NK/T cell lymphoma of the lung: a case report and review of literature

Primary lymphoma of the lung is rare and is usually of B cell type. Tissue samplings taken by transbronchial biopsy and computed tomographic (CT) guided needle biopsy of the right perihilar area of an elderly woman who presented with refractory pneumonia showed T cell lymphocytosis with no evidence of active infection. The patient's respiratory status rapidly deteriorated and she eventually died. Post mortem examination revealed primary pulmonary T cell lymphoma with natural killer (NK) cell features. We present what may be the first case of primary NK/T cell pulmonary lymphoma and review the literature on the subject.     

Sphenoid sinus lymphoma. Case report and review of the literature

A 64-year-old man presented to his general practitioner with an history of headaches and recent diplopia. Neuroradiological investigation showed a sphenoid sinus mass involving the sella and the clivus. Diagnosis of non-Hodgkin lymphoma was made via a transsphenoidal approach. The patient subsequently underwent a 6-month course of chemotherapy (M COPPA protocol) followed by 50 Gy locoregional radiotherapy. At three years follow-up the patient was in complete clinical and radiological remission. This case underscores the importance of thorough radiological work-up for accurate identification of tumor masses involving the pituitary fossa and provides an opportunity to review the literature on the management of this rare entity.     

Hepatocellular carcinoma presenting as a solitary metastasis to the scapula. Case report and review of the literature

Although primary hepatocellular carcinoma is uncommon, metastasis to the upper extremity as a presenting symptom is even more rare. Recent case reports and autopsy surveys document that extrahepatic spread of this carcinoma occurs in 30% to 78% of patients, who usually are without regional symptoms involving bone. Although metastatic spread to the lungs and lymph nodes occurs more commonly, the incidence of bone metastases has increased according to previous reports and is now estimated from 2% to 13%. This case report concerns widely disseminated hepatocellular carcinoma presenting initially without any other systemic signs except for shoulder pain and induration. Due to the aggressive nature of this tumor, early detection is crucial. Early diagnosis may offer the only real hope for establishing effective treatment and improving the chances for long-term survival.     

Ependymoma of the pituitary fossa. Case report and review of the literature

The authors describe a case of pituitary fossa ependymoma and discuss its immunohistochemical and ultrastructural characteristics. A 43-year-old man presented with decreased libido and panhypopituitarism. Magnetic resonance imaging demonstrated a well-demarcated enhancing lesion of the pituitary fossa that was completely resected via a transsphenoidal approach. Ependymomas rarely occur in the pituitary fossa, and have been reported in this location only three times in humans and once in a horse. This is the first study in which investigators examined the appearance of a pituitary ependymoma by using electron microscopy. Theories of the origin and treatment of these rare tumors are discussed as they relate to other articles on intracranial ependymomas.     

Colorectal cancer metastasis presenting as a testicular mass: case report and review of the literature

Metastatic lesions to the testicle are uncommon. The authors report a testicular mass as the initial manifestation of distant metastasis from colorectal cancer. This case describes a 51-year-old white man who presented with an enlarged right testicle 9 months after undergoing a right hemicolectomy for a stage IIIC colon adenocarcinoma. The diagnostic and management strategy is discussed. In addition, the literature is reviewed to characterize this uncommon entity further. Although rare, testicular metastasis must be considered in patients with previously resected colorectal carcinoma.     

Renal cell carcinoma presenting as a perineal mass: case report and review of the literature

Perineal involvement in renal cell carcinoma (RCC) has not been reported. Vaginal metastases of RCC are also rare. We present a case of metastatic RCC, initially presenting as a perineal cyst. A 53-year-old woman presented with a perineal cyst, which was excised and diagnosed as clear cell carcinoma. A workup further revealed a vaginal mass and a renal tumor. A nephrectomy and local vaginal excision were performed, leading to the diagnosis of metastatic RCC. This case illustrates the variability in RCC presentation. Also, because vaginal clear cell carcinoma is rare, all such lesions should be considered potentially renal in origin.     

Actinomycetoma of the colon presenting as abdominal wall abscess. Case report and review of the literature

Introduction and importanceAbdominal actinomycetoma is a rare and often a missed diagnosis by most of clinicians due to its rarity and different clinical presentations. It is caused by Actinomyces speces which are gram positive bacilli and normal commensal inhabitants of the human bronchial and gastrointestinal tracts. A.Israelli is responsible for disease in humans once the mucosal barrier is broken.Case presentationThis case report presents an adult female patient who consulted for a localized abdominal wall mass of 3 weeks duration and the clinical exam was in favor of an abdominal wall abscess, but later found to be an actinomycotoma of the colon invading the abdominal wall and forming an abdominal wall abscess. Transverse colectomy and drainage of abscess was done and she improved well.Clinical discussionActinomycosis is common in the tropical and subtropical area. However, this is the first case reported in Rwanda and prompt surgical treatment and antibiotherapy have led to a good clinical outcome.ConclusionAbdominal actinomycetoma should be considered as a differential diagnosis of any abdominal wall mass for patients with known risk factors and surgery and antibiotics are the only curative treatment.     

Aspergillus infection of total knee arthroplasty presenting as a popliteal cyst. Case report and review of the literature.

Fungal infections have only rarely been reported to occur in patients having undergone total knee arthroplasty. This case report documents the first known case of Aspergillus fumigatus as the offending organism. Its initial presentation as a popliteal cyst further reinforces the known association of popliteal cysts and intra-articular knee pathology.     

Haemangiopericytoma presenting with intracerebral haemorrhage. Case report and review of literature

Summary A case of an intracerebral bleeding from haemangiopericytoma is reported. To our best knowledge it is the first published case. The literature concerning apoplectic presentation of brain tumours is reviewed.     

Pheochromocytoma-related cardiomyopathy presenting as broken heart syndrome: Case report and literature review

IntroductionPheochromocytoma are neuroendocrine tumors that arise from sympathetic chromaffin cells within the adrenal medulla. They principally secrete catecholamines, potentially causing life-threatening cardiovascular complications. A myriad of symptomatology and clinical findings are associated with pheochromocytoma, including a catecholamine-induced dilated cardiomyopathy.Presentation of caseA 50-year-old woman presented with retrosternal chest pain and underwent diagnostic evaluation for acute coronary syndrome. Cardiac catheterization demonstrated patent coronary arteries and a pattern of ventricular hypokinesis consistent with takotsubo cardiomyopathy, also known as broken heart syndrome. Further imaging with abdominal CT revealed an adrenal mass. Laboratory markers supported the clinical picture of pheochromocytoma. Right adrenalectomy was performed and our patient was symptom-free at discharge on post-operative day three.DiscussionAlpha and beta adrenergic blockade are used in a critical care setting to prevent perioperative hemodynamic instability as well as catecholamine-induced heart failure in the setting of pheochromocytoma. Patients commonly require vasopressors in the postoperative period due to the rapid reduction in circulating catecholamines following resection. Discharge planning should include recommendations for genetic counseling to screen for syndromic causes of pheochromocytoma that increase the risk for other neoplasms.ConclusionWe present a case report of a rare adrenal tumor in a middle-aged woman that manifested as acute coronary syndrome. A presumptive diagnosis of takotsubo cardiomyopathy on cardiac catheterization led to further investigation. Abdominal imaging located an adrenal mass that correlated with laboratory studies positive for high levels of catecholamines and their metabolites. The tumor was excised and the patient recovered without complications.     

Multiple spinal extradural meningeal cysts presenting as acute paraplegia. Case report and review of the literature

Multiple spinal extradural meningeal cysts are rare. To the authors' knowledge, there have been only four reported cases in the world literature. The authors report a case of multiple spinal extradural meningeal cysts in a 31-year-old woman presenting with acute paraplegia. Magnetic resonance imaging of the thoracolumbar spine revealed multiple extradural cystic lesions extending from T-7 to T-8 and from T-12 to L-3. Intraoperative findings demonstrated a white, fibrous, and tense cyst filled with cerebrospinal fluid-like colorless fluid. Excision of the posterior wall of the symptomatic cyst was followed by immediate neurological improvement. The examination of the pathological specimen showed a thick duralike layer of collagen and an inner membrane of arachnoid that is often not found in these lesions. The final diagnosis was based on combined imaging, intraoperative, and histopathological findings. The authors review the literature and discuss the etiological, diagnostic, and therapeutic aspects of this lesion.     

Concurrent lymphocytic hypophysitis and pituitary adenoma. Case report and review of the literature

Lymphocytic hypophysitis (LyH) is an uncommon intrasellar lesion characterized by lymphocytic infiltration of the adenohypophysis. Evidence suggests that the cause is autoimmune, and the symptoms are usually related to either a mass effect or endocrine dysfunction. Lymphocytic hypophysitis has been described rarely in the setting of other simultaneous pathological processes that involve the pituitary and sella turcica, and is postulated to arise from an intrinsic inflammatory response. The authors report the case of a 43-year-old woman who presented with a 2-month history of galactorrhea and pseudohyperprolactinemia secondary to a 10-mm lesion within an enlarged pituitary gland. She was nulliparous and had no contributory medical history. Serial neuroimaging performed over a 2-year period demonstrated lesion growth, and visual deficits had developed; together these warranted surgical intervention. A transsphenoidal resection was performed. Microscopic and immunohistopathological examinations revealed a nonsecreting pituitary adenoma with concurrent lymphocytic adenohypophysitis. This is the first documented case of LyH in the setting of a null-cell pituitary adenoma. The authors review the related literature and outline potential mechanisms for the concurrent development of LyH and a pituitary adenoma.     

Carotid-cavernous sinus fistula presenting as a posterior fossa mass. Case report.

The authors report a case in which trigeminal neuralgia and hearing loss developed 14 years after a severe head injury. Arteriography demonstrated a carotid-cavernous sinus fistula producing a large venous mass in the posterior fossa.