OpenMed/multicare-articles huggingface dataset:
Case Report: Adolescent With Autism and Gender Dysphoria
Authors: Sanja Zupanič, Ivona Kruljac, Mojca Šoštarič Zvonar, Maja Drobnič Radobuljac
Journal: Front Psychiatry (2021)
Keywords: anxiety, autism spectrum disorder, case report, child and adolescent, depression, gender dysphoria, transgender (lgbt)
MeSH terms: Case Reports

There is increasing clinical evidence of an association between gender variability, gender dysphoria (GD), and autism spectrum disorder (ASD). This seems to be a two-way relationship, a person with GD is more likely to be diagnosed with ASD and vice versa. In youth, it is important to distinguish whether the presented symptoms are a manifestation of ASD focus on special interests or symptoms of co-occurring GD. This distinction is crucial in the process of planning reversible and especially irreversible medical procedures in the context of treatment. We present the case of a birth-assigned female adolescent with GD, who enrolled in our clinic at the age of 16.5 years with "being transgender" as her main complaint accompanied by a wish for surgical breast removal. His (as the patient prefers to use male pronouns) medical and developmental history involved obesity, hyperlipidemia, delays in social and language development and specific interests and rituals. He presented with half a year of untreated depression, suicidal thoughts and non-suicidal self-injuring, social phobia and relative social isolation. Comprehensive clinical assessments revealed a female karyotype (46, XX), normal female genitalia and unremarkable hormonal status. Clinical psychological assessments reported GD, ASD with average intellectual abilities and co-occurring symptoms of depression and anxiety. Other disorders, such as psychosis, personality disorder and dysmorphophobia, were excluded during longer-term diagnostic and psychotherapeutic processes. Our first aim was to build a good therapeutic alliance with the patient and treat depression and suicidality. He refused to take sertraline, but took a St. John's Wort over-the-counter peroral preparation in the form of infusions. His mood improved, he was no longer suicidal and started social transitioning, yet he remained socially phobic. At the time of writing, he is 20 years old, waiting for bilateral mastectomy and receiving regular triptorelin depot and testosterone depot intramuscular injections. Even though the diagnostic procedures and transition process in autistic gender diverse adolescents may take longer than in non-autistic individuals, ASD is not a contraindication to the gender transition process. We present a well-documented case of a slow social and medical transition resulting in gradual improvement of co-occurring symptoms of GD.
Pseudo cardiac tamponade in the setting of excess pericardial fat
Authors: Thang Nguyen, Kanwal Kumar, Andrew Francis, Jonathan R Walker, Michael Raabe, Shelley Zieroth, Davinder S Jassal
Journal: Cardiovasc Ultrasound (2009)
MeSH terms: Adipose Tissue / diagnostic imaging, Cardiac Tamponade / diagnostic imaging, Diagnostic Errors, Echocardiography, Pericardium / diagnostic imaging, Case Reports, Adipose Tissue / surgery, Aged, Coronary Artery Bypass, Coronary Artery Disease / diagnostic imaging, Coronary Artery Disease / surgery, Female, Humans, Pericardium / surgery

Cardiac tamponade is the phenomenon of hemodynamic compromise caused by a pericardial effusion. Following a myocardial infarction, the most common causes of pericardial fluid include early pericarditis, Dressler's syndrome, and hemopericardium secondary to a free wall rupture. On transthoracic echocardiography, pericardial fluid appears as an echo-free space in between the visceral and parietal layers of the pericardium. Pericardial fat has a similar appearance on echocardiography and it may be difficult to discern the two entities. We present a case of a post-MI patient demonstrating pseudo tamponade physiology in the setting of excessive pericardial fat.
Case Report: The Complete Remission of a Mixed Germ Cell Tumor With Somatic Type Malignancy of Sarcoma Type With a GCT-Oriented Therapy: Clinical Findings and Genomic Profiling
Authors: Maria A Pantaleo, Marcella Mandruzzato, Valentina Indio, Milena Urbini, Margherita Nannini, Lidia Gatto, Angela Schipani, Michelangelo Fiorentino, Tania Franceschini, Valentina Ambrosini, Valerio Di Scioscio, Maristella Saponara, Manuela Ianni, Sergio Concetti, Annalisa Altimari, Andrea Ardizzoni, Annalisa Astolfi
Journal: Front Oncol (2021)
Keywords: peb, rna-sequencing, exome sequencing, germ cell tumor, sarcoma, teratoma with malignant transformation
MeSH terms: Case Reports

Somatic malignant transformation in a germ cell tumor (GCT) is the development of non-germ malignancies; much of available literature refers to teratoma with malignant transformation (TMT). There are various transformation histologies such as sarcoma, adenocarcinoma, primitive neuroectodermal tumors, and more rarely carcinoid tumors, hemangioendothelioma, lymphoma, or nephroblastoma. The treatments of these entities include surgery and/or chemotherapy. A standard approach in choosing chemotherapy in TMT cases has not yet been established. Many authors suggest using chemotherapeutic agents based on the transformed histology, while others recommend GCT-oriented therapy combined with surgery as the primary treatment, reserving histology-driven chemotherapies for metastatic relapse. We report the clinical findings and the genomic profile of a mixed GCT case with somatic-type malignancy of sarcoma type. We achieved a complete radiological response with GCT-oriented chemotherapy performed as salvage therapy after sarcoma-histology therapy. In addition, molecular profiles with RNA-sequencing and exome sequencing analyses of the primary tumor and the tumor with somatic-type malignancy of sarcoma type were explored.
A 36 kg Giant Ovarian Fibroma with Meigs Syndrome: A Case Report and Literature Review of Extremely Giant Ovarian Tumor
Authors: Miyu Tanaka, Koji Yamanoi, Sachiko Kitamura, Naoki Horikawa, Yoshitsugu Chigusa, Akihito Horie, Ken Yamaguchi, Junzo Hamanishi, Eiji Kondoh, Masaki Mandai
Journal: Case Rep Obstet Gynecol (2021)
MeSH terms: Case Reports

Ovarian tumors can get extremely giant to occupy the whole abdominal cavity. We report a case of 36 kg solid ovarian tumor, which was the largest ovarian solid tumor that have been ever reported. A 54-year-old woman presented to our hospital with a chief complaint of markedly distended abdominal wall. Preoperative imaging examinations revealed that most of the tumor was uniform and its density was like that of subcutaneous fat. Pleural effusion was detected in the right thoracic region. We organized a multidisciplinary team and successfully resected the right adnexa. The patient had an uneventful postoperative course, and she was discharged on the 7th postoperative day and diagnosed with a fibroma of the ovary with Meigs syndrome. A comprehensive literature search revealed 48 cases of extremely giant ovarian tumor in these 20 years. Six out of 48 cases are solid. Twelve out of 48 cases are malignant or borderline malignant, and patients' age and tumor size/weight were not related to the frequency of malignancy/borderline malignancy. As many as 4 out of 48 patients died before their first hospital visit or early after surgery. Clinicians should consider a considerable high mortality and frequency of severe surgical complications when planning the treatment strategy for extremely giant ovarian tumors.
Combined Ipsilateral Humeral Shaft and Galeazzi Fractures Creating a Floating Elbow Variant
Authors: Patrick Lee, Allison Z Piatek, Michael J DeRogatis, Paul S Issack
Journal: Case Rep Orthop (2018)
MeSH terms: Case Reports

"Floating elbow" injuries of the arm traditionally represent a combination of humeral shaft and forearm fractures which require anatomic rigid open reduction and internal fixation of all fractures to allow for early range of motion exercises of the elbow. There are published variants of the floating elbow injury which include ipsilateral diaphyseal humeral fracture, proximal ulna fracture with proximal radioulnar joint disruption, and ipsilateral diaphyseal humeral fracture with elbow dislocation and both bones forearm fracture. We present the case of a 21-year-old woman whose left arm became caught between the side of a waterslide and adjacent rocks at a park. She sustained a torsional and axial loading injury to her left upper extremity resulting in ipsilateral humeral shaft and Galeazzi fractures. The combination of ipsilateral humeral shaft and Galeazzi fractures resulted in a rare floating elbow variant. Prompt open reduction and internal fixation of both fractures and early range of motion of the elbow and wrist resulted in an excellent clinical and radiographic result. Floating elbow injuries and their variants should be promptly recognized as early anatomic reduction, and rigid internal fixation can allow for good elbow function with minimization of stiffness.
Thalidomide-induced serious RR interval prolongation (longest interval >5.0 s) in multiple myeloma patient with rectal cancer: A case report
Authors: Li Huang, Yuemin Kuang, Zhiyong Jiang, Yan Zhu, Xinguo Luo, Fangjing Shi, Shanshan Hu, Xinfang Gao
Journal: Open Med (Wars) (2020)
Keywords: rr interval prolongation, multiple myeloma, rectal cancer
MeSH terms: Case Reports

Primary secondary tumor increased recently with the use of immunomodulatory drugs in patients with multiple myeloma (MM). However, MM with prior diagnosis of primary secondary tumor is relatively rare. In this study, we reported an MM patient with prior diagnosis of rectal cancer. In brief, an 85-year-old man was first diagnosed with rectal cancer. Given the age, heart failure and small-cell hypochromic anemia (hemoglobin level: 54 g/L), rectal cancer resection was not advised and symptomatic treatments were performed (including sufficient iron supplementation). Eight months later, the patient was diagnosed with MM due to worsening anemia. Anemia and heart failure were corrected after three cycles of treatment with thalidomide, dexamethasone and capecitabine. Radical resection of rectal carcinoma (Hartmann) was finally performed due to acute abdominal distension. Meanwhile, RR interval prolongation (longest interval >5.0 s) and atrial fibrillation occurred in the fifth cycle treatment. One month after discontinuation of thalidomide, RR interval returned to normal range, while atrial fibrillation developed into persistent atrial fibrillation.
Platypnea-orthodeoxia: an unusual case of hypoxemia
Authors: Jennifer Slim, Jennifer McNear, Rachel Beck, Robert Saad, Jorge Alvarez, Ahmad Slim
Journal: Case Rep Cardiol (2011)
MeSH terms: Case Reports

A 52 year old female presented for two weeks of acute onset dyspnea on exertion. She was found to be hypoxic with a room air saturation of 88%. Baseline echocardiogram was normal with the exception of aortic root dilation. Right and left heart catheterizations were performed. The coronary arteries were normal in original and without disease. The right heart catheterization demonstrated normal pulmonary pressures and "no evidence of intra-cardiac shunt". Repeat echocardiogram was performed with agitated saline contrast and revealed a small amount of right to left shunting across the intra-atrial septum with cough while supine and significant right to left shunting while upright; these findings were consistent with the presence of a patent foramen ovale (PFO) and platypnea-orthodeoxia syndrome. The patient underwent percutaneous closure of her PFO with an Amplatzer device, and exhibited rapid resolution of her symptoms and hypoxia. She is off oxygen and has returned to work as a nurse practitioner. The case highlights the importance of clinical vigilance and consideration of this syndrome in the differential diagnosis of unexplained hypoxia. Our patient had a dramatic and positive outcome: complete alleviation of dyspnea and oxygen dependence after PFO closure.
Childhood cryptosporidiosis: a case report
Authors: P Agnamey, D Djeddi, A Diallo, A Vanrenterghem, N Brahimi, C da Costa, A Totet
Journal: J Parasitol Res (2010)
MeSH terms: Case Reports

Cryptosporidium has emerged as an important cause of diarrheal illness worldwide, especially amongst young children and patients with infectious or iatrogenic immune deficiencies. The authors describe a case of mild cryptosporidiosis in a well-nourished, immunocompetent, one-year-old child. Rapid clinical and parasitological improvement was observed after a 3-day course of nitazoxanide.
Lithopedion in a Geriatric Patient
Authors: Andrés Ricaurte Sossa, Henry Bolaños, Andrés Ricaurte Fajardo, Ángela Camila Burgos, Valentina Garcia, Paola Muñoz, Diego Rosselli
Journal: Rev Bras Ginecol Obstet (2019)
MeSH terms: Calcinosis / diagnostic imaging, Fetus / diagnostic imaging, Case Reports, Aged, Female, Humans, Incidental Findings

Lithopedion (lithos = rock and paidion = child) is a rare condition that only occurs in 1.5 to 1.8% of extrauterine pregnancies and in 0.00045% of all pregnancies. It consists of an ectopic pregnancy in which the fetus dies but cannot be reabsorbed by the mother's body, which then coats it in a calcium-rich substance. We present the case of a 77-year-old woman with an incidental diagnosis of a lithopedion, which had been retained in her left pelvis for presumably 40 years.
Extramedullary hemopoiesis with undiagnosed, early myelofibrosis causing spastic compressive myelopathy: Case report and review
Authors: Udita Dewan, Niraj Kumari, Awadesh Jaiswal, Sanjay Behari, Manoj Jain
Journal: Indian J Orthop (2010)
Keywords: extramedullary hemopoiesis, myelofibrosis, spastic paraparesis, spine

Extramedullary hemopoiesis (EMH) is a common compensatory phenomenon associated with chronic hemolytic anemia. Abnormal hemopoietic tissue usually develops in sites responsible for fetal hemopoiesis, such as spleen, liver and kidney; however, other regions such as the spine may also become involved. In this study, a patient presenting with spastic paraparesis due to EMH in the dorsal spine is described. A 62-year-old man presented with paraparesis. Magnetic resonance imaging revealed a large lesion involving the T2-L2 vertebral levels with a large extradural component causing thecal sac compression. Laminectomy with excision of mass was carried out. The histopathology revealed EMH. The patient had no known cause for EMH at the time of diagnosis but, subsequently, a bone marrow examination revealed early myelofibrosis. This case represents the rare occurrence of a large extradural extramedullary hematopoiesis in a patient with no known predisposing factor for hemopoiesis at the time of presentation.
Necrotizing Pancreatitis Infected with Stenotrophomonas maltophilia: An Emerging Rare Multidrug-Resistant Organism
Authors: Sophia Dar, Nooraldin Merza, Maryam Haider, Yousaf Zafar, Noren Din, Rosario Ligresti, Rani Sebti
Journal: Case Rep Gastrointest Med (2023)
MeSH terms: Case Reports

Stenotrophomonas maltophilia (SM) is a multidrug-resistant, Gram-negative (GN) bacillus that is an increasingly recognized nosocomial and environment pathogen. It is intrinsically resistant to carbapenems, a drug commonly utilized in the management of necrotizing pancreatitis (NP). We report a 21-year-old immunocompetent female with NP complicated by pancreatic fluid collection (PFC) infected with SM. One-third of patients with NP will develop infections by GN bacteria, while broad-spectrum antibiotics, including carbapenems, cover most infections, trimethoprim-sulfamethoxazole (TMP-SMX) is the first-line treatment antibiotic for SM. This case is critical because it highlights a rare pathogen that should be considered a causal pathogen in patients who do not respond to their care plan.
De Novo CD5+ Primary Gastrointestinal Diffuse Large B-Cell Lymphoma: Challenges With Treatment and Clinical Course
Authors: Preethi Ramachandran, Sonu Sahni, Jen C Wang
Journal: J Investig Med High Impact Case Rep (2019)
Keywords: b-cell lymphoma, cd5+ lymphoma, dlbcl, gastrointestinal lymphoma, small bowel lymphoma
MeSH terms: CD5 Antigens / metabolism, Intestinal Neoplasms / therapy, Lymphoma, Large B-Cell, Diffuse / therapy, Case Reports, Research Support, Non-U.S. Gov't, Antineoplastic Agents / therapeutic use, Colectomy, Fatal Outcome, Humans, Intestinal Neoplasms / diagnosis, Intestinal Neoplasms / pathology, Lymphoma, Large B-Cell, Diffuse / diagnosis, Lymphoma, Large B-Cell, Diffuse / pathology, Male, Middle Aged, Tomography, X-Ray Computed, Antineoplastic Agents, CD5 Antigens

The gastrointestinal tract is a common extranodal site for lymphomas. However, primary gastrointestinal lymphomas are rare. Diffuse large B-cell lymphomas (DLBCL) are the most commonly encountered type in the gastrointestinal tract. Most of the DLBCL are CD5 negative. CD5+ DLBCL is very rare and a poor prognostic subtype of lymphoma. We report a rare case of primary small bowel CD5+ DLBCL that evolved from being a localized low International Prognostic Index-scored disease into an advanced and aggressive disease primarily dictated by the presence of CD5 antigen positivity.
Late-onset of pulmonary embolism following hospitalization for COVID-19 despite thromboprophylaxis: a report of two cases
Authors: Falmata Laouan Brem, Zakariae Missaoui, Mohammed Arghal, Hammam Rasras, Narjisse Aichouni, Imane Skiker, Noha El Ouafi, Bazid Zakaria
Journal: Pan Afr Med J (2021)
Keywords: covid-19, post-discharge, case report, coagulopathy, pulmonary embolism
MeSH terms: Anticoagulants / administration & dosage, COVID-19 / complications, Pulmonary Embolism / virology, Case Reports, Aged, Dose-Response Relationship, Drug, Hospitalization, Humans, Male, Time Factors, Venous Thromboembolism / prevention & control, Anticoagulants

The global pandemic caused by the SARS-CoV-2 has resulted in an increased incidence of venous thromboembolism among hospitalized COVID-19-patients, especially those who required intensive care, despite thromboprophylaxis. This has resulted in the use of higher doses of thromboprophylaxis or therapeutic anticoagulation therapy even in the absence of thrombotic events. However, after their hospital discharge, authors and current guidelines are not unanimous about extended anticoagulant therapy in patients with COVID-19. Here, we report two pulmonary embolism cases following hospitalization for COVID-19, despite intermediate doses of thromboprophylaxis. These rare cases suggest that there may be a residual thrombotic risk following hospitalization for COVID-19 and highlight questions about extended prophylactic-anticoagulation therapy after hospital discharge of patients with COVID-19.
Treatment-Responsive Granulomatous-Lymphocytic Interstitial Lung Disease in a Pediatric Case of Common Variable Immunodeficiency
Authors: Robert Tillman, R Paul Guillerman, Timothy Trojan, Manuel Silva-Carmona, Ivan K Chinn
Journal: Front Pediatr (2019)
Keywords: common variable immunodeficiency, granulomatous-lymphocytic interstitial lung disease, chemotherapeutic agents, pediatrics, treatment
MeSH terms: Case Reports

Granulomatous-Lymphocytic Interstitial Lung disease (GLILD) is a granulomatous and lymphoproliferative condition occurring in ~25% of Common Variable Immunodeficiency (CVID) patients with the highest prevalence in the late teen to young adult years. GLILD was first described in adults and carries a poor prognosis with survival estimated to be reduced by half. Here we report a pediatric case of CVID-associated GLILD that presented with rapid deterioration over 3 months and responded to adult-based treatment with dual chemotherapeutic agents (rituximab and azathioprine), resulting in complete resolution of clinical findings and near complete resolution of radiologic findings. This case highlights the opportunity to achieve a favorable outcome in GLILD following appropriate diagnosis and therapy.
Case Report: Giant insulinoma, a very rare tumor causing hypoglycemia
Authors: Georges Tarris, Alexia Rouland, Kévin Guillen, Romaric Loffroy, Anne-Cécile Lariotte, Patrick Rat, Benjamin Bouillet, Haingo Andrianiaina, Jean-Michel Petit, Laurent Martin
Journal: Front Endocrinol (Lausanne) (2023)
Keywords: giant insulinoma, hypoglycemia, neuroendocrine tumors, pancreas, pathology
MeSH terms: Hypoglycemia / etiology, Insulinoma / complications, Insulinoma / pathology, Insulinoma / surgery, Neuroendocrine Tumors / pathology, Pancreatic Neoplasms / complications, Pancreatic Neoplasms / pathology, Pancreatic Neoplasms / surgery, Case Reports, Humans, Neoplasm Recurrence, Local / complications

Insulinomas, with an incidence of 4 cases per million individuals per year, remain amongst the most frequent functional neuroendocrine tumors. The usual diameter of insulinomas usually remains under 3 cm of major axis. However, 44 exceptional cases of "giant insulinomas", have been reported worldwide, generally exceeding 9 cm in major axis. In this article, we report the case of a 38-year-old woman whom suffered from chronic hypoglycemia despite treatment with diazoxide. Abdominal CT-scan revealed a 88 x 73 mm mass located at the tail of the pancreas. Following surgical excision, histopathological analysis confirmed G1 neuroendocrine tumor, with focal cytoplasmic expression of insulin in tumor cells. After a 16-month follow-up period, the patient didn't address any specific complaint, and no disease recurrence and/or metastasis were observed. A 68Ga-DOTATATE-PET scan was performed 6 months after surgery, which came back normal. Genetic evaluation has not been performed in our patient. The physiopathology of giant insulinomas remain unexplained, however with possible relationship with type 1 multiple endocrine neoplasia, sporadic somatic YY1 mutations and possible transformation of bulky non-functional pancreatic neuroendocrine tumors to a functional phenotype, with slow insulin secretion. While giant insulinomas remain rare in the literature, multicentric genetic analysis of tumor samples might reveal unique features of this rare subtype of neuroendocrine pancreatic tumors. Insulinomas of large size tend to have greater malignancy and higher rates of invasiveness. Careful follow-up, especially for liver and lymph node metastases, must be performed using functional imaging techniques to avoid disease relapse.
Serous Borderline Tumor in Transgender Female-to-Male Individuals: A Case Report of Androgen Receptor-Positive Ovarian Cancer
Authors: Cristina Ferreira, João Fraga, Célia Antunes, Manuela Gonçalo, Paulo Donato
Journal: Case Rep Radiol (2021)
MeSH terms: Case Reports

Ovarian cancer is the most fatal gynecologic malignancy. The incidence of ovarian cancer among female-to-male transsexuals receiving treatment with testosterone is unknown, and few cases have been reported in the literature. We report a recent case in our institution, a 23-year-old female-to-male transsexual patient who received testosterone supplementation. The patient underwent a pelvic magnetic resonance imaging to study an ovarian complex cyst that revealed the presence of a bilateral ovarian tumor with imaging features of borderline serous tumor. These masses were surgically removed and the pathology report confirmed the diagnosis associated with noninvasive peritoneal implants and the presence of numerous androgen receptors in the tumor cells. Although there is still insufficient data to validate a direct correlation between hormonotherapy and ovarian cancer in these patients, this case may reinforce previous reports on this association and highlights the relevance of radiological follow-up and bilateral salpingo-oophorectomy as part of gender reassignment surgery.