Paget’s bone disease (PBD) is a benign tumor of osteoclasts. We report a case of an isolated temporal bone’s Paget disease with unusual evolution to a rapidly functional degradation of vestibulocochlear system. A 60 years old female was admitted for an isolated, left sided mastoid tumefaction without any inflammatory signs. Initial temporal bone computed tomography (CT) showed a left cotton wool appearance without any ossicles lesion or vestibulocochlear extension. Anatomo pathological tests confirmed the diagnosis. The outcome was marked by the occurrence of vestibulocochlear symptoms. Treatment had consisted on subtotal surgery in combination with oral bisphosphonate with improvement of her clinical conditions. The post operative’s follow-up was simple without any abnormalities PBD of temporal bone is a benign disorder. Imaging is considered the most useful diagnosis modality for revealing the disorder that will be confirmed by histological tests. The treatment is based on medical approaches and surgery has few indications.
Acute recurrent pancreatitis is a rare entity in children. It can be caused by a number of reasons, anatomical variations being one of them. Panctreatica divisum is the most common form of ductal anomaly while ansa pancreatica is the least studied and explored. In recurrent pancreatitis, Ansa Pancreatica was recently found to be a key risk factor. It is usually found among adult alcoholics. We submit a report of a rare but important cause of acute recurrent pancreatitis; an 11-year-old child with 2 previous episodes of pancreatitis diagnosed with ansa pancreatica on magnetic resonance cholangiopancreatography (MRCP). He was advised to get stenting of Pancreatic duct. To the best of our belief, only another case has been reported in the pediatric population.
AnIn knee arthritis with extra-articular deformity of the femur, total knee arthroplasty becomes more challenging. Simultaneous femoral deformity correction and TKA can be a complex procedure. We present a case in which TKA and femoral osteotomy for varus femoral deformity were performed simultaneously. Non-union in the osteotomy portion occurred after the operation. Teriparatide therapy and low intensity pulsed ultrasound therapy was administered after a diagnosis of non-union. Bony union was partially obtained at 29 months after surgery.
An emergency presentation of a paraoesophageal hernia with acute respiratory distress and an acute abdomen is a rare presentation. Hereby, we are presenting a 73year old female who presented with an acute dyspnoea and acute bowel obstruction, the imaging revealed large paraoesophageal hernia almost collapsing the right lung, she had an emergency surgery, an anterior gastropexy was performed since she was unstable. Despite subsequent surgeries e.g Collis gastroplasty and mesh cruroplasty, patient developed recurrent hiatal hernia. Unfortunately, the patient ultimately passed away from a vancomycin resistant enterococci (VRE) bacteraemia and due to overwhelming medical comorbidities. As presentation of paraoesophageal hernia with acute dyspnea and acute abdomen is a rare incidence, we discuss this and its management options through a case report.
Glomangiopericytoma is defined as a sinonasal tumor with perivascular myoid phenotype, which was first described in 1942 by Stout and Murray as a soft tissue tumor with characteristic proliferation including branching vessels and small vessel perivascular hyalinization. A 47-year-women presented with two years history of permanent left nasal obstruction and frequent epistaxis , without anosmia or any other sinonasal symptoms Rhinoscopy was done which revealed a friable grayish pink polypoidal mass, fully occupying the left anterior naris. the right nasal cavity was free . Computed tomography showed a lesion involving the left nasal cavity, with a soft tissue density (70 UH) consisting of about 50*16 mm , widely infiltrative (left nasal turbinates , uncinate process , left half of nasopharynx and palatine bone ) , with a posterior left ethmoidal sinus mucosal thickening and without any bony destruction .Microscopic examination of the biopsy showed subepithelial tissue showed the lobular arrangement of spindle-shaped cells admixed with vascular channels of variable size, The differential diagnosis of hemangiopericytoma and solitary fibrous tumor (SFT) , The staining of STAT 6 immunohistochemistry (IHC) was heterogeneous confirmed the solitary fibrous tumor . Endoscopic surgery was performed to remove the mass , considering the size, limited expansion and the accessible location of the tumor.
Anemia is a common finding in patients on Nucleoside Reverse Transcriptase Inhibitors (NRTI’s) among which LAMIVUDINE induced anemia is uncommon whereas ZIDOVUDINE induced anemia is common. This is the first case series related to TLE (TENOFOVIR + LAMIVUDINE + EFAVIRENZ) regimen induced anemia. In case one, two and three Hb levels dropped within one year, 7 months, 6 months respectively. Anemia can be managed by intake of Iron, vitamin B12, Folate and nutritional supplements or with draw of medication based on severity.
Primary lymphoma of the bone (PLB) primarily arising from the medullary cavity is an extremely rare entity, with only limited number of studies and sporadic cases reported in the literature. The current study presents one case of PLB presented with unique presentation and treated with chemotherapy only. A 66 year old male presented with severe pain in the left hip that persisted for two months. Initial laboratory work up showed anemia, hypercalcemia and increase in free light chains kappa to lambda ratio, a diagnosis of multiple myeloma was suspected, magnetic reso¬nance imaging of the vertebral spine extensive involvement of bone marrow of the vertebrae. An 18F fluorodeoxyglucose positron emission tomography computed tomography (FDG PET CT) scan showed widely scattered moderate to intense uptake in multiple lytic of skeleton, Impression was : Image compatible with extensive multiple myeloma, No extra osseous involvement was found. Bone marrow examination was performed confirmed a diagnosis of extensive bone marrow involvement by High grade B-cell neoplasm with areas of bone marrow necrosis. The patient received six cycles of R-CHOP regimen (Rituximab, cyclo-phosphamide, Anthracycline, vincristine and prednisone) and achieved a complete response, as confirmed by FDG PET CT. At present, the patient is in a good condi¬tion.so this patient presentation mimicking multiple myeloma, which represent diagnostic dilemma. Primary lymphoma of the bone is rare disease entity, there is no strong evidence supporting some diagnostic and therapeutic decisions, and therefore, case presentation of the rare disease may facilitate treatment of similar diseases. A review of the literature to elucidate the clinical, radiological, pathological phenotype and optimal treatment of PLB done.
Primary central nervous system (CNS) lymphomas are tumours localised only in the brain, spinal cord, and rarely, the eyes (i.e. involving only the CNS). These can be detected by imaging modalities, namely computed tomography (CT) and magnetic resonance imaging (MRI), in which they appear as lesions, most often with surrounding enhancement (i.e. peripherally-enhancing or ring-enhancing lesions). However, similar lesions can be seen in a variety of other conditions and differentiating these diagnoses by imaging alone is difficult. We report a case of primary CNS lymphoma in a 21-year old gentleman who was misdiagnosed as and treated for neurocysticercosis and brain tuberculomas due to misleading investigation results, in addition to the relative unlikelihood of CNS lymphoma in this patient compared to other similar individuals. Fortunately, appropriate management was initiated as soon as CNS lymphoma was confirmed by biopsy of the brain lesion, with good treatment response.
In the late 1800’s, Morel-Lavallèe described a pattern of injury to the proximal thigh involving a fluid collection associated with a de-gloving type of injury. These injuries typically result from blunt trauma and falls. There is existing literature that suggests surgical management as primary treatment, although no rigorous controlled trials are found in English language medical literature. Non-surgical aspiration with sclerodesis is an option, however individual case reports suggest that using multiple aspirations without sclerodesis could be effective. This series illustrates that nonsurgical management (i.e. aspiration without sclerodesis) is a viable option for these injuries.
Introduction: Panniculitis is the inflammation of subcutaneous adipose tissue which is caused by many infectious and inflammatory conditions. It is high time to document panniculitis in the skin lesions with cutaneous leishmaniasis (CL) in Sri Lanka. Objectives: This study was performed to assess demographic data and to describe panniculitis in patients with CL. Methods: A descriptive cross-sectional study was done from 2013 to March 2018 at Teaching Hospital Kandy, Sri Lanka. The skin biopsies clinically suspected as CL evaluated histologically for diagnostic or indicative evidence of CL, and patients responded completely to the specific anti-leishmaniasis treatment were taken as the study population. Skin biopsies of 123 patients were assessed in view of dermal granulomata, Leishman-Donovan bodies and panniculitis. Results: The majority of patients were in the age group of 36 to 50 years (N= 36:29.3%: mean=41.64 years: SD18.15 years) and there was a slight female predominance in the study (N=65:52.8%). A majority of skin biopsies revealed Granulomata (N=95: 77.2%). Leishmania Donovan bodies were identified among 43.1% of the lesions (N=53). Though there were 123 patients, only 66 (53.6%) skin biopsies were deeper enough to reveal subcutaneous tissue. A significant amount of skin lesions showed subcutaneous tissue inflammation (N=59:89.39%), predominantly non-granulomatous in morphology (N=44:74.6%). Conclusion: Subcutaneous tissue inflammatory infiltrates in the non-granulomatous morphology is an important feature of the skin biopsies of CL especially in the granulomatous variant of the CL, which can be achieved by a deeper elliptical biopsy.