Huge inflammatory pseudotumor of the spleen with postoperative portal vein thrombosis: report of a case

We report the rare case of a splenic inflammatory pseudotumor associated with massive splenomegaly, diagnosed after surgery. A 51-year-old woman was admitted to our hospital for investigation of anemia. Physical examination revealed a palpable left upper quadrant mass. Computed tomography and magnetic resonance imaging showed a splenic mass, 20 cm in diameter. We performed splenectomy for both diagnosis and treatment. The spleen weighed 2400 g, and histologic examination of the mass confirmed an inflammatory pseudotumor. Portal vein thrombosis (PVT) developed the day after surgery, but resolved with anticoagulation therapy. This case highlights that there is a risk of PVT after splenectomy in patients with massive splenomegaly, and that anticoagulant therapy should be initiated promptly.     

Bilateral adrenal metastasis as first clinical manifestation of pulmonary carcinoma: report of a case and review of the literature

Bilateral adrenal metastases are rare, and the first manifestation from non-small cell lung cancer is also exceptional. We report a case of bilateral adrenal metastases from a poorly differentiated lung adenocarcinoma in a 50 year-old-man. The treatment was local excision of tumor and the diagnosis was histological. We comment the clinical presentation, diagnosis, treatment and evolution of this case, with special attention to the histopathological analysis of this lesion and literature review.     

Chronic diarrhea as a first manifestation of small cell lung cancer. A case report]

We report the case of a 57-year-old man presenting with chronic diarrhea for more than three months and a solitary pulmonary nodule of the right upper lobe. After atypical resection, showing a clinical stage I small cell lung cancer (SCLC), a lobectomy combined with a systematic mediastinal lymphadenectomy were performed. The histopathological examination revealed a pT1, pN0, SCLC. Postoperatively, the diarrhea improved for four weeks. The patient developed septic complications after adjuvant chemotherapy and died two months after the diagnosis was established. After exclusion of other causes for chronic diarrhea we suppose that the patient's diarrhea can be considered as an atypical paraneoplastic syndrome of SCLC.     

Sternal metastasis as first manifestation of a papillary thyroid carcinoma: A case report

IntroductionPapillary thyroid carcinomas (PTC) are differentiated forms of thyroid carcinoma. Sternal metastases from differentiated thyroid cancers (DTCs) are rare and are of particular prognostic interest. Radioiodine therapy has traditionally been the treatment of choice for metastases from differentiated thyroid cancers; however, bone metastases are known to be resistant to this form of treatment. Surgical resection of distant metastases from DTCs offers a better chance of achieving long survival and a better quality of life. We report the case of a 59-year-old women who presented a presternal mass for one year revealing metastatic papillary thyroid carcinoma, a total thyroidectomy with lymph node dissection and reconstruction of the sternal defect were performed. Overall, we demonstrate that radical resection of sternal metastases can be performed safely even in patients with poor prognosis to achieve palliation and potentiation of Radioiodine therapy.Case reportThis is a 59-year-old women referred by the endocrinology service for a sternal metastasis of a papillary thyroid carcinoma, who presented a painless, firm and fixed presternal mass for one year, a total thyroidectomy with lymph node dissection was performed with En-bloc resection and reconstruction as a one-stage procedure. Reconstruction of the chest wall was obtained by the rigid reconstruction with titanium bars and coverage with polymesh dual prosthesis, followed by radioiodine therapy and substitution with L-thyroxine. The patient is currently in good health condition, and does not present any complications and was in euthyroidism under substitution for the long term follow up.DiscussionThyroid cancer is the fastest increasing cancer in the United States, It is expected to replace colon cancer as the fourth leading cancer by 2030.2 More than 90% of thyroid carcinoma cases are classified as papillary or follicular carcinoma, both referred to as differentiated thyroid carcinomas (DTCs) and are associated with a 97%–98% 10-year survival rate. However, this rate can decrease to 14%–21% when patients present with bone metastases. Bone metastases have been reported to occur in 2%–13% of patients with DTC (Osorio et al. [1]). Several techniques have been used to repair after wide sternal resection for metastatic malignancies. Furthermore, choice of the reconstruction techniques depends on the size and the site of the defect and the preference of the surgeon (Lequaglie et al. [2]).ConclusionSternal metastases from papillary thyroid carcinomas are rare,few cases of sternal metastasis as first presentation of a well-differentiated PTC are described in the literature. Operative management of these metastases is still controversial, but radical resection offer patients an optimal probability of long-term survival.     

Inflammatory breast cancer presenting with acute central venous thrombosis: a case report

Inflammatory breast cancer is a relatively rare disease associated with varied presentations, which frequently obscure the underlying diagnosis. We discuss a 54-year-old woman who presented to our emergency department with a chief complaint of right arm swelling and was admitted to the surgical service with an initial diagnosis of spontaneous brachial, axillary, and subclavian venous thrombosis. Further workup revealed an extensive inflammatory breast cancer. To our knowledge there have been no literature reports of inflammatory breast carcinoma in which the sole presenting symptom complex was due to central venous thrombosis.     

Intrameningioma metastasis as first clinical manifestation of occult primary breast carcinoma

Metastasis from extracranial tumor into an intracranial primary tumor is an uncommon event. A predominant tendency of meningioma to be the host tumor for breast carcinoma has been found. In the current report, three cases of breast carcinoma metastatic to intracranial meningiomas are described. In our cases, metastasis in meningioma was the first clinical manifestation of the occult primitive breast carcinoma. We review widely the literature concerning such rare occurrences and discuss all the postulated pathogenetic mechanisms. There are few cases reported in the literature on resonance magnetic imaging of metastatic carcinoma in meningioma. Two of our patients have been studied by MRI, but we do not find predictive radiological finding of this particular association.     

Cystic adventitial disease of the femoral vein presenting as deep vein thrombosis: a case report and review of the literature

Cystic adventitial disease of veins is a rare condition. We report the case of a 28-year-old man who presented with a swollen leg secondary to obstruction of the common femoral vein as a result of this disease. He underwent excision of the cyst and made a full recovery. The presentation, investigation, treatment and pathology of this condition is discussed.     

Portal vein thrombosis after total knee replacement: a case report

We present a 74-year-old woman who developed a portal vein thrombosis following an elective total knee replacement. She had atrial fibrillation for which she was taking warfarin for anticoagulation. Seven days prior to surgery, she was instructed to discontinue warfarin and replace it with prophylactic low-molecular-weight heparin. On postoperative day 1, routine blood tests revealed deranged hepatic synthetic function, despite standard anticoagulation management. Doppler ultrasonography confirmed a portal vein thrombosis. She was treated with therapeutic doses of low-molecular-weight heparin until her international normalised ratio reached therapeutic levels. Her liver function results had normalised 2 weeks later. Portal vein thrombosis is a potentially fatal complication that is reversible if identified and treated early.     

Posttransplant bilioportal fistula with portal vein thrombosis: a case report

An 8-year-old female patient, known to have post-Kasai biliary atresia with mild intrapulmonary shunting, underwent living donor liver transplantation because of recurrent cholangitis. After the treatment of postoperative biliary stricture with percutaneous transhepatic biliary drainage, the patient subsequently developed hematochezia with portal vein thrombosis. The intraoperative findings showed portal vein thrombosis with a bilioportal fistula. We performed closure of the bilioportal fistula and reconstruction of the portal vein with a native internal jugular vein interposition graft. A bilioportal fistula due to percutaneous hepatobiliary procedures is a reportedly a rare complication following liver transplantation. The patient is currently doing well after a successful surgical intervention.     

Phlebectasia of the external jugular vein with thrombosis: report of a case

An 81-year-old male presented with a soft mass on his neck noted in the supine position. After undergoing an operation for an inguinal hernia, the mass was noted to persist regardless of the patient’s position. Computed tomography and magnetic resonance imaging revealed phlebectasia of the external jugular vein with an associated thrombosis. Under general anesthesia, the external jugular vein was ligated and removed, along with the thrombus. A histological section revealed that the tunica media of the external jugular vein was absent, and the smooth muscle layer and elastic fibers were attenuated in the fusiform area of the vein. Due to the risk of propagation of the clot and pulmonary embolism, resection of the external jugular vein is advised in cases of phlebectasia of the external jugular vein.     

Venous congestion of the breast mimicking inflammatory breast cancer: case report and review of literature

Abstract:  Unilateral breast edema can be worrisome for inflammatory breast cancer. We review the literature and present a clinical case of a patient presenting with features concerning for inflammatory breast cancer, but in fact were the result of dialysis access related venous congestion of the breast.     

Axillary giant lipoma: a case report

Lipoma are the most frequent mesenchymal soft tissue tumours but rarely present huge sizes in their cutaneous localization. Some cases of so-called "giant lipomas" have been reported in the literature and here is presented a giant lipoma of the axillary area which is, to our best knowledge, the second report of such a giant lipoma in this localization.     

Pulmonary thromboembolism secondary to left spermatic vein thrombosis: a case report

Spermatic vein thrombosis is a particularly rare entity which can be difficult to diagnose. Pulmonary embolism associated with spermatic vein thrombosis is rarely seen. We report the diagnosis and management of a case at our institution and recommend spermatic vein ligation as the definite treatment for thrombosed spermatic veins associated with pulmonary thromboembolism. We prefer laparoscopy as a minimally invasive approach because of its clear advantages over open surgery.     

Glomerular deposition of immune complexes as a first manifestation of malignant melanoma – a case report

Introduction: Immune complex (IC) deposition in renal tissue is considered as a possible tumor marker. This raised the hypothesis that some tumor markers might be related to the patient prognosis, with emphasis in the possibility to detect them in tissue sample, not only in blood. We report a patient with membranous glomerulonephritis (MGN) and tumoral IC deposition that were detected previous to the diagnosis of melanoma. Case report: A 55-year-old male was admitted to our department with symptoms of renal disease; a kidney biopsy was performed and the diagnosis was phase II MGN. A few months later he returned to the hospital with ascites, dyspnea, anorexia, and macular erythematous skin lesions in the body. A new urinalysis showed proteinuria, hematuria, and leukocyturia; the chest X-ray showed a lung nodule; and a brain CT scan revealed a frontal nodular lesion, suggesting metastasis. The brain biopsy suggested the diagnosis of metastatic melanoma and a posterior kidney immunohistochemistry study with S-100 and HMB-45 antibodies showed glomerular and tubular positivity for these markers. Conclusions: MGN and deposition of tumoral IC as a first manifestation of melanoma has not been previously reported. This case reinforces the importance of a clinical evolution focused on the diagnosis of a hidden cancer in patients with MGN. Oncologists should also be aware of the potential occurrence of glomerular lesion in their patients and that could be important during tumor therapy.     

Portal vein arterialization for liver transplantation with extensive portomesenteric vein thrombosis: a case report

We report herein a case of extensive thrombosis of portal venous system including mesenteric vein in a 70-year-old man who suffered from end-stage post-hepatitis C cirrhosis and who underwent orthotopic liver transplantation. There was no way to divert portal blood flow to the new liver because such an extensive thrombosis of portomesenteric venous system. There are some case reports of portocaval hemitransposition with some success but high mortality. We decided to arterialize the portal vein of the liver allograft with the recipient hepatic artery and the donor hepatic artery was anastomosed to the supraceliac aorta. He recovered slowly from the operation. At 1 year after the transplantation, he is doing well with perfect liver function tests. This case challenges our belief that portal blood flow is essential for the liver because of hepatotrophic factors.