OpenMed/multicare-articles huggingface dataset:
An Early Diagnosis of an Ovarian Steroid Cell Tumor Not Otherwise Specified in a Woman
Authors: Patrícia Alves, Inês Sá, Miguel Brito, Cátia Carnide, Osvaldo Moutinho
Journal: Case Rep Obstet Gynecol (2019)
MeSH terms: Case Reports

Steroid cell tumor not otherwise specified is a subtype of steroid ovary tumors. These are a rare subgroup of ovarian sex cord-stromal tumors. We present a case of a young woman submitted to laparoscopic cystectomy with ovarian steroid cell tumor as histological finding. This represents the second case where laparoscopic cystectomy is performed in this type of tumor. Up to 36 months after surgery, the woman remains under surveillance, without recurrence of the tumor, and attempts to conceive. This case suggests that steroid cell tumors can be asymptomatic, and gynecologists must think about preserving fertility in women of reproductive age.
Case Report: Two Patients With EGFR Exon 20 Insertion Mutanted Non-Small Cell Lung Cancer Precision Treatment Using Patient-Derived Xenografts in Zebrafish Embryos
Authors: Qian Wang, Wenxian Wang, Weiwei Pan, Xiaojing Lv, Lei Zhang, Kaiming Zheng, Fang Tian, Chunwei Xu
Journal: Front Oncol (2022)
Keywords: egfr mutation, non-small cell lung cancer, screening, xenograft, zebrafish
MeSH terms: Case Reports

Background:
Epidermal growth factor receptor (EGFR) exon 20 insertion mutations are uncommon EGFR mutations and generally resistant to first- and second-generation EGFR-tyrosine kinase inhibitors (TKIs). In precision oncology, treatment regimens are tested for improving the clinical outcomes. Zebrafish embryo tumor transplant models are used in cancer research.
Methods:
We report two Chinese females who were diagnosed with stage IV lung adenocarcinoma and shown to harbor EGFR exon 20 insertion mutations by next-generation sequencing (NGS). Then, we established lung cancer patient-derived xenografts using a zebrafish model. The tumor cells were isolated from the patient. For case one, tumor cells were collected from lymph node biopsy, while the tumor cells were obtained from the pleural effusion. Zebrafish were inoculated with tumor cells and placed in the culture medium containing the third-generation EGFR-TKI, osimertinib. Fluorescence microscope photographs were used to record the red fluorescence area, which represented the proliferation and migration of tumor cells in the zebrafish.
Results:
Case one was diagnosed with lung adenocarcinoma (cT4N3M1b, stage IVB) and had an EGFR exon 20 mutation (p. N771delinsHH [abundance 14.08%]). Tumor cell proliferation and migration were significantly reduced in the osimertinib group compared with the control group. The patient received first-line osimertinib (160 mg). According to RECIST v1.1, she achieved a partial response. Case two had stage IVA lung adenocarcinoma with a pleural effusion. The pleural effusion sample was selected to obtain tumor cells for injection, and the zebrafish lung cancer model was established. The proliferation of tumor cells in the osimertinib group was significantly reduced compared to the control group. The migration of tumor cells was not significantly reduced compared to the control group. The patient also received first-line osimertinib (160 mg). The lung lesions were stable, but the pleural effusion was poorly controlled.
Conclusion:
Our study demonstrates the applicability of a zebrafish embryos model as an innovative platform to targeted drug testing. More precise methods are needed to select treatment options in the future.
Case Report: Hepatopulmonary syndrome as the first clinical manifestation of cirrhosis in a patient with underlying chronic lung disease
Authors: Charles Murphy, Danit Arad
Journal: F1000Res (2018)
Keywords: bronchiectasis, copd, hepatopulmonary syndrome, mai infection
MeSH terms: Hepatopulmonary Syndrome / diagnosis, Liver Cirrhosis / diagnosis, Lung Diseases / diagnosis, Case Reports, Aged, 80 and over, Chronic Disease, Diagnosis, Differential, Female, Hepatopulmonary Syndrome / complications, Humans, Liver Cirrhosis / complications, Lung Diseases / complications, Prognosis

An 86 year old woman with multiple chronic lung diseases (including chronic obstructive pulmonary disease, bronchiectasis, and untreated mycobacterium avium-intracellulare) presented with two weeks of increased shortness of breath, notably worse when seated as compared to when lying down. After treatments focused on her known conditions did not resolve her dyspnea, the differential diagnosis was broadened and she was found to have evidence of cirrhosis on imaging. As a result of this new diagnosis, transthoracic echocardiography and arterial blood gas analysis were performed and together yielded the diagnosis of hepatopulmonary syndrome. We describe a rare presentation of hepatopulmonary syndrome manifesting as a patient's first clinical evidence of suspected cirrhosis, a diagnosis made difficult by this patient's numerous other lung diseases which muddied the picture.
Hypoxemia and Right-to-Left-Shunt in Patient with Antiphospholipid Syndrome: A Case Report with Multimodality Imaging Findings and Literature Review
Authors: Mnahi Bin Saeedan, Mashael Alrujaib, Ahmed L Fathala
Journal: Case Rep Radiol (2016)

This is a case report of an extremely rare cause of superior vena cava syndrome with systemic-to-pulmonary venous shunts, illustrated using different imaging modalities with successful SVC and IVC dilatation and stenting.
Urothelial carcinoma of the fossa navicularis successfully treated with laser ablation and distal urethrectomy: A case report
Authors: Khalid Assadiq, Ahmad Rimawi, Khaled Jebreen
Journal: Qatar Med J (2021)
Keywords: laser ablation, penis neoplasms, transitional cell carcinoma

Primary urothelial carcinomas very rarely arise from the fossa navicularis of the penis. They are rarely reported in the literature, with only 13 cases reported thus far. Herein, we present the case of a 34-year-old man with bloody urethral discharge due to a mass detected by cystourethroscopy in the fossa navicularis. Biopsy confirmed the diagnosis of noninvasive urothelial carcinoma. The patient was managed successfully with two sessions of holmium laser ablation, followed by distal urethrectomy. After the treatment, the patient's erectile function and continence were preserved, and no tumor recurrence was observed after 1 year of follow-up.
Sunitinib Treatment for Advanced Paraganglioma: Case Report of a Novel SDHD Gene Mutation Variant and Systematic Review of the Literature
Authors: Franz Sesti, Tiziana Feola, Giulia Puliani, Roberta Centello, Valentina Di Vito, Oreste Bagni, Andrea Lenzi, Andrea M Isidori, Vito Cantisani, Antongiulio Faggiano, Elisa Giannetta
Journal: Front Oncol (2021)
Keywords: familial paraganglioma syndrome, sdhd, paraganglioma, succinate dehydrogenase, sunitinib
MeSH terms: Systematic Review

Background:
Paragangliomas (PGLs) are neuroendocrine neoplasms arising from chromaffin cells of sympathetic or parasympathetic paraganglia. Systemic therapies have been used only in metastatic PGLs. Antiangiogenic agents, such as sunitinib, could be a viable therapeutic choice in the subgroup of patients with SDH-positive PGLs. We describe the case of a man with Familial Paraganglioma Syndrome type 1 (FPGL) related to a novel mutation in SDHD gene treated with sunitinib. Furthermore, we performed a systematic review of the literature aimed to address the following question: is sunitinib treatment effective in patients with advanced/progressive/metastatic PGL?
Methods:
We performed a data search using MEDLINE, Cochrane Library, and Scopus between April 2019 and September 2020. We included studies reporting data on clinical or biological characteristics, or clinical outcomes of patients with PGLs treated with sunitinib.
Results:
The search leaded to the selection of 25 publications. Data from case reports and case series showed that disease control rate (DCR = stable disease + partial response + complete response) was achieved in 34.7% of cases under sunitinib treatment. In 39% of patients DCR was followed by progressive disease (PD) or tumor relapse, 26.1% patients showed PD. Data from clinical trials showed that DCR was 83%, and the median progression free survival was 13.4 months.
Discussion:
Data from the present literature review suggested that sunitinib could be a viable therapeutic option in advanced/progressive/metastatic inoperable PGLs. However, further trials on the efficacy of sunitinib in FPGL and sporadic PGL are needed.
Case report: 10-year survival of a patient with a primary hepatic gastrointestinal stromal tumor
Authors: Jie Lian, Meiyan Feng, Shumei Zhang, Haibo Lu
Journal: Front Oncol (2022)
Keywords: extra-gastrointestinal stromal tumors, imatinib, long-term survival, molecular-targeted therapeutic strategies, primary hepatic gist, sunitinib
MeSH terms: Case Reports

Background:
Gastrointestinal stromal tumors (GISTs) are mesenchymal tumors of the gastrointestinal tract. Extra-gastrointestinal stromal tumors (EGISTs) predominantly arise outside the gastrointestinal tract, although primary hepatic GISTs are extremely rare. GISTs are highly aggressive; they often grow to a large size. Here, we report the 10-year survival of a patient with a primary hepatic GIST following sequential response therapy.
Case presentation:
A 50-year-old Chinese man complained of fatigue and slight abdominal pain, and presented with a large lump in the liver, which was detected by computed tomography (CT). He was subsequently diagnosed with a primary hepatic GIST, based on CT-guided fine needle aspiration cytology and immunohistochemistry analyses. The presence of GIST or EGIST metastases was excluded using CT, esophagogastroduodenoscopy, colonoscopy, and ultrasound. Cytological examination showed that the tumor was composed of epithelioid and spindle cells. Immunohistochemistry analysis revealed positive staining for CD117 (KIT) and DOG1, and negative staining for CD34, S-100, and α-smooth muscle actin (SMA). Following tumor ablation with argon-helium cryosurgery, the patient received imatinib mesylate for 61 months. However, this treatment was discontinued because of disease progression, at which point interventional therapy was administered once. One month later, sunitinib malate was administered for 71 months. The patient achieved long-term survival for 135 months.
Conclusions:
EGISTs can be easily misdiagnosed as other types of tumors because they have no specific characteristics to distinguish them during imaging examinations. However, our case study demonstrates that the long-term survival of patients with EGISTs can be achieved with molecular targeted therapy.
A Case of Type II Achalasia Presenting With Markedly Elevated Troponins
Authors: Talia F Malik, Daniel Khan, Pallavi Shah, Andrew M Moon
Journal: Cureus (2023)
Keywords: achalasia, acute coronary syndrome, megaesophagus, myocardial injury, troponin
MeSH terms: Case Reports

Achalasia is an esophageal motility disorder that presents with dysphagia to solids and liquids and regurgitation of undigested food. Cardiac troponin (cTn) is a sensitive biomarker for myocardial injury, and elevated levels suggest an increased risk of mortality from acute coronary syndrome (ACS). Non-cardiac gastrointestinal (GI) causes of troponin elevation are rare and have generally been described in cases of critical illness (e.g., significant gastrointestinal bleeding (GIB) or acute liver failure). We report a rare case of type II achalasia presenting with markedly elevated troponins. This case illustrates an important GI-related mimic of ACS that should be considered by frontline providers and gastroenterologists.
Cytotoxic T Lymphocyte Antigen 4 Haploinsufficiency Presenting As Refractory Celiac-Like Disease: Case Report
Authors: Lauren V Collen, Carlos Andres Salgado, Bin Bao, Erin Janssen, Dascha Weir, Jeffrey Goldsmith, Alan Leichtner, Nasim Sabery Khavari, Yael Gernez, Scott B Snapper
Journal: Front Immunol (2022)
Keywords: ctla4 deficiency, ctla4 haploinsufficiency, abatacept, autoimmunity, case report, celiac disease, primary immunodeficencies (pid), refractory celiac disease
MeSH terms: Celiac Disease / diagnosis, Celiac Disease / genetics, Case Reports, Research Support, N.I.H., Extramural, Autoimmunity, CTLA-4 Antigen / genetics, Child, Preschool, Diet, Gluten-Free, Haploinsufficiency, Humans, CTLA-4 Antigen

Primary immunodeficiency may present with treatment-refractory enteropathy. We present two patients with celiac/celiac-like disease diagnosed in early childhood and refractory to the gluten-free diet. One patient had features of multi-system autoimmunity, whereas the other had celiac-like disease as an isolated clinical finding. Both patients underwent genetic testing given disease refractoriness and were ultimately diagnosed with cytotoxic T lymphocyte antigen 4 (CTLA4) haploinsufficiency. They are both now in complete clinical and endoscopic remission on abatacept. CTLA4 haploinsufficiency has incomplete penetrance and significant phenotypic heterogeneity but should be considered in the differential diagnosis of refractory celiac/celiac-like disease, as treatment implications are significant.
Case report: Iliac vein rupture during endovascular stenting in radiation-induced iliac venous stenosis
Authors: Qilin Xiang, Jingbo Tian, Xiaonin Zhu, Chunshui He, Shang Huang
Journal: Front Oncol (2023)
Keywords: iliac vein rupture, iliac vein stenting, case report, endovascular treatment, radiation-induced venous stenosis
MeSH terms: Case Reports

Only a few case reports in the medical literature describe radiation-induced iliac vein stenosis and endovascular therapy. We present a case of left external iliac vein stenosis resulting from radiotherapy for cervical cancer in which the iliac vein ruptured during the standard iliac vein stenting procedure. The emergency condition was resolved with the implantation of a covered stent and resuscitation with crystalloid and blood transfusion. The patient recovered without additional complications and was discharged eight days after endovascular therapy. At the six-month follow-up, the left lower limb edema had resolved completely, and the deep vein remained patent. This case might raise concerns regarding the potential risk of treating radiation-induced iliac venous stenosis, which may differ from that of a patient without a history of radiation therapy. Iliac vein rupture, iliac vein stenting, radiation-induced venous stenosis, case report.
Spontaneous massive splenic infarction in the setting of renal transplant and septic shock: a case report and review of the literature
Authors: Christine L Bokman, Maroun Sfeir, Veer Chahwala, Enrique Ginzburg
Journal: Case Rep Med (2014)

Massive splenic infarction (MSI) is a rare phenomenon that results from compromised blood flow to more than half of the spleen. Causes of MSI include hematological disorders, coagulopathies, infection, and embolization, and, rarely, MSI is spontaneous. The mainstay of treatment is splenectomy. We report the case of a 50-year-old man with a history of renal transplant who presented with diffuse abdominal pain and rapidly developed septic shock. A computed tomographic study (CT scan) of the abdomen demonstrated MSI. The surgical team was consulted for splenectomy but conservative management was maintained and immune function preserved. The patient's clinical condition was resolved over a three-week period. This report demonstrates successful nonoperative management of a spontaneous MSI most likely secondary to hypoperfusion and a hypercoagulable state from both septic shock and renal transplant.
Asymptomatic Bacteriuria in Pregnancy Complicated by Pyelonephritis Requiring Nephrectomy
Authors: Sharon J Kim, Pavan Parikh, Amanda N King, Mary L Marnach
Journal: Case Rep Obstet Gynecol (2018)
MeSH terms: Case Reports

Routine prenatal care in the United States includes screening for asymptomatic bacteriuria (ASB), which occurs in 2 to 7 percent of pregnant women and can cause urinary tract infection and pyelonephritis. We present the case of a pregnant woman affected by multidrug resistant Klebsiella induced ASB during her prenatal screen, which was untreated due to a repeat urine culture showing mixed flora; subsequently, the patient's postpartum course was complicated by pyelonephritis and perinephric abscess, concluding in a radical nephrectomy. Current recommendations are to treat ASB after two consecutive voided urine cultures showing the same bacterial strain in quantitative counts of =/> 10(5) colony forming units (cfu)/mL or a single-catheterized specimen with quantitative count of =/> 10(2) cfu/mL. For women with ASB in their prenatal screen or other high risk factors, consideration should be given to testing urine cultures every trimester until the completion of pregnancy to prevent the complications of persistent bacteriuria.
Success of ceftazidime-avibactam and aztreonam in combination for a refractory biliary infection with recurrent bacteraemia due to bla IMP-4 carbapenemase-producing Enterobacter hormaechei subsp. oharae
Authors: Genevieve McKew, John Merlino, Alicia Beukers, Sebastian van Hal, Thomas Gottlieb
Journal: Access Microbiol (2021)
Keywords: enterobacter hormaechei subsp oharae, aztreonam, blaimp-4, carbapenemase, ceftazidime–avibactam
MeSH terms: Case Reports

Background:
Infections due to metallo-beta-lactamase (MBL)-producing organisms are becoming a significant problem, and antibiotic treatment options are limited. Aztreonam inhibits MBLs, and its use in combination with ceftazidime-avibactam (CAZ-AVI-AZT) to inhibit other beta-lactamases shows promise.
Methods:
A 45-year-old woman suffered from recurrent and sustained MBL (blaIMP-4)+ Enterobacter cloacae complex bacteraemia from an undrainable biliary source, and had failed nine alternative antibiotic regimens over a 5-month period. The 10th episode was successfully treated with CAZ-AVI-AZT, and she has had no further relapses. Three of the isolates underwent whole-genome sequencing (WGS) on the MiSeq platform and were analysed with the Nullarbor pipeline.
Results:
A layered Etest method for synergy between CAZ-AVI and aztreonam demonstrated an MIC of 2 mg l-1 for the combination. Isolates were identified by WGS as Enterobacter hormaechei subsp. oharae . All three of the isolates had blaTEM-4 ESBL, blaOXA-1 and blaACT-25. Two of the carbapenem-resistant isolates contained blaIMP-4.
Conclusion:
While aztreonam inhibits MBLs, MBL-positive isolates often express other beta-lactamase enzymes. Avibactam inhibits ESBLs and other beta-lactamases, and its use in this case possibly contributed to therapeutic success due to inhibition of the concomitant blaTEM-4 in the isolates. This case demonstrates that phenotypic antimicrobial susceptibility testing (layered Etests for synergy), backed up by WGS, can produce results that allow tailored antimicrobial therapy in difficult infections. This case adds to the evidence for using CAZ-AVI-AZT in serious MBL infections.
Case Report: Complete response after tislelizumab treatment in a hepatocellular carcinoma patient with abdominal lymph node metastasis
Authors: Haihui Deng, Bin Chen, Deti Peng, Jian He, Weicheng Zhao, Tuantuan Chen, Zonggui Xie, Fuwen Pang
Journal: Front Immunol (2023)
Keywords: case report, hepatocellular carcinoma, immunotherapy, locoregional therapy, tislelizumab
MeSH terms: Carcinoma, Hepatocellular / drug therapy, Carcinoma, Hepatocellular / pathology, Chemoembolization, Therapeutic / methods, Liver Neoplasms / drug therapy, Liver Neoplasms / pathology, Case Reports, Research Support, Non-U.S. Gov't, Combined Modality Therapy, Humans, Lymph Nodes / pathology, Lymphatic Metastasis, Male, Middle Aged, tislelizumab

Background:
Abdominal lymph node (ALN) metastasis is associated with a poor prognosis in patients with hepatocellular carcinoma (HCC) because of the limited number of effective therapeutic options available. Immunotherapy with immune checkpoint inhibitors, such as those targeting programmed death receptor-1 (PD-1), have produced encouraging results in patients with advanced HCC. Here, we report a complete response (CR) in a patient with advanced HCC and ALN metastasis after combination treatment with tislelizumab (a PD-1 inhibitor) and locoregional therapy.
Case summary:
A 58-year-old man with HCC experienced progressive disease with multiple ALN metastases after undergoing transcatheter arterial chemoembolization (TACE), radiofrequency ablation (RFA), and laparoscopic resection. Because the patient did not wish to receive systemic therapy, including chemotherapy and targeting therapy, we prescribed tislelizumab (as a single immunotherapeutic agent) together with RFA. After four tislelizumab treatment cycles, the patient achieved a CR without tumor recurrence for up to 15 months.
Conclusion:
Tislelizumab monotherapy can be effectively used to treat advanced HCC with ALN metastasis. Moreover, the combination of locoregional therapy and tislelizumab is likely to further increase therapeutic efficacy.
A 5-week Non-Surgical Approach towards Denture Induced Hyperplasia
Authors: Carolina Mayumi Iegami, Regina Tamaki, Pedro Tortamano Neto
Journal: Open Dent J (2017)
Keywords: complete denture, denture rebasing, elderly, hyperplasia, oral disease, vacuum chamber
MeSH terms: Case Reports

Background:
Despite the standard approach towards denture-induced hyperplasia being surgery, as elderly population increases the systemic problems are carried along. Thus, surgery might be risky for patients with medical conditions.
Objective:
In this report, a patient with severe inflammatory papillary hyperplasia, medical problems and dental fear was treated with a 5-week nonsurgical protocol.
Method:
Once in a week, the upper denture was relined with a zinc enolic paste, for four weeks. In the fifth week, the denture was relined with fast set polymethyl methacrylate resin instead of zinc enolic paste so that the material would last longer than only a week until the new pair of dentures was manufactured.
Results and conclusion:
The generated pressure combined with antioxidant and anti-inflammatory properties of the paste led to the elimination of the inflammatory papillary hyperplasia completely, satisfying the patient and allowing the manufacturing of a new set of complete dentures.