OpenMed/multicare-articles huggingface dataset:
Embryonal rhabdomyosarcoma arising from the uterine corpus in a postmenopausal female: a surgical case challenging the genuine diagnosis on a cytology specimen
Authors: Sohsuke Yamada, Yoshikazu Harada, Hirotsugu Noguchi, Naoko Satoh, Satoshi Kimura, Toshiyuki Nakayama, Akihide Tanimoto
Journal: Diagn Pathol (2016)
MeSH terms: Postmenopause, Rhabdomyosarcoma, Embryonal / pathology, Uterine Neoplasms / pathology, Case Reports, Biomarkers, Tumor / analysis, Biopsy, Diagnosis, Differential, Female, Humans, Immunohistochemistry, Magnetic Resonance Imaging, Middle Aged, Predictive Value of Tests, Rhabdomyosarcoma, Embryonal / chemistry, Rhabdomyosarcoma, Embryonal / surgery, Treatment Outcome, Tumor Burden, Uterine Neoplasms / chemistry, Uterine Neoplasms / surgery, Biomarkers, Tumor

A 55-year-old postmenopausal female presented with genital bleeding and lower abdominal mass. An abdominal MRI revealed a heterogeneously enhanced, 15 × 10 cm mass, completely filling the lumen of the enlarged uterus. The cytologic analysis of the mass showed tumor cells in small clusters and as individual cells showing hyperchromatic round to oval nuclei, and pleomorphic and occasionally unipolar "tadpole"-shaped cytoplasm, in a background of severe necrosis and many degenerated squamous cells. We first interpreted it merely as atypical cells, possibly originated from sarcoma. A total abdominal hysterectomy and salpingo-oophorectomy were performed, and gross examination showed an exophytic polypoid mass with a whitish to white-grayish, necrotic appearance, protruding from the endometrial mucosa. Microscopically, the tumor was composed of a diffuse proliferation of highly atypical spindle-shaped cells, admixed with many characteristic rhabdomyoblasts having abundant densely eosinophilic cytoplasm with sometimes distinct cross-striations, coexisted with cellular primitive small blue round to oval cells foci. However, neither carcinoma nor additional heterologous sarcoma components were completely seen within our thorough investigation. Therefore, we finally made a diagnosis of embryonal rhabdomyosarcoma arising from the uterine corpus. We should be aware that owing to its characteristic features, cytopathologists might be able to determine a genuine diagnosis, based on multiple and adequate cytology samplings.
Death following partner bereavement: A self-controlled case series analysis
Authors: Michael King, Rebecca Lodwick, Rebecca Jones, Heather Whitaker, Irene Petersen
Journal: PLoS One (2017)
MeSH terms: Bereavement, Death, Case-Control Studies, Female, Humans, Male, Sexual Partners

Background:
There is mixed evidence that older people bereaved of a spouse or partner are at risk of adverse outcomes. The main difficulty is to take account of other explanatory factors. We tested for an association between a patient's death and the timing of any bereavement of a cohabitee.
Method:
Self-controlled case series study in which each case serves as his or her own control and which thereby accounts for all fixed measurable and unmeasurable confounders. We used the Health Improvement Network (THIN) primary care database to identify patients who died aged 50-99 years during the period 2003 to 2014. We used the household identifier in the database to determine whether they had an opposite sex cohabitee at the start of the observation period.
Results:
38,773 men and 23,396 women who had died and who had a cohabitee at the start of the observation period, were identified and included in male and female cohorts respectively. A higher risk of death was found in the 24 months after the death of the cohabitee than in the time classified as unexposed. The greatest risk was during the first 3 months after the death of the cohabitee (age-adjusted incidence rate ratio [IRR] 1.63, 95% CI 1.45-1.83 in the male cohort, and IRR 1.70, 95% CI 1.52-1.90 in the female cohort).
Conclusion:
Risk of death in men or women was significantly higher after the death of a cohabitee and this was greatest in the first three months of bereavement. We need more evidence on the effectiveness of interventions to reduce this increased mortality.
Late-Onset Posttransplant Lymphoproliferative Disorder Results in Jejunal Stricture Managed with Endoscopic Dilation
Authors: Steven Park, John Miller, Janice Cheong, Asad Ullah, Lawrence Saubermann, Arthur Decross
Journal: Case Rep Gastrointest Med (2021)
MeSH terms: Case Reports

Background:
Late-onset posttransplant lymphoproliferative disorder (PTLD) after orthotopic heart transplantation is rare. Case Presentation. We present a rare diagnosis of small bowel stricture caused by healed lymphomatous ulcers in a patient with orthotopic heart transplantation and PTLD diagnosed 25 years after initial transplantation. We also demonstrate successful endoscopic balloon dilations that improved the patient's obstructive symptoms.
Conclusion:
It is important to consider stricture from healed lymphomatous ulcers in posttransplant patients presenting with obstructive symptoms.
Shaggy photoreceptors with subfoveal fluid associated with a distant choroidal melanoma
Authors: Ann Q Tran, James A Eadie, Michael M Altaweel
Journal: Case Rep Ophthalmol Med (2015)

Purpose. To describe the enhanced depth imaging optical coherence tomography (EDI-OCT) findings in a patient with an extra macula choroidal melanoma before and after treatment. Methods. Observational case report. Results. A 45 year-old Caucasian male patient was referred to retina clinic for management of choroidal melanoma. Examination revealed a nasal choroidal melanoma while EDI-OCT illustrated subfoveal fluid pocket with elongated shaggy photoreceptors distant and separate from the tumor. The patient was treated with plaque brachytherapy and intravitreal bevacizumab. One week after plaque removal, there was a dramatic reduction in the shaggy photoreceptors. Conclusion. Choroidal melanomas have effects that are not localized to the area of the tumor. This loculated pocket of subretinal fluid and coinciding changes to photoreceptor morphology may be related to global changes in choroidal function or release of tumor related cytokines.
Small cell transformation of ROS1 fusion-positive lung cancer resistant to ROS1 inhibition
Authors: Jessica J Lin, Adam Langenbucher, Pranav Gupta, Satoshi Yoda, Isobel J Fetter, Marguerite Rooney, Andrew Do, Marina Kem, Kylie Prutisto Chang, Audris Y Oh, Emily Chin, Dejan Juric, Ryan B Corcoran, Ibiayi Dagogo-Jack, Justin F Gainor, James R Stone, Jochen K Lennerz, Michael S Lawrence, Aaron N Hata, Mari Mino-Kenudson, Alice T Shaw
Journal: NPJ Precis Oncol (2020)
Keywords: lung cancer
MeSH terms: Case Reports

Histologic transformation from non-small cell to small cell lung cancer has been reported as a resistance mechanism to targeted therapy in EGFR-mutant and ALK fusion-positive lung cancers. Whether small cell transformation occurs in other oncogene-driven lung cancers remains unknown. Here we analyzed the genomic landscape of two pre-mortem and 11 post-mortem metastatic tumors collected from an advanced, ROS1 fusion-positive lung cancer patient, who had received sequential ROS1 inhibitors. Evidence of small cell transformation was observed in all metastatic sites at autopsy, with inactivation of RB1 and TP53, and loss of ROS1 fusion expression. Whole-exome sequencing revealed minimal mutational and copy number heterogeneity, suggestive of "hard" clonal sweep. Patient-derived models generated from autopsy retained features consistent with small cell lung cancer and demonstrated resistance to ROS1 inhibitors. This case supports small cell transformation as a recurring resistance mechanism, and underscores the importance of elucidating its biology to expand therapeutic opportunities.
A Succession of MRI Scans Supports the Diagnosis of Lumbar Ligamentum Flavum Hematoma: A Case Report and Review of the Literature
Authors: Yuyu Ishimoto, Mamoru Kawakami, Elizabeth Curtis, Cyrus Cooper, Nami Moriguchi, Yukihiro Nakagawa
Journal: Case Rep Orthop (2018)
MeSH terms: Case Reports

Ligamentum flavum hematoma (LFH) is a rare cause of spinal nerve compression. This condition remains challenging to diagnose using MRI due to the changing intensity of the hematoma on imaging. The aim of this study was to describe the patient with LFH who had a succession of MRI scans carried out. We report on a 71-year-old woman with a mass at L4/5 and decompression surgery was performed for her left leg symptom. She had MRI carried out in a previous hospital and also had MRI again in our hospital. In a 2nd MRI of the same area, after a 2-week interval, a newly isointense mass was present within the anterior part of the previously identified lesion on T1-weighted image and the hyperintense area in the lesion was a little extended on T2-weighted imaging. Her symptoms were resolved immediately after decompression surgery. Following a review of previous cases, we suggest that consecutive MRI scanning may support the diagnostic process for LFH.
Deglutition Syncope: Two Case Reports Attributed to Vagal Hyperactivity
Authors: Sukhdeep Bhogal, Pooja Sethi, Yasir Taha, Muralidhar Papireddy, Akhilesh Mahajan, Syed Imran M Zaidi, Vijay Ramu, Timir Paul
Journal: Case Rep Cardiol (2017)
MeSH terms: Case Reports

Deglutition syncope is a relatively rare cause of syncope that belongs to the category of neurally mediated reflex syncopal syndromes. The phenomenon is related to vagal reflex in context to deglutition causing atrioventricular block and acute reduction in cardiac output leading to dizziness or syncope. We present case series of two cases of deglutition syncope, of which first was managed medically and second with pacemaker implantation.
Penoscrotal Elephantiasis nostras verrucosa: A case report and literature review
Authors: Yasmin Moussa, Mohamad Moussa, Mohamed Abou Chakra
Journal: Int J Surg Case Rep (2019)
Keywords: acitretin, case report, elephantiasis nostras verrucosa, lymphedema, penoscrotal

Background:
Elephantiasis Nostras Verrucosa (ENV) is a rare clinical condition associated with chronic non-filarial lymphedema caused by bacterial or non-infectious lymphatic obstruction.
Case description:
We reported an unusual case of isolated peno-scrotal ENV of a 67-year-old man with a history of Gastrointestinal Stromal Tumors (GIST) of the stomach. Our patient presented for progressive painless lymphedema of the penis and scrotum since 8 years ago before the diagnosis of GIST tumors, associated with skin changes consistent of superimposed hyperkeratotic papulonodules with a verrucose or cobblestone-like appearance. The patient refused surgical excision. He was treated with oral Acitretin 30 mg/day for 4 weeks where a minimal improvement was noted. Acitretin was stopped due to an increase in liver enzymes. Conservative treatment was applied to decrease lymphostasis.
Discussion:
ENV is characterized by lymphedema and skin changes consisting of hyperkeratotic, verrucous and papillomatous lesions. It is most commonly caused by bacterial infection, trauma, neoplasia and obesity. The diagnosis of ENV is achieved clinically by history and typical skin changes. Imagery and skin biopsy are used to differentiate ENV from other diseases. Management of ENV remains challenging. Strategies to reduce lymph stasis include lymphatic massages, compressive dressings are often inadequate. Surgical debridement may be considered in cases where there is no improvement depsite medical therapy. Oral retinoids can be used if tolerated with variable results.
Conclusion:
ENV is a rare disorder that results from chronic obstructive lymphedema. There is no standard therapy but a variety of medical and surgical treatment options have been reported.
Severe COVID-19 in Third Trimester Pregnancy: Multidisciplinary Approach
Authors: Jerald Pelayo, Gabriella Pugliese, Grace Salacup, Eduardo Quintero, Adeeb Khalifeh, David Jaspan, Bhavna Sharma
Journal: Case Rep Crit Care (2020)
MeSH terms: Case Reports

The rapidly expanding cases of the coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have exposed vulnerable populations, including pregnant women to an unprecedented public health crisis. Recent data show that pregnancy in COVID-19 patients is associated with increased hospitalization, admission of the intensive care unit, and intubation. However, very few resources exist to guide the multidisciplinary team in managing critically ill pregnant women with COVID-19. We report our experience with managing a morbidly obese pregnant woman at 36 weeks' gestation with history of asthma and malignancy who presented with persistent respiratory symptoms at an outside hospital after being tested positive for SARS-CoV-2 polymerase chain reaction (PCR). Early in the course of the hospitalization, patient received remdesivir, convalescent plasma, bronchodilator, systemic steroids, and IV heparin for COVID-19 and concomitant asthma exacerbation and pulmonary embolism. Due to increasing oxygen requirements, she was eventually intubated and transferred to our institution for higher level of care. Respiratory acidosis, severe hypoxemia, and vent asynchrony were managed with vent setting adjustment and paralytics. After 12 hours from spontaneous rupture of her membranes and with stabilization of maternal status, patient underwent a term cesarean delivery for nonreassuring fetal heart tracing. The neonate was discharged on the 2nd day of life, while the patient was extubated on the 6th postpartum day and was discharged to acute inpatient rehabilitation facility on the 19th hospital day. This report highlights the disease progression of COVID-19 in a pregnant woman, the clinical challenges in the critical care aspect of patient management, and the proposed multidisciplinary strategies utilizing an algorithmic approach to optimize maternal and neonatal outcomes.
Azathioprine Hypersensitivity Syndrome during Treatment of Severe Interstitial Lung Disease with Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis
Authors: Eri Nakano, Tomohiko Asakawa, Mea Asou, Eri Nohara, Tomoyuki Seki, Makoto Araki
Journal: Case Rep Pulmonol (2020)
MeSH terms: Case Reports

Azathioprine is used to treat anti-neutrophil cytoplasmic antibody- (ANCA-) associated vasculitis. Azathioprine hypersensitivity syndrome is often missed. An 81-year-old man undergoing treatment for interstitial pneumonia developed a high fever and was diagnosed with ANCA-associated vasculitis based on an elevated myeloperoxidase- (MPO-) ANCA titer and renal biopsy findings. After induction therapy, his clinical symptoms improved, but his MPO-ANCA remained elevated (>300 U·L-1) and hematuria persisted. Prednisolone plus azathioprine was administered as maintenance therapy. Three exacerbations of the inflammatory response occurred during the subsequent 3 months. In each instance, we suspected opportunistic infection or a flare-up of vasculitis. The first exacerbation was treated with an increased prednisolone dose and antibiotics. At the onset of the second exacerbation, which was accompanied by systemic erythema, we stopped azathioprine and administered antibiotics. The third exacerbation, which occurred the day after restarting azathioprine, involved a fever with chills and an acute inflammatory reaction; we therefore suspected an azathioprine allergy. A drug provocation test was performed, and a hyperinflammatory response was observed. The patient received prednisolone (15 mg·day-1) monotherapy; no further fever was observed during the subsequent 2 months. We therefore diagnosed azathioprine hypersensitivity syndrome. Under treatment with prednisolone (5 mg·day-1) and mycophenolate mofetil (1 g·day-1) (replacing the azathioprine), no signs of relapse or infection have occurred for more than two years. Renal function and the pulmonary lesions are stable, although the high MPO-ANCA titer and hematuria persist. The diagnosis of azathioprine hypersensitivity is often delayed because of the difficulty in identifying the relationship between immunosuppressive agents and hypersensitivity and in distinguishing this from infection or relapse of the primary disease. The misdiagnosis of azathioprine hypersensitivity leads to unnecessary treatment; thus, clinicians should consider allergic reactions specific to azathioprine when switching from induction to maintenance therapy.
Screw Fixation as the Primary and Definitive Treatment of an Isolated Uncommon Fracture of the Anterior Margin of the Distal Tibia
Authors: Stamatios A Papadakis, Dimitrios Pallis, Konstantinos Tsivelekas, Margarita-Michaela Ampadiotaki, Dimitrios Segos
Journal: Cureus (2023)
Keywords: fracture, pilon, screw fixation, tibia, tibia plafond
MeSH terms: Case Reports

Tibial plafond fractures constitute one of the most challenging fracture types while they are commonly associated with soft tissue damage and severe bone comminution. We present the clinical outcomes of screw fixation as the initial and definitive treatment of an isolated uncommon fracture of the anterior margin of the distal tibia. This is a case of an uncommon type of fracture of the distal tibia. The patient underwent a successful screw fixation and the fracture healed in three months. There was no bone and soft tissue infection. Sixteen months after the injury, an excellent function of the ankle joint was noted. Although fractures of the anterior margin of the distal tibia are uncommon high-energy injuries, uneventful healing with very good functional results can be achieved with screw fixation as the initial and definitive treatment.
TRIP11-PDGFRB fusion in a patient with a therapy-related myeloid neoplasm with t(5;14)(q33;q32) after treatment for acute promyelocytic leukemia
Authors: Hoon-Gu Kim, Ja-Hyun Jang, Eun-Ha Koh
Journal: Mol Cytogenet (2014)
Keywords: acute promyelocytic leukemia, pdgfrb, trip11, therapy-related myeloid neoplasm, t(5, 14)(q33, 32)
MeSH terms: Case Reports

Background:
Therapy-related myeloid neoplasm after treatment for acute promyelocytic leukemia (APL) is a relatively infrequent but severe complication. Most therapy-related myeloid neoplasms after treatment for APL are classified as therapy-related myelodysplastic syndrome or therapy-related acute myeloid leukemia. Translocation of 5q31-33, PDGFRB occur rarely in therapy-related myeloid neoplasm and there has been two identified PDGFRB partner genes located at 14q32, TRIP11 and KIAA1509.
Results:
The TRIP11-PDGFRB fusion was identified in a patient with therapy-related myeloid neoplasm with t(5;14)(q33;q32) after treatment of APL using conventional cytogenetics, fluorescence in situ hybridization (FISH) and molecular methods. Cytogenetic analysis of the bone marrow aspirate revealed 46, XY, t(5;14)(q33;q32) in all 20 analyzed cells. No other cytogenetic abnormalities were observed. Break-apart FISH analysis demonstrated that rearrangement of PDGFRB at 5q33 was positive in 460 of 500 cells analyzed, while the PML-RARA rearrangement remained undetectable by RT-PCR. Sequencing of RT-PCR products revealed fusion between exon 16 of TRIP11 and exon 11 of PDGFRB. However, the KIAA1509-PDGFRB fusion was not detected by RT-PCR.
Conclusion:
We firstly demonstrated that therapy-related myeloid neoplasm with TRIP11-PDGFRB fusion was identified after treatment of APL.
Occult Cranial Cervical Dislocation: A Case Report and Brief Literature Review
Authors: Joshua B Shatsky, Timothy B Alton, Carlo Bellabarba, Richard J Bransford
Journal: Case Rep Orthop (2016)

Study Design. Retrospective case report and review. Objective. Cranial cervical dislocation (CCD) is commonly a devastating injury. Delay in diagnosis has been found to lead to worse outcomes. Our purpose is to describe a rare case of occult cranial cervical dislocation (CCD) and use it to highlight key clinical and radiographic findings to ensure expedited diagnosis and proper management avoiding delays and subsequent neurologic deterioration. Method. Case report with literature review. Results. We describe a unique case of occult cranial cervical dislocation where initial imaging of the cervical spine failed to illustrate displacement of the occipital-cervical (O-C1) articulation or C1-C2 articulation. Careful evaluation of subtle radiographic clues suggested a more severe injury than initial review. Additional imaging was obtained due to these subtle clues confirming true cranial cervical dislocation allowing subsequent treatment with no neurologic sequelae. Conclusion. A high index of suspicion of CCD may prevent injury in select patients who present without gross cord compromise. Careful consideration of associated fractures, soft tissue injuries, and mechanism of injury are essential clues to the correct diagnosis and management of injuries to the craniocervical junction (CCJ).
The Influence of Pin Deviation on the Fracture Correction and the Fixator Adjustment with Sensitivity and Kinematic Analysis
Authors: Xia Zhao, Jianfeng Li
Journal: Biomed Res Int (2018)
MeSH terms: Fractures, Bone / pathology, Fractures, Bone / physiopathology, Fractures, Bone / surgery, Internal Fixators, Models, Biological, Biomechanical Phenomena, Humans

Fracture correction is important orthopedics operation and can be performed by unilateral external fixator. Due to pin deviations being inevitable during the operation, searching the impacts of pin deviation on the fracture correction and fixator joint adjustment are important. This study puts forward evaluation index with sensitivity analysis for investigating the impact of three orientation deviations and three position deviations on fracture correction. Meanwhile, based on a clinical case from a 28-year-old female, the influence of pin deviation on the adjustment of fixator joints was analyzed by inverse kinematic method. Different pin deviations have different sensitivity; the sensitivity of orientation deviation is relatively larger than position deviation. The existence of pin deviation will result in the change of the adjustment value of fixator joints. In addition, the experiments of seven situations were established to verify the analytical results. This study revealed the sensitivity of different pin deviations which can also be used to predict the adjustment value of fixator joints and the accuracy of fracture correction. This research also helps to reduce operation time and decrease damage to soft tissue by reducing the frequency of inserting pins.