Journal of Case Reports in Practice
Volume:1 Issue: 3, Oct 2013

A 60-year-old male patient presented with complaints of loss of appetite and bloated abdomen of two weeks duration. The radiological examination revealed large mass involving left kidney. With a clinical and radiolog- ical diagnosis of renal cell carcinoma, radical nephrectomy was done. Histopathological examination revealed a neoplasm composed purely of epithelioid cells. Based on histopathological and immunohistochemical findings a diagnosis of Epithelioid Angiomyolipoma of kidney was made. We are reporting this case because of the rarity of this variant of angiomyolipoma and to highlight the diagnostic difficulties of this entity when compared to the more common classic angiomyolipoma.

Diabetic muscle infarction is a rare complication of long-standing diabetes mellitus (DM) with multiple-organ microvascular sequels. This report covers sixty-year old male with a history of DM for 12 years and an experience of hemodialysis for one year with acute onset of pain in the right calf. The diagnosis of diabetic muscle infarction needs increasing awareness of clinicians. The main aim of this case report is to draw attention to this condition, so that unnecessary invasive diagnostic test, biopsy and surgical debridement which could be avoided.

Urogenital tuberculosis (UGTB) is the second common form of tuberculosis (TB) in countries with severe epi- demic situation and the third common form in regions with low incidence of TB. UGTB is complicated by bladder TB in more than half of cases; late diagnosis and/or absence of pathogenetic therapy leads to the development of shrinked bladder. The intravesical bacillus Calmette-Guerin (BCG) after transurethral resection (TUR) in Ta and T1 bladder cancer provides a significantly better prophylaxis of tumour recurrence than TUR alone. Nevertheless alongside with positive results many complications of BCG therapy, including lethal, were noted. We describe two cases of shrinked bladder TB – one was caused by M. tuberculosis, and second – by M. bovis.

44-year-old gentleman with history of gastric lymphoma status-post multiple cycles of chemotherapy, atrial fibril- lation (AF) and hypertension was brought to the hospital in an unconscious state after a syncopal episode. He was tachycardic in the 130s-140s with systolic blood pressure in the 70s. He was given intravenous fluids and vasopressors. Naso-gastric tube placement brought back blood. Patient was on rivaroxaban for primary prevention of stroke. Patient reported one episode of dark colored stool and was complaining of epigastric discomfort. Gas- troenterology was consulted and a pantoprazole drip was started. His creatinine was 4.8, baseline value was 0.9. Esophago-gastro-duodenoscopy showed blood in proximal stomach and tumor mass in distal body of the stomach. No point source was found amenable to endoscopic treatment. Surgical consultation was requested but patient developed cardiac arrest with asystole. Resuscitation attempts failed, and patient died of hemorrhagic shock. Rivaroxaban was approved in November 2011 by the US Food and Drug Administrationfor stroke prevention in non-valvular AF. Thispatient had a score of 1, for hypertension and had gastric lymphoma which increased his bleeding risk. The risk outweighed benefit of anticoagulation, especially with an irreversible agent. Physician education is thus necessary to ensure appropriate patient selection and safety for use of irreversible oral anticoag- ulants.

Granulocytic sarcomas are rare extramedullary tumors consisting of granulocytic precursor cells. Rarely it may precede peripheral blood or bone marrow involvement, presenting as a diagnostic challenge. We report here a case of myeloid sarcoma in a 36-year-old man, who presented with cervical lymphadenopathy of one month duration. Fine needle aspiration cytology (FNAC) was performed and a diagnosis of myeloid sarcoma was offered. Subse- quently, peripheral blood smear examination and complete blood counts done, which revealed features of chronic myeloid leukemia (CML) with accelerated phase. We report here a rare case to emphasize the diagnostic utility of FNAC in making the correct diagnosis of myeloid sarcoma.

Diabetic Fine needle aspiration cytology (FNAC) can act as a useful and reliable pre-operative procedure in pedi- atric renal tumors. It is a safe technique that does not upstage the tumor. Primary renal tumors constitute the fourth commonest solid tumors of childhood. Wilms tumor along with neuroblastoma being two most common malignant round cell tumors of abdominal cavity. Here we report 2 years old male child presented with mass in left flank and left lumbar region. Clinicoradiological diagnosis of bilateral Wilms tumor was kept. In view of this diagnosis, CT guided FNAC was done. Cytodiagnosis of Wilms tumor was given. In this case report we discussed the interesting cytological findings of presence of many skeletal muscle fibers with prominent cross striations in Wilms tumor which are not described in FNAC smears of any case in the literature reviewed. So this case is presented here for its rare cytological findings.

We present a patient with large fibrovascular polyp of the sigmoid; an extremely rare submucosal tumor with only one case report in the literature. A 78-year-old woman presented with constipation and abdominal pain and intermittent maroon stool. Colonoscopic examination and other imaging revealed a large (6 centimeter), intralu- minal pedunculated polyp in the sigmoid that was removed as segmental colectomy. Histological diagnosis of the surgical specimen was fibrovascular polyp. Fibrovascular polyp of the colon is an extremely rare submucosal intraluminal tumor that can cause constipation, abdominal pain, obstruction, and or bleeding.

Cetuximab is a monoclonal antibody that treats malignant disease by inhibiting epidermal growth factor receptors. Cetuximab has many common adverse events have been reported including infusion reactions, skin rashes, head- ache and gastrointestinal disturbances. Cardiactoxicity and cardiac complications such as heart failure (HF), myo- cardial ischaemia, arrhythmias, hypertension, and thromboembolism are some types of side effects of anticancer agents, cardiovascular complications are one of the most feared side-effects as they can increase mortality which interferes with the gain in life expectancy due to anticancer therapy. Up till now, cetuximab associated cardiotox- icity has been rarely reported in the literature.In this paper we are reporting a case of 89-year-old male diagnosed to have laryngeal squamous cell carcinoma with a history of hypertension but no history of coronary artery disease; he developed non-ST elevation myocardial infarction (NSTEMI) after receiving the loading dose of cetuximab; his case was deteriorated to develop heart fail- ure and atrial fibrillation and required admission to cardiac intensive care unit (CCU) on mechanical ventilation. Assessment of cardiac toxicity remains a critical issue in cancer management; physicians should be aware of the potential for cardiotoxicity associated with the administration of cetuximab. Before treatment with monoclonal antibodies; caution and baseline assessment are suggested for patients aged >60 years, or with cardiovascular risk factors such as hypertension, hypercholesterolaemia, diabetes, obesity, or with a history of coronary artery disease, congestive heart failure, or arrhythmias,critical monitoring of serum electrolytes (including magnesium, potassi- um and calcium) should be monitored during and after treatment.

Cystic soft-tissue sarcomas have been known to mimic chronic hematomas in clinical and radiological presenta- tion. We report two cases of space-occupying masses previously diagnosed as chronic hematomas, but presenting with recent changes raising concern for malignancy. Preoperative imaging was inconclusive in both cases, leaving biopsy the only possible method of diagnosis. Excisional biopsy of one case confirmed the diagnosis of chronic hematoma. However, in the other case an incisional biopsy was performed and over 90% of the biopsy sample was hemorrhagic and necrotic, resulting in an indeterminate diagnosis. The final diagnosis of high-grade angiosarco- ma could only be made after the mass was completely excised and meticulously examined. A thorough specimen sampling technique was used instead of the traditional excisional biopsy sampling techniques. We propose that the best practice to prevent misdiagnosis of a possible soft tissue sarcoma masquerading as a chronic hematoma is to completely excise and thoroughly examine the mass.

Biotinidase deficiency is an autosomal recessive disorder that is presented with dermatitis and neurologic manifes- tations such as seizure, ataxia, hypotonia, mental retardation and autistic behavior. Basal ganglia lesions in mag- netic resonance imaging (MRI) in biotin deficiency was reported and we report a ten year old girl with biotinidase deficiency and basal ganglia lesions in MRI. She is a 10-year-old girl with attacks of seizure from the age of two years. In the first admission, she had mild metabolic acidosis and her brain MRI showed multiple lesions in the basal ganglia and enzyme assay revealed partial biotinidase enzyme deficiency. Treatment with 10 mg daily biotin was started and rapid and good control over seizures was seen. She had episodes of seizure at the ages of four, six and nine years with fever and upper respiratory infection for which biotin dosage was increased. Now and in the last follow up, she is a student of fourth grade of primary school and academic performance is partially favorable and has some residual neurological dysfunction on examination such as dysarthria, ataxia, and tremor, dystonia of the left hand and mild stiffness of lower extremities. The new brain MRI showed severe degeneration of the caudate nucleus and the putamen that unchanged during the eight year follow-up.