Bronchial foreign body presenting as pneumothorax and pneumomediastinum in a young child.Rajendra Shilpakar1, Nipun Shrestha1, Dhruba Shrestha1*1 Siddhi Memorial Hospital (For Women and Children), Bhaktapur, Nepal.Keywords: Foreign body aspiration, Pneumomediastinum, Pneumothorax, Subcutaneous emphysema

“UNUSUAL COEXISTENCE: A CASE OF MIXED SMALL AND LARGE CELL NEUROENDOCRINE TUMOR IN A BLADDER PREVIOUSLY AFFECTED BY BILHARZIAL CYSTITIS”1Mohammed Saleh E. Khalifa SALEM,1Abdulhamid ALHEREK, 1Martin VAN ROOYEN, 1Alain Mwamba MUKENDI1University of the Witwatersrand, Division of Urology, Department of Surgery, Klerksdorp Hospital, Klerksdorp, Northwest, South Africa.*Corresponding AuthorAlain Mwamba MukendiCel: 0027711576350E-mail: [email protected]

Cutaneous leishmaniasis mimicking psoriasis: a case report

A document by Mohammad Dalili. Click on the document to view its contents.

IntroductionForeign body aspiration (FBA) is common at both extremes of age and is a potentially life-threatening event(1). Advanced age, alcohol intoxication, psychiatric illness, seizure disorders, stroke, neuromuscular disorders, sedative or hypnotic drugs, and chronic debilitating conditions predispose the elderly to FBA(2). Common foreign bodies (FBs) aspirated include metallic objects, organic substances, dentures, chicken or fish bones, and peas(3). FBA in the elderly poses a diagnostic and therapeutic challenge due to several factors. These include the masking of respiratory symptoms post-aspiration, atypical imaging findings, the patient’s inability to recall the aspiration event, and the challenges encountered during bronchoscopy(4). FBA usually follows a choking event, often during feeding. The patient might present with dyspnea, hemoptysis, cough, a fall in oxygen saturation, anxiety, etc.(5). The signs and symptoms depend on the size of the foreign body and the level of obstruction. Small objects lodged in distal airways seldom produce acute symptoms, while the opposite is true for larger FBs lodged in larger airways. Stridor is present if FBs are lodged in trachea(6). FBA results in collapse/hyperinflation of lungs aerated by the airway. If there is chronic obstruction, obstructive pneumonia, bronchiectasis, and lung abscess can develop(2). FBs generally lodge in the right middle and lower lobe bronchi(4). FBA causing acute airway obstruction and respiratory failure requiring urgent intervention.

Introduction Arteriovenous fistulas (AVFs) are a form of arteriovenous malformations clinically characterized by anomalous communications between arterial and venous systems that bypass the normal anatomic capillary beds (1). Broadly it can be divided into two forms based on the cause: acquired or congenital. Surgery, penetrating trauma, and percutaneous catheterization are the most common causes of acquired AVFs. Rarely AVFs can be formed in the absence of a clear cause and are called spontaneous AVFs which are rare with very few case reports in the literature (2-4). The anatomy of the fistula depends on the location in the body and where the causative factor was applied. Greater than 50% of traumatic AVFs happen in the lower extremity, and about one-third occur in the femoral vessels, while 15% take place in the popliteal vessels but AVF can occur at any site (5-8).AVFs present clinically with progressively growing pulsatile mass on each respective site associated with or without complications including infection, thrombosis, aneurysm, hypertension, and heart failure demanding timely intervention (9).

A document by Simeon Mengistu. Click on the document to view its contents.

Papaverine Effect on Superficial Vein in Thumb Replantation Procedure: A Case Study

“Chronic Periodontitis in a Patient with Multiple Sclerosis_ Case Report”Rayeheh Tavajohi1, Amitis Sarbaz2, Hooshyar Honarmand1, Abdorreza Naser Moghadasi3*1Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran2Georgia School of Orthodontics, Atlanta, Georgia, USA3Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, IranCorrespondence: Abdorreza Naser Moghadasi; Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran; Email: [email protected]

IntroductionHerpes simplex virus (HSV), is a member of an enveloped, double-stranded DNA virus family named Herpesviridae, this virus causes latent infection of neural ganglia(1). It has a worldwide distribution and a wide range of clinical presentations depending on the host’s immune status and the infection site. In immunocompetent individuals, the most common presentation includes painful vesicles and erosions on an erythematous base, which can evolve into pustules and/or ulcerations (2, 3). In immunocompromised individuals such as solid organ or bone marrow transplant recipients, patients with hematologic malignancies, and acquired immunodeficiency syndrome (AIDS), HSV infection can have atypical manifestations, including chronic non-healing ulcers, verrucous plaques, and large protruding tumors. In the case of immunosuppressed patients, the lesions may disseminate and occur at multiple sites, including atypical locations such as the buttocks, abdomen, and lower back. Depending on the level of immunosuppression, HSV infection can have a variable duration, severity, and outcome. It can affect multiple or atypical sites, such as the abdominal, and thoracic regions, or even become disseminated(4, 5). In this article, we report a case of cutaneous perianal infection that presented as warty skin-colored papules and plaques underline the challenges in the morphologic and clinical diagnosis of this entity, and review the literature on verrucous HSV lesions in non-HIV patients.

Sympathetic Ophthalmia Following an Evisceration Surgery – A Case Report

INTRODUCTIONPrimary tracheal tumors are rare. Commonly tracheal neoplasms are either squamous cell carcinoma or adenoid cystic carcinoma.1Tracheal Schwannoma are extremely rare and are more often found in the lungs and bronchi.2 Schwannoma’s are tumors that originate from tumorigenic Schwann cells attributed to loss-of-function mutations of NF type2 tumor suppressor gene.3 Standard treatment has not been established yet. Endoscopic resection has been widely used as a treatment modality but recurrence has always been a possibility. Previous literature has shown that optimal treatment is surgical resection and anastomosis of the involved trachea. Cases such as multiple tracheal schwannoma,4 transmural tracheal schwannoma,2,5 transmural schwannoma of trachea compressing the esophagus6 and plexiform schwannoma involving trachea and left recurrent laryngeal nerve7have been reported which were all treated by resection and anastomosis of involved trachea.We report a similar case of transmural tracheal schwannoma with extraluminal component of tumor extending into the left lobe of thyroid. Initially Nd:YAG laser ablation was performed to relieve the airway obstruction. Patient later underwent surgical resection with end to end anastomosis of trachea with en-bloc resection of left thyroid lobe. This case has been reported in line with the SCARE criteria.8KEY CLINICAL MESSAGE : Tracheal Schwannoma are rare neoplasms and can have spectrum of clinical presentation which causes diagnostic dilemma and delay in diagnosis. So far, tracheal resection and anastomosis has been the optimal management and follow up is essential.

IntroductionBlastic plasmacytoid dendritic cell neoplasm (BPDCN) is an uncommon hematologic malignancy originating from plasmacytoid dendritic cells (1). These cells harbor a specific immunophenotype, positive for CD4 and CD56 and negative for CD3 and CD19(2). The BPDCN is classified as a separate category besides acute myeloid leukemia and B/T cell leukemia/lymphoma in the 2022 World Health Organization Classification of Hematolymphoid Tumors 5th edition (1). It commonly involves skin, and skin lesions including nodules and papules can be the only disease presentation; however, it can involve bone marrow, lymph nodes and spleen (3, 4). Leukemic reaction may also occur. Breast tissue infiltration by BPDCN has been reported in one case (4). Aggressive course and poor prognosis of the patient as well as diagnosis difficulties for pathologists and clinicians are problems that have not been resolved so far. Here we describe a case of BPDCN, someone who presented with a forehead skin lesion with focus on histopathologic diagnosis. Immunophenotyping by immunohistochemistry methods confirmed the diagnosis.

Herpes simplex encephalitis complicated with vasculitis in a young Male: A case reportDr. Sebhatleab T.1, Dr.Abel T. 1Dr.Estifanos B2,Dr.Zablon M 3, Dr.Merchaye A.3, Dr. Raja T.41. Department of Internal Medicine, School of Health Sciences, Addis Ababa University, Addis Ababa.2.Department of Neurology, School of Health Sciences, Addis Ababa University, Addis Ababa3.Bethzatha General Hospital, Addis Ababa, Ethiopia4.Department of Radiology, School of Health Sciences, Addis Ababa University, Addis Ababa

An unusual case of ventral spontaneous thoracic epidural hematomaJunge ZhouDepartment of Neurosurgery, General Hospital of The Yangtze River Shipping, Wuhan Brain Hospital, Wuhan, Hubei 430010, ChinaE-mail: [email protected]: 15827617486Fax Number: +86-027 -82451001Patient consent: Written informed consent was obtained from the patient for the publication of this manuscript.Ethics approval: This research was approved by the ethics committee of General Hospital of The Yangtze River Shipping.Acknowledgments: We would like to thank Editage (www.editage.cn) for English language editing.Funding source: None.Conflicts of interest: None.Data access statement:  The data used to support the findings of this study have been included in this article.

A document by Moushami Singh. Click on the document to view its contents.

Introduction:Invasive cribriform carcinoma of the breast, initially described by Page et al in 1983 due to its predominant cribriform growth pattern in the invasive component and relatively favourable prognosis, is a rare type of breast carcinoma, accounting for 0.3 to 3.5% of primary breast carcinomas [1, 2]. ICC patients typically have a small tumour size, few axillary lymph node invasion, low distant metastasis rate, tumour with a high frequency of well differentiation, high ER and PR positive rates with rarely-observed human epidermal growth factor receptor 2 (HER2) amplification and a low proliferation index [3, 4, 5]. To date, studies of skin manifestations of invasive cribriform breast of the breast are notably scarce. We herein report a patient of ICC with a presentation as an erythematous papule on the nipple that no one has reported before.Case history / examination:A 71-year-old Asian woman visited our Department of Dermatology with a chief complaint of a reddish protruding skin lesion on the tip of her right nipple that had appeared for 6 months. Upon physical examination, the skin lesion was a solitary, well-demarcated papule, 0.2 by 0.2 cm in size, appearing centrally erythematous with violaceous in the periphery, fairly dome-shaped and firm [Figure 1a-c]. Besides, the papule was completely asymptomatic. The patient did not report any other abnormal symptoms. Her medical history was also unremarkable.Differential diagnosis and investigations:With these clues, a benign skin lesion had been impressed. Therefore, a local excision was performed to obtain a specimen of 0.7 by 0.5 by 0.3 cm in size. Biopsy results turned out to be pure invasive cribriform carcinoma of the breast (pure ICC), characterized by the invasive cribriform pattern comprising >90% of the lesion, in addition to mammary Paget’s disease (MPD) in the epidermis [Figure 2a-c]. Immunohistochemical tests showed positive expressions of both oestrogen and progesterone receptors [ER >95%, PgR >95%]. The reaction to HER2 (human epidermal growth factor receptor type 2) protein was negative [HER 2 (-)] [Figure 3a-c]. The Ki-67 labelling index was 5 %.Treatment, outcome and follow-up:In the diagnosis of pure ICC with MPD, she was referred to the Breast Surgery Department for further survey and treatment. Results on both CEA and CA15-3 levels were normal. Bilateral breast mammography (CC and MLO view) revealed segmental fine pleomorphic microcalcifications in the lower-inner quadrant of her right breast. These findings raise high suspicion for malignancy and are consistent with a classification of 4C in the BIRADS-US system. Breast ultrasound revealed two oval hypoechoic lesions with tiny calcifications which were 7.8 mm and 24.5 mm in size at the right breast near the areola. Whole body bone scan found no evidence of bone metastasis. With a previous biopsy pathology report revealing ICC and MPD, a full discussion was carried out with the patient. Finally, a simple mastectomy and sentinel lymph node biopsy were performed on her right breast.With the right side simple mastectomy, pathology of the surgical specimen showed residual multifocal ductal carcinomas in situ. Both frozen sections of sentinel lymph nodes revealed no evidence of metastasis. The pathological TNM stage was pT1aN0 according to AJCC eighth edition. Further treatment plans for this patient included a five-year Tamoxifen therapy and regular follow-up at the Breast Surgery Department.Discussion:Based on the clinical features of the papule on her nipple, our initial impressions were benign skin lesions such as pyogenic granuloma, nipple adenoma, Spitz nevus and intradermal nevus. However, the pathologic diagnosis was pure ICC with MPD in the epidermis. Although ICC usually presents as an asymptomatic mass or may even be clinically occult[1, 3], the chance of ICC presenting as skin lesions cannot be ignored. The case reported by Katarzyna et al, in which ICC mimicked a breast abscess [6], along with our case of ICC presenting as a nipple papule, collectively demonstrates ICC’s potential to primarily manifest through skin lesions. To the best of our knowledge, ICC is a tumour having a more favourable prognosis than invasive breast carcinoma with less cribriform pattern and low grade invasive ductal carcinoma [11]. Despite favourable prognosis of ICC, there are still chances of aggressive behaviour or development into an advanced stage if left untreated long enough. Mishra et al reported a case of ICC with extensive perineural infiltration and lymphovascular invasion in a 58-year-old female; and Zhang et al also reported a case of pure ICC with bone metastasis when left untreated for 13 years[7, 8]. Therefore, such manifestation of a papule on the nipple, as in our case, may result in delayed diagnosis and treatment to ICC. It is crucial for dermatologists to have early awareness about skin manifestation of ICC and to avoid misdiagnosis.Mammary Paget’s disease (MPD), first described by Sir Paget in 1874 as eczematous nipple and areola skin lesions, is a rare form of breast carcinoma comprising 1 to 3% of all breast cancers. Nearly all cases of MPD are affiliated with underlying breast carcinomas, typically located near the areola, and >90% are either ductal carcinomas in situ (DCIS) or invasive ductal carcinomas (IDC). Pathophysiologically, there are two main hypotheses proposed for the origin of MPD: the epidermotropic theory and the malignant transformation theory. The epidermotropic theory states that Paget cells originate from underlying breast carcinoma, and they migrate via the lactiferous ducts to the epidermis of the nipple. On the other hand, the malignant transformation theory states that Paget cells are malignant transformation of pluripotent keratinocyte stem cells or cells of apocrine gland ducts[9]. Although remains controversial, it is currently widely accepted that MPD is associated with underlying breast carcinoma, forming the concept based on the epidermotropic theory. In our case, ICC and MPD were diagnosed within the papular lesion on the nipple. This case stands out from >90% of cases in which mammary Paget’s disease was diagnosed exclusively with underlying DCIS or IDC. Furthermore, to the best of knowledge, only one publication focusing on radiologic characteristics of 52 MPD cases mentioned a case of invasive lobular and invasive cribriform carcinoma being diagnosed with mammary Paget’s disease presenting as a mass on mammography[10], but details or images were not provided. As to our case, it is worth knowing that the patient was diagnosed with multifocal DCIS at 1 cm near the right areola in the surgical specimen from simple mastectomy. In our opinion, it was the invasive cribriform carcinoma of the breast but not DCIS resulting in the mammary Paget’s disease in the epidermis of the papule [Figure 2c] as consistent with the epidermotropic theory. Although DCIS has been diagnosed near the areola, we believe that the chance of mammary Paget’s disease originating from the DCIS was slim. That is because malignant Paget cells were not seen at other parts of the nipple nor at the areola, but merely in the epidermis of the papule on the nipple. Furthermore, based on pathologic images, the gross pictures and the clinical manifestations of ICC and MPD, we believe that the invasive cribriform carcinoma of breast had caused the dome-shaped violaceous papule on the nipple, and mammary Paget’s disease contributed to the central erythematous part of the papular lesion [Figure 1a]. Undoubtedly, more studies are needed to bring attention to the skin manifestation of invasive cribriform carcinoma of the breast. As far as we know, no publication has ever reported on ICC with skin manifestation as a papule on the nipple. Also, no case has been reported with detailed images and descriptions regarding a pure ICC being diagnosed with MPD. In this case report, we aim to bring awareness to skin manifestation of ICC.References:1. Cong Y, Qiao G, Zou H, Lin J, Wang X, Li X, et al. Invasive cribriform carcinoma of the breast: A report of nine cases and a review of the literature. Oncol Lett. 2015;9: 1753-1758.2. Page DL, Dixon JM, Anderson TJ, Lee D, Stewart HJ. Invasive cribriform carcinoma of the breast. Histopathology. 1983;7: 525-36.3. Zhang W, Zhang T, Lin Z, Zhang X, Liu F, Wang Y, et al. Invasive cribriform carcinoma in a Chinese population: comparison with low-grade invasive ductal carcinoma-not otherwise specified. Int J Clin Exp Pathol. 2013;6: 445-57.4. Mo CH, Ackbarkhan Z, Gu YY, Chen G, Pang YY, Dang YW, et al. Invasive cribriform carcinoma of the breast: a clinicopathological analysis of 12 cases with review of literature. Int J Clin Exp Pathol. 2017;10: 9917-9924.5. Liu J, Zheng X, Han Z, Lin S, Han H, Xu C. Clinical characteristics and overall survival prognostic nomogram for invasive cribriform carcinoma of breast: a SEER population-based analysis. BMC Cancer. 2021;21: 168.6. Dobruch-Sobczak K, Roszkowska-Purska K, Chrapowicki E. Cribriform carcinoma mimicking breast abscess - case report. Diagnostic and therapeutic management. J Ultrason. 2013;13: 222-9.7. Zhang W, Lin Z, Zhang T, Liu F, Niu Y. A pure invasive cribriform carcinoma of the breast with bone metastasis if untreated for thirteen years: a case report and literature review. World J Surg Oncol. 2012;10: 251.8. Mishra S, Yadav K, Singh Anshul, Misra Vatsala, Chaudhary Kuldeep. Unusual case of Invasive Cribriform Carcinoma of Breast (ICC). JCR [serial online] 20219. Lopes Filho LL, Lopes IM, Lopes LR, Enokihara MM, Michalany AO, Matsunaga N. Mammary and extramammary Paget’s disease. An Bras Dermatol. 2015;90: 225-31.10. Günhan-Bilgen I, Oktay A. Paget’s disease of the breast: clinical, mammographic, sonographic and pathologic findings in 52 cases. Eur J Radiol. 2006;60: 256-63.

ABSTRACT.Squamous cell carcinoma (SCC) of the bladder is a rare urologic malignancy, estimated to affect 3% to 5% of the bladder. Squamous cell carcinoma (SCC) of the bladder remains the most common subtype throughout Africa. Most literatures focused on management of Transitional cell carcinoma(TCC) with fewer discussion in SCC management. TCC typically presents with painless hematuria, whereas SCC presents with painful hematuria, bladder mass, and necroturia. SCC is mostly radioresistant and does not respond to chemotherapy. The mainstay treatment is Partial Cystectomy or radical cystectomy, which can be performed through open surgery, laparoscopic or robot-assisted approach, all techniques with acceptable results. We report a case with favourable outcome following partial cystectomy which was managed by open surgery. In a 12months follow up the patient remained asymptomatic with good surgical outcome.