OpenMed/multicare-articles huggingface dataset:
Incidental Presacral Myelolipoma Resembling the Liposarcoma: A Case Report and Literature Review
Authors: Naoto Tokuyama, Hisashi Takeuchi, Isao Kuroda, Teiichiro Aoyagi
Journal: Case Rep Urol (2016)
MeSH terms: Case Reports

Presacral myelolipomas are rare, benign, asymptomatic tumors composed of mature adipose tissue and hematopoietic elements, but fewer than 50 cases have been reported in the literature. They are usually discovered incidentally during imaging studies and are often misdiagnosed as liposarcoma, which have a malignant nature, because the imaging findings of myelolipoma can be similar to those of liposarcoma. It is challenging to distinguish presacral myelolipomas from other presacral fat-containing tumors without performing a histological examination. We should consider the possibility of a malignant tumor, and imaging-guided biopsy carries a risk of tumor spread along the biopsy tract. Therefore, surgical management might sometimes be required; however, it is not necessary in all cases. We present an incidentally detected case of presacral myelolipoma that was difficult to differentiate from other malignant tumors in a 71-year-old male.
Mirtazapine-induced bilateral secondary angle closure in a female
Authors: Srishti Raj, Manpreet Kaur, Kandragunta Srinivasarao, Faisal Thattaruthody, Sushmita Kaushik, Surinder Singh Pandav
Journal: GMS Ophthalmol Cases (2020)
Keywords: ciliary body edema, mirtazapine, secondary angle closure, side effects
MeSH terms: Case Reports

Purpose: To report a case of bilateral secondary angle closure in a female using mirtazapine for 6 months. Patient and method: A 55-year-old female was diagnosed with secondary angle closure in both eyes with raised intraocular pressure, and ultrasound biomicroscopic findings suggestive of ciliary body effusion. It was associated with adjoining cyst presumably because of the use of mirtazapine for depression and sleep disturbances. Results: After the planned discontinuation of mirtazapine, the ocular angle opened, the ciliary body edema decreased, and the cyst regressed in size. The intraocular pressure was controlled with topical timolol (0.5%). Conclusion: Patients with risk factors for angle closure should be prescribed antipsychotic drugs with caution. The peripheral laser iridotomy is not indicated in secondary angle closure due to ciliary body effusion.
Two new cases of anti-Ca (anti-ARHGAP26/GRAF) autoantibody-associated cerebellar ataxia
Authors: Sven Jarius, Pedro Martínez-García, Adelaida León Hernandez, Jan Christoph Brase, Kathrin Borowski, Jens Ulrich Regula, Hans Michael Meinck, Winfried Stöcker, Brigitte Wildemann, Klaus-Peter Wandinger
Journal: J Neuroinflammation (2013)
MeSH terms: Autoantibodies / biosynthesis, Cerebellar Ataxia / immunology, Cerebellar Ataxia / pathology, GTPase-Activating Proteins / immunology, Case Reports, Research Support, Non-U.S. Gov't, Adult, Aged, Cerebellar Ataxia / diagnosis, Female, Humans, Male, ARHGAP26 protein, human, Autoantibodies, GTPase-Activating Proteins

Recently, we discovered a novel serum and cerebrospinal fluid (CSF) autoantibody (anti-Ca) to Purkinje cells in a patient with autoimmune cerebellar ataxia (ACA) and identified the RhoGTPase-activating protein 26 (ARHGAP26; alternative designations include GTPase regulator associated with focal adhesion kinase pp125, GRAF, and oligophrenin-1-like protein, OPHN1L) as the target antigen. Here, we report on two new cases of ARHGAP26 autoantibody-positive ACA that were first diagnosed after publication of the index case study. While the index patient developed ACA following an episode of respiratory infection with still no evidence for malignancy 52 months after onset, neurological symptoms heralded ovarian cancer in one of the patients described here. Our finding of anti-Ca/anti-ARHGAP26 antibodies in two additional patients supports a role of autoimmunity against ARHGAP26 in the pathogenesis of ACA. Moreover, the finding of ovarian cancer in one of our patients suggests that anti-Ca/anti-ARHGAP26-positive ACA might be of paraneoplastic aetiology in some cases. In conclusion, testing for anti-Ca/anti-ARHGAP26 should be included in the diagnostic work-up of patients with ACA, and an underlying tumour should be considered in patients presenting with anti-Ca/ARHGAP26 antibody-positive ACA.
Large twisted ovarian fibroma in menopausal women: a case report
Authors: Majdouline Boujoual, Ihsan Hakimi, Jaouad Kouach, Mohamed Oukabli, Driss Rahali Moussaoui, Mohammed Dehayni
Journal: Pan Afr Med J (2015)
Keywords: ovarian fibroma, postmenopausal, torsion
MeSH terms: Abdominal Pain / etiology, Fibroma / diagnosis, Ovarian Neoplasms / diagnosis, Postmenopause, Case Reports, Diagnosis, Differential, Female, Fibroma / pathology, Humans, Middle Aged, Ovarian Neoplasms / pathology, Ovarian Fibromata

Ovarian fibroma is the most common benign solid tumors of the ovary, commonly misdiagnosed as uterine fibromaor as malignant ovarian tumors. It occurs generally in older perimenopausal and postmenopausal women. Occasionally large fibromas may undergo torsion causing acute abdominal pain. Doppler Ultrasonographyimaging is the choice study. CT and MRI are often needed for further characterization and differentiation from other solid ovarian masses. The choice treatment is surgical removal with intraoperative frozensection. Immunohistochemicalanalysis is recommended to rule out the differential diagnosis. Here we present a case of a postmenopausal woman with a large twisted ovarian fibroma reflecting diagnostic and management difficulties including potential misdiagnosis of the tumor as a malignant ovarian neoplasm that may influence the surgical approach.
Case report: Multimodality imaging revealing ruptured giant coronary artery aneurysm presenting with hemoptysis
Authors: Xiangfeng Gong, Hongwei Zhang, Wanlin Peng, Gang Yang, Zhenghua Xiao
Journal: Front Cardiovasc Med (2023)
Keywords: cardiac surgery, case report, giant coronary artery aneurysm, hemoptysis, multimodality imaging
MeSH terms: Case Reports

Giant coronary artery aneurysm (CAA) is a relatively uncommon disease that is defined by a focal dilation of at least 20 mm and characterized by various clinical symptoms. However, cases presenting primarily with hemoptysis have not been reported. A man in his late 20 s suffering from persistent chest pain for over 2 months was transferred to our emergency department for intermittent hemoptysis lasting for 12 h. Bronchoscopy detected fresh blood in the left upper lobe bronchus without a definite bleeding source. Magnetic resonance imaging (MRI) demonstrated a heterogeneous mass and the high-intensity signals suggested active bleeding. coronary computed tomography (CT) angiography demonstrated a giant ruptured CAA wrapped in a large mediastinal mass Coronary angiography confirmed the CAA originating from the left anterior descending artery. The patient underwent an emergency sternotomy and an enormous hematoma arising from a ruptured CAA densely adhering to the left lung was identified. The patient recovered uneventfully and was discharged on the 7th day later. The ruptured CAA masquerading as hemoptysis highlights the indispensability of multimodality imaging for accurate diagnosis. Urgent surgical intervention is desirable in such life-threatening conditions.
Perforation causing abdominal compartment syndrome after colonoscopic polypectomy: A case report
Authors: Ying-Chun Lin, Jen-Yin Chang, Chen-Han Wu, Jian-Syun Chen, Chien-Chuan Chen
Journal: Int J Surg Case Rep (2019)
Keywords: abdominal compartment syndrome, case report, colonoscopy, intra-abdominal hypertension, polypectomy

Introduction:
Bowel perforation is a potential complication of colonoscopy, and colonoscopic polypectomy has a higher risk. Perforation may be responsible for abdominal compartment syndrome (ACS), which causes multiple organ dysfunction.
Case presentation:
Here, we have described the case of a woman who underwent colonoscopic polypectomy. Subsequent to the procedure, she developed progressive abdominal distension, dyspnea, drowsy consciousness, and hypotension. Her physical examination revealed increased abdominal circumference, coldness, and paleness of the lower limbs. ACS were accordingly diagnosed, most likely to have resulted from bowel perforation. Thus, decompression with a large-bore intravenous catheter and emergent laparotomy were performed. A 0.5-cm lesion over the cecum was discovered and repaired. The patient tolerated the procedure well and underwent intensive care. She was discharged on day 7 after operation, and she had completely recovered.
Discussion:
ACS is a rare complication followed by perforation after colonoscopy. Multiple organ dysfunction may occur from ACS, affecting the cardiovascular, pulmonary, and gastro-intestinal system. In our case, we used a small-sized catheter for decompression but in vain due to the kinking of the catheter. ACS was eventually resolved via surgical intervention. Thus, when ACS occurred, emergent decompression with an appropriate size of catheter and surgical intervention are recommended.
Conclusion:
Colonoscopy perforation must be considered as a contributing factor to ACS; accordingly, early recognition and intervention may avoid deterioration of ACS.
Tracheocutaneous Sinus following Tracheocutaneous Fistula Repair: Management Strategies in a Pediatric Patient
Authors: Adam Bender-Heine, Habib G Zalzal, Nainika Nanda, Hassan Ramadan
Journal: Case Rep Otolaryngol (2018)
MeSH terms: Case Reports

Objective:
To present a rare case of a pediatric tracheocutaneous sinus years after repair of a tracheocutaneous fistula and to review management strategies.
Background:
A tracheocutaneous fistula is a common sequela of pediatric tracheostomy and can occur in as many as one in three pediatric patients. There is debate in the literature regarding optimal surgical management.
Case presentation:
An 8-year-old girl presented to the emergency department with swelling and erythema over the anterior neck. Clinical exam and diagnostic imaging revealed an underlying tracheocutaneous sinus.
Discussion:
Complications following pediatric tracheostomy are common and range in complexity from stomal granulation to tracheocutaneous fistula. There is some debate regarding the optimal surgical management of children with tracheocutaneous fistula following tracheostomy. This report discusses the management of a pediatric child with an unusual tracheocutaneous sinus and reviews the various surgical techniques which have been described for definitive repair.
History and Development of TCM Case Report in a Real-World Setting
Authors: Hua Zeng, Yiqi Qiao, Xue Luo, Xin Chen, Zhendong Wang, Huafeng Pan, Qi Wang, Guo-Qing Zheng
Journal: Evid Based Complement Alternat Med (2021)

Objective:
The medical record of Chinese medicine is a miniature of the theoretical system of traditional Chinese medicine (TCM), with a time-honored history in a real-world setting and a firm place in medicine. In modern times, people have emphasized the value and standardization of TCM cases. The aim of this study was to explore the historical origins and developments of TCM case records.
Methods:
A chronological narrative style was used to divide the development history of TCM case records into early (1600 BC-220 AD), middle (220-1911 AD), and modern periods (1912-till now). The historical context of the origin and development of TCM case records was analyzed through the evolution of the format and content of the case recording files with the specific documents and distinctive cases.
Results:
From the early to middle period, the development of TCM case record had experienced four periods: the budding, blossoming, maturity, and heyday. In modern times, they presented the following characteristics: A, the establishment and development of the discipline of TCM medical records; B, the standardization of the writing format of TCM medical records; C, a large number of books concentrating on recording and studying TCM medical records, especially those of prestigious veteran TCM doctors; D, the proliferation of TCM case reports published in journals; E, the establishment of TCM medical records databases and application platforms integrating computer programs and artificial intelligence; F, many reporting guidelines have been developed in order to improve the reporting quality of case report in TCM.
Conclusions:
The study analyzed and illustrated the characteristics of TCM case records of different dynasties in terms of writing content and format. TCM case record is a relatively young discipline in spite of its ancient origins. TCM case records still have far-reaching significance for the inheritance and development of TCM theory and clinical experience. From the wisdom of history, its positive impact has just been revalued to be validated and it will continue to develop.
Asymptomatic Severe Vagal and Sympathetic Cardiac Denervation in Holmes-Adie's Syndrome
Authors: B Estañol, R C Callejas-Rojas, S Cortés, R Martínez-Memije, O Infante-Vázquez, G Delgado-García
Journal: Case Rep Neurol Med (2017)
MeSH terms: Case Reports

A 40-year-old woman was found to have bilateral Adie's pupils and generalized muscle stretch areflexia. She did not have orthostatic hypotension but, in an ECG strip in the office, she appeared to have an almost fixed heart rate. We thus studied the heart rate variability (HRV) and the systolic blood pressure variability (SBPV) in supine and standing position and also during rhythmic breathing. We found a decreased HRV in the time domain with very low standard deviation in supine and standing position and during rhythmic breathing. HRV in the frequency domain was low with a decrease in the absolute power of HF and LF and a decrease in the sympathovagal balance in supine and standing positions. SBPV in the time and frequency domains was found to be normal. This patient with Holmes-Adie syndrome had an asymptomatic severe loss of HRV and a preserved SBPV. The global decrease in the HRV in the time and frequency domains indicated that she had both vagal and sympathetic cardiac denervation, whereas the preserved SBPV suggested normal innervation of the blood vessels.
Case Report: Late Onset of Myelodysplastic Syndrome From Donor Progenitor Cells After Allogeneic Stem Cell Transplantation. Which Lessons Can We Draw From the Reported Case?
Authors: Mirko Farina, Simona Bernardi, Lisa Gandolfi, Camilla Zanaglio, Enrico Morello, Alessandro Turra, Tatiana Zollner, Doriana Gramegna, Benedetta Rambaldi, Federica Cattina, Nicola Polverelli, Michele Malagola, Domenico Russo
Journal: Front Oncol (2020)
Keywords: donor cell myelodysplasia, immunosuppression, immunosurveillance, leukemogenesis, stem cells, transplant

Background:
Myelodysplastic syndromes and acute leukemias after allogeneic stem cell transplantation (allo-SCT) are mainly caused by recurrence of the primitive leukemic clones. More rarely, they originate from donor hematopoietic stem cells, developing the so-called donor cell leukemia (DCL) or myelodysplastic syndromes (DC-MDSs). DCL and DC-MDS can be considered as an in vivo model of leukemogenesis, and even if the pathogenetic mechanisms remain speculative, a genetic predisposition of donor progenitor cells, an altered host microenvironment, and the impairment of immune surveillance are considered the main causes.
Case presentation:
We report a case of DC-MDS diagnosed 5 years after an allo-SCT from a matched related donor (patient's sister) in a patient with Philadelphia chromosome-positive B-cell acute lymphoblastic leukemia (Ph+ B-ALL). The sex-mismatch allowed us to identify the donor cell origin. At the onset, the DC-MDS was characterized by chromosome seven monosomy and NRAS, RUNX1, and BCOR mutations. Because of a familiar history of colorectal neoplasia and the variant allele frequency (VAF) of NRAS mutation at the onset, this mutation was searched on germline DNA in both the donor and the recipient, but the result was negative. Moreover, after transplant (+4 months), the patient developed severe and long-lasting chronic graft-versus-host disease (cGVHD), requiring multiple lines of treatments. Because of the severe immunosuppression, recurrent infections occurred and, lately, the patient died due to septic shock.
Conclusion:
This case report highlights the need, whenever possible, to evaluate the donor origin of the posttransplant myelodysplasia and acute leukemias. The potential key role of the impaired immune surveillance and of long-lasting immunosuppression appears to be emerging in the development of this case of DC-MDS. Finally, this case reminds the importance to investigate the familiar genetic predisposition in donors with a familiar history of neoplasia.
Latissimus Dorsi Tendon Transfer with GraftJacket® Augmentation to Increase Tendon Length for an Irreparable Rotator Cuff Tear
Authors: John G Skedros, Tanner R Henrie
Journal: Case Rep Orthop (2017)
MeSH terms: Case Reports

Massive irreparable rotator cuff tears can be reconstructed with latissimus dorsi tendon transfers (LDTT). Although uncommon, the natural length of the latissimus dorsi tendon (LDT) could be insufficient for transfer even after adequate soft tissue releases. Descriptions of cases where grafts were needed to lengthen the LDT are therefore rare. We located only two reports of the use of an acellular dermal matrix to increase effective tendon length in tendon transfers about the shoulder: (1) GraftJacket patch for a pectoralis major tendon reconstruction and (2) ArthroFlex® patch for LDTT. Both of these brands of allograft patches are obtained from human cadavers. These products are usually used to cover soft tissue repairs and offer supplemental support rather than for increasing tendon length. Extending the LDTT with GraftJacket to achieve adequate length, to our knowledge, has not been reported in the literature. We report the case of a 50-year-old male who had a massive, irreparable left shoulder rotator cuff tear that was reconstructed with a LDTT. The natural length of his LDT was insufficient for transfer. This unexpected situation was rectified by sewing two patches of GraftJacket to the LDT. The patient had greatly improved shoulder function at two-year follow-up.
Implications of the Incidental Finding of a MYCN Amplified Adrenal Tumor: A Case Report and Update of a Pediatric Disease Diagnosed in Adults
Authors: Anna Koumarianou, Panagiota Oikonomopoulou, Margarita Baka, Dimitrios Vlachodimitropoulos, Stylianos Argentos, Theodoros Piperos, Maria-Ioanna Christodoulou, Kakoulis Theodoulou, Theodoros Mariolis-Sapsakos
Journal: Case Rep Oncol Med (2013)

MYCN is a well-known oncogene overexpressed in different human malignancies including neuroblastoma, rhabdomyosarcoma, medulloblastoma, astrocytoma, Wilms' tumor, and small cell lung cancer. While neuroblastoma is one of the most common childhood malignancies, in adults it is extremely rare and its treatment is based on pediatric protocols that take into consideration stage and genotypic features, such as MYCN amplification. Although neuroblastoma therapy has evolved, identification of early stage patients who need chemotherapy continues to pose a therapeutic challenge. The emerging prognostic role of MYCN phenotype of this disease is currently under investigation as it may redefine MYCN amplified subgroups. We describe an unusual case of adult neuroblastoma with MYCN amplification diagnosed incidentally and discuss possible therapeutic dilemmas.
Case Report: Response to Regional Melphalan via Limb Infusion and Systemic PD1 Blockade in Recurrent Myxofibrosarcoma: A Report of 2 Cases
Authors: Edmund K Bartlett, Sandra P D'Angelo, Ciara M Kelly, Robert H Siegelbaum, Charles Fisher, Cristina R Antonescu, Charlotte E Ariyan
Journal: Front Oncol (2021)
Keywords: immunotherapy, sarcoma, isolated limb infusion, myxofibrosarcoma, undifferentiated pleomorphic sarcoma (ups)
MeSH terms: Case Reports

Treatment options for patients with advanced sarcoma remain limited. Promising responses to checkpoint inhibition have been observed, but responses to single-agent PD-1 inhibition are rare. We report on two patients with multiply recurrent myxofibrosarcoma treated with the combination of regionally administered melphalan (via isolated limb infusion) and pembrolizumab. Both patients had recurrent disease after multiple surgical resections and radiation. Analysis of primary tumors demonstrated microsatellite stable tumors with few mutations. After combination treatment, one patient had a significant partial response of 6 months duration, the second patient had a complete response of 2 years duration. Post treatment biopsies demonstrated immune infiltration into the tumor. These promising responses in patients with multiply recurrent myxofibrosarcoma have prompted the development of an investigator-initiated clinical trial to formally study the combination of regional melphalan and pembrolizumab in a systematic fashion (NCT04332874).
Yersinia pseudotuberculosis Infection Complicated with Bacteremia in a 10-Month-Old Boy
Authors: Takuro Kamura, Yuhei Tanaka, Naoya Tsumura, Takashi Ohya, Yuki Okamatsu
Journal: Case Rep Pediatr (2020)
MeSH terms: Case Reports

Yersinia pseudotuberculosis (Y. pseudotuberculosis) infection complicated with bacteremia rarely occurs. Y. pseudotuberculosis infection is also known to produce various symptoms similar to Kawasaki disease (KD) due to the production of Y. pseudotuberculosis-derived mitogen (YPM), an exotoxin with superantigen activity. Moreover, it causes terminal ileitis and is responsible for appendix swelling. Here, we report a case of Y. pseudotuberculosis infection in a 10-month-old boy who was brought to our hospital due to fever, watery stool, and poor vitality. Abdominal echocardiography revealed wall thickening of the entire colon and appendix swelling; therefore, he was admitted and treated with antibiotics for bacterial enteritis or appendicitis. After the antibiotic administration, facial skin rashes and hand and foot edema developed. However, he had 5/6 major symptoms of KD and was diagnosed with Y. pseudotuberculosis infection because of its presence in the blood and stool cultures. Thereafter, antibacterial therapy improved his symptoms and increased the inflammatory response. After his hospital discharge, the skin on his fingers showed desquamation like that of KD. Y. pseudotuberculosis infection should be considered as a differential disease in KD, terminal ileitis, and appendicitis. Furthermore, its infection route and culture methods should also be carefully considered.
Case report: Intravitreal methotrexate in intraocular acute lymphoblastic leukemia
Authors: Matteo Pederzolli, Fabio Giglio, Maria Vittoria Cicinelli, Alessandro Marchese, Giulio Modorati, Sara Mastaglio, Fabio Ciceri, Francesco Bandello, Elisabetta Miserocchi
Journal: Front Oncol (2022)
Keywords: acute lymphoblastic leukemia, case report, intraocular leukemia, intravitreal injections, intravitreal methotrexate, methotrexate
MeSH terms: Case Reports

Direct leukemic infiltration of the eye is most frequently associated with acute lymphoblastic leukemia (ALL), probably due to its well-known central nervous system (CNS) tropism. Systemic treatment alone may not be sufficient for intraocular leukemia. Data on local treatment are scarce. Here, we present two cases of intraocular ALL treated with intravitreal methotrexate (MTX). Initially, anatomical improvement and visual stability were observed. The first patient experienced anatomical and visual worsening after a year of treatment. Treatment was withheld after 2 months for the second patient due to poor systemic conditions. Corneal toxicity and intraocular pressure elevation were observed in the first case. In both cases, eye involvement was associated with CNS or systemic relapse. This highlights the importance of incorporating ocular disease management in a comprehensive approach to therapy. Our experience corroborates previous findings on MTX injections as an effective and safe therapeutic option for intraocular leukemia. Further evidence is needed to consolidate the use of intravitreal MTX to treat such a debilitating localization of leukemia.