An unusual presentation of solitary ovarian metastasis from colorectal cancer in an elderly woman: a case report
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SUBMITTER: Tang F
PROVIDER: S-EPMC11231835 | biostudies-literature | 2024 Jun
REPOSITORIES: biostudies-literature
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Project description:IntroductionA pyosalpinx is the acute inflammation of the Fallopian tube fills up and swells with pus, which commonly results from inadequate or delayed treatment of pelvic inflammatory disease. Herein we report a case of bilateral pyosalpinx mimicking an ovarian torsion.Presentation of caseWe reported the case of a 27-year-old female patient, who presented to the emergency department with complaints of constant, worsening lower abdominal pain for 2-3 days. Pelvic and transvaginal ultrasound examinations were performed which demonstrated a large, complex cystic structure in the right adnexa with peripheral flow on color Doppler imaging. The possibilities included ovarian torsion or hemorrhagic cyst. Intraoperative findings showed bilateral pyosalpinx and treated successfully by laparoscopic bilateral salpingostomy.ConclusionThe present case highlights the diagnostic dilemma of bilateral pyosalpinx must be taken into account in the differential diagnosis of ovarian torsion or tumor, particularly in women of reproductive age.
| S-EPMC7052398 | biostudies-literature
Project description:BackgroundParathyroid carcinoma is a rare and challenging malignancy, often confirmed by histopathological analysis. Due to its rarity, it can present in atypically. We present a case of parathyroid carcinoma with an unusual course of pulmonary metastasis emphasizing the complexities of its diagnosis and management.Case descriptionA 38-year-old lady was referred to our department when her newborn was found to have hypoparathyroidism. Laboratory tests showed elevated parathyroid hormone (PTH) and adjusted calcium levels. Imaging studies suggested the presence of parathyroid tumors, and histopathology confirmed parathyroid carcinoma. Immunohistochemistry was positive for GATA3 in the tumor cells, and next generation sequencing revealed CDC73 mutation, MYC rearrangement, ASXL1 mutation, and a tumor mutational burden (TMB) of 11 Muts/Mb. Despite surgical intervention and initial remission, she developed pulmonary metastasis, which was surgically addressed. She is currently under immunotherapy with six cycles of pembrolizumab due to recurrence.ConclusionsThis case highlights the importance of prolonged surveillance and imaging for parathyroid carcinoma due to recurrence and metastasis. Aggressive resection of parathyroid carcinoma and metastasis are important to decrease mortality. This case also highlights the importance of genetic factors, like CDC73 mutations, confirmed in this study.
| S-EPMC11760510 | biostudies-literature
Project description:This report describes a unique presentation of stridor in an elderly patient who presented to the emergency department (ED) with neck and back pain after a fall down a flight of stairs. The patient had no airway issues on initial evaluation in the resuscitation room, but developed stridor and respiratory distress after returning from imaging. The unexpected stridor and respiratory distress were alleviated with basic airway maneuvers that included airway repositioning and a breathing treatment. Cervical computed tomography (CT) showed a cervical fracture and a retropharyngeal hematoma, which was responsible for the partial obstruction of this patient's upper airway leading to delayed stridor. Following management of the respiratory distress, the patient was diagnosed with and treated for central cord syndrome. The key takeaway from this case is that there should be a low level of suspicion for impending upper airway compromise in elderly patients presenting to the ED with a cervical spine injury.TopicsStridor, retropharyngeal hematoma, cervical spine fracture, central cord syndrome.
| S-EPMC10332537 | biostudies-literature
Project description:BackgroundInvasive mole is responsible for most cases of localized gestational trophoblastic neoplasia. Gestational trophoblastic disease describes a number of gynecologic tumors that originate in trophoblastic layer including hydatidiform mole (complete or partial), invasive mole, choriocarcinoma, placental site trophoblastic tumor and epitheloid trophoblastic tumor. Invasive mole may arise from any pregnancy event although in most cases is diagnosed after molar pregnancy. Overall cure rate in low risk patients is nearly 100% and in high-risk patient 90%. In rare cases, molar tissue traverses thickness of myometrium and leads to perforation and acute abdomen and invasive mole infrequently metastasis. The best treatment option is chemotherapy (according to stage and score with single or multiple agent) and in patients that fertility is not the matter, hysterectomy can be done.Case presentationA 41 years old G3P2ab1 woman referred to Firouzgar hospital 2 months after curettage of molar pregnancy with vaginal bleeding and acute abdomen. In workup, HCG 224000 mIU/ml and evidence of metastasis was detected. Chemotherapy due to stage 3 and score 9 and surgery due to acute abdomen was done. This case was reported for its rarity.DiscussionThis case reported about ovarian metastasis and uterine rupture with acute abdomen and involvement of omentum in metastatic invasive mole. Lack of surveillance led to extensive morbidity. Management of this patient was successful. In follow up, she was free of disease without sequel of any kind for five years now.
| S-EPMC5359859 | biostudies-literature
Project description:Ischemia with non-obstructive coronary artery disease (INOCA), a common cause of angina, can occur due to coronary vasospasm, microvascular dysfunction, endothelial dysfunction, atherosclerosis or a combination of these mechanisms. We describe a case of adenosine-associated paradoxical coronary vasospasm and Takotsubo-like apical ballooning in a postmenopausal woman with underlying mild coronary atherosclerosis and microvascular dysfunction.
| S-EPMC10978165 | biostudies-literature
Project description:In public health, the plight of the solitary elderly is associated with serious social and medical burden. In this vulnerable population, neuropsychiatric complications such as senile depression and dementia as well as chronic pain conditions often co-occur. In this case report, we present a case of an 81-year-old solitary woman who received one year of visiting care service with Korean medicine treatments in a public health setting. During the one year, her pain severity (measured using numeric rating scale) remained moderate after her initial decline and her depressive symptoms and cognitive function scales (Geriatric Depression Scale-Short Form Korean and the Korean version of the Mini-Mental State Examination for Dementia Screening) remained almost unchanged; however, another cognitive function scale (Korean version of the Montreal Cognitive Assessment) showed noticeable improvements. This case report suggests that providing visiting care services with Korean medicine may be a viable strategy for addressing the issues of the solitary elderly.
| S-EPMC7166112 | biostudies-literature
Project description:INTRODUCTION:Cyclopia (alobar holoprosencephaly) (OMIM% 236100) is a rare and lethal complex human malformation, resulting from incomplete cleavage of prosencephalon into right and left hemispheres occurring between the 18th and the 28th day of gestation. Holoprosencephaly occurs in 1/16,000 live births, and 1/250 during embryogenesis. Approximately 1.05 in 100,000 births are identified as infants with cyclopia, including stillbirths. Cyclopia typically presents with a median single eye or a partially divided eye in a single orbit, absent nose, and a proboscis above the eye. Extracranial malformations described in stillbirths with cyclopia include polydactyl, renal dysplasia, and an omphalocele. The etiology of this rare syndrome, which is incompatible with life, is still largely unknown. Most cases are sporadic. Heterogeneous risk factors have been implicated as possible causes. CASE PRESENTATION:A live full-term baby with birth weight of 2900 g, product of cesarean section because of severe fetal bradycardia, was born at Prince Hashem Military Hospital - Zarqa city/Jordan. This newborn was the first baby to a non-consanguineous family, and a healthy 18-year-old mother, with no history of drug ingestion or febrile illnesses during pregnancy. Antenatal history revealed severe hydrocephalus diagnosed early by intrauterine ultrasound but the pregnancy was not terminated because of the lack of medical legitimization in the country. On examination, the newborn was found to have a dysmorphic face, with a median single eye, absence of nose, micrognathia, and a proboscis above the eye, all of which made cyclopia the possible initial diagnosis. Multiple unusual abdominal defects were present that include a huge omphalocele containing whole liver and spleen, urinary bladder extrophy, and undefined abnormal external genitalia, which called for urgent confirmation. Brain MRI was done and revealed findings consistent with alobar holoprosencephaly (cyclopia). CONCLUSION:Presentation of cyclopia is not fully exposed and new cyclopian syndromes still can appear. The prenatal diagnosis of cyclopia can be made early by ultrasound, and the awareness of the spectrum of sonographic findings of cyclopia can improve the accuracy of prenatal diagnosis. The legitimization of pregnancy termination for indexed cases in many countries around the world should be revised.
| S-EPMC4324465 | biostudies-literature
Project description:BackgroundThousands of people suffer from anxiety, depression, and insomnia every day, with benzodiazepines being one of the strategies used to treat these conditions. Withdrawal from its long-term use can lead to potentially life-threatening complications, including Takotsubo syndrome. The authors highlight an atypical case of Takotsubo syndrome secondary to benzodiazepine withdrawal, a rare life-threatening complication of acute substance withdrawal.Case summaryA 58-year-old female presented to the emergency department with altered mental status and acute pulmonary oedema after discontinuing her prescribed benzodiazepines 3 days prior to presentation. Electrocardiogram (ECG) demonstrated anterior ST-segment elevation, with Q-wave and T-wave inversion with prolonged QT interval. Troponin I concentration and B-type natriuretic peptide were elevated to 5407 ng/L (normal ≤ 16 ng/L) and to 1627.0 pg/L (normal ≤ 100 pg/mL), respectively. Echocardiogram showed ballooning of the left ventricle (LV) apex with dyskinesia of the mid and apical segments, with LV function of 15%. Coronary angiography was normal, but left ventriculography showed severe LV systolic dysfunction with akinesis of the mid and apical LV segments and hyperdynamic basal segments. A presumptive diagnosis of benzodiazepine withdrawal-induced Takotsubo syndrome was made, and patients' symptoms, ECG findings, and LV dysfunction resolved after benzodiazepine administration. Six months post discharge, the patient remained asymptomatic with a normal biventricular function, and a beta-blocker was successfully introduced as part of a lifelong plan.DiscussionA diagnosis of benzodiazepine withdrawal-induced Takotsubo syndrome is an underrecognized and challenging diagnosis, due to its atypical clinical presentation. High degree of clinical suspicion for this syndrome is crucial, since favourable prognosis depends on prompt diagnosis and treatment.
| S-EPMC10996924 | biostudies-literature
Project description:BackgroundSystemic lupus erythematosus (SLE) is an autoimmune disease, frequently associated with cardiovascular involvement. One of the most frequent complication is mitral valve regurgitation in more than one-third of the patients.Case summaryA 30-year-old woman with arthralgia, butterfly rash, and Raynaud phenomenon presented with a systolic murmur and renal impairment. Based on the kidney biopsy the diagnosis of SLE was made. Echocardiography revealed the presence of pulmonary hypertension, restrictive mitral valve disease with nodular thickening of the anterior leaflet and moderate regurgitation, compatible with Libman Sacks (LS) endocarditis. Immunosuppressive therapy was started and the patient status improved with normalization of systolic pulmonary artery pressure. After 8 years without follow-up, she presented with fatigue and dyspnoea based on a severe mitral valve stenosis. Subsequently, she underwent a minimal invasive mitral valve replacement and the diagnosis of LS endocarditis could be confirmed upon histopathological examination.DiscussionThis case demonstrates that LS endocarditis can not only lead to mitral regurgitation but occasionally to mitral stenosis due to chronic inflammation with thickening and fusion of mitral valve leaflets. Hereby, comprehensive echocardiography, inclusive stress echocardiography, plays a critical role.
| S-EPMC6426048 | biostudies-literature
Project description:IntroductionImmune checkpoint inhibitors have revolutionized cancer treatment owing to their ability to activate cellular immune checkpoint pathways and mediate an antitumor activity. Due to their immunological actions, immune-related adverse events (irAEs) have become a concern. Neurological adverse events are rarely seen whether in the central or peripheral nervous system and can be potentially life-threatening. We present a rare case of occipital encephalitis following dual immunotherapy treatment in a patient with melanoma.Case presentationA 41-year-old man diagnosed with nodular melanoma of the right torso with axillary lymphadenopathies was treated with dual immunotherapy: nivolumab and ipilimumab. After 24 weeks, patient developed right homolateral hemianopia, and imaging findings correlated with occipital encephalitis. Autoantibodies were not detected. The patient was treated with steroids and exhibited radiological improvement of his encephalitis but maintained his right hemianopia.ConclusionNeurological side effects of immunotherapy are not very common and range from mild to severe life-threatening symptoms. Previous analyses have shown that combination immunotherapy has a higher risk of side effects than monotherapy. Diagnosis of neurological manifestations is usually made by imaging, mainly brain magnetic resonance imaging or detection of autoantibodies in the CSF. The gold standard treatment is usually corticosteroids or rarely other molecules such as IVIg or monoclonal antibodies. The prognosis is usually favorable.
| S-EPMC11805547 | biostudies-literature