Reports, Volume 3, Issue 2 (June 2020) – 12 articles

We report a case of spontaneous gastrosplenic fistula in a 57 year old female who presented to the emergency department with abdominal pain and weight loss. From the physical examination, she had a palpable abdominal mass. A CT scan was performed and showed a mass involving the proximal greater curve of the stomach, infiltrating the spleen and pancreas. There was a 12 mm defect in the cardia of the stomach with gas entering the large mass but there was no free gas in the abdomen. The defect was a gastrosplenic fistula. A gastroscopic biopsy confirmed the diagnosis of diffuse large B cell lymphoma. Surgical removal of the mass was not feasible; therefore she was treated with RCHOP chemotherapy, achieving complete remission. Full article

Cavernous sinus cavernomas, a rare vascular malformation, represents 3% of all benign cavernous sinus tumors. Both clinical and radiological signs are important for differentiating this condition from other cavernous sinus diseases. The best treatment is radical removal tumor surgery; however, due to the tumor being located in the cavernous sinus, there are many difficulties in the surgery. We report a case of a 35-year-old female who only presented sporadical headache. After serial magnetic resonance imaging acquisitions, a tumor measuring 30 mm in the left cavernous sinus and heterogenous enhencement was observed. Then, the patient underwent an operation with an extradural basal temporal approach. Postoperatively, the tumor was safely gross total removed. The patient developed left oculomotor nerve palsy but fully recovered after 3 months of acupunture treatment, and developed persistent left maxillofacial paresthesia. The surgical treatment for cavernous sinus cavernomas may be considered a best choice regarding safety and efficiency. Full article

The objective of this paper is to present a rare case with negative final histologic examination despite abnormal findings of all previous exams indicating breast cancer in an 80 year old woman. Mammographic and magnetic resonance imaging findings were concordant with the frozen section biopsy result of DCIS. However, the final histologic diagnosis was radial scar (benign breast lesion that can radiologically mimic malignancy). As a conclusion, abnormal mammographic and magnetic resonance imaging findings with positive for DCIS frozen section reports are not always confirmed in the final histologic examination. Furthermore, considering that screening does not seem to be associated with a reduction in mortality due to breast cancer after the age of 75, breast cancer screening could be individualized in this age group. Full article

There is high degree of prevalence and variety of risk factors of postpartum Posttraumatic Stress Disorder (PTSD). However, some postpartum women seem to struggle with their past traumatic life events and previous PTSD can result in them sinking deeper into a new PTSD, a postpartum PTSD. The person who has undergone detoxification has endured a very painful process and there is a strong association between drug addiction and mortality. The aim of this case report study is to raise the understanding of health professionals regarding the impact that these two factors might have on ex-drug addicted women. Data were collected from the Maternity unit of the University Hospital of Larisa in Greece. A mother on day 2 after elective cesarean section confirmed her participation and filled in a Life Events Checklist (LEC-5), Posttraumatic Checklist (PCL-5), Criteria A, and a socio-demographic questionnaire. After the sixth postpartum week, the woman answered via telephone, adapted for postpartum PCL-5. This case study describes vividly and painfully the impact of past drug addiction not only on her cesarean section but also how it affected her postpartum period. Eight past traumatic life events led to the creation of a chronic PTSD, i.e., trauma re-experiencing, avoidance, negative thoughts and feelings, agitation, and reactivity. Unfortunately, in cases of traumatic childbirth, especially cesarean section, when there are past traumatic experiences, such as addiction or sexual abuse, postpartum PTSD is an unbearable experience. Full article

Descemet’s membrane detachment (DMD) is an uncommon, vision-threatening, ocular surface complication of cataract surgery. Among several treatment strategies, sulfur hexafluoride (SF₆) descemetopexy is the standard of care. Herein, we report three cases of DMD after cataract surgery managed with SF₆ descemetopexy, showing different outcomes. Anatomical success was achieved in cases 1 and 2 while intraocular pressure (IOP) was elevated in case 2. In case 3, despite SF₆ descemetopexy, recurrent DMD was observed. Due to persistent corneal edema and possible corneal decompensation in case 3, Descemet’s stripping automated endothelial keratoplasty was performed and a clear graft was found at the final visit. In conclusion, descemetopexy with 20 % SF₆ is an effective and safe procedure for repairing DMD in most cases. Pupillary block with elevated IOP is another concern and prophylactic peripheral iridectomy is recommended. For recurrent DMDs, repeat descemetopexy could be considered. However, close monitoring is advocated since secondary management, such as endothelial keratoplasty, may be required. Full article

Primary intraosseous squamous cell carcinoma (PIOSCC) is a rare and aggressive malignancy arising exclusively within the jaws, without any initial connection with the oral mucosa. The etiology and the epidemiology are unclear due to the rarity of the disease, and there is no current universally accepted staging or treatment protocol. Clinically, the posterior mandible is the most affected site, and common symptoms are swelling and pain. The diagnosis is often difficult either because it requires stringent criteria to be satisfied or because of the absence of a pathognomonic histological pattern. Aggressive surgery is the first-choice treatment, often followed by radiotherapy. The lymph nodal status seems to be the most important factor influencing the prognosis, which is usually poor, with a 5-year survival rate ranging from 30% to 40%. In the present article, we report an unusual case of cystogenic PIOSCC interesting the anterior mandible of a young 34-year-old male, which came to our attention after complaint about recurrent infective episodes affecting a dentigerous cyst (impacted lower canine) discovered ten years before. The age, site, and extension are uncommon. Extensive surgical treatment with fibula free flap reconstruction, adjuvant therapy, and salvage surgery was carried out. The patient was disease-free at a 31-month follow-up. Full article

Chilaiditi’s syndrome is a rare and often asymptomatic anomaly, typically found as an incidental radiographic sign (gas under the diaphragm) due to hepato-diaphragmatic interposition of the transverse colon. We report a case of Chilaiditi’s syndrome following colonoscopy presenting with severe abdominal pain, dyspnoea and radiograph findings similar to the presence of bowel perforation (appearance of gas under the hemidiaphragm on erect chest radiograph). Computed tomography (CT) evidence of Chilaiditi’s sign prevented unnecessary laparotomy. Full article

Pancreatic pseudocysts are a known complication of pancreatitis. There are a multitude of complications which have been described in relation to pancreatic pseudocysts. Perforation of a gastrointestinal hollow viscus is rare but has previously been reported. We report a case of a 72-year-old female with the development of three pancreatic pseudocysts four weeks post gallstone pancreatitis. The patient deteriorated and was found to have a duodenal perforation due to compression forces from the underlying pseudocysts. The patient required emergency surgical intervention and recovered fully following hospital admission. Full article

Snakebite envenomations are classified as Category A Neglected Tropical Diseases by the World Health Organization. In Brazil, 405 snake species are distributed among 11 families, with the genera Bothrops and Crotalus being the most studied and main responsible for severe and lethal envenomations. In the country, Crotalus genus (i.e., rattlesnakes) is represented by Crotalus durissus species, showing seven different subspecies distributed along the country, including Crotalus durissus ruruima, which inhabits Roraima, the Brazilian nothermost state from Amazon forest. Here, we report a fatal case of a severe envenomation following a rattlesnake bite. The patient presented classic crotalic neurological signs and symptoms such as ptosis, drooling of saliva, sluggishness, macroscopic hematuria, and oliguria, which evolved to acute kidney failure (AKF) and hemodynamic instability. Although the patient was treated with the specific antivenom therapy, the severe envenomation resulted in three cardiac arrests and death of the victim in less than 38 h. This study discusses the causes of the patient death, the features of rattlesnake venom-induced AKF, and shows evidences that the Brazilian crotalic antivenom should be improved to treat rattlesnake envenomations caused by C. d. ruruima venom in Roraima state. Full article

Currently, transcatheter aortic valve replacements within degenerated surgical bioprosthetic aortic valves (valve in valve) are increasing in frequency with studies supporting their safety and efficacy. We present the rare case of a patient requiring a second transcatheter bioprosthetic aortic valve placed within a previously placed degenerated transcatheter aortic valve, which was implanted in a degenerated surgical bioprosthetic aortic valve. The procedure was performed using a percutaneous cardiopulmonary bypass with TandemLife for hemodynamic support. Full article

Secretory carcinoma (SC) is a recently described salivary gland tumor reported in the fourth edition of World Health Organization classification of head and neck tumors. SC is characterized by strong S-100 protein, mammaglobin, and vimentin immunoexpression, and harbors a t(12;15)(p13;q25) translocation which leads to ETV6-NTRK3 fusion product. Histologically, SC displays a lobulated growth pattern and is often composed of microcystic, tubular, and solid structures with abundant eosinophilic homogenous or bubbly secretion. SC is generally recognized as low-grade malignancy with low-grade histopathologic features, and metastasis is relatively uncommon. In this case, we described a SC of hard palate that underwent high grade transformation and metastasis to the cervical lymph node in a 54-year-old patient. In addition, this case showed different histological findings between primary lesion and metastasis lesion. Therefore, the diagnosis was confirmed by the presence of ETV6 translocation. Here, we report a case that occurred SC with high-grade transformation in the palate, and a review of the relevant literature is also presented. Full article