OpenMed/multicare-articles huggingface dataset:
Transoral Endoscopic-Assisted Resection of Laryngeal Schwannoma: A Case Report
Authors: Dian Paramita Wulandari, Anisa Haqul Khoiria, Elida Fadhilatul Latifa
Journal: Iran J Otorhinolaryngol (2024)
Keywords: laryngeal schwannoma, surgical management, tracheostomy, transoral approach
MeSH terms: Case Reports

Introduction:
Schwannoma, a peculiar benign nerve sheath tumour, is frequently hard to differentiate from other nerve tumours, such as neurofibroma. Around 25%-45% of all schwannomas emerge in the head and neck region, but only 0.1-1.5 % involve laryngeal structure. This tumour is most accurately diagnosed with biopsy via direct laryngoscopy; however, at some points this approach cannot detect a definitive diagnosis due to the surrounding capsule of the tumour and its similar histopathologic finding with other nerve sheath tumour.
Case report:
Here, a case of 56-year-old female is reported with chief complaints of severe progressive dyspnea and dysphagia. Diagnosis of schwannoma was confirmed on radiological and histopathological examination with certain hurdles. A complete surgical excision via endoscopic approach was done, revealing that the bottom of the mass was attached to the right arytenoid mucosa. The histopathological features showed non-malignant atypical neurofibroma but later confirmed as laryngeal schwannoma from immunohistochemical staining.
Conclusion:
Although schwannoma has an excellent outcome and prognosis when occurring elsewhere in the body, laryngeal involvement is an extremely rare area for this lesion. Complete resection with a patient-customized approach to the lesion is required to avoid relapses and provide good functional results.
Whole-body muscle magnetic resonance imaging in inflammatory myopathy with mitochondrial pathology
Authors: Wagner Cid Palmeira Cavalcante, André Macedo Serafim da Silva, Rodrigo de Holanda Mendonça, Cristiane de Araújo Martins Moreno, Bruna Moreira de Souza Proença, Júlio Brandão Guimarães, Alípio Gomes Ormond Filho, Edmar Zanoteli
Journal: Front Neurol (2024)
Keywords: inclusion body myositis, inflammatory myopathy, magnetic resonance imaging, mitochondria, polymyositis

Introduction:
Inflammatory myopathy with mitochondrial pathology (IM-Mito) is a rare condition described in a few case series, and it is not clear whether it is a specific disease or a variant of Inclusion Body Myositis (IBM). Radiological data of IM-Mito patients has only been evaluated in one study.
Aim:
To analyze whole-body muscle magnetic resonance imaging (MRI) features in patients with IM-Mito compared with individuals with IBM.
Methods:
Fourteen IM-Mito and ten IBM patients were included. IM-Mito was defined by endomysial inflammatory infiltrate, presence of at least 1% of Cytochrome C Oxidase negative fibers, and absence of rimmed vacuoles in muscle biopsy; and IBM was defined by the presence of dystrophic muscular abnormalities, endomysial inflammatory infiltrate, and rimmed vacuoles. Patients underwent clinical evaluation and whole-body muscle MRI to determine the presence of edema, and fatty infiltration in various muscles.
Results:
Muscle imaging abnormalities were asymmetric in most patients with IM-Mito and IBM. Muscles with the highest average degree of fatty infiltration in both conditions were the quadriceps and medial gastrocnemius. Most patients with IM-Mito and IBM showed imaging patterns of rectus femoris relatively spared compared to other quadriceps muscles. The flexor digitorum profundus was the most affected muscle of the upper limbs in both IBM and IM-Mito.
Discussion:
Although the results suggest some similarities in muscle imaging features between IM-Mito and IBM, there remains uncertainty whether these two conditions are part of the same clinical spectrum.
Langerhans cell histiocytosis: unusual bone marrow infiltration-report of 2 cases in Ecuador
Authors: Paulina Santana, Marlon Arias-Intriago, Juan S Izquierdo-Condoy
Journal: Front Med (Lausanne) (2024)
Keywords: ecuador, langerhans cells, latin america, bone marrow, histiocytes
MeSH terms: Case Reports

Langerhans cell histiocytosis (LCH) is a histiocytic neoplasm characterized by the abnormal proliferation of Langerhans cells. Bone marrow (BM) involvement is associated with high-risk disease and poor survival. Although BM involvement is particularly uncommon, no reported cases of LCH with BM infiltration have been documented in Latin America until now. The aim of this report is to highlight the clinical, hematological, and BM findings of two cases of LCH with BM infiltration, providing insights that may aid in detecting suspected patients. We present two cases of LCH with BM infiltration. One case involved a 23-month-old male patient, and the other a 16-month-old female patient. Common clinical findings in both cases included hepatosplenomegaly and fever. Hematological findings revealed anemia in both cases. The key diagnostic tool was the BM biopsy, which revealed histiocyte nests with characteristic morphology, CD1a-positive cells, increased eosinophils, and reactive paratrabecular lymphocytes. This report underscores the significance of clinical profiles in predicting BM infiltration in LCH. The presence of histiocyte nests displaying the characteristic morphology of Langerhans cells, accompanied by an elevation in eosinophils, indicates bone marrow involvement. Furthermore, the demonstration of CD1a-positive cells through immunohistochemistry serves as a crucial diagnostic tool.
Giant Poroid Hidradenoma of the Forearm
Authors: Nadir Miry, Anass Haloui, El Mehdi Tiabi, Nassira Karich, Amal Bennani
Journal: Cureus (2024)
Keywords: hidradenoma, poroid hidradenoma, poroid neoplasm, skin adnexal tumor, sweat gland tumor
MeSH terms: Case Reports

Poroid hidradenoma represents an uncommon and benign tumor originating from skin adnexa. It falls under the category of sweet duct neoplasms, along with poromas. It affects the elderly population most frequently. Typically, it emerges as a small, distinct, and painless lump beneath the skin's surface, often occurring on the head and neck regions. It is characterized by a low risk of malignant transformation. Accurate identification relies especially on histomorphological analysis considering the intricate resemblance it shares with other tumors originating from eccrine glands. Poroid hidradenoma has only recently been recognized, and only a limited number of cases have been reported in the medical literature. In this instance, we present an unusual occurrence of a giant poroid hidradenoma on the left forearm of an elderly patient.
Unusual Finding in a Patient Presenting with Abdominal Pain and Dyspnea
Authors: Wisam Al-Saad, Nasroola Damry, Gerogiana Pintea Bentea
Journal: J Belg Soc Radiol (2024)
Keywords: cardiac angiosarcoma, clinical presentation, diagnostic imaging
MeSH terms: Case Reports

This article discusses the rarity of primary cardiac tumors, particularly angiosarcomas, accounting for 10% of primary cardiac neoplasms. The article highlights the challenge of early diagnosis due to nonspecific symptoms. The importance of sectional imaging, particularly computed tomography (CT) scans, in emergent situations is emphasized. Teaching point: Despite the rarity of primary cardiac tumors, radiologists should remain alert, especially when pericardial effusion is present.
Relapsing TIPIC Syndrome after Administration of an mRNA-Based COVID-19 Vaccine
Authors: Georgiana C Sandu, Gregor Weisser, Stefan Krämer, Matthias Reinhard
Journal: Case Rep Vasc Med (2023)
MeSH terms: Case Reports

Reported vascular complications following mRNA-based COVID-19 vaccines are consisting of myocarditis, cerebral venous thrombosis, cerebral vascular thrombosis, and vaccine-induced thrombocytopenia. Here, we describe a case of a 49-year-old woman with left-sided pain above the middle common carotid artery (carotidynia) starting a few days after her second vaccination with an mRNA-based COVID-19 vaccine (Spikevax). Imaging was indicative of transient perivascular inflammation of the carotid artery (TIPIC) syndrome. The diagnostic workup for other immunologically mediated diseases was negative. The inflammation subsided after a course of prednisone and aspirin, and clinical symptoms vanished, but later mildly relapsed in the context of a viral upper respiratory tract infection other than SARS-CoV-2. Carotidynia because of TIPIC syndrome may present as an immunogenic side effect of the newly developed mRNA-based vaccinations against COVID-19. TIPIC syndrome should be considered in new-onset neck pain after vaccination.
Pheochromocytoma/Paraganglioma (PPGL): A Misdiagnosed Cause of Hypertension during Pregnancy
Authors: Rafael Buck Giorgi, Priscila Teixeira Aroucha, Thalissa M Favreto, Micaela F Montero, Julia M F Velloni, Ilana Korkes, Elisa Napolitano Ferreira, Caroline Olivati, Jose Viana Lima Jr, Claudio E Kater, Flavia A Costa-Barbosa
Journal: Case Rep Obstet Gynecol (2024)
MeSH terms: Case Reports

Hypertension (HT) during pregnancy is not an infrequent obstetric problem, reaching a prevalence of 5-10%. This condition is highly associated with both maternal and fetal complications if not precisely diagnosed and managed. Even though primary HT, obesity, and preeclampsia are the main causes of HT in this period, other less familiar conditions must be considered during the investigation. Pheochromocytoma and paraganglioma (PPGL) are chromaffin cell tumors that produce, store, and secrete catecholamines, leading to HT and other adrenergic manifestations. Recognition of PPGL is crucial since misdiagnosis and improper management can lead to high morbidity and mortality, particularly during pregnancy. We report on two cases of PPGL diagnosed during pregnancy with different managements. Case 1 is a 25-year-old female at 31 weeks of first pregnancy, whose severe HT and life-threatening symptoms prompted an emergency delivery without previous confirmation or medical treatment of a suspected PPGL. After confirmation, a right adrenal PPGL was surgically resected 4 months later, following 15 days of medical therapy. Case 2 is a 22-year-old female at 18 weeks of pregnancy whose symptomatic PPGL was resected in the second trimester. A next-generation sequencing panel, including 23 PPGL-related genes, found no germline pathogenic variants (GPVs) in case 1 and an exon 1-4 germinative heterozygous deletion of the MAX gene in case 2. Despite the different medical approaches, both cases had satisfactory outcomes. Although uncommon, PPGL should be considered in the differential diagnosis of HT in pregnancy since missing the diagnosis and failing to introduce appropriate and timely treatment may lead to dramatic consequences for the mother and fetus. PPGL diagnosed during reproductive age is likely to result from GPV, prompting genetic investigation and counseling.
Deaths during Sexual Activity
Authors: Agnė Okulevičiūtė, Sigitas Chmieliauskas, Sigitas Laima, Diana Vasiljevaitė, Jurgita Stasiūnienė
Journal: Acta Med Litu (2024)
Keywords: autoerotic deaths, autopsy, deaths during sexual activity, deaths during sexual intercourse, forensic pathology
MeSH terms: Case Reports

Background:
Deaths during sexual activities are rarely identified phenomena in forensic medicine practice. Most often, such deaths are classified as accidents or deaths due to the manifestation of certain diseases during sexual activity. It is important to rule out homicide or suicide as the cause of death when investigating sexual deaths. Determining the cause of death requires a comprehensive assessment of the evidence and circumstances and should not be based solely on autopsy findings. When determining the cause of death, it is necessary to evaluate the circumstances of the discovery, important evidence found near the body, the position of the deceased, the place where the deceased was found, and the characteristics of the environment.
Cases:

Case 1: A 65-year-old male was clothed in women's underwear and was found hanging in a noose in a bedroom after a house fire. The autopsy revealed a ligature mark on the neck, bruises in neck muscles, tears in carotid arteries, and signs of acute pulmonary distension. The cause of death was determined to be suffocation due to neck compression by a ligature, compounded by significant alcohol intoxication, with additional postmortem burns covering 30% of the body surface area likely occurring after death.Case 2: A 55-year-old naked male was found without external injuries but with a plastic tube inserted into the rectum, causing a 2.5 cm rupture in the ileum. The perforation led to complications, including purulent diffuse peritonitis, intoxication, and acute cardiac and respiratory failure, resulting in death within 3-6 hours after insertion. Concurrent findings included atherosclerotic changes in the heart, internal organ hyperemia and edema, hepatic steatosis, renal cyst, and a lack of ethyl alcohol in blood but 0.17 ‰ presence in urine according to toxicology analysis.
Conclusions:
A detailed evaluation of all the evidence is very important in the forensic examination of the deceased during sexual activity. Therefore, to determine the cause of death, not only the autopsy data, toxicological and microscopic examinations of the deceased are important, but also the evaluation of all findings at the scene. The most common cause of death of an autoerotic nature is asphyxia, and the most commonly identified group of the dead are men aged around 40 years.
A case report of cardiac neuromodulation in a young patient with a third-degree atrioventricular block
Authors: Noemi Valenti, Antonio Di Monaco, Imma Romanazzi, Nicola Vitulano, Federica Troisi, Federico Quadrini, Massimo Grimaldi
Journal: Front Cardiovasc Med (2024)
Keywords: autonomic nervous system (ans), cardioneuroablation (cna), case report, catheter ablation, third-degree atrioventricular block
MeSH terms: Case Reports

Background:
There are some functional bradyarrhythmias that are caused by a dysregulation of the autonomic nervous system, for which a therapeutic strategy of cardioneuroablation (CNA) is conceivable.
Case summary:
In this study, we report the case of a 19-year-old woman with a non-congenital third-degree atrioventricular block (AVB), symptomatic for lipothymia and dyspnea caused by mild exertion. She had a structurally normal heart and no other comorbidities. The atropine test and the exercise stress test documented a sinus tachycardia at 190 bpm with a 2:1 AVB, a narrow QRS, and an atrioventricular conduction of 1:1 until reaching a sinus rhythm rate of 90 bpm. She underwent the CNA procedure, which targeted the inferior paraseptal ganglion plexus, with a gradual change in the ECG levels recorded during the radiofrequency delivery from a third-degree AVB to a first-degree AVB. After the procedure, we observed a complete regression of the third-degree AVB, with evidence of only a first-degree AVB and a complete regression of symptoms until the 6-month follow-up.
Conclusions:
Although not yet included in current guidelines, the CNA procedure could be used to treat AV node dysfunction in young subjects, as it could represent an alternative to pacemaker implantation. However, more randomized studies are needed to assess the long-term efficacy of this promising technique.
Utility of 18F-FDG PET/CT in Detecting Spinal Drop Metastases from Pineal Gland Tumors
Authors: Kabilash Dhayalan, Harish Goyal, Pradap Palanivelu, Dhanapathi Halanaik
Journal: Asia Ocean J Nucl Med Biol (2024)
MeSH terms: Case Reports

Pineal gland tumors are significant despite being rare (<1%) among all brain tumors. Germ cell tumors are the most common among the pineal gland tumors. Often affecting young adults, pineal gland germ cell tumors are hard to diagnose due to different symptoms and potential spread. But they rarely show leptomeningeal spread and extracranial metastases. Other differentials include primary tumors of the pineal region, Pineal gliomas, and metastases. The leptomeningeal spread of these tumors has not been studied so far. Conventional radiological imaging modalities are routinely used to diagnose and evaluate these tumors. We report a case here showing a pineal gland tumor with leptomeningeal spread detected by 18F-FDG PET/CT. Our case shows how pineal gland tumors can behave unusually and how 18F-FDG PET/CT can be crucial for accurately assessing the extent of the disease in the body to provide effective treatment. This case report illustrates the rare type of spread of pineal gland tumor and how 18F-FDG PET/CT helps detect this rare type of metastasis, thereby helping in prognostication and deciding further treatment of the patient.
Hourglass Bladder Deformity Induced by Chronic Ketamine Abuse
Authors: Kevin Badran, Olivier Rahier, Emmanuel Agneessens
Journal: J Belg Soc Radiol (2024)
Keywords: bladder, ct scan, hourglass, ketamine, ultrasound
MeSH terms: Case Reports

Regular and chronic use of ketamine causes inflammatory changes in the urinary tract. Imaging has a crucial role in the assessment of this pathology. A particular imaging characteristic of an hourglass-shaped bladder is highlighted in three cases of ketamine intoxication. Teaching point: Three cases of ketamine intoxication with a characteristic bladder deformation are reported.
A case of Staphylococcus epidermidis osteomyelitis in the absence of spine hardware
Authors: Erin Coonahan, Bita Shahrvini, Morgan Birabaharan, Nikdokht Farid, Annie Cowell
Journal: IDCases (2024)
Keywords: endocarditis, magnetic resonance imaging (mri), osteomyelitis, staphylococcus epidermidis
MeSH terms: Case Reports

Staphylococcus epidermidis is a typically indolent pathogen that is often considered a blood culture contaminant. It is a rare and unexpected cause of osteomyelitis, especially in the absence of recent surgical intervention or orthopedic implants. We highlight a case in which a 90-year-old Caucasian male with no recent spine surgery was found to have osteomyelitis of the lumbar spine and repeat positive blood cultures for methicillin resistant Staphylococcus epidermidis (MRSE). Further investigation revealed a history of mitral valve replacement and a new diagnosis of endocarditis leading to persistent bacteremia and seeding of his lumbar vertebrae. This case demonstrates that S. epidermidis can cause vertebral osteomyelitis resulting in severe complications that are more similar to highly pathogenic bacteria. We describe the steps to diagnosing this chronic undetected infection and related comorbidities.
When the fever will not stop, stop the pills! A case report
Authors: César Ricardo Coimbra de Matos, Eduarda Maria da Conceição Sério Pereira Beirão, Rafael Simões Neves, António José Assunção, Rui Moreira Marques
Journal: Sao Paulo Med J (2023)
MeSH terms: Antipsychotic Agents / adverse effects, Neuroleptic Malignant Syndrome / diagnosis, Neuroleptic Malignant Syndrome / drug therapy, Neuroleptic Malignant Syndrome / etiology, Case Reports, Adult, Female, Haloperidol / adverse effects, Humans, Quetiapine Fumarate / adverse effects, Risperidone / adverse effects, Antipsychotic Agents, Haloperidol, Quetiapine Fumarate, Risperidone

Background:
Neuroleptic malignant syndrome (NMS) is a neurologic emergency potentially fatal. This rare side effect is most commonly associated with first-generation antipsychotics and less frequently with atypical or second-generation antipsychotics. The diagnosis relies on both clinical and laboratory criteria, with other organic and psychiatric conditions being ruled out.
Case report:
A 39-year-old female patient, who is institutionalized and completely dependent, has a medical history of recurrent urinary infections and colonization by carbapenem-resistant Klebsiella pneumoniae. Her regular medication regimen included sertraline, valproic acid, quetiapine, risperidone, lorazepam, diazepam, haloperidol, baclofen, and fentanyl. The patient began experiencing dyspnea. Upon physical examination, she exhibited hypotension and a diminished vesicular murmur at the right base during pulmonary auscultation. Initially, after hospitalization, she developed high febrile peaks associated with hemodynamic instability, prompting the initiation of antibiotic treatment. Despite this, her fever persisted without an increase in blood inflammatory parameters, and she developed purulent sputum, necessitating antibiotherapy escalation. The seventh day of hospitalization showed no improvement in symptoms, suggesting NNMS as a differential diagnosis. All antipsychotic and sedative drugs, as well as antibiotherapy, were discontinued, after which the patient showed significant clinical improvement.
Conclusion:
Antipsychotic agents are commonly employed to manage behavioral changes linked to various disorders. However, their severe side effects necessitate a high degree of vigilance, the cessation of all medications, and the implementation of supportive care measures. A prompt and accurate diagnosis of NMS is crucial to alleviating the severe, prolonged morbidity and potential mortality associated with this syndrome.
Fatal Coronary Artery Anomaly Concealed in Young Athletes with Exertional Syncope
Authors: Toshinobu Ifuku, Keigo Nakatani, Kentaro Ueno, Naoto Yamashita, Yutaka Imoto
Journal: Case Rep Pediatr (2024)
MeSH terms: Case Reports

Background:
Syncope is a common symptom in children, many of which are benign and do not require treatment. Anomalous aortic origin of a coronary artery (AAOCA) is a rare congenital malformation but can be a risk for serious cardiovascular events, including sudden death as well as cardiogenic syncope. Case Report. We describe the case of a 14-year-old boy who suffered an initial syncope and afebrile seizure during a soccer game. A detailed medical history and imaging studies led to the diagnosis of the anomalous aortic origin of the left main coronary artery with an intramural course (AAOLCA-IM).
Conclusion:
Symptomatic AAOLCA-IM has the highest risk of sudden death among AAOCA, and surgical repair may be performed. Onset during exercise or preceding chest symptoms are suspicious signs of cardiogenic syncope and should be considered for cardiovascular imaging evaluation.
Two Ectopic Liver Lobes Discovered Incidentally at an Autopsy: A Case Report
Authors: Satoshi Sumida, Nobuo Satake, Koichi Tsuneyama
Journal: Cureus (2024)
Keywords: anomaly, autopsy, ectopic liver lobe, liver development, portal venopathy
MeSH terms: Case Reports

The ectopic liver lobe is a rare anomaly and is most frequently reported as a solitary mass. Herein, we report a case of multiple (two) ectopic liver lobes detected at an autopsy. A Japanese man in his 70s died of an infectious disease associated with acquired immunodeficiency syndrome (AIDS). Autopsy revealed the incidental finding of two 1-cm masses, located anterior to the inferior vena cava. Both masses were composed of liver tissue and had internal microscopic structures resembling the porta hepatis, consisting of an outflow bile duct and blood vessels. The outflow bile duct appeared to be continuous with the common bile duct, but the connection point of the outflow vessel was unclear. The liver tissue showed fibrous thickening of the central veins and portal venopathy, including fibrosis in the portal area as well as narrowing and loss of the portal veins. There was no evidence of congestion, fibrosis, biliary stasis, or neoplasm. The incidence of hepatocellular carcinoma is higher in the ectopic liver lobe than in the proper liver, presumably due to the abnormal circulation and bile excretion pathways. The patient also presented with portal venopathy; this suggests the presence of abnormal circulatory dynamics.