Diffuse Leukoplakia of the Bladder Ostium-Sparing in Patient Treated with Leuprorelin for Breast Cancer

Case. A 55-year-old woman came to our attention in April 2020 referring haematuria, frequency and urgency. The patient referred previous treatment with leuprorelin 3.75 mg/2 ml for breast cancer three years ago. Urine culture was performed and resulted always negative for pathogens. Cystoscopy revealed a whitish plaque lesion on the fundus, dome, trigone, and left lateral wall of the bladder. Histology of the biopsy confirmed the diagnosis of leukoplakia of the bladder. The plan is to follow her up repeating a cystoscopy every three months and biopsy in 6 months. Literature search revealed very little information on pathogenesis and prognosis of this condition due to its rare occurrence. The main objective of our case study was to describe individual situation of a woman affected by diffuse leukoplakia of the bladder ostium-sparing with a previous treatment with leuprorelin 3.75 mg/2 ml for breast cancer and to show safety of follow-up by cystoscopy and biopsy. Conclusions. We showed a case of a woman treated with leuprorelin and with diffuse leukoplakia of the bladder. We support the recommended long-term follow-up and surveillance based on the literature review by cystoscopy with or without biopsy.

Spontaneous urinary bladder perforation: An unusual presentation of well-differentiated papillary peritoneum mesothelioma

Introduction: Well-differentiated papillary mesothelioma (WDPM) is a very rare neoplasm. Most of WDPM are asymptomatic and are often incidentally detected during surgery. This report describes a case of WDPM of the peritoneum unexpectedly diagnosed in a male with a spontaneous intraperitoneal bladder rupture. Case presentation: A 65-year-old male presented to our Emergency Department in November 2019 with a two-day history of anuria, abdominal pain, distention, and sepsis. The CT scan reported a large amount of extra and intraperitoneal free fluid. The CT cystogram showed bladder perforations on the dome and on the left lateral wall which was repaired through exploratory laparotomy. Intraoperatively, we encountered extensive suppurative peritonitis with large fibrino-purulent exudation. The purulent perivesical peritoneum was dissected and sent for histopathological examination which unexpectedly resulted in WDPM of the peritoneum. Conclusion: Although we can’t affirm with certainty, this case would seem to suggest that WDPM had played a role in patient’s clinical presentation. However, further research is necessary to draw stronger conclusion.

Isolated upper vaginal wall laceration in an underage: a need to re-examine child sexual abuse in South-South Nigeria.

<p>Child sexual abuse includes any sexual act between a minor and an adult, or between two minors, when one exerts power over the other. It involves forcing, coercing or persuading a child to engage in any type of sexual act. It also involves non-contact acts such as exhibitionism, exposure to pornography, voyeurism, and communicating in a sexual manner by phone or internet. An eight-year-old girl was rushed to the gynaecological emergency unit of the Federal medical centre, Yenagoa with complaints of a three-hour history of sudden onset vaginal bleeding following a fall astride in their house. There was no injury to the vulva and the child and her relatives denied any form of sexual abuse by anyone within or outside their home. She had examination under anaesthesia in theatre and a 3 cm laceration was identified at the proximal one-third of the left lateral wall of the vagina, covered with a blood clot; not bleeding actively. Repair was done and she was subsequently discharged home on the fourth post-operative day after counselling of mother and child. Child sexual abuse is common in our environment. Education and bonding with children, education of the public via outreaches, social media campaigns and other means possible, and improvement in the socio-economic situation of people will help reduce the incidence of child sexual abuse and encourage reporting and early disclosure where they occur.</p>

Anaesthetic Management of Pheochromocytoma with Atrial Fibrillation - A Case Report

An elderly female aged 65 years weighing 69 Kgs presented to the Pre-Anaesthetic Clinic (PAC) for transurethral resection of bladder carcinoma. As part of the evaluation of bladder carcinoma, Contrast Enhanced Computed Tomography (CECT) abdomen done showed a left adrenal lesion. She was a known case of hypertension since the last 10 years and was on telmisartan tablets 40 mg once daily (OD) since then. She had a history of palpitations 3 years back, which when evaluated was diagnosed as atrial fibrillation. She was started on metoprolol tablets 25 mg OD and warfarin 2 mg OD. In view of her history and positive findings on CECT abdomen, it was decided in the PAC to screen her for pheochromocytoma. There was no definite history of classic triad of headache, palpitation and sweating. No history of headache, weight loss, fatigue, syncopal attacks, hypo / hyperthyroidism were reported. Physical examination showed Heart Rate (HR) of 96 beats per minute (bpm), irregular in rhythm, Respiratory Rate (RR) of 16 breaths per minute and Blood Pressures (BP) of 146 / 98 mmHg and 140 / 90 mmHg in the supine and sitting positions respectively. Biochemical test results showed 24-hour urine metanephrine 0.452 mg / l which is 1.45 mg / 24 hrs. (normally < 1 mg / 24 hrs.) and urine vanillylmandelic acid 8.1 mg / gm creatinine (2 – 7 mg / gm). Electrocardiography (ECG) showed right bundle branch block and AF (Atrial Fibrillation) with controlled ventricular rate. Echocardiography showed mild aortic stenosis, aortic regurgitation and ejection fraction of 68 % with no evidence of clots / thrombus. In terms of clinical imaging, the CECT showed a well-defined lesion in the left adrenal measuring 19 x 12 mm with a relative washout of 21 % and a faint subtle hyperdense lesion in the base of left lateral wall of the urinary bladder measuring approximately 20 x 19 mm. Other blood investigations like Hb, haematocrit, urea, creatinine and blood sugars were within normal limits.

Hairy Polyp in the Nasopharynx - A Case Report

Background: Hairy polyp or dermoid is a benign bigerminal congenital germ cell tumour. It is a rare condition in the nasopharynx. Hairy polyp in head and neck region consists less than 5% of that occurs in whole body. Objective: To report a rare nasopharyngeal benign condition presented without obstructive symptoms. Case: A four-year-old female child presented with a pedunculated dermoid tumour attached to the left lateral wall of nasopharynx. There was an associated unilateral cleft in soft palate. The tumour was removed by dissecting with bipolar diathermy by combined endonasal endoscopic and transoral approach. Conclusion: Hairy polyp in nasopharynx may present as an incidental asymptomatic mass in throat and may be associated with a cleft palate. Bangladesh J Otorhinolaryngol; April 2017; 23(1): 92-95

Paravertebral thoracic mesothelial cyst in teenager (case report)

Mesothelial intrathoracic cysts are rare manifested by spi-nal symptoms. 15 years old girl complained on the mod-erate backpain (3/10 degree by VAS) in thoracic spine during the one year. MRI revealed a small paravertebral cyst besides the aorta with deformity of left lateral wall of Th5 vertebral body. The complains resolved completely after open removal of the cyst. The mesothelial cyst ver-ified by morphology, incl. immunnohistochemistry. The patient continue to be asymptomatic during a year after surgery.

VS02.05: LAPAROSCOPIC TREATMENT OF IATROGENIC ESOPHAGEAL PERFORATION AFTER PNEUMATIC DILATION FOR ESOPHAGEAL ACHALASIA

Description We present in this video a case of laparoscopic surgical repair of an esophageal perforation during pneumatic dilation for achalasia. When diagnososed with achalasia and offered adequate treatment, the patient chose pneumatic dilation. We followed the protocol used in the European trial but, after the second dilation with a 3.5 cm balloon, a perforation of the esophageal wall occurred. Gastrografin swallow and a CT confirmed the perforation. For the worsening conditions of the patient, we preferred the surgical treatment, as opposed to the conservative one. At laparoscopy, the lesion was well visible on the left lateral wall of the esophagus, 2 cm above the cardia. The mucosa was sutured with interrupted stitches, and the muscular layer reconstructed with continuous suture. A Heller myotomy was then performed on the anterior esophageal wall, and a Dor fundoplication completed the operation. The patient was discharged in 7th POD and at a 1-year follow-up she is free of dysphagia. The laparoscopic surgical repair of esophageal perforation during pneumatic dilation is feasible: proper treatment of the basic disease with myotomy is necessary, however, to achieve good final results. Disclosure All authors have declared no conflicts of interest.

Lymphoepithelioma-Like Carcinoma of the Bladder: A Case Report of a Rare and Particular Variant of Urothelial Carcinoma

Lymphoepithelioma-like carcinoma of the bladder (LELCB) is a rare variant of urothelial carcinoma first described by Zukerberg in 1991 and confirmed as a variant of urothelial carcinoma by the WHO classification of tumors of the urinary system. LELCB is characterized by a marked infiltration of lymphocytes in the area involved by the tumor which may coexist with the conventional urothelial carcinoma. LELCB are classified according to the percentage of lymphoepithelioma component within the tumor with the prognosis depending on the percentage. We report a new case of pure LELCB occurring in 63-year-old woman presenting with hematuria. Ultrasonography and cystoscopy revealed a large tumor on the left lateral wall of the bladder. Transurethral resection of the bladder tumor (TURBT) was performed. Pathological and immunohistochemical analysis revealed a high-grade muscle-invasive LELCB (G3pT2). The patient underwent an adjuvant systemic chemotherapy with no recurrence after a ten-month follow-up. To our knowledge, this is the second Moroccan case of LELCB reported in the English literature. Although its rare occurrence prognosis and ideal therapeutic management of LELCB have not been clearly established yet, literature findings encourage the adoption of a conservative approach in treatment of LELCB.

Surgical management of perineal laceration in a cow affected with cervico vaginal prolapse

A five year old cow was brought with the history of delivering the calf without untying Buhner’s suture which was applied to retain the recurrent cervico vaginal prolapse, resulting in rare occurrence of extensive laceration of perineum accompanied with cervico vaginal prolapse. Examination of perineum revealed two tears on the left lateral wall of the vagina. Absorbable suture material, poly glycolic acid (PGA) was used to appose the vaginal tears. Vulval labium was applied with simple interrupted suture using silk. Perineal repair was helpful in reconstructing the vagina and vulva. In conclusion, proper surgical apposition would restore the normal conformation of reproductive passage in cows affected with perineal laceration and Buhner’s suture should essentially be removed to avoid extensive damage to the perineum at the time of second stage parturition.

Congenital Heminasal Hypoplasia with an Intranasal Cyst and Its Management by Subnasal Rotation Flap

ABSTRACT Various congenital nasal deformities can occur because of the complexities of the developmental process. These conditions range from partial deformities of the nose (such as isolated absence of the nasal bones, absence of columella, absence of the septal cartilage, and absence of vomeral bone) to complete absence of the nose. Congenital heminasal hypoplasia is an extremely rare defect of embryogenesis. We present a case of 25-year-old lady with congenital heminasal hypoplasia associated with intranasal cyst. Computed tomography (CT) scan revealed gross septal deviation to left, rudiment left lateral wall of the nose, rudiment left external nasal framework, and intranasal cyst. Functional septorhinoplasty was done with subnasal rotation flap technique to gain airway on both sides of the nose. How to cite this article Devasamudra CR, Sagar NJ, Jayaraju RM. Congenital Heminasal Hypoplasia with an Intranasal Cyst and Its Management by Subnasal Rotation Flap. Int J Otorhinolaryngol Clin 2016;8(2):56-59.