Mesothelioma and asbestosis in a young woman following occupational asbestos exposure: Short latency and long survival: Case Report

Background

Occult neoplastic cells (ONCs) are the tumor cells floating in the lymph node sinuses, distant from the primary tumor, and supposed to be one of most reliable marker of prognosis.

Methods

We report here the case of a 52-year-old woman with a gastric cancer associated by numerous ONCs.

Results

Postoperative examination of the stomach disclosed an advanced, poorly differentiated adenocarcinoma with frequent lymph node metastases. In addition to ONCs and occasional micrometastases, focal aggregates of ONCs, one of the possible intermediate lesions between the ONCs and the usual metastases, are also observed.

Conclusions

In the present case, at least some of ONCs seem to form the microaggregates of tumor cells in lymph nodes, anchor in the sinuses, and grow up to the large tumorous lesion. Even if most of the ONCs were trapped and disappeared under the influence of tumor immunity, the detection of ONCs could be one of the reliable clues to estimate the prognosis.     

A case report of an unrecognized nevoid melanoma in a young woman--clinicopathological diagnostic challenge

Nevoid melanoma is a rare form of melanoma histologically resembling benign melanocytic nevi and may be overlooked in routine histological sections. Authors are presenting a case of a 31-year-old woman who presented with bizarre pigmented skin lesions in the area of the postoperative scar on the back where, 6 years earlier, a "nevus pigmentosus epidermo-dermalis" was excised and hystologically confirmed in outer institution. The lesions were surgically removed and histopathological findings were characteristic for nevoid melanoma. Additionally, specimen of primary removed lesion was reexamined and primary nevoid melanoma was then recognized, therefore indicating that the lesions our patient presented with are nevoid melanoma recidivisms. Extensive diagnostic procedures showed no signs of melanoma dissemination. Three months later, the patient returned for consultation and presented with two new brownish-pigmented papules in the area of the new postoperative scar. The lesions were excised and new nevoid melanoma recidivism was confirmed. The patient remained under the regular follow up and, almost 9 years after the removal of primary nevoid melanoma, followed by two cutaneous recidivisms, remains disease-free. This case aims to highlight the problematic area in the analysis of pigmented skin lesions where nevoid melanoma represents one of the clinical and pathological diagnostic challenges.     

A review of drug therapy for sporadic fatal insomnia

Background: Sporadic fatal insomnia (sFI) is a rapid progressive neurodegenerative disease characterised by gradual to perpetual insomnia, followed by dysautonomia, coma and death.¹ Lugaresi E, Medori R, Montagna P, Baruzzi A, Cortelli P, Lugaresi A, Tinuper P, Zucconi M, Gambetti P. Fatal familial insomnia and dysautonomia with selective degeneration of thalamic nuclei. New England J of Med. 1986;315:997–1003. doi:10.1056/NEJM198610163151605.[Crossref], [PubMed], [Web of Science ®] [Google Scholar] The cause of sFI was recently mapped to a mutation in a protein, the prion, found in the human brain. It is the unfolding of the prion that leads to the generation of toxic oligomers that destroy brain tissue and function. Recent studies have confirmed that a methionine mutation at codon 129 of the human Prion is characteristic of sFI. Current treatment slows down the progression of the disease, but no cure has been found, yet. Methods: We used Molecular Docking and Molecular Dynamics simulation methods, to study the toxic Fatal-Insomnia-prion conformations at local unfolding. The idea was to determine these sites and to stabilise these regions against unfolding and miss-folding, using a small ligand, based on a phenothiazine "moiety". Conclusion: As a result we here discuss current fatal insomnia therapy and present seven novel possible compounds for in vitro and in vivo screening.     

Inflammatory-like presentation of CADASIL: a diagnostic challenge

ABSTRACT: BACKGROUND: CADASIL is an autosomal dominant genetic leukoencephalopathy linked to mutations in the Notch3 gene. In rare cases, widespread brain lesions on T2 MRI mimicking multiple sclerosis are observed. From a national registry of 268 patients with adult-onset leukodystrophy, we identified two patients with an atypical presentation of CADASIL without co-occurrence of another systemic disease.Case presentationsPatient 1 experienced progressive gait disability and patient 2 relapsing optic neuritis and sensory-motor deficit in the leg. Both patients responded to corticotherapy and patient 2 was also responsive to glatiramer acetate. No oligoclonal bands were found in the CSF, and MRI showed myelitis and lesions with gadolinium enhancement in brain (patient 1) or incomplete CADASIL phenotype (patient 2). CONCLUSIONS: In rare cases, an inflammatory-like process can occur in CADASIL. In these patients, immunomodulatory treatments, including corticosteroids, could be effective.     

Cyclocongestive angle closure glaucoma: a diagnostic challenge

The cyclocongestive angle closure glaucomas are a group of disorders in which choroidal congestion produces forward rotation of the ciliary body, resulting in closure of the peripheral anterior chamber angle. Continued aqueous production induces an acute rise in intraocular pressure. The following case report illustrates and discusses the presentation, etiologies, pathogenesis, differential diagnosis and management of this rare clinical entity. Since prompt intervention in cyclocongestive angle closure glaucoma is crucial, optometrists should be familiar with this set of disorders as well as optimal comanagement strategies.     

Periocular Dirofilariasis in a Young Woman: A Case Report

A case of periocular dirofilariasis has been diagnosed in Iran. A 27-yr old female referred with a history of edema and redness in the left eye since 2 wk ago. On slit lamp examination, a moving thread-like worm was seen in the subconjunctival area. Two days later, a 126 mm long, live filaria worm was extracted from the lower lid subcutaneous tissue. The worm was diagnosed as, likelihood, Dirofilaria immitis on microscopic examinations. The present case suggests that D. immitis can cause periocular infections.     

Unusual cause of cardiomyopathy in a young woman

Dual atrioventricular nodal nonreentrant tachycardia (DAVNNT) is a rare form of supraventricular tachycardia. In some patients, the presence of a dual pathway physiology results in two paths in the atrioventricular (AV) node with different conduction velocities. An atrial impulse arriving at the AV node may unfold and travel along these two pathways simultaneously, causing two ventricular activations. Thus, the ventricular rate will be twice the atrial rate. DAVNNT is less common than AVNRT, but its frequency may be underestimated.The ECG is crucial to suspect the diagnosis. At first glance it looks like an irregular tachycardia, but a more careful look shows a rhythmic pattern. A sinus P wave followed by two QRS complexes (narrow or wide) should raise suspicion of this arrhythmia.It is often unnoticed by the patient, and ventricular dysfunction due to tachycardiomyopathy is not uncommon. The response of DAVNNT to medication, including beta-blockers, flecainide, and amiodarone is very poor or absent, so the treatment of choice is slow pathway ablation. We report a Case of cardiomyopathy caused by this entity.