Case Review Research Articles

Primary non-Hodgkin lymphoma of the palatine tonsil: Case report and review of the literature

Primary non-Hodgkin lymphoma of the palatine tonsil: Case report and review of the literature

Use of Preoperative Spinal Angiography in Severe Spinal Deformity Patients Who Require Thoracic 3 Column Osteotomy: A Case Series and Review of the Literature.

Three-column osteotomy (3CO) offers substantial spinal deformity correction. Thoracic neurovascular bundle sacrifice is often required, and anterior spinal artery (ASA) perfusion can be compromised. Spinal angiography allows localization of variable ASA vascular contribution. This study's objective was to describe a series of patients who underwent preoperative spinal angiography and discuss the impact on surgical planning and execution of thoracic 3CO for deformity correction. Patients who underwent preoperative spinal angiograms and thoracic 3CO for deformity correction were reviewed. Preoperative, angiographic, and postoperative information was recorded. A literature review on preoperative spinal angiography in deformity surgery was performed. Eight patients were identified: single-level pedicle subtraction osteotomies (1), single-level vertebral column resections (2), and multilevel vertebral column resections (5). The average age was 40.0 years, and 75.0% were female. Thoracic scoliosis ranged from 0 to 105° preoperatively and 0 to 45.1° postoperatively. Thoracic kyphosis ranged from 29° to 120° preoperatively and 20.6° to 54.9° postoperatively. Twelve ASA supply vessels were identified bilaterally in 6 patients. Four patients had nontraditional ASA supply at T4 (1), T6 (1), and L2 (2), and 4 had multiple ASA feeders. Based on angiographic results, osteotomy site was changed (1), and neurovascular bundles were spared (2), a 37.5% rate of surgical plan alteration. There were no permanent neuromonitoring changes or postoperative neurologic deficits. No articles reported on using spinal angiography specifically for deformity surgery. Spinal angiography is low risk and provides critical information regarding ASA supply to potentially mitigate ischemic risk during neurovascular bundle takedown during thoracic 3CO. Further case series are warranted to evaluate the benefits in larger populations, but its clinical applications appear practical.

Autoimmune hepatitis presenting with recurrent fever and HBsAg positivity: A case report and review of the literature

Autoimmune hepatitis presenting with recurrent fever and HBsAg positivity: A case report and review of the literature

The probable progression of Epstein-Barr virus (EBV) to chronic active EBV/reactivation weakens the immune response and stimulates Cryptococcus neoformans infection, which invariably proves fatal: a case report and review of the literature

The probable progression of Epstein-Barr virus (EBV) to chronic active EBV/reactivation weakens the immune response and stimulates Cryptococcus neoformans infection, which invariably proves fatal: a case report and review of the literature

Autoimmune hepatitis presenting with recurrent fever and HBsAg positivity: A case report and review of the literature

Autoimmune hepatitis presenting with recurrent fever and HBsAg positivity: A case report and review of the literature

Changes in HER2 Amplification Status for Breast Cancer Patients After Immunohistochemistry Directed In Situ Hybridization.

The 2018 ASCO/CAP guidelines for HER2 testing for breast cancer implemented the addition of immunohistochemistry (IHC) directed in situ hybridization (ISH) recount to resolve equivocal results. The implementation of an additional 2+ IHC-directed ISH recount adds additional complexity to the testing workflow for an unclear impact on HER2 results. A retrospective review of all equivocal ISH cases (groups 2, 3, and 4) that underwent 2+ IHC-directed ISH, since the 2018 guidelines, which were finalized as either amplified or not amplified, was performed. HER2 group number and final HER2 amplification status frequently changed after IHC guided ISH assessment, which was due to significant changes in HER2/CEP17 ratio and average HER2 signal number per cell. Equivocal groups 2, 3, and 4 samples with a result of HER2 amplified after 2+ IHC-directed ISH counts were closer to the threshold for amplification on the original ISH count, yet their counts also increased significantly after IHC-directed count in comparison to those samples, which were not amplified. Groups 2 and 4 ISH counts significantly increased after IHC directed ISH for HER2/CEP17 ratio and HER2 signal number per cell. This study represents the most extensive examination of efforts to resolve equivocal HER2 ISH results, highlighting a significant shift in therapeutic options after IHC-guided ISH for a subset of breast cancer patients.

Female urethral diverticular carcinoma: a case report and review of the literature

ObjectiveTo investigate the etiology, clinical manifestations, treatment methods, and prognosis of urethral diverticulum cancer to enhance understanding of this disease.MethodsThis paper reports a case of urethral diverticulum cancer with “hematuria and dysuria” as the main clinical manifestations. The case is discussed in conjunction with relevant literature.ResultsThe patient initially presented to the gynecology department due to postmenopausal bleeding but was not diagnosed with the disease. Subsequently, the patient developed hematuria and dysuria and was referred to the urology department. MRI indicated urethral diverticulum-like changes with suspected tumorous lesions. Cystourethroscopic biopsy confirmed urethral diverticulum cancer. The patient underwent urethrectomy, and postoperative pathological diagnosis was poorly differentiated urothelial adenocarcinoma.ConclusionUrethral diverticulum cancer is a rare and highly aggressive malignant tumor of the urethra with a poor prognosis. The onset of urethral diverticulum cancer is concealed, and its clinical manifestations are nonspecific and diverse. Preoperative diagnosis is challenging, and imaging studies and cystourethroscopy are the primary preoperative diagnostic methods for urethral diverticulum cancer. Pathology and immunohistochemistry serve as the basis for confirmation of diagnosis. Currently, there is no unified treatment protocol for female urethral diverticulum cancer internationally. For female patients with urethral diverticulum cancer without distant metastasis, surgery remains the primary treatment. For patients with distant metastasis, a combination of surgery, chemotherapy, and radiotherapy may be considered.Genetic testing and targeted immunotherapy offer new approaches for future treatment.

Orbital emphysema and medial orbital wall fracture after nose-blowing: a case report and review of literature

Nose-blowing is commonly known as the harmless act of expelling nasal mucus by exhaling forcefully through the nose. We report a case of orbital emphysema in a 49-year-old female patient, who suffered from fractures of the medial orbital wall after forcefully blowing her nose. The patient presented to our emergency department with acute right sided periorbital swelling and pain as well as an unremarkable endoscopic examination of the nose. Prior to the event, a common cold with signs of acute sinusitis had been reported. A trauma to the eye was credibly denied, which is consistent with the medical imaging pattern. A CT-scan confirmed the diagnosis and showed air trapped into the orbit as well as multiple fractures of the lamina papyracea with displaced bone fragments. Visual acuity and extraocular muscle motility were intact. The patient was treated conservatively with prophylactic antibiotics and was instructed not to blow her nose. Follow-up examination after seven days showed a complete remission.

Chronic osteomyelitis with pathological fracture induced by Mycoplasma hominis infection: a case report and review of the literature

Mycoplasma hominis, commonly residing in the genitourinary tract, can cause rare extragenital infections, especially in immunocompromised individuals. This report details a case of chronic osteomyelitis with a pathological femur fracture in a 79-year-old woman. Despite a history of bone tuberculosis, the infection was identified as Mycoplasma hominis through culture and mass spectrometry, highlighting the diagnostic challenges due to the organism’s lack of a cell wall. This case underscores the necessity for advanced diagnostic methods and awareness of Mycoplasma hominis in non-urogenital infections.

Concomitant Myocardial Infarction and Stroke Managed With a Unique Approach: A Case Report and Review of Literature

Concomitant Myocardial Infarction and Stroke Managed With a Unique Approach: A Case Report and Review of Literature

Clinical Spectrum of Epstein Barr Viremia in Hematological Disorders: Case Series and Review of Literature

Clinical Spectrum of Epstein Barr Viremia in Hematological Disorders: Case Series and Review of Literature

Primary Ovarian Leiomyosarcoma: A Case Report and Review of the Literature

Primary Ovarian Leiomyosarcoma: A Case Report and Review of the Literature

Giant Solitary Fibrous Tumor of the Retropharyngeal Space: A Case Report and Review of the Literature.

Solitary fibrous tumor (SFT) is an uncommon spindle cell neoplasm, which generally arises from the pleura. There have been documented a number of extrapleural origins including the head and neck in the literature. It is emphasized to make a diagnosis in a rare location such as the retropharyngeal space. We present a case of a 54-year-old man diagnosed with giant solitary retropharyngeal SFT. Clinical symptoms were pharyngeal foreign body sensation and dysphagia associated with dyspnea. Physical examination showed a sizable submucosal mass under the posterior pharyngeal wall, which partially obstructed the upper aerodigestive tract. With radiologic images to evaluate the dimension and relationship with surrounding structures, the tumor was surgically removed en bloc via a transcervical approach. The histology and immunohistochemistry play a crucial role in differential diagnosis. Complete surgical excision is an alternative and curative strategy.

Fluorescence-Guided Surgery to Detect Microscopic Disease in Ovarian Cancer: A Systematic Review with Meta-Analysis

Abstract: Background: The objective in epithelial ovarian cancer is to reach maximal cytoreduction with no visible residual tumor. Tumor detection during cytoreductive surgery depends on visual inspection, palpation, or blind biopsy, methods that lack reliability for identifying microscopic disease. Although the importance of microscopic disease in epithelial ovarian cancer is controversial, it may harbor chemoresistant cells and explain the high recurrence rates. Fluorescence-guided surgery (FGS) is an emerging approach. However, the potential in ovarian cancer remains underexplored; the majority of the existing evidence pertains to gastrointestinal tumors and a limited group of ovarian cancer patients. Their comparative effectiveness is still uncertain. Objective: To systematically review and evaluate the role of fluorescence-guided surgical techniques in detecting microscopic disease in ovarian cancer and compare their efficacy to total peritonectomy. Data Sources: A systematic search was made in three databases (PubMed, Web of Science, and Embase). The search was conducted from 1975 to 2024, including randomized controlled trials, observational studies, and conference abstracts in the last 25 years. Study Selection: Clinical studies published in English involving ovarian cancer patients undergoing FGS or total peritonectomy were included. Case reports, reviews, animal studies, and studies involving mixed cancer populations without ovarian cancer-specific data were excluded. Two independent reviewers screened 631 studies, yielding 12 eligible studies for final analysis. Data Extraction and Synthesis: Data were extracted and synthesized in accordance with PRISMA and MOOSE guidelines, using random-effects models for independent analysis. Sensitivity, specificity, positive predictive value (PPV), and odds ratios (ORs) were grouped, accompanied by subgroup analyses based on the fluorescence agent employed. For quality assessment, we utilized the NIH quality tool. Main Outcome(s) and Measure(s): The primary outcome was the rate of change in surgical management due to fluorescence guidance or total peritonectomy. Secondary outcomes comprised lesion-level sensitivity, specificity, and PPV. Safety outcomes included adverse events associated with fluorescence agents. Results: There were 12 studies involving 429 ovarian cancer patients. FGS improved the detection of microscopic disease compared to standard visualization methods, with a pooled sensitivity of 0.77. Folate receptor-targeted agents had high sensitivity (84%) but low specificity (26%). Aminolevulinic acid (5-ALA) showed superior diagnostic accuracy with a sensitivity of 84% and a specificity of 96%. Total peritonectomy showed no significant advantage over FGS for detecting microscopic disease. The adverse events were mild, with no serious events reported. We observed a high heterogeneity across studies and methodologies. Conclusions and Relevance: Fluorescence-guided surgery utilizing fluorescence tracers demonstrates potential in improving the detection of microscopic disease and may change surgical management in epithelial ovarian cancer, particularly with 5-ALA. Variability in performance and limited data on survival outcomes necessitates additional research. Total peritonectomy does not offer further advantage in the detection of microscopic disease. Future trials should focus on standardizing methodology and evaluating the effects of microscopic disease removal on survival outcomes. Registration: The study was registered to PROSPERO as CRD42024578274.

Challenges Associated with Negative Pressure Pulmonary Oedema: A Case Report and Review

Challenges Associated with Negative Pressure Pulmonary Oedema: A Case Report and Review

Deep orbital puncture of the superior ophthalmic vein for embolization of indirect carotid-cavernous fistula: a case report, technical note and review of the current literature.

Carotid-cavernous fistulas (CCFs) are abnormal connections between the carotid artery and cavernous sinus, often causing ocular symptoms like chemosis, proptosis, and diplopia. Endovascular embolization is the preferred treatment, typically performed via the transfemoral transvenous route through the inferior petrosal sinus (IPS). However, we present a case and a systematic review of indirect CCF treated through deep orbital puncture of the superior ophthalmic vein (SOV) for embolization. We systematically revised the current literature on PubMed, Web of Science, and Embase, based on PRISMA guideline, concerning the deep orbital puncture of the SOV for embolization of indirect CCFs. Our systematic review identified only eight eligible studies encompassing 17 patients, ranging in age from 34 to 82 years, underscoring the rarity of this specific approach. The most frequently used trajectory directed the needle along the floor of the orbit towards the superior orbital fissure or orbital apex, and a variety of embolization materials were used in the studies. While the technique has been mentioned in the literature, our analysis indicates that it remains infrequently reported, with many cases lacking consistent procedural details. Furthermore, we present a case of a 63-year-old woman with imaging suggesting a CCF and compatible symptoms. A transorbital puncture of the SOV was performed. Embolization was successfully achieved with ethylene vinyl alcohol copolymer. The follow-up confirmed the resolution of the CCF without new neurological deficits and no new symptoms. This case highlights transorbital SOV puncture as a feasible and minimally invasive alternative for treating CCFs when conventional access is unsuccessful.

Hidden Trauma: An Analysis of the Identification of Contusions on Different Skin Tones.

While abrasions and lacerations are typically easily identified, darker pigmentation of the skin may obscure contusions. Forensic pathology literature shows a disproportionate number of illustrations of contusions on lighter skin tones compared to darker ones. Skin and soft tissue dissection is the most reliable method to confirm contusions.The authors seek to establish a correlation between skin tone and the visual identification of contusions, confirmed by soft tissue dissection. Additionally, they aim to determine the utility of specialized dissections for identifying contusions on different skin tones to identify cases that may benefit from such procedures.A review of cases from the Cook County Medical Examiner's Office from 2014 to 2024 was conducted. The office database was searched for deaths in custody, causes including "assault," and "child abuse." Autopsy photos were compiled into predissection and postdissection sets, reviewed for skin tone, visual identification of contusions, and final confirmation of soft tissue hemorrhage.Results found a negative association between skin color and accurate visual identification of contusions and determined that decedents with a skin tone of 7 or higher on the Massey-Martin scale may benefit from specialized dissections.

Hemolytic disease of fetus due to multiple alloantibodies (anti-D, anti-C, and anti-s) requiring intrauterine transfusions: A case report and review of Indian literature

Abstract Immune hemolytic disease of fetus (HDF) and newborn is a serious complication in pregnancy and is associated with perinatal mortality and morbidity. Intrauterine transfusion (IUT) is performed for the treatment of fetal anemia caused by red cell alloimmunization. Here, we present the case of a 28-year-old multiparous pregnant female, with a history of bad obstetric outcomes. At 24 weeks gestation, she was referred to our center requesting one unit of irradiated leuco-depleted packed red cells (LDPRC) for 2nd IUT due to difficulty in finding a compatible unit elsewhere. A detailed immunohematology (IH) workup revealed the presence of anti-D, anti-C, and anti-s antibodies. The patient received O RhD Negative and C, and s red cell phenotype negative, crossmatch compatible, irradiated LDPRC unit for IUT. She received a total of three episodes of IUT at 24, 29, and 33 weeks of gestation and delivered a healthy female child at 36 weeks. Managing HDF with multiple antibodies requires coordination between interdisciplinary teams and an advanced IH lab along with trained staff and active involvement of transfusion medicine specialists to support early interventions and reduce HDF-related mortality.

Gluteus medius contracture: A case report and review of the literature.

Bilateral gluteus medius contractures in adults are rare in clinical practice, with only a few cases reported. These contractures may result from repeated intramuscular injections during childhood. Understanding the clinical manifestations, diagnostic process, treatment, and outcomes can provide insights into effective management strategies. A 28-year-old female presented with an abnormal walking posture characterized by an out-toeing gait. She reported long-standing difficulties in walking and sought medical attention to improve her mobility and quality of life. The patient was diagnosed with bilateral gluteus medius contractures. The patient underwent open surgical release of the contractures on both sides, followed by a structured rehabilitation program to restore muscle function and improve gait. Postoperative exercise guidance was provided to ensure optimal recovery. At the 1-year follow-up, the patient demonstrated significant improvement in gait, functional abilities, and overall quality of life. She expressed high satisfaction with the surgical and rehabilitative outcomes. Once diagnosed with gluteus medius contracture, early surgical intervention is recommended. Through case reports and literature review, we have summarized the etiology, diagnostic methods, clinical characteristics, and existing treatment options for this condition.

Multiple Eruptive Dermatofibromas: A Case Series and Review of Diagnostic Challenges and Systemic Associations

Multiple Eruptive Dermatofibromas: A Case Series and Review of Diagnostic Challenges and Systemic Associations