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New-Onset Neurologic Symptoms and Related Neuro-Oncologic Lesions Discovered After COVID-19 Vaccination: Two Neurosurgical Cases and Review of Post-Vaccine Inflammatory Responses.

Cureus 2021 Jun 15;13(6):e15664. Epub 2021 Jun 15.

Neurosurgery, Lenox Hill Hospital/Donald and Barbara Zucker School of Medicine, New York, USA.

A global effort is underway to distribute coronavirus disease 2019 (COVID-19) vaccines to limit the crisis. Although adverse events related to vaccination are rare, there have been cases of new-onset neurologic symptoms following vaccination. We present two cases of new-onset neurologic symptoms post-vaccination that, upon further workup, revealed two different neuro-oncologic processes requiring neurosurgical intervention and further treatment. Read More

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Unique triad of shunts in a patient with paroxysmal palpitations!

BMJ Case Rep 2021 Jul 13;14(7). Epub 2021 Jul 13.

Cardiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada

We present the case of a 34-year-old woman with a rare constellation of congenital cardiovascular defects. She presented with new-onset dyspnoea on exertion and intermittent palpitations. Extensive cardiac workup revealed anomalous drainage of the inferior vena cava and a large secundum atrial septal defect. Read More

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Vertigo and Cytotoxic Lesions of the Corpus Callosum: Report with Review of the Literature.

Case Rep Neurol Med 2021 18;2021:5573822. Epub 2021 Jun 18.

University of Nevada, Reno School of Medicine, 1155 Mill Street, W-11, Reno, NV 89502, USA.

Background: The term cytotoxic lesions of the corpus callosum (CLOCCs) encompasses the entity reversible splenial lesion syndrome (RESLES). RESLES typically presents with altered levels of consciousness, seizures, and delirium and is distinguished radiographically by reversible focal lesions of the splenium of the corpus callosum. This disease pathology is associated with withdrawal of antiepileptic medications, infections, metabolic disturbance, or high-altitude cerebral edema. Read More

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Functional Olfactory Neuroblastoma Inducing Symptomatic SIADH.

Ear Nose Throat J 2021 Jun 16:1455613211022102. Epub 2021 Jun 16.

Valley ENT, Scottsdale, AZ, USA.

Olfactory neuroblastoma (ONB) is a rare malignancy of the sinonasal cavity, originating from neuroepithelial olfactory cells. Olfactory neuroblastoma can be difficult to diagnose due to its anatomic position and variable symptomatic presentation, leading to diagnosis at a more advanced stage. Here, we present the case of a 35-year-old man with no previous medical history who had a bicycle accident secondary to syncope. Read More

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Embryo transfer can be performed in either uterine horn. Two successive pregnancies in a patient with uterus didelphys: a case report.

Zakwan Khrait

J Med Case Rep 2021 Jun 14;15(1):317. Epub 2021 Jun 14.

Consultant, Reproductive Endocrinology and Infertility, FAKIH IVF Center, Dubai, UAE.

Background: Uterus didelphys results from a failure in Mullerian duct fusion and may be associated with complete or partial vaginal septa. Most cases of uterus didelphys are discovered incidentally during the workup of infertility or recurrent miscarriage. The incidence of uterus didelphys has been reported to be 0. Read More

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Chronic Liver Disease Presenting as Immune Hemolytic Anemia: The Challenges of Diagnosis in the Critically Ill in a Resource-Limited Health Care Setting.

Cureus 2021 May 6;13(5):e14880. Epub 2021 May 6.

Department of Medicine, Lady Hardinge Medical College, Delhi, IND.

Immune hemolytic anemia is very rarely associated with chronic liver disease. Diagnosis is often complicated in critically ill patients, where an etiological diagnosis can be elusive, especially in routine health care settings. A 48-year-old man presented with jaundice for three months. Read More

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Machine learning-based texture analysis for differentiation of radiologically indeterminate small adrenal tumors on adrenal protocol CT scans.

Abdom Radiol (NY) 2021 Jun 3. Epub 2021 Jun 3.

Department of Body Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.

Goal: To evaluate the ability of radiomic feature extraction and a machine learning algorithm to differentiate between benign and malignant indeterminate adrenal lesions on contrast-enhanced computed tomography (CT) studies.

Background: Adrenal "incidentalomas" are adrenal lesions that are accidentally discovered during workup not related to the adrenal glands; they have an incidence as high as 5%. Small adrenal incidentalomas (< 4 cm) with high attenuation values on pre-contrast CT(> 10 HU) need further evaluation to calculate the absolute percentage of washout (APW). Read More

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Rates of invasive disease and outcomes in NSCLC patients with biopsy suggestive of carcinoma in situ.

Lung Cancer 2021 07 26;157:17-20. Epub 2021 May 26.

Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.

Introduction: Carcinoma in situ is a rare non-invasive histology of non-small cell lung cancer (NSCLC) with excellent survival outcomes with resection. However, management of lung biopsy suggestive of in situ disease remains unclear. To inform decision-making in this scenario, we determined the rate of invasive disease presence upon resection of lesions with an initial biopsy suggestive of purely in situ disease. Read More

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Primary ovarian Burkitt's lymphoma presentation in a young woman: A case report.

Int J Surg Case Rep 2021 Jun 27;83:105904. Epub 2021 Apr 27.

Department of General Surgery, S.C. General and Emergency Surgery, "Vito Fazzi" Hospital, Lecce, Italy.

Introduction And Importance: Burkitt's lymphoma is one of the fastest growing human cancers and it needs a rapid diagnosis.

Case Presentation: A young woman presented to our institution with acute abdominal pain, tenderness and constipation. Ultrasound reported a right ovarian mass; at laparoscopy, we discovered ascites, peritoneal carcinomatosis and a voluminous pelvic mass. Read More

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Repair of renal artery aneurysm with stent angiography and coil embolization.

Proc (Bayl Univ Med Cent) 2021 Jan 11;34(3):391-393. Epub 2021 Jan 11.

Baylor Scott & White, The Heart Hospital - Plano, Plano, Texas.

Renal artery aneurysms (RAAs) are rare and are frequently discovered incidentally during the workup for other renal issues. Open surgery has been a popular approach to managing RAAs; however, endovascular techniques have recently emerged as a less invasive option. Endovascular therapy involves stent angiography and coil embolization of the aneurysm. Read More

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January 2021

A lobulated mass on the upper back with prominent vasculature: A giant basal cell carcinoma.

Dermatol Reports 2021 Mar 7;13(1):9046. Epub 2021 Apr 7.

Department of Dermatology, UT Southwestern Medical Center, Dallas, TX.

Basal cell carcinoma (BCC) is characterized by slow but locally invasive growth. Although there is low metastatic potential, if not treated early, these skin cancers can lead to significant morbidity and mortality. In this case report, we present a man with a neglected BCC that developed into what is termed a giant BCC or one that is greater than 5 cm. Read More

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Incidentally found rib hemangioma: case report and discussion of management.

AME Case Rep 2021 25;5:13. Epub 2021 Apr 25.

Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.

Rib hemangioma is a rare chest wall tumor for which few reports in the literature exist to help guide treatment. The clinical presentation, radiographic findings, and treatment strategies vary in the literature, with the majority of patients undergoing surgical resection to definitively rule out malignancy. Here, we report a 23-year-old woman with an incidentally discovered rib hemangioma, who had a history of migraines, during the workup of a severe headache refractory to medical treatment. Read More

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Supernumerary Testis Discovered Upon Workup of a Paratesticular Mass.

Urology 2021 Apr 15. Epub 2021 Apr 15.

University of Oklahoma Health Sciences Center, Oklahoma City, OK.

A supernumerary testis is a rare finding with limited description in the literature. Presentations of supernumerary testes vary and often involve initial discovery intraoperatively or in association with a separate condition. In this case report, we describe our experience of a patient with ultrasound imaging concerning for a left paratesticular mass. Read More

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Synchronous intrathyroidal parathyroid carcinoma and thyroid carcinoma: case report and review of the literature.

BMC Endocr Disord 2021 Apr 7;21(1):60. Epub 2021 Apr 7.

General Surgery Unit, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Miraglia, 80138, Naples, Italy.

Background: Parathyroid carcinoma is a rare endocrine malignancy, rarer when synchronous with a non medullary well differentiated thyroid carcinoma. Parathyroid carcinoma accounts of 0.005% of all malignant tumors and it is responsible for less than 1% of primary hyperparathyroidism. Read More

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Case Report: Totally Laparoscopic Resection of Retroperitoneal Paraganglioma Masquerading as a Duodenal Gastrointestinal Stromal Tumor.

Front Surg 2021 9;8:586503. Epub 2021 Mar 9.

Department of General Surgery, Suzhou Ninth People's Hospital, Affiliated Wujiang Hospital of Nantong University, Suzhou, China.

Retroperitoneal paraganglioma (RPGL) is a rare clinical tumor derived from the retroperitoneal sympathetic paraganglion tissue. Since RPGLs are locate deeply and have no specific symptoms and imaging manifestations at the early stage, which easily causes missed diagnosis or misdiagnosis. In addition, reports on totally laparoscopic resection of RPGLs are scarce due to their close proximity to large vessels, giant size, uncertain location, and unknown malignant status. Read More

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Techniques of Onyx Embolization of Arteriovenous Malformation: 2-Dimensional Operative Video.

Oper Neurosurg (Hagerstown) 2021 05;20(6):E430

Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.

Advances in endovascular techniques and tools have allowed for treatment of complex arteriovenous malformations (AVMs), which historically may have posed unacceptable risk for open surgical resection. Endovascular treatment may be employed as an adjunct to surgical resection or as definitive therapy. Improvements in embolization materials have made endovascular AVM treatment safer for patients and useful across a variety of lesions. Read More

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Vitamin D analyses in veterinary feeds by gas chromatography-tandem mass spectrometry.

Eur J Mass Spectrom (Chichester) 2021 Feb 15;27(1):48-62. Epub 2021 Mar 15.

Michigan State University Veterinary Diagnostic Laboratory, Toxicology Section, Michigan State University, East Lansing, MI, USA.

This report examines the feasibility of determination of Vitamin D3, D2 and their 25-hydroxy metabolites utilizing Gas Chromatography Tandem Mass Spectrometry (GC/MS/MS) as a potential alternative to popular Liquid Chromatography Tandem Mass Spectrometric (LC/MS/MS) methodologies. The GC/MS/MS approach was found to operate reasonably well despite long-standing concerns that gas-liquid chromatography of vitamin D compounds invoke thermal rearrangements owing to the relatively high inlet and capillary column temperatures used. The workup procedure involved incubation of feed samples with concentrated potassium hydroxide for overnight fat saponification, extraction of D Vitamins in n-hexane and reaction with N,O-bis(trimethylsilyl)trifluoroacetamide at 70 °C for 30 mins. Read More

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February 2021

Pubic Bone Aplasia as an Incidental Finding in the Adult Population: Case Report and Review of the Literature.

Cureus 2021 Jan 14;13(1):e12703. Epub 2021 Jan 14.

Orthopedics and Traumatology, General Hospital of Patras "Saint Andrews", Patras, GRC.

Pubic bone aplasia is a rare finding that is either diagnosed as incidental finding or associated with various clinical syndromes. It is usually discovered in early childhood, however, there are few reported cases of late discovery during adulthood. We present a case of a 64-year-old male with unilateral superior pubic rami aplasia, discovered incidentally during workup for sustained trauma. Read More

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January 2021

Diagnosis and management of primary malignant tumors in the upper extremity.

Orthop Rev (Pavia) 2020 Dec 27;12(4):8345. Epub 2021 Jan 27.

NYU Langone Orthopedic Hospital, New York, NY, USA.

Bone and soft tissue sarcomas of the upper extremity are relatively uncommon. In many cases, they are discovered incidentally during evaluation of traumatic injuries or common ailments such as rotator cuff tendonitis or tennis elbow. Thus, it is important for all orthopedic surgeons to understand the differential diagnosis, workup, and treatment for upper extremity lesions. Read More

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December 2020

Complete laparoscopic-transhiatal removal of duplex benign oesophageal tumour: case report and review of literature.

BMC Gastroenterol 2021 Feb 2;21(1):47. Epub 2021 Feb 2.

Department of Surgery, University of Szeged, Semmelweis u. 8, 6725, Szeged, Hungary.

Background: Leiomyoma is the most common benign oesophageal tumour. Half of all leiomyoma patients have oesophagus-associated complaints, such as dysphagia and epigastric pain, and the other 50% are asymptomatic with a diagnosis made on incidental discovery. Endoscopic ultrasonography is essential for an accurate preoperative workup and can enable guided-tissue acquisition for immunohistochemistry in certain cases. Read More

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February 2021

Narrative review of molecular pathways of kinase fusions and diagnostic approaches for their detection in non-small cell lung carcinomas.

Transl Lung Cancer Res 2020 Dec;9(6):2645-2655

Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Basel, Switzerland.

The discovery of actionable oncogenic driver alterations has significantly improved treatment options for patients with advanced non-small cell lung cancer (NSCLC). In lung adenocarcinoma (LUAD), approved drugs or drugs in clinical development can target more than half of these altered oncogenic driver genes. In particular, several gene fusions have been discovered in LUAD, including , , , , and . Read More

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December 2020

Accelerated Idioventricular Rhythm: A Rare Case of Wide-Complex Dysrhythmia in a Teenager.

J Emerg Med 2021 Apr 21;60(4):e89-e94. Epub 2021 Jan 21.

Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Division of Cardiology, Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine, Cincinnati, Ohio.

Background: Accelerated idioventricular rhythm (AIVR) is an uncommon and typically benign dysrhythmia with similarities to more malignant forms of ventricular tachycardia (VT). It is often seen in adults after myocardial infarctions, although it also arises in the newborn period, as well as in children with and without congenital heart disease.

Case Report: We describe a presentation of AIVR in an otherwise healthy 13-year-old girl, discovered on arrival to the pediatric emergency department in the setting of post-tonsillectomy bleeding. Read More

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Uncrossed corticospinal tracts presenting as transient tumor-related symptomatology.

Acta Neurochir (Wien) 2021 04 21;163(4):947-951. Epub 2021 Jan 21.

Division of Neurosurgery, Department of Surgery, Royal University Hospital, University of Saskatchewan, 103 Hospital Drive, Saskatoon, Saskatchewan, S7N 0W8, Canada.

Ipsilateral corticospinal innervation is rare. No prior cases have described ipsilateral tumor-associated symptoms as the presentation of an uncrossed corticospinal tract. Herein, we describe a case associated with a left frontal tumor, presenting with transient ipsilateral hemiparesis and aphasia. Read More

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Pancytopenia caused by allopurinol and azathioprine interaction in a heart transplant patient: a case report.

Eur Heart J Case Rep 2020 Dec 15;4(6):1-4. Epub 2020 Nov 15.

Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, Guggenheim Pavilion Floor 6 Room 271, 1190 5th Avenue, New York, NY 10029, USA.

Background: Azathioprine is an immunosuppressive now less commonly prescribed after orthotopic heart transplantation. Patients with solid organ transplantation are at increased risk for numerous comorbidities including gout. Co-administration of allopurinol for gout prophylaxis and azathioprine increases the risk for severe myelosuppression due to drug-drug interactions. Read More

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December 2020

Active Surveillance for Papillary Thyroid Microcarcinoma in a Population with Restrictive Diagnostic Workup Strategies.

Thyroid 2021 Feb 23. Epub 2021 Feb 23.

Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.

The worldwide incidence of papillary thyroid carcinoma (PTC) has increased. Efforts to reduce overtreatment follow two approaches: limiting diagnostic workup of low-risk thyroid nodules and pursuing active surveillance (AS) after diagnosis of microscopic PTC (mPTC). However, most studies on AS have been performed in countries with a relatively high proportion of overdiagnosis and thus incidental mPTC. Read More

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February 2021

Disseminated cryptococcosis presenting with cutaneous involvement in an immunocompromised patient.

Dermatol Online J 2020 Dec 15;26(12). Epub 2020 Dec 15.

Department of Dermatology, Wayne State University, Detroit, MI.

Cryptococcosis is a fungal infection that typically affects immunocompromised patients. It most commonly affects the lungs and may then disseminate to the central nervous system, bone, skin, and adrenal glands. Herein, we describe a 69-year-old man who presented with skin lesions as the initial manifestation of disseminated cryptococcosis. Read More

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December 2020

Functional Adrenal Collision Tumor in a Patient with Cushing's Syndrome.

Case Rep Endocrinol 2020 14;2020:7415762. Epub 2020 Dec 14.

Department of Surgery, University of California, Davis Medical Center, Sacramento, CA, USA.

Adrenal collision tumors are rare and produce unique diagnostic challenges for clinicians. We report the case of a 45-year-old woman with obesity and diabetes mellitus and an incidentally-discovered adrenal mass containing macroscopic fat, thought to be a myelolipoma. A functional workup confirmed adrenocorticotropic hormone- (ACTH-) independent Cushing's syndrome. Read More

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December 2020

Intraocular T-cell lymphoma metastasizing from a primary adrenal T-cell lymphoma: Case report.

Ann Med Surg (Lond) 2020 Dec 27;60:646-650. Epub 2020 Nov 27.

Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.

Introduction: Most intraocular T-cell lymphomas arise from metastatic source. We are reporting a rare case of intraocular T-cell lymphoma masquerading as pseudo-hypopyon and vitritis. The eye involvement proved to represent a metastatic spread from a co-existing adrenal T-cell lymphoma, which was discovered after the initial ophthalmic presentation. Read More

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December 2020

Salicylate toxicity from chronic bismuth subsalicylate use.

BMJ Case Rep 2020 Nov 30;13(11). Epub 2020 Nov 30.

Department of Medicine, University of Toronto, Toronto, Ontario, Canada.

A 79-year-old man presented to the emergency department with a 1-week history of worsening confusion, falls and hearing impairment. An initial workup for infectious, metabolic and structural causes was unrevealing. However, further history discovered that he had been ingesting one to two bottles of Pepto-Bismol (bismuth subsalicylate) daily for gastro-oesophageal reflux symptoms. Read More

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November 2020