Burkitt's lymphoma: an unusual cause of obstructive jaundice

Biliary obstruction secondary to malignancy is a common clinical problem. Rarely, biliary obstruction is due to non-Hodgkin's lymphoma. Obstructive jaundice in these patients usually presents late in the course of the disease. Burkitt's lymphoma is a subtype of non-Hodgkin's lymphoma. Unlike other forms of non-Hodgkin's lymphoma, Burkitt's lymphoma presents as an extranodal disease. We present the case of a patient suffering from non-endemic Burkitt's lymphoma whose initial presenting symptom was obstructive jaundice.     

Burkitt's lymphoma of the testis: an unusual scrotal mass in childhood

Burkitt's lymphoma was originally described as a sarcomatous tumor among Ugandan children but it is becoming more prevalent in the United States. We describe a case of Burkitt's lymphoma that presented as a scrotal mass. The management of Burkitt's lymphoma involving the testis is discussed.     

Case report; the posttraumatic regeneration of the clavicle

Fractures of the lateral part account for 25% of all the clavicle fractures. In rare cases, especially with late presentation, the highly osteogenic periosteal sleeve will form bone from the distal epiphysis towards the medial part of the clavicle. In patients with trapezius muscle involvement, we suggest excision of the regenerated limb with a subsequent lock-down procedure of the posterior located clavicle in the periosteal sleeve.     

Primary osteogenic sarcoma of the clavicle. Case report

The clavicle is an unusual site for any primary bone tumor, including osteogenic sarcoma. The authors report the case of a young girl aged 13 years who was affected with primary osteogenic sarcoma of the right clavicle, and who was treated by preoperative and postoperative chemotherapy and radical clavicle excision, including the acromioclavicular and the sternoclavicular joints.     

Peri-implant distal clavicle fracture: Case report (overlaying plate fixation: Solution for peri-implant clavicle fractures)

Introduction and importanceSurgical treatment for clavicle injuries is indicated for displaced and shortened fractures. Osteosyntheses with plate fixation may present with complications in 6.3% to 8.5% of patients. Peri-implant clavicle fractures (PIF) are rare, and we have not found any previous cases in our literature search.Case presentationA 25-year-old male with previously (six years earlier) surgically treated clavicle fracture presented with a peri-implant clavicle fracture requiring surgical treatment. The management involved overlaying an implant to fix the lateral clavicle fracture without removing the previous plate. Complete bone healing was observed without any further complication.Clinical discussionDespite the low rate of implant failure in clavicle fractures, this complication occurs mainly in elderly patients with poor bone quality. No PIF have been described in the literature prior to this. This case report demonstrates a young patient with good bone quality and previous fracture fixation presenting with PIF which has now shown complete bone healing.ConclusionIn this case, overlying an additional plate on the lateral clavicle portion without removing the previous plate increased the stability of the fracture. It demonstrates the value of overlaying plate osteosyntheses for patients with clavicle PIF.     

锁骨内侧骨折合并同侧肩锁关节脱位漏诊1例

患者,男,50岁,2h前从高约5m屋顶坠落,右侧肩部着地,起立后无法上举、外展右侧上肢,感右肩部、胸部及足部疼痛,就诊我院急诊科,行胸腰部CT检查(仅扫描到一部分锁骨,且患者非严格仰卧位,身体左侧倾斜)示右侧锁骨内侧端骨折,第3-5肋骨骨折(图1a).仰卧位右肩部X线示右锁骨内侧端骨折(图1b).由于患者足部受伤,未予...     

Ipsilateral posterior sternoclavicular dislocation and fracture of the medial third clavicle: a case report

Ipsilateral fracture of the medial third clavicle and posterior dislocation of Sternoclavicular joint is an extremely rare presentation. This case report illustrates an 11-year-old male patient with ipsilateral fracture of the medial third clavicle and posterior Dislocation of the sternoclavicular joint sustained after a fall while playing at school. The diagnosis of this condition requires a high incidence of suspicion in view of the potential for associated neurovascular injury.     

Primary ovarian Burkitt's lymphoma presentation in a young woman: A case report

Introduction and importanceBurkitt's lymphoma is one of the fastest growing human cancers and it needs a rapid diagnosis.Case presentationA young woman presented to our institution with acute abdominal pain, tenderness and constipation. Ultrasound reported a right ovarian mass; at laparoscopy, we discovered ascites, peritoneal carcinomatosis and a voluminous pelvic mass.Clinical discussionDiagnosis was confirmed as non-Hodgkin sporadic Burkitt's lymphoma: the careful workup was the key to initiate multiagent chemotherapy.ConclusionPrimary ovarian Burkitt's lymphoma, in a young woman in a non-endemic zone, is a rarity that represents a strong diagnostic challenge, but rapid identification can lead the patient to appropriate therapies and improvement of prognosis.     

Burkitt's lymphoma of the testicle: report of 2 cases occurring in elderly patients

Burkitt's lymphoma is rare in patients older than 50 years and almost never presents as a testicular tumor. We report 2 cases of primary Burkitt's lymphoma of the testicle in men 68 and 79 years old. In 1 man the extragonadal tumor had a rapid and lasting response to combination chemotherapy. The cases are of interest for the unusual presentation of the disease and for the possibility to control Burkitt's lymphoma in older patients without undue toxicity. The management of testicular lymphoma requires radical orchiectomy and prophylactic irradiation of the contralateral testis. Chemotherapy is indicated for advanced disease and may prevent relapses in patients with early disease. The role of central nervous system prophylaxis is controversial.     

Natural history of medial clavicle fractures

BackgroundFractures of the medial third of the clavicle comprise less than 3% of all clavicle fractures. The natural history and optimal management of these rare injuries are unknown. The aim of our study is to describe the demographics, management and outcomes of patients with medial clavicle fractures treated at a Level 1 Trauma Centre.MethodsA retrospective review was conducted of patients presenting to our institution between January 2008 and March 2013 with a medial third clavicle fracture. Clinical and radiographic data were recorded including mechanism of injury, fracture pattern and displacement, associated injuries, management and complications. Functional outcomes were assessed using the Glasgow Outcome Scale Extended (GOS-E) scores from the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR). Shoulder outcomes were assessed using two patient reported outcomes scores, the American Shoulder and Elbow Society Score (ASES) and the Subjective Shoulder Value (SSV).ResultsSixty eight medial clavicle fractures in 68 patients were evaluated. The majority of patients were male (n = 53), with a median age of 53.5 years (interquartile range (IQR) 37.5–74.5 years). The most common mechanism of injury was motor vehicle accident (n = 28). The in-hospital mortality rate was 4.4%.The fracture pattern was almost equally distributed between extra articular (n = 35) and intra-articular (n = 33). Fifty-five fractures (80.9%) had minimal or no displacement. Associated injuries were predominantly thoracic (n = 31). All fractures were initially managed non-operatively, with a broad arm sling.Delayed operative fixation was performed for painful atrophic delayed union in two patients (2.9%). Both patients were under 65 years of age and had a severely displaced fracture of the medial clavicle. One intra-operative vascular complication was seen, with no adverse long-term outcome.Follow-up was obtained in 85.0% of the surviving cohort at an average of three years post injury (range 1–6 years). The mean ASES score was 80.3 (SD 24.8, range 10–100,), and the mean SSV score was 77.0 (SD 24.6, range 10–100).ConclusionSixty eight patients with medial clavicle fractures were identified over a 5 year period, with excellent functional results seen following conservative management.     

胸锁关节外锁骨近端骨折的治疗

目的 探讨胸锁关节外锁骨近端骨折的治疗方法及疗效. 方法 对2007年1月至2009年8月收治的15例胸锁关节外锁骨近端骨折患者资料进行回顾性分析,男14例,女1例;年龄26～ 82岁,平均54.9岁.骨折根据Edinburgh分型:1A1型5例,1B1型10例.入院时损伤严重度评分为8 ～75分,平均26.1分.均为闭合性骨折,无神经、血管损伤.对于断端之间无骨皮质接触、锁骨节段性骨折或合并同侧肩胛骨骨折的9例患者,行切开复位钢板内固定术;另6例患者采用患肩悬吊制动等保守治疗.末次随访时采用Constant-Murlev评分标准评定患肩功能. 结果 9例手术患者术后获12 ～ 18个月(平均15.3个月)随访.锁骨近端骨折均获解剖复位和骨性愈合,愈合时间为2～5个月,平均3个月.末次随访时Constant-Murley评分为80 ～100分,平均95分;1例患者术后发生钢板断裂.6例保守治疗患者术后获10 ～ 13个月(平均12.2个月)随访.4例不稳定型锁骨近端骨折患者的Constant-Murley评分为70 ～ 80分,平均77.5分;1例患者因肺部感染于伤后1个月死亡. 结论 对于不稳定型胸锁关节外锁骨近端骨折,通过手术恢复胸锁关节之间的解剖、重建上肩胛悬吊带复合体的稳定性,可以获得较好疗效.     

CT误诊胃淋巴瘤1例

患者男,49岁,主因"食欲缺乏、乏力2月余"就诊。外院B超示脾占位、胰腺占位。入院CT:胃底后部、脾脏及胰尾间见12.2cm×14.4cm×13.1cm巨大等密度软组织肿块,边缘欠规则,平扫CT值约30HU,增强后轻度强化,动脉期CT值为42HU,静脉期CT值为52HU;病灶与胃底关系密切,表面见溃疡形成,并包埋脾动     

Intestinal presentation of non-Hodgkin lymphoma: Case report

BackgroundMEITL (monomorphic epitheliotropic intestinal T-cell lymphoma) is a rare primary intestinal T-cell lymphoma associated with high mortality rate. Being intestinal this implies difficult diagnostic workup and management.CaseWe present a case of 59-year-old male presented with abdominal pain and found to have 15 × 11 cm mass in the right iliac fossa. Decision for surgical excision was retained and the Pathological examination determined monomorphic epitheliotropic intestinal T-cell lymphoma (MEITL) with CD30 positive immune-histochemical profile.ConclusionMEITL is a rare entity which retains challenging diagnosis and management as well as variable immune-histochemical profile. In the absence of clear guidelines for the management of intestinal manifestation of lymphoma, surgical approach may have its indications.     

Parafalcine chondrosarcoma: an unusual localization for a classical variant. Case report and review of the literature

BACKGROUND: Intracranial chondroid tumors are infrequently seen in neurosurgical practice. These tumors usually arise from cartilaginous synchondroses at the base of the skull, but occasionally from the pluripotential mesenchymal cells of the meninges. We present here a case of classic low-grade giant chondrosarcoma of the falx cerebri. This is only the second case of this variant reported in this location, and we summarize the diagnostic criteria with a brief review of literature. CASE REPORT: A 56-year-old female patient was admitted to the hospital with a history of progressive right-sided weakness occurring in the last 8 months and a recent grand mal seizure. Radiological evaluation demonstrated a large extra-axial mass in the left parafalcine area, suggesting a possible meningioma. An anterior interhemispheric approach enabled gross total removal of the tumor and a histologic diagnosis of a low-grade classic chondrosarcoma was made. The patient is currently stable and has shown no evidence of recurrence in more than 3 years without any adjuvant treatment. CONCLUSIONS: Intracranial cartilaginous tumors include classical, mesenchymal and myxoid chondrosarcomas in addition to benign chondromas. Parafalcine localization should be considered for all these variants as well as for meningiomas, hemangiopericytomas, solitary fibrous tumors, and meningeal metastatic carcinomas. Detailed radiological evaluation, light microscopic and ultrastructural analyses, and immunocytochemistry are essential for correct diagnosis. In contrast to mesenchymal and myxoid types, the prognosis of classic variants is usually good and does not require adjuvant treatment modalities if a radical resection of the tumor can be obtained. Increased documentation of clinical, radiological, and histologic findings as well as response to treatment modalities will provide a better understanding of the pathophysiology of these rare tumors, and highlight the optimum treatment strategies     

Primary malignant B-cell-type dural lymphoma: Case report

BACKGROUND: The primary malignant dural lymphoma of B-cell type is rare. Our review of the literature (24 cases) indicated that patients with this tumor had female predominance, immunocompetency, and longer survival compared with those with primary malignant intracerebral lymphomas. Based on its clinicopathological features, this dural lymphoma may be classified differently from other types of malignant lymphomas in the central nervous system. CASE DESCRIPTION: The authors report an example of a patient who had a favorable course of malignant dural lymphoma. A 59-year-old woman presented with primary malignant dural lymphoma in the frontal area. Histological diagnosis was a diffuse large B-cell-type lymphoma of intermediate malignancy, but MIB-1 index was extremely high. Subtotal tumor removal was followed by 4 courses of chemotherapy. Thirty months after surgery, the patient is asymptomatic with no MRI evidence of recurrence. A combination of subtotal resection and chemotherapy for a primary malignant dural lymphoma is an effective means to attempt cure of this tumor. CONCLUSION: These rare tumors may be managed successfully by subtotal resection and postoperative treatment. We believe that chemotherapy is the treatment of choice after subtotal resection of malignant dural lymphomas, as experienced in our case.