Present Case Research Articles

A Rare Case Presentation of Adenoid Cystic Carcinoma of the Breast in a 36-Year-Old Fe-male

A Rare Case Presentation of Adenoid Cystic Carcinoma of the Breast in a 36-Year-Old Fe-male

Colitis-Induced Pancreatic Fistula with Pancreatic Ascites

Introduction: Although cases of severe pancreatitis causing fistula formation into the colon have been documented, the reverse process of colitis causing a pancreatic fistula remains undocumented. Case Presentation: We present the case of a 79-year-old male with severe colitis resulting in perforation and pericolonic abscess formation adjacent to the pancreas, which resulted in an internal pancreatic fistula and pancreatic ascites. After 2 paracenteses, our patient ultimately underwent endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and pancreatic duct stent placement. The patient clinically improved and was ultimately discharged. Conclusion: Follow-up ERCP was performed 2 months after discharge and showed no contrast extravasation, illustrating closure of the previous pancreatic fistula. Ultimately, our case demonstrates that cases of severe colitis may contribute to adjacent pancreatic fistula and ascites formation.

Beyond the Obstruction: A Case of Lung Cancer with Coincidental COPD Diagnosis

Background: Lung cancer frequently coexists with chronic obstructive pulmonary disease (COPD), particularly among smokers. The presence of both conditions can complicate diagnosis and lead to poorer outcomes. This case report presents a patient with lung cancer and concurrent COPD, highlighting the diagnostic and management challenges. Case presentation: A 60-year-old male presented with a history of smoking, progressive dyspnea, and a recent diagnosis of right lung cancer (T4N3M1c, stage IV B). He also exhibited symptoms suggestive of COPD, such as chronic cough and expectoration. Spirometry confirmed moderate restriction and severe obstruction, consistent with COPD GOLD 3. The patient was managed with both lung cancer treatment and COPD therapy. Conclusion: This case underscores the importance of considering COPD in patients with lung cancer, especially those with a history of smoking. Early diagnosis of both conditions is crucial for optimizing treatment strategies and improving patient outcomes.

A Case of Concomitant Acute Zonal Occult Outer Retinopathy and Secondary Nonparaneoplastic Autoimmune Retinopathy

Introduction: Acute Zonal Occult Outer Retinopathy (AZOOR) is a rare inflammatory retinal disease with rapid outer retinal function loss, photopsias, unremarkable fundus findings, and electroretinography (ERG) abnormalities. AZOOR diagnosis can be challenging due to its overlap with other retinal conditions, such as acute idiopathic blind spot enlargement syndrome (AIBES) and autoimmune retinopathies (AIRs). Multimodal imaging, including fundus autofluorescence (FAF) and optical coherence tomography (OCT), has improved detection, revealing progressive outer retinal damage. Although the etiology of AZOOR remains uncertain, autoimmune mechanisms and viral associations have been proposed. Recent studies have identified anti-retinal antibodies, complicating differentiation from other autoimmune retinopathies.. Case Presentation: A 63-year-old male presented with photopsias, floaters, and worsening vision in his left eye. He had a prior diagnosis of autoimmune retinopathy with serum antibodies against enolase, arrestin, and heat shock protein 27 (HSP27). Despite corticosteroid therapy, his visual acuity worsened from 20/20 to 20/60. Fundus examination showed subtle changes, and multimodal imaging revealed outer retinal damage consistent with AZOOR. He was started on mycophenolate mofetil, cyclosporine, and intravenous immunoglobulin (IVIg). Over a year of follow-up, his vision improved to 20/25, and imaging showed stabilization of retinal damage. Conclusion: This case report highlights AZOOR can be associated with secondary npAIR. Multimodal imaging, electrophysiologic testing of retina and RPE, and anti-retinal antibody may be helpful for diagnosis of these patients. A combination of conventional immunomodulatory therapy and IVIg can help with controlling AZOOR and secondary npAIR.

Durable and Drastic Response to the Trastuzumab, Letrozole, Abemaciclib, and Goserelin Combination as First-Line Therapy in HER2-Positive and Hormone Receptor-Positive Metastatic Breast Cancer: A Case Report

Introduction: Chemotherapy combined with anti-human epidermal growth factor receptor 2 (HER2)-targeted therapy is currently a standard treatment for advanced HER2/HR-positive breast cancer (BC), although evidences showed that HR expression compromised effectiveness of the treatment. While cyclin-dependent kinase (CDK) 4/6 inhibitors combined with endocrine therapy is a key therapy for the BC with HR expression, data on the effectiveness and safety of CDK 4/6 inhibitors combined with trastuzumab and endocrine therapy as a first-line treatment for HER2-positive and HR-positive metastatic BC are limited. Case Presentation: Here, we report a case of a 46-year-old premenopausal woman diagnosed with stage 4 HER2/HR-positive invasive ductal carcinoma from both right and left breast with hypermetabolic activities in multiple lymph nodes, adrenal, bone, and skin. Interventions: Due to the patient’s refusal to use chemotherapy, she was started on goserelin, abemaciclib, letrozole, and trastuzumab. Outcomes: The patient’s symptoms were relieved with near resolution of the primary breast mass and nearly all of the metastatic sites. Metabolic resolution was observed in bone lesions. The disease was under control for 57 weeks. During the treatment, neutropenia (grade 1–2) and anemia (grade 1) occurred, which spontaneously recovered. Additionally, diarrhea improved after symptomatic treatment. Conclusion: We believe that the combination of trastuzumab, hormone suppression, and abemaciclib is a practicable and effective treatment for HER2-positive and HR-positive metastatic BC in premenopausal patients who cannot tolerate the first-line chemotherapy.

Diagnostic Role of Tissue Biopsy in Leukaemic or Lymphomatous Infiltrative Optic Neuropathy: A Case Report and Systematic Review of Literature

Purpose: To explore the role of tissue biopsy in diagnosing leukemic or lymphomatous infiltrative optic neuropathy through a systematic literature review and presentation of a new case. Methods: A systematic literature review was conducted using PubMed, Scopus, and Google Scholar databases to identify cases of leukemic or lymphomatous optic neuropathy in which optic nerve or sheath biopsy was performed. A newly reported case was also included. Results: A total of 420 studies were identified, with 26 meeting inclusion criteria. In total 29 patients were included, with a mean age of 55.9 years. Of these, 48.3% had a known history of leukemia or lymphoma, and 50% were in remission at presentation. Imaging showed optic nerve enhancement and enlargement in most cases. Biopsies were performed on the optic nerve, sheath, chiasm, tract, or surrounding orbital tissue. Direct nervous tissue biopsies (optic nerve, chiasm, or tract) were diagnostic in 100% of cases, while only 18.2% of sheath biopsies were diagnostic. Visual outcomes were poor, with many presenting with no light perception. Postoperatively, vision remained stable in 40%, deteriorated in 20.7%, and improved in 17.2%. Discussion: Tissue biopsy remains a critical last-line investigation for diagnosing leukemic or lymphomatous optic neuropathy when noninvasive methods remain inconclusive. While highly diagnostic, optic nerve biopsy carries visual risk, especially for patients with residual vision. Direct nerve biopsy is recommended for severe vision loss, while a more cautious surgical approach, considering alternative diagnostic techniques, is advised for those with partially preserved vision. Optic nerve sheath biopsy, though theoretically safer, has a limited diagnostic yield.

Naegleria fowleri Infections: Bridging Clinical Observations and Epidemiological Insights

Purpose: Naegleria fowleri is the main etiologic agent implicated in primary amoebic meningoencephalitis (PAM). It is also known as the brain-eating amoeba because of the severe brain inflammation following infection, with a survival rate of about 5%. This review aims to identify Naegleria fowleri infections and evaluate patients’ progression. This literature review emphasizes the importance of rapid diagnosis and treatment of infected patients because only prompt initiation of appropriate therapy can lead to medical success. Compared to other articles of this kind, this one analyzes a large number of reported cases and all the factors that affected patients’ evolution. Materials and methods: Two independent reviewers used “Naegleria fowleri” and “case report” as keywords in the Clarivate Analytics—Web of Science literature review, obtaining 163 results. The first evaluation step was article title analysis. The two reviewers determined if the title was relevant to the topic. The first stage removed 34 articles, leaving 129 for the second stage. Full-text articles were evaluated after reading the abstract, and 77 were eliminated. This literature review concluded with 52 articles. Key findings: This review included 52 case report articles, 17 from the USA, eight from India, seven from China, four from Pakistan, two from the UK, and one each from Thailand, Korea, Japan, Italy, Iran, Norway, Turkey, Costa Rica, Zambia, Australia, Taiwan, and Venezuela, and Mexico. This study included 98 patients, with 17 women (17.4%) and 81 men (82.6%). The cases presented in this study show that waiting to start treatment until a diagnosis is confirmed can lead to rapid worsening and bad outcomes, especially since there is currently no drug that works very well as a treatment and the death rate is around 98%. Limitations: The lack of case presentation standardization may lead to incomplete case information in the review since the cases did not follow a writing protocol. The small number of global cases may also lead to misleading generalizations, especially about these patients’ treatment. Due to the small number of cases, there is no uniform sample of patients, making it difficult to determine the exact cause of infection.

Anesthetic Management of Renal Tumor with Level 3 Inferior Vena Cava Extension at a University Hospital in Vietnam: A Case Report

Background: Renal tumors with inferior vena cava (IVC) invasion pose significant challenges for surgical and anesthetic management. This report presents the anesthetic management of a patient with a level 3 IVC-invading renal tumor, emphasizing the complexity and multidisciplinary approach required. Case Presentation: A 55-year-old woman with a large left renal tumor causing complete obstruction of the left renal vein and near-total obstruction of the IVC was admitted for surgery. Multidisciplinary planning included a nephrectomy with removal of tumor from the IVC. The patient underwent general anesthesia with extensive hemodynamic monitoring and fluid management to mitigate potential blood loss and cardiovascular instability. The surgery, lasting 5 h, involved successful radical nephrectomy, tumor removal from the IVC, and resection of liver metastases. Postoperative recovery was without complications, and the patient was discharged 7 days. Conclusion: Managing anesthesia for renal tumors with IVC invasion requires careful preoperative planning, invasive monitoring, and multidisciplinary approach.

Coexisting Congenital Mesoblastic Nephroma and Lissencephaly: Unique Case Report with Pathological Analysis and Its Clinical Significance

Background: Congenital mesoblastic nephroma represents 3–10% of all pediatric renal tumors. With the advancement of ultrasound diagnostics and magnetic resonance imaging, the diagnosis of this renal neoplasm is increasingly being established prenatally and at birth. It usually presents as a benign tumor, but it can severely affect pregnancy outcomes, contributing to perinatal morbidity and mortality. Lissencephaly belongs to a rare category of neurodevelopmental disorders marked by the absence of a substantial reduction in the typical folds and grooves in the cerebral cortex. The prognosis for patients with lissencephaly is extremely poor, carrying with it a high mortality rate. Case Presentation: We present a case of congenital mesoblastic nephroma (CMN) diagnosed with polyhydramnios at 28 weeks of gestation, which led to preterm delivery at 29 weeks and a fatal outcome for the newborn. Histopathological examination confirmed the diagnosis of CMN along with fetal pachygyria/lissencephaly. The aim of this study is to point out the characteristics and unique correlation between CMN and lissencephaly, and to illustrate the histopathological features of CMN and lissencephaly through an educational example derived from our presented index case. To the best to our knowledge, the association of CMN with lissencephaly has not been described in the literature so far. Conclusions: Outlining the prenatal progression of CMN and the outcome of pregnancies involving fetal CMN and lissencephaly, this case underscores the importance of comprehensive ultrasound examinations, including central nervous system evaluation, to identify potential coexisting anomalies and refine prenatal diagnostic practices.

Treatment of excessive growth of granulation tissue in horses by topical application of resveratrol

AbstractExcessive growth of granulation tissue (EGT) is a common complication during wound healing in horses. Wounds involving lower limbs are especially prone to the development of EGT. Often increased expression of transforming growth factor‐β (TGF‐β) is found in the EGT. In the present report, resveratrol was used as TGF‐β modifier. Topical application of an aqueous solution of resveratrol at 0.01 mg/mL once daily for 5‒7 weeks depending on EGT size, successfully suppressed the EGT growth in all seven horses in the present case report.

Deep Brain Stimulation Lead Functional Repositioning After Spontaneous Pneumocephalus Resorption: A Clinical Case Presentation and Systematic Review

Deep Brain Stimulation Lead Functional Repositioning After Spontaneous Pneumocephalus Resorption: A Clinical Case Presentation and Systematic Review

A Case of Ear Canal Cancer with a High Venous Arch That Benefited from an Intraoperative Navigation System

Introduction: Cancers of the external auditory canal are rare. Surgery may be the treatment of choice for localized cases. Lateral temporal bone resection is one surgical treatment option. It is rarely performed by skilled surgeons and requires caudal and anterior cutting of the tympanic chamber bone, which is not usually performed in ear surgery. It is imperative to ensure that the internal jugular vein and important nerves are present. Case Presentation: In this report, we describe a case of adenoid cystic carcinoma of the external auditory canal in which lateral temporal bone resection was safely performed using intraoperative navigation. A 33-year-old woman was diagnosed with an adenoid cystic carcinoma of the right external auditory canal by another physician and presented to our department. After close examination, she was diagnosed with T3N0M0 cancer of the external auditory canal and was referred to our department for lateral temporal bone resection. Although the patient had a high venous arch, intraoperative navigation enabled unblocked resection without exposing the tumor or damaging the vital tissues. Conclusion: Intraoperative navigation is considered a safer lateral temporal bone resection approach.

Successful Management of Post-Thymectomy Pure Red Cell Aplasia with Rituximab: A Case Report

Background: Pure red cell aplasia (PRCA) is a rare cause of anemia characterized by decreased red blood cell production, often associated with thymomas. While thymectomy is commonly performed to treat thymoma-associated PRCA, the development of PRCA post-thymectomy is less understood. Case Presentation: We present a case of a 25-year-old woman who developed PRCA and autoimmune diabetes mellitus (DM) following radical thymectomy for malignant thymoma. Initial treatment with prednisolone showed minimal improvement, leading to the inclusion of rituximab. This combination resulted in a significant increase in reticulocyte counts and transfusion independence. Discussion: This case highlights the potential for PRCA to develop after thymectomy and the challenges of treating PRCA in the context of additional conditions like autoimmune DM. While immunosuppressive therapies such as cyclosporin A and corticosteroids are standard, their side effects necessitated exploring alternative treatments. Rituximab proved effective and was well-tolerated, suggesting its potential as a primary option in similar cases. Conclusion: This case illustrates the occurrence of PRCA after thymectomy and highlights rituximab’s effectiveness as a treatment option, offering a viable alternative to standard therapies in managing this complex condition.

Jackhammer Esophagus as a Complication of Tonsillectomy and Adenoidectomy: A Case Report

Introduction: Tonsillectomy is a safe and common procedure. It has not been associated with the development of hypercontractile conditions of the esophagus. Jackhammer esophagus is a type of hypercontractile esophagus with vigorous contraction of the esophagus associated with dysphagia and chest pain. Case Presentation: A 42-year-old woman with no previous history of gastroesophageal dysfunction or symptoms developed Jackhammer esophagus with severe dysphagia and chest pain after undergoing tonsillectomy and adenoidectomy. Conclusion: Although Jackhammer esophagus has been reported as a complication of several invasive procedures, this is the first report of Jackhammer esophagus as a complication of tonsillectomy and adenoidectomy.

Using expert knowledge and peer review to create a reproducible process for the NAHRS Nursing Essential Resources List (NNERL)

Background: Librarians have relied on resource lists for developing nursing collections, but these lists are usually in static or subscription-based formats. An example of this is the 26th edition of the Essential Nursing Resources last published in 2012. The Nursing and Allied Health Resources and Services (NAHRS) Caucus Nursing Essential Resources List (NNERL) Task Force has been working on a new list since Fall 2020. The goal of the Task Force is to create a nursing resource list that represents current materials and formats, uses a selection process that is transparent and reproducible, and will be available to a broad audience. Case Presentation: Working from the Essential Nursing Resources 26th edition, the NNERL Task Force updated the purpose statement then began reviewing the resources on the list. Two working groups were formed: 1) an evaluation rubric working group developed a tool to evaluate the resources and 2) a tagging work group developed guidelines for creating metadata and “tags.” Volunteers were recruited from the NAHRS Caucus to tag the resources. Lastly, the Task Force finalized the list of resources in the NNERL then cleaned and reconciled the data. Conclusions: The final version of the NNERL will be published in Airtable, a cloud-based project management product, that will include metadata for every item on the list. The NNERL will be copyrighted to the NAHRS NNERL Task Force and made available through the Open Science Framework (OSF) under an Attribution-NonCommercial-NoDerivatives 4.0 International Creative Commons License.

Successful Anesthetic Management of a Cesarean Section in a Patient with Cardiomyopathy and Cardiogenic Shock: A Case Report

Background: Cardiomyopathy in pregnancy is a rare but serious condition that can lead to significant maternal and fetal morbidity and mortality. Anesthetic management of these patients is challenging due to the complex interplay of physiological changes and the potential for hemodynamic instability. This case report describes the successful anesthetic management of a cesarean section in a patient with cardiomyopathy and cardiogenic shock. Case presentation: A 29-year-old woman with cardiomyopathy and cardiogenic shock presented for emergency cesarean section at 36-37 weeks gestation. She had a history of global hypokinetic, left ventricular and atrial dilatation, and an ejection fraction (EF) of 32%. She was also in atrial fibrillation. Epidural anesthesia was selected due to its lower risk of complications compared to general anesthesia. The patient was carefully monitored throughout the procedure, and her hemodynamics were maintained with a combination of fluids and inotropes. The surgery was successful, and the patient delivered a healthy baby boy. Conclusion: This case report demonstrates that successful anesthetic management of cesarean section is possible in patients with cardiomyopathy and cardiogenic shock. Careful planning, close monitoring, and a multidisciplinary approach are essential for a positive outcome.

Spiradenoma: A Case Report and Review of the Literature

Background and Clinical Significance: Spiradenoma is a rare benign skin adnexal tumor with unknown incidence and prevalence, typically affecting young to middle-aged adults without a sexual predilection. Case Presentation: A 59-year-old woman presented with a palpable lesion in the suprapubic region that had been there for 20 years and had become enlarged over the past 2 months. Physical examination revealed a firm, non-tender, subcutaneous mass, approximately 2 cm in size, in the right pubic region. Ultrasound revealed a hypoechoic, heterogeneous lesion with a well-defined border, measuring 2.37 × 0.94 × 1.67 cm, without hypervascularity. Therefore, the patient underwent excision of the subcutaneous tumor. The pathology report confirmed the diagnosis of spiradenoma of the pubis. Histochemistry showed that the inner luminal cells were positive for CK7, and the outer basaloid cells were positive for p63. CD56 and CD117 were focally positive. Conclusions: With an accurate diagnosis and appropriate surgical excision, the prognosis for spiradenoma is generally excellent. However, a long-term follow-up is advisable.

The Relevance of the Virchow Node and Virchow Triad in Renal Cancer Diagnosis

Background: The purpose of this article is to overview the clinical significance of left supraclavicular adenopathy and review the etiology of inferior vena cava (IVC) thrombosis, starting from a presentation of a rare case of renal cell carcinoma (RCCs) with Xp11.2 translocation involving TFE3 gene fusion. This article also aims to review the literature to understand the characteristics of this rare type of renal tumor. Renal cell carcinoma (RCC) associated with Xp11.2 translocation/gene fusion TFE3 is a rare subtype of kidney cancer that was classified in 2016 as belonging to the family of renal carcinomas with MiT gene translocation (microphthalmia-associated transcription factor). The prognosis for these kidney cancers is poorer compared to other types. Methods: We present a case of a 66-year-old man with Virchow–Troisier adenopathy during physical examination, which raises the suspicion of infra-diaphragmatic tumor. The echocardiography highlighted a heterogeneous mass in the right cardiac cavities, and the abdominal ultrasound exam revealed a solid mass at the upper pole of the left kidney. Results: Following computed tomography, magnetic resonance imaging, PET-CT, and histopathological and immunohistochemical examinations, the patient was diagnosed with renal carcinoma with Xp11.2 translocation and TFE3 gene fusion. Conclusions: IVC thrombosis is often associated with neoplastic disease due to the procoagulant state of these patients, the most common malignancies related to IVC thrombosis being represented by RCCs (38%), genitourinary cancers (25%), bronchus and lung cancers, retroperitoneal leiomyosarcoma, and adrenal cortical carcinoma. Imaging methods play a crucial role in differential diagnosis, allowing for the localization of the primary tumor and assessment of its characteristics.

Case report: Movement-related neuroplasticity in a patient after spinal cord injury in response to task-oriented bimanual training

BackgroundBimanual motor training is an effective neurological rehabilitation strategy. However, its use has rarely been investigated in patients with paralysis caused by spinal cord injury (SCI). Therefore, we conducted a case study to investigate the effects of robot-assisted task-oriented bimanual training (RBMT) on upper limb function, activities of daily living, and movement-related sensorimotor activity in a patient with SCI.MethodsA patient with bilateral upper limb paresis due to incomplete cervical SCI underwent 20 sessions of RBMT. Functional recovery was measured using clinical scales for upper limb motor function and activities of daily living. Training-induced neuroplasticity was evaluated using event-related desynchronization (ERD) induced by movement of the right hand (the more affected side), recorded on the electroencephalogram (EEG).ResultsRBMT improved the patient’s upper limb motor function and activity independence. At baseline, our EEG paradigm demonstrated an ipsilateral predominance of movement-related ERD responses over the sensorimotor cortex (SMC) in relation to the moving hand. Following the RBMT, the ERD pattern shifted from being predominantly ipsilateral to a contralateral allocation.ConclusionThe present case study provides preliminary evidence to support the therapeutic use of RBMT to restore upper limb function in patients with incomplete SCI. The recovery of function following SCI might be related to the rebalancing of sensorimotor activation.

Eosinophilic folliculitis with multifocal distribution in a dog

AbstractA 10‐month‐old non‐neutered male beagle exhibited alopecia with scabbing and erythema on the head and lateral sides of all four limbs, alongside itching and general deterioration. Histopathological findings revealed intraepidermal or infundibular eosinophil‐dominated pustules. A diagnosis of canine eosinophilic dermatitis was established based on histopathological and clinical findings. Treatment with prednisolone (2 mg/kg, once daily) promptly improved the dermatological symptoms and general condition. The dose was gradually tapered over 3 weeks until withdrawal without recurrence. Canine eosinophilic dermatitis with intraepidermal pustules is rare and reported to be recurrent. However, the present case responded extremely well to treatment with prednisolone and did not experience recurrence, similar to eosinophilic dermatitis without intraepidermal pustules.