Rare Site Research Articles

ДИФФЕРЕНЦИРОВАННЫЙ ПОДХОД К ДИАГНОСТИКЕ И ЛЕЧЕНИЮ АКУШЕРСКИХ КРОВОТЕЧЕНИЙ ПРИ ЭКТОПИЧЕСКОЙ БЕРЕМЕННОСТИ: СЛУЧАЙ ИЗ ПРАКТИКИ

Ectopic pregnancy is a pathological condition in which the implantation of a fertilized egg occurs outside the uterine cavity. According to statistics, the most common localization of ectopic pregnancy is the fallopian tubes (98-99% of cases), while the cervix is a rare implantation site (0.1-0.4%). At the same time, analyzing the complications of the gestational process, we can say that it is cervical pregnancy that increases the risk of bleeding leading to the need for emergency surgery. The article presents a case from clinical practice that characterizes the tactics of diagnosis and treatment in case of suspected cervical pregnancy. The analysis of the management of this pregnancy proved the need for a differentiated approach to each case of ectopic pregnancy. This algorithm contributes to the rapid and accurate diagnosis and development of tactics for management pregnancy with bleeding.

Osteochondroma of Dorsal Scapula: A Case Report and Review of Literature.

Osteochondroma of the scapula constitutes only 3-5% of all osteochondromas; osteochondroma on dorsal aspect of scapula is a rare entity. Diagnosis is almost always clinicoradiologically. Additional computed tomography scan and magnetic resonance imaging may be required for osteochondroma of flat bones such as scapula. Indications for surgery include pain, deformity, dysfunction, neural or vascular compromise, failure of conservative management, or in clinical settings with the high suspicion of malignant transformation and occasionally cosmesis. Outcome of a surgery should be assessed by Patient-Reported Outcome Measures (PROMs) which appraises what "matters to the patient." A 10-year-old boy presented to us with painless swelling over the right upper back since 3 years of age and discomfort over the area while sleeping on his back for 6 months. Diagnosis confirmed it to be a pedunculated osteochondroma arising from the dorsal scapula. Here, we report the diagnosis, treatment, and successful Patient-Reported Outcome using QuickDASH© score for an osteochondroma of dorsal scapula using CARE© case reporting guidelines. We report a rare site of osteochondroma, review the relevant literature, and also stress upon the necessity of analyzing PROMs after surgical treatment of benign tumors of bone which would enable us to evaluate the result of surgery on symptoms, functioning, and health-related quality of life from the patient's perspective.

Breast Cancer Metastatic to Gluteus Maximus: A Case Report

Breast cancer rarely metastasizes to skeletal muscle. Moreover, skeletal muscle is a rare site of metastasis for any type of cancer. In this study, we report an unexpected finding of an enlarged mass in the gluteus maximus of an asymptomatic patient with a distant history of breast cancer. The mass was observed during computed tomography evaluation in preparation for a non-oncologic procedure. Biopsy and pathological investigation confirmed breast cancer metastasis. An increased awareness of rare metastatic sites is important so that such lesions are critically evaluated during early imaging examination.

A rare presentation site for osteochondroma scapula and pelvis, intramembranous ossifying bones of axial skeleton: case series

Osteochondroma is the most common primary bone tumour comprising over 33% of benign bone tumours. The formation of osteochondroma occurs because of exophytic protuberance on the surface of growing bones. The most common sites for osteochondroma are the distal femur, proximal tibia, and proximal humerus. We are presenting a case series of three patients with rare presentation sites of osteochondroma, scapula and pelvis. Osteochondroma is primarily disease of appendicular skeleton but we are reporting it in axial skeleton. Radiographic findings include fluffy cartilaginous outgrowth arising from the external surface of a long tubular bone that may be pedunculated or sessile. Osteochondromas usually develop in bones that develop by enchondral ossification and rarely develop in bones developing by intramembranous ossification like pelvis. These tumours are usually asymptomatic but can cause pubic visceral compression or neurovascular compromise by compressing external and internal iliac vessels and lumbosacral pluxes. Scapular osteochondroma can cause compression or neurovascular compromise in thoracic cavity and axillary vessels and brachial pluxes. Treatment with surgical excision gives consistent results and relief of pain.

Hepatocellular carcinoma presenting as a chest wall mass - An unusual case diagnosed on cytology with review of literature.

Hepatocellular carcinoma (HCC) is associated with an aggressive behavior and a strong tendency for extrahepatic metastasis. Although 5%-15% patients have metastases at diagnosis, presentation with symptoms exclusively related to extrahepatic metastases is rare. An 82-year-old male presented with an isolated left anterolateral chest wall swelling. Ultrasonography revealed a soft tissue mass involving the anterior chest wall with adjacent rib erosion. Serum protein electrophoresis showed increase in beta-2 region. A clinical diagnosis of multiple myeloma was considered. Fine needle aspiration cytology from the swelling showed loosely cohesive clusters of polygonal cells with traversing blood vessels. Cells showed abundant vacuolated to granular cytoplasm, round nuclei with frequent intranuclear cytoplasmic inclusions. A differential of metastatic HCC and renal cell carcinoma was considered. Subsequent imaging showed a 12 cm mass in the liver. Biopsy from chest wall mass with immunohistochemistry confirmed the diagnosis. Lungs and lymph nodes are the commonest sites for metastatic HCC; presentation as chest wall metastasis is rarely reported. The classical cytomorphology of HCC proved useful in diagnosing metastasis at a rare site. Recent studies have shown that beta-2-globulin is a promising biomarker for early diagnosis of HCC in patients with chronic liver disease.

Sebaceous cell carcinoma of the scalp in a young male: A rare case report

Sebaceous carcinoma is a rare locally aggressive neoplasm of the sebaceous gland, which occurs frequently in elderly males. It constitutes 0.2 to 4.6% of all the malignant cutaneous tumours and occurs commonly in the periocular area. Scalp is a rare site for this tumor. Here we report a case of sebaceous carcinoma in a young 28 years old male patient who presented with firm to hard exophytic growth over right posterior occipital region with enlarged suboccipital and post auricular lymph nodes. Wide local excision was done and a diagnosis of sebaceous carcinoma of the scalp with lymph node metastasis was rendered after histopathological and Immunohistochemical examination.

Type A, Type B, and Non-atrophic Gastritis

The gastric cancer risk varies based on the etiology and severity of gastritis, which depends on a history of Helicobacter pylori infection and the secretory capacity of the stomach. Type A gastritis is associated with reverse atrophy of the corpus and type B with progressive atrophy extending from the antrum to the corpus. Diffuse or spotty redness in the corpus together with high serum pepsinogen (PG) II levels and a low PG I/II ratio are observed in patients with H. pylori infection when secretory capacity of the stomach is intact. Diffuse-type gastric cancer may develop near the gastric folds, which is a rare site of atrophy. Low serum PG I levels are associated with progressive gastric corpus atrophy and intestinal metaplasia in patients with chronic and previous H. pylori infections. This clinical scenario predisposes patients to intestinal-type gastric cancer, which originates in the atrophic and metaplastic gastric mucosa. Conversely, a high PG I/II ratio is observed in patients without H. pylori infection. Serum PG I levels and the PG I/II ratio are high in patients with acute H. pylori-negative gastritis, including drug-induced gastritis but are significantly low in autoimmune gastritis. Gastric neuroendocrine tumors may develop in patients with autoimmune gastritis or in those with long-term acid suppressant use. Fasting serum gastrin levels and the risk of neuroendocrine tumors are high in both cases. In this review, types of gastritis are summarized along with evaluation performed to determine the secretory capacity of the background gastric mucosa.

A case report of osteochondroma of radial neck in a young adult

Introduction: Osteochondroma, often referred to as exostosis, is the most common benign tumor characterized by a bony protuberance surrounded by cartilaginous surface, most commonly in proximal tibia, distal femur, proximal humerus. Our case was presented in a very unusual site, i.e., Radial neck. Case Report: A case report of unusual manifestation of a solitary osteochondroma, i.e., exostosis, a common benign tumor but in a rare site, i.e., in the radial neck. We report this case due to its unusual site of presentation. The lesion for surgically managed. Conclusion: Osteochondroma involving rare location such as radial neck can be challenging to diagnose for clinicians but with thorough examination and radiological studies the swelling was recognizable as osteochondroma and the patient was treated accordingly.

Elbow hemiarthroplasty with a 3D-printed prosthesis for distal humeral bone defects after tumor excision: a case report

IntroductionThe distal humerus is a rare site for primary and metastatic bone tumors. Due to the scarcity of cases and lack of standardized surgical strategies, it is often difficult for surgeons to choose the right choice. The application of a 3D-printed prosthesis with hemiarthroplasty for the treatment of the distal humerus after tumor resection can be a very effective option.Case presentationWe present a clinical case of a 3D-printed distal humeral prosthesis for the treatment of bone defects caused by metastatic bone tumors. The preoperative evaluation was aggressively performed, and the decision was made to distal humeral hemiarthroplasty (DHH) after wide resection of the tumor segment bone. Processing of the Digital Imaging and Communications in Medicine (DICOM) data from CT scans performed after mirror conversion using CT data of the contralateral humerus, we designed a 3D-printed distal humeral prosthesis with hemiarthroplasty. After reconstruction of bone and surrounding soft tissue by the 3D-printed prosthesis combined with the LARS ligament and regular follow-up for 12 months, the patient had an MSTS-93 score of 29 and an MEP of 100, which reached a good level, and the patient was fully competent in normal daily activities.ConclusionsOur results show that the 3D-printed modular prosthesis with hemiarthroplasty is a very effective option for cases of large elbow bone defects due to primary bone tumors or metastatic disease. However, careful preoperative preparation is required for the best outcome. Careful preoperative preparation and long-term follow-up are essential for the best outcome.

Cervical endometriosis in pregnancy: A rare cause of bleeding in pregnancy

Introduction: Cervical endometriosis is a very rare site for endometriosis, with a reported incidence of 0.11–2.4%. Case Report: We present a histologically proven case of cervical endometriosis in a 33-year-old pregnant woman who presented with post-coital bleeding during the first trimester of her pregnancy, with subsequent spontaneous regression, and successful vaginal delivery. Conclusion: This case emphasizes the importance of a thorough pelvic examination in patients presenting with bleeding in early pregnancy and biopsy of any lesions as long as it is safe. Cervical endometriosis should be added to the list of differential diagnoses of bleeding in pregnancy after the more common causes have been excluded.

Gingival Swelling; Surprisingly Actinomycosis!

ABSTRACT Actinomycosis is a rare disease. Its diagnosis is challenging clinically as it mimics many other infectious diseases and neoplasms. In this scenario, a simple timely biopsy can come to the clinician’s rescue. Actinomycosis can be reliably diagnosed on histopathological examination accompanied by special stains without losing much time. Culturing this organism is a tedious job in view of its fastidious nature and requires a long waiting time. Polymerase chain reaction (PCR) can be useful and is less time-consuming, but histopathology is more cost-effective in our country like India. This case report emphasizes the fact that a rare possibility of actinomycosis should also be kept in mind even in immunocompetent individuals in rare sites like gingiva even if there are no discharging sinuses noted clinically. Actinomycosis requires long-duration antibiotic treatment, so if diagnosis time is reduced, timely treatment of actinomycosis can be started and complications can be prevented.

Cutaneous Metastasis from Solid Malignancies Heralding Underlying Dissemination: A Case Series of Rare Presentations

ABSTRACT Metastasis to the skin remains a rare site of disease involvement in visceral malignancies. It is also a poor prognostic marker for survival. We present a case series of four cases that presented with cutaneous metastasis in a background of solid tumors of the esophagus, gall bladder, kidneys, and lungs, respectively. In all cases, the appearance of the skin lesion acted as a herald that led to the discovery of recurrence or widespread dissemination of the malignancy. Three of the patients passed away within 6 months of the appearance of skin metastases. The use of targeted therapy showed a good response in the patient with renal cell carcinoma with significant regression of disease.

Necrotizing Fasciitis of Breast: A Rare but Fatal Entity

Necrotising fasciitis is a rapidly developing, fatal bacterial infection of deep subcutaneous tissues. It may occur at any site in the body; breast being a rare site. We describe a case of necrotizing fasciitis in the breast that was diagnosed on the basis of ultrasound and CT scan findings.

Bilateral hydatid cyst of the breast: a case report and review of the literature.

Hydatid cyst disease is a parasitic infestation caused by the tapeworm Echinococcus granulosus. The incidence of the disease is 1-200 cases per 100000. The usual presentation is the formation of fluid-filled cysts in the liver or lungs and, less commonly, in the brain. The breast is a rare site of presentation for this disease. An isolated hydatid cyst in the breast is very rare, even in endemic regions, occurring in only 0.27% of all hydatid cases. Although these cases are very rare, they should be considered severe. A hydatid breast cyst may mimic a fibroadenoma, phyllodes tumor, chronic abscess, or even carcinoma. Therefore, a high incidence of misdiagnosis may occur. Preoperative diagnosis can be made using needle aspiration and imaging facilities such as breast ultrasonography, mammograms, and computerized topographic images. Nevertheless, in most cases, the final diagnosis cannot be made until the pathological report is obtained postsurgery. This paper reports the first case of a bilateral hydatid cyst of the breast that was diagnosed preoperatively by radiological facilities. We present the patient history, physical examination, and investigations, discuss the risk factors, and present our treatment plan.

Neanderthal bones collected by hyena at Grotta Guattari, central Italy, 66–65 ka: U/Th chronology and paleoenvironmental setting

After eight decades since its discovery in 1939, new investigations have been undertaken at Grotta Guattari (Latium, central Italy), a coastal cave by the Tyrrhenian Sea coast and one of the iconic sites of the Italian prehistory, as it yielded an almost complete skull and other remains of Neanderthals. The new excavations of the innermost and untouched cave deposits resulted in an outstanding amount of mammal bones, 40 out of which attributable to Neanderthal, including new large portions of cranial remains. Preliminary taphonomic hints and the collected stratigraphic evidence strongly indicate that the impressive accumulation of the large mammal bones was the work of spotted hyena, in a period in which human frequentation was really sporadic or even completely absent. The new acquired U/Th chronology of Grotta Guattari speleothems provided new constraints for reconstructing the sedimentary and paleoenvironmental history of the archaeological successions and human remains. The accumulation of terrestrial sediments started at ∼112 ka, immediately after the end of the Last Interglacial sea-level highstand (∼116 ka). However, the hyena frequentation, and thus the bone accumulations, occurred several thousands of years after and lasted for a very short time interval, precisely between slightly before 66 ka and 65 ka. The cave became abandoned by hyena after ∼65 ka and before ∼59 ka, because of the cave obstruction and/or the altered environmental conditions related to the Heinrich Event 6 (∼64–60 ka). The regional paleoclimatic records indicate severe conditions during the short interval of the hyena frequentation. In contrast, though providing evidence of open and arid environments, the faunal assemblage and the pollen from Grotta Guattari reveal that the local conditions were less severe, likely because of the mitigating effect of the Tyrrhenian Sea. In the framework of the Italian findings, Grotta Guattari results the richest and better chronologically constrained site of Neanderthal remains, posing it as one of the rare sites of the European prehistory that allows putting into the context an extraordinary large sample of the population of Neanderthals, and of other large mammals, in a very narrow and precisely dated temporal interval of the early Pleniglacial.

Seborrheic keratosis at the cavum concha of the pinna: a case report

Seborrheic keratosis is a benign cutaneous tumour. The most common sites include head, neck, trunk and extremities except palms and soles. Pinna is a very rare site for such a lesion. They mostly present as multiple small lesions and solitary large lesion is very rare. Ultraviolet light exposure and human papilloma virus infection are possible etiologies. The differential diagnosis may include various benign lesions along with malignancy. The treatment options include removal of the tumour by simple surgical excision or by other means such as laser ablation. The confirmation of the diagnosis is by histopathological examination of excised specimen. There may be chances of recurrence of the lesion and so close follow up is required. We are reporting a brownish lesion at the cavum concha of left ear pinna appreciated since 1 year following thermal injury sustained during the welding work. The lesion was surgically excised and histopathology confirmed it as seborrheic keratosis. Patient has been followed up for 6 months and no recurrence noted.

Known monster, unknown “avatars”: Pediatric rhabdomyosarcoma case series with uncommon presentation

Rhabdomyosarcoma (RMS) is a rare soft-tissue tumor, accounting for 3% of all childhood cancers. RMS can arise virtually anywhere in the body, as it originates from the embryonal mesenchyme. Embryonal RMS (ERMS) and alveolar RMS are the most prevalent types. In this case series, five children with unusual sites of presentation of ERMS have been reported. The first case is a 6-year-old male who presented with episodes of recurrent hemoptysis for 2 months and computed tomography chest showed lung mass. The second case is a 3-year-old male, who presented with right abdominal distention and was diagnosed as a liver ERMS which is a very rare site for RMS. The third case is a 1-year-old male child who presented with isolated right inguinal lymph node swelling. The fourth case presented with recurrent admissions for respiratory distress requiring intubation and was misdiagnosed as recurrent viral infection, but on further, investigation was diagnosed as a laryngeal ERMS. Our fifth case is a 6-year-old male child who presented with infraumbilical mass, diagnosed as a retroperitoneal ERMS. The 5-year survival rate of such tumors is 70% in children with localized disease who receive combined-modality therapy. Therefore, an awareness of the typical signs and symptoms, radiological features, and histomorphological features in a case of pediatric RMS can help a physician to consider this tumors in the differential diagnoses, even at unusual sites.

Infantile Fibromatosis of the Infratemporal Fossa Extending to Oropharynx

The Case Study describes the clinical radiographic Surgical Procedure with reconstruction and histopathology Infantile fibromatosis of infratemporal fossa extending to oral cavity and Oropharynx in a two-year-old male child. This condition is rarer in two-year-old child mainly in infratemporal fossa extending to Oropharynx and protruding into oral cavity leading to tremendous suffering of the child for breast feeding, eating with occasional profuse bleeding. The differential diagnosis, management and long term follow up for two years are also mentioned. The need for aggressive surgical management, rare site and operability in this region is very rarer of rarest. The absence of recurrence after 2 years follow up is significant and we can declare the patient is cured from the primary disease. This paper gives guide to how to approach the disease process.

The effect of glass structure and local rare earth site symmetry on the optical properties of rare earth doped alkaline earth aluminosilicate glasses

The effect of glass structure and local rare earth site symmetry on the optical properties of rare earth doped alkaline earth aluminosilicate glasses

Primary extragastrointestinal stromal tumor of the prostate: review of the literature and case report.

A 58-year-old man was presented with lower urinary tract symptoms for 6 months. A digital rectal examination revealed a markedly enlarged prostate with a smooth, bulging surface. Prostate-specific antigen density was 0.5ng/ml. MRI of the prostate showed an enlarged prostatic mass with hemorrhagic necrosis. Transrectal ultrasound-guided prostate biopsy was performed and pathological reports suggested a gastrointestinal stromal tumor. The patient refused radical prostatectomy and received only imatinib treatment. The diagnosis of EGIST of the prostate is extremely rare and depends on the histopathologic features with immunohistochemical results. The treatment is essentially based on radical prostatectomy, but there are other therapeutic modalities associating surgery with adjuvant or neoadjuvant chemotherapy. For patients refusing surgery, treatment with imatinib alone appears to be a therapeutic solution. Despite the rarity, EGIST of the prostate should be included in the differential diagnosis of patients presenting with lower urinary tract symptoms. There is no consensus regarding the treatment of EGIST, and the patients are treated as per the risk stratification.