Primary cardiac lymphoma masquerading as right atrial myxoma causing complete heart block—a case report

Secondary involvement of the heart and pericardium by systemic lymphoma is well documented. Primary Cardiac lymphomas (PCL) are extremely rare. Incidence of PCL is increasing in immunocompromised patients. However PCL in immunocompetent is much rarer. We report such a case of PCL in an immunocompetent elderly female masquerading as right atrial myxoma causing complete heart block which was surgically debulked successfully. Her rhythm resumed to Sinus rhythm following surgical debulking. Immunohistochemistry of the excised tumour revealed Diffuse Large B cell lymphoma. With combination chemotherapy, she is symptom free on six months follow up.     

Successful stenting in ductal disruption favorably impacts treatment outcomes in patients undergoing transmural drainage of peripancreatic fluid collections

Background and Aim: The role of pancreatic duct (PD) stenting in patients undergoing endoscopic transmural drainage of peripancreatic fluid collection (PFC) remains unclear. The objective of this study is to evaluate the effect of PD stenting on treatment success in patients undergoing endoscopic transmural drainage of PFC. Methods: This is a retrospective follow‐up study of all patients who underwent endoscopic and endoscopic ultrasonography‐guided transmural drainage of PFC during a 5‐year period. Double‐pigtail stents were deployed in all patients; in addition, nasocystic catheters were deployed in those with abscess/necrosis. An endoscopic retrograde cholangiopancreatogram was attempted whenever feasible in all patients, and pancreatic stents were placed when the duct disruption could be bridged. Success was defined as an improvement in symptoms and resolution of PFC upon follow‐up computed tomography at 8 weeks. Results: Of the 110 patients who underwent PFC drainage, 40 (36%) underwent simultaneous PD stenting. Treatment was successful in 95 of the 110 patients (86%). The PFC types were: pseudocyst (62%), necrosis (20%), and abscess (18%). The median duration of follow up was 9.9 months. Those who underwent PD stenting were significantly more likely to have treatment success than those who did not undergo PD stenting (97.5% vs 80%; risk ratio [RR]_crude = 1.48, P = 0.01). In the multivariable analysis, this association remained significant (RR_adjusted = 1.14, 95% confidence interval: 1.01–1.29, P = 0.036), even after adjusting for the etiology of pancreatitis, type and location of PFC, luminal compression at endoscopy, enteral nutrition, white blood cell count, and number of endoscopic interventions. Conclusions: Transpapillary PD stenting improves treatment outcomes in patients undergoing endoscopic transmural drainage of PFC.     

Acne Keloidalis Nuchae

Acne keloidalis nuchae (AKN) is an inflammatory disease related to the spectrum of keloidal scarring alopecias. No association with internal disease has been described so far. We describe a case series of four Indian patients who showed an association of AKN with acanthosis nigricans, a skin marker for the metabolic syndrome (in particular obesity). Well known risk factors for AKN such as curly hair or wearing of a helmet were not present in these patients. AKN shows some similarities to acne inversa. We propose that AKN may be considered a cutaneous marker for the metabolic syndrome but casecontrol studies will be necessary to validate this clinical observation. Wehope that our findings will stimulate other dermatologists to search for such an association.