OpenMed/multicare-articles huggingface dataset:
A Rare Case of Adrenocortical Carcinoma Manifesting as a Pulmonary Embolism
Authors: Madeline Vithya Barnaba Durairaj, Kasey Shallenburg, Neeraj Ashri, Punam Rajput
Journal: Cureus (2024)
Keywords: adrenocortical carcinoma (acc), cushing's syndrome, hirsutism, pulmonary embolism (pe), virilization
MeSH terms: Case Reports

Adrenocortical carcinoma (ACC) is a very rare malignancy with a poor prognosis. It is predominantly noted in the fourth to fifth decades of life and is more common in White females. ACC is most commonly detected as an incidental finding but may have other presentations, such as rapid-onset Cushing's syndrome or pulmonary embolism. In the current case, ACC was incidentally observed in a 24-year-old female during imaging, and the patient later developed a pulmonary embolism. Lab investigations were suggestive of hypercortisolism along with hyperandrogenism. Following preoperative treatment with beta-blockers, metyrapone, and therapeutic anticoagulation, she underwent left radical nephrectomy with left open adrenalectomy and inferior vena cava (IVC) resection and reconstruction. Surgery was uncomplicated, and she was discharged with plans for outpatient adjuvant chemotherapy. This case highlights the fact that a seemingly unprovoked pulmonary embolism may point to the possibility of an underlying occult malignancy and undetected ACC should be included in the differential diagnosis of such cases.
Ovarian cancer with intestinal wall invasion and hyperamylasemia: a case report
Authors: Yu Jie, Juan Li, Chang-Feng Man, Yu Fan
Journal: Front Oncol (2024)
Keywords: case reports, diagnosis, hyperamylasemia, neoplasm metastasis, ovarian cancer
MeSH terms: Case Reports

Numerous studies have suggested a robust association between amylase and ovarian cancer. however, few amylase-producing ovarian cancers have been reported because amylase is a rare product of ovarian cancer. A case of an elderly female patient with an upper abdominal unfitness, intestinal wall along with uterine adnexal invasion, and high serum and urinary amylase is summarized in this article. The patient was initially suspected of having a gastrointestinal tumor. Initial laboratory findings showed markedly significantly raised serum and urinary amylase levels. Imaging showed invasion of the intestinal wall and uterine adnexa, and histology of the specimen taken through the abdominal wall lump and electron colonoscopy showed ovarian cancer. The patient's blood amylase levels decreased to normal after 4 cycles of neoadjuvant chemotherapy with paclitaxel and carboplatin. Following this, she underwent interval debulking surgery, which included total hysterectomy, bilateral adnexectomy, great omentectomy, appendectomy, resection of pelvic and abdominal lesions, and partial rectal resection. Postoperative pathology and immunohistochemistry staining confirmed a diagnosis of high-grade serous ovarian cancer. This case suggests that in female patients, hyperamylasemia may indicate the presence of ovarian cancer. It is necessary to perform a multisite, multipoint histologic examination to identify the tumor's origin in patients with multiple sites of invasion.
Phonological remediation effects on a child with giftedness and developmental dyslexia
Authors: Alba Miranda Beserra Gurgel Sena, Bárbara Louise Costa Messias, Roberta Louise Mariano Bezerra, Anna Irenne de Lima Azevedo, Hellen França Alcantara, Cíntia Alves Salgado Azoni
Journal: Codas (2024)
MeSH terms: Child, Gifted, Dyslexia / rehabilitation, Phonetics, Reading, Case Reports, Child, Humans, Male, Writing

Twice-exceptionality is characterized as the presence of high performance concomitantly with deficiencies or incompatible conditions. An example is when giftedness manifest associated with neurodevelopmental disorders. This study is a clinical case report referring to the evaluative and interventional process of a 9- year-old child with the paradoxical combination of giftedness associated with dyslexia. It aims to compare the performance in phonological processing, reading and writing before and after phonological remediation. In the first assessment, the child demonstrated alphabetic level in reading, a transition phase between syllabic-alphabetic and alphabetical writing levels, and below-expected performance in phonological processing skills. After intervention, the results showed consistent improvements in phonological processing, the consolidation of alphabetical writing and orthographic reading level. In general, children with isolated dyslexia have persistent difficulties in several skills after intervention. The evolution shown after phonological remediation, especially at reading level, shows different characteristics than expected. Thus, it can be concluded that twice-exceptionality may have favored the overcoming of some of the shown difficulties more successfully. Studies on these combined conditions can contribute to a better understanding of this framework during the development of learning and to formulate specialized interventions.
Drumming performance and underlying muscle activities in a professional rock drummer with lower-limb dystonia: a case study
Authors: Kazuaki Honda, Shizuka Sata, Mizuki Komine, Satoshi Yamaguchi, SungHyek Kim, Makio Kashino, Shinya Fujii
Journal: Front Neurol (2024)
Keywords: drummer, electromyography, movement disorder, synchronization error, task-specific focal dystonia

Task-specific focal dystonia (TSFD), characterized by the loss of fine motor control and coordination, affects drummers' lower-limb movements. This study explores lower-limb dystonia's impact on drumming performance and underlying muscle activity in a professional rock drummer. The drummer executed an eight-beat pattern on a drum kit. The participant reported the occurrence of symptoms when he felt the abnormality such as the loss of control related to involuntary aspects of movement. We measured the peak amplitude of the bass drumhead vibration, synchronization errors as the time elapsed between the metronome onset and the bass drum onset, and amplitude of electromyographic (EMG) recordings centered on metronome beat. Dystonia symptoms primarily manifested in the initial beat, with fewer symptoms on syncopation of the third beat. Analysis revealed decreased bass-drum peak amplitude and earlier synchronization error during the initial beat. EMG measurements of 10 muscles in the affected right lower limb showed significant changes in the Biceps Femoris (BF), Tibialis Anterior (TA), Extensor Digitorum Longus (EDL), and Extensor Digitorum Brevis (EDB) muscles during symptom onset. We observed (1) earlier overactivation of the TA and EDL muscles during the leg lift-up motion or preparatory phase of pedaling, (2) reduced activation of the EDB muscle, and (3) increased activation of the BF muscle during the final pedaling movement when symptoms occurred. These findings suggest that lower-limb dystonia symptoms are characterized by a reduction in amplitude of the bass drumhead vibration and an increase in synchronization error, potentially due to premature overactivation of the ankle dorsiflexor muscles.
Early post-surgical rehabilitation and functional outcomes of a traumatic ulnar nerve injury: a pediatric case report
Authors: Federica Fulceri, Chiara Marinelli, Giulia Ghelarducci, Anna Maria Nucci, Andrea Poggetti, Larisa Ryskalin, Marco Gesi
Journal: Front Neurol (2024)
Keywords: functional rehabilitation, nerve repair, peripheral nerve injury, termino-terminal (end-to-end) neurorrhaphy, ulnar nerve injury, ulnar nerve rehabilitation
MeSH terms: Case Reports

Background:
Peripheral nerve injuries (PNIs) of the upper limb are very common events within the pediatric population, especially following soft tissue trauma and bone fractures. Symptoms of brachial plexus nerve injuries can differ considerably depending on the site and severity of injury. Compared to median and radial nerves, the ulnar nerve (UN) is the most frequently and severely injured nerve of the upper extremity. Indeed, due to its peculiar anatomical path, the UN is known to be particularly vulnerable to traumatic injuries, which result in pain and substantial motor and sensory disabilities of the forearm and hand. Therefore, timely and appropriate postoperative management of UN lesions is crucial to avoid permanent sensorymotor deficits and claw hand deformities leading to lifelong impairments. Nevertheless, the literature regarding the rehabilitation following PNIs is limited and lacks clear evidence regarding a solid treatment algorithm for the management of UN lesions that ensures full functional recovery.
Case presentation:
The patient is a 11-year-old child who experienced left-hand pain, stiffness, and disability secondary to a domestic accident. The traumatic UN lesion occurred about 8 cm proximal to Guyon's canal and it was surgically treated with termino-terminal (end-to-end) neurorrhaphy. One month after surgery, the patient underwent multimodal rehabilitative protocol and both subjective and functional measurements were recorded at baseline (T0) and at 3- (T1) and 5-month (T2) follow-up. At the end of the rehabilitation protocol, the patient achieved substantial reduction in pain and improvement in quality of life. Of considerable interest, the patient regained a complete functional recovery with satisfactory handgrip and pinch functions in addition with a decrease of disability in activities of daily living.
Conclusion:
A timely and intensive rehabilitative intervention done by qualified hand therapist with previous training in the rehabilitation of upper limb neuromuscular disorders is pivotal to achieve a stable and optimal functional recovery of the hand, while preventing the onset of deformities, in patients with peripheral nerve injuries of the upper limb.
Case Report: A Pathological Odyssey in Primary Cutaneous Apocrine Carcinoma
Authors: Dr Suhit Naseri, Samarth Shukla, Dr Sourya Acharya, Sunita Vagha
Journal: F1000Res (2023)
Keywords: apocrine carcinoma, axillary mass, apocrine neoplasms, lymph node excision, malignant, rare presentation, solid lesion, surgical excision
MeSH terms: Apocrine Glands / pathology, Sweat Gland Neoplasms / pathology, Sweat Gland Neoplasms / surgery, Case Reports, Carcinoma / pathology, Carcinoma / surgery, Diagnosis, Differential, Humans, Male, Middle Aged, Skin Neoplasms / diagnosis, Skin Neoplasms / pathology, Skin Neoplasms / surgery

Apocrine carcinoma is an extremely rare malignant cutaneous neoplasm that usually arises in areas with a high density of apocrine glands. Diagnosis can be challenging as tumours share histological and immunophenotypic characteristics with them. At first evaluation, the disease is often assumed to be benign. There have been approximately 100 reports of apocrine neoplasms in the literature. A 48-year-old male presented with a right axillary mass which increased in size over a period of 2 years. The patient was reported to have had ayurvedic therapy, but his swelling remained unchanged. Axillary lymph nodes were palpable. USG axilla suggested a well-defined fungating solid isoechoic lesion. USG neck did not reveal any abnormality. The mass was surgically excised as a whole by removing the overlying skin with margins and lymph node excision. The patient was diagnosed with primary apocrine carcinoma after surgical excision. The differentials include adenocarcinoma of breast and prostate and apocrine adenoma. There are no established standards for the care of this form of carcinoma due to its rarity and the absence of clinical studies. A literature evaluation and further reporting will aid in developing diagnostic standards and the most efficient treatment options.
How word meaning structure relates to executive functioning and theory of mind in children with developmental language disorder: A multiple case study
Authors: Thomas F Camminga, Daan Hermans, Eliane Segers, Constance T W M Vissers
Journal: Autism Dev Lang Impair (2024)
Keywords: developmental language disorder, behavioral problems, executive functioning, theory of mind, word meaning structure

Background and aims:
Many children with developmental language disorder (DLD) have difficulties in executive functioning (EF) and theory of mind (ToM). These difficulties might be explained by the theory that children's conceptual understanding changes over five stages of word meaning structure, from concrete and context-dependent to abstract and precise. We present a multiple case study examining how word meaning structure relates to EF and ToM in children with DLD.
Methods:
Participants were five children with DLD aged 9-12 and five typically developing children matched for age, gender, and nonverbal intelligence. Word meaning structure was assessed using new dynamic test. EF was assessed using the Zoo Map Task and Behavioral Rating Inventory for EF. ToM was assessed using the ToM test, Frith-Happé Animations, and Bermond-Vorst Alexithymia Questionnaire. Behavioral problems were measured using the Child Behavior Checklist. Anamnestic interviews with the parents were conducted to describe the case histories.
Results:
For the children with DLD, lower scores in the word meaning structure task were observed compared to those observed for their matched peers, with no statistical test applied. Word meaning structure related positively to EF and ToM, but not to behavioral problems. Instances in which word meaning structure dissociates from EF and ToM are discussed in individual case descriptions.
Conclusions:
By linking language to conceptual development, variations in word meaning structure may explain some EF and ToM difficulties in children with DLD.
Implications:
The present study offers a basis for future research on the relationships among word meaning structure, EF, and ToM.
Delayed bilateral spontaneous renal rupture after surgery for unilateral upper ureteral calculi: a case report
Authors: Wen Tang, Denghao Yang, Tao Wu, Guobiao Liang
Journal: Front Med (Lausanne) (2023)
Keywords: bilateral, case report, delayed, infection, spontaneous renal rupture, ureteral calculi postoperative
MeSH terms: Case Reports

Spontaneous renal rupture is a rare clinical condition characterized by spontaneous bleeding in the renal subcapsular and perinephric spaces in patients without a history of trauma. It occurs mainly in pathologic kidneys and after some renal surgeries. We report a 40-year-old male patient admitted with a diagnosis of gallstones with cholecystitis due to fever and abdominal pain after unilateral ureteral calculi. The patient developed delayed right renal rupture hemorrhage during treatment, controlled after selective arterial embolization (SAE). Still, the patient developed spontaneous left renal rupture due to a systemic inflammatory response. Finally, the patient's life was saved after several selective embolizations of the renal artery. We retrospectively analyzed this case to improve our understanding of the disease.
Pleural cryptococcosis diagnosed by pleural biopsy in an immunocompromised patient: a case report
Authors: Hongxia Jia, Hongping Liu, Meng Tu, Yan Wang, Xudong He, Guojun Zhang
Journal: Front Cell Infect Microbiol (2023)
Keywords: immunocompromised, pleural biopsy, pleural cryptococcosis, pleural effusion, thymoma
MeSH terms: Cryptococcosis / microbiology, Pleural Effusion, Case Reports, Research Support, Non-U.S. Gov't, Biopsy / adverse effects, Humans, Immunocompromised Host, Pleura

Objective:
The aim of this study is to report an isolated pleural cryptococcosis with pleural effusion as the only manifestation, confirmed by pleural biopsy in a patient with thymoma combined with myasthenia gravis, who developed pleural effusion of unknown origin after long-term glucocorticoids and tacrolimus therapy.
Methods:
Pathological examination of the right pleural biopsy tissue from a patient with unexplained recurrent pleural effusion was implemented. Morphological analysis of the fungal component and metagenomic next-generation sequencing (mNGS) on the pleural tissue were performed.
Results:
A biopsy specimen of the right pleura revealed numerous yeast-like organisms surrounded by mucous capsules and Cryptococcus neoformans was detected by mNGS with a species-specific read number (SSRN) of 4, confirming the diagnosis of pleural cryptococcosis. Pleural effusion was eliminated with amphotericin B and fluconazole, and healthy status was maintained at the time of review 1 year later.
Conclusion:
Cryptococcosis, manifested by simple pleural effusion, is extremely rare, but when repeated pleural effusion occurs in immunocompromised patients or in patients with malignant tumors, the possibility of cryptococcosis should be treated with high vigilance and pleural biopsy is recommended if necessary in order to confirm the diagnosis.
A Rare Clinical Case of Oral White Sponge Nevus and the Associated Challenges in Its Differential Diagnosis
Authors: E Deliverska, Marusya Genadieva, B Yordanov, J Kirilova
Journal: Case Rep Dent (2024)
MeSH terms: Case Reports

White sponge nevus is a rare genetic autosomal dominant disorder characterized by irregular patches of thick, white diffuse plaques, which mainly affects the oral mucosa and, very rarely, the skin or mucosa of the nose, esophagus, and anogenital region. We present a case of oral white sponge nevus in a 62-year-old woman, the differential diagnosis of which was of particular interest due to other similar white oral lesions, some of which are potentially malignant. The lesions were verified histologically. However, no treatment was performed due to the benign and asymptomatic nature of the lesions.
Twin pregnancy with one normal fetus and one complete hydatidiform mole: Outcome of expectant management
Authors: Samia Shuja, Sadia Rauf
Journal: Pak J Med Sci (2024)
Keywords: complete mole, gestational trophoblastic neoplasia, live birth, normal fetus, twin pregnancy
MeSH terms: Case Reports

Twin pregnancy with one fetus and one complete mole falls amongst extremely rare obstetric situations. The spectrum of complications associated with it is wide. Once diagnosed, the choice between continuation and termination of pregnancy depends upon couple's preference and readiness to accept possible complications. Key to success lies in clinical vigilance and tailoring management according to emerging needs during pregnancy and follow up. We present a case of twin pregnancy with complete hydatidiform mole and coexisting normal fetus diagnosed at 25 weeks. Pregnancy was complicated by anemia, gestational diabetes mellitus, recurrent vaginal bleeding, intrauterine growth restriction and iatrogenic preterm delivery. She was followed for development of GTN, none occurred.
A Case Report and Literature Review of Gastric Stump Carcinoma: An Uncommon Entity Following the Billroth II Procedure
Authors: Nida Ansari, Mark Munairji, Gabriel Melki, Walid Baddoura
Journal: Cureus (2024)
Keywords: anastomose, bile acid, billroth 2, gastric tumor, gastro-jejunostomy
MeSH terms: Case Reports

Gastric stump carcinoma is a rare phenomenon and could occur in individuals after a distal gastric resection. Regardless of the surgical approach, it can lead to certain complications. However, the Billroth II gastrojejunostomy procedure has been noted to have some specifically interesting complications due to the anatomical changes it triggers. These changes, such as bacterial overgrowth and enterogastric reflux, can cause metaplasia. We discuss a case of an 81-year-old male with a history of peptic ulcer disease (PUD) status post-Billroth II gastrojejunostomy 30 years prior who presented with a four-day history of bright red blood per rectum. On esophagogastroduodenoscopy (EGD), he was found to have friable, ulcerated mucosa at the anastomosis site. Biopsy results revealed CDX2-positive cells, indicating gastric adenocarcinoma. Although it is well-known that the anatomical changes of gastrojejunostomy will undoubtedly change the microbiome of the stomach, physicians should also be mindful of the more feared complications such as gastric stump carcinoma.
Progression of fertility-sparing treatment for atypical endometrial hyperplasia in a woman with lynch syndrome: a case report and review of the literature
Authors: Ya-Ting Hsu, Chi-Hau Chen
Journal: Front Oncol (2024)
Keywords: atypical endometrial hyperplasia, endometrial cancer, fertility-sparing treatment, lynch syndrome, oncology outcome
MeSH terms: Case Reports

Endometrial cancer in Lynch syndrome is characterized by a higher incidence, younger age at onset, and increased recurrence rates compared to sporadic cases, while the safety and efficacy of fertility-sparing treatments remain uncertain. This case report presents the oncology outcome of fertility-preserving treatment in a 39-year-old woman diagnosed with Lynch syndrome and atypical endometrial hyperplasia. Initially, she responded favorably to fertility-preserving treatment but subsequently experienced disease relapse and rapid progression during retreatment. Final pathology revealed endometrial cancer with metastasis to the right ovary, categorized as FIGO 2023 stage IIIA1. This population's unique molecular mechanisms and genetic mutations warrant special consideration when opting for fertility-sparing treatment. We have reviewed and summarized the oncology and pregnancy outcomes among Lynch syndrome and MMR-deficient patients through previous literature. However, no studies have investigated retreatment after recurrence in Lynch syndrome. Our case highlights the potential risks associated with retreatment following relapse. Vigilant monitoring and prompt consideration of surgical intervention are recommended upon disease relapse.
Isolated Unilateral Testicular Tuberculosis in a Young, Immunocompetent Patient: A Case Report
Authors: Jayanthi Gunasekaran, Rahul Ranjan, Ina Joshi, Priya Karlapudi, Rajiv M Gupta
Journal: Cureus (2024)
Keywords: cbnaat (cartridge based nucleic acid amplification), extrapulmonary tuberculosis, genitourinary tuberculosis (gutb), lj (lowenstein jensen) culture, lpa (line probe assay), paucibacillary, rifampicin, testicular tuberculosis, tuberculosis, ziehl-neelsen stain
MeSH terms: Case Reports

Testicular or epididymal tuberculosis is a rare form of extrapulmonary tuberculosis. Extrapulmonary tuberculosis of any form is very difficult to diagnose by microscopy because it is usually paucibacillary. Therefore, molecular methods play a major role in the diagnosis of extrapulmonary tuberculosis. We present a rare case of unilateral testicular tuberculosis in a 23-year-old immunocompetent patient with no history of contact with a known tuberculosis case. He presented to us with swelling on his testis for one month and a discharging sinus in the left testis for 15 days, along with an intermittent fever for a week. A pus swab from the discharging sinus of the testis was sent to microbiology, where a cartridge-based nucleic acid amplification test (CBNAAT) was done, which detected Mycobacterium tuberculosis complex (MTBC), but resistance to rifampicin was not detected. A line probe assay was also done on the sample for first-line drugs, and no resistance was detected for rifampicin or isoniazid. The patient was started on first-line drugs in the intensive phase, and after the completion of two months of treatment, the patient's discharge stopped and he showed clinical improvement. Being a young patient, if he had not been diagnosed and treated as early as possible, it could have led to infertility. This again emphasizes the importance of molecular methods for the diagnosis of extrapulmonary tuberculosis.