Journal of Clinical Case Reports

Brachial plexus tumors are rare. It comprises of only 5% of all tumors of upper limb. The two most common brachial plexus region tumors are schwannomas and neurofibromas. Brachial plexus tumours comprises of only 5% of all tumours of upper limb. Schwannomas are most frequently found in the head and neck region, which comprises 25% of all Schwannomas. There are only about 5% of schwannomas present as brachial plexus tumours. Here we report four cases of brachial plexus schwannoma with surgical removal managed in our centre from 2013 to 2016.

Spontaneous hepatic rupture constitutes very rare complication of pregnancy and is associated with an increased risk of mortality. The patient presented at 30 weeks of gestation with HELLP syndrome developed life threatening hepatic rupture. She underwent an emergent cesarean delivery followed by exploration of her abdomen by hepatobiliary surgeons. An expanding hematoma with rupture of the right and left lobe of the liver was successfully treated with radiofrequency ablation electrode. The patient was discharged home in good condition 13 days after surgery. Quick diagnosis, multidisciplinary approach and radio-frequency ablation help to achieve an excellent clinical outcome in a patient with hepatic rupture from HELLP syndrome.

Background: Obscure gastrointestinal bleeding seems to be important problem affecting increasing group of patients. Due to its localization and mild symptoms investigation is difficult and usually requires advanced procedures. Unfortunately, it is often impossible to show precisely a source of bleeding what delays treatment and can cause severe bleeding. Methods: We describe a case report of the patient who refused surgical treatment despite proper bleeding localization by enteral capsule what caused serious bleeding few months later. Patient was operated on duty intraoperative endoscopy was necessary to perform. After treatment he left hospital in a good condition without any negative consequences. Discussion: Authors discussed investigation methods, a role of endoscopy performed intraoperatively and propose a scheme helpful during obscure bleeding investigation.

  HIV-related pulmonary complication is a serious problem in the worldwide. In order to understand features of AIDS-associated pulmonary complications in clinical. Imaging features, microbe characterization and pathology of 14 AIDS-associated pulmonary disease patients derived from Nanyang Medical College hospitals were measured by corresponding techniques. 14 patients infected by different virus, fungus and bacteria showed special features of image and pathology, respectively. Regarding of various clinical characterizations derived from AIDS-associated pulmonary complications, combination different strategy is contributing to elucidate characterizations of AIDSassociated pulmonary complications.

Background: Hydrocele of the canal of Nuck (HCN) causes inguinal swelling in women. This study aimed to evaluate the outcomes of laparoscopic intracorporeal hydrocelectomy and posterior wall suture repair for treating HCN. Methods: We retrospectively reviewed the charts of 56 adult female patients with HCN at Damsoyu Hospital, Seoul, Republic of Korea, from September 2012 to July 2016. Results: Of the 56 patients, encysted hydroceles were observed in 43 (76.8%) and communicating hydroceles were observed in 13 (23.2%). Among the 43 patients with encysted hydroceles, 30 (69.8%) had serous hydroceles, 12 (27.9%) had hemorrhagic hydroceles, and one (2.3%) had an inflammatory hydrocele. Fifteen (28.6%) patients, especially those with hemorrhagic hydroceles (11/12) and one with an inflammatory hydrocele (1/1), complained of inguinal pain (p<0.001). No recurrence was observed during the follow-up period. Conclusion: HCN should be considered during the differential diagnosis of hernia in women with inguinal swelling. The diagnosis was made with preoperative ultrasonography, and laparoscopic intracorporeal hydrocelectomy with posterior wall repair was performed as an effective treatment.

Background: A Spigelian Hernia (SH) is an uncommon clinical entity comprising 0.12% to 2% of all the abdominal wall hernias. Usually the symptoms of the hernia are non-specific and therefore a diagnosis based only on the clinical examination is difficult. Imaging studies are particularly useful during the diagnostic process, but sometimes do not give the proper presurgical diagnosis. Case presentation: We present the case of a 77-year-old woman with a suspected tumor of the blind gut, where only a more accurate preoperative examination later enabled the identification of the presence of a SH. Furthermore, during the less conventional classical surgery it was revealed that the appendix, which is an event that rarely occurs, was found incarcerated within the hernia contents. Conclusion: We present the clinical difficulty with diagnosis of SH with incarcerated appendix and the variety of the symptoms. Additionally, we present a brief literature review with a concomitant description of the clinical appearance, diagnostic approach, and treatment options concerning SH.

We report the case of a 78-year-old male patient with a solitary 7 cm × 9 cm × 11 cm extracranial and intracranial metastasis from hepatocellular carcinoma. Because of the swelling of his right temporal region, a benign soft-tissue tumor was initially considered as a cause. A resection attempt was performed, resulting in severe bleeding from tumor tissue. A biopsy provided diagnostic evidence of HCC. Eighteen months later the patient presented with a symptomatic secondary generalized seizure and the tumor threatened to ulcerate through the skin. A diagnostic assessment revealed that the tumor extended to the skull base and had infiltrated the orbita, dura, and calvaria.

Angioedema is a local, non-inflammatory, self-limiting oedema that is circumscribed, and is caused by increased vascular permeability and leakage of plasma into the deeper skin layers. Angioedema can occur with or without urticaria. It can be acute or chronic (more than six weeks in duration) as well as being allergic, hereditary or idiopathic in nature. The reaction is self-limited, usually lasting few days, but may occur repetitively with each exposure to the allergen which may cause a fatal reaction at some point. This is the main reason behind the removal of the valuable drug (rivaroxaban) like in our patient because the result of angioedema occurred 2 months after administration of the rivaroxaban.

Introduction: Liposarcomas are infrequent tumors. Only 5.6% of these tumors occur in the head and neck. Primary liposarcomas of the larynx comprise ∼10% to 15% of head and neck liposarcomas. Multiple surgeries and recurrences history are common. Case summary: We present the case of a 33-year-old male whose illness started at 16 years of age, and who underwent multiple surgeries due to multiple recurrence (six) by a liposarcoma in the neck, all treated with organ preservation. In 2014 patient arrived with a big recurrence a total pharyngolaryngectomy with a jejunal are flap was performed. after 18 month of the follow up the patient comes to the visits and refered developed headache, ataxia and shortness of breath, that is why a MRI of the brain and CT of the torax shown intraxial lesions in the brain and multiple bilateral pulmonary nodules compatible with metastatic disease, We propose palliative treatment with radiotherapy but the patient refuse treatment so he was sent to palliative care. Discussion: The mainstay of treatment is surgical resection. Multiple recurrence is the rule but metastasis to the brain was not reported before. The role of radiotherapy is not well know. Chemotherapy until now showed no sustancial benefit.

Background: Cavernous sinus (CS) involvement has rarely been reported in malignant lymphoma. CS syndrome is uncommon as an initial presentation of non-Hodgkin’s extra nodal lymphomas. Case report: A 57-year-old man presented with a one-month history of headache, ocular pain and diplopia. Neurological examination revealed incomplete palsy of the left III and right VI nerves, and sensory loss of the first division of the left trigeminal nerve. Initial Magnetic Resonance Imaging (MRI) suggested left CS thrombosis. Despite optimal anticoagulation therapy, he developed right oculomotor nerve palsy, with ptosis and mydriasis of the left eye and bilateral sensory loss of the first and second division of the trigeminal nerves. MRI demonstrated a homogenous tissue lesion occupying the CS with moderate gadolinium enhancement. A body scan showed hepatosplenomegaly with hepatic and splenic nodules. The patient underwent percutaneous transhepatic biopsy and the lesion was histologically diagnosed as non-Hodgkin’s lymphoma, diffuse large B-cell type. Tumor cells were positive for CD20, CD79a and Ki67. Following four cycles of intravenous and intrathecal chemotherapy, the right oculomotor nerve palsy was completely resolved. There was partial improvement of enhancing lesion noted on follow-up MRI.
Conclusion: CS syndrome is a rare presentation of malignant non-Hodgkin lymphoma. The diagnosis rests largely on imaging and biopsy results. It is associated with poor prognosis and Aggressive combined modality treatment appears to improve survival.

Granulosa tumors are rare malignant tumors of the ovary. There are two histological types: the adult form (95%) and the juvenile form (5%). They often occur in the adult population with extreme ages ranging from 40 to 70 years. The clinical signs are very variable with a slow evolution and a risk of recurrence that can go up to 30-40 years after the diagnosis. The radiological diagnosis is based on ultrasound data and magnetic resonance image (MRI). Radical surgical treatment is the basis of their therapeutic management.

Adrenal tumors are nowadays being detected with increasing frequency due to the widespread use of various radiological imaging techniques (CT, MRI, US). Incidentally discovered adrenal masses (incidentalomas) are shown in 1% to 5% of all abdominal CT scans performed. Cavernous hemangiomas of the adrenal gland are extremely rare, benign in nature and most usually non-functioning lesions. We report a case of a 50-year-old female who presented with flank pain and abdominal discomfort. MRI of the abdomen revealed a large, oval, adrenal tumor mass, embedded between the upper pole of the right kidney and inferior surface of the liver. Surgery was performed, and tumor was excised completely. Histopathological examination revealed a cavernous hemangioma of the adrenal gland.