OpenMed/multicare-articles huggingface dataset:
Adjuvant Radiochemotherapy with a 23-Month Overall Survival Time in a Patient after a Surgery due to Splenic Hemangiosarcoma Rupture: A Case Report with the Literature Review
Authors: M Bilski, D Surdyka, I Paśnik, M Bilska, P Cisek, P Korona, J Szumiło, L Grzybowska-Szatkowska
Journal: Case Rep Oncol Med (2018)
MeSH terms: Case Reports

Spleen sarcoma is one of the most rare soft tissue malignancies. The annual incidence is 0.14-0.25/1,000,000 and the average age of diagnosis is 50 to 73 years. The incidence of this cancer has been increasing. Treatment of choice is surgical splenectomy, which rarely gives good results due to the aggressive course of the disease as well as the high potential for metastasis. Overall survival in primary spleen sarcomas as described by various authors is between 4 and 14 months. 80% of patients after spleen rupture do not survive 6 months. We report the case of a 42-year-old male diagnosed with spleen angiosarcoma. The patient underwent surgery in an emergency mode because of rapid rupture of the organ. Due to positive surgical margins, he underwent adjuvant radiochemotherapy followed by chemotherapy. Overall survival time was relatively long (23 months). The international guidelines provide information based on limited data. The role of postoperative radiotherapy in angiosarcomas remains controversial. Postoperative radiotherapy may increase local disease control, especially after nonradical operation, but this does not translate into improvement in overall survival time of these patients. The case shows that adjuvant radiotherapy as part of cancer treatment strategy may prolong the overall survival.
Ventriculo-atrial gradient due to first degree atrio-ventricular block: a case report
Authors: Giuseppe Ando', Francesco Versaci
Journal: BMC Cardiovasc Disord (2005)
MeSH terms: Heart Block / therapy, Pacemaker, Artificial, Case Reports, Research Support, Non-U.S. Gov't, Aged, Aortic Valve Stenosis / physiopathology, Aortic Valve Stenosis / therapy, Cardiac Catheterization, Cardiac Output, Low / physiopathology, Cardiac Output, Low / therapy, Female, Heart Block / physiopathology, Hemodynamics, Humans

Background:
Isolated, asymptomatic first degree AV block with narrow QRS has not prognostic significance and is not usually treated with pacemaker implantation. In some cases, yet, loss of AV synchrony because of a marked prolongation of the PR interval may cause important hemodynamic alterations, with subsequent symptoms of heart failure. Indeed, AV synchrony is crucial when atrial systole, the "atrial kick", contributes in a major way to left ventricular filling, as in case of reduced left ventricular compliance because of aging or concomitant structural heart disease.
Case presentation:
We performed a trans-septal left atrium catheterization aimed at evaluating the entity of a mitral valve stenosis in a 72-year-old woman with a marked first-degree AV block, a known moderate aortic stenosis and NYHA class III symptoms of functional deterioration. We occurred in a deep alteration in cardiac hemodynamics consisting in an end-diastolic ventriculo-atrial gradient without any evidence of mitral stenosis. The patient had a substantial improvement in echocardiographic parameters and in her symptoms of heart failure after permanent pacemaker implantation with physiological AV delay.
Conclusion:
We conclude that if a marked first degree AV block is associated to instrumental signs or symptoms of heart failure, the restoration of an optimal AV synchrony, achieved with dual-chamber pacing, may represent a reasonable therapeutic option leading to a consequent clinical improvement.
Low-grade central fibroblastic osteosarcoma may be differentiated from its mimicker desmoplastic fibroma by genetic analysis
Authors: Wangzhao Song, Eva van den Berg, Thomas C Kwee, Paul C Jutte, Anne-Marie Cleton-Jansen, Judith V M G Bovée, Albert J Suurmeijer
Journal: Clin Sarcoma Res (2018)
Keywords: bone sarcoma, cdk4, desmoplastic fibroma, low-grade osteosarcoma, rb1
MeSH terms: Case Reports

Background:
We studied two cases of rare fibrous bone tumors, namely desmoplastic fibroma (DF) and low-grade central osteosarcoma (LGCOS) resembling desmoplastic fibroma (DF-like LGCOS). As the clinical presentation, imaging features and histopathology of DF and DF-like LGOS show much overlap, the objective of this study was to investigate the value of cytogenetic analysis, molecular pathology and immunohistochemistry in discrimination of these two mimickers.
Case presentation:
A mutation in CTNNB (S45F) and nuclear beta-catenin immunostaining were observed in DF. DF-LGCOS had amplification of CDK4 and showed strong nuclear expression of CDK4 by IHC. Moreover, the karyotype of DF-LGCOS showed an interstitial heterozygous deletion of the long arm of chromosome 13 (q12q32), associated with loss of the RB1 tumor suppressor gene.
Conclusions:
Karyotyping and molecular genetic analysis may contribute to a conclusive diagnosis.
Point of Care Ultrasound (POCUS) in Bedside Diagnosis of Pyomyositis
Authors: Olusegun Oduyoye, Euan Thomas
Journal: POCUS J (2022)
Keywords: abscess, collection, deep vein thrombosis (dvt), point of care ultrasound (pocus), pyomyositis, wells score
MeSH terms: Case Reports

A 43 year old man with a history of IV drug use, and presenting with three days of painful and swollen left calf, was referred to exclude deep vein thrombosis (DVT). Ultrasound showed no evidence of DVT. An area of localised warm, erythematous, which was disproportionately tender, prompted a point of care ultrasound (POCUS) assessment. POCUS confirmed a hypoechoic area in the underlying tissue, likely representing a collection because of no recent trauma. It led to prompt antibiotic therapy for the treatment of his pyomyositis. The patient surgical team reviewed the patient and recommended a conservative approach with a satisfactory clinical outcome that led to a safe discharge. Overall, this case demonstrates the versatility of POCUS as an efficient diagnostic tool in the acute setting, and it also helped to differentiate cellulitis from pyomyositis.
Case Report: Haemolytic anaemia with ceftazidime use in a patient with cystic fibrosis
Authors: Jun Yong, Freddy Frost, Dilip Nazareth, Martin Walshaw
Journal: F1000Res (2018)
Keywords: ceftazidime, cephalosporins, drug induced immune haemolytic anaemia

Drug-induced Immune Haemolytic Anaemia (DIIHA) is a rare but serious complication of cephalosporin use. Ceftazidime is recognized to be a rare cause of DIIHA. We report and discuss a case of DIIHA in a person with cystic fibrosis who developed severe haemolytic anaemia following use of ceftazidime in the management of an acute pseudomonal pulmonary exacerbation.
Cold at the Core: Osborn Waves in Neurosarcoidosis-Induced Central Hypothermia
Authors: Gregory Scott Troutman, Jason Salamon, Matthew Scharf, Jeremy A Mazurek
Journal: Case Rep Cardiol (2019)
MeSH terms: Case Reports

Osborn waves, or J waves, initially described by John Osborn in 1953 in hypothermic dog experiments, are highly sensitive and specific for hypothermia. Initially thought to be secondary to a hypothermia-induced "injury current," they have more recently been attributed to a voltage differential between epicardial and endocardial potassium (Ito) currents. While the exact conditions required to induce such waves have been debated, numerous clinical scenarios of environmental and iatrogenic hypothermia have been described. Below, we report a novel case of hypothermia-that of neurosarcoidosis-induced central hypothermia with resultant Osborn waves and other associated findings found on electrocardiogram (ECG).
Case Report: A Rare Case of Esophagogastric Junctional Squamous Cell Carcinoma After the Successful Treatment of Neuroendocrine Carcinoma: Clonal Tumor Evolution Revealed by Genetic Analysis
Authors: Hiroki Sato, Takeshi Saito, Hiroshi Horii, Mami Kajiura, Noriaki Kikuchi, Nobuhisa Takada, Koichi Taguchi, Mika Yoshida, Masakazu Hasegawa, Hiroyuki Taguchi, Yukinori Yoshida, Katsuyoshi Ando, Mikihiro Fujiya, Yuko Omori, Thomas Hank, Andrew S Liss, Manish K Gala, Yoshio Makita, Yusuke Ono, Yusuke Mizukami, Toshikatsu Okumura
Journal: Front Genet (2021)
Keywords: clinicopathological correlation, esophagogastric junction, genetic pathology, multidisciplinary therapy, neuroendocrine carcinoma, sequential chemotherapy, squamous cell carcinoma, tumor genotyping
MeSH terms: Case Reports

Neuroendocrine carcinoma (NEC) of the esophagogastric junction (EGJ) is a rare disease with no established treatments. Herein, we describe a case of recurrent squamous cell carcinoma (SCC) after achieving complete response to chemotherapy against NEC of the EGJ. A 67-year-old man was referred to our hospital because of epigastric discomfort. Computed tomography imaging and esophagogastroduodenoscopy revealed ulcerated tumors at the EGJ. Endoscopic biopsy revealed small tumor cells with a high nuclear/cytoplasmic ratio, suggesting small-cell NEC. Immunohistochemistry (IHC) analysis showed tumor cells with an MIB-1 index of 80%. The patient achieved complete response after 10 cycles of chemotherapy. Follow-up endoscopic examination revealed small red-colored mucosal lesions in the center of the cicatrized primary lesion. Re-biopsy detected cancer cells harboring large eosinophilic cytoplasm with keratinization and no evidence of NEC components. IHC of the cells were cytokeratin 5/6-positive and p53-negative. The tumor persisted without evidence of metastases after chemoradiotherapy, and total gastrectomy with lymph node dissection was performed. Pathological assessment of the resected specimens revealed SCC, without evidence of NEC. The patient survived without a recurrence for >3 years after the initial presentation. Somatic mutation profiles of the primary NEC and recurrent SCC were analyzed by targeted amplicon sequencing covering common cancer-related mutations. Both tumors possessed TP53 Q192X mutation, whereas SMAD4 S517T was found only in SCC, suggesting that both tumor components originated from a founder clone with a stop-gain mutation in TP53. The somatic mutation profile of the tumors indicated that that loss of heterozygosity (LOH) at the TP53 gene might have occurred during the differentiation of the founder clone into NEC, while a SMAD4 mutation might have contributed to SCC development, indicating branching and subclonal evolution from common founder clone to both NEC and SCC. The mutation assessments provided valuable information to better understand the clonal evolution of metachronous cancers.
Case Report: Prolonged Anorexia With Nausea Caused by Immune Checkpoint Inhibitors for Malignant Melanoma Treated Using Kampo Medicines Bukuryoingohangekobokuto and Ninjin'yoeito
Authors: Shin Takayama, Ryutaro Arita, Tadashi Ishii
Journal: Front Pharmacol (2022)
Keywords: anorexia, immune checkpoint inhibitors, kampo medicine, recover, side effect
MeSH terms: Case Reports

Immune checkpoint inhibitors (ICIs) are indicated for several cancers, including malignant melanoma. Anorexia and nausea resulting in malnutrition are side effects of ICIs. In such cases, conventional drugs are used for symptom relief, but the symptoms may persist. We report a case of advanced malignant melanoma with prolonged anorexia and nausea, which occurred after nivolumab administration, and was successfully treated using Kampo medicines. A 75-year-old man with nasal bleeding visited our hospital. A nasal scope revealed an obstructive tumor in the left nasal concha. Tissue biopsy showed malignant melanoma, and computed tomography showed metastasis to the liver and bone. Thus, the patient was diagnosed with stage IV malignant melanoma. He received radiotherapy (30 Gy) and nivolumab with ipilimumab four times, followed by nivolumab administration alone. During the administration of nivolumab, he complained of severe anorexia and nausea, with a numeric rating scale (no symptoms, 0; severe symptoms, 10) score of 10. He could not consume food because of these symptoms, even after nivolumab administration was discontinued. His blood pressure was 92/59 mmHg, his performance status (PS; no fatigue, 0; bedridden or disabled, 4) was 4, and his body weight gradually decreased from 60 to 39 kg in a month. The patient showed malnutrition and dehydration and experienced anxiety and depression. Nivolumab was terminated, and conventional symptomatic drugs were prescribed, but the symptoms persisted. We then prescribed 9.0 g/day of ninjin'yoeito (TJ-108, Tsumura and Co.) to allow recovery from anorexia and subsequently added bukuryoingohangekobokuto (TJ-116, Tsumura and Co.) to treat the persistent nausea. After treatment with these two Kampo medicines, the patient's appetite gradually recovered. Along with the recovery of nutritional status, his PS improved to 0, his anxiety and depressive state improved, and his body weight increased to 60 kg. The patient remained in good condition without cancer recurrence. The patient's clinical course shows the usefulness of Kampo medicine as supportive care for symptom relief and maintenance of nutritional and mental status during cancer treatment.
Baseline thrombocytopenia complicated by recurrent episodes of transient severe thrombocytopenia following infections in an adult woman with a non involuting congenital hemangioma - a case report
Authors: Mitrakrishnan C Shivanthan, Bandula Wijesiriwardena, Indira S Wijesiriwardena
Journal: BMC Hematol (2013)
Keywords: hemangioma, infection, platelet, severe thrombocytopenia, thrombocytopenia
MeSH terms: Case Reports

Background:
Congenital hemangiomas are benign abnormal proliferation of blood vessels. Noninvoluting congenital hemangiomas are a rare variant which persist, and may become bigger. Hemangiomas are known to be associated with thrombocytopenia, microangiopathic hemolytic anemia and Kasabach-Merritt phenomenon. Kasabach-Merritt phenomenon is characterized by consumptive coagulopathy with microangiopathic haemolyic anemia and thrombocytopenia. Platelet sequestration in the hemangioma or increased destruction which may either be immune or non immune are also further contributors to thrombocytopenia.
Case presentation:
A 45 year old female with a non involuting hemangioma and baseline thrombocytopenia was observed to develop repeated episodes of transient severe thrombocytopenia associated with a variety of infectious conditions. Laboratory investigations suggested a peripheral mechanism. Platelet counts always returned to baseline levels on resolution of the precipitating infection.
Conclusion:
The authors report this phenomenon as the first reported case of baseline thrombocytopenia complicated by recurrent episodes of transient severe thrombocytopenia following infections associated with a non involuting congenital hemangioma. The observations made in this patient were unique and hitherto unreported in medical literature. Both peripheral sequestration and destructive consumption were considered likely. Consumptive mechanisms were likely to encompass either or both immune and non immune causes. Further studies are needed to establish the precise pathogenesis.
Choledochal cyst and aberrant biliary configuration along with situs inversus totalis: a case report
Authors: David Eng Yeow Gan, Dinesh Alagoo, Kheng Hooi Chan, Rebecca Xin Yee Choi, Harivinthan Sellappan, Mohd Sharifudin Sharif, Firdaus Hayati
Journal: Pan Afr Med J (2021)
Keywords: choledochal cyst, case report, situs inversus
MeSH terms: Choledochal Cyst / diagnosis, Choledocholithiasis / complications, Sepsis / etiology, Situs Inversus / diagnosis, Case Reports, Adult, Biliary Tract Diseases / diagnosis, Biliary Tract Diseases / pathology, Choledochal Cyst / pathology, Female, Humans, Sepsis / diagnosis, Situs Inversus / pathology

Situs inversus totalis is the complete transpositioning of thoracoabdominal viscera into a mirror image of the normal configuration. Choledochal cyst is the congenital cystic dilation of the biliary tract. Both these conditions coexisting in a patient is extremely rare. We hereby present a case of type IC choledochal cyst in a patient with situs inversus totalis presenting with biliary sepsis secondary to choledocholithiasis. Also detailed are the management and operative strategies employed to deal with this rare entity.
Benign fibrous histiocytoma of the buccal mucosa: case report and literature review
Authors: Paraskevi Giovani, Anna Patrikidou, Aris Ntomouchtsis, Soultana Meditskou, Henri Thuau, Kostas Vahtsevanos
Journal: Case Rep Med (2010)
MeSH terms: Case Reports

Benign fibrous histiocytoma is an interesting and challenging entity even in its most usual, cutaneous presentation. Noncutaneous presentation is extremely limited, even more so for the mucosa of the head and neck area. We herein report such a case, describing the clinical characteristics of the lesion, complete diagnostic evaluation, management, and follow-up. Diagnostic histopathological challenges are specifically illustrated. A complete review of the relevant literature is also included.
Adult Wilms with Biphasic Pattern; A Case Report
Authors: Mahdi Farzadnia, Mahboobe Karrabi, Hamidreza Ghorbani
Journal: Caspian J Intern Med (2021)
Keywords: adult, case report, nephroblastoma, wilms tumor
MeSH terms: Case Reports

Background:
Wilms' tumor, nephroblastoma, is an extremely uncommon kidney tumor of adulthood. We reported a woman with a huge kidney mass diagnosed with nephroblastoma.
Case presentation:
A 39-year-old female was assessed due to right flank pain. CT scan revealed a mass measuring 128×100 mms involving the upper portion of the right kidney. The patient underwent nephrectomy, and the diagnosis of adult Wilms' tumor was confirmed based on the morphological and immunohistochemical findings.
Conclusion:
In adult patients with flank pain and renal mass, the diagnosis of Wilms' tumor should be pronounced in the absence of histopathologic features of renal cell carcinoma.
Retroperitoneal abscess with concomitant hepatic portal venous gas and rectal perforation: a rare triad of complications of acute appendicitis. A case report
Authors: Michele Diana, Alexandre Paroz, Nicolas Demartines, Markus Schäfer
Journal: World J Emerg Surg (2010)

Background:
While retroperitoneal abscess is a known complication, hepatic portal venous gas and rectal perforation have not been reported as a concomitant sequelae of acute appendicitis. Here we report a case of a patient with a perforated appendicitis that was associated with these triad of complications.
Materials and methods:
In addition to report our case, we carefully reviewed the literature in order to detect similar cases and the causes of such rare conditions.
Results:
Only 26 cases (including our patient) of acute appendicitis complicated by retroperitoneal abscesses have been published in the English literature between 1955 and 2008. There was one case having hepatic portal venous gas, and one further case with a rectal perforation associated with acute appendicitis. All patients with retroperitoneal abscess presented with non specific clinic symptoms that not revealed any suspicion for such a complicated disease. Hence, delayed diagnosis and treatment are not uncommon.
Conclusions:
So far, no patient has been described with such a triad of rare complications related to acute appendicitis. We want to emphasize the insidious onset of retroperitoneal abscess formation, and the need of prompt recognition and adequate treatment to avoid deleterious outcome.
A Non-severe Coronavirus Disease 2019 Patient With Persistently High Interleukin-6 Level
Authors: Nurfarah Lydia Hambali, Malehah Mohd Noh, Shahleni Paramasivam, Tock Hing Chua, Firdaus Hayati, Alvin Oliver Payus, Tze Yuan Tee, Khairul Taufiq Rosli, Mohammad Faruq Abd Rachman Isnadi, Benny O Manin
Journal: Front Public Health (2020)
Keywords: covid-19, hbv infection, hcc, il-6, cytokine release syndrome
MeSH terms: COVID-19, Interleukin-6 / blood, Case Reports, Research Support, Non-U.S. Gov't, Humans, Male, Middle Aged, SARS-CoV-2, Severity of Illness Index, Interleukin-6

Interleukin 6 (IL-6) is one of the markers of immune system activation indicating existent infection and inflammation. We present here a case of a 55-year-old male COVID-19 patient with an unusual high level of interleukin 6 (IL-6). Further investigation revealed he had hepatocellular carcinoma (HCC) with underlying hepatitis B. He did not present with respiratory symptoms although a baseline chest x-ray showed changes, and the patient was categorized as Class 3A of COVID-19. Routine investigations proceeded with high-resolution computed tomography and IL-6 to monitor for progression to severe COVID-19. Notably, there was a high IL-6 level but other parameters did not show he was in severe COVID-19. In this report, we conclude that elevated IL-6 level in a COVID-19 patient is not necessarily associated with severe COVID-19.
An Unusual Presentation of Limited Granulomatosis with Polyangiitis Involving Vagina and Urethra
Authors: Sandra Soro Marín, Enrique Júdez Navarro, Manuela Sianes Fernández, Ginés Sánchez Nievas, Juan Gabriel Lorenzo Romero
Journal: Case Rep Rheumatol (2017)
MeSH terms: Case Reports

Granulomatosis with polyangiitis (GPA) is a systemic necrotizing granulomatosis vasculitis characterized by predilection to affect small- and medium-sized blood vessels and commonly affects the upper and lower respiratory tract and kidneys in most cases. Genital involvement is reported in <1% of cases in large cohorts and nearly all cases have been in the setting of multisystemic disease or during the course of the disease in patients already diagnosed as GPA. A case is presented of uncommon limited urogenital GPA in a 66-year-old woman with an irregular mass occupying urethra and vagina. The patient showed a good response after Corticoids and Methotrexate.
A case of small bowel obstruction caused by bezoars diagnosed with double balloon enteroscopy
Authors: Masayuki Saita, Hiroshi Maekawa, Koichi Sato, Hajime Orita, Mutsumi Sakurada, Tomoaki Ito, Kunihiro Sinjoh, Yoshihiro Komatsu, Shigeo Nohara
Journal: Case Rep Gastrointest Med (2012)
MeSH terms: Case Reports

Primary small bowel bezoars are rare and cause acute abdomen due to small bowel obstruction (SBO). A 69-year-old Japanese man presented with epigastric pain associated with fullness. Physical examination of the abdomen showed no marked signs of peritoneal irritation. An erect X-ray film of the abdomen showed small bowel obstruction. Computed tomography (CT) showed a dilated small bowel loop proximal to the site of the obstruction. Retrograde double balloon enteroscopy (DBE) was performed and showed yellow, hard bezoars blocking the distal ileum. At surgery, a bezoar was found impacted in the distal ileum, and enterotomy with extraction was performed. After 9 days, the patient was discharged from our hospital in satisfactory condition. DBE also appears to be a safe and useful diagnostic tool in patients with SBO, and the findings of DBE influence the strategy of therapy in patients in whom the cause of SBO could not be determined by conventional radiography.