scholarly journals Foot metastasis: Current knowledge

2020 ◽  
Author(s):  
Tommaso Greco ◽  
Luigi Cianni ◽  
Domenico De Mauro ◽  
Giacomo Dughiero ◽  
Maria Beatrice Bocchi ◽  
...  
Keyword(s):  
Metastatic Disease ◽  
Primary Tumor ◽  
Current Knowledge ◽  
Case Reports ◽  
Late Phase ◽  
Foot Pain ◽  
Old Patients ◽  
Metatarsal Bones ◽  
Occult Malignancy ◽  
The Right

Foot metastasis are rare and often overlooked due to non-specifical symptoms. This often leads to misdiagnosis delaying the right diagnosis. Metastatic disease of the foot is rare. Foot pain and swelling may be the presenting symptom of an occult malignancy. If metastatic disease is not kept in the differential diagnosis of foot pain, diagnosis and treatment will be delayed. The purpose of this study was to analyze articles presenting cases of foot metastasis to provide a more accurate incidence of symptomatic foot acrometastasis as well as to review the clinical course and outcomes. Studies were searched on PubMed/Medline from the inception to February 2020. All studies included in the review presented foot metastasis either with or without a known primary tumor. Most of the articles were case reports, to which we added two case reports of foot acrometastasis produced by our Institute. Forty-three studies with a total of 45 patients were included in this review. The literature published mostly concerning case reports about old patients (average age: 63,2), in a late phase of their disease. Lung cancer appeared to be the most common primary tumor, followed by endometrial and breast cancer. In the 36% of the cases foot metastasis were found when the primary site was still unknown. Calcaneus and metatarsal bones were the most common bones involved. Surgical solution is rare, the chosen treatments are often of palliative care. Prognosis was often poor, death occurred within 2 years since the discovery of foot metastasis in about 50% of cases.

scholarly journals Primary Intraosseous Synovial Sarcoma with Molecular Confirmation: Expanding and Clarifying the Spectrum of This Rare Neoplasm

2020 ◽  
Vol 2020 ◽  
pp. 1-11
Author(s):  
Kelsey E. McHugh ◽  
John D. Reith ◽  
Nathan W. Mesko ◽  
Scott E. Kilpatrick
Keyword(s):  
Soft Tissue ◽  
Synovial Sarcoma ◽  
Soft Tissues ◽  
Case Reports ◽  
Bone Lesion ◽  
Metastatic Potential ◽  
Metatarsal Bones ◽  
Synovial Sarcomas ◽  
Primary Bone ◽  
The Right

Synovial sarcoma is a well-known malignant tumor usually originating within deep soft tissues of the lower extremities of adolescents and young adults. Rare radiologically confirmed examples of primary bone synovial sarcoma have been documented, generally in isolated case reports. Herein, we report two cases of primary intraosseous synovial sarcoma, with molecular confirmation, involving the left humerus of a 45-year-old female and the right fourth metatarsal bone in a 36-year-old male. Additionally, we clarify the spectrum of primary intraosseous synovial sarcoma by separately analyzing reported cases with radiographic confirmation of bone origin and molecular support for the diagnosis. There are clinicopathologic differences between those tumors with documented molecular confirmation and those lacking such confirmation, specifically regarding their anatomic distribution (p<0.0001). Regarding the radiology of our two cases, the humeral lesion appeared almost entirely intramedullary without soft tissue extension; the midfoot lesion demonstrated a destructive, metatarsal-centered bone lesion, initially thought clinically to represent primary bone osteosarcoma. The diagnoses of monophasic synovial sarcoma were rendered via core needle biopsies, with molecular FISH confirmation of SYT gene rearrangement. Clinical follow-up data was only available for the female patient with the primary humeral lesion, who underwent surgical resection, with no local recurrence or distant metastasis at 7 months postsurgery. To our knowledge, these are the first reported examples of molecularly confirmed, primary intraosseous synovial sarcomas of the humerus and metatarsal bones. Primary intraosseous synovial sarcomas with molecular confirmation differ clinically from those lacking it; however, the demographic features and metastatic potential appear similar to primary soft tissue synovial sarcoma.

scholarly journals Bone morphogenetic proteins, breast cancer, and bone metastases: striking the right balance

2017 ◽  
Vol 24 (10) ◽  
pp. R349-R366 ◽  
Author(s):  
Catherine Zabkiewicz ◽  
Jeyna Resaul ◽  
Rachel Hargest ◽  
Wen Guo Jiang ◽  
Lin Ye
Keyword(s):  
Breast Cancer ◽  
Cancer Progression ◽  
Bone Morphogenetic Proteins ◽  
Therapeutic Potential ◽  
Current Knowledge ◽  
Breast Tumour ◽  
Cellular Functions ◽  
Foetal Development ◽  
Key Factor ◽  
The Right

Bone morphogenetic proteins (BMPs) belong to the TGF-β super family, and are essential for the regulation of foetal development, tissue differentiation and homeostasis and a multitude of cellular functions. Naturally, this has led to the exploration of aberrance in this highly regulated system as a key factor in tumourigenesis. Originally identified for their role in osteogenesis and bone turnover, attention has been turned to the potential role of BMPs in tumour metastases to, and progression within, the bone niche. This is particularly pertinent to breast cancer, which commonly metastasises to bone, and in which studies have revealed aberrations of both BMP expression and signalling, which correlate clinically with breast cancer progression. Ultimately a BMP profile could provide new prognostic disease markers. As the evidence suggests a role for BMPs in regulating breast tumour cellular function, in particular interactions with tumour stroma and the bone metastatic microenvironment, there may be novel therapeutic potential in targeting BMP signalling in breast cancer. This review provides an update on the current knowledge of BMP abnormalities and their implication in the development and progression of breast cancer, particularly in the disease-specific bone metastasis.

scholarly journals Cephalad misplacement of a pulmonary artery catheter in a patient with a preexisting Hickman catheter

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hoon Choi ◽  
Joon Pyo Jeon ◽  
Jaewon Huh ◽  
Youme Kim ◽  
Wonjung Hwang
Keyword(s):  
Mitral Valve ◽  
Pulmonary Artery ◽  
Pulmonary Artery Catheter ◽  
Case Reports ◽  
Mitral Valve Regurgitation ◽  
Catheter Insertion ◽  
Routine Practice ◽  
Hickman Catheter ◽  
Risk Patients ◽  
The Right

Abstract Background Pulmonary artery catheter insertion is a routine practice in high-risk patients undergoing cardiac surgery. However, pulmonary artery catheter insertion is associated with numerous complications that can be devastating to the patient. Incorrect placement is an overlooked complication with few case reports to date. Case presentation An 18-year-old male patient underwent elective mitral valve replacement due to severe mitral valve regurgitation. The patient had a history of synovial sarcoma, and Hickman catheter had been inserted in the right internal jugular vein for systemic chemotherapy. We made multiple attempts to position the pulmonary artery catheter in the correct position but failed. A chest radiography revealed that the pulmonary artery catheter was bent and pointed in the cephalad direction. Removal of the pulmonary artery catheter was successful, and the patient was discharged 10 days after the surgery without complications. Conclusions To prevent misplacement of the PAC, clinicians should be aware of multiple risk factors in difficult PAC placement, and be prepared to utilize adjunctive methods, such as TEE and fluoroscopy.

scholarly journals A Rare Case Report of Unusual Path of Left Internal Jugular Central Line

2021 ◽  
pp. 1-3
Author(s):  
Rajashekar Rangappa Mudaraddi ◽  
Hany Fawzi Greiss ◽  
Navin Kumar Manickam
Keyword(s):  
Superior Vena Cava ◽  
Case Reports ◽  
Superior Vena ◽  
Vena Cava ◽  
Central Line ◽  
Left Superior Vena Cava ◽  
Common Procedure ◽  
Rare Case Report ◽  
The Right ◽  
Line Path

Central venous cannulation is the most common procedure performed in perioperative setting and intensive care unit. Many case reports reported unusual positioning of central line catheters. Here, we would like to report a case of central line path in persistent left superior vena cava, a rare entity with a course similar to the right internal jugular central line. Preoperative computed tomography chest showed duplex superior vena cava which was not reported.

scholarly journals Delayed Extradural Hematoma after Evacuation of Contralateral Acute Extradural Hematoma

2020 ◽  
Author(s):  
Majid Anwer ◽  
Atique Ur Rehman ◽  
Farheen Ahmed ◽  
Satyendra Kumar ◽  
Md Masleh Uddin
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Postoperative Period ◽  
Road Traffic ◽  
Case Reports ◽  
Mass Effect ◽  
Extradural Hematoma ◽  
Traumatic Head Injury ◽  
Neurologic Deterioration ◽  
The Right

Abstract Introduction Traumatic head injury with extradural hematoma (EDH) is seen in 2% of patients. Development of EDH on the contralateral side is an uncommon complication that has been reported in various case reports. Case Report We report here a case of an 18-year-old male who had a road traffic injury. He was diagnosed as a case of left-sided large frontotemporoparietal acute extradural bleed with a mass effect toward the right side. He was managed with urgent craniotomy and evacuation of hematoma. A noncontrast computed tomography (NCCT) scan performed 8 hours after postoperative period showed a large frontotemporoparietal bleed on the right side with a mass effect toward the left side. He was again taken to the operating room and right-sided craniotomy and evacuation of hematoma were performed. A postoperative NCCT scan revealed a resolved hematoma. The patient made a complete recovery in the postoperative period and is doing well. Conclusion Delayed onset epidural hematoma is diagnosed when the initial computed tomography (CT) scan is negative or is performed early and when late CT scan performed to assess clinical or ICP deterioration shows an EDH. The diagnosis of such a condition requires a high index of suspicion based on the mechanism of injury along with fracture patterns. Additionally, change in pupillary size, raised intracranial pressure, and bulging of the brain intraoperatively are additional clues for contralateral bleeding. Neurologic deterioration may or may not be associated with delayed EDH presentation. An early postoperative NCCT scan within 24 hours is recommended to detect this complication with or without any neurologic deterioration.

scholarly journals Pulmonary Hypertension in Acute and Chronic High Altitude Maladaptation Disorders

2021 ◽  
Vol 18 (4) ◽  
pp. 1692
Author(s):  
Akylbek Sydykov ◽  
Argen Mamazhakypov ◽  
Abdirashit Maripov ◽  
Djuro Kosanovic ◽  
Norbert Weissmann ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
High Altitude ◽  
Clinical Experience ◽  
Current Knowledge ◽  
Hypoxic Pulmonary Vasoconstriction ◽  
Treatment Options ◽  
Right Heart Failure ◽  
Channel Blockers ◽  
The Right ◽  
Extensive Clinical Experience

Alveolar hypoxia is the most prominent feature of high altitude environment with well-known consequences for the cardio-pulmonary system, including development of pulmonary hypertension. Pulmonary hypertension due to an exaggerated hypoxic pulmonary vasoconstriction contributes to high altitude pulmonary edema (HAPE), a life-threatening disorder, occurring at high altitudes in non-acclimatized healthy individuals. Despite a strong physiologic rationale for using vasodilators for prevention and treatment of HAPE, no systematic studies of their efficacy have been conducted to date. Calcium-channel blockers are currently recommended for drug prophylaxis in high-risk individuals with a clear history of recurrent HAPE based on the extensive clinical experience with nifedipine in HAPE prevention in susceptible individuals. Chronic exposure to hypoxia induces pulmonary vascular remodeling and development of pulmonary hypertension, which places an increased pressure load on the right ventricle leading to right heart failure. Further, pulmonary hypertension along with excessive erythrocytosis may complicate chronic mountain sickness, another high altitude maladaptation disorder. Importantly, other causes than hypoxia may potentially underlie and/or contribute to pulmonary hypertension at high altitude, such as chronic heart and lung diseases, thrombotic or embolic diseases. Extensive clinical experience with drugs in patients with pulmonary arterial hypertension suggests their potential for treatment of high altitude pulmonary hypertension. Small studies have demonstrated their efficacy in reducing pulmonary artery pressure in high altitude residents. However, no drugs have been approved to date for the therapy of chronic high altitude pulmonary hypertension. This work provides a literature review on the role of pulmonary hypertension in the pathogenesis of acute and chronic high altitude maladaptation disorders and summarizes current knowledge regarding potential treatment options.

Intracardiac Self Insertion of a Darning Needle in a Psychiatric Patient

2021 ◽  
Vol 4 (5) ◽  
pp. 01-13
Author(s):  
Avra Laarakker
Keyword(s):  
Left Ventricle ◽  
Psychiatric Patient ◽  
Surgical Intervention ◽  
Case Reports ◽  
Interventricular Septum ◽  
Intravenous Drug User ◽  
Standard Of Care ◽  
Pubmed Search ◽  
Needle Entry ◽  
The Right

Objective: We report a case of self inserted needle into the left ventricle of the heart and a description of our surgical intervention in a psychiatric patient without decision-making capacity. We discuss issues regarding obtaining consent in this patient with a sub-acute presentation, report our operative approach, and summarize a treatment approach based on a review of current literature. Methods: A PubMed search using terms “needle, “heart”, “insertion”, “intracardiac foreign object”, yielded 69 relevant papers. 67 of these were case reports yielding 72 individual cases. Age, gender, cause of the needle entry (Accidental Plus (A+), Intravenous Drug User [IVDU], Self-inflicted (SI)), type of needle, location in heart, neuropsychiatric history, treatment, and outcome were documented. Results: Within the SI category, there were a total of 28 cases, 89.3% had a neuropsychiatric history whereas only there were only 2 such patients in both the IVDU and A+ group. The location of the needle in the heart in all 72 cases was as follows: right ventricle 40.3%, other 20.8%, left ventricle 19.4 %, ventricle and interventricular septum 16.7% and the right and left atrium were each 1.4 %. In all three groups (n=72), 77.8% of patients underwent surgery, with 92.9% having a stable outcome. Conclusion: Our case and review demonstrates that management of such cases, particularly when active mental health issues are present, requires a case-by-case evaluation and treatment as a specific standard of care has not been established. Surgical intervention appears to be the preferred management regardless of presentation with good outcomes. Running Title: Intracardiac Self Insertion of a Darning Needle in a Psychiatric Patient

Change from triple negative type to triple positive type: A case report of discordance of re-biopsy from primary breast cancer

2020 ◽  
pp. 1-5
Keyword(s):  
Primary Tumor ◽  
Triple Negative ◽  
Lobular Carcinoma ◽  
Rare Event ◽  
Metastatic Tumor ◽  
Complete Response ◽  
Current Treatment ◽  
Positive Type ◽  
Impact On Treatment ◽  
The Right

The patient was a 60-year-old woman who had visited a clinic with the chief complaint of a mass in the right breast prior to being referred to our hospital. Breast examination revealed the presence of a 3-cm hard elastic mass in the C region of the right breast. Computed tomography (CT) further indicated metastases to the liver and lungs. Upon needle biopsy of the primary tumor, the patient was diagnosed with triple-negative (ER (-), PgR (-), HER2 (-)) invasive lobular carcinoma. Chemotherapy was successful in achieving a transient partial response (PR); however, the tumor later advanced to a progressive disease (PD) after five cycles of oral fluoropyrimidine derivative therapy (S-1). Re-biopsy of the primary tumor revealed that the tumor was triple-positive (ER (+), PgR (+), HER2 (+)). The patient was subsequently treated with anti-HER2 therapy and has since achieved complete response (CR). Although biological changes sometimes occur from the primary to the metastatic tumor, changes in the primary tumor itself during the course of treatment is a rare event. Furthermore, the transition from triple-negative to triple-positive status is very uncommon. Re-biopsy rarely changes the biological characteristics of a tumor; however, biological changes can have a significant impact on treatment if they do occur. Thus, it is important to perform a re-biopsy if the current treatment results in PD.

Abstract WP190: Clinical Features of Sarcoid Patients With Ischemic Stroke

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Ahmed Z Obeidat ◽  
Heidi Sucharew ◽  
Charles J Moomaw ◽  
Dawn O Kleindorfer ◽  
Brett M Kissela ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Current Knowledge ◽  
Case Reports ◽  
Brain Mri ◽  
Sporadic Case ◽  
Prior History ◽  
Stroke Patients ◽  
Stroke Subtype ◽  
Stroke Event ◽  
History Of

Background: Current knowledge on ischemic stroke in sarcoid patients stems from sporadic case reports. The mechanism is thought to be related to granulomatous involvement of brain vasculature. However, clinical, demographic, and radiographic features of sarcoid patients with ischemic stroke are lacking. If sarcoid patients are at higher risk for ischemic stroke event, we hypothesized that the risk factors for ischemic stroke and stroke subtype distribution would differ between sarcoid and non-sarcoid ischemic stroke patients. Methods: Cases of ischemic stroke were identified for the years 2005 and 2010 from the population-based Greater Cincinnati/Northern Kentucky Stroke Study (population 1.3 million). Ischemic stroke cases were physician study confirmed and patients with a history of sarcoid were identified through medical chart review. Clinical variables were compared between stroke patients with history of sarcoid and those with no prior sarcoid history. Results: A total of 4258 cases of ischemic stroke were identified; of them, only 18 had prior diagnosis of sarcoid (0.04%). Brain MRI showed diffusion restriction in 14 out of 15 (93%) MRIs performed in sarcoid patients. The table presents risk factor and subtype data on sarcoid patients compared with non-sarcoid patients. Conclusions: We identified only a few cases of prior sarcoid history in our two-year ascertainment of ischemic stroke patients in our population. In comparison with stroke patients with no prior history of sarcoid, the sarcoid patients tended to be of younger age at presentation, female, have a history of diabetes and hyperlipidemia, and more likely of African descent, perhaps related to the diagnosis of sarcoid itself. We were unable to detect differences in stroke subtype distributions between sarcoid and non-sarcoid ischemic stroke patients.

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