Journal of Clinical Case Reports

Pregnancy is one of those important medical conditions during which more specific evaluations and increased attention towards the treatment of patients by physicians are needed. Although the prevalence of psychiatric disorders during pregnancy appears to be neutral, in reality, (kaynak:Arch gen), approximately one fifths of pregnant women experience a depressive or anxiety disorder.

Mucinous adenocarcinoma (MAC) is a glandular tumor characterized by large pools of extracellular mucin. The tumor can arise as a primary tumor of the major salivary glands. However, its occurrence is exceedingly rare and has only recently been recognized. Only few cases in the major salivary glands have been reported. This report is an additional case of MAC with origin in minor salivary gland at the oral floor. Immunohistochemical analysis of the tumor for cytokeratins 7, 8, 10, 13, 14, 18 e 20, vimentin, SMA, CEA, EMA, p53, ki-67 e histochemical analysis for PAS, Alcian blue e mucicarmin was performed. Predominantly, the tumor expressed cytokeratins 7, 18 and 20 that are commonly found in simple epithelia. Therefore, was observed positivity to PAS, Alcian blue and mucicarmin. No other cancer has been detected. The tumor is considered to be a primary mucinous adenocarcinoma, being the twenty-third case in minor salivary gland reported in the literature and the fourth MAC located in the mouth floor.

Dyshormonogenetic goiter is a rare cause of congenital hypothyroidism occurring due to a lack of enzymes necessary for the synthesis of thyroid hormones. It is morphologically characterized by architectural and cellular pleomorphism that may mimic thyroid malignancy and cause difficulties in differential diagnosis. We report a new case occurring in a 37-year-old male with history of hypothyroidism since the age of 6 years treated by L-thyroxin. He developed a progressively slow growing multinodular goiter and consulted for recent dyspnea. Computed tomography scan showed a multinodular plunging goiter with compression of the trachea and vessels in the left side. A total thyroidectomy was performed. Gross examination revealed an enlarged and multinodular thyroid gland, presenting hemorrhagic changes in the larger nodules. Histologically, the features were consistent with dyshormonogenetic goiter. The literature on the histopathology of dyshormonogenetic goiter is reviewed and clues to avoid inappropriate overdiagnosis of malignancy are given.

Anorectal malformations occur in 1 in 5,000 births. Some patients persist until adulthood with the problem; however, due its infrequent presentation in adult patients, colorectal surgeons in general are not familiar with this condition, therefore these patients are commonly advised to have a permanent stoma. The posterior sagittal anorectoplasty (PSAR) has become a proven and standard technique for operative correction of anorectal malformations in childhood and many pelvic conditions and must be part of the colorectal surgeon armamentarium as it is also an effective technique in adults.

Introduction: Symmetrical peripheral gangrene (SPG, or peripheral symmetrical gangrene, PSG) is defined as acute onset of symmetrical ischemic gangrene over multiple sites of acral area, mostly extremities and sometimes nose, ear or scalp, without vascular occlusion or vasculitis. The pathogenesis is still unknown but related to local ischemia due to disseminated intravascular coagulation, infection, or medications. Case presentation: A 87 year-old Asian man was admitted to the intensive care unit under the impression of septic shock. Vasopressors were administered due to hypotension. However, bilateral cyanosis over limbs was noted gradually few days after the medications given. Dry gangrene over distal limbs developed even after we stopped the medication as early as possible. Discussion: Symmetrical peripheral gangrene may be an indicator for disseminated intravascular coagulation and poor prognosis. Quick reversal of underlying disease and elimination of precipitating factors are both significant managements once symmetrical peripheral gangrene is diagnosed.

Introduction: Mini-implants are being extensively used in orthodontics, providing a new field of possibilities for treatment of the cases when a maximum anchorage is required. The procedure is critical during the insertion of miniimplants in the alveolar process between the roots of the tooth, and major complications can include contact and damage to adjacent tooth roots. Objective: The following case report describes a failure because of unintentional root damage after orthodontic mini-implant placement, resulting in longitudinal root fracture followed by extraction of the damaged mandibular second molar. Discussion: Factors which might have contributed to the irreversible iatrogenic injury associated with the use of mini-implants in a diabetic patient submitted to orthodontic treatment are discussed and analyzed. Conclusion: Although mini-implant placement has become a routine procedure in the orthodontic practice, it still represents an intrinsic risk to the process of insertion, which is the damage to adjacent structures. The placement of mini-implants must be carefully monitored, even in those cases which present low risk for iatrogenic injury. However much confident the professional may be, self-confidence in excess often leads to failure, provoking irreversible damages.

T-cell Pro-Lymphocytic Leukemia (T-PLL) is a rare disease caused by malignancy of mature post-thymic T-cell. Myelodysplastic Syndrome (MDS) is caused by abnormal differentiation of myeloid lineage cells resulting in myeloid leukemia. Both of these hematological disorders are frequently diagnosed in elderly persons. Myeloid lineage is believed to be situated at the position far from lymphoid one as it is regarded on a tree diagram about the blood cell maturation. We reported herein a rare case of T-PLL accompanied by plural M-proteins with MDS a nonagenarian. The 96 years old patient was admitted to our hospital because of lymphocytosis and abnormal lymphocytes. From the bone marrow aspirate, biopsy and hematological findings, abnormalities were observed in cells of three different lineages, namely, (i) neutrophils with hypersegmented-nuclei (ii) erythroblasts with nuclear division, large platelets and megakaryoblastic cells, and (iii) reticulum cells with phagocytosed iron in their cytoplasm. Lymphocytes showed CD3 (+), CD4 (±), CD5 (+), CD8 (+), CD10 (+), CD56 (-) and CD57 (-). Mast cells and large lymphocytic cells with nuclear pockets were also seen. Anti-HTLV-1 antibody was negative. Soluble IL-2 receptor was significantly elevated to 7910 U/ml. Both IgGλ and IgGκM-protein were detected. No Bence-Jones protein was detected in the urine. Chromosomal abnormality of 45 (X, 0) or loss of Y chromosome was also demonstrated. Due to his high age, it was difficult to classify his condition according to the conventional classification. Thus, what we had experienced is truly a rare case that coincidentally showed T-PLL and MDS with plural M-proteins.

Background: Mosaic triploidy is uncommon in a liveborn. There have been no previous reports of prenatally diagnosed diploid/triploid mosaicism by amniocentesis. We present a case of prenatally diagnosed diploid/triploid mosaicism. Case: A 26 year old G3P1 presented for ultrasound at 21 weeks 5 days following a positive quad screen. Asymmetrical growth restriction, abnormal hand positioning and suspected heart defect were noted. Amniocentesis revealed mosaic triploidy; 69, XXX (10)/46, XX (6). Infant was delivered at 37 weeks by repeat cesarean section. Neonatal cord blood karyotype confirmed mosaic triploidy; 69, XXX (2)/46, XX (18). Conclusion: Prenatal diagnosis and subsequent outcome of a liveborn mosaic diploid/triploid infant has not been previously described. Our case demonstrates that diploid/triploid mosaicism may be diagnosed by amniocentesis and that the pregnancy may be managed to live birth near term.

Myelodysplastic Syndrome (MDS) is a problem of ineffective hematopoesis, due to a clonal disorder of the hematopoetic stem cells. MDS is rare in children and considered premalignant as it often progresses to leukemia over time. There are known inherited predisposing conditions to MDS that have been reported in the literature. We describe the case of a 12-year-old girl with multiple dysmorphic features, short stature, and developmental delay with a new diagnosis of MDS (RAEB) with no confirmed genetic diagnosis linking all these features together. We propose that her underlying syndromic diagnosis may have predisposed her to MDS.

We report the case of a 75-year-old female with an intrapulmonary smooth, round 2-cm nodule that contained heterotrophic thyroid tissue with no malignant or teratomatous features. She also had a normally located multinodular goiter. Ultrasound examinations of the thyroid and CT-scans of the pulmonary nodule done 7 years apart showed no significant change. Thyroid/whole body scans using TC-99m done 7 years apart also provided similar findings. The lack of change in the thyroid and pulmonary nodules makes a thyroid malignancy highly unlikely. Intrapulmonary heterotrophic thyroid tissue is a very rare entity, with only 2 reported cases in the literature. Our case is different from the other 2 in that they did not have a co-existing goiter. This case report draws attention to the occurrence of intrapulmonary heterotrophic thyroid tissue. Although rare, it needs to be considered in the differential diagnoses of a pulmonary nodule.