The intratesticular leiomyoma: an unusual location. Report of a case

Malignant mixed müllerian tumors (MMMT) of the ovary are rare, aggressive and rapidly progressive tumors. According to the available literature, the presence of metastatic disease rarely permits long term survival. We report on a 64-year old patient with stage IV ovarian MMMT who achieved a surgically-documented complete response (CR) after 6 cycles of carboplatin, mesna, ifosfamide, cis-platin. Pelvic recurrence was diagnosed 14 months later; the patient received 6 cycles of the same regimen used as first-line chemotherapy which resulted in a second complete response lasting for 4 months. The patient died 37 months after initial diagnosis due to intestinal occlusion. In the current case Ca 125 was significantly increased at clinical presentation of disease but not at the time of recurrence.     

Granulocytic sarcoma. A case with an unusual location

A 58-year-old male was admitted to our hospital with a preliminary diagnosis of bacterial endocarditis. After admission, echocardiography indicated the presence of vegetation-like tissues on both the left coronary cusp and the anterior mitral leaflet, although retrograde aortography two months earlier hadn't indicated an abnormal finding on the aortic cusp. The vegetation-like tissues had gradually enlarged despite the administration of antibiotics at another hospital, and aortic and mitral regurgitation had become severe. We decided to perform replacements of the aortic and mitral valves on the day of admission. During the operation, the aortic valve was found not to have vegetation, but an aneurysmal pouch on the left coronary cusp. It was supposed that either bacterial endocarditis or catheter injury had made a part of the aortic cusp weak and intolerant of diastolic pressure gradient, and as a result, the weakened part of the cusp progressively dilated into the left ventricle forming an aneurysmal pouch. To our knowledge, there have been only two previous reports of an aneurysmal pouch on the aortic cusp documented in the literature.     

Suicidal excess--presentation of an unusual case

The authors report the case of a suicide pact of two men (22 and 24 years old), which exhibits extraordinary circumstances concerning the personal profile and the suicide procedures. Both had a psychiatric history and were found dead near their severely damaged car, with gaggs in their mouth and a rope tightened around the neck and fixed to the car. Extra gas cans had also been placed in the car. Autopsy confirmed death due to severe trauma and rope strangulation. Toxicological analysis of the blood revealed codeine, dihydrocodeine, paracetamol in high, doxepine in lethal concentrations. According to police investigations, which has been confirmed by medical examination, both men had made arrangements for their suicide selecting a range of methods to kill themselves.     

Parry-Romberg syndrome. Summary and new knowledge based on an unusual case

A 52 year old female with Parry-Romberg syndrome presented with gradual atrophy of the subcutaneous fat and muscle on her chest and back. The disease process was limited to the C3 to T2 dermatomes on the right side. In addition, there was muscle atrophy of the right arm and extending down the back to T10, als well as right sided paralysis of the diaphragm. Sympathetic nerve blockage reduced pain and hyperesthesia; no progression was seen over several months using NMR to monitor the patient. The Parry-Romberg syndrome has been defined in many ways; in view of this unusual case, we review the literature, attempting to provide a more accurate case definition.     

Metastatic malignant melanoma: an unusual case presentation

Secondary involvement of the genitourinary tract with malignant melanoma is a common autopsy finding, but rarely evident clinically. We report a rare case involving a previously asymptomatic patient presenting with gross hematuria and a large renal mass, which was found to be metastatic melanoma. We propose that metastatic melanoma to the kidney, although rare, be considered in the differential diagnosis of disease processes causing hematuria.     

Extrapulmonary tuberculosis. An unusual case

Skeletal tuberculosis with extravertebral location is rare. We report a case of tuberculous osteomyelitis simultaneously affecting two right ribs and the left ulna. We emphasize the diagnostic problems (failure or delay in diagnosis) in extrapulmonary tuberculosis interesting uncommon sites and having relatively indolent presenting symptoms.     

An unusual case of autoscopic hallucinations.

A young Okinawan woman perceived her double who became aggressive toward her, attempted to strangle her, and cut off the anterior ? of her tongue. Physical findings, psychological observations, and historical data are reported. A comparison is made between the reported case, the usual cases of autoscopic hallucinations, and cases of multiple personalities. This case has features of both. An attempt is made to combine all available data and integrate it into a formulation that makes this rare phenomenon more understandable. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A case of epididymal sarcoidosis

We reported a case of epididymal sarcoidosis. The patient was a 13-year-old boy with a chief complaint of right scrotal mass. On physical examination, a firm, nontender 7 mm mass was palpable in the right hemiscrotum and appeared to involve the head of the epididymis. Ultrasonography showed a highly echogenic mass in the epididymis. A routine chest X-ray revealed lymphadenopathy of the mediastinum and reticular shadows in bilateral lung fields. Because the lesion might be confined to the epididymis, a partial epididymectomy was performed. The histopathologic specimen showed noncaseating granulomas consistent with sarcoidosis. Lung biopsies also revealed noncaseating granulomas. Subsequent pulmonary function studies revealed a mild obstructing ventiratory defect, therefore therapy was instituted with systemic steroids. There were no further recurrent scrotal masses. Although sarcoidosis is known to affect many organs, involvement of the genital system is relatively rare. Most of the patients with intrascrotal sarcoid lesions have an abnormal chest X-ray. We need to differentiate these lesions from advanced testicular cancer. This is the 5th case of intrascrotal sarcoidosis in Japanese literature.     

Wandering spleen with torsion in a geriatric patient. Report of an unusual case with a brief review of the clinical picture and management

Wandering spleen is a rare condition that is extremely uncommon in the elderly. A case of wandering spleen with torsion in a 73-year-old female is described in detail. Our patient's presentation is unusual because in 1972, during a total hysterectomy, she had no evidence of a wandering spleen. Preoperative technetium-99 radionuclide liver-spleen studies were utilized to minimize the potential for vascular difficulties. Splenectomy was the treatment of choice for this condition and was performed to avoid splenic infarction. A review of the literature and etiologic considerations are discussed.     

External ear canal schwannoma: an unusual case report

To the best of our knowledge, this is the first report of external ear canal schwannoma in the English literature. Several detailed clinical and pathological features were demonstrated. We suggest that if a tender, encapsulated mass is found in the external ear canal, the diagnosis of schwannoma should be taken into consideration.     

Adenocarcinoma of the appendix: an unusual case and review

The use of the Systematised Nomenclature of Pathology as the basis of an indexing system to histopathological data is outlined. Two computer programs which perform the task of producing codes from free English summaries are compared. It is concluded that a simple system has a great deal to offer the pathologist who is prepared to accept a set of constraints.     

Hemoglobin sickle-lepore: an unusual case of sickle cell disease

We report the case of a newborn with a large left-sided congenital diaphragmatic hernia (CDH) who required extra corporeal membrane oxygenation (ECMO) for severe respiratory insufficiency. CDH repair had to be performed on bypass circulation. Intraoperatively, an atypical hemihepatectomy of the herniated lobe was conducted, because reposition of the liver led to a kinking of the vena cava and to a torsion of the right lobe, resulting in ischemia and compromised venous flow. The extraordinary anatomical indication and the potential danger of uncontrollable bleeding are discussed.     

Thyroxine abuse: an unusual case of thyrotoxicosis in pregnancy

The use of EMLA eutectic cream is very effective and well tolerated in superficial anaesthesia. It is particularly indicated in surgical treatment of inguinal hernia by local anaesthesia, to achieve the analgesia of superficial layers. This allows to reduce the total dose of anaesthetics administrated by infiltration, reducing the risk of overdose, eliminating the pain due to injection, and is very agreeable for the patients.     

Ulcerated carcinoma of the breast in an elderly woman. An unusual clinical case report

The authors analyze the most current methods for the treatment of ulcerated breast cancer in the elderly. They describe a peculiar case recently observed, characterized by an ulcerative lesion spreading from the hemiclavicle to the foreaxilla including the axillary cavity, causing a large phlebo-lymphaedema, anaesthesia and paresis of the homoteral upper limb. After an initial treatment with tamoxifen a scapulo-humeral disarticulation and a suture of the cutaneous wide defect were performed using a myo-skin graft which included the deltoid muscle. A radiotherapeutic treatment followed by tamoxifen therapy was carried out. No distant metastases and no local relapses were registered in the one year follow up. The Authors on the basis of their experience and according to the review of the Literature suggest that age itself is not a limiting factor to the therapeutic approach of ulcerated breast cancer.