Radiological Work-up Research Articles

X-ray and MRI Correlation of Bone Tumors Using Histopathology As Gold Standard.

IntroductionBone tumors are a common pathology of the musculoskeletal system being frequently encountered by clinicians. Radiological workup is a mainstay in the diagnostic workup of bone tumors. This study aimed to highlight the importance of plain radiography and MRI in the diagnosis of bone tumors keeping histopathology as a gold standard. It is a descriptive validation study conducted in the Radiology Department of Pakistan Institute of Medical Sciences Islamabad.MethodologyThe study included 92 patients with suspected bone lesions. After taking a complete history and receiving informed written consent. X-rays radiographs and magnetic resonance imaging were performed. X-ray radiograph and magnetic resonance imaging parameters were recorded and compared with the histopathology of lesions as a standard.ResultsThe mean age of patients was 30.50 ± 8.95 years. Of 92 patients examined on X-ray, 51 (55.4%) had lytic lesions, 34 (37.0%) had sclerotic lesions, and seven (7.6 %) had mixed lesions. MRI revealed the location of the lesion. There were 25 (27.2%) bone lesions in diaphysis, 19 (20.7%) in metaphysis, nine (9.8%) at meta-diaphysis, and 32 (34.8 %) in the meta-epiphyseal region. These findings were later on confirmed with histopathological results.ConclusionMRI can differentiate soft-tissue components and periosteal reactions. An X-ray radiograph can provide information about bony matrix and calcifications within tumors. After analysis of imaging findings and histopathological results, it is concluded that these modalities can be used to diagnose bone tumors with high diagnostic accuracy.

Inflammatory Myofibroblastic Tumor of the Bladder in an 8-Year-Old Girl: About a Case with Review of the Literature

Introduction: The inflammatory myofibroblastic tumor is a rare tumor. It most often occurs in the bladder in the genitourinary sphere. This benign and aggressive spindle cell tumor affects children and frequently girls. The objective of this work is to describe from a clinical case, the clinical, radiological, and histological characteristics of an inflammatory myofibroblastic tumor in an 8 years old girl. Case Presentation: An 8-year-old girl was followed for an inflammatory myofibroblastic tumor of the bladder revealed by micturition burns complicated by hematuria. She underwent an ultrasound and radiological workup demonstrating an anterior bladder parietal mass reaching the rectus abdomen is muscle. Subsequently, an excisional biopsy was performed and histological and immunohistochemical examination revealed an inflammatory myofibroblastic tumor. Discussion: Inflammatory myofibroblastic tumors of the bladder are benign tumors with aggressive features usually revealed by voiding symptoms, pelvic pain, and pelvic mass. Treatment is based on Trans urethral resection of the bladder. Anatomical pathology examination shows spindle-shaped myofibroblast and fibroblast cells, a collagenous or myxoid matrix, and inflammatory cells composed of plasma cells, lymphocytes, and eosinophils. The diagnosis is confirmed by immunohistochemistry with an expression of CAM5.2, desmin, aSMA, and vimentin and especially of Anaplasic Lymphoma Kinase (ALK). Conclusion: Rare tumor process, whose malignant potential remains unknown. Management is by conservative surgery of the bladder.

Accuracy of pelvic measurements on virtual radiographic projections based on computed tomography scans compared to conventional radiographs pre- and postoperatively

BackgroundThe anteroposterior (ap) radiograph of the pelvis is decisive in the diagnosis of different pathologies of the hip joint. Technical advantages have reduced the radiation dose of pelvic CT to levels comparable to radiographs. The purpose of this study was to validate if standard radiographic parameters (lateral center edge angle, medial center edge angle, acetabular index, acetabular arc, extrusion index, crossover sign and posterior wall sign) can accurately be determined on radiograph-like projections reconstructed from the CT dataset pre- and postoperatively.MethodsA consecutive series of patient with symptomatic dysplasia of the hip and a full radiologic workup (radiographs and CT scan pre- and postoperatively) who underwent periacetabular osteotomy were included. Standard radiographic parameters were compared between radiographs and radiograph-like projections by two authors pre- and postoperatively.ResultsA total of 16 hips (32 radiographs/32 radiograph-like projections) were included in the study. No significant difference was found between the radiographs and radiograph-like images for all parameter for both examiners. ICC between radiograph and radiograph-like projections for all investigated parameters showed good to excellent reliability (0.78–0.99) pre- and postoperatively.ConclusionRadiograph-like projections show comparable results to radiographs with regard to the important investigated parameters (lateral center edge angle, medial center edge angle, acetabular index, acetabular arc, extrusion index, crossover sign and posterior wall sign). Thus, ultra-low-dose CT scans may reduce the need for conventional radiographs in pre- and postoperative analyses of 3-dimensional hip pathologies in the future, as the advantages increasingly outweigh the disadvantages.

Vulvar melanoma with multisystemic metastases: A rare case presentation

Malignant melanoma is the second most common vulvar malignancy which occurs in elderly females. In advanced stages of the disease, distant metastases can occur to any organ; hence, comprehensive radiological evaluation is necessary. We report a case of a 45-year-old female who presented with progressively increasing growth over the vulva for 6 months. On detailed clinical, pathological, and radiological workup, multiple metastases were found in the brain, liver, pancreas, peritoneum, lungs, and pleura. The final diagnosis of vulvar melanoma with multisystemic metastases was made after the histopathological examination.

Synchronous prostate and rectal cancers across a large distributed healthcare system: Implications for national accreditation program for rectal cancer (NAPRC) guidelines.

e15591 Background: Prostate and colorectal cancers are among the most common cancers in men. The prevalence of patients (pts) diagnosed with prostate and rectal cancers at the same time (synchronous) is unknown and guidelines for co-management are not well established despite implications on their co-management. This study aggregated data using several methods across New York’s largest healthcare system, studied the prevalence of synchronous diagnoses, and identified a potential need for prostate specific antigen (PSA) assessment in NAPRC guidelines. Methods: We conducted an IRB approved review of pts using 3 different cohorts from 2010-2021: Northwell Health NAPRC tumor boards, the Oncora radiation oncology database, and the Northwell Health clinical informatics tool Population Analyzer to access electronic health records across the entire Northwell Health System. Synchronous diagnosis was defined as prostate cancer diagnosed during the workup of rectal cancer. Results: Ten pts had synchronous prostate and rectal cancers. Workup of prostate cancer was prompted by elevated PSA alone (n = 3), prostate lesion on rectal cancer staging MRI alone (n = 3), or both (n = 4). Two pts declined recommended treatment (tx). Radiation (RT) volume for pts during neoadjuvant RT included the rectum and prostate. Patients received total neoadjuvant therapy (n = 6) or neoadjuvant chemoRT (n = 4) alone. Three pts had surgery for rectal cancer after neoadjuvant tx. Eight patients received androgen deprivation therapy (n = 8); after neoadjuvant tx pts also had prostate-specific RT (n = 6) or prostate brachytherapy (n = 2). Six pts completed neoadjuvant tx; after a median follow up of 25.9 months 4 pts have no evidence of prostate or rectal cancers. One pt has residual disease with plan for surgical resection; one pt developed new metastases. Median overall survival was 114 months with one death. Among 273 newly diagnosed rectal cancer pts presented at NAPRC tumor boards, there were 122 male pts age ≥ 40 years of which 70% (n = 81) did not have PSA screen at rectal cancer diagnosis. Medical oncologists ordered PSA in 72% (n = 13) of pts not evaluated by primary care. Conclusions: We aggregated data via several methods and performed system wide evaluation of electronic health records across New York State’s largest healthcare system. PSA was not evaluated in a majority of eligible pts. These results support PSA testing in NAPRC guidelines for new rectal cancer diagnosis as it is inexpensive, non-invasive, and may prompt prostate cancer workup. Additionally, 3 pts with prostate cancer did not have prostate lesions on rectal MRI imaging, suggesting a potential role for prostate-protocoled imaging during radiological workup of rectal cancer. Future studies are needed to develop best management of synchronous prostate and rectal cancers due to a lack of consensus guidelines.

LINTERET DE LILEO-COLOSCOPIE DANS LE BILAN DEXTENSION DU LYMPHOME GASTRIQUE

Gastric lymphomas are rare tumorsand accounts for only 3%. There are two groups of lymphomas: mucosa-associated lymphoid tissue (MALT) gastric lymphoma or diffuse large B-cell lymphoma. The management of this tumordepends on the histological grade and extension workup. It includes a clinical examination, radiological and endoscopic work-up including a total ileo-coloscopy in order to look for a synchronous intestinal localization.We report in this article the experience of our department concerning the interest of ileo-coloscopy in the assessment of gastric lymphoma extension. We included 87 patients followed for gastric lymphoma, 34 of whom underwent ileo-coloscopy preceded by thoracoabdomino-pelvic CT scan. Colonoscopy revealed an ulcerative colonic process in only 02 patients, whose CT scan also revealed a colonic thickening and the anatomopathological study was in favour of a colonic lymphoma.In the light of these results, is it not necessary to reconsider the interest of an invasive procedure in the work-up of gastric lymphoma with a normal abdominal scan?

Robot assisted laparoscopic adrenalectomy: Should this be the new standard?

Minimal invasive surgeries (MIS) for large size adrenal tumors are still debatable. The objective is to evaluate the contemporary peri- and post-operative outcomes of patients undergoing (open = OA, laparoscopic = LA, and robotic = RA) adrenalectomies in three institutions. Retrospectively gathered peri- and post-operative data of 235 patients, underwent adrenalectomy at three Institutions over a 7-year period (2013-2020) were analyzed. All patients underwent thorough radiological and endocrine workup. Two hundred and thirty five patients who underwent adrenalectomy (OA (n = 29), LA (n = 146), and RA (n = 60)) were assessed. OA (n = 29) versus Minimally invasive surgery (n = 206) showed significant differences (median, p value) in larger tumour size, cm (9.4 vs 5, (p = 0.0001)), longer operative time, mins (240 vs 100, (p = 0.0001)), longer hospital stay, days (8 vs 3,(p = .0001)), Higher readmission rates (14% vs 1.9%), higher blood loss, ml (400 vs 100, (p = 0.0001)) requiring blood transfusion (14% vs 4.3%) (p = 0.03), higher intraoperative complication (21% vs 6%) (p = 0.0004), and post op complications (17% vs 5.3%) (p = 0.01). Amongst the MIS (RA vs LA), RA appeared be have better outcomes in terms of shorter operative time, less blood loss and less intra operative complications with a p value <0.05. These results were consistent for the assessment of patients who had ⩾6 cm tumor size. The postoperative complication rates were lowest with RA (3.3%) compared to OA (17%) and LA (6.1%). Contemporary practice of adrenalectomy shows that robotic adrenalectomy is safe and effective irrespective of the tumor size.

Rare Carotid Bifurcation Tumor

Introduction: Paraganglioma or chemodectoma of the carotid corpuscle or carotid glomus is a relatively rare neoplasm of slow progression, late diagnosis and uncertain prognosis. This tumor originates from the chemoreceptors of the carotid bifurcation and clinically presents as a laterocervical mass. It represents the majority of paragangliomas of the head and neck (60-70%). Observation: We report the observation of a 56-year-old female patient who consulted for a right laterocervical swelling without any other associated clinical signs. A complete radiological workup (Angioscanner/Angiography) will confirm the vascular nature of the lesion, characterize the size of the mass, its nature, its mapping, and its relationship to adjacent organs. Surgical excision had confirmed the diagnosis on histopathological examination. From this observation, we review the clinical, radiological and histopathological features of this tumor, as well as its uncertain evolutionary mode and the therapeutic modalities. Conclusion: Lateral cervical paragangliomas remain rare and poorly known affections which require an early diagnosis and a multidisciplinary management: ENT surgeon, vascular surgeon, oncologist and radiotherapist according to the evolutive forms.

Bilateral external iliac artery pseudoaneurysms causing urinary obstruction and acute renal failure

BackgroundWe report an exceedingly rare case of bilateral external iliac artery pseudoaneurysms causing urinary obstruction and acute renal failure.Case presentationA young man presented with acute severe bilateral testicular pain radiating to the back. Clinical and radiological workup showed bilateral external iliac artery pseudoaneurysms, which caused bilateral ureterohydronephrosis due to urinary obstruction with subsequent renal failure. Management included immediate bilateral external iliac artery endovascular repair and bilateral ureterolysis using a retroperitoneal approach, with resolution of the obstruction and successful endovascular treatment of both pseudoaneurysms. The only identifiable risk factor for cardiovascular disease was cocaine addiction.ConclusionsThis case highlights an unusual and severe clinical presentation of bilateral EIA pseudoaneurysms causing bilateral ureterohydronephrosis and subsequent renal failure. Awareness of this condition may help avoid misdiagnosis and delayed management, which is of utmost importance for a favorable outcome.

Papillary carcinoma arising from a thyroglossal duct cyst: A case report and literature review

IntroductionPapillary carcinoma originating from a thyroglossal cyst is rare and peculiar, with majority of cases detected after surgery. Despite an excellent prognosis, its management remains controversial. Herein, we report the case of a 53-year-old woman who underwent Sistrunk procedure for a thyroglossal duct cyst and was subsequently confirmed to have papillary thyroid carcinoma.Presentation of caseA 53-year-old woman presented with an anterior midline neck mass for 7 years. The patient had no symptoms of hypo-or hyperthyroidism. Additionally, she had no history of compressive symptoms. Neck ultrasound revealed a well-defined 3.5 cm × 2.2 cm × 3 cm-sized cystic lesion inferior to the hyoid bone, with a peripheral solid component. Neck computed tomography revealed a well-defined 3.7 cm × 3.4 cm × 2.7 cm-sized cystic lesion with an enhanced central solid component with focal calcifications, inferior to the hyoid bone, and in contact with the anterior wall of the thyroid cartilage. Sistrunk procedure was performed. The patient was then diagnosed with papillary thyroid carcinoma with TNM stage pT2 and underwent total thyroidectomy as a follow-up procedure.DiscussionThyroglossal duct cyst carcinoma is usually detected in the fourth decade of life with a higher prevalence in women. Neck ultrasound is performed during the initial radiological workup to assess the cyst and confirm the presence of the thyroid gland.ConclusionThe Sistrunk procedure is highly effective in low-risk patients. A more aggressive approach is required for high-risk patients.

Metastatic Sarcomatous Tumor to Mandible Identifies Pleuropulmonary Blastoma Tumor Predisposition Syndrome

<h3>Introduction</h3> Pleuropulmonary blastoma (PPB) affects infants and young children and may occur as a cystic (Type I), partially cystic-partially solid (Type 2), or solid (Type 3) tumor. PPB is an embryonal tumor derived from lung and pleural mesenchyme. This malignant tumor is composed of sarcomatous elements, most commonly a mixture of spindle cell sarcoma with focal rhabdomyosarcomatous elements. However, it may have a wide variety of sarcomatous components. The tumor is characterized by DICER1 mutation, which may be somatic (tumoral) or constitutional. Constitutional DICER1 mutation indicates a predisposition for the development of other tumors and may have implications for the child and other family members. <h3>Clinical Presentation and Pathology Findings</h3> This 18 month-old male presented with a rapidly enlarging, expansile left mandibular mass. A biopsy was performed which showed a predominantly spindle cell sarcoma (vimentin-positive) with focal areas of readily identified rhabdomyoblasts (positive for desmin; negative for myogenin and MyoD1. Molecular genetic testing of the tumor identified a DICER 1 mutation and was negative for rearrangements associated with rhabdomyosarcoma (FOXO1, FUS-TFCP2, EWSR1-TFCP2, NCOA2, VGLL2). Radiologic workup identified a predominantly solid pulmonary mass. Lobectomy was performed and diagnosis of PPB was confirmed. Sarcoma-based oncologic management was carried out. Subsequent genetic testing identified DICER1 constitutional mutation. <h3>Conclusion</h3> PPB presenting as a metastatic disease is not unusual, with the involvement of various sites and organs (most common sites: brain, bone). Although exceedingly rare, PPB should be considered in an infant or young child when encountering a possible metastatic sarcomatous tumor and prompts radiologic evaluation for a possible primary lung tumor. Molecular genetics plays an essential role in identifying risk for PPB Tumor Predisposition Syndrome. Oncologic management is sarcomabased and children with isolated lung tumors have variable outcomes (Type I - 85%, Type 2 - 60%, Type 3 - 40%).

Concurrent omphalomesenteric duct cyst and ileal diverticulum causing small bowel obstruction; a case report.

Introduction and importanceThe omphalomesenteric duct (OMD) usually involutes by the ninth gestational week. If this obliteration fails, OMD remnant will result in different pathologies mostly in the pediatrics and infrequently in adults. The most well-known OMD remnant disease is Meckel's diverticulum. Omphalomesenteric cyst is rather rare, and their combination is even more exceptional with few cases in literature.Case presentationWe present an adolescent patient with nausea and vomiting and occasional periumbilical abdominal pain who was diagnosed with concurrent omphalomesenteric cyst and ileal diverticulum, causing internal hernia and bowel obstruction that underwent surgery.Clinical discussionOMD remnants mostly present in childhood with symptoms of intestinal obstruction, and rarely internal hernias for which conservative management is usually not curative, warranting surgery. Imaging presence of cystic lesion in mid abdomen in young patient with bowel obstruction should raise the suspicion for OMD remnants. Presence of OMD cyst together with Meckel's diverticulum necessitates more extensive resection, rare concurrence which is better to be prepared for in advance.ConclusionPreoperative radiologic workup is helpful to diagnose the obstruction and its probable cause. Presence of periumbilical cyst should raise the suspicion of OMD remnant specially in young adults with previous episodes of crampy abdominal pain and obstruction without history of abdominal surgery. Being familiar with possible concurrence of OMD cyst and Meckel's diverticulum will increase preparedness at the time of surgery.

Incidental finding of a rare ureteroinguinal hernia: general surgeons take heed!

Ureteroinguinal hernias are a rare phenomenon where the ureter is found in the hernia sac of an inguinal hernia, with less than 150 cases reported worldwide. They can be asymptomatic or symptomatic, and are commonly found perioperatively. We present a case of a 74-year-old man who was initially referred for consideration of surgery of bilateral inguinal hernias. The patient was relatively asymptomatic and given comorbidities the risk of surgery outweighed the benefits and he was discharged from the clinic. He was re-referred to general surgery after he sustained a fall, and subsequent computer tomography (CT) imaging of his abdomen demonstrated a right inguinal hernia containing the right distal ureter, resulting in ureteric obstruction and hydronephrosis. He subsequently underwent an open right inguinal hernia repair where the ureter was not able to be identified, but was safeguarded with blunt dissection techniques. Post operatively his renal function was stable. Ureteroinguinal hernias are most commonly found perioperatively, and therefore are at risk during dissection. Preoperative CT imaging is invaluable in the detection of ureteroinguinal hernias, and can help in the safeguarding of the ureter during operation. While a clinical diagnosis is usually all that is required for decision-making for an inguinal hernia repair; the surgeon should consider the addition of radiological work-up when the patient presents with atypical symptoms, or the hernia sac may contain intra-abdominal structures. This will ensure correct diagnosis of the contents and subtype of inguinal hernia, and help prevent iatrogenic injury.

Profile and Clinical Outcome of Children with Wilms' Tumor treated at a Tertiary Care Centre, India.

Pritanjali SinghBackground Wilms' tumor (WT) is the most common kidney tumor of the pediatric age group. The outcome of WT has improved due to the evolution of the treatment approach. A prospective observational study was conducted at All India Institute of Medical Sciences (AIIMS), Patna, to analyze the clinical profile along with the response and outcome to neoadjuvant chemotherapy according to the International Society of Pediatric Oncology (SIOP) protocol. Materials and Methods In total, 28 patients of WT visited the radiotherapy department from January 2015 to December 2019. Results Gender distribution showed male preponderance with a median age at diagnosis was 31 months. The abdominal lump was the dominant clinical presentation. The median volume of tumor at diagnosis was 359.48 mL (52.67-1805.76). Radiological staging workup shows that stage I, II, III, IV, and V were 7.1%, 39.3%, 39.3%, 10.7%, and 3.6% respectively. Neoadjuvant chemotherapy (NACT) was received by all patients. Also, 71.4% of patients showed > 50% of tumor volume reduction, while 28.6% of patients showed < 50% of tumor mass reduction. There was a statistically significant decrease in the tumor volume reduction following neoadjuvant chemotherapy ( p < 0.001). There was a statistically significant stage down ( p = 0.018) of the disease. Bivariate correlation studies showed recurrence was correlating statistically significantly with age < 24 months ( p = 0.049), locoregional lymph nodes ( p = 0.008), histopathological subtypes ( p < 0.001), stage of the disease ( p = 0.003), and risk groups ( p < 0.001). In addition, 25% of patients developed recurrence during the median follow-up of 25 months. The median disease-free survival (DFS) and overall survival (OS) were not reached. The mean DFS and OS were 48 and 59.13 months, respectively. One- and 3-year DFS were 100% and 64.1%, respectively. One- and 3-year OS were 100% and 75% respectively. Conclusion Our study suggests that most of the patients presented at an advanced stage, thus rendering most of the cases difficult to undergo surgery at presentation. Neoadjuvant chemotherapy followed by surgery may be considered a well-balanced approach with a comparable response and survival outcomes.

Different clinical symptoms and surgical treatment of Meckel's diverticulum in children

Objective: Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract and is usually identified incidentally during surgery for other reasons, upon radiological workup while investigating another disease or during autopsy. Among certain major symptoms of Meckel's diverticulum include gastrointestinal bleeding, volvulus, diverticulitis, intussusception, Littre's hernia or stool discharge from the umbilicus. In this study, we examined pediatric patients who were operated on for Meckel's diverticulum presenting with different clinical symptoms.&#x0D; Methods: The files of pediatric patients who were operated for Meckel's diverticulum in the pediatric surgery clinic between July 2002 and July 2017 were retrospectively reviewed. Patients who underwent incidental diverticulectomy were excluded from the study.&#x0D; Results: The 47 patients included in the study were 34 boys, 13 girls, and their mean age was 4.8 (1 day, 16 years). 49% of the patients were younger than 2 years old. The most common symptom observed in the patients was abdominal pain (63.8%). The most common indication for surgery was intestinal obstruction (53.2%). Intussusception was the cause in 64% of the patients in whom intestinal obstruction was the initial diagnosis. We detected gastrointestinal (GI) bleeding complaint in 12.8% of the patients. Segmentary bowel resection (46.8%) was the most common surgical procedure. In the pathological examination, ectopic tissue was found in 27 (57.4%) pathological specimens. While postoperative complications developed in 9 patients, 4 patients were treated conservatively and 5 patients were treated surgically.&#x0D; Conclusion: Establishing a preoperative diagnosis of Meckel's diverticulum may be difficult non other than rectal bleeding with currant jelly stool. In symptomatic Meckel's diverticulum, simple diverticulectomy, wedge resection or segmental bowel resection should be planned according to the complication caused by the diverticulum.

Mucinous cystadenocarcinoma of the breast: a new entity with broad differentials\u2014a case report

BackgroundMucinous cystadenocarcinoma is a rare and recently described primary breast cancer with strikingly similar histomorphology to ovarian, pancreatic, and gastrointestinal counterparts. The diagnosis cannot be made until the metastatic lesion is ruled out.Case presentationWe are reporting the case of a 65-year-old woman with primary mucinous cystadenocarcinoma of the breast while exploring clinicopathological features and approach to diagnosis. Though the immunohistochemistry panel of CK7, CK20, CDX2, SATB2, PAX8, mammoglobin, and GATA3 plays a crucial role in ruling out metastasis but aberrant CK20 positivity was seen in our case, the final diagnosis was made after a complete radiological workup. We also noted strong membranous HER2-protein expression and HER2-gene amplification by fluorescence in situ hybridization while in literature this tumor is reported to show mainly triple-negative basal type immunophenotype.ConclusionA combined clinic-radio-immunohistochemical approach is essential to make a diagnosis of primary mucinous cystadenocarcinoma.

Urinary bladder Schistosoma haematobium-related squamous cell carcinoma: a report of two fatal cases and literature review

BackgroundSchistosomiasis is still a public health issue in certain areas of developing countries (especially in sub-saharan Africa). Schistosoma haematobium is a proven carcinogenic agent that causes mainly bladder squamous cell carcinoma. This type of cancer has characteristic epidemiological, clinical and histopathological features with poor prognosis as compared to other urinary bladder cancers not associated with this parasite.Cases presentationWe report two fatal cases of advanced-stage bladder squamous cell carcinoma associated with Schistosoma haematobium in a sub-saharan developing African country (Niger), illustrating the devastating complications of this tropical neglected disease. The two cases were a 38-year-old woman and a 37-year-old male. They presented with chronic pelvic pain and hematuria. The clinical and radiological work-up revealed invasive urivary bladder tumor extended to the pelvis, that was histopathologically proven to be an invasive squamous cell carcinoma associated with Schistosoma haematobium. The two patients died shortly after the diagnosis before chemotherapy prescription.ConclusionSchistosoma-associated bladder squamous cell carcinoma has characteristic features with dismal prognosis. Eradication of this parasite remains the only efficient way to prevent the devastating consequences of this particular cancer.

Unilateral absence of internal carotid artery: A rare case report

Unilateral absence of internal carotid artery (ICA) is a rare congenital anomaly. We present the case of a 35-year-old man with episodes of recurrent strokes in the past and now presenting with right-sided upper limb weakness. Radiological diagnostic workup revealed a thin left ICA in the neck with non-visualization beyond petrous bone in the intracranial course. The ipsilateral brain parenchyma is supplied by vessels from the contralateral side of the Circle of Willis. As the patient had no evidence of a cerebrovascular accident on radiological evaluation and no neurological signs and symptoms, he was discharged with anticoagulant medications with the advice of follow-up. This is the first report to describe a case of ICA agenesis with a pattern of collateral circulation that doesn’t fit any of the six types described by Lie.

COVID-19 Pneumonia with Ischemic Heart Event After Neglect Yasser's COVID-19 Discrepancy Phenomenon and Its Regimen; The Seriousness Impact and Deterioration Outcome

Rationale: A novel COVID-19 is a multi-systemic serious worldwide pandemic. Undoubtedly, strict management with protocols and guidelines in the COVID-19 pneumonia is remarkable advice but its neglect may be leading to a critical event. Yasser’s COVID-19 Discrepancy phenomenon is a novel descriptive phenomenon that is always seen in all COVID-19 pneumonia. Initial dramatic improvement of the clinical status of COVID-19 pneumonic patient, not a simultaneously after the management, not a coincide with laboratory, radiological, and electrocardiographic workup. Patient Concerns: A 65-year-old married housewife Egyptian female patient was presented to the physician outpatient clinic with COVID-19 pneumonia that deteriorates after early spontaneous stoppage of all COVID-19 medications after the sense of generalized temporary improvement. Diagnosis: COVID-19 pneumonia with angina after neglect Yasser's COVID-19 discrepancy phenomenon and its regimen. Interventions: Electrocardiography, oxygenation, chest CT, and echocardiography. Outcomes: Initial good and dramatic outcome but, the worst outcome with deterioration had happened after early spontaneously stopped all COVID-19 medications. Lessons: The missed time, long-stay hospitalization, patient and governmental economic costs, and psychological stress on both patient and family are hazardous sequels due to neglect to follow Yasser’s COVID-19 Discrepancy phenomenon and its regimen. This is a typical applied example of this phenomenon. Female sex, unstable angina with coronary artery spasm, elevated cardiac biomarkers, a Wavy triple sign (Yasser’s sign) of hypocalcemia and COVID-19 pneumonia represent bad prognostic points and is indicating a high-risk condition.

Same same, but different? The neurological presentation of wildtype transthyretin (ATTRwt) amyloidosis

Background Both hereditary transthyretin (ATTRv) amyloidosis and wildtype transthyretin (ATTRwt) amyloidosis can be associated with neurological diseases such as carpal tunnel syndrome and polyneuropathy. While ATTRv amyloidosis has been extensively studied, to date little is known about neurological complications of ATTRwt amyloidosis. In particular, the prevalence, pattern and extent of polyneuropathy and autonomic dysfunction has not been adequately investigated in the context of ATTRwt amyloidosis. To tackle this issue, we aimed to characterise the neurological presentation of ATTRwt amyloidosis and to compare between the presentations of ATTRv and ATTRwt amyloidoses. Patients and methods Between November 2019 and September 2020, we included 50 patients with ATTRwt amyloidosis in this cohort study. All patients presented to the amyloidosis centre in Berlin, Germany and underwent neurological, cardiological and radiological work-up including neurological examination, laboratory testing, nerve conduction studies (NCS), echocardiography and scintigraphy. Patients were screened for symptoms of autonomic dysregulation and a subgroup of patients underwent tilt-table testing for orthostatic dysregulation. Results The cohort included 46 men and 4 women; the mean age of the study participants was 80.6 (standard deviation [SD] ± 5.0) years. All patients showed signs of cardiomyopathy on echocardiography. Neurological examination revealed peripheral, symmetric and length-depended predominately sensory polyneuropathy in 74% (n = 37) of patients. Neuropathy impairment scores (NIS) ranged from 0 to 50 with an average score of 8.4 (SD ± 10.1) indicating mild to moderate impairment. 90% and 92% of patients were classified as FAP stage I and PND stage I, respectively. Unilateral or bilateral carpal tunnel syndrome (CTS) was present in 70% (n = 35) and spinal stenosis was seen in 11% (n = 5) of patients. We detected a low rate of autonomic symptoms with a median COMPASS-31 total score of 18.4 points (IQR 32.4 points). Additional tilt-table testing of a subgroup of 8 patients yielded negative results for orthostatic intolerance. Conclusion Distal-symmetric, predominantly sensory polyneuropathy is a common neurological complication in ATTRwt amyloidosis besides carpal tunnel syndrome and spinal stenosis, further substantiating the systemic character of the disease. Compared to ATTRv amyloidosis, the severity of polyneuropathy in ATTRwt amyloidosis is milder and without relevant motor involvement. Symptoms of autonomic dysfunction were not common in this cohort. Nevertheless, ATTRwt amyloidosis is a treatable disease and should be included in the differential diagnosis of sensory polyneuropathy in the elderly.