OpenMed/multicare-articles huggingface dataset:
Acute Liver Failure as the Leading Manifestation of Spontaneous Tumour Lysis Syndrome in a Patient with NonHodgkin Lymphoma: Do Current Diagnostic Criteria of Tumour Lysis Syndrome Need Re-Evaluation?
Authors: Janja Tarčuković, Lara Valenčić, Željka Polonijo, Ana Fućak, Boban Dangubić, Igor Grubješić
Journal: Case Rep Crit Care (2019)
MeSH terms: Case Reports

Tumour lysis syndrome (TLS) is a group of pathophysiological processes caused by rapid degradation of tumour cells with subsequent release of intracellular contents into the extracellular space. It is characterized by the development of systemic metabolic disturbances with or without clinical manifestations. The process usually occurs in highly proliferative, large tumours after induction of cytotoxic therapy. Rarely, however, spontaneous TLS can develop, as well as signs of multiorgan failure triggered by an excessive metabolic load and sterile inflammation. The combination of the aforementioned is thus quite unique. Here, we present a 63-year-old male in which spontaneous TLS was accompanied with acute liver failure and delineated underlying nonHodgkin lymphoma. Initial laboratory findings included hyperkalaemia, hyperphosphataemia, hypocalcaemia, uraemia, and increased creatinine levels indicating the onset of TLS with acute kidney injury. Moreover, the patient showed signs of jaundice, coagulopathy, and hepatic encephalopathy. Development of TLS with multiorgan failure prompted rapid initiation of critical care management, including vigorous intravenous fluid therapy, allopurinol treatment, high flow continuous venovenous haemodiafiltration, and commencement of chemotherapy. The case highlights the possibility of TLS as a differential diagnosis in patients presenting with multiorgan failure and the importance of early detection of this potentially challenging and fatal diagnosis.
Infarcted adenomatoid tumour of epididymis: a rare case report
Authors: A Gupta, M Livingston, R Singh, D Tansey, L Solomon
Journal: Case Rep Urol (2013)

Paratesticular tumours are pathologically rare. The vast majority are benign in nature with adenomatoid tumours representing the most common pathological entity. We present the case of a 32-year-old man, from the Indian subcontinent, who presented with a painful scrotal swelling sustained after trauma. The history suggested that the scrotal mass had been present for approximately 12 months, and a preliminary diagnosis of a haemorrhagic cyst caused by trauma was made. Initial management included scrotal support, analgesia, and a follow-up magnetic resonance imaging (MRI) scan. Subsequent imaging and then further histological analysis confirmed a partly necrotic/infarcted adenomatoid tumour of the right epididymis. After scrotal exploration and epididymectomy, the patient made a complete recovery, and, with the histological diagnosis, he was discharged with no further followup. The case is presented as a learning point in the identification and management of such pathologies.
Primary Angiosarcoma of the Thyroid in an Asian Woman: A Case Report with Review of the Literature
Authors: Shih-Hsuan Huang, Shang-Chung Wu
Journal: Case Rep Pathol (2020)
MeSH terms: Case Reports

Primary thyroid angiosarcoma is a rare malignant tumor and characterized by its prevalence in Alpine regions of Central Europe, close relation to longstanding goiter, and aggressive clinical course with dismal prognosis. We describe the case of an 83-year-old Chinese female who lives in the coastal area of Taiwan. She came to our hospital due to a progressively enlarged mass at her anterior neck. The sonography of the thyroid revealed a well-circumscribed mass in the left lobe. She underwent left hemithyroidectomy. The diagnosis of angiosarcoma of the thyroid was made and further confirmed at a different institution. To the best of our knowledge, this is the first case of primary thyroid angiosarcoma reported from Taiwan and the sixth Asian afflicted with primary thyroid angiosarcomas in the English literatures. The literature search in the PubMed database identified 58 cases who had histologically proven primary thyroid angiosarcomas. A preliminary analysis of epidemiological presentation, clinical features, immunohistochemical characters, and prognosis of primary thyroid angiosarcoma was proposed. The prognosis of this rare neoplasm is surprisingly favorable in comparison with that of its morphological similar, the anaplastic thyroid carcinoma. The use of a comprehensive panel of immunohistochemical stains, including at least two endothelial markers (especially CD31 and ERG) and PAX-8, in combination with thorough light microscopic examination may assist in the discrimination between these two tumors.
Total rupture of hydatid cyst of liver in to common bile duct: a case report
Authors: Hassan Robleh, Fahmi Yassine, Khaiz Driss, Elhattabi Khalid, Bensardi Fatima-Zahra, Berrada Saad, Lefriyekh Rachid, Fadil Abdalaziz, Zerouali Ouariti Najib
Journal: Pan Afr Med J (2014)
Keywords: common bile duct (cbd), hydatid liver cyst, rupture, jaundice
MeSH terms: Common Bile Duct / parasitology, Common Bile Duct / pathology, Echinococcosis, Hepatic / pathology, Rupture, Spontaneous / pathology, Case Reports, Cholecystectomy, Common Bile Duct / surgery, Drainage, Echinococcosis, Hepatic / complications, Echinococcosis, Hepatic / therapy, Humans, Male, Middle Aged, Rupture, Spontaneous / parasitology, Rupture, Spontaneous / therapy

Rupture of hydatid liver cyst into biliary tree is frequent complications that involve the common hepatic duct, lobar biliary branches, the small intrahepatic bile ducts,but rarely rupture into common bile duct. The rupture of hydatid cyst is serious life threating event. The authors are reporting a case of total rupture of hydatid cyst of liver into common bile duct. A 50-year-old male patient who presented with acute cholangitis was diagnosed as a case of totally rupture of hydatid cyst on Abdominal CT Scan. Rupture of hydatid cyst of liver into common bile duct and the gallbladder was confirmed on surgery. Treated by cholecystectomy and T-tube drainage of Common bile duct.
Matrix-producing metaplastic breast carcinoma - a rare tumor with heterologous elements
Authors: Sharma Shruti, Fouzia Siraj
Journal: Ger Med Sci (2017)
Keywords: chondromyxoid areas, matrix-producing carcinom, metaplastic breast carcinoma
MeSH terms: Breast / pathology, Breast Neoplasms / metabolism, Breast Neoplasms / pathology, Carcinoma, Ductal, Breast / metabolism, Carcinoma, Ductal, Breast / pathology, Case Reports, Female, Humans, Keratins / metabolism, Metaplasia / metabolism, Middle Aged, Mucin-1 / metabolism, S100 Proteins / metabolism, Mucin-1, S100 Proteins, Keratins

Metaplastic breast carcinomas are ductal carcinomas that undergo metaplasia into non-glandular growth patterns. They are very rare and account for less than 1% of all invasive breast carcinomas. Matrix-producing carcinoma is an extremely rare and aggressive subtype of metaplastic breast carcinoma that is characterized by a ductal carcinomatous component with direct transition to areas with cartilaginous/osseous differentiation without an intervening spindle cell element. It has a better prognosis than metaplastic carcinoma. Even though these tumors are composed of a mixture of infiltrating ductal carcinomas and areas of heterologous stroma, each of which behaves aggressively individually, these composite tumors have a better 5-year survival rate with rare nodal metastasis. Immunohistochemically, they are positive for keratin, epithelial membrane antigen and S100. The tumor, which is matrix-producing, is S100-reactive and nonreactive for cytokeratin. They are usually hormone receptor-negative. The average age of these patients is approximately 58 years. Since these tumors are usually triple-negative, chemotherapy after surgery is the mainstay of therapy, using either mastectomy or local excision. Our report highlights this rare entity in a 55-year-old female patient with matrix-producing metaplastic breast carcinoma. Its distinctive histological features and peculiar clinical behavior warrants clear knowledge about this unique entity.
Persistent Corneal Decompensation due to Anterior Dislocation of Soemmering Ring Cataract
Authors: Travis Peck, Shruti Aggarwal, Sandra Johnson
Journal: Case Rep Ophthalmol Med (2017)
MeSH terms: Case Reports

Purpose:
We present a case of a patient with Soemmering ring after cataract surgery and a potential complication that can arise as a result of its presence.
Observations:
A patient with history of ruptured globe status after repair and lensectomy, complicated by aphakic secondary open angle glaucoma, was referred for management of second injury to the same eye. This injury resulted in Soemmering ring dislocation into the anterior chamber. The cortical material caused a significant increase in intraocular pressure and corneal decompensation. Surgical removal of the Soemmering ring and Ahmed glaucoma tube implant was performed with control of intraocular pressures; however corneal edema could not be reversed.
Conclusions and importance:
This case report illustrates the serious consequences that can be caused by Soemmering rings without early surgical intervention. Care must be taken to completely remove cortical material during cataract surgery to prevent their formation.
Long-Term Intravitreal Ranibizumab as a Potential Additional Risk Factor for Neurodegeneration in Parkinson's Disease: A Case Report
Authors: Gianluca Trifirò, Ilaria Marcianò, Paola M Cutroneo, Edoardo Spina, Eliana Mirabelli, Costantino J Trombetta, Francesca Morgante
Journal: Front Pharmacol (2018)
Keywords: parkinson’s disease, anti-vascular endothelial growth factors, intravitreal, neurodegeneration, ranibizumab

In November 2012, a 72-year old patient was diagnosed with left eye wet age-related macular degeneration. The patient received three monthly intravitreal injections of ranibizumab, with complete resolution of retinal hemorrhage and edema and reinstatement of visual acuity. In May 2015, symptomatic relapse was detected. The patient was again treated with intravitreal ranibizumab, with overall six injections till the end of February 2016. In May 2016, the patient complained of left hand resting tremor, bradykinesia, and postural rigidity of head and trunk. A diagnosis of clinically established PD was made based on new criteria of the Movement Disorders Society. Single Photon Emission Computerized Tomography of the Dopamine Transporter with (123I) ioflupane documented a low Dopamine Transporter (DAT) uptake mostly in the right striatum. Due to the documented protective role of vascular endothelial growth factor (VEGF) on the dopaminergic neurons, intensive intravitreal injections of the anti-VEGF agent ranibizumab may have played as an additional risk factor accelerating the neurodegeneration process related to PD and the onset of the related clinical signs and symptoms.
Spontaneous severe haemoperitoneum in the third trimester leading to intrauterine death: case report
Authors: Harriet Williamson, Radha Indusekhar, Alexander Clark, Ismail M Hassan
Journal: Case Rep Obstet Gynecol (2011)
MeSH terms: Case Reports

Spontaneous haemoperitoneum during pregnancy is a rare but potentially catastrophic cause of acute abdominal pain. A healthy 37-year-old primigravida presented with acute abdominal pain and hypovolaemic shock at 37-weeks gestation. An emergency caesarean section was indicated on the clinical suspicion of placental abruption. However, an ultrasound scan confirmed the absence of a fetal heartbeat, and, in light of the mother's haemodynamic stability, a vaginal delivery was deemed most appropriate. Subsequent imaging, due to deterioration over the following 24-hours, revealed a large heterogenous haematoma within the pelvic cavity, which was later found to be caused by severe pelvic endometriosis. Despite fertility problems associated with severe endometriosis, advanced assisted reproductive technology enables more of these patients to become pregnant, highlighting the need to be aware of this rare complication in pregnancy.
Bilateral femoral insufficiency fractures likely related to long-term alendronate therapy
Authors: Ravindra Gudena, Jason Werle, Kelly Johnston
Journal: J Osteoporos (2011)
MeSH terms: Case Reports

Osteoporosis-related fractures are a major public health problem and one in two women and one in four men are affected with osteoporosis-related fractures. Alendronate (Fosamax) is one of the first bisphosphonates used to treat osteoporosis effectively. Recently, however, there is a concern regarding long bone insufficiency fractures related to long-term alendronate therapy. We report a case of bilateral femoral insufficiency fractures likely related to long-term alendronate therapy, the classic symptoms, signs, and treatment of these fractures.
Deep inspiration breath-hold (DIBH) technique applied in right breast radiotherapy to minimize liver radiation
Authors: L Rice, S Harris, M M L Green, P M Price
Journal: BJR Case Rep (2015)
MeSH terms: Case Reports

A right-sided breast cancer patient (stage T1N0M0) was referred for post-surgical radiotherapy to minimize risk of local tumour recurrence. During the CT simulation and intensity-modulated radiotherapy planning process undertaken in free breathing, it was apparent that an unusually large volume of normal liver tissue (134 cc) was in the high-dose region of the tangential radiation field. This raised concern for risk of liver side effects and was considered suboptimal for this excellent prognosis patient. A deep inspiration breath-hold (DIBH) technique using three-dimensional (3D) surface monitoring-primarily developed and applied in left breast cancer to displace cardiac tissue from the target field-was investigated to determine potential benefit to optimize radiotherapy delivery. Resimulation of DIBH resulted in considerable displacement of the liver, reducing the volume of liver tissue in the target field by 63% (to 50 cc) and the mean liver dose by 46% (to 2.6 Gy). As the patient was deemed suitable for the DIBH technique, treatment was delivered according to the DIBH plan. A total of 40.05 Gy in 15 fractions was successfully delivered in the DIBH position using a technique that incorporated 3D body surface imaging with automated radiation beam hold-off when out of tolerance. Additional advantages were optimal set up without extensive immobilization and the elimination of respiratory motion. Acute mild skin erythema was the only side effect experienced-no liver sequalae were experienced by the patient up to 6 months after treatment. DIBH treatment may improve liver sparing in other similar right breast cancer patients.
Penile epidermal inclusion cyst
Authors: M El-Shazly, A Ghobashy, A Allam, T Alenezy, N Alenezy, E Yordanov, B Hathout, R Albunnai
Journal: Case Rep Urol (2012)
MeSH terms: Case Reports

We report a case of epidermal inclusion cyst in a 32-year-old male. This was a complication of circumcision that was neglected over years to form stones and urethrocutaneous fistula. Complete excision of the cyst and repair of the fistula were performed successfully. Histopathological examination confirmed our diagnosis.
HELLP! The Novel Use of Continuous Renal Replacement Therapy and Nitric Oxide in the Treatment of Acute Respiratory Failure in HELLP Syndrome
Authors: Obteene Azimi-Ghomi, Glenn Miller, Carlos Guida, Adrian Marimon, Dessislava Boneva, Mark McKenney
Journal: Case Rep Crit Care (2021)
MeSH terms: Case Reports

HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome is a rare but serious complication of pregnancy characterized by hemolytic anemia, elevated liver enzymes, and thrombocytopenia. It occurs in <1% of all pregnancies with 70% of cases developing before delivery, the majority occurring between the 27th and 37th weeks of gestation. Respiratory failure seen in HELLP syndrome clinically and radiographically appears similar to acute respiratory distress syndrome (ARDS), with presence of bilateral pulmonary opacities on imaging as well as persistent hypoxemia requiring elevated ventilator requirements. It is seen to complicate 3-10% of cases of HELLP syndrome. Pulmonary complications are theorized to occur as sequelae of the proinflammatory state induced by HELLP syndrome with endothelial dysfunction and subsequent microangiopathic hemolysis and thrombocytopenia. A robust cytokine inflammatory response similar to ARDS is seen, resulting in noncardiogenic pulmonary edema due to vasoplegia and capillary leak syndrome. We present a case of a 27-year-old uniparous female with a term pregnancy complicated by HELLP syndrome who developed respiratory failure requiring mechanical ventilation. Early CRRT and nitric oxide therapy were initiated, with the patient experiencing clinical and radiological improvement of respiratory function within 48 hours. We document the novel treatment of our patient's acute respiratory failure with CRRT and nitric oxide and delve into the literature regarding its use in acute respiratory failure and ARDS in association with HELLP syndrome.
Percutaneous aspiration embolectomy of superior mesenteric artery using a 5MAX ACE reperfusion catheter
Authors: Hironori Kikuchi, Ichiro Ikushima, Hajime Ohta, Shunrou Uchinokura, Gou Irisa, Toshinori Hirai, Yasuyuki Yamashita
Journal: BJR Case Rep (2016)
MeSH terms: Case Reports

Acute mesenteric ischaemia is a rare abdominal emergency that commonly results in bowel infarction and has a very high mortality rate. Therefore, prompt recognition and treatment are crucial for a successful outcome. A thrombectomy for embolism in the mid portion of the main trunk of the superior mesenteric artery (SMA) is proposed. A near-complete thrombi removal from the main trunk of the SMA was achieved by using a 5MAX ACE reperfusion catheter, which was designed for treating cerebral embolism. This is the first report describing the treatment of acute mesenteric ischaemia using this catheter. Percutaneous aspiration embolectomy with this catheter is a useful modality for recanalization of embolic occlusion of not only the cerebral artery but also the SMA.
A Rare Clinical Case: Giant Splenic Artery Aneurysm and Its Successful Endovascular Treatment
Authors: Alptekin Yasim, Hakan Kara, Erdinc Eroglu
Journal: Case Rep Vasc Med (2017)
MeSH terms: Case Reports

Objectives:
The true giant splenic artery aneurysms are extremely rare and can be fatal. Although surgical approach has been the standard of care in the past, endovascular methods gained more importance in recent years.
Background:
We describe a case with true giant splenic artery aneurysm, treated with endovascular approach.
Methods:
A 68-year-old female patient with abdominal pain admitted to our clinic had true splenic artery aneurysm (14 × 10 × 9 cm). We decided on endovascular treatment using vascular plug and the treatment was performed successfully.
Conclusions:
Due to high mortality and morbidity in open surgery, endovascular treatment of giant splenic artery aneurysm is a better treatment option.
Clinical and immunologic correlates of response to PD-1 blockade in a patient with metastatic renal medullary carcinoma
Authors: Kathryn E Beckermann, Pradeep C Jolly, Ju Y Kim, Jennifer Bordeaux, Igor Puzanov, W Kimryn Rathmell, Douglas B Johnson
Journal: J Immunother Cancer (2017)
Keywords: nivolumab, pd-1, renal cell carcinoma, renal medullary carcinoma
MeSH terms: Carcinoma, Medullary / therapy, Kidney Neoplasms / therapy, Programmed Cell Death 1 Receptor / immunology, Tumor Microenvironment / drug effects, Case Reports, Adult, Antibodies, Monoclonal / administration & dosage, Carcinoma, Medullary / genetics, Carcinoma, Medullary / immunology, Carcinoma, Medullary / pathology, Female, Humans, Kidney Neoplasms / genetics, Kidney Neoplasms / immunology, Male, Neoplasm Metastasis, Nivolumab, Programmed Cell Death 1 Receptor / antagonists & inhibitors, Programmed Cell Death 1 Receptor / genetics, Tumor Microenvironment / immunology, Antibodies, Monoclonal, PDCD1 protein, human, Programmed Cell Death 1 Receptor, Nivolumab

Background:
Renal medullary carcinoma (RMC) is a rare kidney tumor that occurs in adolescent and young adults, typically in association with sickle cell trait. RMC exhibits rapid disease progression, frequent metastases at diagnosis, and dismal clinical outcomes. Currently available therapies, including cisplatin-based combination chemotherapy, multi-tyrosine kinase, and mTOR inhibitor strategies demonstrate either transient responses or minimal activity. Therefore, further molecular characterization and additional treatment strategies are urgently needed in this aggressive disease. The role of immune system surveillance and responsiveness to anti-PD-1 therapies in RMC are completely unexplored.
Case presentation:
A 29 year old male with sickle cell trait presented with painless hematuria that ultimately resulted in a diagnosis of RMC. He underwent total nephrectomy and adjuvant cytotoxic chemotherapy with carboplatin, gemcitabine, paclitaxel, and bevacizumab. As is common in this aggressive form of kidney cancer he recurred with biopsy proven lymph node metastasis. He was started on checkpoint inhibitor therapy with nivolumab that inhibits program cell death protein 1 (PD-1), and on his first follow-up imaging he was found to have a partial response that on subsequent scans ultimately resulted in a complete response lasting greater than nine months. In this report, we present a patient with metastatic RMC who exhibited a clinical response to nivolumab, as well as the genetic and immunologic correlates of the pre-treatment tumor. Provocatively, robust immune infiltrate and expression of immune checkpoints were observed, despite the presence of a low mutation burden.
Conclusions:
Here, we report the first case of immune microenvironment profiling and response to anti-PD-1 in a patient with RMC to our knowledge. This case suggests that anti-PD-1 based therapies may have clinical activity in RMC.
Postoperative thrombotic thrombocytopenic purpura after aortofemoral bypass
Authors: Naba R Mainali, Madan R Aryal, Madan Badal, Vijaya R Bhatt, Richard Alweis
Journal: J Community Hosp Intern Med Perspect (2013)
Keywords: aortofemoral bypass, plasmapheresis, postoperative thrombotic thrombocytopenic purpura
MeSH terms: Case Reports

Thrombotic thrombocytopenic purpura (TTP) is uncommon in the postoperative setting, even more so after vascular surgery. We present a case of thrombocytopenia after aortofemoral bypass, which highlights the importance of a high index of suspicion for postoperative TTP to avoid life-threatening consequences.