Concurrence of granular cell tumor and Mycobacterium tuberculosis

Granular cell tumors (GCT) are rare, usually benign neoplasms of Schwann cell origin. Since discovery in 1926, fewer than 80 cases of GCT involving the lung have been reported. This report presents a 45-year-old male who presented with symptoms consistent with chronic pancreatitis associated with night sweats, weight loss, and a chronic productive cough. Chest radiography revealed a 3 x 4 cm left upper lobe lung mass with an unremarkable right lung field. Bronchoscopy revealed mixed mucosal abnormalities in the left upper lobe and a 4-mm polypoidal lesion in the right lower lobe. Bronchial washings stained positive for acid-fast bacilli. The left upper lobe lesion biopsy showed granulomatous inflammation with caseous necrosis consistent with tuberculosis. The right lower lobe lesion was a GCT without evidence of tuberculosis. This report reviews the literature regarding GCT and presents this unusual case of granular cell tumor co-occurring with active tuberculosis.     

Recurrence of tuberculosis after hip replacement 58 years after primary infection

The paper presents the case of a 73-year-old patient with a history of tuberculosis of the hip in childhood who received an Exeter total hip prosthesis. Tuberculosis recurred 58 years after primary infection and 9 years after THA. The authors analyzed the available literature, which described only a few case reports, because Mycobacterium tuberculosis infections of a joint implant after THA are extremely rare. They are frequently the result of local reactivation of the pathogen or, less commonly, an overlooked diagnosis of tuberculosis at the time of endoprosthesis implantation. Proper diagnostic work-up of infection is particularly difficult because synovial fluid cultures are usually negative. In addition, a coexisting Staphylococcus aureus infection may obscure the clinical presentation. In post-THA patients, complete anti-TB treatment is recommended. Particular caution should be observed in patients from regions with high TB morbidity or with a history of pulmonary and operated joint tuberculosis.     

肾自截伴流注脓肿1例报道并文献回顾

目的 了解肾结核导致流注脓肿患者的临床表现、诊断、治疗及预后.方法 对川北医学院附属医院骨科诊断的1例肾自截伴流注脓肿患者的临床表现、实验室及影像学检查、治疗和预后进行分析,并回顾和总结国内外迄今为止关于肾结核致腰大肌脓肿的文献报道.结果 该例71岁女性患者以腰背部疼痛伴右臀部、右大腿根部包块处红肿热痛为主要症状,有低...     

One rare side effect of zolpidem--sleepwalking: a case report

Zolpidem is an imidazopyridine agent indicated for the short-term treatment of insomnia. Sleepwalking is a rare side effect of zolpidem. A review of the literature produced only 2 cases. We report a case of a male rehabilitation inpatient in his mid fifties with a history of alcoholism and traumatic brain injury who had undergone a right hip hemiarthroplasty. He had no history of somnambulism or insomnia but walked in his sleep on 2 nonconsecutive nights after taking zolpidem. He had exhibited no such behavior before taking zolpidem, on the intervening night that was he was not given medication, and after the medication was discontinued. We conclude that zolpidem can cause sleepwalking, and patients who have suffered a brain injury may be more susceptible to this side effect. Here we describe the clinical presentation and review the relevant literature on zolpidem and sleepwalking.     

Metastasis to the breast from an adenocarcinoma of the colon

Metastases to the breast from extramammary malignancies are rare. We report a case of metastasis to the breast from a colonic adenocarcinoma in a 50-year-old man who was 6 years status after a right hemicolectomy for T3N1M1 adenocarcinoma of the ascending colon. Sonographic evaluation of the right breast lump showed a hypoechoic mass with slightly irregular margins, but there was no internal vascularity. Chest CT also documented a poorly enhancing suspicious mass in the right breast. The diagnosis of adenocarcinoma metastasis to the breast was achieved with sonographically guided core biopsy.     

Osteoarticular manifestations of Mycobacterium tuberculosis infection

Mycobacterium tuberculosis has affected humans for much of our existence. The incidence of global tuberculosis infection continues to rise, especially in concert with HIV coinfection. Many disease processes, such as diabetes, increase the likelihood of tuberculosis infection. Tuberculosis bacteria can infect any bone, joint, tendon, or bursa; however, the most common musculoskeletal site for infection includes the spine and weight-bearing joints of the hip and knee. Many patients who present with osteoarticular tuberculosis infection will have a gradual onset of pain at the site of infection. Many patients who develop a musculoskeletal tuberculosis infection will have no evidence of a pulmonary tuberculosis infection on x-ray film and many will have very mild symptoms with the initial infection. Healthcare providers must remember that many patients who develop tuberculosis infection do not progress to active tuberculosis disease; however, the latent infection may become active with immune compromise.     

Inflammatory pseudotumor (myoblastic tumor) of the breast: A case report and review of the literature

Inflammatory pseudotumor of the breast is a very rare cause of breast mass. To our knowledge, only a few cases have been described in the English literature. In this case, the lesion appeared on mammography as a round high‐density mass with ill‐defined margins and on sonography as an irregular mass of complex echogenicity with ill‐defined margins and an echogenic rim. The lesion was resected with no evidence of local recurrence after 3 years. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound 2010     

Inflammatory myofibroblastic tumors of the breast with simultaneous intracranial,lung, and pancreas involvement: ultrasonographic findings and a review of the literature

We encountered a case of inflammatory myofibroblastic tumor (IMT) of the breast with simultaneous intracranial, lung, and pancreas involvement. Here, we present the clinical imaging results and report the significance of sonographic findings of breast IMT along with a review of the literature. A 16-year-old girl with a history of subarachnoidal hemorrhage was admitted to our hospital due to tonic–clonic seizure. Computed tomography (CT) and magnetic resonance imaging (MRI) showed multiple intracranial, lung, and pancreas mass lesions and a solitary mass lesion in the right breast. Breast ultrasonography showed a circumscribed oval-shaped hypoechoic mass with a central hyperechoic region. Power Doppler sonography revealed an unusual spiral-shaped flow signal. Breast tumorectomy was performed for definitive diagnosis, and pathological analysis indicated IMT. A literature review indicated that ultrasonographic findings of IMT of the breast are nonspecific, as in other systems or organs. It would be difficult to make a diagnosis of IMT of the breast preoperatively due to its rarity and the lack of specificity of clinical imaging findings. In addition, it is better to consider the possibility of IMT of the breast especially in younger patients without an obvious family history of hereditary breast cancer.     

KSHV-associated extracavitary primary effusion lymphoma in an HIV seronegative patient: a case report and review of the literature

Primary effusion lymphoma (PEL) is a rare type of non-Hodgkin’s lymphoma presenting as a lymphomatous effusion and absence of a solid tumor mass. Extracavitary PEL (EC-PEL) is a subtype of PEL with the absence of an effusion but presence of solid tumor. PEL and EC-PEL share the same histopathologic and immunophenotypic features. Kaposi sarcoma-associated herpesvirus (KSHV) positivity is seen universally in these malignancies and is a requisite for diagnosis. Most cases are seen to occur in HIV positive individuals. We present a unique case of a 21-year-old male who presented with ongoing chest pain and right hip pain found to have an extensive lytic lesion of the right iliac bone, a paratracheal mass and a large pelvic mass. All the involved sites were FDG (F-18 fluorodeoxyglucose)-avid on PET-CT scan. The patient was seronegative for HIV with no risk factors for immunosuppression. A biopsy of the pelvic mass and bone marrow showed large atypical cells with irregular multi-lobulated nuclei, prominent nucleoli, and abundant amphophilic cytoplasm. The cells were positive for MUM1, in situ hybridization for EBV-encoded RNA (EBER), and KSHV, while negative for B-cell and T-cell markers. The patient was treated with six cycles of DA-EPOCH with a follow up PET scan showing a decrease in size of the masses and bone lesion and conversion to non-FDG-avid status. To the best of our knowledge, our case is the first in published English literature with bone involvement with EC-PEL regardless of HIV status. We review the reported cases of EC-PEL including their presentation, diagnostic features, treatment and outcomes.     

The treatment of the sacroiliac joint component to low back pain: a case report.

This case report describes the treatment of a patient who had symptoms and signs suggestive of a sacroiliac joint component of low back pain. The patient developed right-sided low back pain without provocation. He appeared to have sacroiliac joint dysfunction, excessive right hip lateral rotation, and limited right hip medial rotation. The patient's habit of crossing his right leg over his left leg while sitting was believed to have contributed to the excessive lateral hip rotation. After treating the sacroiliac joint and restoring symmetrical hip rotation, the patient no longer complained of low back pain. This case report suggests that asymmetrical hip rotation may contribute to what is often called a sacroiliac joint component of low back pain.     

A rare cause of breast mass that mimics carcinoma: Foreign body reaction to amorphous surgical material

A breast mass caused by foreign body type granulomatous reaction to surgical material is a very rare lesion and may mimic carcinoma. Reported foreign materials have included suture materials, silicone, paraffin, gunpowder and carbon particles used for localization of a nonpalpable breast lesions. To our knowledge, a foreign body reaction to gauze sponge has not been reported previously. A 58-year-old woman who had an enlarging mass that mimicked breast carcinoma, due to foreign body reaction to gauze sponge is presented here, and relevant literature is reviewed.     

乳腺结核的超声诊断

目的 通过对乳腺结核的超声显像回顾性分析,进一步提高超声医师对乳腺结核的认识,减少乳腺结核的漏误诊.方法 对1998年3月至2010年11月在玉山县中医院外科手术证实的16例乳腺结核病患者的超声显像资料进行回顾性分析.结果 16例乳腺结核中,实质包块型5例,溃疡瘘管型7例,混合包块型3例,脓肿型1例,实质包块型最易误诊.结论 乳腺结核超声表现多种多样,无特异性,但超声对乳腺结核定位准确,结合临床能对乳腺结核作出初步诊断.     

Hip moments during level walking, stair climbing, and exercise in individuals aged 55 years or older

BACKGROUND AND PURPOSE: Low bone mass of the proximal femur is a risk factor for hip fractures. Exercise has been shown to reduce bone loss in older individuals; however, the exercises most likely to influence bone mass of the proximal femur have not been identified. Net moments of force at the hip provide an indication of the mechanical load on the proximal femur. The purpose of this study was to examine various exercises to determine which exercises result in the greatest magnitude and rate of change in moments of force at the hip in older individuals. SUBJECTS AND METHODS: Walking and exercise patterns were analyzed for 30 subjects (17 men, 13 women) who were 55 years of age or older (X = 65.4, SD = 6.02, range = 55-75) and who had no identified musculoskeletal or neurological impairment. Kinematic and kinetic data were obtained with an optoelectronic system and a force platform. Results. Of the exercises investigated, only ascending stairs generated peak moments higher than those obtained during level walking and only in the transverse plane. Most of the exercises generated moments and rate of change in moments with magnitudes similar to or lower than those obtained during gait. CONCLUSION AND DISCUSSION: Level walking and exercises that generated moments with magnitudes comparable to or higher than those obtained during gait could be combined in an exercise program designed to maintain or increase bone mass at the hip.     

Imaging findings in a case of epidermal inclusion cyst arising within the breast parenchyma

Epidermal inclusion cysts rarely occur in the breast, but when they do, the consequences can be severe. Here, we report the case of a 23-year-old woman who presented with a palpable mass in the right breast. The mass had persisted for 4 years and had been causing pain for 1 month at the time of the patient's presentation. We examined the mass by means of mammography and sonography. Sonographic examination revealed a well-circumscribed solid, avascular mass suggestive of an epidermal inclusion cyst. Excision was performed at the patient's request. Histopathologic examination of the mass after excision confirmed the diagnosis of epidermal inclusion cyst and its localization within the breast parenchyma. To our knowledge, reports on epidermal inclusion cysts within the breast parenchyma are rare.     

Rare submandibular gland metastasis of hepatocellular carcinoma: case report and review of the literature

Hepatocellular carcinoma (HCC), the most common primary hepatic tumor, metastasizes in more than 50% of cases. However, metastasis of HCC to the submandibular glands is very rare. HCC rarely metastasizes to the salivary glands; only six cases of metastasis to the parotid gland have been reported in the English-language literature. Moreover, only one case of metastasis of HCC to the submandibular glands has been reported to date, and the affected patient died of hepatic failure. This clinical report describes a 55-year-old man who had undergone two surgeries for liver cancer and subsequently presented with a 2-week history of a right submandibular mass. We performed dissection of the right submandibular triangle, and metastatic HCC of the submandibular gland was diagnosed. Although HCC metastases to the oral cavity have been reported, this is only the second case of HCC metastasis to the submandibular gland. Fine-needle aspiration biopsy is recognized as a simple, direct approach for morphologic diagnosis of salivary gland lesions; however, histological and immunohistochemical examination of the surgical specimen remains necessary.     

Bone mineral density and bone turnover in postmenopausal women treated for breast cancer

Chemotherapy and endocrine treatments for breast cancer are believed to increase risk of osteoporosis by causing early menopause in premenopausal women and by further depleting estrogen levels in postmenopausal women. Multivariate analyses were used to evaluate the contributions of 7 predictors (age, body mass index [BMI], family history of osteoporosis, months since menopause, past use of chemotherapy, and current use of tamoxifen or aromatase inhibitors) in explaining variability in bone mineral density (BMD) at the hip and the spine and bone turnover in 249 postmenopausal women who are breast cancer survivors. This report was an analysis of baseline data from a federally funded (1 R01 NR07743-01A1) intervention study on osteoporosis prevention. Mean age of the women was 58.5 years, and average BMI was 26.7 kg/m; 98% were white. All had measurable bone loss, 167 had chemotherapy, 76 were on tamoxifen, and 21 were on aromatase inhibitors. Women with higher BMI had higher BMD at the hip (P < .001) and the spine (P = .004). Women on tamoxifen had lower measures of bone formation (Alkphase B) (P < .001), suggesting less bone turnover, and higher BMD at the hip (P = .035). There was a trend for women who had received chemotherapy to have lower BMD at the spine (P = .06). The implications of these findings are discussed in the article.     

Mycobacterium kansasii infection in a patient with AIDS.

We have presented the case of a 45-year-old HIV-positive man who had a 2-week history of shortness of breath and fever and who was found to have pneumonia due to an acid-fast bacillus. Despite treatment with isoniazid, rifampin, ethambutol, and clofazimine, he died of the infection. Culture results obtained after his death showed the organism to be Mycobacterium kansasii. Mycobacterial infections are common in patients with AIDS, but are usually due to M tuberculosis or M avium complex. Of the 35 patients with AIDS and M kansasii infection mentioned in the literature, only eight of these were described; and of the four patients (including our patient) who received therapy considered appropriate for this infection, only two survived.     

肝移植术后髋关节新型隐球菌感染1例并文献复习

目的报道1例肝移植术后髋关节新型隐球菌感染病例及相关文献复习,关注此病的发生及诊治。方法回顾性分析1例肝移植术后髋关节新型隐球菌感染病例,并以英文关键词“Cryptococcus”和“joint”或“arthritis”、中文关键词“隐球菌感染”和“关节”为检索词,检索PubMed数据库、中国知网数据库(CNKI)、万方数据库和维普数据库等国内外报道的病例,结合文献复习综合分析关节隐球菌感染的临床特点及诊疗方法。结果患者男性,39岁,因“左侧髋部肿痛2个月”入院,既往因肝硬化在外院行同种异体原位肝移植术,术后长期口服抗免疫排斥药物及激素治疗。髋关节经穿刺引流液培养确诊为新型隐球菌感染,严格抗真菌治疗后好转。文献共检索到9例关节隐球菌感染患者,其中男性5例,女性4例,年龄4~92岁;主要受累部位是膝关节4例,其次是髋关节3例。8例的临床症状仅表现为局部肿痛,1例合并发热;影像学多表现为关节周围溶骨性病变5例,其中2例合并局部软组织肿物形成。经及时手术干预和(或)抗真菌治疗后,7例患者治愈且随访未见复发,1例于出院3个月后不明原因死亡,1例确诊后要求转院失访。结论关节隐球菌感染的临床及影像学表现均缺乏特异性,极易与肿瘤、结核等疾病相混淆,当临床上怀疑本病时,应尽早行穿刺液或组织病原学检测,以免误诊和延误治疗造成严重后果。     

A case of intussusception of the appendix secondary to endometriosis: US and CT findings

Intussusception of the appendix is an uncommon condition that is difficult to diagnose with radiology. Endometriosis causing appendiceal intussusception is a rare condition that has only been reported a few times in the literature. Here, we report a case of appendiceal intussusception caused by endometriosis in a 33‐year‐old woman who presented with intermittent right lower abdominal pain. Sonography revealed a hypoechoic mass invaginating into the cecum, which was covered by echogenic cecal wall with central dimpling indicating the appendiceal orifice. On CT, the mass was identified as an enhancing mass invaginating into the cecum at the level the appendiceal orifice. © 2014 Wiley Periodicals, Inc. J Clin Ultrasound 43 :443–446, 2015     

乳腺结核病（附23例报告）

我院自1962～1987年间收治乳腺结核共23例,平均年龄37.9岁(年龄最小者19岁,最大者55岁),左乳10例,右乳13例,术前仅1例诊断为结核,误诊率达95.6％,其中18例(78.3％)诊断为乳腺癌,且两例误行根治术。其教训是深刻的。