blood vessels were invaded, which brought great challenges to radical resection. The postoperative pathology of the patient's first operation was dedifferentiated liposarcoma, and some areas showed myxofibrosarcoma differentiation. With the recurrence of sarcoma, myxofibrosarcoma dedifferentiated into rhabdomyosarcoma, and malignant fibrous histiocytoma appeared in some areas. How to treat this type of patient after recurrence? How to deal with blood vessels wrapped by sarcoma during surgery? The medical community has not yet reached the same conclusion. We describe the process of treating the patient and the experience of dealing with blood vessels during surgery.
Results of the prolonged use of subcutaneous continuous infusion of hydrocortisone in a man with congenital adrenal hyperplasia
Authors: Emmanuel Sonnet, Nathalie Roudaut, Véronique Kerlan
Journal: ISRN Endocrinol (2011)
MeSH terms: Case Reports

This is a case report study of a young man with Congenital Adrenal Hyperplasia (CAH) who has been treated during 2 years by a subcutaneous continuous infusion hydrocortisone (SCIH) to optimize his treatment. Hydrocortisone was delivered via an insulin infusion device. We also studied the evolution of testicular adrenal rest tumors (TARTs) and the quality of life through SF36 survey. Four rates were determined, with a total of 47 mg per day. Biochemical parameters were normalized at 2 months. The SF36 questionnaire showed a progress of well-being. The weight decreased to 106 kg, that is, -5 kg (height: 1.71 m). Unfortunatly, there was no change of the TARTs. Two episodes of dermohypodermitis, with abscess at the infusion site, were observed. This case demonstrates the feasibility of prolonged SCIH therapy in patients with CAH, reporting positive effects on quality of life and on BMI.
Uncommon Odontogenic Orocutaneous Fistula of the Jaw Treated with Platelet-Rich Fibrin
Authors: Kani Bilginaylar
Journal: Case Rep Dent (2017)
MeSH terms: Case Reports

Orocutaneous fistula (OCF) of dental origin is a relatively rare condition and continues to be a challenging diagnosis. Misdiagnosis of OCF usually leads to unnecessary and noneffective treatment. A 21-year-old male referred with a complaint of a lesion on the chin which was misdiagnosed as a carbuncle (lesion of nonodontogenic origin) by a physician. After radiological examination, there was a lesion around the apical region of right central incisor. These findings indicated a sinus tract associated with dental origin. After root canal treatment, apical surgery was performed and platelet-rich fibrin (PRF) was administered to the cavity of the lesion as a gel form to improve healing and also used as a membrane form to cut off the relation between infected area and the skin. All procedures were performed intraorally; no extraoral intervention was performed. Three months later, clinical and radiological examination showed total healing without scar formation. The key to successful treatment of OCF is accurate diagnosis. Additionally, the use of PRF after surgical interventions is an effective and innovative therapy to improve healing.
Gastric extremely well differentiated adenocarcinoma of gastric phenotype: as a gastric counterpart of adenoma malignum of the uterine cervix
Authors: Won Ae Lee
Journal: World J Surg Oncol (2005)

Background:
Most of gastric adenocarcinoma can be simply diagnosed by microscopic examination of biopsy specimen. Rarely the structural and cellular atypia of tumor cells is too insignificant to discriminate from benign foveolar epithelium.
Case presentation:
A 67-year-old male presented with a gastric mass incidentally found on the abdominal computed tomography (CT) for routine medical examination. Gastric endoscopic examination revealed a huge fungating mass at the cardia and mucosal biopsy was performed. Microscopically the biopsy specimen showed proliferation of bland looking foveolar epithelia in the inflammatory background and diagnosed as foveolar epithelial hyperplasia. Because the clinical and endoscopic features of this patient were strongly suggestive of malignancy, the patient underwent radical total gastrectomy. The resected stomach revealed a huge fungating tumor at the cardia. The cut surface of the tumor was whitish gelatinous. Microscopically the tumor was sharply demarcated from surrounding mucosa and composed of very well formed glandular structures without significant cellular atypia, which invaded into the whole layer of the gastric wall. Tumor glands were occasionally complicated or dilated, and glandular lumina were filled with abundant mucin. Immunohistochemically the tumor cells revealed no overexpression of p53 protein but high Ki-67 labeling index. The tumor cells and intraluminal mucin were diffusely expressed MUC1 and MUC5AC and only focally expressed MUC2. On abdominal CT taken after 12 months demonstrated peritoneal carcinomatosis and multiple metastatic foci in the lung.
Conclusion:
The clinicopathologic profiles of gastric extremely well differentiated adenocarcinoma of gastric phenotype include cardiac location, fungating gross type, very similar histology to foveolar epithelial hyperplasia, foveolar mucin phenotype, lack of p53 overexpressoin and high proliferative index.
Untypical symptoms for rather uncommon surgical entities: report of two rare cases of secondary intussusception in children (a case report)
Authors: Godosis Dimitrios, Mouravas Vasileios, Lambropoulos Vassilis, Kepertis Chrysostomos, Anastasiadis Kleanthis, Spyridakis Ioannis
Journal: Pan Afr Med J (2020)
Keywords: case report, inflammatory myofibroblastic tumor, non-hodgkin lymphoma, secondary intussusception
MeSH terms: Ileal Diseases / diagnosis, Ileal Neoplasms / diagnosis, Intussusception / diagnosis, Lymphoma / diagnosis, Case Reports, Adolescent, Child, Female, Humans, Ileal Diseases / pathology, Ileal Diseases / surgery, Ileal Neoplasms / pathology, Ileal Neoplasms / surgery, Intestine, Small / pathology, Intestine, Small / surgery, Intussusception / pathology, Intussusception / surgery, Lymphoma / pathology, Lymphoma / surgery, Male

Intussusception in infants and children represents a relatively usual challenge for the pediatric surgeon. However, the incidence of lymphoma of the small intestine or inflammatory myofibroblastic tumor, acting as a lead point for invagination, are rather rare. We hereby present two cases of secondary intussusception, with the aforementioned lead points.
Case report: Pragmatic impairment in multiple sclerosis after worsening of clinical symptoms
Authors: Sara Lago, Francesca Bevilacqua, Maria Rosaria Stabile, Cristina Scarpazza, Valentina Bambini, Giorgio Arcara
Journal: Front Psychol (2022)
Keywords: case report, communication, language, multiple sclerosis, pragmatic impairment, pragmatics
MeSH terms: Case Reports

Pragmatics, defined as the ability to integrate language and context to communicate effectively, may be impaired in Multiple Sclerosis (MS). We present the case of a patient with active secondary progressive MS who, after a first neuropsychological assessment that evidenced only a slight pragmatic impairment, suffered a sudden worsening of her clinical conditions, treated with corticosteroids. After this clinical worsening, her pragmatic abilities declined markedly, both in comprehension and production. This worsening was accompanied by a decline only in one attention task, in the context of an overall stable cognitive functioning. We conclude that pragmatics may be a domain particularly susceptible to cognitive worsening, highlighting the importance of its assessment in clinical practice.
Quadricuspid aortic valve diagnosed by multidetector computed tomography (MDCT)
Authors: S K Bellamkonda, A Pasumarthy, S Velicheti
Journal: BJR Case Rep (2015)
MeSH terms: Case Reports

A quadricuspid aortic valve is very rare form of congenital cardiac valvular disease with an incidence between 0.003 and 0.043% and often incidentally found during echocardiography, surgery or on post-mortem examination (Feldman BJ, Khandheria BK, Warnes CA, Seward JB, Taylor CL, Tajik AJ. Incidence, description and functional assessment of isolated quadricuspid aortic valves. Am J Cardiol 1990; 65 : 937-8). Its diagnosis is often missed, even with the transthoracic echocardiogram, as in this patient. We report a case of a quadricuspid aortic valve that was incidentally found by 256-slice electrographically-gated multidetector row CT/tomographic angiography during screening for coronary artery disease.
Site of analysis matters - Ongoing complete response to Nivolumab in a patient with HIV/HPV related metastatic anal cancer and MLH1 mutation
Authors: Melanie Demes, Ursula Pession, Jan Jeroch, Falko Schulze, Katrin Eichler, Daniel Martin, Peter Wild, Oliver Waidmann
Journal: Oncotarget (2022)
Keywords: anal cancer, high-throughput nucleotide sequencing, immunotherapy, microsatellite instability, nivolumab
MeSH terms: Anus Neoplasms / drug therapy, Anus Neoplasms / genetics, HIV Infections, Papillomavirus Infections, Case Reports, Carboplatin, Humans, Microsatellite Instability, MutL Protein Homolog 1 / genetics, Mutation, Nivolumab / therapeutic use, Paclitaxel, Programmed Cell Death 1 Receptor, MLH1 protein, human, Programmed Cell Death 1 Receptor, Nivolumab, Carboplatin, MutL Protein Homolog 1, Paclitaxel, Anal Canal Carcinoma

Anal cancer is a rare disease with increasing incidence. In patients with locally recurrent or metastatic disease which cannot be treated with chemoradiotherapy or salvage surgery systemic first-line chemotherapy with carboplatin and paclitaxel is standard of care. For patients who progress after first-line therapy and are still eligible for second-line therapy Programmed cell death protein 1 (PD-1) antibodies are potential therapeutic options. However, prediction of response to immunotherapy is still challenging including anal cancer. We report here to our knowledge the first anal cancer case with microsatellite instability (MSI) due to MLH1 mutation and a deep and ongoing response to Nivolumab treatment. Namely, thorough analysis of the primary tumor as well as metastatic sites by next generation sequencing (NGS) revealed that MSI was formally only found in the metastatic sites but not in the primary tumor. Concomitantly, tumor mutational burden (TMB) was higher in the metastatic site than in the primary tumor. Therefore, we conclude that all anal cancer patients should be tested for MSI and whenever possible molecular analysis should be performed rather from metastatic sites than from the primary tumor.
Cervical lymphadenopathy as initial presentation of metastatic prostate cancer: A retrospective study of five cases and literature review
Authors: Yangyang Liu, Zhihong Dai, Jiange Hao, Liang Wang, Zhiyu Liu
Journal: Front Surg (2023)
Keywords: case report, cervical lymph nodes, cervical lymphadenopathy, metastatic prostate cancer, supraclavicular lymphadenopathy

Cervical lymphadenopathy as the initial presentation of metastatic prostate cancer is particularly uncommon, and easily misdiagnosed. In the current study, we describe five cases of metastatic prostate cancer in our hospital that presented with cervical lymphadenopathy as an initial symptom. The diagnosis was confirmed by needle biopsy of the suspicious lymph nodes and the serum prostate specific antigen (PSA) levels of all patients exceeded 100 ng/ml. The five patients were treated with hormonal therapy; four received traditional hormonal therapy, including bicalutamide and goserelin; one patient received hormonal therapy that included abiraterone and goserelin. Case 1 developed into castration-resistant prostate cancer (CRPC) after 7 months and died after 12 months. Case 2 rejected regular hormonal therapy for personal reasons and died 6 months after the initial diagnosis. Case 3 was still alive at the time of writing. Case 4 was administered with abiraterone, prednisolone and goserelin; the treatment was effective and the patient has remained symptom-free for the last 24 months. Case 5 was treated with hormonal and chemotherapy but died 8 months after diagnosis. In conclusion, any elderly male presenting with cervical lymphadenopathy should be considered the possibility of prostate cancer, especially when the needle biopsy reveals adenocarcinoma. The prognosis for patients presented with cervical lymphadenopathy as the initial presentation is usually poor. Hormone therapy based on abiraterone may yield a better response in such cases.