Publications by authors named "Fahmi H Kakamad"

92 Publications

Pattern of facial nerve palsy during parotidectomy: a single-center experience.

J Int Med Res 2022 Jul;50(7):3000605221108930

Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq.

Objective: This study was performed to report and analyze the prevalence of permanent facial nerve paralysis following parotidectomy for various benign and malignant lesions in a single center.

Methods: This single-center retrospective study included all patients who underwent parotidectomy (total and superficial) for benign and malignant tumors and chronic inflammatory diseases during a 6-year period. Patients who had previously undergone an operation of the parotid gland and those with preoperative facial weakness were excluded.

Results: The study included 127 patients ranging in age from 14 to 83 years (median, 45.89 years). Most patients were female (n = 83, 65.4%). The most prevalent procedure was superficial parotidectomy (n = 117, 92.1%), followed by total parotidectomy (n = 6, 4.7%). The average operative duration was 138 minutes (range, 80-400 minutes). Histopathology revealed that 109 (85.8%) patients had benign tumors, 14 (11.0%) had malignant tumors, and 4 (3.1%) had chronic sialadenitis. Only two patients sustained an injury to the cervical branch of the facial nerve.

Conclusion: In this single-center experience of parotid surgery, the rates of transient and permanent facial paralysis were acceptably low at 9.0% and 1.6%, respectively, for all pathologies.
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http://dx.doi.org/10.1177/03000605221108930DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9274412PMC
July 2022

Bilateral invasive ductal carcinoma of the breast; a case report with literature review.

Ann Med Surg (Lond) 2022 Jun 10;78:103743. Epub 2022 May 10.

Shar Hospital, Sulaimani, Kurdistan, Iraq.

Introduction: Carcinoma of breast is a heterogeneous disease. Using their light microscopic appearance, the invasive forms are usually divided into three main types: infiltrating lobular carcinomas, infiltrating ductal carcinomas, and other infiltrating carcinomas. This paper aims to discuss and report a case of bilateral invasive ductal carcinoma of the breast.

Case Report: A 48-year-old female presented with bilateral breast masses of 5-month duration. On examination. she had bilateral palpable breast masses, which were hard, mobile, and irregular. On the right side, there was skin tethering and palpable axillary lymph nodes. Ultrasound examination showed a heterogeneous, irregular, ill-defined, mass-like lesion, seen in the upper outer quadrant of the right breast along with a hypoechoic. irregular mass 12*13mm in the upper outer quadrant of the left breast. FNA showed bilateral invasive ductal carcinoma. Right axillary lymph nodes were positive for adenocarcinoma. She received 4 sessions of NACT which was followed by right-side mastectomy with axillary lymph node dissection and left-side mastectomy with sentinel lymph node biopsy.

Discussion: Bilateral breast carcinomas are very rare. They form 2-5% of all breast malignancies. About 2-11% of breast cancer patients develop cancer in the opposite breast in their lifetime with an incidence rate varying from 4 to 8 per 1000 people per year.

Conclusion: Bilateral carcinoma of the breast is very rare. Microscopically, the findings usually reveal infiltrative ductal carcinoma. The treatment of choice is bilateral modified radical mastectomy.
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http://dx.doi.org/10.1016/j.amsu.2022.103743DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9206930PMC
June 2022

Resistance to thyroid hormone in a child with thyroid agenesis: A case report with review of the literature.

Ann Med Surg (Lond) 2022 May 6;77:103569. Epub 2022 Apr 6.

Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq.

Introduction: The coexistence of thyroid dysgenesis and resistance to thyroid hormone (RTH) is a very rare occurrence. The current study aims to report a unique case of thyroid agenesis with RTH in a pediatric patient.

Case Report: A 5-year-old male patient presented with poor feeding, excessive somnolence, and a noticeable umbilical hernia since the age of 2 months. He was initially diagnosed as a case of congenital hypothyroidism, and since then, he had been placed on thyroid replacement therapy. No further investigations were conducted until the age of 5 years. Recent laboratory findings revealed an elevated TSH level (42.41 μIU/mL). X-ray examination showed delayed bone age (30 months). Ultrasound (US) examination demonstrated the complete absence of thyroid lobes, isthmus, and ectopic thyroid tissue, but small 2.7 x 2.5-mm non-echoic, cystic, and hypo-vascular nodules were seen in the bed of the right thyroid lobe. The patient was kept on thyroid replacement therapy (levothyroxine) and under close follow-up. On follow-up, the patient's thyroid function status revealed resistance to exogenous thyroid hormone.

Discussion: Thyroid agenesis is the complete absence of the thyroid gland. Meanwhile, RTH is a hereditary disease characterized by decreased sensitivity of body tissues to thyroid hormone. Most cases of RTH are due to mutations in the gene encoding for THRβ. However, recently RTH due to THRα mutations has also been reported. The presentations of RTH cases in general and with thyroid dysgenesis are quite heterogenous.

Conclusion: Although the combination is exceedingly rare, thyroid agenesis can coexist with RTH.
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http://dx.doi.org/10.1016/j.amsu.2022.103569DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9142399PMC
May 2022

Hypocalcemia as a cause of reversible heart failure: A case report and review of the literature.

Ann Med Surg (Lond) 2022 May 5;77:103572. Epub 2022 Apr 5.

College of Medicine, University of Sulaimani, Sulaimani, Kurdistan, Iraq.

Introduction: In both pediatric and adult populations, hypocalcemia-induced heart failure is an extremely rare presentation. The aim of the current study is to report a case of reversible heart failure caused by severe hypocalcemia resulting from hypoparathyroidism, which was resolved by correcting the serum calcium level.

Case Report: A 29-year-old female presented with orthopnea, dyspnea on mild exertion, and bilateral lower limb swelling. She had a positive Trousseau's sign. Vital signs were stable except for tachycardia. On chest auscultation, there were bilateral basal fine inspiratory crackles. She was immediately treated as a case of pulmonary edema with intravenous furosemide and oxygen therapy. Subsequent treatment for correcting the hypocalcemia was then initiated.

Discussion: Hypocalcemia has been proven to influence cardiac function, resulting in lower cardiac contractility as determined by decreased left ventricular work index, stroke index, and cardiac index. In rare circumstances, the clinical, biochemical (elevation of cardiac enzymes), electrocardiographic, and echocardiographic data may lead to an incorrect diagnosis of an acute ischemic attack.

Conclusion: Hypocalcemia as a possible factor leading to heart failure should be considered in the differential diagnosis of all individuals with congestive heart failure.
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http://dx.doi.org/10.1016/j.amsu.2022.103572DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9142408PMC
May 2022

Mammary analogue secretory carcinoma presenting with cervical lymphadenopathy: A rare case report with review of the literature.

Int J Surg Case Rep 2022 Jun 29;95:107132. Epub 2022 Apr 29.

College of Medicine, University of Sulaimani, Sulaimani, Iraq; Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq.

Introduction: Mammary analogue secretory carcinoma is a rare malignant tumor of the salivary glands that typically involves the major glands. The aim of the current study is to report a rare case of mammary analogue secretory carcinoma that presented with left cervical lymphadenopathy.

Case Report: A 59-year-old lady presented with left cervical lymphadenopathy. Tissue biopsy and immunohistochemistry revealed metastatic carcinoma, favoring ovarian origin. Staging workup was performed and, ultimately, the patient was treated as having a carcinoma of unknown primary. After showing partial response to therapy, left side neck dissection was performed. Based on better assessment of the histologic picture and a broader panel of immunohistochemistry performed on the excision specimen, the final diagnosis was that of mammary analogue secretory carcinoma.

Discussion: Mammary analogue secretory carcinoma is usually an indolent salivary gland carcinoma, with the majority of patients presenting with a slow-growing, painless mass measuring approximately 2 cm in size, and a reported duration ranging from 2 months to several years. In certain cases, pain and facial paralysis have been reported. It could also be found incidentally during radiologic assessment for thyroid illness or routine dental screening.

Conclusion: Diagnosing mammary analogue secretory carcinoma is challenging, and this should be in the differential diagnosis list of metastatic carcinomas to cervical lymph nodes.
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http://dx.doi.org/10.1016/j.ijscr.2022.107132DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9136354PMC
June 2022

Subcutaneous bronchogenic cyst of the chest wall: A case report with brief literature review.

Int J Surg Case Rep 2022 Jun 21;95:107118. Epub 2022 Apr 21.

Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq; Iraqi Board for Medical Specialties, Department of General Surgery, Sulaimani Center, Iraq.

Introduction: Bronchogenic cysts are congenital lesions found in the mediastinum, particularly the posterior-superior area. The current study aims to report a rare case of a subcutaneous bronchogenic cyst in the chest wall.

Case Report: A 41-year-old patient presented with a swelling of the chest wall. The mass had been present since birth. On examination, there was a large soft, round mass over the sternum subcutaneously. It was a fixed, non-flatulence, non-pulsatile, and non-tender mass.

Discussion: Usually, the condition develops between the fifth and sixteenth weeks of gestation, when the primordial intestine separates into two parts: dorsal, which gives rise to the esophagus, and ventral, which gives rise to the pulmonary bud and tracheobronchial tree. As a result, the cyst is an ectopic lung bud that may or may not be connected to the tracheobronchial tree but lacks mesenchymal tissue.

Conclusion: Although chest wall bronchogenic cysts are uncommon, they should be considered in the differential diagnosis of cystic and soft tissue lesions in adults with chest wall swelling.
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http://dx.doi.org/10.1016/j.ijscr.2022.107118DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9126761PMC
June 2022

Accelerated heparin-induced thrombocytopenia in a COVID-19 patient; a case report with literature review.

Ann Med Surg (Lond) 2022 Jun 11;78:103749. Epub 2022 May 11.

College of Medicine, University of Sulaimani, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq.

Introduction: Heparin-induced thrombocytopenia (HIT) is a rare and serious immune-mediated complication of heparin therapy which is seldom reported in association with COVID-19. This report aims to present a case of accelerated HIT in a severe COVID-19 patient.

Case Report: A 63-year-old man presents with symptoms of COVID-19 for one week. He was conscious, ordinated, feverish, and had diffused chest crackles. Initial laboratory tests revealed elevated C-reactive protein of 87.66 mg/dL, elevated D-dimmer of 1258.9 ng/ml, elevated ferritin of 1020 ng/ml, and his platelet count was within the normal range. Polymerase chain reaction (PCR) confirmed the diagnosis of COVID-19. On the 9th day of admission, he developed a progressive worsening of dyspnea. His D-dimmer level significantly increased to 7020 ng/ml, and his interleukin-6 was 27.3 pg/ml. Hence, we started him on unfractionated heparin (UFH) for thromboprophylaxis. On the 12th day of hospitalization, the platelet count dropped from 258000 to 111000 cells/μL. He had a high probability of HIT (4Ts score = 6). As a result, we discontinued UFH and switched him to apixaban. His platelet count normalized (174000 cells/μL) within two weeks of ceasing UHF.

Discussion: HIT results from the production of antibodies against platelet factor 4/heparin complexes. It is associated with a diminished platelet count within 5-10 days post heparin initiation. Because thrombocytopenia can occur in COVID-19 patients, HIT is seldom suspected.

Conclusion: HIT should be considered a differential diagnosis in COVID-19 patients with thrombocytopenia.
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http://dx.doi.org/10.1016/j.amsu.2022.103749DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9090824PMC
June 2022

Acute intestinal pseudo-obstruction by pheochromocytoma: A case report with review of literature.

Int J Surg Case Rep 2022 May 4;94:107008. Epub 2022 Apr 4.

Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq; College of Medicine, University of Sulaimani, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq.

Introduction: Pheochromocytomas are rare tumors of the adrenal gland. Intestinal pseudo-obstruction is a very rare presentation of a functioning catecholamine-secreting tumor. We present a case of intestinal pseudo-obstruction due to a large functioning pheochromocytoma.

Case Report: A 29-year-old female presented with abdominal distension, pain, nausea, and vomiting with constipation for 3 weeks. She was hypertensive and diabetic and was on multiple medications. She reported frequent spells of severe headaches, palpitations, night sweats, and a 17 kg weight loss over 6 months. She had pallor, dyspnea, marked abdominal distension, and diminished bowel sounds. Her blood pressure was high at 200/120 mmHg. She had tachycardia (pulse 120 bpm) and tachypnea (35 pm). Serum metanephrine levels were significantly elevated, measuring 1203 pg/ml. Abdominal CT showed a heterogeneous, hyper-vascular mass near the upper pole of the left kidney, measuring 10.75 cm × 8.72 cm. Open left adrenalectomy was performed through an anterior subcostal approach to remove the tumor with the left adrenal gland. Histopathological examinations were consistent with pheochromocytoma.

Discussion: Some authors documented the correlation between tumor size and metabolic activity of catecholamine-secreting tumors with intestinal pseudo-obstruction by paralytic ileus. This case corresponds with these findings, with a tumor mass of 350 g and a serum metanephrine level of 1203 pg/ml.

Conclusion: Although it is extremely rare, functioning pheochomocytoma could be a cause of instestinal obstruction or pseudo-obstruction.
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http://dx.doi.org/10.1016/j.ijscr.2022.107008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9043669PMC
May 2022

Osteoclast-like giant cell tumor of the parotid gland; a case report with literature review.

Ann Med Surg (Lond) 2022 May 28;77:103509. Epub 2022 Mar 28.

Kscien Organization, Hamdi Str, Azadi Mall, Sulaimani, Kurdistan, Iraq.

Introduction: The osteoclast-like giant cell is a benign tumor that presents as either an isolated benign tumor or one with a carcinomatous component. This study aims to report a rare case of osteoclast-like giant cell tumor (GCT) of the parotid gland.

Case Report: A 67-year-old female presented with a painless left pre-auricular swelling of 2-month duration which increased in size gradually over that period. On examination, there was a firm, mobile mass with well-defined borders in the left parotid gland. Fine needle aspiration cytology showed a giant cell-rich lesion that was highly cellular and contained a large number of osteoclast-like multinucleated giant cells, with clusters of spindle and epithelioid cells. Total parotidectomy was performed. After the operation, the patient was sent for radiotherapy.

Discussion: The histogenesis and exact nature of this tumor are unknown although numerous ideas have been put forward. The most common clinical manifestation is a painless slow-growing tumor in the parotid area. Primary osteoclast-like GCT of the salivary gland might show concomitant benign or malignant neoplasms. There is also a "pure form" of the tumor that has no accompanying neoplasm.

Conclusion: GCT of the parotid gland is a rare tumor. The histogenesis and nature of parotid gland GCT are not completely understood. The treatment of choice is total excision followed by radiotherapy.
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http://dx.doi.org/10.1016/j.amsu.2022.103509DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9006646PMC
May 2022

Simultaneous pituitary and adrenal adenomas in a patient with non ACTH dependent Cushing syndrome; a case report with literature review.

Int J Surg Case Rep 2022 May 5;94:107038. Epub 2022 Apr 5.

Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq; College of Medicine, University of Sulaimani, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq; Kscien Organization, Hamdi Str, Azadi Mall, Sulaimani, Kurdistan, Iraq. Electronic address:

Introduction: Cushing syndrome is a rare disorder with a variety of underlying etiologies, that can be exogenous or endogenous (adrenocorticotropic hormone (ACTH)-dependent or ACTH-independent). The current study aims to report a case of ACTH-independent Cushing syndrome with adrenal adenoma and nonfunctioning pituitary adenoma.

Case Report: A 37-year-old female presented with amenorrhea for the last year, associated with weight gain. She had a moon face, buffalo hump, and central obesity. A 24-hour urine collection for cortisol was performed, revealed elevated cortisol. Cortisol level was non-suppressed after administering dexamethasone. MRI of the pituitary region revealed a pituitary microadenoma, and the CT scan of the abdomen with adrenal protocol revealed a left adrenal adenoma.

Discussion: Early diagnosis may be postponed due to the variety of clinical presentations and the referral of the patient to different subspecialists based on their dominant symptoms (gynecological, dermatological, cardiovascular, psychiatric); it is, therefore, critical to consider the entire clinical presentation for correct diagnosis.

Conclusion: Due to the diversity in the presentation of CS, an accurate clinical, physical and endocrine examination is always recommended.
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http://dx.doi.org/10.1016/j.ijscr.2022.107038DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9018131PMC
May 2022

Post COVID-19 pulmonary fibrosis; a meta-analysis study.

Ann Med Surg (Lond) 2022 May 6;77:103590. Epub 2022 Apr 6.

Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq.

Introduction; Pulmonary fibrosis is a frequently reported COVID-19 sequela in which the exact prevalence and risk factors are yet to be established. This meta-analysis aims to investigate the prevalence of post-COVID-19 pulmonary fibrosis (PCPF) and the potential risk factors. Methods; CINAHL, PubMed/MEDLINE, Cochrane Library, Web of Science, and EMBASE databases were searched to identify English language studies published up to December 3, 2021. Results; The systematic search initially revealed a total of 618 articles - of which only 13 studies reporting 2018 patients were included in this study. Among the patients, 1047 (51.9%) were male and 971 (48.1%) were female. The mean age was 54.5 years (15-94). The prevalence of PCPF was 44.9%. The mean age was 59 years in fibrotic patients and 48.5 years in non-fibrotic patients. Chronic obstructive pulmonary disease was the only comorbidity associated with PCPF. Fibrotic patients more commonly suffered from persistent symptoms of dyspnea, cough, chest pain, fatigue, and myalgia (p-value < 0.05). Factors related to COVID-19 severity that were associated with PCPF development included computed tomography score of ≥18, ICU admission, invasive/non-invasive mechanical ventilation, longer hospitalization period, and steroid, antibiotic and immunoglobulin treatments (p-value < 0.05). Parenchymal bands (284/341), ground-glass opacities (552/753), interlobular septal thickening (220/381), and consolidation (197/319) were the most common lung abnormalities found in fibrotic patients. Conclusion, About 44.9% of COVID-19 survivors appear to have developed pulmonary fibrosis. Factors related to COVID-19 severity were significantly associated with PCPF development.
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http://dx.doi.org/10.1016/j.amsu.2022.103590DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8983072PMC
May 2022

Ductal carcinoma in situ arising from fibroadenoma; a rare case with review of literature.

Ann Med Surg (Lond) 2022 Mar 2;75:103449. Epub 2022 Mar 2.

Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq.

Introduction: ibroadenoma (FA) is a common benign breast mass representing a group of hyperplastic breast lobules due to the deviation of normal development. This study aims to present a rare case of ductal carcinoma in situ (DCIS) associated with fibroadenoma.

Case Report: A 49-year-old married female presents with a right breast mass for five years. Core needle biopsy diagnosed the specimen as cellular complex fibroadenoma. A breast-lumpectomy and the histopathological examination of the surgical specimen confirmed ductal carcinoma in-situ.

Discussion: Malignant changes within fibroadenomas typically happen at an older age, with the age of detection in the fifth decade. Complex fibroadenomas are more related to malignant transformation. Old age and strong family history are risk factors for malignant transformation of fibroadenomas.

Conclusion: Fibroadenomas are common benign tumors. They can rarely be associated with DCIS. Therefore, the risk of malignancy should always be kept in mind.
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http://dx.doi.org/10.1016/j.amsu.2022.103449DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8977904PMC
March 2022

Recurrent seasonal severe hypertriglyceridemia-induced acute pancreatitis; a case report.

Ann Med Surg (Lond) 2022 Mar 24;75:103406. Epub 2022 Feb 24.

Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq.

Introduction: Acute pancreatitis (AP) is a serious inflammatory condition of the pancreas. Hypertriglyceridemia (HTG) is considered an uncommon cause of AP. The current study aims to present a unique case of recurrent seasonal severe HTG-induced AP (HTG-AP); treated with insulin and heparin.

Case Report: A 36-year-old male presented with recurrent attacks of severe upper abdominal pain that was radiating to the back and associated with repeated vomiting. The condition has being occurring every autumn-winter for the last three years. He had thalassemia minor and had a history of HTG-AP. His TG levels were relatively normal from February to August; however, from September to February, his TG levels highly elevated which has resulted in HTG-AP every year for the past three years. The condition was confirmed via a contrast-enhanced computerized tomography scan of the abdomen. To prevent the next HTG-AP, his TG level was monitored monthly. When TG levels spiked again, the patient was put on an insulin infusion with heparin, glucose, and potassium to rapidly reduce TG level. After two days, serum TG was dramatically reduced (<500 mg/dL).

Discussion: Despite multiple theories being proposed, the pathogenesis of HTG-AP is yet to be understood. Usually, HTG-AP is a single episodic, and recurrent HTG-AP is considered uncommon finding. Previous reports are contradictory regarding TG level and seasonal variation. There is currently no standard management approach to treat HTG-AP cases.

Conclusion: HTG-AP rarely reoccurs on an annual basis, and seasonal variation seems to play a major role in its onset. The condition can be managed with insulin, heparin, and glucose infusions.
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http://dx.doi.org/10.1016/j.amsu.2022.103406DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8977940PMC
March 2022

Adult embryonal rhabdomyosarcoma in the nasal cavity; a case report with a review of the literature.

Ann Med Surg (Lond) 2022 Mar 2;75:103424. Epub 2022 Mar 2.

Kscien Organization, Hamdi Str., Azadi Mall, Sulaimani, Kurdistan, Iraq.

Introduction: Rhabdomyosarcoma (RMS) is a primitive malignant soft tissue tumor arising from premature mesenchymal cells. The current study presents a rare case of embryonal rhabdomyosarcoma in the nasal cavity of an adult patient.

Case Presentation: An 18-year-old female presented with right nasal obstruction for five months. Examination showed a pale soft, painless mass in the right nasal cavity with attachment to the nasal septum at the osteocartilaginous junction. The patient was falsely suspected for bacterial infection, but later histological examination showed undifferentiated small round blue cell tumor with extensive necrosis. Immunohistochemistry confirmed the diagnosis of embryonal RMS. The patient was operated on for endoscopic sinus surgery to remove the mass with additional cleaning of surrounding sinuses.

Discussion: Embryonal RMS is a rare type of malignant tumor that mostly affects the head and neck area in children while usually occur in the extremities of adults. Encountering an adult ERMS of the nasal chambers represents a small portion of head and neck cases that lack specific presentations.

Conclusion: Adult embryonal RMS of the nasal cavity is exceedingly rare and presents a diagnostic and management challenge, with immunohistochemistry being the only definitive diagnostic method.
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http://dx.doi.org/10.1016/j.amsu.2022.103424DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8977900PMC
March 2022

Post COVID - 19 neurological disorders; a single center experience; a case series.

Ann Med Surg (Lond) 2022 Apr 27;76:103508. Epub 2022 Mar 27.

Kscien Organization, Hamdi Str, Azadi Mall, Sulaimani, Kurdistan, Iraq.

Introduction: Coronavirus disease 2019 (COVID-19) pandemic, is a newly conducted respiratory disease caused by infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2). The current study aims to estimate the neurological diseases which develop after COVID-19 infection.

Method: This is a single center retrospective case series conducted in seven months. the patients were collected in an out-patient clinic. Diagnosis of COVID-19 and the way of diagnosis is confirmed through either polymerase chain reaction (PCR) test for COVID-19 and/or typical findings on chest computed tomography scan (CT scan). Patients developed neurological symptoms after being infected with COVID-19. Symptoms have to be developed within less than 6 months of recovery, or developed during illness and persisted after recovery.

Result: A total number of 59 patients infected with SARS-CoV2 were included. The majority of the patients had mild symptoms 32 (54%), 12 (20%) patients developed severe symptoms. Headache was the most common presenting symptom 27(46%) followed by fatigue in 8 (13.5%). The majority of the patients 55 (91.6%) presented with no focal signs. MRI was done for 27 (46%) patients without abnormal finding in 22 cases. Nearly 22 (37.3%) cases were diagnosed as recurrent episodes of migraine or new onset of migraine. All patients were managed according to the underlying pathology, only (28, 47.5%) patients were known to be completely recovered.

Conclusion: SARS-CoV2 can invade and cause inflammation in the central and peripheral nervous systems. It is responsible for many neurological problems. More studies are necessary to analyze the long term effect of the virus on the nervous system.
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http://dx.doi.org/10.1016/j.amsu.2022.103508DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8957714PMC
April 2022

Synchronous occurrence of papillary thyroid microcarcinoma, medullary thyroid carcinoma and Hashimoto thyroiditis in a single thyroid: A case report with literature review.

Int J Surg Case Rep 2022 Apr 1;93:106888. Epub 2022 Mar 1.

Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq; College of Medicine, University of Sulaimani, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq.

Introduction: The synchronous development of a medullary and papillary carcinoma as two different tumors has only been reported very rarely. The aim of the current report is to describe an extremely rare occurrence of medullary carcinoma, papillary microcarcinoma, and Hashimoto thyroiditis.

Case Report: A 53-year-old man presented with a right-sided neck mass. Ultrasound showed a well-defined nodule in the right mid third with microcalcification and increased nodular vascularity associated with multiple right-sided cervical lymphadenopathy. The histopathological examination showed multifocal medullary carcinoma with incidental finding of unifocal papillary microcarcinoma conventional type on the left side. Additional pathology of Hashimoto thyroiditis with a small intra-thyroidal parathyroid gland in the left thyroid gland. The procedure went perfectly and the patient was discharged home without any difficulties.

Discussion: Synchronous existence of these two neoplasms can occur in two forms: distinct medullary carcinoma and papillary carcinoma isolated by normal thyroid tissue, or mixed medullary and follicular-derived thyroid carcinoma, in which single or multiple lesions show morphology and immunoreactivity for both medullary carcinoma and follicular-derived carcinoma.

Conclusion: The synchronous coexistence of papillary microcarcinoma, medullary carcinoma, and Hashimoto's thyroiditis is an uncommon thyroid condition.
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http://dx.doi.org/10.1016/j.ijscr.2022.106888DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8935503PMC
April 2022

Ectopic papilla of Vater in the pylorus presenting with cholangitis: A case report with literature review.

Int J Surg Case Rep 2022 Apr 1;93:106887. Epub 2022 Mar 1.

College of Medicine, University of Sulaimani, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq; Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq; Kscien Organization, Hamdi Str, Azadi Mall, Sulaimani, Kurdistan, Iraq. Electronic address:

Introduction: The papilla of Vater is situated in the second part of the duodenum. The current study aims to report a rare occurrence of an ectopic papilla of Vater in the pyloric region presenting with cholangitis.

Case Report: A 59-year-old male patient presented with right upper quadrant pain, anorexia, nausea, and jaundice. He was feverish and exhibited tenderness in the right upper quadrant. Endoscopic retrograde cholangiopancreatography revealed an ectopic papilla of Vater on the pyloric canal. A gastroscope was used instead of a duodenoscope for better visibility of the opening, easier cannulation, and a less risky sphincterotomy. He returned one year after his last procedure with no symptoms and no recurrence of acute cholangitis.

Discussion: It has been suggested that developmental defects are acquired during embryogenesis. If subdivision happens early in embryogenesis, leaving the pars hepatica above the zone of proliferation that divides the stomach from the duodenum, the pars hepatica will develop into a duct that empties into the pylorus area.

Conclusion: It is preferable to use a gastroscope rather than a duodenoscope to visualize and manipulate the common bile duct in the case of an ectopic papilla of Vater in the pylorus.
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http://dx.doi.org/10.1016/j.ijscr.2022.106887DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8928074PMC
April 2022

The diagnostic challenge of juvenile hyaline fibromatosis, a case report with literature reviews.

Int J Surg Case Rep 2022 Apr 1;93:106897. Epub 2022 Mar 1.

Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq; Kscien Organization, Hamdi Street, Azadi Mall, Sulaimani, Kurdistan, Iraq; College of Medicine, University of Sulaymaniyah, Sulaimani, Kurdistan, Iraq. Electronic address:

Introduction: Juvenile hyaline fibromatosis (JHF) is a rare genetic condition characterized by impaired collagen production or metabolism. This study aims to present a rare case of JHF.

Case Report: An 11-year-old boy presented with bilateral keloid-like lesions on his ears and admitted intermittent reappearance of such lesions since he was seven. He was born to second-degree relative consanguineous parents. Physical examination revealed bilateral soft pink masses on the ears, multiple scars on the scalp, severe gingival hypertrophy, multiple small soft white papules on the anterior neck, broadly shaped enlargements on the ends of the fingers and toes, and multiple reticulated hard livedoid and hyperpigmented macules on the back and anterior lower extremities. A 5 mm biopsy was taken from the lesion on the ear and histopathological examination of the specimen revealed a normal epidermis but dermal and subcutaneous deposits of nodules composed of abundant amorphous eosinophilic hyaline material with sparse embedded fibroblast associated with areas of congestion and focal hemorrhage. The ear lesions were managed by surgical excision with intraregional steroid injections to prevent relapse. To improve eating ability and oral hygiene, a gingivectomy was planned.

Discussion: JHF presents with bone lesions, gingival hypertrophy, joint contractures, and skin lesions. The clinical features usually appear late in infancy and up to 5 years. The condition occurs mostly sporadically. A portion of the cases can be in siblings born to consanguineous parents.

Conclusion: JHF is a rare genetic disorder that can present even beyond five years. There is no standard treatment for these cases.
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http://dx.doi.org/10.1016/j.ijscr.2022.106897DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8927703PMC
April 2022

Thyroid collision tumors; A case series with literature review.

Ann Med Surg (Lond) 2022 Apr 3;76:103444. Epub 2022 Mar 3.

Rizgary Oncology Center, Peshawa Qazi Street, Erbil, Kurdistan, Iraq.

Background: Collision tumors are two histologically distinct types of malignancies within the same mass and organ. The aim of this study is to present a case series of thyroid collisions.

Methods: This was a multicenter retrospective case series study. The participants were consecutive in order. Socio-demographic and clinical data were obtained from hospital records.

Results: The study included eight cases comprising six (75%) females and two (25%) males. The patients had different presentations, including neck swelling, dyspnea, and dizziness. The pathology was successfully determined through fine-needle aspiration. Four patients (50%) underwent lobectomy, whereas the other half (four patients) underwent total thyroidectomy.

Conclusion: Collision tumors of papillary thyroid cancer (PTC) and follicular thyroid carcinoma (FTA) or medullary thyroid carcinoma (MTC) and FTA are exceedingly rare phenomena that most commonly affect females. Complete or partial thyroidectomy is the ideal management of choice for these cases and is associated with good survival.
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http://dx.doi.org/10.1016/j.amsu.2022.103444DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8921309PMC
April 2022

Multiple angiolipoma of the hand, back, and abdomen; a case report.

Int J Surg Case Rep 2022 Apr 1;93:106901. Epub 2022 Mar 1.

Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq; Kscien Organization, Hamdi Str, Azadi Mall, Sulaimani, Kurdistan, Iraq; College of Medicine, Department of Surgery, University of Sulaimani, Sulaimani, Kurdistan, Iraq. Electronic address:

Introduction: Angiolipoma is a rare and benign variant of lipoma that usually occurs as single or multiple entities. The aim of this study is to present a case of multiple angiolipoma located in the hand, back, and abdomen.

Case Report: A 38-year-old male presented with multiple swellings in his body for a 6-year duration. Physical examination revealed 3 painless masses in the hands, back, and abdomen. Laboratory findings were normal and ultrasound (US) examination suggested multiple body lipoma. The patient was managed with total excision and histopathological examination confirmed the diagnosis of benign angiolipoma. No reoccurrence was observed upon follow-up.

Discussion: Angiolipoma mainly composed of a mixture of proliferating blood vessels and mature adipose tissues, with a degree of vascularity much higher than that of a normal lipoma. It has a slow growing nature that it can be presented as single or multiple neoplasia. It is reported to be more common in the young adult population with male predominance.

Conclusion: Angiolipoma is a rare variant of lipoma. It rarely occurs in the hands, especially as a painless mass. Histopathology is required for definitive diagnosis.
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http://dx.doi.org/10.1016/j.ijscr.2022.106901DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8927707PMC
April 2022

Recurrent spontaneous subcutaneous emphysema of unknown origin: A case report with literature review.

Ann Med Surg (Lond) 2022 Apr 2;76:103443. Epub 2022 Mar 2.

Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq.

Introduction: Subcutaneous emphysema caused by a surgical operation is known as surgical emphysema, and if the cause is unknown, it is known as spontaneous subcutaneous emphysema. The current study aims to report a rare case of recurrent spontaneous SE of unknown origin.

Case Report: A 27-year-old male patient presented with swelling of the chest, neck, and face that had started 20 days prior. There was crepitation on palpation. Pulmonary function tests were normal. Laryngoscopy showed a normal larynx. Bronchoscopy showed a normal bronchial tree except for some redness in the trachea and left main bronchus. Computed tomography of the chest with contrast showed subcutaneous emphysema in the anterior chest and lower neck.The patient reported a similar condition 3 years prior resulting in swelling of the upper left chest with an associated pneumothorax that was treated with tube thoracostomy. Workup including VATS was done to find the underlying cause but no cause was found.

Discussion: The pathogenesis is the same as in the most cases. Air that is driven into the interstitial tissues around the pulmonary vasculature gradually moves back toward the lung's hilum, resulting in pneumomediastinum. The air gradually spreads to the soft tissues of the neck, face, chest, and limbs, resulting in widespread subcutaneous emphysema.

Conclusion: Spontaneous subcutaneous emphysema without known origin is a rare condition that may resolve by conservative treatment.
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http://dx.doi.org/10.1016/j.amsu.2022.103443DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8918830PMC
April 2022

Breast cancer recurrence 27 years after full recovery; A case report with literature review.

Int J Surg Case Rep 2022 Mar 12;92:106827. Epub 2022 Feb 12.

Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq; College of Medicine, University of Sulaimani, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq.

Introduction: Breast cancer can recur after a decade of healthy life. The purpose of this study is to describe a rare case of breast cancer recurrence after 27 years of full recovery.

Case Report: A 67-year-old married nulliparous (G1P0A1) female presented with a few weeks of left axillary swelling. She is a known case of left breast cancer that was identified and treated in 1994 with a standard mastectomy without axillary intervention. An ultrasound and mammography imaging revealed a normal right breast and a clear left breast bed. Fine needle aspiration cytology (FNAC) revealed metastasized ductal carcinoma of the breast. The patient underwent general anesthesia and axillary dissection for level I and II axillary lymph node groups.

Discussion: The incidence of recurrence in axillary lymph nodes following excision of the original tumor in breast cancer patients varies according to the surgical approach, ranging from 0.8% to 8.6%. Patients with breast cancer who have a positive estrogen receptor are at a higher risk of delayed recurrence.

Conclusion: Breast cancer can recur even 27 years after being diagnosed and treated. This demonstrates the significance of continuing follow-up in patients diagnosed with breast cancer throughout their lives.
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http://dx.doi.org/10.1016/j.ijscr.2022.106827DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8917279PMC
March 2022

Post COVID-19 neurological complications; a meta-analysis.

Ann Med Surg (Lond) 2022 Apr 3;76:103440. Epub 2022 Mar 3.

Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq.

Introduction: Despite numerous studies regarding neurological manifestations and complications of COVID-19, only a few cases of neurological consequences following complete recovery from SARS-CoV-2 infection have been described.

Objectives: The current study aims to present a quantitative meta-analysis of published studies regarding the post-infectious neurological complications of COVID-19.

Data Sources: The Web of Science, PubMed, MEDLINE on OVID, and Google scholar were searched for English-language researches published after January 1, 2020.

Result: The review of the literature revealed 60 cases - of which 40 (66.7%) cases were male, and 18 (30%) were female. The average age was 44.95 years. Overall, 17 (28.3%) patients had comorbid conditions. Twenty-four (40%) patients were hospitalized during an active COVID-19 infection. The average interval from the COVID-19 infection to the onset of neurological sequelae was 33.2 days. Guillain-Barre syndrome was the most commonly reported neurological condition (15, 25%).

Conclusion: Despite recovery from acute infection, the pandemic highlights the significance of ongoing, comprehensive follow-up of all COVID-19 patients - even those initially were believed to be asymptomatic.
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http://dx.doi.org/10.1016/j.amsu.2022.103440DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8891214PMC
April 2022

The relationship between CT severity infections and oxygen saturation in patients infected with COVID-19, a cohort study.

Ann Med Surg (Lond) 2022 Apr 3;76:103439. Epub 2022 Mar 3.

College of Medicine, University of Sulaimani, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq.

Introduction: Thin-section chest computed tomography is an important diagnostic test and utilized to determine the severity of lung involvement in COVID-19 pneumonia. The goal of this study is to examine the relationship between CT severity and the oxygen saturation level of individuals with COVID-19.

Method: This is a single-center retrospective study of COVID-19 patients that were admitted at a COVID-19 hospital. Patients confirming COVID-19 with PCR testing, patients undergoing lung CT-scan and measures of capillary oxygen saturation using pulse oximetry at the time of admission were all included.

Result: The total number of the cases were 105. The age was classified into four age groups, with the majority of them falling into the fourth to sixth decade of life (42, 40%). Diabetes was the most common comorbidity disease (29, 27.6%). Pulse oximetry showed hypoxemia in 87 (82.9%) cases. The most common CT finding was ground glass opacities (GGO) (45, 42.9%). The data showed a significant positive correlation between oxygen saturation and CT severity in patients infected with covid-19.

Conclusion: These findings support the importance of using pulse oximetry to monitor COVID-19 patients in order to evaluate or even estimate their clinical situations.
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http://dx.doi.org/10.1016/j.amsu.2022.103439DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8891116PMC
April 2022

COVID-19 associated with pulmonary mucormycosis; a case series.

Ann Med Surg (Lond) 2022 Apr 3;76:103434. Epub 2022 Mar 3.

College of Medicine, University of Sulaimani, Sulaimani, Kurdistan, Iraq.

Introduction: Coronavirus disease 2019 (COVID-19) has evolved as a result of severe acute respiratory syndrome coronavirus 2 (SARS-CoV2). With the rise of cases worldwide, plenty of potential COVID-19 complications have emerged, including increased susceptibility to subsequent bacterial and fungal infections. This study aims to report four cases of COVID-19 associated with pulmonary mucormycosis.

Method: This is a multi-center case series study. Diagnosis of COVID-19 was confirmed by reverse transcriptase-polymerase chain reaction.

Result: A total of 4 patients infected with SARS-CoV2 were involved in this study. The majority of the cases were female, aged >42 years old. All patients developed severe symptoms. All of the patients had received steroids, half of them had co-morbidities. The most common computerized tomography (CT) scan findings were pulmonary cavitation and empyema. All of the cases were treated with a combination of surgery and antifungal treatment.

Conclusion: As the number of COVID-19 cases rises, enhanced surveillance for co-infections with unusual pathogens should be continued. Clinicians should raise awareness of these deadly infections, which can further aggravate severe COVID-19.
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http://dx.doi.org/10.1016/j.amsu.2022.103434DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8891121PMC
April 2022

Bilateral brachial plexus block as alternative to general anaesthesia in high-risk patient; a case report and literature review.

Ann Med Surg (Lond) 2022 Mar 11;75:103378. Epub 2022 Feb 11.

Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq.

Introduction: Bilateral brachial plexus blocks can be an alternative to general anaesthesia in the surgery of arm, forearm, wrist, or hand. This study aims to report a case in which a risky patient underwent amputation surgery under regional anaesthesia.

Case Presentation: A 64-year-old male was admitted to the hospital for an amputation operation. Ultrasonography revealed normal findings regarding internal organs, aside from grade II increased echogenicity of both kidneys and a small bladder cyst. Echocardiography revealed mildly left ventricular dilation, moderate systolic left ventricular dysfunction, ejection fraction 38%, left ventricular wall hypokinesia with left ventricular dilation. The amputation was performed under a bilateral supraclavicular brachial plexus block with the guidance of ultrasound.

Discussion: Theoretically, there are some advantages to regional anaesthesia in comparison to general anaesthesia, such as decreasing the ordinary body response to stress in the presence of low levels of cortisol and catecholamines, increasing blood flow and peripheral vasodilatation, decreasing hypercoagulability, lower risk of arterial and venous thrombosis and it aids to prevent endotracheal intubation and mechanical ventilation.

Conclusion: Bilateral brachial plexus blocks, as a type of regional anaesthesia under ultrasound guidance, can be depended upon as a reliable substitute for general anaesthesia in perilous conditions.
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http://dx.doi.org/10.1016/j.amsu.2022.103378DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8881413PMC
March 2022

Xanthogranulomatous epididymo-orchitis: A case report with review of the literature.

Int J Surg Case Rep 2022 Mar 12;92:106832. Epub 2022 Feb 12.

Kscien Organization, Hamdi Str, Azadi Mall, Sulaimani, Kurdistan, Iraq.

Introduction: Xanthogranulomatous orchitis is an extremely rare condition of the test is marked by the necrosis and effacement of testicular parenchyma by an inflammatory process. The current study aims to report a case of xanthogranulomatous epididymo-orchitis.

Case Report: A 35-year-old man presented with a history of recurrent attacks of dull pain and swelling of the right side of the scrotum for 3 weeks. He denied having any history of trauma or urinary symptoms. Physical examination revealed tenderness and warmth of the right side of the scrotum. Urine culture was negative. The patient managed operatively.

Discussion: The underlying pathophysiology of xanthogranulomatous orchitis is yet unknown. The pathogenesis of this inflammatory process in the testis is frequently driven by obstruction of the epididymis or the urinary tract. Urinary tract infection has also been considered as an etiologic factor.

Conclusion: Xanthogranulomatous orchitis is an uncommon testicular inflammatory condition. Histopathologic examination is required for definitive diagnosis and for the exclusion of occult germ cell malignancy.
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http://dx.doi.org/10.1016/j.ijscr.2022.106832DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8889127PMC
March 2022

Primary diffuse B-cell non-Hodgkin's breast lymphoma; A case report with a brief literature review.

Ann Med Surg (Lond) 2022 Mar 26;75:103310. Epub 2022 Jan 26.

Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq.

Introduction: Primary non-Hodgkin's breast lymphoma is a very rare entity. The present study aims to report a case of primary diffuse B-cell non-Hodgkin's breast lymphoma.

Case Presentation: A 55-year-old female presented with a right breast mass for a duration of 4 months. There was no history of cancer in her family. She has had umbilical hernial repair two years before this presentation. Examination revealed the presence of a suspicious mass in the right breast and multiple axillary lymph nodes. Ultrasound showed a rounded vascular mass (46*40mm) and pathological axillary lymph nodes, U5. Mammography showed a round, dense mass with an indistinct posterior margin and a few round axillary lymph nodes, M4. A Core needle biopsy was done which showed an invasive mammary carcinoma; the result of the FNA of the axillary lymph nodes was benign lymphoid tissue. Histopathological examination confirmed the presence of a tumor, sized 6.4cm, non-Hodgkin's lymphoma. Modified radical mastectomy was performed. The histopathological examination confirmed non-Hodgkin's lymphoma.

Clinical Discussion: There are two main groups of primary breast lymphoma. The bilateral diffuse-type affects the younger puerperal women associated with pregnancy or recent childbirth that may involve the CNS, ovaries, and gastrointestinal tract without lymph node involvement. The second type, the unilateral type, which appears in elderly women without extra mammary involvement.

Conclusion: Primary breast non-Hodgkin's lymphoma is a rare disease. It mimics breast cancer, and hence, may lead to misdiagnosis. The common modalities of treatment include chemotherapy, radiotherapy, and surgery.
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http://dx.doi.org/10.1016/j.amsu.2022.103310DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8844393PMC
March 2022

Post COVID-19 hemorrhagic pericardial effusion; A case report with literature review.

Ann Med Surg (Lond) 2022 Feb 27;74:103300. Epub 2022 Jan 27.

Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq.

Introduction: Pericardial effusion (PE) related to COVID-19 has rarely been observed, with most reported cases being non-hemorrhagic. This study aims to present a rare case of post-COVID-19 hemorrhagic PE.

Case Report: A 44-year-old male presented with shortness of breath upon exertion, palpitation, and left-sided chest tightness. He was a recently recovered from COVID-19. He was conscious, oriented, tachypneic, and tachycardic. Chest examination revealed a mixture of fine and coarse crackles along with muffled heart sounds. He had elevated D-dimer, C-reactive protein, prothrombin time, and aPTT. Computed tomography pulmonary angiogram showed acute pulmonary thromboembolism involving the posterior segmental lobar branch of the left lower lobe with concomitant pulmonary infarction. Echocardiography showed severe PE without diastolic collapse. Pericardial drainage was performed and by the 2nd day, there was no more effusion. On the 7th day, the patient developed severe complications which led to cardiac arrest.

Discussion: PE is a collection of fluid in the pericardium. It has been rarely observed in relation to COVID-19, both during and after the viral infection. If PE is suspected, Echocardiography can be used to confirm its diagnosis. There is no standard management for these cases and only non-hemorrhagic patients with mild to moderate effusion can be treated using conservative measures.

Conclusion: Hemorrhagic PE can be a rare but possible post-COVID-19 sequel, and echocardiography can be used to confirm its diagnosis. Drainage is necessary to resolve the effusion.
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http://dx.doi.org/10.1016/j.amsu.2022.103300DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8791848PMC
February 2022

Mixed germ cell tumor of sacrococcygeal region; A case report with literature review.

Ann Med Surg (Lond) 2022 Feb 15;74:103247. Epub 2022 Jan 15.

Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq.

Introduction: Mixed germ cell tumors are uncommon tumors that contain two or more types of malignant, primitive, or germ cell components. This study aims to report a rare case of extragonadal mixed germ cell tumor of the sacrococcygeal area.

Case Report: A 4-year-old female presented with lower back swelling for two weeks. It was associated with pain and fever. Investigations showed elevated Alpha-fetoprotein and normal beta HCG levels. Magnetic resonance imaging showed a large well defined heterogeneous mass at the midline of the lower coccygeal region, which displaced the rectum anteriorly without invasion. Surgical dissection of the mass with excision of the coccyx was performed. Afterward, the patient was referred to an oncology center for chemotherapy.

Discussion: The emergence of extragonadal germ cell tumors may be caused by a disruption in the migration of primordial germ cells along the urogenital ridge, which then undergo a malignant transformation as a consequence of their microenvironment. Another idea states that extragonadal germ cell tumors occur when germ cells that routinely migrate into the extragonadal region during embryogenesis undergo malignant transformation.
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http://dx.doi.org/10.1016/j.amsu.2022.103247DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8777134PMC
February 2022
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