PD-1/PD-L1-negative tracheal mucoepidermoid carcinoma: A case report and systematic review of the literature
Background: Tracheal mucoepidermoid carcinoma is a rare form of non-small cell lung carcinoma and is defined as a tumor characterized by a combination of squamous, mucus-secreting, and intermediate cell types. This carcinoma is usually located in the lobar or segmental bronchus. Currently, surgery is the preferred treatment for this disease, which includes pneumonectomy, lobectomy, and sleeve lobectomy. Case presentation: A 50-year-old Chinese male presented with cough, shortness of breath and hemoptysis, and the effect of antibiotic therapy was not good. Subsequently, the airway occupied lesion was found by chest CT, and he was transferred to our hospital for surgical resection. Histologically, the tumor contained squamous epidermal cells, mucoepidermoid cells and intermediate cells. Immunohistochemistrically, the tumor cells were positive for p63, CK5/6, CK7 and Ki67. However, the tumor is generally negative for TTF-1 and neuroendocrine markers. The patient had no recurrence 15 months after the surgery. Conclusions: We report a rare case of mucoepidermoid carcinoma in the distal trachea in which the surgery was difficult and could not be performed like a traditional pulmonary resection. We first provide a comprehensive description of airway management and anesthesia intubation. After surgery, we reviewed the literature and found that PD-1/PD-L1 detection had never been reported in tracheal mucoepidermoid carcinoma. Therefore, we studied the PD-1/PD-L1 pathway in this patient, and the results were negative, which may indicate that potential adjuvant therapy with immune checkpoint inhibitors (ICIs) is not useful in this case.
Covid 19 pandemic has taken away millions of lives. Our understanding of this disease, till to date, is not complete. This disease has a wide variety of neurological manifestations. Acute transverse myelitis is one such rare neurological complication of Covid 19. The exact etiology is not clear. Auto immunity might be one of the possible mechanisms. We report a case of 39-year-old lady, who had recent history of high-grade fever and cough. This was followed by weakness of both legs and in- ability to pass urine. SARS-CoV-2 (PCR) from nasopharyngeal swab was positive. She was found to have features of acute non compressive myelopathy. MRI brain and MRI cervical spine with contrast was normal. MRI dorso lumbar spine with contrast was suggestive of diffuse hyper intensity of conus medullaris with contrast enhancement suggestive of conus myelitis. CSF analysis ruled out infection and autoimmune causes. She was pulsed with high dose steroids. There was some transient improvement in symptoms. Learning points: 1) Physicians should not consider Covid as a respiratory illness only. It can present with a variety of extra pulmonary manifestations. 2) Acute transverse myelitis is a rare complication of Covid 19 infection. Timely recognition and treatment can prevent permanent neurological damage and residual disability. 3) Conus myelitis might not present with classic upper motor neuron signs. Any new onset bladder dysfunction in a setting of a recent covid infection should be taken seriously and requires urgent imaging of the spine.
Myocardial infarction as initial presentation of polycythemia vera and its treatment challenges, a case report
Polycythemia vera (PV) is one of Myeloproliferative neoplasm which has common and uncommon mode of presentations. Myocardial infarction (MI) is rare at initial presentation. Here we report 55-year-old women presented with MI and found to have PV in whom, coronary intervention was delayed as there is no evidence based literature guidance in cases of acute MI and PV.
The fall of conventional mechanical ventilation into the emergence of Veno -Venous Extracorporeal Membrane Oxygenation influenced Extreme Super Super obese patient survival with a COVID-19 ARDS
The COVID-19 pandemic has unfolded and merged across 220 countries, territories worldwide. Recent studies conclude that obesity is an independent significant risk factor for COVID-19 infection. Thus, obesity is an epidemic disease. Any obesity allied with COVID-19 ARDS is life-threatening, heading to respiratory life support associated with several complications and mortality. In this clinical setting, the World health organization (WHO) and Extracorporeal Life Support Organization (ELSO) provide interim guidelines that Veno-Venous extracorporeal membrane oxygenation (VV- ECMO) can be beneficial in selective COVID-19 patients. However, the benefit of extracorporeal membrane oxygenation (ECMO) in Obesity and Severe Obesity remains controversial. Although a few studies favored ECMO in Obesity associated with COVID-19. In contrast, its benefit in extreme super-super obese (class v) is unknown to the present day. Herein we report our successful early VV- ECMO and its retrieval challenges in an extreme super-super obese of Body mass index (BMI >65 kg/m2). Our report describes our institutional practice, clinical characteristics, and early VV- ECMO induction to enhance patients’ speedy recovery and survival. ECMO is a limited resource and must be used selectively, particularly during a pandemic when all resources are scarce.
Appendiceal diverticulosis: Asymptomatic positive FDG-PET uptake in the appendix should prompt operative management
Appendiceal diverticulosis is rarely diagnosed and presentation mimics acute appendicitis. It has a documented high malignant risk and increased complication rate and excision is recommended if suspected preoperatively. We report a case of an incidental FDG avid appendiceal lesion on PET scan which was suspected to be an appendiceal neoplasm, however histologically was appendiceal diverticulosis. This is the first case of appendiceal diverticulosis detected via PET scan and we discuss the implications of this.
Neurocysticercosis (NC) is a common condition worldwide while glioblastoma is the most common brain cancer among adults but overall, a rare disease. NC is the most common cause of seizures in developing countries. Although no causal relationship is established, there have been an association previously reported between NC and glioblastoma. Here we present a case of a 41-year-old female who was diagnosed with NC, treated with antiparasitic medications who developed worsening neurologic deficits despite treatment, and was subsequently diagnosed with a large left frontotemporal mass consistent with glioblastoma. Patient then underwent treatment with concurrent radiation and temozolomide.
Introduction. Loss of domain represents a defect in abdominal wall or loss of continuity of fascial closure, with more than 20% of the peritoneal cavity content under the skin in a serous sac, where the reconstruction involves additional reconstructive techniques. Clinical Case. A 63-year-old active smoker with multiple comorbidities such as COPD severe form with the need for oxygen at home (may be an absolute contraindication) and surgical history of open umbilical hernia repair with a rapid development of loss of domain hernia (2 weeks after surgery) was prepared preoperatively with Botulinum Toxin type A and Preoperative Progressive Pneumoperitoneum. Discussion. Despite comorbidities, by optimizing the abdominal wall with Botulinum Toxin type A and Preoperative Progressive Pneumoperitoneum with the intraoperative use of the Rives-Stoppa technique or posterior separation of components, Abdominal Wall Strength Score improves significantly in a short time, with quick socio-economic reintegration and low-rate of complications. Conclusions. By preoperative preparation, with augmentation techniques of the abdominal wall, thus, even the barriers given by comorbidities (absolute contraindications) are overcame, with low postoperative risks, offering the patient a normal quality of life.