Rare Clinical Case Research Articles

Aneurysmatic Dilation of Autovenous Conduit After Coronary Bypass Graft: Clinical Case

Considering the prevalence of cardiovascular pathology and the increase in coronary interventions, including coronary artery bypass grafting (CABG), therapeutic observation and assessment of results, as well as possible complications in this cohort of patients is an urgent problem in the clinic of internal medicine. Autovenous conduits, namely the great saphenous vein, is one of the most common conduits during coronary artery bypass grafting. The reported incidence of minor dilation of great saphenous vein grafts used for CABG varies up to 14 %, but significant dilation of the aneurysm is rare. When performing coronary angiography or multispiral computed angiography, it is possible to establish the true size of the aneurysm, but the presence of mural thrombi can distort the true picture. Complications may include compression of the native coronary vessels, distal embolization, myocardial ischemia, compression of the right atrium, or fistula formation and rupture into the right atrium. The article discusses a rare clinical case of aneurysmal dilatation of an autovenous conduit up to 7.3 cm after 23 years of coronary artery bypass grafting. Considering that the development of aneurysms and pseudoaneurysms in the field of coronary bypass surgery can occur both early and late, clinical vigilance is necessary throughout the entire period of follow-up and informing the patient. The article discusses diagnostic and treatment algorithms for identifying aneurysms and pseudoaneurysms.

A rare variant of the development of the proarrhythmogenic effect of etacizine in a child with chronic kidney disease (clinical case)

This article describes a rare clinical case of the development of severe ventricular tachycardia while taking etacizine in a 3-year-8-month-old patient with chronic kidney disease. A clinical case demonstrates the pharmacodynamics and pharmacokinetics of class 1C antiarrhythmic drugs in pediatric patients with kidney pathology.

The unusual connection between Right-Sided Aortic Arch and bronchial asthma

This work describes a rare clinical case of anomalous positioning of the aortic arch in a female patient with asthma. It highlights literature suggesting that this anomaly may sometimes mimic bronchial asthma, underscoring the importance of conducting bronchodilator reversibility tests more frequently to identify underlying asthma. The patient, a woman presenting with asthma symptoms, was found to have a Right-Sided Aortic Arch (RSAA), which is an unusual finding in the absence of congenital heart disease. Given the rarity of this presentation, it underscores the need for thorough evaluation and consideration of alternative diagnoses in patients with atypical asthma symptoms. This case emphasizes the importance of comprehensive diagnostic approaches, including spirometry and bronchodilator testing, to accurately diagnose and manage patients with asthma-like symptoms associated with rare anatomical variations such as RSAA.

A rare case of classic Kaposi’s sarcoma with a lesion of the oral mucosa

Kaposi’s sarcoma is a systemic tumor multifocal disease of vascular genesis. In the classic Kaposi’s sarcoma, lesions are most often localized on the skin of the lower extremities, lesions of the mucous membranes are extremely rare. The article presents a rare clinical case of the classic Kaposi’s sarcoma in a 56 years old man with lesions of the oral mucosa. This clinical case is of particular interest due to the difficulties of differential diagnosis of Kaposi’s sarcoma and lichen planus when mucous membranes are involved in the pathological process. The presented case emphasizes the importance of a histological examination of the biopsy in differential diagnosis of Kaposi’s sarcoma. In case when the rash is widespread and the mucous membranes are involved, it is recommended to collect the material from the skin, because the histological picture will be more characteristic. It is important to pay attention to the duration of the elements’ existence, as morphological diagnosis in the early stages of Kaposi’s sarcoma can imitate the pattern of chronic dermatosis.

Undifferentiated pleomorphic prostate sarcoma: a rare clinical case and systematic literature review

Undifferentiated pleomorphic prostate sarcoma is an extremely rare neoplasm. In the available literature, less than 50 clinical cases were described. Usually, the clinical manifestation of the disease is nonspecific and is primarily associated with bladder outlet obstruction. Additionally, most patients have normal levels of prostate-specific antigen, while ultrasound and MRI can visualize irregularly shaped lesions, often extending beyond the prostate gland. Diagnosis requires exclusion of other signs of specific differentiation, apart from fibroblastic and myofibroblastic. There is no established treatment plan for patients with pleomorphic prostate sarcoma due to extreme rarity of the disease. For localized forms of the disease, radical laparoscopic prostatectomy is often used, but more aggressive treatment options are also being considered, including total pelvic exenteration, chemotherapy and radiation therapy. However, in most cases metastasis is revealed after primary treatment. Regional metastases are often localized in the rectum, bladder, in the area of previous surgery, and regional lymph nodes, while distant metastases are found in the lungs, liver, bones and distant lymph nodes, thereby indicating aggressive progression and poor prognosis of the disease.In this article, we present our own clinical observation of a patient with confirmed undifferentiated pleomorphic prostate sarcoma.

Isolated ocular sarcoidosis

A rare clinical case of a patient with isolated sarcoidosis of the eyes is presented. Sarcoidosis is a polyethological disease, the morphological feature of which is the formation of epithelioid cell granulomas in various organs and tissues, which is accompanied by a violation of their structure and function. Both congenital and adaptive immune systems are involved in the pathogenesis of sarcoidosis, with damage to lymph nodes, lungs, skin, organ of vision, etc. Risk factors for the development of sarcoidosis have not been definitively established. Environmental factors and genetic predisposition play a crucial role in the development of the disease. The above clinical observation demonstrates the polymorphism of the clinical picture of isolated ocular sarcoidosis. In addition to standard ophthalmic examination methods, the genetic method of reverse transcription and quantitative polymerase chain reaction (RT-PCR, English qRT-PCR) was also used to determine the expression profile of signature microRNAs as potential diagnostic markers of sarcoidosis of the organ of vision.An increase in the expression level of hsa-miR-455-3p, hsa-miR-4663, hsamiR68063p, hsa-miR-450b-5p, hsa-miR-6716-3p, hsa-miR-5000-5p, hsa-miR150-5p can be considered as potential diagnostic biomarkers of sarcoid lesion of eye structures. With sarcoidosis, the involvement of the lacrimal gland is possible. In the presented clinical observation, this was indicated by the results of a functional examination, sonographic signs: revealed multiple linear tubular hyperechoic structures and a decrease in blood flow velocity in the ocular and lacrimal arteries, as well as an increase in the expression activity of hsa-miR150-5p (p < 0.05). In order to prevent possible damage to the ocular surface due to the development of lacrimal gland dysfunction, it is advisable to prescribe local tear replacement therapy with hyaluronic acid preparations. Such effective drugs include tear substitutes of the Optinol® line: “Optinol® Express Moisture” and “Optinol® Deep Moisture”.

A rare clinical case of malignant ectopic retrosternal goiter of a large size in a patient with aberrant right subclavian artery

Background. Ectopic goiter accounts for only 0.2 % to 1 % of all mediastinal goiters. The aberrant right subclavian artery (arteria lusoria) is an extremely rare anomaly of the major vessel, with a prevalence not exceeding 0.3 % in the general population. This paper presents the first case of malignant ectopic retrosternal goiter of a large size in combination with the aberrant right subclavian artery. Clinical case description. A 61-year-old male presented to the thoracic surgery department of P. Herzen Moscow oncology Research institute with a large posterior mediastinal mass measuring 108×106×79 mm and adjacent to the right lobe of the thyroid gland. The tumor displaced the trachea and esophagus. Open biopsy through a thoracotomy incision revealed thyroid gland cells without signs of atypia. A detailed examination revealed mediastinal vascular anomaly – retrotracheal position of the right subclavian artery. a complete longitudinal sternotomy, complemented by a right-sided thoracotomy at the 3rd intercostal space, served as the surgical approach. The operation lasted 320 minutes, with a blood loss of 3500 ml. The postoperative period was uneventful. The morphological examination of the surgical specimen revealed nodular hyperplasia of the ectopic thyroid tissue with the growth of well-differentiated follicular carcinoma without metastatic involvement of removed lymph nodes. Considering the identified follicular carcinoma, total thyroidectomy was performed. Conclusion. In surgical planning, it is crucial to assess the location of major mediastinal vessels and their relationship with the goiter. Therefore, all patients with mediastinal lesions should undergo preoperative contrast-enhanced ct. Retrosternal goiter predisposes to a higher rate of malignancy compared to cervical goiter. If the lower edge of the goiter is at the level of or below the aortic arch, cervical access should be supplemented with sternotomy. In cases of a massive thoracic component, additional thoracotomy is justified.

Correction of hyperphosphatemia in a patient with end-stage chronic kidney disease and a complex case of anemia. A clinical case

Iron supplements and/or blood transfusions in combination with recombinant human erythropoietin injections are routinely used to correct renal anemia, which is a common complication of end-stage renal disease. However, massive blood transfusions and inadequate intravenous iron supplementation can lead to iron overload syndrome, and anemia is not always nephrogenic. A rare clinical case of a patient with end-stage chronic kidney disease with complex genesis of anemia, who is on hemodialysis, is presented. The case is interesting because the prescription of first-line drugs was life-threatening in nature, and sevelamer was the drug chosen for the correction of mineral-bone disorders.

Organ-preserving treatment of a patient with a trophoblastic tumor of the placental bed (clinical observation and literature review)

Placental site trophoblastic tumor (PSTT) is а rare form of gestational trophoblastic neoplasia (GTN), accounting 0,2 % of total cases of GTN. PSTTs occur in women of childbearing age and most of them have strong desire to preserve fertility. PSSTs are tumors with unpredictable biological behavior, high chemo-resistance and possibly fatal outcome in case of metastatic disease.Hysterectomy is the primary treatment of choice in early disease. We report a rare clinical case of fertility sparing treatment for PSTT.

ВРОЖДЕННАЯ АНОМАЛИЯ ЧЕРВЕОБРАЗНОГО ОТРОСТКА, ОСЛОЖНИВШАЯСЯ АППЕНДИЦИТОМ

Congenital malformations of the appendix are an extremely rare pathology, do not have a specific clinical picture and are usually detected at the time of surgery or pathohistological examination of the removed appendix. The purpose of the study. To present a description of a rare pathology – a case of incomplete doubling of the appendix and its atypical location, which contributed to the development of chronic recurrent appendicitis and periappendicitis. Results. The patient, aged 19, was operated on with a diagnosis of acute appendicitis. Laparoscopy has revealed that the appendix is partially retracted into the inguinal hernia and purulent fibrinous periappendicitis occurs. The vermiform appendix was removed. During its examination by both the surgeon and the pathologist, no developmental abnormality was detected. Pathohistological examination revealed incomplete doubling of the appendix. The additional process was located in the thickened mesentery of the main appendix. The complete absence of the outer layer in the muscle membrane and the serous membrane of the accessory process was revealed. This abnormality has provoked the development of chronic recurrent appendicitis and periappendicitis with the formation of an appendicular infiltrate. Conclusion. This article describes a rare clinical case of not only abnormal development of the appendix with the formation of chronic recurrent appendicitis, the formation of periappendicular infiltrate, but also its atypical location – it was partially involved in an inguinal hernia.

Siderosis of the esophagus

This publication describes a rare clinical case of esophageal siderosis. The patient was found to have flat irregularly shaped superficial scars with areas of hyperpigmentation of the esophageal mucosa in a dark color. It is known from the anamnesis that she has long suffered from iron deficiency anemia and takes iron preparations. A conclusion was made about the defeat of the esophageal mucosa by iron sulfate preparations - esophageal siderosis. The endoscopic conclusion was confirmed by a pathomorphological study - a few cells with brown pigment in the cytoplasm were found in the subepithelial connective tissue - a picture of siderosis

A malignancy phantom: a rare clinical case report of metastatic renal cell carcinoma with no evidence of a primary lesion presenting as cerebellar ataxia

Background: Anti-Ma2 antibody associated paraneoplastic syndrome (PNS) usually presents as limbic encephalitis in the context of testicular tumors. We report a rare case of anti-Ma2 positive PNS with deviation from the classic scenario, thus expanding the phenotype of anti-ma2 associated PNS. Case presentation: This is a 53-year-old male who presented with what was later diagnosed as anti-Ma2 antibody positive cerebellar ataxia. Further workup revealed retroperitoneal lymphadenopathy which, using biopsy, was identified as metastatic clear cell renal cell carcinoma (RCC). However, imaging did not reveal a primary renal lesion. Conclusion: Physicians should be aware of non-classic presentations of paraneoplastic syndromes, especially given that they commonly precede and point towards an underlying, many times undiagnosed, malignancy.

A rare clinical case of diagnosis and treatment of metastases of Merkel carcinoma in the right inguinal lymph nodes without an identified primary focus

Introduction. Merkel’s carcinoma is a neuroendocrine malignant epithelial skin tumor, rapidly progressive, prone to local recurrence and metastasis to regional lymph nodes and internal organs. The etiology and pathogenesis of Merkel’s carcinoma are still an insufficiently studied issue. Because of its rare occurrence, only single observations of Merkel’s carcinoma metastasis without an identified primary focus, most often with regional lymph node involvement, have been described in the world literature.Clinical case. This article presents a clinical case of metastatic lesion of inguinal lymph nodes with microinvasion into femoral artery in Merkel’s carcinoma without identified primary focus. After a comprehensive examination and onco-consilium the patient underwent surgical treatment in the scope of cytoreductive excision of the inguinal lymph node conglomerate on the right side and artery prosthesis with an autovenous graft. According to the routine postoperative pathomorphologic and immunohistochemical studies, the diagnosis of Merkel’s carcinoma metastasis was finally confirmed.Conclusion. Identification and description of such clinical cases are practically significant and can serve for formation of certain algorithms for treatment of Merkel’s carcinoma both with local manifestations and in progressive forms. Patients with Merkel’s carcinoma should be discussed in oncological consiliums, as treatment may include surgical stage, including biopsy of sentinel lymph nodes, adjuvant radiotherapy, chemotherapy and immunotherapy in case of tumor dissemination.

Case Study On Pulmonary and Right Atrial Cardiac Metastases Among Children with Hepatocellular Carcinoma

The occurrence of hepatocellular carcinoma(HpC) hepato-blastoma (HB) in children with metastases in both the right atrium and lungs is a rare occurrence. Overcoming these challenges in treatment is an intricate and demanding process. We present a rare clinical case involving a pediatric patient diagnosed with hepatoblastoma (HpC) that exhibited metastasis to both the lungs and the right atrium. In response to this complex condition, surgical intervention was undertaken, complemented by a carefully administered combination of chemotherapy. This dual-phase chemotherapy, administered both pre- and post-operation, served as an adjuvant treatment strategy. The primary objective of this comprehensive therapeutic approach was to attain full remission, eliminating any traces of the malignancy. The intricacies of managing metastatic HpC in pediatric cases underscore the importance of multidisciplinary interventions, emphasizing the critical role of surgery and adjuvant chemotherapy in the pursuit of a positive treatment outcome. Thus, individuals with HB that has spread to the lungs and right atrium may have a favorable outcome by undergoing proactive and multimodal therapy.

Sinonasal diffuse large B-cell lymphoma: own clinical observation and literature review

Diffuse large B-cell lymphoma is the most common immunomorphological variant of lymphoma in adults. Extranodal lesions are observed in a third of patients at the disease onset. The organs most often involved are the gastrointestinal tract, testicles, bones, thyroid gland, and skin. Primary involvement of the nasal cavity and paranasal sinuses occur extremely rarely and cause diagnostic and therapeutic difficulties.The article demonstrates a rare clinical case of newly diagnosed diffuse large B-cell lymphoma with sinonasal tract involvement. It took 6 months to verify the final diagnosis. At the moment, the induction stage of treatment for diffuse large B-cell lymphoma continues, the achieved complete metabolic response is maintained.

Rare clinical case of harlequin ichthyosis: opportunities and difficulties of prenatal diagnosis

Rare clinical case of harlequin ichthyosis: opportunities and difficulties of prenatal diagnosis

Distal ureteral atresia, megaureter of a lower pole of a duplicated kidney: the rare clinical case

Ureteral atresia is a rare pathology, the diagnosis of which is difficult, and a unified approach to the method of surgical correction has not been formed. The aim of this study is to demonstrate a rare clinical case of a patient with distal ureteral atresia of a non-functioning lower pole of a duplicated kidney, and also to present the method of surgical treatment. A 12-year-old female patient was diagnosed with a cystic formation of the retroperitoneal space. During the operation, it was determined that this cyst was an atretic, dilated ureter of a lower pole of the duplacated kidney. Lower heminefrureterectomy was chosen as the method of surgical correction. Ureteral atresia is rarely combined with any other anomalies of the upper urinary tract, and the presented clinical case has not previously been described in the available foreign and Russian literature. The methods of surgical correction of ureteral atresia include nephrureterectomy, ureteroureterostomy, intestinal ureteroplasty, and Boari procedure. In the presented case, heminefrureterectomy was chosen because of severe hypoplasia of the lower pole of the duplicated kidney and the almost complete absence of its parenchyma. When examining patients with cystic formations of the retroperitoneal space, it is necessary to remember about the ureteral atresia, which may be accompanied by other anomalies of the upper urinary tract.

A rare clinical case of systemic AA amyloidosis with cardiac involvement complicating ankylosing spondylitis: a case report

BackgroundAnkylosing spondylitis (AS) is a type of chronic inflammation that is most prevalent in young adults and is characterized by an inflammatory enthesiopathy that gradually develops toward ossification and ankylosis. If inflammation is left unchecked, it can potentially lead to complications such as secondary amyloidosis, also known as AA amyloidosis, involving the deposition of amyloid serum A protein. Our case presents with a thyroid localization of AA amyloidosis which is secondary to this AS. Such a case has been described in only four cases in the literature. Cardiac localization of AA amyloidosis has been exceptionally described in the literature.Case presentationWe report the case of a young patient with severe AS complicated by secondary amyloidosis with thyroid, cardiac, and probably renal localization. He was treated with anti-TNF therapy, and his condition improved significantly.ConclusionsOur case presents several localizations of AA amyloidosis secondary to this AS. Although cardiac involvement is rare in secondary AA amyloidosis, it should always be screened for, even in a cardiacly asymptomatic patient.

Bacterial Meningitis Caused by Streptococcus Suis, Complicated by Secondary Ventriculoperitoneal Shunt-Associated Peritonitis: A Rare Clinical Case Presentation

The main method of treating hydrocephalus is through liquor shunt surgery, with preference given to Ventriculoperitoneal Shunts (VPS). However, as the number of implanted bypass systems in the abdominal cavity increases, so does the number of complications, both intraventricular and abdominal. We present a unique case of primary bacterial meningitis caused by Streptococcus suis, which was complicated by secondary shunt-associated diffuse fibrinous peritonitis in a 28-year-old female patient.

Adenovirus keratoconjunctivitis after LASIK as a complication of COVID-19 vaccination: a clinical case

During large-scale vaccination against coronavirus infection, studying possible side effects after the introduction of the vaccine is of great practical value. We present a rare clinical case of a complication of COVID-19 vaccine prophylaxis. A 40-year-old female patient was diagnosed with a bilateral adenoviral keratoconjunctivitis complicated by corneal erosion and iritis after a LASIK refractive intervention and a subsequent (after 5 days) immunoprophylaxis with the Gam-COVID-Vac vaccine followed by a displacement of the corneal flap due to involuntary friction of the left eye. The corneal flap was urgently repositioned; its adhesion and stabilization were achieved usinga bandage soft contact lens. The timely local and systemic anti-inflammatory and antiviral therapy allowed achieving a successful visual result (1.0). Ophthalmologists need to remain vigilant about possible adverse effects after immunoprophylaxis on the part of the eye, specifically the conjunctiva and cornea. A timely diagnosis and treatment are important to prevent complications such as persistent corneal opacities that reduce visual acuity, especially in patients who have undergone refractive surgery aimed at achieving the highest possible vision. In our opinion, it is advisable to perform vaccination at least 1 month after the refractive surgery.