Mansour, Marah

Key Clinical MessageEctopic pituitary adenoma is a rare neoplasm located in the clivus and could mimic other clival tumors. Diagnosis and treatment could be challenging. It should be considered in the differential diagnosis of clival tumors.AbstractEctopic pituitary adenomas (EPAs) are isolated adenomas that can be located in variable locations outside the sella turcica and have a normal‐appearing pituitary gland. These tumors are rare and are thought to often arise from embryological remnants along the route of Rathke's pouch migration. EPAs are associated with a wide range of clinical manifestations depending on hormonal activity and involvement of adjacent structures, which can represent a challenge in making the diagnosis and deciding on the most appropriate management. In this case study, we report a 47‐year‐old male who presented with visual disturbances, a headache, and generalized weakness. Magnetic resonance imaging showed a 2 cm mass located in the clivus invading the sphenoid sinus with an intact pituitary gland. The patient underwent endoscopic transsphenoidal surgery to eradicate the mass while maintaining the integrity of the pituitary gland, which was successful and uneventful. Pathological studies were consistent with prolactinoma, with no cytological malignant features. Post‐surgery, symptoms notably improved, and serum prolactin levels significantly dropped, The patient's condition was satisfactory on follow‐up with no long‐term complications reported. This paper contributes to the existing literature by sharing the clinical management of a challenging and uncommon case.

Introduction and importance: Edward syndrome is a severe chromosomal defect that occurs as a result of non-disjunction through meiosis. It presents with cardiac septal defects, horseshoe kidneys, patent ductus arteriosus, central nervous system dysgenesis, distinctive craniofacial deformities, and overriding or overlapping fingers. Klinefelter syndrome (47, XXY) is found in 1 in 660 newborn males. It is considered to be one of the most common genetic causes of infertility. It manifests with small firm testes, androgen insufficiency, and azoospermia. Case presentation: A 2-month-old male infant with a history of weakness in feeding, frequent convulsions, and an increase in cyanosis two days ago. There were multiple skeletal deformities and a tendency to spasm in the extremities, left ventricular atrophy, mitral atresia, atrial septal defect, ventricular septal defect with dilated right cavities, tricuspid valve regurgitation, pulmonary valve stenosis; and the aorta exits in the right ventricle. There is a widening of the subdural space, which was observed in the left frontal-parietal side with cortical atrophy in that area and a widening of the Sylvian fissure. A karyotype test confirmed the presence of Edward and Klinefelter syndromes. Clinical discussion: Aneuploidy is a chromosomal issue characterized by an abnormal number of a chromosome copies. The coexistence of two aneuploidies is called “double aneuploidy” which is a rare occurrence. Herein, we report a case of a 2-month-old male with Edward syndrome and Klinefelter syndrome. Conclusion: This publication aims to highlight the challenges in diagnosing and treating a complicated genetic disease.

Abstract Background Over the past decades, cytomegalovirus has stood out as one of the most common viruses to cause acute infection in kidney transplantation patients, especially during the first six months, noting that the causes of late and very late infection are still not sufficiently studied. Symptoms of cytomegalovirus infection range from asymptomatic to end-organ infection that may cause graft rejection, which makes it an important factor for investigation and further study. Cytomegalovirus infection showed an increase in the morbidity and mortality of patients in addition to life-threatening complications associated with hypercoagulability and deep vein thrombosis, such as pulmonary embolism. Case presentation A65-year-old man with a history of kidney transplant 15 years ago due to idiopathic chronic renal failure, hypertension, diabetes type 2, and ischemic heart disease presented to the emergency department with a complaint of fatigue and hematemesis. His vital signs were normal, and initial tests showed an increase in creatine numbers. An upper gastrointestinal endoscopy was performed, and a biopsy was taken from the superior side of the pylorus, which later revealed signs of chronic gastritis. A cytomegalovirus-polymerase chain reaction was made, which came back positive, and the patient was diagnosed with chronic cytomegalovirus gastritis and treated with ganciclovir. The patient was discharged later with no signs of deep venous thrombosis. Five days after the discharge, the patient was admitted with signs of deep venous thrombosis only in the right lower limb and, after a few days, developed superficial vein thrombosis in his right arm. He was treated for both and left to rest. Conclusion Cytomegalovirus can cause deep venous thrombosis through an unknown mechanism that needs to be studied and analyzed. It is important to note that there is only one case report in the medical literature similar to ours (33) to the best of our knowledge, which makes our case considered to be a very rare case. In addition, CMV infection is a predisposing factor for thrombosis that needs to be considered in kidney transplant patients. Therefore, physicians should be aware of this complication and consider using prophylactic anticoagulants for high-risk patients.

Abstract Struma ovarii comprises 1% of all ovarian tumors and 3% of ovarian teratomas. It occurs in older females. Struma ovarii is often asymptomatic, unilateral, and accidentally detected through abdominal ultrasound or computed tomography. It presents with palpable abdominal pain or irregular menstrual cycles. Generally, it is treated with surgical resection, even though the best procedure in these cases remains under discussion. In this study, we present a case of a 28-year-old female with severe pain in the right iliac fossa. Physical examination and radiological images showed a large mass. A bilateral salpingo-oophorectomy with omentectomy, a total mass resection, and an abdominal hysterectomy were performed. A biopsy confirmed the diagnosis of a follicular thyroid tumor. The management decision is based on clinical and pathological data. This is particularly challenging due to its rarity and the insufficient guidelines regarding the management of this type of cancer.

Background: Congenital mesoblastic nephroma is the most common renal tumor in children under the age of 6 months, comprising 3–10% of all kidney tumors in children. It is a rare and mostly benign tumor. It divides into cellular, classic, and mixed subtypes. It is typically detected in the third trimester of pregnancy using ultrasonography and magnetic resonance imaging. The best treatment is surgically by completely removing the tumor. Case presentation: We reported a case of a one-day-old female who was born at 31 weeks gestation weighing 1670 g. Preterm labor was due to polyhydramnios, which was diagnosed predelivery. A large mass was detected in the left hypochondrium using computerized tomography, total nephrectomy was performed, and the histopathological examination of the specimen confirmed the diagnosis of congenital mesoblastic nephroma. Clinical discussion and conclusion: Early polyhydramnios could be the most significant sign of renal tumors in infants, especially congenital mesoblastic nephroma.

Introduction: Esophageal varices bleeding after portal hypertension is a rare condition in children but is associated with significant morbidity and mortality. Neonatal umbilical catheterization is one of the risk factors for the development of portal vein thrombosis (PVT) and portal hypertension. Case presentation: Neonatal umbilical catheterization was used here to provide appropriate treatment for postpartum sepsis. Color Doppler revealed an approximate total obstruction of the portal vein, and endoscopy showed esophageal varices. The patient was sequentially managed with endoscopic sclerotherapy. Discussion: The manifestations associated with PVT (like splenomegaly and bleeding esophageal varices) have been detected in a 10-month-old, which is considered a relatively young age according to the medical literature review. Conclusion: Using umbilical vein catheterization in neonates may be associated with several complications, including PVT. This case report describes a rare instance of portal hypertension complicated by bleeding esophageal varices in a 10-month-old infant who had undergone newborn umbilical catheterization.

Background: Ectopic breast tissue (EBT) is normally found along the rudimentary mammary line, which is located from the axilla to the inguinal region and disappears during embryogenesis. Up to 6% of females around the world suffer from EBT. EBT cancer is rare, with only a few reports in the literature. The diagnosis, and treatment of these rare cases can be very difficult and complex. Case presentation: The authors report an interesting case of a 74-year-old female patient with a vulvar lump located on the mons pubis associated with ulceration, pain, and size increase. The histopathological study demonstrated an invasive ductal carcinoma grade 2 arising from EBT in the vulva. Within 4 months of follow-up, the patient’s condition was stable. Clinical discussion and conclusions: Throughout this paper, the authors aim to highlight the diagnostic and therapeutic challenges since there are no current guidelines for treatment for such cases. Furthermore, this article describes this rare disease and includes surgical details, difficulties, diagnostic methods, and treatment options.

Introduction: Intussusception is a common finding among children. Conversely, it is infrequent in adults. Colonic lipomas are generally clinically silent making them a very rare etiology of intussusception. Presentation of case: The authors present a case of a 48-year-old male who presented to the emergency department suffering from severe abdominal pain. Following examination and investigations, a giant lipoma (GL) in the transverse colon was identified via ultrasound which showed the classical “target sign”. Clinical discussion: Intussusception among adults is unusual as it accounts for only 1% of bowel obstruction cases. Being colo-colonic makes it even more unlikely since it occurs only in 17% of intestinal obstruction cases. GLs exceeding 5 cm in size can present with a variety of symptoms. Intussusception is an uncommon presentation of a GL. Preoperative diagnosis of GL-induced intussusception is highly improbable and surgical resection is the treatment of choice. Conclusion: Despite the dominance of the asymptomatic presentation of lipomas, considering its diagnosis in the case of an intussusception-induced acute abdomen should cross physicians’ minds.