bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical management for hepatocellular carcinoma with concurrent portal vein tumour thrombus and bile duct tumour thrombus: a case report
Authors: Pham Anh The , Duc Vu Trung , Nguyen Thinh Duy , Truong Cuong Manh , Pham Anh Viet , Quang Vu Toan 
Published: June 2024

Introduction:
Hepatocellular carcinoma (HCC) associated with concurrent portal vein tumour thrombus (PVTT) and bile duct tumour thrombus (BDTT) is sporadic and presents a puzzle to management with miserable prognostic.

Case presentation:
The authors reported a case of HCC in the right liver with PVTT involving the right portal vein and BDTT developing in the common bile duct, detected in a 43-year-old man. The patient was admitted to our hospital with abdominal pain in the right hypochondrium and obstructive jaundice. Imaging studies showed a large mass in the right liver with invasion of the first branch of the portal vein and dilated intrahepatic bilateral bile ducts. A liver biopsy confirmed the diagnosis of hepatocellular carcinoma. Right hepatectomy plus thrombectomy en bloc with extrahepatic bile duct resection was performed. Subsequently, the patient received a postoperative adjuvant transarterial chemoembolization (PA-TACE) 1 month after surgery.

Discussion:
In the present case, the authors were not aiming for curative treatment by aggressive management but for palliative treatment. At the time of diagnosis, the tumour had already invaded the portal bifurcation. Hepatectomy plus thrombectomy en bloc with resection of common bile duct can remove biliary obstruction caused by BDTT, optimize portal flow by eliminating PVTT, and reduce the tumour burden, consequently improving the quality of life and liver function. Then, PA-TACE takes care of microfoci left behind by the surgery, which may prolong survival time.

Conclusion:
An aggressive therapeutic strategy should be considered in exceptional cases for resectable HCC with PVTT and obstructive BDTT. However, the follow-up period remains limited. A longer duration of observation is necessary to definitively assess the surgery’s impact on patient’s recurrence and survival time.
Management of chylothorax after retrocrural lymphadectomy in a patient with ovarian cancer: a case report
Authors: Wu Qingyun , Huo Yanqin , Zhang Fang , Gao Fufeng , Wu Jianlei , Chen Liang 
Published: June 2024

Introduction and importance:
With the widespread use of positron emission tomography and computed tomography (PET/CT), a significantly greater proportion of patients with advanced ovarian cancer (OC) are now diagnosed with superior renal-vein lymph node metastases involving retrocrural and mediastinal nodes. To the authors’ knowledge, retrocrural lymphadenectomy has not yet been reported in patients with OC. The authors performed retrocrural lymph node resection in a patient with ovarian cancer.

Case presentation:
A 64-year-old woman with ovarian cancer who had not undergone surgery upon initial diagnosis was admitted to the authors’ hospital because tumour markers increased during bevacizumab maintenance therapy. PET/CT imaging revealed adnexal masses and multiple metastases in pelvic, para-aortic, retrocrural, and mediastinal lymph nodes. Reduction surgery was performed, and retrocrural lymph nodes were excised. However, the patient’s postoperative course was complicated by a chylothorax. Because of the failure of conservative treatment, interventional embolization was performed, but failed to obstruct lymphatic vessels. The patient underwent reoperation. A fistula was located where Hem-o-lock clips penetrated the pleura, clearly indicating the injury site, which was then sutured and embedded in the surrounding diaphragmatic tissue and filled with gel sponge. The patient recovered from chylous leakage postoperatively. She later underwent chemotherapy and targeted maintenance therapy.

Clinical discussion:
The authors may have injured the communicating branch of the thoracic duct posterior to the diaphragm during the first operation and did not ligate it. The accumulated chylous fluid finally penetrated through the weak point on the pleura and led to chylothorax 3 days later. If conservative treatment or interventional embolization are unsuccessful, surgical treatment should be selected in time.

Conclusion:
The location of the retrocrural lymph node at the anastomosis of the chylous cistern and the thoracic duct may pose a significant risk of chylous leakage as a complication of lymphadenectomy. Full exposure of the surgical field and thorough ligation of the lymphatic vessels may lead to successful superior renal-vein lymphadenectomy.
Primary bladder B-cell lymphoma: a rare case report and review of literature
Authors: Dominic Jerry Lorren , Ganduboina Rohit , Dutta Palak , Gubran Khalid , Toussaint Michael Lord , Isrow Derek Michael 
Published: June 2024

Introduction and importance:
Primary bladder lymphoma accounts for a mere fraction of vesical tumours and extranodal lymphomas, which mostly affect women. IGH-BCL2 translocation, which occurs in 80–100% of Western follicular variants but only 60% in Asian communities, must be studied to determine its effects on prognosis and treatment. This study analyses and compares relevant literature and data for the authors’ case report.

Case presentation:
The authors report a 69-year-old Caucasian female with one gross haematuria episode and no smoking history. Computed tomography (CT) showed a bilateral massive intraluminal mass left ureterovesical junction, hydronephrosis, and hydroureter.

Clinical discussion:
Following the removal of a massive transurethral urinary bladder tumour, histological examination revealed lymphoma cells positive for IRTA and LMO2 but negative for IGH-BCL2. After these analyses, the patient received 3 weeks of 30 Gy/15 f IMRT/IGRT. Comparisons were made to previous case reports’ histopathology.

Conclusion:
The current case report emphasizes the rarity of primary bladder lymphoma and the absence of the IGH-BCL2 fusion gene. Following the successful administration of 30 Gy of radiation therapy, the patient’s prognosis improved. The report emphasizes clinical vigilance and timely management while also urging further investigation.
Obturator hernia: a persisting clinical diagnostic challenge – a case report
Authors: Bhujel Sushim , Adhikari Sanjit , Pant Prashant , Pandey Anish , Baral Bishant R. , Chhetri Suchit T. 
Published: June 2024

Introduction:
The presentation of a strangulated obturator hernia is rare, with it accounting for less than 0.04% of all hernias. Delay in presentation and diagnosis results in complications like bowel ischemia, necrosis, perforation, and peritonitis, thereby increasing morbidity and mortality.

Case presentation:
The authors report the case of an 85-year-old multiparous woman who presented with a 3-day history of abdominal pain and vomiting. Upon examination, she exhibited hypotension, altered sensorium, and a distended abdomen with visible peristalsis. An abdominal pelvic computed tomography scan confirmed the diagnosis of ‘intestinal obstruction secondary to an incarcerated obturator hernia’. Subsequently, a lower midline laparotomy was performed, successfully reducing the bowel and repairing the hernial orifice. The patient was discharged on the fourth postoperative day, and there has been no hernia recurrence as of her 3-month follow-up.

Discussion:
The presentation of a strangulated obturator hernia can be elusive. During clinical examination, both the Howship–Romberg sign and the Hannington-Kiffs sign tests may be negative. Laparoscopic obturator hernia repair has been shown to reduce hospital stay and morbidity. A midline laparotomy has the advantage of easy manual reduction, minimizing bowel trauma, accurately accessing the bowel, and facilitating bowel resection.

Conclusion:
Obturator hernias constitute rare subtypes of abdominal hernias. They typically occur in older women, and patients often present with poor functional status and multiple comorbidities. The clinical diagnostic tests are uncertain, even in patients with a high index of suspicion. Timely diagnosis and appropriate surgical management are crucial for a favorable outcome.
Hirayama disease successfully treated by posterior fixation: a case report
Authors: Kayastha Sabik R. , Pandey Archana , Pandey Abhishek , Keshari Suraj , Pandey Ajit 
Published: June 2024

Introduction and importance:
Hirayama disease is a rare form of motor neuron amyotrophy that usually presents with weakness and atrophy of the distal upper extremities in young males. It is believed that it is caused by spinal cord compression during neck flexion because of the widening of the posterior extradural space. This case has been brought to attention due to its extraordinary rarity, serving as an educational tool for medical professionals and to advocate for surgical intervention when deemed necessary.

Case presentation:
The authors present a case of a young male in his 20s who was diagnosed with Hirayama disease, had weakness and atrophy in both of his upper limbs, and has been successfully treated by posterior fixation at C4, C5, and C6 with lateral mass screws.

Clinical discussion:
The majority of cases stabilize after 2–3 years of progression; therefore, cervical collars are generally sufficient for therapy. However, in certain serious cases with progression even after that time, surgical intervention is an option. Because this is such an uncommon incidence, surgical therapy has not been explored and is controversial.

Conclusion:
The use of posterior fixation at C4, C5, and C6 with lateral mass screws as a therapy for Hirayama disease may be regarded as a successful approach.
Tigecycline-induced pancreatitis in a patient with recurrent malignancy: a case report and literature review
Authors: Arafat Hasan , Sadaqa Dana , Sabateen Ali 
Published: June 2024

Introduction and importance:
Drug-induced pancreatitis is an important health issue that makes a minority of causes of acute pancreatitis. Tigecycline-induced pancreatitis is a rare condition with poorly understood mechanism and has a small incident compared to other causes of pancreatitis

Case presentation:
The authors present a case of a 39-year-old female patient with acute pancreatitis. Tigecycline was the suspected culprit by exclusion. The patient was managed by keeping her nill per os, rehydration, pain management and discontinuation of the drug. The patient improved gradually.

Clinical discussion:
Tigecycline-induced acute pancreatitis is a rare but known complication that is mostly seen in patients with chronic renal insufficiency combined with high dose of administration. Onset is usually within 14 days of initiation. Discontinuation of the drug is the most effective intervention in addition to supportive management.

Conclusion:
Acute pancreatitis should be suspected in any patient presenting with vomiting, abdominal pain and acidosis while on tigecycline. Monitoring of amylase and lipase can be beneficial especially in those with chronic renal insufficiency or those receiving a high dose.
Gallbladder fossa lymphangioma encasing the common bile duct: a case report and review of the literature
Authors: Samidoust Pirouz , Moayerifar Maziar , Gholipour Mahboobeh , Poursadrolah Selvana , Zamani Athar , Moayerifar Mani 
Published: June 2024

Introduction:
Lymphangiomas are rare low-flow lymphatic vessel malformations mostly diagnosed in childhood. Among the abdominal lymphangiomas, the gallbladder lymphangioma is a rare presentation, and only a few cases have been reported till date, of which majority were cystic lymphangiomas.

Case presentation:
The authors present a case of a 48-year-old female with abdominal pain and normal physical examination and laboratory findings. On the performed imaging, a multiloculated cystic lesion, located in the gallbladder fossa, was found. The patient underwent open cholecystectomy, and surprisingly, the cyst extended to the common bile duct, which was separated cautiously. The cyst was resected, and the histopathological findings confirmed cystic lymphangioma.

Conclusion:
The cystic lymphangioma of the gallbladder can be asymptomatic, although most of the literature has reported abdominal pain. The diagnosis of lymphangioma is complicated, especially when intra-cystic hemorrhage happens. Ultrasonography, computed tomography, and magnetic resonance imaging are usually performed. The surgical excision of the cyst and the gallbladder is the treatment of choice. Although bile duct involvement is extremely rare, it should be considered during the surgery.
A case of multiple myeloma misdiagnosed as seronegative rheumatoid arthritis: a rare case report
Authors: Kudsi Maysoun , Drie Tasneem , Haidar Ghina , Hodaifa Yara , Tarcha Raghad 
Published: June 2024

Introduction:
Multiple myeloma (MM) is a malignant plasma cell proliferation producing large numbers of monoclonal immunoglobulins. Typical MM symptoms include anemia, bone pain, hypercalcemia, and renal failure. Atypical presentations like joint involvement were rarely reported in the literature and may cause significant delays in treatment and adverse outcomes.

Case presentation:
The authors report a case of a 54-year-old female who presented with symmetrical polyarthritis and was misdiagnosed with rheumatoid arthritis. The diagnosis of MM was made after failing many treatments of rheumatoid arthritis and with further laboratory tests and procedures.

Conclusion:
This rare manifestation of MM carries a diagnostic challenge and causes a significant delay in treating such patients. Here, the authors report this unusual initial presentation with a review of several cases in the literature describing similar presentations.
Deciphering the molecular mechanism of long non-coding RNA HIF1A-AS1 regulating pancreatic cancer cells
Authors: Zhang Jiaxin , Sun Yifeng , Ma Jiahui , Guo Xiang 
Published: June 2024

Background:

HIF1A-AS1, an antisense transcript of HIF1α gene, is a 652-bp LncRNA that is globally expressed in multiple tissues of animals. Recent evidence indicated that HIF1A-AS1 was involved in tumorigenesis of several types of cancer. However, the role of lncRNA in PC has not been reported, and the molecular mechanism remains elusive.

Results:
In order to investigate the role of HIF1A-AS1 in PC, it was overexpressed in some PC cell lines (PANC-1, PATU8988 and SW1990), and a series of experiments including cell viability detection, flow cytometry, transwell migration, clone formation and wound healing were performed. Functionally, the results indicated that overexpression of HIF1A-AS1 could greatly inhibit proliferation and migration and promote apoptosis of PC cells. Moreover, the isobaric tags for relative and absolute quantification (iTRAQ) quantitative proteomics analysis was implemented to explore the underlying mechanism and the results indicated that OE of HIF1A-AS1 globally affected the expression levels of multiple proteins associated with metabolism of cancer. At last, the network analysis revealed that most of these differentially expressed proteins (DEPs) were integrated and severed essential roles in regulatory function. In view of this, we guessed HIF1A-AS1 overexpression induced the dysfunction of metabolism and disordered proteins’ translation, which may account for its excellent tumour suppressor effect.

Conclusions:

HIF1A-AS1 altered the cell function of PC cell lines via affecting the expression of numerous proteins. In summary, HIF1A-AS1 may exhibit a potential therapeutic effect on PC, and our study provided useful information in this filed.
Primary spinal oligodendroglioma with intracranial extension: a case report
Authors: Bashour George , Ismaiel Nahar , Ebrahim Yousef , Ibrahim Manar , Deeb Tala , Khatab Karam , Ali Mohammad S. , Alshehabi Zuheir 
Published: June 2024

Introduction:
Primary spinal cord oligodendrogliomas (PSO) are sporadic tumors that arise from oligodendrocytes in the central nervous system (CNS). They can affect adults and children and make up about 2% of all intramedullary (IM) spinal tumors. Here, the authors present the second case in the literature of a primary spinal oligodendroglioma with intracranial extension.

Presentation:
A 28-year-old right-handed female presented to our emergency room severely malaised with left-sided hemiparesis, numbness, tingling, and urinary retention with positive Babinski and negative Hoffmann. MRI showed a widespread heterogeneous mass extending from the medulla to C7 with syringomyelia inferior to the mass. The mass was removed surgically, and her neurological condition improved rapidly. The gross, pathological exams, and immunohistochemistry confirmed the diagnosis of oligodendroglioma.

Discussion:
Up until 2017, there have been 60 documented cases of PSO in the literature and we have found two more cases in our search between 2017 and 2023. Also, there has been only one case recorded with an intracranial extension, making our case the 63rd PSO case and the second one with cranial extension.

Conclusion:
The golden standard for imaging is MRI. Surgical excision is the main treatment in the literature. Single-stage laminectomy showed promising results and surgical resection was the critical intervention to which the patient responded. This matches what was stated in the literature that surgery is the primary mode of treatment in PSO patients.
A rare hemoglobinopathy duo: Hb Adana×Hb SEA in a 1-year-old patient – a case report and a brief literature review
Authors: Faheem Youmna , Baroudi Mustafa M. , Emad Al Saddik Samia , John Steffi , Hafez Wael 
Published: June 2024

Introduction and importance:
Alpha thalassemia, resulting from nondeletional mutations, typically presents a more severe clinical manifestation compared to deletional mutations. Severe outcomes, such as hydrops fetalis, are associated with two specific nondeletional mutations. Therefore, DNA-based investigation is crucial for suspected carriers exhibiting subtle hematological abnormalities to facilitate proper diagnosis and effective family counseling.

Case presentation:
In this report, the authors describe a phenotypically normal 1-year-old girl with a rare and unique alpha-thalassemia genotype due to the presence of Hb Adana, a nondeletional alpha-chain mutation compounded with Hb SEA, an alpha-globin gene deletion.

Clinical discussion:
Mutations determine the clinical manifestations of alpha-thalassemia. DNA testing is recommended for suspected carriers with relatively small hematological abnormalities, for precise diagnosis and family counseling. To provide clinicians with a reference for diagnostic assessment, the authors established a genotype-phenotype correlations based on reported cases of Hb Adana following an exhaustive literature review. Being interested in determining which ethnicities and genotypes are associated with a higher risk of complications, including hydrops fetalis and transfusion dependence, the authors formalized a diagnostic evaluation guide and a guide for early screening to improve outcomes.

Conclusion:
Precise genetic evaluation is important for the diagnosis of alpha thalassemia. Hematologists play a critical role in managing these disorders, understanding genotype-phenotype correlations, and highlighting the significance of genetic counseling for high-risk patients. Extensive studies on these various genophenotypes are required to improve the diagnosis and prognosis of such medical conditions and advocate preventative strategies.
A rare variation of common hepatic artery identified during pancreaticoduodenectomy: a case report and literature review from Syria
Authors: Saiouf Yaman , Nayouf Oubai , Aldairi Omar , Durra Ahmad , Alshiekh Ali , Alkurdi Muhammad Fadi , Hamed Hamoud 
Published: June 2024

Introduction:
It is common for the liver to be supplied blood by a hepatic artery branching off the coeliac trunk. Occasionally, a replaced common hepatic artery (RCHA), emerges from the superior mesenteric artery (SMA), can supply the liver in 1.5–4.0% of cases. Computed tomography (CT) angiography is a highly accurate method for identifying arterial anomalies, which may remain undetected until the time of surgery, leading to unexpected complications.

Case presentation:
A 53-year-old male exhibiting symptoms of decreased appetite, weight loss, vomiting, and altered sclera, urine, and stool colour, underwent a contrast-enhanced CT scan revealing biliary tract dilatation and pancreatic abnormalities, leading to a pancreaticoduodenectomy. During the surgery, an uncommon arterial finding—CHA from SMA—was noted. Pancreatic cancer was confirmed. The patient was discharged a week post-surgery without issues, emphasizing perioperative care progress.

Discussion:
The authors’ study focused on the detection conditions of the same hepatic artery anomaly in eight cases reported between 2017 and 2023. In two of them the anomaly was discovered in cadaver by routine autopsy. In three cases, this variation was identified before the surgery, but in three other cases it wasn’t detected until the surgical procedure. In the authors’ case, due to multiple reasons, the anomaly remained undetectable until the surgery.

Conclusion:
This study underscores the importance of thorough preoperative evaluation to grasp vascular variations for better patient care. Also, a noteworthy observation in our case is that the surgeon identified an expanded hepatic vessel, prompting further investigation into this anomaly.
Massive cystic falcine meningioma presented with slight symptoms: a case report
Authors: Hassan Mostafa , Salman Iyas , Salman Ali , Tofan Sameer , Salman Issam 
Published: June 2024

Introduction and importance:
Meningiomas are the most common intracranial tumors while their presence with cysts is relatively low. In general, large ones usually present with severe symptoms and have a high recurrence rate even after total resection which is also difficult.

Case presentation:
The authors present a case of an elderly patient with a large Falcine meningioma associated with peritumoral cysts. The patient presented with mild symptoms despite the tumor’s significant size. Imaging studies revealed a large mass in the falcine region with peritumoral cysts. The patient underwent surgical resection of the tumor, which was completed without complications.

Clinical discussion:
The atypical presentation of this large Falcine meningioma with peritumoral cysts highlights the variability in clinical manifestations of these tumors. Despite the tumor’s size and the presence of peritumoral cysts, the patient experienced mild symptoms and recovered after relatively easy surgery challenging conventional expectations.

Conclusion:
The successful outcome of this case demonstrates that even large meningiomas can present with mild symptoms. Medical practitioners should not always link the tumor size to the severity of symptoms, recurrence rate, and complexity of surgery.