Signs Of Recurrence Research Articles

Successful Manitol Treatment in Young Man Patient with Spontaneous Operable Chronic Subdural Hematoma: A Case Report

Chronic subdural hematoma (cSDH) is a common neurosurgery disorder among the elderly, but it is rare in the younger patients. Incidence of cSDH is approximately 5/100.000 a year in the general population but it has higher rate in elderly. Most cases of cSDH has prior trauma event which then leads to hematoma formation in subdural space and inflammation is believed to have an important role in its pathophysiology. This study reports a spontaneous cSDH case in a young adult patient whose symptoms appeared to be chronic headache, nausea, vomiting and dizziness. Any neurological deficit was absent. This patient was treated conservatively using an osmotic agent, mannitol, despite the fact that the current patient had an indication of surgical treatment. The patient was discharged from the hospital with a good outcome. After 2 months of follow-up, there was no sign of recurrence. Our study found several considerations in deciding treatment options for cSDH, including the condition of the patient and the doctor in charge’s viewpoint.

Spontaneous Chronic Subdural Hematoma in Young Man Patient with Conservative Treatment : A Case Report

Background: Chronic subdural hematoma (cSDH) is a common neurosurgery disorder among the elderly, but it is rare in the younger patients. Incidence of cSDH is approximately 5/100.000 a year in the general population but it has higher rate in elderly. Most cases of cSDH has prior trauma event which then leads to hematoma formation in subdural space and inflammation is believed to have an important role in its pathophysiology.
 Case Report: This study reports a spontaneous cSDH case in a young adult patient whose symptoms appeared to be chronic headache, nausea, vomiting and dizziness. Any neurological deficit was absent. This patient was treated conservatively using an osmotic agent, mannitol, despite the fact that the current patient had an indication of surgical treatment. The patient was discharged from the hospital with a good outcome. After 2 months of follow-up, there was no sign of recurrence.
 Conclusion: Our study found several considerations in deciding treatment options for cSDH, including the condition of the patient and the doctor in charge’s viewpoint.

Uterine tumor resembling ovarian sex-cord tumor - a rare gynecological neoplasm.

Uterine tumor resembling ovarian sex-cord tumor is a rare group of uterine neoplasms with unknown histogenesis and differentiation towards ovarian sex-cord elements. They are benign in nature with low malignancy potential. Diagnosis is based on immunohistochemistry and morphological features, and the distinction from other more malignant differentials is paramount to correctly individualizing treatment.

Margin-negative minimally invasive pancreatoduodenectomy following FOLFIRINOX neoadjuvant chemotherapy in invasive intraductal papillary mucinous neoplasm of pancreas: a case report.

This study shows a case of neoadjuvant chemotherapy application for the management of a 34-year-old male patient diagnosed with invasive intraductal papillary mucinous neoplasm (IPMN), for which curative margin-negative resection initially seemed challenging. Five cycles of the FOLFIRINOX regimen (5-fluorouracil, leucovorin, irinotecan, and oxaliplatin) were administered preoperatively, resulting in a significant reduction of the intraductal mass size and deformity of the main vessels. The patient subsequently underwent a successful robotic pylorus-preserving pancreatoduodenectomy. Postoperatively, the patient received adjuvant chemotherapy with FOLFIRINOX, and after 5 months, showed no signs of tumor recurrence or specific complications. These findings suggest that neoadjuvant therapy can be a potentially effective strategy even in advanced invasive IPMN. Further research is necessary to establish guidelines for its application.

Odontogenic Keratocyst Imitating Lateral Periodontal Cyst: A Case Report

Collateral Odontogenic Keratocyst (OKC), a rare variant of OKC, is usually present in the mandibular premolar area and is often confused with lateral periodontal cysts due to common features. A 58-year-old male patient presented with a painless swelling in the mandibular left premolar area. The clinical and radiographical features were suggestive of a lateral periodontal cyst. Surgical enucleation followed by peripheral ostectomy was performed and the sample was sent for histopathological examination. The histopathological study demonstrated typical features of OKC. Owing to the high recurrence rate, the patient is kept on regular follow-up. During follow-ups, there were no clinical and radiographical signs of recurrences.

Combined Effects of <italic>Gami-sipjeondaebo-tang</italic> Administration, Acupuncture, and Wet Dressing in a Patient with Grade 4 Pressure Ulcer: A Case Report

Introduction: Pressure ulcers, often found in patients with mobility issues, particularly elderly patients, are increasing in prevalence. Their treatment is complex, with recovery more challenging in advanced stages, and certain factors can delay healing.Case Presentation: An 87-year-old male developed a grade Ⅳ pressure ulcer on his left greater trochanter following lumbar fractures and subsequent percutaneous vertebroplasty in 2021. Despite potential surgical recommendations, his treatment consisted of daily wet dressings, acupuncture from July 2021 to February 2022, and <i>Gami-sipjeondaebo-tang</i> beginning August 2021. The ulcer, initially measuring 6 cm×6 cm and showing a red wound without necrosis, healed completely and showed no signs of recurrence as of August 2023.Conclusion: A grade IV pressure ulcer was effectively treated using wet dressing, acupuncture, and <i>Gami-sipjeondaebo-tang</i>, demonstrating no recurrence over a 1.5-year period.

A dramatic response to checkpoint inhibitor in a woman with small cell carcinoma of the hypercalcemic type of the ovary

ObjectiveWe present the rare case of a 21 year old woman with small cell carcinoma of the right ovary of the hypercalcemic type with dramatic response to checkpoint inhibitor. MethodsCase report. Results and conclusionsOur patient, a 22-year old woman with small cell carcinoma of the hypercalcemic type with hepatic metastases, is currently 43 months under treatment with pembrolizumab. Last MRI revealed no viable liver metastases nor other signs of recurrence. This is the longest survival of a patient with small cell carcinoma of the ovary under therapy with checkpoint inhibitors reported in the literature so far.With this report we emphasize the importance of immunohistological testing for PD-L 1. Treating clinicians should keep off-label use of immune checkpoint blockade in mind when treating this highly aggressive tumor if all other treatment options fail.

Biomarkers in Cancer Detection, Diagnosis, and Prognosis.

Biomarkers are vital in healthcare as they provide valuable insights into disease diagnosis, prognosis, treatment response, and personalized medicine. They serve as objective indicators, enabling early detection and intervention, leading to improved patient outcomes and reduced costs. Biomarkers also guide treatment decisions by predicting disease outcomes and facilitating individualized treatment plans. They play a role in monitoring disease progression, adjusting treatments, and detecting early signs of recurrence. Furthermore, biomarkers enhance drug development and clinical trials by identifying suitable patients and accelerating the approval process. In this review paper, we described a variety of biomarkers applicable for cancer detection and diagnosis, such as imaging-based diagnosis (CT, SPECT, MRI, and PET), blood-based biomarkers (proteins, genes, mRNA, and peptides), cell imaging-based diagnosis (needle biopsy and CTC), tissue imaging-based diagnosis (IHC), and genetic-based biomarkers (RNAseq, scRNAseq, and spatial transcriptomics).

High-grade HER2-positive mucoepidermoid carcinoma of the breast: a case report and review of the literature

BackgroundMucoepidermoid carcinoma of the breast is a rare special type of salivary gland-like tumor of the breast, usually displaying triple-negative phenotype. To date, only 64 cases have been reported in the English literature. Herein, we report the first case of mucoepidermoid carcinoma of the breast with human epidermal growth factor receptor 2 gene amplification.Case presentationA 58-year-old Caucasian woman treated with breast-conserving surgery, radiotherapy, and chemotherapy for an invasive breast carcinoma of no special type, relapsed 20 years later in the ipsilateral left breast. Histological examination of the core needle biopsy of the relapse deferred to the surgical specimen for the definitive diagnosis, because of the broad differential diagnosis. On the resected specimen we observed the presence of a poorly differentiated carcinoma with mucoepidermoid carcinoma of the breast typical features consisting of epidermoid, intermediate and mucinous cells lacking true keratinization, in keeping with the latest World Health Organization diagnostic criteria. The mucoepidermoid carcinoma of the breast was weakly estrogen receptor and androgen receptor positive and progesterone receptor negative, but exceptionally showed human epidermal growth factor receptor 2 gene amplification. Mastermind-like transcriptional coactivator 2 gene translocations were not detected by fluorescent in situ hybridization. The patient received adjuvant chemotherapy with anti-human epidermal growth factor receptor 2 therapy but no endocrine therapy. After 61 months of follow-up, no signs of local or distant recurrence were observed.ConclusionsMucoepidermoid carcinoma of the breast is a very rare entity. Despite being most frequently triple negative, the standard evaluation of receptor status is mandatory, as well as strict application of World Health Organization diagnostic criteria for correct patient management.

The pregnancy and oncology outcome of fertility-sparing management for synchronous primary neoplasm of endometrium and ovary

PurposeTo investigate the efficacy of fertility-preserving treatment for young women with synchronous primary neoplasm of endometrium and ovary.MethodsWe retrospectively reviewed eight patients with concurrent primary grade 1 presumed stage IA endometrioid endometrial adenocarcinoma (EEA) or endometrial atypical hyperplasia (EAH) and primary stage I ovarian tumors who underwent fertility-sparing treatment in the Obstetrics and Gynecology Hospital of Fudan University between April 2016 and December 2022.ResultsSynchronous endometrial and ovarian cancers (SEOC) accounted for 50% of these eight patients. The median age of patients was 30.5 years (range, 28–34 years). None of them received chemotherapy. The median treatment time was 4 months (range, 3–8 months). 87.5% (7/8) cases achieved complete response (CR), and the median time to CR was 3.8 months (range, 1.5–7.7 months). Among patients who got CR, none of them showed any signs of recurrence. Pregnancies and successful deliveries were achieved in 4 of 5 patients. Till September 2023, the median follow-up period was 50.5 months (range:15.2–85.2 months).ConclusionFertility-sparing treatment is feasible for highly selected patients with synchronous neoplasm of the endometrium and ovary, but strict screening and monitoring are mandatory. Though the results of our limited cases are encouraging, long follow-up and more clinical data are required. Enrolled patients must be fully informed of the risks during conservative treatment.

Diagnosis of Hepatic Alveolar Echinococcosis with Massive Peritoneal Seeding Treated Surgically- A Case Report

The diagnosis of Alveolar Echinococcosis is often a difficult diagnosis due to its low incidence and a long asymptomatic incubation period. We report a case of a 32-year-old man with an uncommon location of Alveolar Echinococcosis. He presented abdominal pain, conjunctival icterus and dark urine. Abdominal ultrasonography, CT scan and MRI demonstrated the presence of a hepatic lesion and a pararectal mass associated with peritoneal and omental implants. The lesions showed perilesional hypermetabolism on 18F-fluorodeoxiglucose (FDG) positron emission tomography magnetic resonance imaging (PET/MRI). Para-rectal biopsy, serological test, and sample taken during exploratory laparoscopy all suggested Echinococcus multilocularis infection that was later confirmed by PCR test. The patient was treated with Albendazole and underwent curative-intent twostep surgery by right-extended hepatectomy, resection of all peritoneal implants and total mesorectal excision. Thirty months after initial surgery, the patient is doing well and is followed up with MRI and 18F-FDG-PET without morphological signs of recurrence. This case illustrates the capacity of alveolar echinococcosis to affect different organs by infiltration or metastatic dissemination and highlights the role of 18F-FDG-PET/MRI in diagnosis and disease monitoring.

Middle Ear Meningioma With Recurrence Secretory Otitis Media.

Middle ear meningiomas (MEMs) are rare tumors that can present with nonspecific symptoms, posing challenges in diagnosis and management. This case report focuses on a middle-aged female patient who was misdiagnosed with secretory otitis media for 5 years. However, further evaluation through computed tomography imaging and subsequent pathologic biopsy revealed the presence of a MEM. The patient underwent surgical and gamma knife resection of the tumor and follow-up examination after 1 year showed no signs of recurrence. This case report highlights the importance of considering meningiomas in the differential diagnosis of middle ear pathologies and the need for careful preoperative planning for optimal outcomes. Overall, this case demonstrates that correct diagnosis and appropriate treatment can lead to successful management of MEMs.

Idiopathic granulomatous mastitis with extramammary manifestations: a case report

Introduction and Importance: Granulomatous mastitis is a rare inflammatory disorder of the breast, which can be either idiopathic or due to secondary etiology. This disease affects women of reproductive age. The exact pathophysiology underlying idiopathic granulomatous mastitis (IGM) remains unclear, but it is believed to be mediated by immunological processes. Establishing a diagnosis of this condition could be challenging due to the long list of differential diagnoses that it creates. Case Presentation: We report a 24-year-old Syrian female presented to the clinic complaining of a 2-week history of fatigue, fever and chills, swelling, and localized pain in her left breast. Physical examination revealed erythema nodosum, episcleritis, and arthralgia in the wrists, ankles, and elbows. An excisional biopsy was done and a microscopic examination of the lesion confirmed granulomatous perilobular mastitis. Symptoms had resolved after the surgical excision and follow-up evaluation showed no signs of recurrence. Clinical Discussion: IGM typically presents as an enlarging breast mass that can be mistaken for breast cancer or an abscess. The diagnostic approach should consider the presence of extramammary symptoms such as fever, arthralgia, and fatigue. Treatment options include corticosteroids, surgical excision, or steroid-sparing agents, but relapse rates vary. Conclusions: Episcleritis should be considered as a potential extramammary manifestation in cases of IGM. We highlight the importance of recognizing and investigating the potential systemic involvement in patients with IGM. Accurate interpretation of pathological and radiological findings by a multidisciplinary breast team can facilitate the diagnosis and reduce unnecessary interventions.

A Case of Lymphoepithelial Cyst Mimicking Cervical Plexus Schwannoma

Neck masses can have various origins and diverse presentations, making accurate diagnosis challenging. Schwannomas and lymphoepithelial cysts are commonly encountered neck tumors, and it is hard to get differential diagnosis. A 50-year-old woman presented with a progressively enlarging right neck mass discovered five years ago. Upon examination, a 3 cm firm, non-tender, and mobile tumor was found in the right neck level II region. Imaging studies suggested a tumor originating from the cervical sympathetic chain. The patient underwent a resection of the tumor under general anesthesia. Postoperative follow-up showed no complications or signs of recurrence. However, contrary to the initial suspicion of a schwannoma, the final pathological examination revealed a lymphoepithelial cyst. In this paper, we present a case of a cervical lymphoepithelial cyst misdiagnosed as a schwannoma, aiming to compare the clinical and histological characteristics of these two tumors and provide insights into appropriate diagnosis and management.

Secondary Cutaneous Endometriosis of the Umbilicus in Tanzania: A Case Report

Introduction: Endometriosis is characterised by endometrial tissue outside the endometrial cavity. The implantation sites may be pelvic or extrapelvic in nature. Umbilical endometriosis is a rare type of cutaneous endometriosis, accounting for 0.5-1% of extrapelvic endometriosis cases. Current literature on umbilical endometriosis is absent in the Tanzanian population. Case Report: A 30-year-old woman with prior caesarean deliveries presented with a 3-year history of umbilical swelling, cyclical pain, and menses-related bleeding. Examination revealed a firm brown umbilical lesion measuring 5x4centimetres (cm). Wide excisional biopsy was performed. Histopathological examination confirmed endometriosis and ruled out malignancy. The postoperative follow-up revealed no signs of recurrence. Conclusions: This case report highlights the need for high clinical vigilance and comprehensive differential diagnosis, especially for recurring and cyclical abdominal symptoms. Despite resource limitations, accurate diagnosis and appropriate treatment can result in the successful management of this rare condition. The report emphasises the urgency for clinicians to boost awareness, promote research, and advocate for better resources to ensure optimal patient outcomes.

Prognosis and Clinicopathological Characters of Adult TFEB-Altered Renal Cell Carcinoma: A Single Center Experience of 18 Cases

IntroductionTFEB-altered renal cell carcinoma (RCC) is a rare entity characterized by the rearrangement of the TFEB gene or TFEB amplified. The therapeutic implications and long-term survival of TFEB-altered RCC remain unclear, especially for metastatic cases. Materials and MethodsThe current study initially enrolled 7604 consecutive RCC patients at our center and a total of 248 patients were selected for FISH and immunohistochemistry (IHC) analysis. Eventually, eighteen TFEB-altered RCC patients were identified. We then reported the clinical, morphological, IHC, and radiological features of these cases. ResultsThe median age at initial diagnosis was 45 years, ranging from 18 years to 66 years. The majority of the TFEB-altered RCC patients were male (61.1%), with localized disease (T1-2N0M0, 77.8%). The median split TFEB fluorescent signal was 24%, ranging from 15%-80%. The morphological characteristics of TFEB-altered RCC were variable, with acinar, papillary, solid, or nest patterns. IHC and magnetic resonance imaging features of TFEB-altered RCC were nonspecific. Nine patients with localized disease received partial nephrectomy and five patients with localized disease received radical nephrectomy. During the median follow-up of 67 months, no signs of recurrence or metastasis were found in these patients. Two patients had distant metastasis and received axitinib plus PD-1 immunotherapy. One of them died at 40-month follow-up and another still alive at 88-month follow-up. ConclusionTFEB-altered RCC is an extremely rare variant, exhibited mixed morphological characteristics. The radiological feature lack specificity, resembling clear cell RCC or papillary RCC. Genetic analyses including FISH analysis is crucial in the diagnosis of TFEB-altered RCC. For localized TFEB-altered RCC, both radical nephrectomy and partial nephrectomy conferred satisfactory prognosis. For metastatic TFEB-altered RCC, immunotherapy-based drug combinations could be a promising treatment strategy.

Peripheral Giant Cell Granuloma in Pregnancy: A Case Report

Peripheral giant cell granuloma (PGCG) is an asymptomatic, non-neoplastic, and proliferative lesion of unknown etiology. Possible pre-disposing factors, such as hormonal changes during pregnancy, have been suggested. However, the association between PGCG and pregnancy is controversial. There are few reported clinical cases of pregnancy-associated PGCG in the literature, and they occurred only in the lower jaw. The present report is on a 35-year-old female patient at 36 weeks of gestation who presented with a PGCG in the central and lateral incisors of the upper jaw. Management consisted of complete surgical excision of the lesion along with a margin of healthy tissue under local anesthesia, followed by curettage of the adjacent fibers of the affected bony wall. The patient experienced adequate healing without complications. The diagnosis of PGCG was based on clinical characteristics, imaging examinations, and histopathological confirmation. The patient underwent postoperative follow-up evaluations at 3, 6, and 12 months, and there were no signs of recurrence.

Surgical Options for Aggressive Vertebral Hemangiomas：A case series, literature review and treatment recommendations

PurposeWe retrospectively study twenty-nine surgical cases of aggressive vertebral hemangiomas (AVHs) with neurological deficits and extradural compression to determine the optimal surgical treatment strategy for AVHs at a single institution. MethodsPatients with AVHs with neurological deficits who underwent partial tumor resection plus decompression with or without vertebroplasty (VP), and radiotherapy between 2010 and 2021 were included in this study. Clinical characteristics, surgical outcomes, and follow-up data of the patients were reviewed retrospectively. ResultsTwenty-nine AVH cases with neurological deficits and spinal instability were included in this study and treated surgically. The mean operation time of patients with decompression surgery plus VP (Groupe A) was 215.9 (120-265 min), shorter than that of decompression surgery without VP (Group B) 240.2 (120-320 min). Intraoperative blood loss was 273.3 (100–550 mL) in group A and 635.3 (200–1600 mL) in group B. In addition, a significant reduction in blood loss was observed in group A compared to the group B (p=0.0001). All patients experienced immediate pain relief and improvement in their neurological symptoms. Neurological function was assessed by the Frankel score, ASIA score, and the visual analogue scale (VAS) pain score decreased from 7.4 (4-9) to 1.3 (0-3). Of twenty-nine patients in this study, only 7% (2/29 patients) showed signs of recurrence. ConclusionDecompression plus VP achieve good tumor control and decrease surgical complication. Preoperative vascular embolization and VP can reduce intraoperative bleeding in the treatment of AVH surgery. Moreover, postoperative radiotherapy seems to be a good technique to prevent tumor recurrence.

Extranodal Rosai-Dorfman disease presenting as a suspicious breast lump: An infrequent but elusive differential diagnosis. A case report

Rosai-Dorfman disease represents a very rare idiopathic disorder mainly characterized by sinus histiocytosis and massive lymphadenopathy. In even rarer occasions (<43%), extranodal involvement has been reported, with one of the least common presentations being isolated breast affection (<1%). We report the case of a 64-year-old woman who debuted with a suspicious breast lump and underwent a prolonged study protocol before a proper histopathological diagnosis could be obtained. Surgical management was effective, and follow-up shows no signs of recurrence. In the context of ruling out breast malignancy, even rare alternatives should be considered when a diagnosis eludes us.

A case report of huge pancreas mucinous cystic neoplasm during pregnancy: How doctors think.

Pancreas mucinous cystic neoplasm (PMCN) is uncommon, and its occurrence during pregnancy is rare. The management of PMCN during pregnancy, including diagnosis and surgical timing, is a great challenge. A nontender epigastric mass of the upper abdomen was detected by palpation in a 35-year-old woman, gravida 2, para 1, during the 36th week of gestation. She was referred to our institution for further evaluation. Magnetic resonance imaging (MRI) showed a multilocular cystic mass in the body and tail of the pancreas (16.7/12.1/17.6 cm), well-circumscribed with a hyper signal on T2-weighted MRI images. The diagnosis of a pancreatic cyst, probable mucinous, was established. The patient was informed of the possibilities of malignancy, rapid growth, and rupture of the tumor. After a laparotomy and cesarean section, a large cystic tumor was discovered adherent to the pancreas, spleen, mesocolon, and retroperitoneum. The spleen was preserved since there was no evidence of invasion. According to macroscopic examinations, the tumor measured 18 cm was filled with a dark yellow-brownish mucinous fluid and did not appear to communicate with the pancreatic ducts. After six months of follow-up, there were no signs of recurrence in the patient. PMCN may need to be surgically resected in cases characterized by malignancy risk during pregnancy. As female sex hormones may influence the behavior of PMCN during pregnancy, surgical timing should be determined based on the stage of pregnancy, malignancy status, and condition of the mother and fetus.