Pancreatoblastoma in an adult: Case report and review of the literature

A 50-year-old man presented with progressive gastrointestinal symptoms. An abdominal computed tomography scan demonstrated a 12 × 12-cm pancreatic mass involving the greater curvature of the stomach and multiple hypervascular hepatic metastases. An initial fine needle aspiration of the pancreatic mass was nondiagnostic, and a subsequent fine needle aspiration of a liver mass was read as metastatic acinar cell carcinoma. The patient underwent a palliative resection for tumor-associated pain and gastrointestinal hemorrhage that revealed a large pancreatic tumor invading through the full thickness of the colon at the splenic flexure and adherent to the posterior gastric wall. The pathology from the distal pancreatectomy, splenectomy, partial gastrectomy, partial colectomy, and cholecystectomy unexpectedly supported a diagnosis of pancreatoblastoma with evidence for squamoid corpuscles as well as areas of acinar formation. Despite multiple chemotherapy regimens, the patient’s disease continued to progress in the liver and the lungs. During the course of his therapy, the patient’s serum α-fetoprotein levels and serum lipase levels rose concurrently, suggesting tumor-associated production of both of these factors. Seventeen months after the diagnosis of metastatic pancreatoblastoma, the patient died from his disease. Our case illustrates the fact that pancreatoblastomas are extremely difficult to diagnosis preoperatively. In addition, our case demonstrates that pancreatoblastomas can be α-fetoprotein producing, hormone producing, and enzyme producing when it occurs in adults. The University of California, San Francisco Committee on Human Research approved this project (approval No. H9672-26472-01).     

Volvolus in an adult patient due to intestinal malrotation. Case report and review of literature

Intestinal malrotation is a rare cause of bowel obstruction in adults and it could create a perplexing situation for surgeons not familiar with this pediatric pathology. Symptomatic patients present either acutely with bowel obstruction and intestinal ischemia with a midgut or cecal volvolus, or chronically with vague abdominal pain. Several modalities can be used to describe the intestinal abnormality such as barium X-ray, computer tomography scans, angiography and sometimes also the explorative laparotomy. The authors report on a case 62 years-old women presented to Emergency Center for plurime episodies of biliar emesis and diffuse abdominal pain in the last 5 days and treated for bowel obstruction secondary to a midgut volvolus in anomaly of fetal intestinal rotation.     

Diastematomyelia combined with disc herniation at T 6/7 in an adult. Case report

A case of thoracic diastematomyelia associated with acute disc herniation is reported. The female patient noted sensory and motor symptoms at 49 years of age, four months before hospitalization. Myelography, myelo-computerized tomography and nuclear resonance tomography of the thoracic spine and cord showed the region of diastematomyelia with an additional disc herniation at T 6/7. The bone spur and the disc was successfully excised. Post-operatively, the patient's deficits improved.     

Intestinal perforation secondary to Salmonella typhi: case report and review of the literature

The case of a young woman presenting with fever, abdominal distention, and diarrhea is presented. While hospitalized, she developed peritonitis, and a laparotomy was performed emergently. Intraoperative and pathologic examinations are highly suggestive of Salmonella typhi as an etiology for her symptoms and eventual perforation. Salmonella enteritis can be a difficult diagnosis to make, but in most cases it is a self-limited disease process. In a minority of cases, multidrug antibiotic therapy may be required secondary to an increasing prevalence of resistant strains. Patients who perforate require prompt operation to limit morbidity and mortality. Outcome is significantly improved in those patients by directed resection of the affected segment of bowel and by aggressive perioperative care.     

Brachial plexus palsy secondary to clavicular nonunion. Case report and literature survey

Compression neurapraxias of the brachial plexus secondary to nonunion of the clavicle are extremely rare. These palsies routinely affect the medial cord, producing primarily ulnar nerve symptoms. The nonunions that cause them are almost exclusively hypertrophic and are usually in the middle third of the clavicle. These palsies result from the entrapment of the medial cord of the brachial plexus within the costoclavicular space of Berkheiser. Onset of symptoms is highly variable. Treatment recommendations are divided between partial clavicular excision and open reduction with internal fixation. Because this lesion requires operative intervention, it must be carefully distinguished from traction palsy of the plexus for which it is easily mistaken. This distinction requires a meticulous neurologic examination during the initial evaluation of the patient with an acute calvicular fracture.     

Intestinal obstruction secondary to appendiceal mucocele: case report and review of literature

Appendiceal mucoceles are a group of lesions in where the appendiceal lumen becomes distended with mucus. These are rare conditions. Approximately 25% of mucoceles are asymptomatic and discovered incidentally at surgery. The appendiceal mucocele accounts only the 0,2-0,3% of all appendicectomies. This condition usually requires surgical treatment, either appendicectomy or right colectomy under specific circumstances. In this article we present the case of a male patient 73 years old who developed subacute intestinal obstruction secondary to giant appendiceal mucocele. We also review the international literature on this subject.     

Three-level thoracic disc herniation: Case report and review of the literature

A rare case of three-level thoracic disc herniation with associated neurological impairment, including motor, sensor and urinary disturbances, is reported. The diagnosis and localization of the level of cord compression were mainly based on the clinical examination supported by the findings of magnetic resonance imaging and somatosensory evoked potentials. An anterolateral transthoracic approach at the uppermost affected level was selected for removal of all herniated discs, with the use of a surgical microscope; the resected rib was used for intervertebral fusion. An improvement in the patient's subjective and neurological condition was already apparent a few months after the operation, and solid fusion was roentgenographically found at all operated levels. The use of a surgical microscope allows complete removal of the herniated disc while avoiding wide vertebrectomy and associated iatrogenic damage to the spinal cord.     

Embolic posterior cerebral artery occlusion secondary to spondylitic vertebral artery compression. Case report.

The authors report a case of isolated homonymous hemianopsia secondary to embolic occlusion of the posterior cerebral artery. The cause of embolism was demonstrated to be spondylitic vertebral artery compression. The importance of arteriography is emphasized since the clinical syndrome may be nonspecific and myelographic or plain x-ray changes may be minimal. Surgical therapy is also discussed.     

Intestinal malrotation in an adult: case report

Intestinal malrotation is a developmental anomaly of the midgut in which the normal fetal rotation of intestines around the superior mesenteric artery and their fixation in the peritoneal cavity fail. Rotational anomalies of the midgut are rare in adults. Operative intervention is required generally when they are symptomatic. While difficult to diagnose, prompt recognition and surgical treatment usually lead to a successful outcome. Intestinal malrotation is rarely asymptomatic and generally diagnosed incidentally in adults. In the present report, a case of incidental intestinal malrotation with clinical findings of small bowel obstruction is discussed with a literature review.     

Expansile, enhancing cervical cord lesion with an associated syrinx secondary to demyelination. Case report and review of the literature

The authors describe the case of a patient with an enhancing, intramedullary cervical spinal cord lesion and associated syrinx. Biopsy sampling of the cervical lesion was performed, and the histological findings were consistent with a demyelinating process supporting the diagnosis of multiple sclerosis (MS). Syrinx formation associated with demyelinating disease has only been described in isolated cases, almost exclusively in Japanese patients with MS. A 22-year-old woman of Caribbean descent presented with a subacute, progressive myelopathy including symptoms of pain and weakness in all extremities, bladder incontinence, and the inability to ambulate. Magnetic resonance imaging of the brain and spinal cord demonstrated an enlarged cervical cord with enhancement and central cavitation consistent with a syrinx. The patient underwent a C3-7 laminoplasty and placement of a dural graft for cord decompression as well as fenestration of the central syrinx. Biopsy sampling of the lesion was performed, and the histopathological analysis, in conjunction with subsequent laboratory and diagnostic testing, supported the diagnosis of demyelinating disease. After treatment with a course of high-dose dexamethasone and inpatient rehabilitation therapy, the patient demonstrated significant clinical improvement. Spinal cord involvement is not uncommon in patients with demyelinating disease; however, enhancing lesions associated with extensive tissue loss and syrinx formation have rarely been reported. For the consulting neurological surgeon, demyelinating disease should be included in the differential diagnosis of such lesions given the level of complexity and risk to the patient associated with open biopsy of the spinal cord.     

Cerebral neuroblastoma in an adult: Case report,pharmacology, and review of the literature

The case of a 69-year-old man, who had a 3-week history of symptoms resembling an organic brain syndrome and who had no focal neurologic deficit, is reported. The investigation revealed a mass lesion in the left frontoparietal area, which was found to be a neuroblastoma. Treatment included surgical removal followed by radiation therapy to the brain. A survey of the literature to date reveals only 11 reported cases of cerebral neuroblastoma in adults.     

Reversed rotation of the midgut in an adult. Case report

Management of a patient with a congenital anomaly of the midgut can be difficult for a surgeon since these abnormalities are extremely rare particularly in adults. However a thorough knowledge of embryology and anatomy will allow the complexity of a rotational anomaly to be resolved. A case of reversed rotation of the midgut is presented and the literature on this subject reviewed.