Journal of Case Reports in Practice
Volume:5 Issue: 1, Jan 2017

The coexistence of Systemic Lupus Erythematous (SLE) and Myasthenia Gravis (MG) is a rare but important concurrence. SLE can proceed or follow MG. The diagnosis of this coexistence is misleading when neither of SLE or MG is pre-diagnosed. A 35-year-old woman with the cumulative symptoms of SLE and MG referred to our center. In spite of four positive criteria of SLE, diplopia and weakness resulting in several fallings which were worsened in the afternoons complicated the diagnosis. During the routine diagnostic approach, a mediastinal mass was observed in the spiral CT scan of the chest, pathologically confirmed as thymoma. Finally, Anti-acetylcholine receptor (AChR) antibody evaluation was performed which the positive result confirmed the MG diagnosis. In conclusion, the association of SLE, MG and thymoma should be taken into account in the management of similar cases. We also suggest clinicians consider the interactive susceptibility factors in these disorders.

Colorectal cancer (CRC) is the most common cancer of gastrointestinal (GI) tract, third most common cancer with a prevalence of 13% and the second most frequent cause of cancer mortality among men and women worldwide. Locally advanced colorectal cancers account for 5%- 22% of all colorectal carcinomas (CRCs) and are a subgroup of colorectal tumors that invade adjacent organs without distant metastases. Although anterior abdominal wall abscesses due to direct invasion of colonic tumors are very rare but have been described and according to the largest review by White et al consists of nine cases collected over a 32-year, have an overall incidence of approximately 1 per 1700 colorecal carcinoma cases. Here we describe a case of sigmoid carcinoma with abnormal presentation due to tumor perforation and right lower quadrant abdominal wall abscess formation. Our purpose is to draw attention to this rare presentation and to indicate that such patients are potentially curable especially under purposeful screening programs.

Neuroendocrine tumours are the most common primary malignant neoplasms of the appendix and are found in 0,3-0,9 % of patients undergoing appendectomy. The aim of this study was to provide an updated overview on clinicopathological features, treatment and outcome of neuroendocrine tumours of the appendix. We undertook a retrospective study of 19 patients who were operated on for acute appendicitis at the General Surgery Department of Mongi Slim hospital of Tunis between February 2005 and October 2016. 2900 patients underwent emergency appendicectomy during the same period. Neuroendocrine tumours were incidentally identified in 19 histologically examined appendicectomy specimens (0,65%). There was a female predominance in our series consisting of 7 men and 12 women with a sex-ratio (M / F = 0,6). The average age of our patients was 28 years (ranging from 15 to 71 years). Clinically, all patients presented with acute appendicitis with raised inflammatory markers (n=10). All patients were managed with appendicectomy that was subsequently followed by right hemicolectomy in one case. The tumours ranged in size from 0,1 to 2,3 cm (mean = 1,08 cm). They were classified as grade 1 (n=18) and grade 2 neuroendocrine tumours. All patients remained tumour free with no evidence of metastasis or recurrence during a mean follow-up period of 24 months. Appendicular neuroendocrine tumours are rare and usually diagnosed incidentally; hence precise examination of routine appendicectomy specimens is fundamental in the diagnosis.

Radiation therapy is widely used for intracranial and extracranial tumors management. Although three-dimensional planning and optimal radiation delivery, help to increase efficacy and minimizing the possible side effects but due to the increasing prevalence of brain tumors, whole of the brain especially the hypothalamo-pituitary unit receives significant doses of radiation resulting in radiation induced hypopituitarism and subsequent complications. Due to the fact that hypopituitarism induced by radiation is a concept of probability and increases with time, the first 5 years after exposure is the most common time for the possible radiation effects expressions although new hormonal deficiencies can occur as far as 20 years later. Up to now it is unlikely that the modern radiotherapy methods will be significantly associated with lower risk of radiation induced hypopituitarism so these patients need adequate lifelong monitoring as the pituitary failure can present almost at any time and with plenty of syndromes. Here we introduce a case with panhypopituitarism seven years after the last radiation therapy session presenting with recurrent hypoglycemia induced loss of consciousness.