OpenMed/multicare-articles huggingface dataset:
Rare Epithelioid Leiomyoma of the Vagina Exhibiting a Pelvic Mass
Authors: Yuji Tanaka, Mayuko Nagasaka, Mariko Takahashi, Masashi Kobayashi
Journal: Case Rep Obstet Gynecol (2017)
MeSH terms: Case Reports

Epithelioid leiomyoma of the vagina is extremely rare. Smooth muscle tumors of the vagina usually present with a submucosal growth pattern or a pedunculated growth pattern from the anterior vaginal wall into the vaginal cavity. Here we report a case of a 43-year-old woman with a solid epithelioid leiomyoma and a palpable mass in the pouch of Douglas. Transvaginal biopsy and angiography showed the epithelioid leiomyoma feeding from the vaginal artery behind the posterior vagina. An abdominal wide excision of the tumor with a partial vaginectomy was performed. Our use of ultrasound-guided needle biopsy and angiography was useful for preoperative diagnosis of a vaginal epithelioid leiomyoma exhibiting a pelvic mass.
Infection with the SARS-CoV-2 Omicron variant in children with congenital heart disease: A case series study during Shanghai epidemic
Authors: Yinyu Yang, Yibei Wu, Wen Zhang, Qing Cao, Haibo Zhang, Hao Zhang, Wei Dong
Journal: Front Cardiovasc Med (2022)
Keywords: omicron, children, congenital heart disease, coronavirus, infectious disease

Objective:
To analyze the clinical characteristics and prognostic factors of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variant infections in children with congenital heart disease (CHD).
Methods:
A retrospective analysis was performed on SARS-CoV-2 Omicron-infected children with CHD who were admitted to Shanghai Children's Medical Center from April 1, 2022 to May 31, 2022. The clinical, laboratory and imaging data, and the nucleic acid conversion time of the children in this group were collected and analyzed.
Results:
Thirteen patients were included in this study and had an average age of 1.1 (0.16-14) years. Among the patients, 3 patients were preoperatively treated, and 10 were postoperatively treated. According to the severity of the disease, 1 patient was diagnosed with the moderate type, and the remaining 12 patients were diagnosed with the mild type. The clinical symptoms were mostly associated with upper respiratory tract infections, including 13 with fever (100%), 8 with cough (61.8%), 5 with sputum production (38.5%), 1 of shortness of breath (7.7%), etc. All patients were successfully discharged from the hospital, with 16.4 ± 2.9 days needed to obtain cycle threshold (CT) values ≥35 in nucleic acid testing and 17.5 ± 3.6 days of hospitalization.
Conclusions:
For vulnerable patients such as children with CHD, SARS-CoV-2 Omicron variant infections mostly present with mild upper respiratory tract symptoms with negative or mildly changed chest imaging. Through appropriate treatment of the underlying disease in the quarantine ward, patients might obtain good outcomes, even after long periods of hospitalization.
A Case Report of Acute Acalculous Cholecystitis and Acute Hemorrhagic Cystitis due to Salmonella Typhi
Authors: Hatice Beyazal Polat, Mehmet Beyazal, Fatma Beyazal Çeliker
Journal: Case Rep Med (2014)

Acute acalculous cholecystitis and acute hemorrhagic cystitis due to Salmonella Typhi are a rare condition. A 24-year-old female patient was admitted to our clinic with abdominal pain, nausea, fever, headache, urinary burning, and bloody urine. Based on clinical, laboratory, and radiological evaluations, the patient was diagnosed with acute acalculous cholecystitis and acute hemorrhagic cystitis due to Salmonella Typhi. The patient was treated with intravenous ceftriaxone for two weeks. After the treatment, the patient's clinical and laboratory findings improved. Acute acalculous cholecystitis due to Salmonella Typhi concomitant with acute hemorrhagic cystitis is very rare and might be difficult to diagnose. Infectious agents such as Salmonella Typhi should be considered when acute acalculous cholecystitis and acute hemorrhagic cystitis are detected in adult patients with no underlying diseases.
Pure androgen-secreting adrenal tumor (PASAT): A rare case report of bilateral PASATs and a systematic review
Authors: Zhangcheng Liao, Yuting Gao, Yang Zhao, Zhan Wang, Xu Wang, Jiaquan Zhou, Yushi Zhang
Journal: Front Endocrinol (Lausanne) (2023)
Keywords: adrenal venous sampling (avs), clinical characteristics, diagnosis and treatment, ovarian venous sampling (ovs), pure androgen-secreting adrenal tumor (pasat)
MeSH terms: Adrenal Gland Neoplasms / pathology, Androgens, Case Reports, Systematic Review, Research Support, Non-U.S. Gov't, Adolescent, Adult, Aged, Female, Hirsutism / complications, Humans, Male, Middle Aged, Testosterone, Virilism / etiology, Young Adult, Androgens, Testosterone

Background:
Adult pure androgen-secreting adrenal tumors (PASATs) are extremely rare, and their characteristics are largely unknown.
Methods:
A rare case of adult bilateral PASATs was reported, and a systematic literature review of adult PASATs was conducted to summarize the characteristics of PASATs.
Results:
In total, 48 studies, including 40 case reports and 8 articles, were identified in this review. Analysis based on data of 42 patients (including current case and 41 patients from 40 case reports) showed that average age was 40.48 ± 15.80 years (range of 18-76). The incidence of adult PASAT peaked at 21-30 years old, while that of malignant PASAT peaked at 41-50 years old. Most PASAT patients were female (40/42, 95.23%), and hirsutism was the most common symptom (37/39, 94.87%). Testosterone (T) was the most commonly elevated androgen (36/42, 85.71%), and 26 of 32 tested patients presented increased dehydroepiandrosterone sulfate (DS) levels. In malignancy cases, disease duration was significantly decreased (1.96 vs. 4.51 years, P=0.025), and tumor diameter was significantly increased (8.9 vs. 4.9 cm, p=0.011). Moreover, the androgen levels, namely, T/upper normal range limit (UNRL) (11.94 vs. 4.943, P=0.770) and DS/UNRL (16.5 vs. 5.28, P=0.625), were higher in patients with malignancy. In total, 5 out of 7 patients showed an increase in DS or T in the human chorionic gonadotropin (HCG) stimulation test. Overall, 41 out of 42 patients (including current case) underwent adrenal surgery, and recurrence, metastasis, or death was reported in 5 out of 11 malignant patients even with adjuvant or rescue mitotane chemotherapy.
Conclusion:
Adult PASAT, which is predominant in women, is characterized by virilism and menstrual dysfunction, especially hirsutism. Elevated T and DS may contribute to the diagnosis of adult PASAT, and HCG stimulation test might also be of help in diagnosis. Patients with malignant PASAT have a shorter disease duration, larger tumor sizes and relatively higher androgen levels. Surgery is recommended for all local PASATs, and Malignancy of PASAT should be fully considered due to the high risk of malignancy, poor prognosis and limited effective approaches.
Trauma-associated growth of suspected dormant micrometastasis
Authors: Nagi S El Saghir, Ihab I Elhajj, Fady B Geara, Mukbil H Hourani
Journal: BMC Cancer (2005)
MeSH terms: Bone Neoplasms / secondary, Carcinoma, Non-Small-Cell Lung / pathology, Lung Neoplasms / pathology, Neoplasm Metastasis, Case Reports, Accidents, Traffic, Adult, Bone Neoplasms / mortality, Bone Neoplasms / pathology, Carcinoma, Non-Small-Cell Lung / surgery, Fatal Outcome, Humans, Lung Neoplasms / surgery, Male, Neovascularization, Pathologic, Recurrence, Skull / pathology, Wounds and Injuries / complications

Background:
Cancer patients may harbor micrometastases that remain dormant, clinically undetectable during a variable period of time. A traumatic event or surgery may trigger the balance towards tumor growth as a result of associated angiogenesis, cytokine and growth factors release.
Case presentation:
We describe a patient with non-small lung cancer who had a rapid tumor growth and recurrence at a minor trauma site of his skull bone.
Conclusion:
This case is an illustration of the phenomenon of tumor growth after trauma or surgery and its associated cellular mechanisms. This phenomenon deserves further investigation and study.
Investigating barriers teachers face in the implementation of inclusive education in high schools in Gege branch, Swaziland
Authors: Sifiso L Zwane, Matome M Malale
Journal: Afr J Disabil (2018)

Background:
The kingdom of Swaziland is a signatory to policies on universal education that ensure high quality basic education for all. Education for All is a commitment to provide equal opportunities for all children and the youth as provided for in the country's constitution of 2005. The tone for the introduction of inclusive education in Swaziland was inevitably set by the new constitution of 2005. Since then several policies have been produced by the government, all aimed at providing equal education opportunities to all children in the country. These policies include the Swaziland National Children's Policy (2009), Poverty Reduction Strategy and Action Plan (2006) and Draft Inclusive Education Policy (2008). The Education for All Policy (2010) is the policy that upon implementation became a stimulus for the introduction of inclusive education into mainstream schools; as a result, all teachers in the country's schools were expected to be competent enough to teach learners with a wide range of educational needs. However, in-service teachers received inadequate staff development and training ahead of the implementation of inclusive education and a majority of teachers were not professionally developed for inclusive education, as pre-service students at tertiary training level.
Objectives:
This study investigated barriers in the implementation of inclusive education at high schools in the Gege branch, Swaziland, with a view to finding lasting solutions to inform research and government policy.
Method:
This research is a qualitative interpretive case study based on selected schools in the Gege branch of schools. Data was obtained through semi-structured research interviews and document analysis. It was processed and analysed through data coding, unitising, categorising and emergence of themes, which became the findings of the study.
Results:
Lack of facilities in the governments' schools and teachers' incompetence in identifying learners facing learning challenges in their classrooms are some barriers to inclusivity.
Conclusion:
The study concludes that there is a need for the Ministry of Education and Training to craft an inclusive curriculum in line with the inclusive policy in order to cater for the diverse educational needs of all learners in mainstream schools. It is thought that instituting a vibrant in-service and pre-service teacher training programme by the Ministry of Education and Training will increase teachers' capacity to a level where teaching in inclusive classrooms does not negatively affect their competence.
Multi-Drug-Resistant Elizabethkingia meningoseptica: A Rare Cause of Late-Onset Sepsis in a Preterm Neonate
Authors: Abdul Wasey Hashmi, Muhammad Ahmad, Muhammad Muneeb Israr, Ibtesam E Fajar, Farid Adnan
Journal: Cureus (2023)
Keywords: elizabethkingia, late onset sepsis, meningitis, multi-drug resistance, preterm neonate
MeSH terms: Case Reports

Elizabethkingia meningoseptica is a gram-negative bacillus and is a rare cause of opportunistic infections. Literature shows that this gram-negative bacillus may cause early-onset sepsis in neonates and immunocompromised adults; however, it is a rare cause of late-onset sepsis or meningitis in neonates. We hereby delineate a case of a preterm neonate, born at 35 weeks of gestation, presenting to us on the eleventh day after birth, with fever, tachycardia, and delayed reflexes. The neonate was managed in the neonatal intensive care unit (NICU). Initial laboratory tests, blood, and cerebrospinal fluid (CSF) cultures showed evidence of late-onset sepsis due to multi-drug-resistant E. meningoseptica sensitive to vancomycin and ciprofloxacin. The patient completed the antibiotic therapy and was discharged from the hospital. The patient was followed up at one and two months after discharge in the tele-clinic and was thriving well with no complaints.
Bilateral Cavernous Carotid Aneurysms: Atypical Presentation of a Rare Cause of Mass Effect. A Case Report and a Review of the Literature
Authors: Delia Gagliardi, Irene Faravelli, Luisa Villa, Guglielmo Pero, Claudia Cinnante, Roberta Brusa, Eleonora Mauri, Laura Tresoldi, Francesca Magri, Alessandra Govoni, Nereo Bresolin, Giacomo P Comi, Stefania Corti
Journal: Front Neurol (2018)
Keywords: bilateral cavernous carotid aneurysms, cranial nerves palsy, diplopia, internal carotid artery, pseudomyasthenia
MeSH terms: Case Reports

Bilateral cavernous carotid aneurysms (CCAs) represent a rare medical condition that can mimic other disorders. We present a rare case of bilateral CCAs simulating an ocular myasthenia. A 76-year-old woman presented with a history of fluctuating bilateral diplopia and unilateral ptosis, which led to the suspicion of ocular myasthenia. Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) of the brain showed the presence of large bilateral aneurysms of the carotid cavernous tract. After an unsuccessful attempt with steroid therapy, the patient underwent endovascular treatment, with mild improvement. Bilateral CCAs can cause pupil sparing third nerve palsies and other cranial neuropathies which can mimic signs and symptoms of disorders of the neuromuscular junction. Therefore, the possibility of a vascular lesion simulating ocular myasthenia should be considered especially in older patients.
Isolated radial volar dislocation of the fifth carpometacarpal joint: a rare injury
Authors: Khalid Ibn El Kadi, Mohcine Sbiyaa, Badr Alami, Ilyass Rabhi, Amine Marzouki, Kamal Lahrach, Fawzi Boutayeb
Journal: Pan Afr Med J (2013)
Keywords: volar dislocation, carpometacarpal, diagnosis
MeSH terms: Carpometacarpal Joints / injuries, Joint Dislocations / diagnosis, Case Reports, Review, Adult, Humans, Incidence, Joint Dislocations / epidemiology, Male

Isolated palmar dislocation of the fifth carpometacarpal joint is an uncommon injury and classified as radio-palmar or ulno-palmar according to the direction of displacement of the fifth metacarpal base. This very rare injury is often difficult to recognize. A careful neurologic assessment of the patient is a necessity, as well as obtaining proper radiographs of the hand. The purpose of this report is to present a patient with a pure isolated volar dislocation of the fifth carpometacarpal joint that was satisfactorily treated with closed reduction and casting. A review of the literature is presented.
Herpes simplex type 1 encephalitis restricted to the brainstem in a pediatric patient
Authors: Juliana Harumi Arita, Jaime Lin, Mirella Maccarini Peruchi, Marcelo Masruha Rodrigues, Luiz Celso Pereira Vilanova
Journal: Case Rep Med (2010)
MeSH terms: Case Reports

Herpes simplex encephalitis is a potentially fatal infection of central nervous system that typically involves frontal and temporal lobes. Occasionally, it presents an extratemporal involvement and in rarer cases, it is limited to the brainstem. We describe a case of an adolescent who presented with fever, sore throat, and vertigo. Clinical picture evolved to lethargy, tetraparesis, consciousness impairment, and respiratory failure. MRI showed lesions restricted to the brainstem. PCR of CSF was positive for herpes simplex type 1.
Unusual mucoepidermoid carcinoma of the liver misdiagnosed as squamous cell carcinoma by intraoperative histological examination
Authors: Xiao-qin Guo, Bin Li, Yang Li, Xiao-ying Tian, Zhi Li
Journal: Diagn Pathol (2014)
MeSH terms: Carcinoma, Mucoepidermoid / diagnosis, Carcinoma, Squamous Cell / diagnosis, Cytodiagnosis, Diagnostic Errors, Liver Neoplasms / diagnosis, Case Reports, Cholangiocarcinoma / diagnosis, Fatal Outcome, Female, Humans, Intraoperative Period, Middle Aged, Tomography, X-Ray Computed

As rare condition, mucoepidermoid carcinoma may occur in liver although its etiology and pathogenesis is still unclear. We report here a case of intrahepatic mucoepidermoid carcinoma misdiagnosed as cholangiocarcinoma and squamous cell carcinoma by preoperative radiologic and intraoperative histological examinations, respectively. A 60-year-old woman presented with a 1-month history of progressive jaundice, epigastric discomfort, and weight loss with slightly increased carbohydrate antigen 19-9 (CA19-9). Computed tomography (CT) showed a large tumor, 8.0 cm in diameter, in the left lobe of the liver. A preliminary diagnosis of a cholangiocarcinoma of the liver was made. In the intraoperative histological examination, a diagnosis of squamous cell carcinoma was made based on predominantly invasive epidermoid cells with abundant keratinization and absence of mucin-producing cell component. However, postoperative histological diagnosis of the lesion was mucoepidermiod carcinoma of liver by thoroughly microscopical inspection and the presence of mucin-producing cells confirmed by Alcian blue staining. Despite surgical excision and chemotherapy, the tumor showed very aggressive malignancy with tumor recurrence. The patient died shortly afterward, surviving 6 months after surgery. Due to its rarity and distinct morphological features, mucoepidermoid carcinoma might be erroneously interpreted as squamous cell carcinoma by those who were not familiar with this condition in unusual locations. Therefore, removal of sufficient tissue from different portions of the lesion is essential for the surgeons and pathologists to make a precise diagnosis in the intraoperative histological examination.
Virtual slide:
The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/4956311271136060.
Case Report: A novel PHOX2B p.Ala248_Ala266dup variant causing congenital central hypoventilation syndrome
Authors: Irina N Artamonova, Anna M Zlotina, Olga R Ismagilova, Tatyana A Levko, Natalia Yu Kolbina, Aleksandr V Bryzzhin, Andrey P Smorodin, Alexandr V Borodin, Ekaterina A Mamaeva, Anna A Sukhotskaya, Ilya M Kagantsov, Daria A Malysheva, Elena S Vasichkina, Tatiana M Pervunina, Natalia A Petrova
Journal: Front Pediatr (2023)
Keywords: hirschsprung disease, phox2b, congenital central hypoventilation syndrome (cchs), genotype–phenotype correlation, novel mutation, polyalanine sequence
MeSH terms: Case Reports

Introduction:
Congenital central hypoventilation syndrome (CCHS) is a rare disease characterized by central alveolar hypoventilation and impaired autonomic regulation, caused by pathogenic variants of PHOX2B gene. More than 90% of patients have a polyalanine repeat mutation (PARM) in the heterozygous state, characterized by the expansion of GCN repeats and an increase in the number of alanine repeats, so that genotypes 20/24-20/33 are formed (the normal genotype is 20/20). The remaining 10% of patients harbor non-PARMs.
Case description:
We present a clinical case of a girl with a novel PHOX2B heterozygous genetic variant in the exon 3: NM_003924.4: c.735_791dup, p.Ala248_Ala266dup. The duplication includes 16 GCN (alanine) repeats and 3 adjacent amino acids. Both clinically healthy parents demonstrated a normal PHOX2B sequence. In addition, the girl has a variant of unknown significance in RYR1 gene and a variant of unknown significance in NKX2-5 gene. The child's phenotype is quite special. She needs ventilation during sleep, and has Hirschsprung's disease type I, arteriovenous malformation S4 of the left lung, ventricular and atrium septal defects, coronary right ventricular fistula, hemodynamically nonsignificant, episodes of sick sinus and atrioventricular dissociation with bradycardia, divergent alternating strabismus, and oculus uterque (both eyes) (OU) retinal angiopathy. Two episodes of hypoglycemic seizures were also registered. Severe pulmonary hypertension resolved after appropriate ventilation adjustment. Diagnostic odyssey was quite dramatic.
Conclusion:
Detection of a novel PHOX2B variant expands the understanding of molecular mechanisms of CCHS and genotype-phenotype correlations.
CHILDREN WITH MULTIPLE CONGENITAL DEFECTS: WHAT ARE THE LIMITS BETWEEN THERAPEUTIC OBSTINACY AND THE TREATMENT OF UNCERTAIN BENEFIT?
Authors: Patricia Souza Valle Cardoso Pastura, Marcelo Gerardin Poirot Land
Journal: Rev Paul Pediatr (2017)
MeSH terms: Abnormalities, Multiple / therapy, Life Support Care, Medical Futility, Case Reports, Humans, Infant, Male

Objective:
Therapeutic approach of children with multiple malformations poses many dilemmas, making it difficult to build a line between the treatment of uncertain benefit and therapeutic obstinacy. The aim of this paper was to highlight possible sources of uncertainty in the decision-making process, for this group of children.
Case description:
An 11-month-old boy, born with multiple birth defects and abandoned by his parents, has never been discharged home. He has complex congenital heart disease, main left bronchus stenosis and imperforate anus. He is under technological support and has gone through many surgical procedures. The complete correction of the cardiac defect seems unlikely, and every attempt to wean the ventilator has failed.
Comments:
The first two main sources of uncertainty in the management of children with multiple birth defects are related to an uncertain prognosis. There is a lack of empirical data, due to the multiple possibilities of anatomic or functional organ involvement, with few similar cases described. Prognosis is also unpredictable for neuro-developmental evolution, as well as the capacity for the development and regeneration of other organs. Another source of uncertainty is how to qualify the present and future life as worth living, by weighing the costs and benefits. The fourth source of uncertainty is who has the decision: physicians or parents? Finally, if a treatment is defined futile then, how to limit support? No single framework exists to help these delicate decision-making processes. We propose, then, that physicians should be committed to develop their own perception skills in order to understand patient's manifestations of needs and family values.