Mycetoma clinically masquerading as squamous cell carcinoma: case report and literature review

Mycetoma is a chronic and progressive subcutaneous granulomatous infection characterized by painless swelling and tumefaction, draining sinus tracts, and purulent discharge. The term eumycetoma is used to describe an infection caused by fungi, while an actinomycetoma is used to describe an infection caused by filamentous bacteria. An accurate identification of the pathogen plays a vital role in the treatment plan as well as a positive outcome for the patient. In this report, we present an elderly white female with an initial presentation of mycetoma masquerading as a squamous cell carcinoma. We also review microbiology, diagnostic modalities, and treatment for mycetoma.     

前列腺小细胞神经内分泌癌患者一例报道并文献复习

目的探讨前列腺小细胞神经内分泌癌的临床诊断和治疗。 方法回顾性分析我院收治的1例前列腺小细胞神经内分泌癌患者的资料。结合相关文献讨论前列腺神经内分泌肿瘤的病理学分型、临床表现、影像学特征、诊治和预后。 结果患者男性,64岁,2014年9月因发现PSA 52.72 μg/L,前列腺穿刺活检提示前列腺腺泡腺癌,Gleason评分3+4=7分,予手术去势,后联合持续抗雄治疗（比卡鲁胺50 mg qd）。2017年5月复查发现盆腔巨大肿物伴肠梗阻,全身多发骨转移、肝脏转移、肺转移。予盆腔肿物切除+横结肠造瘘,术后病理提示前列腺小细胞内分泌癌。患者术后2周开始予多西他赛100 mg d1+卡铂450 mg d1,化疗2周期后因多脏器功能衰竭去世。 结论前列腺癌伴神经内分泌分化为最常见的前列腺神经内分泌肿瘤,前列腺小细胞癌临床罕见,早期手术联合化疗为主要治疗手段,肿瘤恶性程度高、进展快,预后差。     

Radiation-induced esophageal cancer: A case report and a review of the literature

A 63 year old woman who had been irradiated for thyroid carcinoma at 36 years of age developed a cervico-esophageal stricture, the biopsy specimens from which revealed squamous cell carcinoma. Total esophagectomy was performed and a small linear ulcer was found in the resected specimen. Histological examination revealed moderately differentiated squamous cell carcinoma with severe fibrosis around the tumor, indicating radiation-induced cervical esophageal cancer. The characteristics of radiation-induced esophageal cancers described in the literature are reviewed in context of the present case.     

Appendiceal carcinoma masquerading as recurrent urinary tract infections: case report and review of literature

We report on a female patient who presented with recurrent urinary tract infections. The investigations revealed an adenocarcinoma of the appendix fistulating into the bladder and causing irritative symptoms. After right hemicolectomy and partial cystectomy, she was well at 3 months without any need for adjuvant therapy. This unusual situation reminds us that the finding of bladder adenocarcinoma is rare, and it would be prudent to examine the lower gastrointestinal tract thoroughly to look for a bowel source, before recommending any ablative surgery.     

Rectal foreign bodies: A case report and review of the literature

IntroductionRectal foreign bodies (RFB) present the modern surgeon with a difficult management dilemma, as the type of object, host anatomy, time from insertion, associated injuries and amount of local contamination may vary widely. Reluctance to seek medical help and to provide details about the incident often makes diagnosis difficult. Management of these patients may be challenging, as presentation is usually delayed after multiple attempts at removal by the patients themselves have proven unsuccessful.Presentation of caseIn this article we report the case of a male who presented with a large ovoid rectal object wedged into his pelvis. As we were unable to extract the object with routine transanal and laparotomy approach, we performed a pubic symphysiotomy that helped widen the pelvic inlet and allow transanal extraction.DiscussionWe review currently available literature on RFB and propose an evaluation and management algorithm of patients that present with RFB.ConclusionManagement of patients with rectal foreign bodies can be challenging and a systematic approach should be employed. The majority of cases can be successfully managed conservatively, but occasional surgical intervention is warranted. If large objects, tightly wedged in the pelvis cannot be removed with laparotomy, pubic symphysiotomy should be considered.     

Polyarteritis nodosa masquerading as a primary testicular neoplasm: a case report and review of the literature

We report a case of polyarteritis nodosa presenting as a mass in the testis mimicking a neoplasm. The diagnosis was confirmed by radical orchiectomy. This is an unusual presentation of this systemic disease. We discuss the physical findings, ultrasonographic features and pathological findings, as well as review the literature for previous similar cases.     

Acrometastasis following colorectal cancer: A case report and review of literature

IntroductionColorectal cancer commonly metastasises to the liver, peritoneum and lungs. Bony metastases are uncommon in colorectal cancer and in particular metastases to the hands or feet (acrometastasis) are an extremely rare occurrence.Case presentationA 65-year-old male with a colonic malignancy underwent elective anterior resection. Intra-operatively he was found to have a pelvic collection necessitating an end colostomy. Histology confirmed complete Dukes B tumour excision with no evidence of lymph node metastases. The patient underwent chemo-radiotherapy but was unsuitable for reversal of Hartmann’s due to elevated CEA levels and asymmetrical thickening of the rectal stump with a solitary lung nodule identified at a one-year surveillance CT. The lung nodule was resected revealing metastatic adenocarcinoma and biopsies from the rectal stump showed chronic inflammatory changes. The patient was offered further chemotherapy. However, six years after his original surgery the patient presented with an acutely painful left foot with radiographic appearances of an infiltrative sclerotic and lucent lesion confirmed as a calcaneal acrometastasis on Magnetic Resonance Imaging (MRI).DiscussionDiagnosis of acrometastasis is challenging and generally constitutes a wider metastatic process with poor prognosis. Patients are often asymptomatic or present with symptoms mimicking benign lesions such as arthritis, infection or ligamentous sprains of the hands or feet. Therefore, there should be a high index of suspicion and prompt radiological investigation is warranted in order to exclude disease recurrence.ConclusionAlthough acrometastasis may indicate a poor prognosis, timely diagnosis and intervention may facilitate improvement of long-term survival and symptomatic management.     

Breast cancer and Poland's syndrome: a case report and literature review

Poland's syndrome is a rare congenital development malformation characterized by unilateral chest wall hypoplasia and ipsilateral hand abnormalities. It is also known to be associated with some malignant diseases. We herein report a case of Poland's syndrome associated with invasive ductal carcinoma of breast, and review the literatures to investigate the clinical characteristics of breast cancer with Poland's syndrome.     

睾丸混合性非精原细胞性生殖细胞癌1例并文献复习

目的:睾丸混合性非精原细胞性生殖细胞癌的文献报道极少,本文旨在探讨睾丸混合性非精原细胞性生殖细胞癌的临床症状、病理特点及诊疗方法。方法:分析1例睾丸混合性非精原细胞性生殖细胞癌的临床资料,并运用组织学、细胞化学和免疫组化技术对该例睾丸混合性非精原细胞性生殖细胞癌进行光镜观察和免疫标记并结合文献就该类肿瘤的临床特征进行探讨。结果:患者以睾丸无痛性肿大3年就诊,病理组织学表现为肿瘤排列结构多样,有乳头状结构、裂隙或腺样结构,细胞大,呈多角形或柱状,核不规则呈泡状,一个或多个核仁,核膜清楚,胞质嗜碱或嗜酸,间质少量淋巴细胞浸润。免疫组化显示:白细胞分化抗原(CD117)(-)、细胞角蛋白(CK8-18)(++)、CD30(++)、CK(+++)、波形纤维蛋白(Vimentin)(-)、胎盘型碱性磷酸酶(PLAP)(±)、抑癌基因产物(P53)(+)、甲胎蛋白(AFP)(+)和上皮膜抗原(EMA)(++)。病理诊断为睾丸畸胎胚胎癌,行手术根治术,按混合性非精原细胞性生殖细胞癌行术后辅助化疗。随访时间l年,健康生存。结论:睾丸混合性非精原细胞性生殖细胞癌是一种罕见的恶性肿瘤,多数临床症状不明显。诊断主要依靠体格检查、B超、CT、血清肿瘤标记物测定等,确诊需要病理学检查,手术切除是其首选的治疗方法。     

Chest wall metastasis of endometrial cancer: case report and review of the literature

Introduction: Endometrial cancer is the fourth most common female cancer and also distant metastases to the chest wall associated with these tumors are seen less common. Surgical treatment options for metastases of endometrial cancer are limited.

Case: A 57-year-old patient who underwent total abdominal hysterectomy?+?bilateral salpingo oophorectomy and received adjuvant chemotherapy for endometrioid-type adenocarcinoma of the endometrium and tuba is presented. The patient initially presented with pleural effusion 8 years ago and the tumor was detected while during etiologic screening. The patient had no problems after adjuvant chemotherapy and had been living in another city when she presented with a mass on the chest wall measuring 20?×?15?×?12?cm 8 years after the initial diagnosis and distant organ metastasis due to the first surgery was detected. The mass was first thought to be a sarcoma and the tru-cut biopsy revealed a metastatic lesion that was immunohistochemically similar to the first surgical specimen. The mass was resected with a wide radical excision and ‘no touch’ technique. The patient was then discharged with no postoperative complications.

Conclusion: Here in, a case with a distant organ metastasis due to an endometrioid-type adenocarcinoma is presented accompanied by literature data.     

Rectal perforation after AxiaLIF instrumentation: case report and review of the literature

Background contextBowel perforation is an uncommon complication of posterior spinal surgery. The AxiaLIF transsacral instrumentation system has been used for the treatment of L5–S1 spondylolisthesis and degenerative disc disease since its introduction in 2005 as a potentially less invasive alternative to traditional anterior or posterior interbody fusion.PurposeIn this article, we report a case of a rectal perforation as a complication of placement of the AxiaLIF instrumentation system that was successfully treated without the removal of the device.Study designCase report.MethodsThe patient presented with progressive back pain and sepsis 3 weeks after an L5–S1 fusion done with the AxiaLIF technique at an outside facility. The patient was managed with antibiotic therapy and a diverting ileostomy, without the removal of the AxiaLIF device.ResultsOver the next year, she had symptoms indicative of nonunion of the operated level and breakdown at the adjacent level, which were confirmed with imaging. She underwent revision posterior spinal fusion without the removal of the AxiaLIF device. Eighteen months after the AxiaLIF device was placed, the patient continued to demonstrate no signs of infection recurrence.ConclusionsDelayed presentation of rectal perforation with a subsequent anaerobic sepsis is a potential complication of the presacral approach to the L5–S1 disc space. Recognition and treatment with fecal diversion and long-term intravenous antibiotics is an alternative to device removal and sacral reconstruction.     

Primary melanoma of small intestine masquerading as gastrointestinal stromal tumor: a case report and literature review

Malignant melanoma of the gastrointestinal tract is a rare entity among intestinal neoplasms. Primary intestinal melanoma is difficult to differentiate from metastatic melanoma, especially given that the primary cutaneous lesion has the potential to regress and disappear. In addition, melanoma by itself is a great mimicker of other neoplastic conditions and may create a major diagnostic challenge when presenting at an intra-abdominal location. Here we report a case of small intestinal melanoma in a 74-year-old female who presented with symptoms of intestinal bleeding and a preoperative clinical and radiological diagnosis of gastrointestinal stromal tumor. The initial frozen section diagnosis also favored gastrointestinal stromal tumor, however furthermore histological and immunohistochemical stain evaluation confirmed the diagnosis of intestinal melanoma.     

Metastatic lobular breast cancer presenting with malignant ascites: case report and review of literature

We review the case of an elderly woman with invasive lobular breast cancer presenting as malignant ascites. This unusual presentation is discussed, as well as the options for treatment. Most invasive lobular breast cancers are hormone receptor positive and the roles of hormonal and chemotherapy are reviewed.     

肝移植术后新发食管癌1例临床分析并文献复习

目的探讨肝移植术后新发食管癌的发病情况、危险因素、预防及治疗。方法对2003年8月至2008年12月中山大学附属第三医院肝移植中心行肝移植术后生存半年以上并能接受定期随访的416例受者,观察其新发恶性肿瘤的情况,分析新发食管癌患者的临床资料,同时进行文献复习。结果该中心肝移植术后新发食管癌1例,发生率为0．24％（国外平均发生率为0．11％）。该例男性患者肝移植时年龄为49岁,术前有长期吸烟史和嗜酒史,术后不完全戒酒、戒烟,术后46个月发现食管癌,从确诊新发食管癌至死亡历时10个月,死于肿瘤进展、多器官功能衰竭。结论烟酒史、免疫抑制过强是肝移植术后新发恶性肿瘤的危险因素,针对高危因素进行规范随诊以及优化免疫抑制方案,是早期防治和提高疗效的关键。     

吉非替尼一线治疗晚期非小细胞肺癌1例并文献复习

目的：探讨吉非替尼一线治疗晚期非小细胞肺癌（NSCLC）的可行性。方法：报告1例晚期NSCLC患者吉非替尼治疗的效果及随访资料,并对有关文献进行复习。结果：患者使用吉非替尼治疗后肺部占位及颅脑转移灶明显减小。结论：吉非替尼对部分晚期NSCLC可作为一线治疗药物疗效确定,不良反应小。     

Pelvic actinomycosis masquerading as malignancy: report of two cases and review of the literature

Pelvic actinomycosis is uncommon, presenting most frequently as an abdominal mass and simulating advanced malignancy in female patients with a past history of intrauterine contraceptive use. It responds favourably to prolonged antibiotic therapy with occasional need for abscess drainage and débridement or ureteric stenting. Incorrect diagnosis may result in overly invasive investigations and unnecessarily radical extirpative surgery.     

Colorectal cancer in a patient younger than 20 years of age: Report of a case and a review of the Japanese literature

This article presents a case of advanced cancer of the transverse colon seen in an 18-year-old woman who underwent a potentially curative resection. The histological type of cancer was well-differentiated adenocarcinoma. After reviewing the clinicopathological features of 110 colorectal cancer cases in patients younger than 20 years of age compiled from the Japanese literature, the high incidence of poorly differentiated carcinoma (51.5% for poorly differentiated adeno-carcinoma, signet-ring cell carcinoma, mucinous carcinoma, and undifferentiated carcinoma) and of more advanced stages (67.1% for clinical stages IIIb and IV) were found to be characteristic for patients with colorectal cancer younger than 20 years of age. The presence of more advanced disease and the high incidence of poorly differentiated carcinoma thus seem to be related to the low postoperative survival rates. The 2-year survival rate was 19.8% and the 5-year survival rate was 8.8% in colorectal cancer patients younger than 20 years of age.     

含5种不同组织学结构的前列腺癌1例报道并文献复习

目的:探讨含有5种不同组织学结构的前列腺癌的临床表现、病理特征、治疗方法。方法:报告1例含有5种组织学结构的前列腺癌的临床资料,并结合文献对其诊断、病理、治疗等进一步分析。结果:患者直肠指检、B超、CT、MRI及PSA均提示前列腺癌,行穿刺活检后确诊。考虑患者全身状况行硬膜外麻醉下经尿道前列腺电切术以改善排尿症状。术中切除可疑肿瘤组织,术后病理:前列腺腺癌(筛状癌、腺泡癌、浸润癌、导管癌、黏液腺癌)。Gleason分级9分。术后应用比卡鲁胺和醋酸戈舍瑞林治疗,术后10个月开始出现全身转移,术后1年死亡。结论:含有5种不同组织学结构的前列腺癌极其罕见,难于早期诊断,确诊主要依靠病理和免疫组化检查。     

Calcaneal osteochondroma masquerading as plantar fasciitis: An approach to plantar heel pain-A case report and literature review

BACKGROUND Heel pain is a common orthopaedic complaint, and if left untreated can be a source of chronic morbidity. Accurate diagnosis can be challenging, owing to the complex anatomy and multiple pain generators present in the foot. We aim to share our clinical experience managing an unusual case of chronic heel pain secondary to osteochondroma.CASE SUMMARY A 41-year-old obese male who works as a porter presented with a long-standing history of left plantar heel pain. He was assessed to have point tenderness over the plantar insertion of the calcaneus as well as a positive Silfverski?ld test. He was treated for plantar fasciitis and tight gastrocnemius but failed conservative therapies as well as surgical intervention. Magnetic resonance imaging revealed the presence of a pedunculated bony protrusion over the plantar aspect of the calcaneus. The decision was made for excision of the osteochondroma, and the patient has been pain-free since.CONCLUSION Osteochondromas are rarely symptomatic in skeletally mature patients. While most are benign with a very low risk of malignant transformation, surgical excision can yield excellent results and significant pain relief in symptomatic patients.