Right Gluteal Abscess: An Unusual Presentation of Perforated Caecal Adenocarcinoma

Introduction

Colonic cancer presenting as a remote abscess in the gluteal region, abdominal wall, retroperitoneal region, groin or thigh is rare.

Case Report

We report a case of advanced carcinoma of the caecum in an elderly lady without bowel symptoms presenting as right gluteal abscess.

Discussion

In the differential diagnosis of gluteal/ upper thigh abscess the rare possibility of colonic cancer perforation as a cause should be considered.     

Necrotizing Fasciitis: An Unusual Presentation

Necrotizing fasciitis (NF) is rare but life threatening multimicrobial soft tissue infection characterized by progressive, usually rapid, necrotizing process of the subcutaneous tissues and fascial planes, with resulting skin gangrene and systemic toxicity. The groin, abdomen and extremities are the most frequent sites involved by this disease and it is rarely seen in the head and neck region. NF of the head and neck region has a potentially high morbidity and mortality. Delay in diagnosis leads to poor outcome. Hence early recognition and aggressive management is imperative for successful outcome. Here we present a case of acute onset of cervical necrotizing fasciitis in a young male.     

Small Bowel Intussusception Due to a Primary Non-Hodgkin's Lymphoma. An Unusual Presentation and Clinical Course

Background/purpose

Adult intussusception is a rare clinical entity accounting for 5% of all intussusceptions. Symptoms and signs are often vague and non-specific making a preoperative diagnosis difficult. The purpose of this study is to present a rare case of a jejuno-jejunal intussusception due to primary intestinal non-Hodgkin's lymphoma in a patient with an unusual clinical course.

Methods

A 78-year-old man presented with a 1-month history of abdominal pain, nausea, epigastric fullness, and weight loss. Computed tomography scan and ultrasonography findings were suggestive of small bowel intussusception.

Results

Laparotomy revealed a jejuno-jejunal intussusception caused by a primary B cell non-Hodgkin's lymphoma 20 cm distal to the ligament of Treitz. Resection without prior reduction was performed. The patient refused postoperative adjuvant chemotherapy. Seven months later, he presented with upper gastrointestinal bleeding, and the diagnostic evaluation revealed gastric infiltration of large B cell non-Hodgkin's lymphoma. Despite chemotherapy, he died of disseminated progressive disease 7 months later.

Conclusions

Adult jejuno-jejunal intussusception due to primary non-Hodgkin's lymphoma is a rare clinical entity. A high index of suspicion is needed as symptoms and signs are not pathognomonic. Appropriate investigations can lead to a prompt preoperative diagnosis. Resection without prior reduction is the treatment of choice. Our patient's refusal of postoperative adjuvant chemotherapy likely resulted in relapse of the disease in another part of the gastrointestinal tract.     

Subcutaneous Metastatic Adenocarcinoma: An Unusual Presentation of Colon Cancer - Case Report and Literature Review

Subcutaneous metastasis from a visceral malignancy is rare with an incidence of 5.3%. Skin involvement as the presenting sign of a silent internal malignancy is an even rarer event occurring in approximately 0.8%. We report a case of a patient who presented to her dermatologist complaining of rapidly developing subcutaneous nodules which subsequently proved to be metastatic colon cancer, and we provide a review of the literature.     

Recurrent Bilateral Breast Abscess Due to Nontuberculous Mycobacterial Infection

Since recurrent bilateral breast infection due to nontuberculous mycobacterium (NTM) is rare, its diagnosis is easily overlooked; in addition, complete recovery is often difficult to achieve. We report a case of recurrent bilateral infection in a 35-year-old woman who had completed treatment for NTM. Although various infectious diseases show similar clinical conditions and imaging findings, recurrences should raise suspicion of NTM infection, and this possibility should be considered in differential diagnoses.     

An Unusual Presentation of Impacted Foreign-Body in the Adult Larynx

Foreign-bodies in the aero-digestive tract are a frequent occurrence in ENT practice. The diagnosis and management are based on clinico-radiological findings. We report a case of a 50 paise coin impacted in the adult larynx where the patient came to us 3 days later with the symptom of change of voice and pain in the throat but, surprisingly no dyspnoea or stridor.     

Recurrent Cervical Abscess Due to Pyriform Sinus Fistula-A Case Report

The pyriform sinus fistula is rare congenital anomaly of either third or fourth branchial pouch, which most frequently presented itself by recurrent episodes of neck abscess for long time. Majority of patients with this anomaly presented with symptoms before 10 years and it is more common than has previously been commonly found on leftside (93%). Clinically high index of suspicion, cannulation of the tract under general anaesthesia, Direct laryngoscopy and fistulogram have freequently been successful in identifying the presence of these embryological remnants. Surgical exploration of sinus tract with its total excision, guided with cannula inside its lumen is the definitive treatment.     

Obstructive Jaundice — An Unusual Presentation of a Secondary Deposit

A well defined eccentric filling defect at the lower end of the common bile duct causing obstruction with dilatation of the biliary system is presented as a sign of a secondary deposit in the head of the pancreas.     

An Unusual Case of Pancreatic Cancer with Leptomeningeal Infiltration

Introduction

Pancreatic cancer is a common malignancy and often presents at an advanced stage. Metastases are common but neurological involvement is rare. We aim to describe an unusual case of leptomeningeal involvement from pancreatic cancer.

Case Report

A 59-year-old man presented with a several-year history of abdominal pain, weight loss and anaemia, which had been extensively investigated. Four years after initial presentation, he presented with left leg weakness and sensory disturbance. He was observed to suffer intermittent complex seizures. CT scan of the abdomen showed subtle narrowing of the common bile duct and pancreatic ducts. Endoscopic ultrasound showed a 5-cm lesion in the head of the pancreas with adenocarcinoma cells on fine needle aspiration. Serum CA19.9 was 2,293 U/ml. MRI study of the brain and spinal cord showed widespread leptomeningeal enhancement. Cytological examination of cerebrospinal fluid revealed epithelial cells staining positive for MNF116 and EMA. He started on a weekly regimen of intrathecal combination chemotherapy of hydrocortisone 50 mg, methotrexate 12.5 mg and cytarabine 50 mg. He was also treated synchronously with palliative systemic gemcitabine. His clinical condition continued to deteriorate, cytotoxic therapy was withdrawn after 2 weeks and he died the following month.

Discussion

This case represents the unusual presentation of advanced leptomeningeal carcinomatosis in a locally early stage pancreatic adenocarcinoma. Other reported cases have been in patients with advanced metastatic disease. In the case of significant neurological symptoms and signs, clinicians should have a low threshold for performing investigations to exclude neurological involvement.     

Diffuse Large B Cell Lymphoma of the Mesentery: An Unusual Presentation and Review of the Literature

Introduction

Diffuse large B cell lymphoma is the most commonly diagnosed non-Hodgkin’s lymphoma, whereas lymphoma is the most common cause of mesenteric masses. We herein present a very rare case of a young male patient with a giant diffuse large B cell lymphoma of the mesentery that was incidentally diagnosed during his admission for a road traffic accident.

Materials and Methods

At laparotomy, a huge tumor measuring 18 × 14 × 10 cm was found originating from the jejunal mesentery. Despite the giant size of the tumor, the patient was completely asymptomatic. After complete surgical recection with clear margins, he recieved six cycles of CHOP chemotherapy in the pre-rituximab era.

Results and Discussion

He remained disease-free 2 years after surgery, but unfortunately, he relapsed with disseminated disease and died 6 months later. Mesenteric lymphomas may remain asymptomatic until they reach a large size. The presence of a bulky mesenteric mass is a poor prognostic indicator.

Conclusion

Although chemotherapy is the treatment of choice for diffuse large B cell lymphoma, in some cases radical surgery has a role in establishing a definitive diagnosis.     

Caecal Arterio-Venous Malformation:An Uncommon Cause of Iron Deficiency Anaemia

Two patients with caecal arteri-ovenous malformations causing intermittent blood loss leading to iron deficiency anaemia are reported. An awareness of this condition (also known as haemangioma and caecal angiodysplasia) as a cause of lower intestinal bleeding and greater use of selective visceral arteriography has led to increased detection of these lesions (Bentley, 1976). Caecal arterio-venous malformations are seen mostly in the elderly and there is increased incidence of these lesions in patients with aortic stenosis.     

Presentation of Garcin Syndrome due to Lung Cancer

Garcin syndrome consists of unilateral palsies of almost all cranial nerves without either sensory or motor long-tract disturbances and without intracranial hypertension, and it is caused by a malignant osteoclastic lesion at the skull base. A 60-year-old woman presented with dizziness and left facial palsy. Progressive left cranial nerve palsies developed over 2 months until gadolinium-enhanced magnetic resonance imaging of the brain revealed an intracranial extension of a tumor from the left skull base. A systemic survey revealed adenocarcinoma of the lung, which had metastasized along the skull base. We experienced a rare case of Garcin syndrome due to skull base metastases from lung cancer.