Combined immune checkpoint inhibitors of CTLA4 and PD-1 for hepatic melanoma of unknown primary origin: A case report

paythelady.612 shared this article with you from Inoreader Combined immune checkpoint inhibitors of CTLA4 and PD-1 for hepatic melanoma of unknown primary origin: A case report Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Apr 16;9(11):2641-2648. doi: 10.12998/wjcc.v9.i11.2641. ABSTRACT BACKGROUND: Melanoma is uncommonly found in lymph nodes, subcutaneous tissue, or visceral organs without a primary lesion, where it is identified as metastatic melanoma with unknown primary (MUP). Hepatic MUP is extremely rare and has a poor prognosis. There is limited information on its pathogenesis, clinical and imaging features, and pathological findings. There are no guidelines for the use of immune checkpoint inhibitors (ICIs) in hepatic MUP, and the treatment outcome has rarely been reported. CASE SUMMARY: A 42-year-old woman presented to our hospital with hepatic tumors found incidentally during a routine check-up. Contrast-enhanced abdominal com-puterized tomography showed multiple mass lesions in the liver. Pathological results revealed melanoma, which was confirmed by immunohistochemical staining for HMB-45(+), Melan-A(+), S-100(+) , and SOX10(+). There was no evidence of primary cutaneous, ocular, gastrointestinal, or anal lesion on a comprehensive examination. The patient was diagnosed with hepatic MUP. She received combined antibodies against cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4, ipilimumab) and programmed death protein-1 (PD-1, nivolumab). She died of hepatic failure 9 mo after hepatic MUP was diagnosed. This the first case of hepatic MUP treated with combined ipilimumab and nivolumab, who showed better outcome than previous cases. CONCLUSION: Combined ICIs of PD-1 and CTLA-4 may be considered as the first-line therapy for patients with hepatic MUP. PMID:33889631 | PMC:PMC8040165 | DOI:10.12998/wjcc.v9.i11.2641 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Cerebellar artery infarction with sudden hearing loss and vertigo as initial symptoms: A case report

paythelady.612 shared this article with you from Inoreader Cerebellar artery infarction with sudden hearing loss and vertigo as initial symptoms: A case report Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Apr 16;9(11):2519-2523. doi: 10.12998/wjcc.v9.i11.2519. ABSTRACT BACKGROUND: Sudden hearing loss (SHL) is associated with serious systematic conditions such as neoplasms, vascular events, autoimmune diseases, infections, and iatrogenic injury. Some authors report that SHL can be an early warning sign of impending vertebrobasilar ischemic stroke. It is important to distinguish stroke from benign disease. CASE SUMMARY: A 48-year-old male patient presented with SHL and vertigo as first symptoms. Diffusion-weighted imaging revealed high signal intensity in the left posterior inferior cerebellar artery territory of the cerebellar hemisphere and high signal intensity in the right pons and bridge cerebellar arm, confirming that the patient had cerebral infarction. Treatment with antiplatelet drugs, steroid anti-inflammatory drugs, and neurotrophic nerve therapy promoted blood circulation and removed blood stasis , and the symptoms of the patient were significantly improved. CONCLUSION: SHL and vertigo could be the initial symptoms of vertebrobasilar ischemic stroke. PMID:33889616 | PMC:PMC8040184 | DOI:10.12998/wjcc.v9.i11.2519 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Cholangiojejunostomy for multiple biliary ducts in living donor liver transplantation: A case report

paythelady.612 shared this article with you from Inoreader Cholangiojejunostomy for multiple biliary ducts in living donor liver transplantation: A case report Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Apr 16;9(11):2649-2654. doi: 10.12998/wjcc.v9.i11.2649. ABSTRACT BACKGROUND: Laparoscopic living donor hepatectomy (LLDH) has been successfully carried out in several transplant centers. Biliary reconstruction is key in living donor liver transplantation (LDLT). Reliable biliary reconstruction can effectively prevent postoperative biliary stricture and leakage. Although preoperative magnetic resonance cholangiopancreatography and intraoperative indocyanine green cholangiography have been shown to be helpful in determining optimal division points, biliary variability and limitations associated with LLDH, multiple biliary tracts are often encountered during surgery, which inhibits biliary reconstruction. A reliable cholangiojejunostomy for multiple biliary ducts has been utilized in LDLT. This procedure provides a reference for multiple biliary reconstructions after LLDH. CASE SUMMARY: A 2-year-old girl dia gnosed with ornithine transcarbamylase deficiency required liver transplantation. Due to the scarcity of deceased donors, she was put on the waiting list for LDLT. Her father was a suitable donor; however, after a rigorous evaluation, preoperative magnetic resonance cholangiopancreatography examination of the donor indicated the possibility of multivessel variation in the biliary tract. Therefore, a laparoscopic left lateral section was performed on the donor, which met the estimated graft-to-recipient weight ratio. Under intraoperative indocyanine green cholangiography, 4 biliary tracts were confirmed in the graft. It was difficult to reform the intrahepatic bile ducts due to their openings of more than 5 mm. A reliable cholangiojejunostomy was, therefore, utilized: Suture of the jejunum to the adjacent liver was performed around the bile duct openings with 6/0 absorbable sutures. At the last follow-up (1 year after surgery), the patient was complication-free. CONCLUSION: Int rahepatic cholangiojejunostomy is reliable for multiple biliary ducts after LLDH in LDLT. PMID:33889632 | PMC:PMC8040162 | DOI:10.12998/wjcc.v9.i11.2649 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Extraosseous spinal epidural plasmocytoma associated with multiple myeloma: Two case reports

paythelady.612 shared this article with you from Inoreader Extraosseous spinal epidural plasmocytoma associated with multiple myeloma: Two case reports Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Apr 16;9(11):2555-2561. doi: 10.12998/wjcc.v9.i11.2555. ABSTRACT BACKGROUND: Multiple myeloma is a malignant hematological disease characterized by proliferation of monoclonal plasma cells mainly in the bone marrow. Extraosseous epidural plasmacytoma associated with myeloma arises from lymphoid tissue in the epidural space without focal vertebral involvement, and is rare. CASE SUMMARY: A 52-year-old woman was diagnosed with kappa subtype nonsecretory multiple myeloma and presented with bilateral arm weakness 11 mo after completing multiple courses of chemotherapy. Spinal magnetic resonance imaging (MRI) showed a posterior C7-T3 epidural mass with spinal cord compression. After five courses of chemotherapy, follow-up MRI showed resolution of cord compression. A 54-year-old man presented with paraplegia 15 mo after a diagnosis of IgD kappa subtype multiple myeloma and completing multiple courses of chemothe rapy. He underwent Th11 and L1 laminectomies for tumor resection because MRI showed an epidural mass causing cord compression. His-topathologic examination was consistent with IgD multiple myeloma. The patients have currently survived for 33 mo and 19 mo, respectively. CONCLUSION: Isolated extraosseous epidural plasmacytoma associated with multiple myeloma without bony involvement is difficult to diagnose by imaging. Definitive diagnosis requires pathological and immunohistochemical examination. PMID:33889620 | PMC:PMC8040174 | DOI:10.12998/wjcc.v9.i11.2555 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Surgical therapy for hemangioma of the azygos vein arch under thoracoscopy: A case report

paythelady.612 shared this article with you from Inoreader Surgical therapy for hemangioma of the azygos vein arch under thoracoscopy: A case report Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Apr 16;9(11):2655-2661. doi: 10.12998/wjcc.v9.i11.2655. ABSTRACT BACKGROUND: Azygos vein aneurysms are extremely rare, and their pathogenesis is not clear. The overwhelming majority of patients have no obvious clinical symptoms and are found to have the disease by physical examination or by chance. There are few reports on the diagnosis of and treatment strategy for this disease. Moreover, the choice of therapeutic schedule and the treatment window are controversial. CASE SUMMARY: We report a case of azygos vein arch aneurysm in a 53-year-old woman. The patient had symptoms of back pain, chest tightness, and choking. Enhanced chest computed tomography showed a soft-tissue mass in the right posterior mediastinum, which was connected to the superior vena cava. The enhancement degree in the venous phase was the same as that of the superior vena cava. The patient received video-assisted thoracoscopic surgery. After the operation, her back pain disappeared, and her dysphagia and chest tightness were also significantly relieved. The postoperative pathology confirmed hemangioma. The patient was discharged on the seventh day after surgery without any comp-lications. CONCLUSION: Some patients with hemangioma of the azygos vein arch may experience dysphagia and chest tightness caused by the tumor compressing the esophagus and trachea. Enhanced computed tomography scanning is vital for the diagnosis of azygos vein aneurysms. In addition, despite the difficulty and risk of surgery, thoracoscopic surgery for azygos vein aneurysms is completely feasible. PMID:33889633 | PMC:PMC8040170 | DOI:10.12998/wjcc.v9.i11.2655 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Early colonoscopy and urgent contrast enhanced computed tomography for colonic diverticular bleeding reduces risk of rebleeding

paythelady.612 shared this article with you from Inoreader Early colonoscopy and urgent contrast enhanced computed tomography for colonic diverticular bleeding reduces risk of rebleeding Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Apr 16;9(11):2446-2457. doi: 10.12998/wjcc.v9.i11.2446. ABSTRACT BACKGROUND: Colonoscopy within 24 h of hospital admission for colonic diverticular bleeding (CDB) is recommended. However, little is known about rates of rebleeding within 30 d. We posited that a group of patients who underwent contrast-enhanced computed tomography (CT) within 4 h of the last hematochezia and colonoscopy within 24 h would experience fewer incidences of rebleeding. AIM: To evaluate the outcomes of early colonoscopy for CDB among different groups of patients. METHODS: Data from 182 patients with CDB who underwent contrast-enhanced CT and colonoscopy between January 2011 and December 2018 at the study site were retrospectively reviewed. Patients were divided into groups based on the timing of the CT imaging, within or at 4 h were defined as urgent CTs (n = 100) and those performed after 4 h were defined as elective CTs (n = 82). Main outcomes included rebleeding within 30 d and the identification of stigmata of recent hemorrhage (SRH) (i.e., active bleeding, non-bleeding visible vessels, or adherent clots). RESULTS: In total, 182 patients (126 men and 56 women) with median ages of 68.6 (range, 37-92) and 73.7 (range, 48-93) years, respectively, underwent CT imaging and colonoscopy within 24 h of the last hematochezia. Patients for whom CT was performed within 4 h of the last hematochezia were included in the urgent CT group (n = 100) and patients for whom CT was performed after 4 h were included in the elective CT group (n = 82). SRH were identified in 35.0% (35/100) of the urgent CT cases and 7.3% (6/82) of the elective CT cases (P < 0.01). Among all patients with extravasation-positive images on CT, SRH was identified in 31 out of 47 patients (66.0%) in the urgent CT group and 4 out of 20 patients (20.0%) in the elective CT group (P < 0. 01). Furthermore, rates of rebleeding within 30 d were significantly improved in the urgent CT and extravasation-positive cases (P < 0.05). Results from the evaluation of early colonoscopy did not show a difference in the ability to detect SRH identification or rebleeding rates. Only cases by urgent CT reduced risk of rebleeding due to the evidence of active bleeding on the image. CONCLUSION: To improve rates of rebleeding, colonoscopy is recommended within 24 h in patients with extravasation-positive CT images within 4 h of the last hema-tochezia. Otherwise, elective colonoscopy can be performed. PMID:33889610 | PMC:PMC8040177 | DOI:10.12998/wjcc.v9.i11.2446 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Calcium pyrophosphate deposition disease of the temporomandibular joint invading the middle cranial fossa: Two case reports

paythelady.612 shared this article with you from Inoreader Calcium pyrophosphate deposition disease of the temporomandibular joint invading the middle cranial fossa: Two case reports Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Apr 16;9(11):2662-2670. doi: 10.12998/wjcc.v9.i11.2662. ABSTRACT BACKGROUND: Pseudogout is a benign joint lesion caused by the deposition of calcium pyro-phosphate dihydrate crystals, but it is invasive. Pseudogout of the temporo-mandibular joint (TMJ) is uncommon, and it rarely invades the skull base or penetrates into the middle cranial fossa. The disease has no characteristic clinical manifestations and is easily misdiagnosed. CASE SUMMARY: We present two cases of tophaceous pseudogout of the TMJ invading the middle cranial fossa. A 46-year-old woman with a history of diabetes for more than 10 years was admitted to the hospital due to swelling and pain in the right temporal region. Another patient, a 52-year-old man with a mass in the left TMJ for 6 years, was admitted to the hospital. Maxillofacial imaging showed a calcified mass and severe bone destruction of the skull base in the TMJ area. Both pati ents underwent excision of the lesion. The lesion was pathologically diagnosed as tophaceous pseudogout. The symptoms in these patients were relieved after surgery. CONCLUSION: Tophaceous pseudogout should be considered when there is a calcified mass in the TMJ with or without bone destruction. A pathological examination is the gold standard for diagnosing this disease. Surgical treatment is currently the recommended treatment, and the prognosis is good after surgery. PMID:33889634 | PMC:PMC8040178 | DOI:10.12998/wjcc.v9.i11.2662 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Gastrointestinal-type chemotherapy prolongs survival in an atypical primary ovarian mucinous carcinoma: A case report

paythelady.612 shared this article with you from Inoreader Gastrointestinal-type chemotherapy prolongs survival in an atypical primary ovarian mucinous carcinoma: A case report Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Apr 16;9(11):2533-2541. doi: 10.12998/wjcc.v9.i11.2533. ABSTRACT BACKGROUND: Primary ovarian mucinous carcinoma is a rare histologic subtype of epithelial ovarian carcinoma and exhibits considerable morphologic overlap with secondary tumour. It is hard to differentiate primary from metastatic ovarian mucinous carcinoma by morphological and immunohistochemical features. Because of the histologic similarity between primary ovarian mucinous carcinoma and metastatic gastrointestinal carcinoma, it has been hypothesized that ovarian mucinous carcinomas might respond better to non-gynecologic regimens. However, the standard treatment of advanced ovarian mucinous carcinoma has not reached a consensus. CASE SUMMARY: A 56-year-old postmenopausal woman presented with repeated pain attacks in the right lower quadrant abdomen, accompanied by diarrhoea, anorexia, and weight loss for about 3 mo. The patient initially mi sdiagnosed as having gastrointestinal carcinoma because of similar pathological features. Based on the physical examination, tumour markers, imaging tests, and genetic tests, the patient was clinically diagnosed with ovary mucinous adenocarcinoma. Whether gastrointestinal-type chemotherapy or gynecologic chemotherapy was a favourable choice for patients with advanced ovarian mucinous cancer had not been determined. The patient received a chemotherapy regimen based on the histologic characteristics rather than the tumour origin. The patient received nine cycles of FOLFOX and bevacizumab. This was followed by seven cycles of bevacizumab maintenance therapy for 9 mo. Satisfactory therapeutic efficacy was achieved. CONCLUSION: The genetic analysis might be used in the differential diagnosis of primary ovarian mucinous carcinoma and non-gynecologic mucinous carcinoma. Moreover, primary ovarian mucinous carcinoma patients could benefit from gastrointestinal-type chemotherapy. PMID:33889618 | PMC:PMC8040163 | DOI:10.12998/wjcc.v9.i11.2533 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Rare histological subtype of invasive micropapillary carcinoma in the ampulla of Vater: A case report

paythelady.612 shared this article with you from Inoreader Rare histological subtype of invasive micropapillary carcinoma in the ampulla of Vater: A case report Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Apr 16;9(11):2671-2678. doi: 10.12998/wjcc.v9.i11.2671. ABSTRACT BACKGROUND: Carcinoma of the ampulla of Vater is an uncommon ampullo-pancreatobiliary neoplasm, and the most common histological type is adenocarcinoma with a tubular growth pattern. Invasive micropapillary carcinoma (IMPC) is an aggressive variant of adenocarcinoma in several organs that is associated with lymph node metastasis and poor prognosis. IMPC was first described as a histological subtype of breast cancer; however, IMPC of the ampulla of Vater is extremely rare, with only three articles reported in the English literature. CASE SUMMARY: We have reported a case of IMPC of the ampulla of Vater in an 80-year-old man. Microscopically, the surface area of the carcinoma was composed of tubulopapillary structures mimicking intra-ampullary papillary-tubular neoplasm, and the deep invasive front area exhibited a pattern of IMPC. The carcinom a showed lymphatic invasion and extensive lymph node metastasis. The immunohistochemical study revealed mixed intestinal and gastric/pan-creatobiliary phenotypes. CONCLUSION: This rare subtype tumor in the ampulla of Vater showed a histologically mixed phenotype and exhibited aggressive behavior. PMID:33889635 | PMC:PMC8040169 | DOI:10.12998/wjcc.v9.i11.2671 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Differences in dietary habits of people with vs without irritable bowel syndrome and their association with symptom and psychological status: A pilot study

paythelady.612 shared this article with you from Inoreader Differences in dietary habits of people with <em>vs</em> without irritable bowel syndrome and their association with symptom and psychological status: A pilot study Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Apr 16;9(11):2487-2502. doi: 10.12998/wjcc.v9.i11.2487. ABSTRACT BACKGROUND: Previous studies have demonstrated that dietary factors are involved in irritable bowel syndrome (IBS), but the role of diet was evaluated mostly based on food frequency questionnaire. Whether food categories, quantity per time, and intake frequency are different between IBS patients and non-IBS individuals has not been clearly clarified. AIM: To explore differences in dietary habits of people with vs without IBS and their correlation with symptom and psychological status. METHODS: A total of 220 questionnaires were administered in a community population and the Rome IV criteria was applied to diagnose IBS. The dietary questionnaire used in this study was multidimensional from food categories, quantity per time, and intake frequency, in contrast to "yes or no" classification used in previous studies. Questionnaires i ncluding IBS symptom severity scale (IBS-SSS), IBS quality of life, visceral sensitivity index, hospital anxiety and depression score (HADS), and gastrointestinal symptom rating scale were used to assess the participants. Rank sum test was used to compare the quantity per time and intake frequency between IBS patients and non-IBS participants. The correlation between psychological factors and diet was evaluated by Spearman correlation analysis. Logistic regression analysis was used to assess the possible dietary risk factors for IBS. RESULTS: In total, 203 valid questionnaires were collected (response rate 92.3%). Twenty-five participants met the Rome IV criteria for IBS, including 15 (60.0%) women and 10 (40.0%) men. Compared with the non-IBS group, the quantity per time and intake frequency of soybean and its products, spicy food, and dry-fried nuts were statistically significant in IBS participants (P < 0.05). They were positively associated with IBS-SSS and HADS anxiety and depression scores (P < 0.05). Besides, seafood, soft drinks, vegetables, and fruits differed only in quantity per time. The intake frequencies of egg, barbecue, and coarse grain were statistically significant in IBS patients (P < 0.05). We also found that the frequency of soybean and its products (≥ 7 times/week, odds ratio = 11.613, 95% confidence interval: 2.145-62.855, P = 0.004) was an independent risk factor for IBS. CONCLUSION: Both quantity per time and intake frequency, especially soybean, differ between IBS patients and non-IBS participants. Dietary habits might play potential roles in the pathophysiology of IBS. PMID:33889614 | PMC:PMC8040167 | DOI:10.12998/wjcc.v9.i11.2487 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.