Bilateral spontaneous hyphaema: case report and review of literature

To report a case of bilateral spontaneous hyphaema in a patient on warfarin sodium for atrial fibrillation and COPD. A case report and literature review. A 76-year-old man presented with bilateral spontaneous hyphaema. There was no anterior chamber pathology known to predispose for spontaneous bleeding except for a history of paroxysmal atrial fibrillation treated with a daily dose of 3 mg of warfarin sodium. In addition, he was also suffering from severe COPD and was on oxygen supplementation. This is a rare case of a bilateral spontaneous hyphaema. Although the patient was on warfarin sodium, his INR was only 2.6 at the onset of his symptoms. It may be possible that the combined action of anti-coagulant properties of warfarin sodium and hypoxic vasodilatation of iris vessels may be responsible for bilateral hyphaema in this case.     

Bilateral pulmonary nodular amyloidosis: A case report and review of the literature

Pulmonary amyloidosis is uncommon and is usually associated with systemic amyloidosis. Localized pulmonary involvement in amyloidosis without systemic amyloidosis is even rarer; it is generally tracheobronchial or parenchymal in location. Parenchymal pulmonary amyloidosis is generally asymptomatic and an incidental finding, presenting as nodules varying in size and number, unilateral or bilateral. We present an unusual case of primary bilateral pulmonary nodular amyloidosis in an elderly female.     

Bilateral testicular microlithiasis: case report and review of the literature

Testicular microlithiasis is a rare diagnostic entity of unknown etiology and clinical significance. We hereby describe a case of bilateral testicular microlithiasis in a 10 year-old boy with a past history of mumps. Diagnosis was made by ultrasonography. Serum testicular tumor markers (alpha fetoprotein and beta human chorionic gonadotropin) were negative. Although the clinical significance of testicular microlithiasis remains obscure, in view of its association with testicular tumor and other pathology, we advocate regular self-examination and clinical follow-up with ultrasonography as an adjunct on a regular and long-term basis.     

Multimodality detection of multiple left ventricular diverticula: A case report and brief review of the literature

Left ventricular diverticula (LVD) are rare congenital anomalies usually detected incidentally in the adult population. Most commonly, they are found as a single left ventricular diverticulum in association with other congenital abnormalities but multiple LVD are exceedingly rare. We are describing a patient who was found to have multiple LVD on multimodality imaging studies. He had presented with a sudden cardiac arrest attributed to a combination of alcohol intoxication and QT interval prolongation from hypokalemia and antidepressant medications. The patient was managed conservatively and discharged with an implantable loop recorder for detecting any occult arrhythmias.     

Presacral ganglioneuroma: A case report and review of literature

Presacral ganglioneuromas are so rare benign tumors that only 17 cases have been reported in the literature. They are abdominal masses growing slowly and differential diagnoses have to be considered. Surgical resection is important for definitive diagnosis because it represents the only therapeutic choice. Because of the benign nature of ganglioneuroma, adjuvant chemo-or radiotherapy is not indicated but regular follow-up is necessary for an early diagnosis of potential local recurrence. We report a case of a 64-year-old man with a presacral ganglioneuroma.     

Bilateral breast MALT lymphoma: a case report and review of the literature

 Breast lymphoma is a rare disease. Both primary and secondary breast involvement have been reported. Most primary breast lymphomas are high-grade malignant neoplasms, mainly large cell and Burkitt type. Low-grade lymphomas of the breast, particularly mucosa-associated lymphoid tissue (MALT) lymphomas, have been exceedingly rare. In this report we present a patient with bilateral breast involvement by MALT lymphoma. Our patient developed localized MALT lymphoma in both breasts in a sequential fashion. She was treated with bilateral lumpectomy, followed by radiation therapy to both breasts. The patient is alive and well more than 1 year after therapy with no recurrence. We believe this is the first such case described in detail in the literature. Received: March 10, 1999 / Accepted: July 6, 1999     

Bilateral renal malakoplakia with acute renal failure: a case report and literature review

Malakoplakia involving the genitourinary tract is a rare inflammatory disorder that presents a diagnostic challenge. Renal parenchymal involvement is particularly uncommon. We report a case of bilateral renal malakoplakia that presented with acute renal failure and simulated xanthogranulomatous pyelonephritis (XGP). The etiology, clinical course, and management of malakoplakia are reviewed, emphasizing the distinct characteristics of the disease that lead to its accurate diagnosis.     

Rectal tonsil:A case report and literature review

The rectal tonsil,a reactive proliferation of lymphoidtissue located in the rectum,is rare.Histologically,benign lymphoid hyperplasia of the rectum is usuallycharacterized by large lymphoid follicles with activegerminal centers and a narrow surrounding mantlezone and marginal zone.This lesion is benign,but must be differentiated from the polypoid type of mucosaassociated lymphoid tissue lymphomas.In the current paper,we present a case of rectal tonsil in a 59-yearold woman.We describe the endoscopic ultrasound imaging findings with literature review.     

Multiseptate gallbladder: A case report and literature review

Rationale:Multiseptate gallbladder (MSG) is a rare congenital gallbladder anomaly. Between 1963 and June 2021, only 56 cases were reported. There is currently no treatment guideline for pediatric or adult cases of MSG.Patient concerns:A 14-year-old woman visited our out-patient clinic in September 2020 for epigastric pain that last for 6 months. Honeycomb appearance of the gallbladder was noted under ultrasonography.Diagnosis:The patient was diagnosed with MSG. The diagnosis was confirmed through computed tomography and magnetic resonance cholangiopancreatography.Interventions:Cholecystectomy was performed.Outcomes:Epigastric pain showed limited improvement after the surgery. Since she was diagnosed with gastritis at the same time, a proton-pump inhibitor was prescribed. Epigastric pain was eventually resolved.Lessons:MSG cases can undergo cholecystectomy and show good recovery without complications. However, concomitant treatment may be required to resolve in the presence of other symptoms such as epigastric pain.     

Bilateral simultaneous facial palsy following scrub typhus meningitis: a case report and literature review

Scrub typhus is widely distributed across the Asia-Pacific region, Taiwan included. The clinical manifestations and complications of scrub typhus vary and the illness ranges in severity from mild to fatal. The etiology of facial nerve palsy varies and infectious agents have been associated with this condition. Rickettsiae species have, however, rarely been reported as the causative agents. We report the case of a 49-year-old man who had fever, malaise, headache, oligouria and tea-colored urine. Bilateral pneumonitis, acute renal failure, acalculous cholecystitis and aseptic meningitis were diagnosed after a series of examinations. The patient recovered after doxycycline treatment but he developed bilateral facial palsy during the convalescent phase, which improved after the administration of a steroid. The diagnosis of infection with Orientia tsutsugamushi was confirmed by the Taiwan Center of Disease Control and the tests for Leptospira, Rickettsia typhi and Coxiella burnetii were all negative. This case indicates that scrub typhus needs to be included in the differential diagnoses of cases of bilateral and simultaneous facial nerve palsy, particularly in areas where the disease is endemic.     

Reninoma: case report and literature review

Reninoma is a tumor of the renal juxtaglomerular cell apparatus that causes hypertension and hypokalemia via hypersecretion of renin. We describe a case of reninoma and provide a review of the literature, with a discussion emphasizing the diagnostic evaluation for such patients. The subject had persistent elevation of both plasma renin activity (PRA) and aldosterone. Imaging studies revealed the presence of a lesion in the renal cortex, which was further identified as a renin-producing lesion via selective venous catheterization following administration of an angiotensin-converting enzyme inhibitor (ACE-I). Following partial nephrectomy, the PRA and plasma aldosterone levels declined rapidly and the blood pressure and potassium supplementation requirements normalized. This case demonstrates the utility of both appropriate imaging studies and selective venous catheterization following provocative administration of an ACE-I for diagnosis.     

淋巴细胞间质性肺炎临床病理分析1例并文献复习

目的了解淋巴细胞性间质性肺炎的临床及病理表现。方法1例淋巴细胞性间质性肺炎行开胸肺活检,标本送检病理及免疫组化。结果本病的病理表现主要为受累部位弥漫性间质浸润,显著地肺泡间隔分布,浸润成分大多为T淋巴细胞、浆细胞和巨噬细胞,与支气管黏膜相关的淋巴组织增生常见。结论本病少见,确诊有赖于胸腔镜或开胸肺活检。治疗为类固醇激素,或免疫抑制剂,治疗反应不一。     

Primary hepatic carcinoid： A case report and literature review

Carcinoids are tumors derived from neuroendocrine cells and often produce functional peptide hormones. Approximately 54.5% arise in the gastrointestinal tract and frequently metastasize to the liver. Primary hepatic carcinoid tumors （PHCT） are extremely rare;only 95 cases have been reported. A 65-year-old man came to our attention due to occasional ultrasound findings in absence of clinical manifestations. His previous medical history, since 2003, included an echotomography of the dishomogeneous parenchymal area but no focal lesions. A computed tomography scan performed in 2005 showed an enhanced pseudonodular-like lesion of about 2 cm. Cholangiomagnetic resonance imaging identified the lesion as a possible cholangiocarcinoma. No positive findings were obtained with positron emission tomography.Histology suggested a secondary localization in the liver caused by a low-grade malignant neuroendocrine tumor. Immunohistochemistry was positive for anti chromogranin antibodies, Ki67 antibodies and synaptophysin. Octreoscan scintigraphy indicated intense activity in the lesion. Endoscopic investigations were performed to exclude the presence of extrahepatic neoplasms. Diagnosis of PHCT was established.The patient underwent left hepatectomy, followed by hormone therapy with sandostatine LAR. Two months after surgery he had a lymph nodal relapse along the celiac trunk and caudate lobe, which was histologically confirmed. The postoperative clinical course was uneventful, with a negative follow-up for hematochemical, clinical and radiological investigations at 18 mo post-surgery. Diagnosis of PHCT is based principally on the histopathological confirmation of a carcinoid tumor and the exclusion of a non-hepatic primary tumor. Surgical resection is the recommended primary treatment for PHCT. Recurrence rate and survival rate in patients treated with resection were 18% and 74%, respectively.     

Anthracycline-induced cardiotoxicity: A case report and review of literature

BACKGROUNDDoxorubicin and other anthracycline derivatives inhibit topoisomerase II and is an important class of cytotoxic chemotherapy in cancer treatment. The use of anthracycline is limited by dose-dependent cardiotoxicity, which may manifest initially as asymptomatic cardiac dysfunction with subsequent progression to congestive heart failure. Despite baseline assessment and periodic monitoring of cardiac function for patients receiving anthracycline agents, there are unmet needs in prediction and prevention of anthracycline-induced cardiotoxicity (AIC).CASE SUMMARYA 35-year-old African American female was found to have a 9-cm high-grade osteosarcoma of right femur and normal baseline cardiac function with left ventricular ejection fraction of approximately 60%-70% determined by transthoracic and dobutamine stress echocardiogram. She underwent perioperative doxorubicin and cisplatin chemotherapy with 3 cycles before surgery and 3 cycles after surgery, and received a total of 450 mg/m² doxorubicin at the end of her treatment course. She was evaluated regularly during chemotherapy without any cardiac or respiratory symptoms. Approximately two months after her last chemotherapy, the patient presented to the emergency department with dyspnea for one week and was intubated for acute hypoxic respiratory failure. Echocardiogram showed an ejection fraction of 5%-10% with severe biventricular failure. Despite attempts to optimize cardiac function, the patient’s hemodynamic status continued to decline, and resuscitation was not successful on the seventh day of hospitalization. The autopsy showed no evidence of osteosarcoma, and the likely cause of death was cardiac failure with the evidence of pulmonary congestion, liver congestion, and multiple body cavity effusions.CONCLUSIONWe present a case of 35-year-old African American female developing cardiogenic shock shortly after receiving a cumulative dose of 450 mg/m² doxorubicin over 9 mo. Cardiac monitoring and management of patients receiving anthracycline chemotherapy have been an area of intense research since introduction of these agents in clinical practice. We have reviewed literature and recent advances in the prediction and prevention of AIC. Although risk factors currently identified can help stratify patients who need closer monitoring, there are limitations to our current understanding and further research is needed in this field.     

肝脏神经内分泌肿瘤报道1例并文献回顾

背景肝脏可疑恶性肿瘤行手术切除后病理诊断肝脏神经内分泌肿瘤(hepatic neuroendocrin neoplasmas,HNENs)病例,此病例易与肝癌混淆,了解转移性和原发性HNENs的特性,对临床治疗手段有很好的指导意义.病例简介一名56岁男性患者体检发现肝脏占位性病变复查腹部增强CT提示肝脏转移性恶性肿瘤可能;胃部包块考虑良性.手术切除胃部包块并行术中冰冻病理检查提示梭形细胞肿瘤;完整切除肝脏包块术后石蜡病理检查结果提示NENs(G2),患者术后恢复佳.结论本文报道了一例HNENs,考虑转移性.术前诊断不能排除肝脏转移性恶性肿瘤可能.通过对患者病情的详细分析,最终行手术切除治疗并行病理检查确诊.同时我们对HNENs相关文献进行了分析,进一步了解原发和转移性HNENs的临床特征、治疗方案以及预后,以期对此类疾病有更深入的了解,对临床治疗方案决策做证据支撑作用.     

淋巴细胞间质性肺炎一例并文献复习

目的回顾分析1例淋巴细胞间质性肺炎（LIP）患者的临床资料,探讨LIP的发病机制、诊断和治疗方法。方法回顾分析我院确诊的1例LIP患者的临床特点,并结合文献报道加以总结。结果（1）免疫性疾病、EBV感染可能和LIP发病有关;（2）LIP起病缓慢,主要表现为进行呼吸困难和咳嗽,双肺底听诊可闻及湿啰音,肺功能表现为限制性通气功能障碍伴弥散功能受损;（3）高分辨CT表现为双下肺弥散分布的磨玻璃样改变、模糊的小叶中心结节和胸膜下小结节,小叶间隔增厚、支气管血管束增厚;（4）病理表现为肺间质弥漫性淋巴细胞（以成熟性T细胞为主）浸润;（5）激素对部分患者有效。结论LIP比较少见,确诊有赖于胸腔镜或开胸肺活检,治疗以皮质激素为主。