Low-grade endometrial stromal sarcoma, a rare uterine tumor: Case report

This case report describes a 45-year-old woman presenting with abnormal uterine bleeding and a cervical mass. Imaging and biopsy revealed low-grade endometrial stromal sarcoma (LGESS), emphasizing the importance of comprehensive evaluation for uterine masses. The report underscores the role of MRI and pathology in diagnosis, with immunohistochemical analysis helping confirmation. A multidisciplinary approach and vigilant follow-up are crucial for optimal management. The rarity of LGESS and its challenging diagnosis highlight the need for continued research to improve diagnostic and therapeutic strategies. Surgical intervention remains primary, but the optimal management approach is debated. This report indicates the necessity of a comprehensive approach to uterine mass evaluation and ongoing research for enhanced patient care.

Pneumoperitoneum, pneumoretroperitoneum and pneumomediastinum: rare complications of perforation peritonitis: a case report

BACKGROUND

Gas extravasation complications arising from perforated diverticulitis are common but manifestations such as pneumoperitoneum, pneumoretroperitoneum, and pneumomediastinum happening at the same time are exceedingly rare. This case report explores the unique presentation of these 3 complications occurring simultaneously, their diagnosis and their management, emphasizing the importance of interdisciplinary collaboration for accurate diagnosis and effective management.

CASE PRESENTATION

A 74-year-old North African female, with a medical history including hypertension, dyslipidemia, type 2 diabetes, goiter, prior cholecystectomy, and bilateral total knee replacement, presented with sudden-onset pelvic pain, chronic constipation, and rectal bleeding. Clinical examination revealed hemodynamic instability, hypoxemia, and diffuse tenderness. After appropriate fluid resuscitation with norepinephrine and saline serum, the patient was stable enough to undergo computed tomography scan. Emergency computed tomography scan confirmed perforated diverticulitis at the rectosigmoid junction, accompanied by the unprecedented presence of pneumoperitoneum, pneumoretroperitoneum, and pneumomediastinum. The patient underwent prompt surgical intervention with colo-rectal resection and a Hartmann colostomy. The postoperative course was favorable, leading to discharge one week after admission.

CONCLUSIONS

This case report highlights the clinical novelty of gas extravasation complications in perforated diverticulitis. The unique triad of pneumoperitoneum, pneumoretroperitoneum, and pneumomediastinum in a 74-year-old female underscores the diagnostic challenges and the importance of advanced imaging techniques. The successful collaboration between radiologists and surgeons facilitated a timely and accurate diagnosis, enabling a minimally invasive surgical approach. This case contributes to the understanding of atypical presentations of diverticulitis and emphasizes the significance of interdisciplinary teamwork in managing such rare manifestations.

Bilateral primary adrenal diffuse large B cell lymphoma: A rare presentation

Primary lymphoma of the adrenal gland is an uncommon origin of adrenal tumors; it must be explicitly invoked anytime bilateral adrenal affections are revealed. We report a case of bilateral primary adrenal diffuse large B cell lymphoma and perform a review of the literature. Our patient was a 55-year-old man who presented night sweats and a feeling of cardiac palpitations all evolving in a context of deterioration of his general condition. An ultrasound study was requested reporting a bilateral mass corresponding to the adrenal region. A thoraco-abdominopelvic CT scan was requested and revealed bilateral homogenous, polylobed, adrenal masses, discreetly enhanced after injection of contrast product. These masses were associated with multiple retroperitoneal, para-aortic, and celio-mesenteric adenopathies. Anatomopathologic examination of the percutaneous CT-guided biopsy specimen of the adrenal tumor revealed the presence of diffuse large B cell lymphoma grade IIIB according to the Ann Arbor system. Primary adrenal lymphoma PAL on its own is an extremely rare disease entity and less than 100 cases have been reported in the last 40 years. A large proportion of PAL case reports showed that this disease usually has no excretory endocrine function and the symptoms are due to the pressure effect of the mass, whereas adrenal insufficiency usually exists. Our patient presented symptoms of indrenal insufficiency which seems to be the reason for the early diagnosis. Primary bilateral adrenal lymphoma is very rare entity that should be kept in mind whenever bilateral adrenal masses are assessed in the CT scan images.

Diagnostic Challenges in Adult Intestinal Malrotation: A Case Report and Literature Review

Adult intestinal malrotation is a rare anatomical anomaly that typically manifests during infancy but can also present in adulthood. Symptoms are mainly digestive, with a long history of intermittent abdominal pain and epigastralgia. It often presents a diagnostic challenge due to the varied and nonspecific nature of clinical symptoms. Radiological evaluations reveal diverse patterns of malrotation, including incomplete rotation, mesenteric base abnormalities, and associated malformations. Computed tomography (CT) scans consistently identify characteristic anatomical distortions, aiding in accurate diagnosis. In this context, we present a unique case in which contrast-enhanced CT of the abdomen, initially conducted to investigate a suspected episode of acute pancreatitis accompanied by epigastralgia, fortuitously revealed the presence of intestinal malrotation. Once the diagnosis has been made, the therapeutic approach is based on monitoring or managing complications such as intestinal obstruction. Early recognition and accurate radiological assessment of intestinal malrotation play an essential role in establishing the diagnosis and guiding appropriate management strategies. Increased awareness among clinicians and radiologists is essential to avoid delays in diagnosis and the potential complications associated with this entity.

Rare case of inguinal cystic lymphangioma diagnosed and treated in elderly patient

Cystic lymphangioma develops due to the interruption of lymphatic-venous connections during embryogenesis, leading to the formation of a cystic lesion containing lymph. These lesions fall under the ISSVA classification of vascular malformations. The first documented case dates back to 1828, with further elucidation provided by Sabin in 1909 and 1919. Cervicofacial region is the most common site, often showing early-stage symptoms. Inguinal location is rare, but if complications arise, it may present as a strangulated inguinal hernia. The tumor's severity lies in its compression and invasion of the aerodigestive tract and adjacent organs. Diagnosis relies on imaging techniques such as ultrasound and computed tomography, which help determine the mass's nature, boundaries, and relationship with neighboring structures. Asymptomatic lesions are generally monitored, while symptomatic ones require complete surgical excision to minimize the risk of recurrence. At Cheikh Khalifa University Hospital, we present a case highlighting our urology department's experience in diagnosis, patient care, and surgical treatment.

Intestinal Spontaneous Intramural Hematoma Secondary to Anticoagulation Therapy: A Case Report

A common complication of anticoagulation therapy is bleeding, especially in patients receiving long-term vitamin K antagonists. Spontaneous intramural hematoma is a rare etiology among life-threatening major bleeds. An 80-year-old female patient presented with diffuse abdominal pain. Her history included ischemic heart disease and chronic atrial fibrillation treated with 3 mg of acenocoumarol per day. Three days before her admission, she developed diffuse abdominal pain with fecaloid vomiting, bloating, and not passing gas. Palpation of the abdomen revealed asymmetrical distension and pain, with no signs of peritoneal irritation or bleeding. Investigations showed anemia with a hemoglobin level of 9.2 g/dL, a white blood cell count of 14200/mm³, a C-reactive protein of 112.6 mg/L, and a prothrombin time of 75.1 seconds with an international normalized ratio (INR) of 8.5. Abdominal contrast-enhanced computed tomography (CT) showed segmental parietal thickening, luminal narrowing, and partial small bowel obstruction secondary to an intramural jejunum hematoma responsible for a gallbladder occlusion with infiltration of the mesenteric fat in front. The patient recovered two days after conservative treatment. In this case, we report an unusual small bowel intramural hematoma of the jejunum secondary to anticoagulant therapy. Physicians should be aware of this unusual cause of abdominal pain. Early diagnosis may avoid unnecessary surgical exploration.

Hydatid cyst of the uterus: Very rare location

The involvement of the genital tract of a hydatid cyst is rare and the occurrence in the uterus is an extreme rarity. The diagnosis of this localization is difficult because the clinical and radiological findings are often misleading and the diagnosis is often worn during surgery and after histopathological examination of the surgical specimen. We report the case of a patient who consulted for primary infertility, with a clinical finding as the only anomaly significantly large uterus, and imaging pointing strongly toward an ovarian multilocular cyst, and in which the discovery of hydatid cyst was accidental intraoperative with double localization uterine and omental. Radical treatment cannot be discussed in this young patient of 32 years and gravid 0. The removal of the cyst wall completely and excision of the mass epiploic seemed reasonable. The patient was placed under Mebendazol and is always under the supervision of a possible recurrence.

Rare association of central pontine myelinolysis with intrasellar arachnoidocele - casual or correlated?

Our case report presents a patient with central pontine myelinolysis and arachnoidocele. He was hospitalized twice these 2 last months for a confusional syndrome associated to an alteration of his general health where metabolic disorders where found: a hyponatremia at 125 mmol/l that was quickly corrected and a hypoglycemia at 0.30 g/l. A central pontine myelinolysis was found as an iso-signal on T1-weighted sequences and a hypersignal on T2-weighted and FLAIR sequences on magnetic resonnance imaging. Central pontine myelinolysis lesions did not enhance with contrast. Incidental imaging findings of arachnoidocele was detected. Through this case, we would like to share with the other practitioners these rare images and the consequence of a diagnostic delay. Indeed, hyponatremia in our patient could be the consequence of the intrasellar arachnoidocele and the overly rapid correction of this chronic hyponatremia caused central pontine myelinolysis, or it is an accidental phenomenon where we found both lesions.

A Unique Case of Radiologically Isolated Syndrome Diagnosed During a Follow-up of Cytomegalovirus Meningoencephalitis

Radiologically isolated syndrome (RIS) refers to an entity in which an MRI of the brain, spine, or both demonstrates incidental white matter lesions that are characteristic of a demyelinating disease in morphology and location. High-risk RIS may require disease-modifying treatment (DMT). A complex interaction among genetic and environmental factors leads to self-reactive immune mechanisms, which are believed to have a pivotal role in the pathogenesis of demyelinating diseases. Viruses are possible triggers to this mechanism. Unlike Epstein-Barr virus (EBV) infection, which is a well-known risk factor for multiple sclerosis (MS), the association between cytomegalovirus (CMV) infection and MS remains uncertain, with some studies indicating a protective effect of CMV on autoimmune diseases. We report a unique case of RIS diagnosed during the follow-up of CMV meningoencephalitis in a patient who presented with generalized seizure onset.

[Bilateral adrenal tuberculosis: about a case]

La localisation surrénalienne isolée de la tuberculose représente moins de 2% des incidentalomes surrénaliens. C'est la cause infectieuse la plus fréquente des insuffisances surrénaliennes. Nous rapportons le cas d'un patient âgé de 53 ans, sans antécédents particuliers, qui présente un tableau d'insuffisance surrénalienne lente évoluant depuis six mois. L'examen physique n'a pas retrouvé de masse ni d'hépato-splénomégalie. La tension artérielle était à 120/60 mmHg. L'examen biologique n'a pas objectivé de syndrome inflammatoire et un taux de LDH normal. La TDM a objectivé une hypertrophie bilatérale des glandes surrénales siège de calcifications. L'intradermo réaction à la tuberculine était positive à 25mm. La recherche de BK dans les expectorations et dans les urines était négative. Le test au Quantiferon^® était positif. Un traitement antibacillaire d'épreuve a été démarré avec une amélioration clinique avec prise de poids de 5kg en 12 mois. Les dosages hormonaux restent bas.