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Plastic and Reconstructive Surgery.... Jun 2024Mucoceles can often present as a complication after prior sinus surgery or maxillofacial trauma when mucosal drainage is obstructed. Their presence in the orbit...
Mucoceles can often present as a complication after prior sinus surgery or maxillofacial trauma when mucosal drainage is obstructed. Their presence in the orbit following orbital wall fracture and subsequent repair represent an exceedingly rare complication whose occurrence is limited to a few reported cases in the literature. In these patients, continuous cyst expansion and subsequent mass effect may lead to ophthalmic symptoms, including orbital pain, proptosis, diplopia, and globe dystopia. We report the discovery of an orbital mucocele after orbital floor fracture repair and its possible association with the nonporous reconstruction plate utilized for fixation. When a patient with history of orbital wall reconstruction presents with new-onset ocular symptoms, an orbital mucocele should be considered as a potential diagnosis.
PubMed: 38911571
DOI: 10.1097/GOX.0000000000005917 -
Cureus May 2024Colonic lymphangiomas are rare and mostly incidental findings found on colonoscopy. It is important to be able to differentiate them from other lesions, such as lipomas....
Colonic lymphangiomas are rare and mostly incidental findings found on colonoscopy. It is important to be able to differentiate them from other lesions, such as lipomas. Furthermore, when in close proximity to the appendiceal orifice, such as cecal lesions, they must be differentiated from mucocele and carcinoid tumors. We present a case of a cecal lymphangioma that was managed conservatively. By using endoscopic ultrasound (EUS) and computed tomography to better characterize the cecal mass, it was unnecessary to perform a biopsy or polypectomy. This case highlights that biopsy and/or removal of lymphangiomas are not warranted in all cases of colonic lymphangiomas, especially when lesions are less than 2 cm.
PubMed: 38910734
DOI: 10.7759/cureus.60808 -
Clinical Case Reports Jun 2024A plunging ranula may present initially as an extensive vallecular cyst and correct diagnosis may be reached with the use of ultrasound, fluid aspiration for amylase...
KEY CLINICAL MESSAGE
A plunging ranula may present initially as an extensive vallecular cyst and correct diagnosis may be reached with the use of ultrasound, fluid aspiration for amylase detection, and MRI imaging.
ABSTRACT
The ranula is a pseudocyst of the sublingual salivary gland and can be divided into two known subtypes. The simple ranula and plunging ranula. While the simple type can be found in the floor of the mouth, the plunging ranula usually pervades the mylohoid muscle and presents as a cervical swelling. The presented case should outline the difficulties in diagnostic and treatment of an uncommon expression of a mucocele above the mylohoid muscle without presenting either a cervical or an intraoral swelling, only extending towards the vallecula. We present a previously unreported clinical manifestation of a ranula of an 18-year old male, which extends posteriorly, remaining confined in the supramylohyoid muscle space. The cystic lesion protrudes in the oropharynx, and clinically appears as an extensive vallecular cyst. On magnetic resonance imaging the initial suspected diagnosis of a vallecular cyst was changed to the final diagnosis of a plunging ranula. The marsupialization of the cyst sac was performed. Outpatient follow-up revealed a persisting ostium, indicating a continuous extravasation of the sublingual gland. The present case report describes an unusual clinical presentation of a plunging ranula, remaining above the mylohyoid muscle and protruding into the oropharynx, misdirecting to the first suspected diagnosis of a vallecular cyst. The case highlights the useful contribution of the MRI imaging for differential diagnoses and the need for criteria to indicate further investigations.
PubMed: 38883226
DOI: 10.1002/ccr3.8964 -
Cureus May 2024Primary appendiceal neoplasms (ANs) are rare entities that can present with acute appendicitis symptoms. Accurate diagnosis of these diverse subtypes is crucial for...
INTRODUCTION
Primary appendiceal neoplasms (ANs) are rare entities that can present with acute appendicitis symptoms. Accurate diagnosis of these diverse subtypes is crucial for prognosis and proper management.
AIMS AND OBJECTIVES
This descriptive retrospective study aims to determine the prevalence and pathological subtypes of incidental ANs in patients presenting with acute appendicitis symptoms at Salmaniya Medical Center (SMC) in Bahrain between the period of January 2020 and March 2024. Particular focus was placed on investigating whether advanced age is a significant risk factor for these neoplasms.
MATERIALS AND METHODS
The study included 38,643 patients (aged 15 years and above) who underwent appendectomy for suspected acute appendicitis during the study period. Demographic data, clinical diagnoses, preoperative imaging findings, histopathological reports, and management details were analyzed. Medical records of patients were retrieved from ISEHA system. Statistical analysis was done using Microsoft Excel.
RESULTS
The results showed that 12 patients (0.04% per year) had different subtypes of appendiceal tumors. Neuroendocrine tumors were the most common, identified in nine patients (75%), including nine cases of well-differentiated neuroendocrine carcinoma (NEC). Other histopathological subtypes included low-grade appendiceal mucinous neoplasm (LAMN), adenocarcinoma, and goblet cell adenocarcinoma, each found in one patient. Additionally, two patients had confirmed appendiceal mucocele. The mean age of patients with ANs was 30 years (range: 19-52 years), and 66.6% were younger than 38 years. Conclusion: These findings highlight the importance of considering ANs in the differential diagnosis of acute appendicitis, especially in older patients. Further research is warranted to confirm the role of age as a risk factor and guide clinical decision-making.
PubMed: 38864054
DOI: 10.7759/cureus.60150 -
European Journal of Case Reports in... 2024Diffuse large B-cell lymphoma (DLBCL) is a prevalent subtype of non-Hodgkin lymphoma (NHL) affecting predominantly elderly individuals.
INTRODUCTION
Diffuse large B-cell lymphoma (DLBCL) is a prevalent subtype of non-Hodgkin lymphoma (NHL) affecting predominantly elderly individuals.
CASE DESCRIPTION
A 68-year-old man with a history of hypertension, hyperlipidaemia and a small pituitary gland tumour presented with sudden-onset binocular diplopia and right-eye blurry vision. A magnetic resonance imaging (MRI) of the brain revealed enhancing soft tissue in the right superolateral orbit inseparable from the lacrimal gland, extending medially to the right superior rectus muscle and soft tissue. Further scanning showed widespread metastasis to the bilateral retroperitoneal lymph nodes, adrenal gland, spine and lymph nodes in the neck. A biopsy of the lacrimal gland confirmed DLBCL.
CONCLUSION
Primary lacrimal gland DLBCL is a rare and delayed diagnosis that often stems from the resemblance of its clinical manifestations to more benign conditions such as dacryocystitis, dacryostenosis or mucocele. Timely recognition and accurate diagnosis are essential for initiating appropriate treatment and improving patient outcomes.
LEARNING POINTS
Lacrimal sac lymphomas represent diagnostic challenges due to their rarity, non-specific symptoms and frequent misdiagnoses as benign pathologies, hence it is crucial to include this in the differential diagnosis.Timely recognition and accurate diagnosis are important in improving outcomes for lacrimal sac lymphomas.
PubMed: 38846660
DOI: 10.12890/2024_004503 -
Journal of Surgical Case Reports Jun 2024Mucinous appendicular neoplasms are a rare and heterogeneous group of tumors, whose treatment may vary based on histologic features and extent. We present a case of...
Mucinous appendicular neoplasms are a rare and heterogeneous group of tumors, whose treatment may vary based on histologic features and extent. We present a case of low-grade appendiceal mucinous neoplasm mimicking an acute appendicitis scenario. The patient underwent appendectomy along with resection of the caecal fundus. Choosing the correct treatment according to the case by following current guidelines is crucial to avoid under- or overtreatment.
PubMed: 38835943
DOI: 10.1093/jscr/rjae397 -
Cureus May 2024Appendiceal mucinous neoplasms (AMNs) are uncommon gastrointestinal tumors characterized by mucus accumulation in the appendix. Patients may complain of acute...
Appendiceal mucinous neoplasms (AMNs) are uncommon gastrointestinal tumors characterized by mucus accumulation in the appendix. Patients may complain of acute appendicitis-like symptoms with other alarming features, but approximately half of the cases of AMNs are found incidentally on imaging. Early diagnosis and management of these neoplasms are important to prevent malignant progression and complications such as bowel obstruction and pseudomyxoma peritonei. We report a case of a 28-year-old female who initially presented with vomiting and acute left lower abdominal pain radiating to the left flank. Computed tomography (CT) revealed a 1.5 mm stone in the left ureteral vesicular junction and a 2.3 x 2.4 x 5.2 cm cystic tubular mass at the base of the cecum, suspicious of an appendiceal mucocele. An elective laparoscopic appendectomy was performed on this admission, which was converted to a right hemicolectomy due to the pathologic finding of a focally high-grade AMN on intraoperative frozen specimen pathology. This report aims to provide an example of a case of an incidental AMN and how it was diagnosed and managed surgically. AMNs are rare tumors that originate from the appendix and can pose diagnostic and therapeutic challenges due to their diverse clinical presentations and variable histopathological features. The majority of cases of AMNs are discovered in middle-aged individuals (40-50 years of age) after an appendectomy is performed and examined by pathology. This case report aims to describe a rare presentation of a 28-year-old female patient with an incidental finding of AMN on a CT scan of the abdomen while being worked up for suspected nephrolithiasis. We will provide a comprehensive overview of a unique presentation of AMN, highlighting its clinical manifestations, diagnostic approach, and management strategies. We present the case of a 28-year-old female patient who presented to the emergency department with complaints of acute left lower quadrant abdominal pain radiating to the left flank and vomiting. After an initial assessment and workup, which included lab investigations and imaging, a diagnosis of unilateral hydronephrosis due to a calculus of the ureterovesical junction was made. However, there was also suspicion of an appendiceal mucocele, as evidenced by a CT scan of the abdomen and pelvis. On admission day one, under the care and management of the urology team, she passed the stone with complete resolution of the presenting symptoms. On hospital day two, she underwent an elective laparoscopic appendectomy followed by a right hemicolectomy due to findings of high-grade mucinous neoplasm on the resected frozen specimen near the base of the appendix. AMN was an incidental finding based on CT imaging and macroscopic findings, which was later confirmed by histopathological assessment and report.
PubMed: 38826949
DOI: 10.7759/cureus.59540 -
Annals of Dermatology Jun 2024Sclerotherapy has shown superior efficacy among the nonsurgical options for managing digital mucous cysts (DMC). Notably, previous research has indicated that bleomycin...
BACKGROUND
Sclerotherapy has shown superior efficacy among the nonsurgical options for managing digital mucous cysts (DMC). Notably, previous research has indicated that bleomycin offers a more favorable side-effect profile and similar efficacy to conventional sclerosing agents.
OBJECTIVE
This study aimed to assess the efficacy and safety of bleomycin intralesional injection (ILI) for treating DMC through a comparative analysis of corticosteroid ILI and surgical excision.
METHODS
We retrospectively reviewed electronic medical records and clinical photographs. Telephone interviews were conducted to further investigate long-term treatment efficacy, safety, and overall treatment satisfaction.
RESULTS
Ten patients underwent surgical excision, and 13 and 15 patients received bleomycin and corticosteroid ILI, respectively. Both surgical excision and bleomycin ILI demonstrated superior treatment efficacy compared to corticosteroid ILI. No statistically significant difference in the treatment effectiveness between surgical excision and bleomycin ILI was observed. No significant adverse effects were observed. In the survey, the level of satisfaction was the highest for bleomycin ILI, followed by surgical excision and corticosteroid ILI.
CONCLUSION
This study revealed that bleomycin ILI exhibits a treatment efficacy higher than that of corticosteroid ILI and slightly lower than that of surgical excision, without any side effects. Therefore, bleomycin ILI is a safe and effective therapeutic option for the treatment of DMC.
PubMed: 38816979
DOI: 10.5021/ad.23.131 -
Journal of Cutaneous and Aesthetic... 2024Plane viral warts on the face can be difficult to treat at times. Various treatment approaches for facial viral warts have had variable degrees of effectiveness. In...
Plane viral warts on the face can be difficult to treat at times. Various treatment approaches for facial viral warts have had variable degrees of effectiveness. In contrast, the majority of existing treatments are more costly, painful, and difficult to manage. In approximately 15.6% of instances, retinoic acid (0.05%) is also ineffective. It is very difficult to cure warts on the face at a young age. In pyogenic granuloma, table salt (NaCl) is useful as a sclerosing agent, and its hypertonic solution (15%) is effective in prolabial mucoceles. The aim of treating viral warts is to necrose infected cells and sclerose or thrombose their feeding capillaries at the wart's base.
PubMed: 38800809
DOI: 10.4103/JCAS.JCAS_43_22 -
PloS One 2024Cholecystectomy is indicated for gallbladder mucoceles (GBM). Evaluating the patency of the biliary duct and precise biliary tree visualization is crucial for reducing...
Cholecystectomy is indicated for gallbladder mucoceles (GBM). Evaluating the patency of the biliary duct and precise biliary tree visualization is crucial for reducing the risk of compromised bile flow after surgery. Therefore, intraoperative cholangiography (IOC) is recommended during cholecystectomy to prevent biliary tract injury. Although indocyanine green (ICG) cholangiography has been extensively reported in human medicine, only one study has been conducted in veterinary medicine. Therefore, this study aimed to demonstrate the use of ICG for IOC to identify fluorescent biliary tract images and determine the patency of the common bile duct during cholecystectomy in dogs. This study comprised 27 dogs, consisting of 17 with gallbladder mucoceles (GBM) and 10 controls, specifically including dogs that had undergone elective cholecystectomy for GBM. ICG injection (0.25 mg/kg) was administered intravenously at least 45 minutes before surgery. During the operation, fluorescent images from cholangiography were displayed on the monitor and obtained in black-and-white mode for the comparison of fluorescence intensity (FI). The FI values of the gallbladders (GBs) and common bile duct (CBD) were measured using FI analyzing software (MGViewer V1.1.1, MetapleBio Inc.). The results demonstrated successful CBD patency identification in all cases. Mobile GBM showed partial gallbladder visibility, whereas immobile GBM showed limited visibility. Additionally, insights into the adequate visualization of the remaining extrahepatic biliary tree anatomy were provided, extending beyond the assessment of CBD patency and gallbladder intensity. Our study demonstrates the potential of fluorescent IOC using intravenous injection of ICG for assessing the patency of the cystic duct and common bile duct during cholecystectomy in patients with GBM, eliminating the need for surgical catheterization and flushing of the biliary ducts. Further research is warranted to investigate and validate the broader applicability of ICG cholangiography in veterinary medicine.
Topics: Animals; Dogs; Indocyanine Green; Cholangiography; Mucocele; Dog Diseases; Male; Female; Biliary Tract; Gallbladder Diseases; Cholecystectomy; Gallbladder
PubMed: 38776340
DOI: 10.1371/journal.pone.0300395