OpenMed/multicare-articles huggingface dataset:
Hepatectomy for hepatocellular carcinoma complicated by vasculitis flare
Authors: Zeinab Abdi, Svetlana Krasnokutsky, Amy Rapkiewicz, Amit Saxena, Gerald Villanueva, Umut Sarpel
Journal: HPB Surg (2010)
MeSH terms: Carcinoma, Hepatocellular / surgery, Cryoglobulinemia / etiology, Hepatitis C, Chronic / complications, Liver Neoplasms / surgery, Vasculitis / etiology, Case Reports, Carcinoma, Hepatocellular / complications, Hepatectomy, Humans, Liver Neoplasms / complications, Male, Middle Aged, Treatment Outcome

Background:
The hepatitis C virus is a major cause of hepatocellular carcinoma. Extrahepatic manifestations of hepatitis C include mixed cryoglobulinemia which can result in ischemic damage to multiple organs. The management of these sequelae in posthepatectomy patients is unclear.
Case report:
A 49-year-old male with hepatitis C was found to have a 4 cm hepatocellular carcinoma on surveillance imaging. He underwent portal vein embolization followed by hepatectomy. His postoperative course was complicated by the development of splenic infarcts, small bowel ischemia, skin lesions, and liver damage. Findings of elevated cryocrit and elevated rheumatoid factor suggested the diagnosis of cryoglobulin-related vasculitis. The patient improved on supportive care.
Conclusion:
Cryoglobulinemia is associated with hepatitis C and may complicate the care of this patient population. The treatment of cryoglobulinemia posthepatectomy patients is complicated by concerns over how medications may affect the regenerating liver. Steroids should be used with caution in this setting.
Summary:
Brief report of hepatectomy complicated by vasculitis in the context of hepatocellular carcinoma secondary to hepatitis C addresses the management of mixed cryoglobulinemia in post-hepatectomy patients.
Uterine tumor resembling ovarian sex cord tumor (UTROSCT), case report with literature review
Authors: Atif Ali Hashmi, Naveen Faridi, Muhammad Muzzammil Edhi, Mehmood Khan
Journal: Int Arch Med (2014)
Keywords: cd99, endometrial stromal tumor with sex cord like elements (estscle), uterine tumors resembling ovarian sex cord tumors (utrosct)
MeSH terms: Case Reports

Introduction:
Uterine tumors resembling ovarian sex cord tumors (UTROSCT) are uterine neoplasms of unknown histiogenesis which show near complete differentiation towards ovarian sex cord elements and are postulated to arise from pluripotential uterine mesenchymal cells or endometrial stromal cells with secondary sex cord differentiation.
Case presentation:
A 48 year old post-menopausal women presented with abnormal uterine bleeding for which she underwent total abdominal hysterectomy with bilateral salpingo-ophorectomy. Gross examination revealed a gelatinous grayish white tumor confined to the myometrium, 7 cm in maximum dimention. Microscopic examination revealed monomorphic round to oval tumor cells in anastomosing cords and trabeculae with myxoid background. Immunohistochemically, tumor cells showed diffuse positivity for vimentin, CD99 and S100, while focal positivity was seen with pancytokeratin immunostain. The case was diagnosed as UTROSCT. No evidence of metastasis was found on systemic clinical and radiologic workup.
Conclusion:
UTROSCT are rare uterine tumors which can be diagnosed with certainty on morphologic and immunohistochemical grounds. It is important to recognize these tumors as they behave differently from endometrial stromal tumors with sex cord like elements (ESTSCLE).
Atypical presentation of cystic schwannoma of the sphenoid sinus: a nonsolitary mass with osseous, intracranial and cavernous sinus invasion
Authors: Gautam Dutta, Daljit Singh, Hukum Singh, Ghanshyam Singhal, Ravindra Kumar Saran
Journal: Pan Afr Med J (2018)
Keywords: cystic schwannoma, mucocele, paranasal sinus, sphenoid sinus
MeSH terms: Neurilemmoma / diagnosis, Paranasal Sinus Neoplasms / diagnosis, Skull Base Neoplasms / diagnosis, Case Reports, Cavernous Sinus / pathology, Humans, Male, Mucocele / diagnosis, Neoplasm Invasiveness, Neurilemmoma / pathology, Paranasal Sinus Neoplasms / pathology, Skull Base Neoplasms / pathology, Sphenoid Sinus / pathology, Vision Disorders / etiology, Young Adult

Although nearly half of all schwannomas involve the head and neck region, nasal and paranasal sinus presentations are quite rarely seen. Cystic schwannoma, characterized by cyst formation lined by S-100 protein positive membrane-like structures is very uncommonly seen in sphenoid sinus with only a single previously reported case. Here we report a young patient of cystic schwannoma of the paranasal sinuses having epicenter in the sphenoid sinus. The tumor had caused extensive erosion of the skull base and paranasal sinuses and extended intracranially that radiologically mimicked as infected mucocele causing loss of vision. This case denotes the aggressive behavior of such uncommon tumors.
Severe Immune-Related Pneumonitis With PD-1 Inhibitor After Progression on Previous PD-L1 Inhibitor in Small Cell Lung Cancer: A Case Report and Review of the Literature
Authors: Xiuju Liang, Yaping Guan, Bicheng Zhang, Jing Liang, Baocheng Wang, Yan Li, Jun Wang
Journal: Front Oncol (2019)
Keywords: immune checkpoint inhibitor, immune-related adverse event, pneumonitis, programmed cell death 1 inhibitor, programmed cell death ligand 1
MeSH terms: Case Reports

Objective: Combination therapy with programmed cell death protein-1 (PD-1) and programmed cell death ligand-1 (PD-L1) inhibitors might be viewed as a promising therapeutic strategy for resistant lung cancer, and it is becoming common that a second PD-1/PD-L1 inhibitor might be used following progression on previous PD-1/PD-L1 inhibitor. However, a subgroup of patients will experience various autoimmune toxicities, termed as immune-related adverse events (irAEs), that occur as a result of on-target and off-tumor inflammation. Materials and Methods: In this report, we presented a patient with small cell lung cancer who received different PD-1/PD-L1 inhibitors during the course of disease progression. This patient experienced radiation-related pneumonitis, immune-related pneumonitis, as well as concomitant bacterial pneumonia. Results: In particular, this patient developed immune-related pneumonitis with a second PD-1 inhibitor when she had a progressive disease on previous PD-L1 inhibitor. This patient was initially responsive to steroid treatment, but rapidly develop more severe pneumonitis and concomitant bacterial pneumonia with no response to antibiotics and steroid treatment. Finally, this patient got a good clinical response when receiving additional immunosuppressive medications infliximab and mycophenolate mofetil. Conclusions: Patients with a history of radiation-induced pneumonitis and treated with sequential different PD-1/PD-L1 inhibitors have a relative high risk to develop high-grade or steroid-resistant pneumonitis, and additional immunosuppressive medications should be used earlier when severe pulmonary toxicity occurs.
Sirenomelia or "Mermaid Syndrome" in a Twin Pregnancy: A Case Report
Authors: Annie F Siddiqui, Vaibhav P Anjankar
Journal: Cureus (2023)
Keywords: congenital, fatal, mermaid, mermaid baby syndrome, mermaid syndrome, rare, sirenomelia, stillbirth, stillborn baby, twin pregnancy
MeSH terms: Case Reports

Sirenomelia, also known as "mermaid syndrome" or "mermaid baby syndrome," is a very rare congenital disorder. The major anomaly in this syndrome is the fusion of the lower legs, giving it a mermaid-like appearance. This syndrome consists of a range of abnormalities affecting various systems, such as the digestive, genitourinary, and musculoskeletal systems. On the basis of the severity of the syndrome, the fetus may have a single fused bone or entirely absent bones in place of a normal pair of distinct bones. In major cases, mermaid syndrome leads to stillbirths. Its occurrence in monozygotic twins is much greater than in dizygotic twins or in a single fetus. The syndrome is believed to mainly occur in cases of maternal age less than 20 years or more than 40 years, women suffering from maternal diabetes, and prenatal exposure to retinoic acid, cocaine, and water contaminated by landfills. A 22-year-old pregnant female was admitted with a history of amenorrhea for nine months (full-term twin pregnancy) and oligohydramnios for a caesarian section. This was the patient's second pregnancy. A cesarean section was done as instructed by the gynecologist. The patient delivered twin babies. In this twin pregnancy, the first baby was normal and healthy, while the second baby was stillborn and suffered from mermaid syndrome.
Tocilizumab Controls Paraneoplastic Inflammatory Syndrome but Does Not Suppress Tumor Growth of Angiomatoid Fibrous Histiocytoma
Authors: Hideaki Sabe, Akitomo Inoue, Shigenori Nagata, Yoshinori Imura, Toru Wakamatsu, Satoshi Takenaka, Hironari Tamiya
Journal: Case Rep Oncol Med (2021)
MeSH terms: Case Reports

Angiomatoid fibrous histiocytoma (AFH) is a rare soft tissue tumor that rarely metastasizes but lacks effective systemic therapy once it propagates. In some reports, high interleukin-6 (IL-6) production promotes tumor growth by autocrine stimulation and tocilizumab, an IL-6 receptor antagonist, can control AFH growth. Here, we present a case report on a patient with local recurrence and distant lymph node metastasis of AFH treated with tocilizumab. As a result, the inhibition of the IL-6 signaling pathway controlled paraneoplastic inflammatory syndrome (PIS); however, the local recurrent tumor progressed. This case implied that IL-6 is not necessarily the cause of tumor growth in AFH. Therefore, physicians should bear in mind that watchful observation is needed whether tocilizumab can control tumor progression despite the amelioration of PIS associated with the attenuated effect of IL-6 on AFH.
Subclinical Partial Attritional Rupture of the Flexor Digitorum Profundus as an Etiology of Atraumatic Trigger Finger
Authors: D Anthony Bastian, Nicholas Kusnezov, John C Dunn, Justin S Mitchell, Miguel Pirela-Cruz
Journal: Case Rep Orthop (2017)
MeSH terms: Case Reports

Background:
Trigger finger is a relatively common clinical entity. The etiology is most often attributable to stenosing tenosynovitis though traumatic cases have been described. When trigger finger is associated with an underlying flexor tendon rupture, previous cases have reported a clear association with overt laceration or previous trauma.
Methods:
We present the case of a 23-year-old male active duty military service member who presented with a characteristic history and clinical exam consistent with trigger finger. The symptomatic onset was gradual, with no history of inciting trauma.
Results:
Given symptomatic persistent triggering following failure of conservative management to include cortisone injections, the patient was taken for open A1 pulley release. Intraoperatively, the triggering was found to be attributable to a partial attritional rupture of the small finger flexor digitorum profundus tendon. Tendon debridement, tubularization, and A1 and partial A2 pulley releases were performed with subsequent resolution of triggering.
Conclusion:
We present the rare case of subclinical atraumatic attritional rupture of the FDP tendon to the small finger as a cause of clinically apparent trigger finger. This is an important consideration as the hand surgeon must be prepared to address more atypical pathologies.
Case Report: A patient with the rare third-generation TKI-resistant mutation EGFR L718Q who responded to afatinib plus cetuximab combination therapy
Authors: Guoqing Zhang, Beibei Yan, Yanan Guo, Hang Yang, Xiangnan Li, Jindong Li
Journal: Front Oncol (2022)
Keywords: egfr, l718q, afatinib, cetuximab, drug resistance, lung adenocarcinoma
MeSH terms: Case Reports

Third-generation tyrosine kinase inhibitors (TKIs), such as osimertinib, almonertinib and furmonertinib, overcome the mechanisms of resistance to first-generation inhibitors (such as gefitinib, erlotinib and icotinib) by incorporating an acrylamide group that alkylates the Cys797 of EGFR T790M. However, drug resistance is inevitable, even for third-generation TKIs. Screening for drug-resistant mutations by repeat biopsy and repeat gene sequencing is necessary after TKI treatment. Among various third-generation TKI-resistant mutations, secondary mutation of the L718 residue of EGFR exon 18 was found in approximately 8% of patients and is responsible for drug resistance in vitro and in vivo. Furthermore, there is limited clinical experience of targeted therapy for this mutation. Herein, we report for the first time that afatinib and cetuximab combination therapy can overcome such drug resistance.
Fulminant Type 1 Diabetes Mellitus Associated With Drug Hypersensitivity and Epstein-Barr Virus Infection: A Case Report
Authors: Xing-Yu Chen, Cong Wang, Shizhi Chen, Mingyuan Tian, Xin Wang, Lili Zhang
Journal: Front Pharmacol (2022)
Keywords: epstain-barr virus, case report, drug hypersensitivity, fulminant type 1 diabetes mellitus, gene
MeSH terms: Case Reports

Background: Fulminant type 1 diabetes mellitus (FT1DM) is a new subtype of type 1 diabetes, first proposed by Japanese scholars in 2000. Herein, the functions of the islets are rapidly destroyed. Its pathogenesis is related to viral infection. Most people have been infected with Epstein-Barr virus (EBV), and many people have also suffered from drug hypersensitivity, however, few cases of FT1DM which were caused by both of the two conditions have been reported. Thus, below, we describe one such valuable case. Case Summary: The plasma glucose levels of a 73-year-old man diagnosed with drug-induced dermatitis showed a sudden increase (42 mmol/L) during methylprednisolone therapy. The urine ketone test was positive. The glycated hemoglobin level was 7%, endogenous insulin secretion decreased significantly, and the islet-related autoantibodies were negative. The patient was diagnosed with FT1DM. The lymphocyte EBV-DNA showed high copies numbers. The general condition of the patient improved after symptomatic treatment with insulin. However, the systemic allergic reaction aggravated after the use of iodinated contrast agents, prednisone, and thymic pentapeptide. The re-test for EBV-DNA showed significantly high relative levels, thus indicating the presence of EBV infection. We think that drug hypersensitivity and EBV infection together led to FT1DM in this case. After an indication for multiple daily insulin therapy, the patient's blood glucose was quickly controlled and he was discharged on the 38th-day post-admission. Conclusion: FT1DM is a rare case, however, drug hypersensitivity and EBV infection are not rare in the population. This is a rare case of FT1DM caused by drug hypersensitivity reaction and EBV infection. Through this case report, we emphasize the importance of the relationship between drug hypersensitivity, EBV infection and FT1DM and vigilance for the occurrence of FT1DM among hypersensitive individuals in clinical practice.
Case report: First case of early adenoid cystic carcinoma and squamous cell carcinoma collision cancer treated by endoscopic submucosal dissection
Authors: Zheng Liang, Yongqiu Wei, Peng Li, Rui Xu, Qiaozhi Zhou, Shutian Zhang
Journal: Front Oncol (2023)
Keywords: collision cancer, early esophageal cancer, endoscopic submucosal dissection, esophageal adenoid cystic carcinoma, esophageal squamous cell carcinoma
MeSH terms: Case Reports

Background:
Collision cancer, a rare tumor, rarely occurs in the esophagus. Most reported cases of esophageal collision cancers are advanced cancers that can only be treated with surgery or palliative chemoradiotherapy. Here, we report a rare case of collisional squamous cell carcinoma (SqCC) and adenoid cystic carcinoma (AdCC) that was detected in the early stages by endoscopy.
Case summary:
A 66-year-old man presented with retrosternal pain after swallowing and underwent endoscopy. Pathological biopsy showed high-grade squamous intraepithelial neoplasia. The lesion was removed by endoscopic submucosal dissection (ESD) after magnification and endoscopic ultrasonography. Postoperative pathology proved that the lesion was collision cancer comprising SqCC and AdCC. After six months of postoperative follow-up, there was no recurrence of esophageal cancer.
Conclusions:
We provided a case report related to the diagnosis and treatment of esophageal collision cancer, especially early collision cancer. More research is needed to provide insights into the management of collision cancers.
Retinal vasculitis with Chronic Recurrent Multifocal Osteomyelitis: a case report and review of the literature
Authors: Victoria K Shanmugam, Marc Phillpotts, Timothy Brady, Monica Dalal, Shawn Haji-Momenian, Esma Akin, Kavita Nataranjan, Sean McNish, Donald S Karcher
Journal: BMC Rheumatol (2019)
Keywords: crmo, case report, chronic recurrent multifocal osteomyelitis, retinal vasculitis, sapho, sternoclavicular
MeSH terms: Case Reports

Background:
Concurrent presentation of retinal vasculitis with mixed sclerotic and lytic bone lesions is rare.
Case presentation:
We present the case of a 37-year old woman with a several year history of episodic sternoclavicular pain who presented for rheumatologic evaluation due to a recent diagnosis of retinal vasculitis. We review the differential diagnosis of retinal vasculitis, along with the differential diagnosis of mixed sclerotic and lytic bone lesions. Ultimately, bone marrow biopsy confirmed diagnosis of chronic recurrent multifocal osteomyelitis (CRMO). Concurrent presentation of CRMO with retinal vasculitis is extremely rare but important to recognize. The patient demonstrated clinical response to prednisone and tumor necrosis factor-alpha inhibition (TNF-i).
Conclusion:
This case reports and unusual presentation of CRMO spectrum disease involving the sternum and sternoclavicular joint with concurrent retinal vasculitis.
Hemangioma of the Rib Mimicking Chondrosarcoma: A Report of Two Cases and Literature Review
Authors: Yusuke Tsuda, Hiroshi Kobayashi, Naohiro Makise, Liuzhe Zhang, Yusuke Shinoda, Tetsuo Ushiku, Sakae Tanaka
Journal: Case Rep Orthop (2021)
MeSH terms: Case Reports

Cases:
Case 1 was a 58-year-old man who presented with an incidentally detected, slowly growing mass in the right hypochondrium area. An imaging study showed the mass arising from the 11th rib, with ill-defined margins and cortical destruction. Differential diagnoses included chondrosarcoma and metastatic malignant tumor. Open biopsy was associated with moderate bleeding (300 mL) despite small incision. Microscopic findings showed numerous irregular, dilated, and thin-walled vessels, consistent with the diagnosis of hemangioma of bone, and en bloc excision was performed with no surgical complication. Case 2 was a 49-year-old man who presented with an incidentally detected 4th rib mass with calcification on computed tomography scan. Chondrosarcoma was suspected according to imaging features. An open biopsy was considered to have a risk of tumor seeding because the tumor was located behind the scapula. En bloc excision of the tumor without biopsy was performed. The pathological findings were consistent with hemangioma of bone.
Conclusion:
We reported two cases of rare hemangioma arising from the rib, which mimicked chondrosarcoma. The preoperative diagnosis was challenging, both clinically and radiologically. Because biopsy for hemangioma of the rib is associated with a bleeding risk, the en bloc excision without biopsy can be a practical treatment option.
Endobronchial mucormycosis diagnosed by fiberoptic bronchoscopy
Authors: Hebatallah Hany Assal, Sabah Ahmed Hussein, Ahmed Mostafa, Dalia Abd El-Kareem, Mostafa Alfishawy, Maged Salah, Habiballah Galal Mohammed
Journal: IDCases (2023)
Keywords: cryoprobe, endobronchial, mucormycosis
MeSH terms: Case Reports

Introduction:
Endobronchial mucormycosis is very rare with only few cases reported in the literature. Here, we report a rare presentation of pulmonary mucormycosis in a diabetic patient who presented with left lung collapse. Bronchoscopy revealed an endobronchial growth, mimicking a tumor, causing complete occlusion of the left main bronchus. Histopathology confirmed the diagnosis of invasive mucormycosis.
Case presentation:
Male patient 35 years old with accidental discovered Diabetes Mellitus, complained of hoarseness of voice and dry irritating cough that didn't respond to antitussives and nonspecific treatment. CT chest was done and revealed left total lung collapse. Fiberoptic bronchoscopy was done and revealed total occlusion of the left main bronchus with whitish fungating glistening tissue from which biopsies were obtained. Histopathological examination was consistent with mucormycosis. A trial of medical treatment failed after which the patient was referred for surgical resection.
Conclusion:
Successful treatment of mucormycosis requires early diagnosis; prompt administration of antifungal therapy, and surgical intervention when applicable. Aggressive surgical intervention to remove necrotic tissue is generally accepted as the therapeutic mainstay for endobronchial obstructing mucormycosis.
Predictors of immune reconstitution inflammatory syndrome associated with Kaposi's sarcoma: a case report
Authors: Anna Maria Cattelan, Adriana Mattiolo, Angela Grassi, Maria Assunta Piano, Lolita Sasset, Marco Trevenzoli, Paola Zanovello, Maria Luisa Calabrò
Journal: Infect Agent Cancer (2016)
Keywords: biomarker, hhv8, iris, immune reconstitution inflammatory syndrome, ks, ks-iris, kshv, kaposi’s sarcoma

We present here a case of immune reconstitution inflammatory syndrome associated with Kaposi's sarcoma (KS-IRIS) developed in an AIDS patient two months after initiation of antiretroviral therapy (ART). Baseline characteristics of this IRIS-KS case, within a cohort of 12 naïve AIDS-KS patients, were analyzed. No statistically significant differences in CD4 cell counts, plasma HIV RNA load, KS clinical staging, human herpesvirus 8 (HHV8) antibody titers and HHV8 load in peripheral blood mononuclear cells and saliva were evidenced. HHV8 load in plasma was found to be significantly higher in the KS-IRIS patient (> 6 log10 genome equivalents/ml, p = 0.01, t-test) compared to the 11 patients with KS regression. This case highlights that measurement of HHV8 load in plasma may be useful to identify patients at risk for KS-IRIS, and that this parameter should be included in the design of larger studies to define KS-IRIS risk predictors.
Diffuse neurofibroma of the scalp presenting as circumscribed alopecic patch
Authors: Bc Sharath Kumar, Mg Gopal, Ankur Talwar, M Ramesh
Journal: Int J Trichology (2010)
Keywords: alopecia areata, diffuse neurofibroma, scalp
MeSH terms: Case Reports

Neurofibroma is a benign tumor of the peripheral nerve sheath characterized by proliferation of Schwann cells, perineural cells and endoneurial fibroblasts. Different types of neurofibromas can be identified, including localized, plexiform, and diffuse types. Diffuse neurofibroma is an uncommon form of neurofibroma that occurs primarily in children and young adults. The head and neck regions are the most common sites of involvement. Diffuse neurofibroma is an ill-defined infiltrative lesion and tends to involve the skin and subcutaneous tissues. It produces localized thickening and induration of the skin. We present a case of a 12-year-old boy who had a diffuse neurofibroma on the scalp since the age of 2 years.