Αρχειοθήκη ιστολογίου

Κυριακή 31 Ιανουαρίου 2021

Late recurrence of papillary thyroid cancer from needle tract implantation after core needle biopsy: A case report.

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Late recurrence of papillary thyroid cancer from needle tract implantation after core needle biopsy: A case report.

World J Clin Cases. 2021 Jan 06;9(1):218-223

Authors: Kim YH, Choi IH, Lee JE, Kim Z, Han SW, Hur SM, Lee J

Abstract
BACKGROUND: Papillary thyroid cancer (PTC) has good prognosis so that the local recurrence or distant metastasis can occur later on the lifetime follow up. In this study, we report recurrence of PTC in subcutaneous area combined with lymph node metastasis. A suspicion of needle tract implantation after core needle biopsy was found.
CASE SUMMARY: A 66-year-old female patients who underwent right thyroid lobectomy for PTC complained of palpable nodule on anterior neck area. The location of the palpable nodule was not associated with her postoperative scar. After excision of the skin tumor, it was diagnosed as recurrence of PTC. Furthermore, results of subsequent imaging showed lymph node metastasis on her right cervical area. According to the previous medical records, the patient received core needle biopsy through the neck of the patient midline and hematoma was noted after the procedure. The time interval from the first diagnosis to local recurrence or metastasis to the skin and lymph nodes was ten years. As treatment, the patient underwent lymph node dissection in the right and completion thyroidectomy for radioisotope treatment.
CONCLUSION: Needle tract implantation can occur after core needle biopsy. Further studies are needed to compare core-needle biopsy and fine-needle aspiration.

PMID: 33511188 [PubMed]

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Atypical adult-onset Still's disease with an initial and sole manifestation of liver injury: A case report and review of literature.

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Atypical adult-onset Still's disease with an initial and sole manifestation of liver injury: A case report and review of literature.

World J Clin Cases. 2021 Jan 06;9(1):224-231

Authors: Yu F, Qin SY, Zhou CY, Zhao L, Xu Y, Jia EN, Wang JB

Abstract
BACKGROUND: Adult-onset Still's disease (AOSD) typically presents with a high spiking fever, polyarthritis, transient maculopapular rash, neutrophilic leukocytosis, and hepatosplenomegaly. It has a wide spectrum of clinical symptoms ranging from mild to severe, with extensive involvement of almost every organ. Although liver involvement in the form of increased hepatic enzymes and bilirubin is common, no AOSD case with liver involvement as the initial manifestation of AOSD has been reported.
CASE SUMMARY: A 35-year-old woman presented to the hepatology department with progressively worsening jaundice for one week. Liver chemistry tests revealed a significantly increased liver enzymes and bilirubin level. Given that the clinical examination was unremarkable, liver biopsy was considered because the patient had a history of AOSD 6 years ago. Liver histopathology revealed that most hepatic lobules were still recognizable. Fusional necrosis was observed around most central veins. A few bridging necrotic zones were also found. Infiltration of multiple plasma cells were observed in the necrotic zone, and the reticular scaffold was still expanded. Additionally, no obvious fibrosis was observed in the portal area. Mild mixed inflammatory cell infiltration was noted in the interstitium of the portal area. Further examination was unremarkable except for a remarkably high level of ferritin. Collectively, a presumptive diagnosis of liver injury secondary to AOSD was made. The hepatic involvement responded well to glucocorticoid treatment.
CONCLUSION: This case highlights that hepatic involvement as an initial and sole manifestation could be a pattern of relapsed AOSD. The diagnosis of AOSD should be considered in the case of nonresolving liver injury after the exclusion of common etiologies for liver diseases. A liver biopsy can be useful for the differential diagnosis of liver injury associated with AOSD.

PMID: 33511189 [PubMed]

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Type A aortic dissection developed after type B dissection with the presentation of shoulder pain: A case report.

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Type A aortic dissection developed after type B dissection with the presentation of shoulder pain: A case report.

World J Clin Cases. 2021 Jan 06;9(1):232-235

Authors: Yin XB, Wang XK, Xu S, He CY

Abstract
BACKGROUND: Aortic dissection (AD) is a life-threatening condition with a high mortality rate without immediate medical attention. Early diagnosis and appropriate treatment are critical in treating patients with AD. In the emergency department, patients with AD commonly present with classic symptoms of unanticipated severe chest or back pain. However, it is worth noting that atypical symptoms of AD are easily misdiagnosed.
CASE SUMMARY: A 51-year-old woman was first diagnosed with scapulohumeral periarthritis due to left shoulder pain. After careful examination of her previous medical history and contrast-enhanced computed tomography angiography, the patient was diagnosed with a new type A AD after chronic type B dissection in the ascending aorta. The patient was successfully treated with surgical replacement of the dissected aortic arch and remains in good health.
CONCLUSION: New retrograde type A AD after chronic type B dissection is relatively rare. It is worth noting that a physician who has a patient with suspected AD should be vigilant. Both patient medical history and imaging tests are crucial for a more precise diagnosis.

PMID: 33511190 [PubMed]

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Hemosuccus pancreaticus caused by gastroduodenal artery pseudoaneurysm associated with chronic pancreatitis: A case report and review of literature.

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Hemosuccus pancreaticus caused by gastroduodenal artery pseudoaneurysm associated with chronic pancreatitis: A case report and review of literature.

World J Clin Cases. 2021 Jan 06;9(1):236-244

Authors: Cui HY, Jiang CH, Dong J, Wen Y, Chen YW

Abstract
BACKGROUND: Hemosuccus pancreaticus is a very rare but severe form of upper gastrointestinal hemorrhage. The most common etiology is peripancreatic pseudoaneurysm secondary to chronic pancreatitis. Due to the rarity of gastroduodenal artery pseudoaneurysms, most of the current literature consists of case reports. Limited knowledge about the disease causes diagnostic difficulty.
CASE SUMMARY: A 39-year-old man with a previous history of chronic pancreatitis was hospitalized due to hematemesis and melena for 2 wk, with a new episode lasting 1 d. Two weeks prior, the patient had visited a local hospital for repeated hematemesis and melena. Esophagogastroduodenoscopy indicated hemorrhage in the descending duodenum. The patient was discharged after the bleeding stopped, but hematemesis and hematochezia recurred. Bedside esophago-gastroduodenoscopy showed no obvious bleeding lesion. On admission to our hospital, he had hematemesis, hematochezia, left middle and upper abdominal pain, severe anemia, and elevated blood amylase. After admission, intermittent hematochezia was observed. Abdominal contrast-enhanced computed tomography revealed a pseudoaneurysm in the pancreas head. Angiography confirmed the diagnosis of gastroduodenal artery pseudoaneurysm. The pseudoaneurysm was successfully embolized with a coil and cyanoacrylate. No bleeding was observed afte r the operation. After discharge from the hospital, a telephone follow-up showed no further bleeding signs.
CONCLUSION: Hemosuccus pancreaticus caused by gastroduodenal artery pseudoaneurysm associated with chronic pancreatitis is very rare. This diagnosis should be considered when upper gastrointestinal bleeding and abdominal pain are intermittent. Abdominal enhanced computed tomography and angiography are important for diagnosis and treatment.

PMID: 33511191 [PubMed]

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Endoscopic treatment for acute appendicitis with coexistent acute pancreatitis: Two case reports.

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Endoscopic treatment for acute appendicitis with coexistent acute pancreatitis: Two case reports.

World J Clin Cases. 2021 Jan 06;9(1):245-251

Authors: Du ZQ, Ding WJ, Wang F, Zhou XR, Chen TM

Abstract
BACKGROUND: Appendectomy is the procedure of choice for the treatment of acute appendicitis. However, surgery may not be appropriate for patients with coexisting severe illness or comorbidities such as acute pancreatitis (AP). Endoscopic retrograde appendicitis treatment (ERAT) may be a novel alternative to surgery for treating such patients where existing medical therapies have failed.
CASE SUMMARY: We report 2 cases of moderately severe AP who developed acute uncomplicated appendicitis during their hospital stay and did not respond to traditional medical therapy. One patient had moderately severe AP due to hyperlipidemia, while the other patient had a gallstone induced by moderately severe AP. Neither patient was fit to undergo an appendectomy procedure because of the concurrent AP. Therefore, the alternative and minimally invasive ERAT was considered. After written informed consent was collected from the patients, the ERAT procedure was performed. Both patients exhibited fast postoperative recovery after ERAT with minimal surgical trauma.
CONCLUSION: ERAT is a safe and effective minimally invasive endoscopic procedure for acute appendicitis in patients with coexistent AP.

PMID: 33511192 [PubMed]

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Residual tumor and central lymph node metastasis after thermal ablation of papillary thyroid carcinoma: A case report and review of literature.

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Residual tumor and central lymph node metastasis after thermal ablation of papillary thyroid carcinoma: A case report and review of literature.

World J Clin Cases. 2021 Jan 06;9(1):252-261

Authors: Hua Y, Yang JW, He L, Xu H, Huo HZ, Zhu CF

Abstract
BACKGROUND: Debate exists regarding the use of thermal ablation (TA) to treat papillary thyroid carcinoma (PTC). Some studies have recommended TA as a new, efficient and safe technology for PTC. In this article, we report one case of a residual tumor and central lymph node metastasis (CLNM) after TA for PTC.
CASE SUMMARY: A 63-year-old female underwent bilateral ultrasound (US)-guided radiofrequency ablation for PTC. Three months later, she was diagnosed as thyroid cancer with suspected CLNM by US and contrast-enhanced computed tomography. The subsequent fine-needle aspiration (FNA) biopsies were negative. Due to her strong personal preference, she underwent total thyroidectomy and central lymph node dissection. Local tissue adhesion and a difficult dissection were noted during the operation. The pathology of the frozen sections during the operation was still negative. The final pathology results of paraffin-embedded sections revealed residual tumor cells at the edge of the PTC and CLNM.
CONCLUSION: TA may lead to a residual tumor in patients with PTC. Follow-up using US and FNA biopsy may not be adequate to evaluate the residual tumor. TA should be carefully considered in PTC treatment.

PMID: 33511193 [PubMed]

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Endoscopic salvage treatment of histoacryl after stent application on the anastomotic leak after gastrectomy: A case report.

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Endoscopic salvage treatment of histoacryl after stent application on the anastomotic leak after gastrectomy: A case report.

World J Clin Cases. 2021 Jan 06;9(1):262-266

Authors: Kim HS, Kim Y, Han JH

Abstract
BACKGROUND: Endoscopic approach could effectively manage postoperative anastomotic leakage. Various endoscopic methods have been developed for the treatment of anastomotic leakage.
CASE SUMMARY: A 53-year-old woman developed anastomotic leak after laparoscopic proximal gastrectomy. Endoscopic clip closure failed due to strong wall tension; therefore, a fully covered self-expandable esophageal metal stent (fc-SEMS) was placed to cover the leak after it was filled with a mixture of fibrin glue and histoacryl. However, fluoroscopy with gastrograffin showed dye leaking out of the fc-SEMS. Using the previous fluoroscopic image for guidance, a catheter was inserted at the leakage site. The radiocontrast dye was injected and was seen spreading along the sinus tract. Thereafter, histoacryl was injected. Seven days after the last procedure, upper gastrointestinal contrast studies showed no leaks. The patient was subsequently discharged 9 d after histoacryl injection without any complications.
CONCLUSION: To seal an anastomosis leak after stent application, salvage technique using histoacryl injection at the leakage site with fluoroscopy guidance could be considered cautiously.

PMID: 33511194 [PubMed]

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Immunosuppressant treatment for IgG4-related sclerosing cholangitis: A case report.

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Immunosuppressant treatment for IgG4-related sclerosing cholangitis: A case report.

World J Clin Cases. 2021 Jan 06;9(1):267-273

Authors: Kim JS, Choi WH, Lee KA, Kim HS

Abstract
BACKGROUND: Immunoglobulin G4-related disease (IgG4-RD) is a multi-system fibroin-flammatory disorder that can involve any organ, including the salivary glands, pancreas, and biliary tree. Treatment of immunoglobulin G4-related sclerosing cholangitis (IgG4-SC) is similar to that for IgG4-RD, but progression is irreversible in some cases. We present a case of IgG4-SC in which an immuno-suppressant induced marked clinical and radiologic improvement.
CASE SUMMARY: A 63-year-old male presented with a prominent itching sensation and wholebody jaundice. He showed obstructive-pattern jaundice, an elevated IgG4 level, and infiltration of a large number of IgG4-positive cells in the ampulla of Vater. The imaging findings of intrahepatic duct (IHD) and common bile duct dilation, an elevated serum IgG4 level, and characteristic histological findings led to diagnosis of IgG4-SC that compatible with the 2019 ACR/EULAR classification criteria. We planned to treat the patient with high-dose glucocorticoid (GC), followed by cyclophosphamide pulse therapy. After treatment with high-dose GC and an immunosuppressant, imaging studies showed that IHD dilatation had completely resolved.
CONCLUSION: Prompt diagnosis and appropriate treatment of IgG4-SC are important. Because there is a risk of relapse of IgG4-SC, the GC dose should be gradually reduced, and a maintenance immunosuppressant should be given.

PMID: 33511195 [PubMed]

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Intraparenchymal hemorrhage after surgical decompression of an epencephalon arachnoid cyst: A case report.

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Intraparenchymal hemorrhage after surgical decompression of an epencephalon arachnoid cyst: A case report.

World J Clin Cases. 2021 Jan 06;9(1):274-277

Authors: Wang XJ

Abstract
BACKGROUND: This study reports the clinical presentation of intraparenchymal hemorrhage as a rare complication after surgical decompression of an intracranial epencephalon arachnoid cyst (IEAC) at the posterior cranial fossa.
CASE SUMMARY: The clinical information of a patient with an IEAC was reported, and the related literature was reviewed. A female patient with nausea presented to our hospital. Computed tomography demonstrated an IEAC located at the posterior cranial fossa, which was large and required surgical intervention. After operation, postoperative intraparenchymal hemorrhage was detected. She had a good recovery with conservative treatment 1 mo later.
CONCLUSION: Though postoperative intraparenchymal hemorrhage is rare after surgical decompression of an IEAC, more attention should be paid to such a complication.

PMID: 33511196 [PubMed]

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Krukenberg tumor with concomitant ipsilateral hydronephrosis and spermatic cord metastasis in a man: A case report.

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Krukenberg tumor with concomitant ipsilateral hydronephrosis and spermatic cord metastasis in a man: A case report.

World J Clin Cases. 2021 Jan 06;9(1):278-283

Authors: Tsao SH, Chuang CK

Abstract
BACKGROUND: Tumors of the spermatic cord are rare, and approximately 25% are malignant neoplasms. Metastatic spermatic cord tumors are even rarer. Several studies have revealed that the most frequent primary tumors metastasizing to the spermatic cord and peritesticular tissues are neoplasms of the stomach and prostate. Furthermore, metastasis to the spermatic cord or epididymis may occur via retrograde lymphatic and hematic routes. We present the case of a man with gastric cancer that metastasized to the spermatic cord and epididymis, with concomitant ipsilateral hydronephrosis after surgical resection and chemotherapy for his primary tumor.
CASE SUMMARY: A 71-year-old man underwent total gastrectomy for pT4aN2 poorly differentiated gastric adenocarcinoma in December 2016. Two months after surgery, he received adjuvant chemotherapy with TS-1 from February 2017 to February 2018. Surveillance computed tomography (CT) was performed in June 2018, which did not reveal any sign of tumor recurrence. In November 2019, he presented with left lower quadrant abdominal pain and a palpable left inguinal-scrotal mass. CT revealed left mild hydronephrosis and a left scrotal mass measuring 4.0 cm × 1.7 cm. Tumor biomarkers, including alpha-fetoprotein (AFP), lactate dehydrogenase (LDH), beta-human chorionic gonadotropin (βHCG), carcinoembryonic antigen (CEA), and carbohydrate antigen 19-9 (CA19-9) were all normal. Renal and testicular echography showed left hydronephrosis and a left peritesticular soft tissue lesion with blood flow. Diagnostic ureteroscopy showed left lower ureter narrowing without an intraluminal lesion. A bi opsy was obtained for the indurated spermatic cord and epididymis, which showed poorly differentiated adenocarcinoma. Immunohistochemical staining demonstrated that the tumor was diffusely and strongly positive for homeobox protein CDX2. The features were consistent with metastatic adenocarcinoma of a primary gastric tumor.
CONCLUSION: In patients with a history of primary cancer, an inguinal mass of unknown cause with accompanying ipsilateral hydronephrosis may be a sign of distant metastasis from a primary tumor, especially of gastrointestinal origin.

PMID: 33511197 [PubMed]

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Simultaneous bilateral acromial base fractures after staged reverse total shoulder arthroplasty: A case report.

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Simultaneous bilateral acromial base fractures after staged reverse total shoulder arthroplasty: A case report.

World J Clin Cases. 2021 Jan 06;9(1):284-290

Authors: Kim DH, Kim BS, Cho CH

Abstract
BACKGROUND: Acromial and scapular spine fractures after reverse total shoulder arthroplasty (RTSA) are a well-known complication that may negatively impact the effects of long-term outcomes. However, to the best of our knowledge, there has been no report of simultaneous bilateral fractures of the acromion or scapular spine that occurred following staged RTSA.
CASE SUMMARY: A 79-year-old right-handed male visited our outpatient clinic with a chief complaint of pain and limited motion of both shoulder joints for a one-year duration. Based on plain radiographs and magnetic resonance images, the preoperative diagnosis was bilateral cuff tear arthropathy with failed rotator cuff repair. This patient was treated with staged bilateral RTSA at a two-month interval. At 5 and 3 mo after right and left side surgery, the patient returned to the outpatient clinic with severe pain and limited motion of both shoulder joints for 2 wk without a traumatic event. A computed tomography scan revealed non-displaced acromial base fractures of both shoulders. Considering bilateral involvement, fracture location, and patient's demand, open reduction and internal fixation (ORIF) using plate for bilateral acromial base fractures were performed. At 2 years after ORIF, the fracture was completely healed, and the patient was satisfied with shoulder status.
CONCLUSION: This report describes an extremely rare case of simultaneous bilateral acromial base fractures after staged RTSA managed successfully by ORIF with a pre-contoured plate designed for distal clavicle fractures. Although acromial fracture after RTSA can be treated conservatively, simultaneous bilateral fractures may warrant surgical intervention as a means of addressing difficulties in activities of daily living.

PMID: 33511198 [PubMed]

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