Cases reported "Disease Progression"

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21/53. An unusual case of CV junction tuberculosis presenting with quadriplegia.

    STUDY DESIGN: Isolated tubercular involvement of craniovertebral junction in a human immunodeficiency virus-positive patient causing paraplegia and sudden death with radiologic features is presented. OBJECTIVES: Isolated involvement of craniovertebral junction by tuberculosis causing quadriparesis is a rare entity. The role of imaging features is presented in diagnosis of craniovertebral junction tuberculosis, which is a treatable disease. Early detection of this entity with prompt treatment can prevent a fatal outcome. SUMMARY OF BACKGROUND DATA: tuberculosis of the cervical spine is a rare and potentially dangerous manifestation of extrapulmonary tuberculosis. The incidence is probably less than 1% of all cases of spinal tuberculosis. However, in the developing countries this constitutes an increasingly important cause of craniovertebral junction instability and cervicomedullary compression. Most of the patients present with pain in the neck and local tenderness. Neurologic deficits of varying degrees have been reported in 24-40% of cases of craniovertebral junction tuberculosis. quadriplegia followed by sudden death is exceptional (as seen in our case). The incidence of craniovertebral junction tuberculosis in immunocompromised patients is not known. Dramatic recovery is possible if craniovertebral junction tuberculosis is detected early in its course. Prompt medical and surgical treatment may avert a potential catastrophic event in such cases. Imaging methods such as computed tomography and magnetic resonance imaging are diagnostic of this condition and aid in the detection and prompt treatment of the same. METHOD: Frontal radiograph of the cervical spine and chest, and lateral view of cervical spine followed by plain and contrast enhanced computed tomography scan of the cervical spine was performed to detect the lesion. RESULT: These radiographic features were correlated with the clinical findings. The computed tomography findings of bone destruction, prevertebral and extradural peripherally enhancing soft tissue and infiltrating opacities in the lung apexes were consistent with tuberculosis. CONCLUSIONS: The computed tomography findings described in this report are very specific for tuberculosis of the craniovertebral junction. Clinical and radiologic correlation could help in making the early diagnosis and prompt treatment possible.
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22/53. A case confirming the progressive stages of pyomyositis.

    A teenage boy presented in the early stage of pyomyositis. He had neck pain, tenderness, and fever. A computed tomography scan showed inflammation in the sternocleidomastoid muscle with no fluid collection. This progressed to a pus-filled drainable mass caused by Stapylococcus aureus. The authors describe this case to highlight the predictable stages and increase the index of suspicion to enhance its early recognition.
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23/53. Depressed host immunity in a case of metachronous primary uterine papillary serous carcinoma and non-Hodgkin's lymphoma.

    Metachronous primary malignant tumors of uterine papillary serous carcinoma (UPSC) and non-Hodgkin's lymphoma (NHL) are rare. UPSC is a clinically aggressive and morphologically distinctive variant of endometrial carcinoma. We describe the clinical features of a 63-year-old patient with UPSC that was found 2 years after chemotherapy for malignant lymphoma of neck, stage IV and 5 months after radiation therapy for recurrence. This patient had undergone staging surgery and postoperative radiation for UPSC. One month after completion of radiotherapy, the patient expired due to persistence of the disease. The association between host immunity and UPSC is rarely described in the literature. Immunological profiles of this patient, with compositional changes of natural killer, B, and T cell, dramatically altered the percentage of CD4( ) T cell, CD8( ) T cell, and CD4/CD8 ratio, signifying depressed host immunity. Immunological profile of this patient stressed the issue of depressed host immunity and associated malignancies.
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24/53. Intracranial spread of Merkel cell carcinoma through intact skull.

    We report an unusual case of Merkel cell carcinoma presenting as a frontal scalp mass with apparent invasion into underlying brain parenchyma through grossly intact calvaria. Despite wide local excision, craniectomy, intracranial tumor resection, and postoperative adjuvant irradiation, widespread systemic metastases resistant to chemotherapy developed, and the patient died 9 months after surgery. This case report confirms that Merkel cell carcinoma of the head and neck, already known to be an aggressive tumor, has the capacity for rapid intracranial extension. We propose that in this case, the mechanism of intracranial metastasis was via communicating veins rather than through bone destruction or systemic metastasis. Appropriate preoperative imaging should be carried out to define the extent of this tumor when it is adjacent to the skull. We found contrast-enhanced magnetic resonance imaging to be superior to computed tomography for defining soft tissue extent and marrow space involvement within underlying bone.
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25/53. Upper and lower eyelid reconstruction for severe disfiguring necrobiotic xanthogranuloma.

    BACKGROUND: necrobiotic xanthogranuloma is a rare disease featuring generalized xanthomatous inflammatory skin lesions associated with paraproteinemia and possible lymphoproliferative diseases. Eyelid involvement can be unilateral or bilateral and ranges from minor xanthelasma-like lesions to severe ulcerative disease with consecutive keratitis and scleritis. CASE REPORT: The authors report the case of a 67-year-old woman with extensive necrobiotic xanthogranuloma involving the eyelids, head and neck, anterior chest, and both upper and lower extremities. Periorbital involvement caused severe upper and lower lid ectropium with chronic conjunctival inflammation and unilateral exposure keratitis. During a persistent period of low disease activity, granulomatous lesions and scars were widely excised, lids partially shortened and large full-thickness skin grafts applied. Uninvolved parts of the upper arms had to serve as donor sites, as other possible donor sites were not available. After successful reconstruction of the left side and no local recurrence of the disease, the right side was corrected in the same way. Full eyelid closure was achieved and skin grafts healed without complications. No recurrence of the disease appeared at the sites of operation, despite continuous new lesions elsewhere. CONCLUSION: Severe cicatricial eyelid deformation caused by necrobiotic xanthogranuloma can be treated with success by excision and free skin grafting. The mechanisms of recurrence at excision sites described by others remain unclear, but at least during phases of low activity, the described treatment is safe and recurrence is not to be expected.
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26/53. Cervical spine metastasis of multiple myeloma: a case report with 16 years of follow-up.

    STUDY DESIGN: Presented is a case report of a 16-year clinical course of a patient with a multiple myeloma of the third cervical vertebra. OBJECTIVE: To describe a rare 16-year follow-up of a cervical multiple myeloma lesion that forced several surgical interventions. SUMMARY OF BACKGROUND DATA: multiple myeloma is a systemic malignancy. It slowly causes bone destruction due to bone marrow infiltration. It is more common in the elderly and rarely affects the young. In patients with continuing neck pain and headache, one has to bear in mind the rare possibility of multiple myeloma or also other malignancies affecting the cervical spine. MATERIALS AND methods: Clinical case analysis, radiographs, magnetic resonance images, and histological sections of the lesion are discussed. Repeated surgical interventions were required due to progressive disease. RESULTS: Initial surgical treatment was aimed at palliation. However, this was in contrast to the slowly progressive clinical course. Thus, further surgical interventions were necessary. The patient died 16 years after the first procedure due to progression of the disease. CONCLUSION: Even in young patients presenting with neck pain and minor neurological symptoms, one should bear in mind the rare possibility of multiple myeloma. At the very least, a radiograph of the cervical spine and a routine blood test should be performed. Surgical interventions must take into account the relatively long period of survival in multiple myeloma patients compared to patients with other secondary bone tumors.
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27/53. Compartmentalization of massive vascular malformations.

    A total of 18 patients with massive vascular malformations of the head and neck region were treated with compartmentalization using nonabsorbable sutures followed by injection of a sclerosant agent into each compartment. The indication for compartmentalization was either to stop potentially uncontrollable, life-threatening hemorrhage during the dissection of the lesion or to reduce its vascularity to allow a less dangerous subsequent resection. Compartmentalization was used in both high-flow and low-flow vascular malformations. In this technique, large nonabsorbable sutures are placed deeply in multiple areas within the lesion. The aim is to divide the malformation into multiple compartments by changing the direction of the suturing; in this way the sclerosing agent is provided with a more effective environment. The sclerosant used was either sodium tetradecyl sulfate 3%, absolute alcohol, or both. The total amount of infiltrate varied from 3 to 35 cc, according to the size of malformation. After compartmentalization, swelling was the most noticeable complication. With this technique, it was possible to treat what were considered untreatable malformations using standard techniques and to control the inevitable serious bleeding.
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28/53. Cystic hygroma in a tactical aviator: a case report.

    Cystic hygroma of the neck is a benign, congenital tumor of lymphatic origin rarely seen in adults, with approximately 100 cases presented in the literature. The etiology of this lesion is poorly understood, with spontaneous occurrence, upper respiratory infection, or trivial trauma being suggested. We present a recent unique case report of an adult male tactical aviator who experienced a progressively enlarging cystic hygroma of the neck over a 2-week period without history of infection or obvious trauma. This case is unusual in that there may have been an element of continuous microtrauma to the area given the individual's occupation and required flight head gear. A successful surgical dissection and removal of the cystic hygroma was performed. A discussion and brief literature review of cystic hygroma in adulthood is presented.
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keywords = neck
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29/53. Secondary cardiac tumour originating from laryngeal carcinoma: case report and review of the literature.

    Although most malignant tumours metastasize to the heart they rarely produce clinical symptoms. Cardiac metastasis of tumours arising from head and neck and particulary of the larynx are extremely rare. Herein we report an unusual case of successfully treated, advanced laryngeal carcinoma with subsequent late symptomatic metastatic disease to the heart. The patient discussed, developed a right ventricular intracavitary tumour with pseudo-infarct pattern on the ECG. Current litterature regarding incidence, diagnostic techniques, treatment modalities and survival rates of secondary heart tumours are reviewed.
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30/53. Vesiculobullous eruption from intense pulsed light treatment.

    BACKGROUND: Intense pulsed light (IPL) systems emit non-coherent, polychromatic light and are increasingly used for various dermatologic indications. Although generally regarded as safe therapy, IPL is not without risk. OBJECTIVE: We report a 21-year-old woman who experienced a severe blistering eruption after IPL treatment by a nonphysician. MATERIALS AND methods: Case report. RESULTS: The patient reported a 10-year history of persistent redness on her medial and lateral cheeks. She had tried no previous oral or topical therapies. She was diagnosed with rosacea and was treated with IPL. The following day, intense vesiculation and bullae formation occurred, progressing to dramatic facial edema by day 3 and eschar formation by day 5. Ten weeks later, prominent erythema with papularity remained on both cheeks and the lateral neck, with textural change and reticulated dyschromia. She continued to recover 20 weeks after treatment. CONCLUSION: This case most likely represents high-fluence photothermal tissue injury induced by the laser-like qualities of the IPL source, with resulting acantholysis leading to formation of vesicobullae in the context of an uncertain primary diagnosis. This case highlights the potential hazards of IPL therapy and raises questions regarding appropriate use of this medical technology.
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