Manoj P Rai

CK 20‐positive and CK 7‐negative Merkel cell carcinoma of the cheek

Merkel cell carcinomas (MCCs) are uncommon, highly malignant skin tumors that develop in sun‐exposed areas of the skin. Most of the MCCs are CK 20‐positive and CK 7‐negative such as our case. About 80% of Merkel cell carcinoma is associated with Merkel cell polyomavirus.

Angioimmunoblastic T-cell lymphoma: a rare subtype of peripheral T-cell lymphoma

Angioimmunoblastic T‐cell lymphoma (AITL) is a rare form of NHL and usually presents in the late stage due to the atypical laboratory findings. Immunohistochemistry of the lymph node in AITL is characterized by positive CD2, CD3, CD4, CD10, CXCL‐13, PD1 often BCL‐6 and CD20 positive. Meshworks of follicular dendritic cells are seen outside follicles with CD21 and CD23 stains. EBV can be often positive as well. Autologous transplantation should be offered in the first remission as poor outcome is reported with anthracycline‐containing regimens.

Atypical Presentation of Lemierre’s Syndrome Causing Septic Shock and Acute Respiratory Distress Syndrome

Lemierres disease is a rare but life-threatening condition characterized by an oropharyngeal infection complicating with thrombophlebitis of the internal jugular vein and disseminated abscesses. We are presenting a case of a young female who initially presented with fevers, chills, sore throat, and swollen neck later developed progressively worsening shortness of breath along with sudden onset pleuritic chest pain. She then developed progressively worsening acute hypoxic respiratory failure requiring intubation and mechanical ventilation. Interval chest X-ray showed worsening bilateral effusions. She also developed septic shock requiring pressors. Blood culture showed Fusobacterium, and antibiotics were changed accordingly following which there was a clinical improvement. The diagnosis of Lemierres syndrome was then established based on her presenting age and bilateral pulmonary empyema in the setting of septicemia with Fusobacterium.

Endometrial Adenocarcinoma With Pulmonary Recurrence

We present the case of an 83-year-old woman with axa0history of grade 1 stage IB endometrial cancer (endometrial adenocarcinoma) (figure 1) involving thexa0lower uterine segment. She underwent robotic hysterectomy with right salpingo-oophorectomy followed by brachytherapy. A year and axa0half later, she presented with difficulty in breathing. A chest X-ray showed 8u2009mm nodular density in the right lower lobe. The above finding was confirmed with CT. Given the concern for a malignant lesion, positron emission tomography/CT scan was performed, which revealed two metabolically active lung nodules, measuring 1.2u2009cm in …

Delayed Presentation of Isolated Adrenocorticotropin Insufficiency after Nivolumab Therapy for Advanced Non-small-cell lung carcinoma (NSCLC)

We describe a 73-year-old man who developed adrenal insufficiency 7u2009months after completing nivolumab therapy for advanced non-small cell lung cancer. He presented with non-specific symptoms of malaise and fatigue with an insidious 13.6 kilogram weight loss, prompting an evaluation for disease progression, which was negative. Subsequent evaluation revealed isolated adrenocorticotropin insufficiency as the aetiology, attributed to a delayed side effect of nivolumab therapy.

Spontaneous tumour lysis syndrome in small cell lung cancer: a rare phenomenon

Tumour lysis syndrome (TLS) is an oncological emergency. It is caused by cellular death occurring secondary to cancer therapy or spontaneously in rapidly dividing tumours. More common in haematological malignancies, it has also been reported in solid tumours. Out of 14 cases of small cell lung cancer (SCLC) with TLS, only three cases of spontaneous TLS have been reported in literature to date. Here we report a case of SCLC presenting as a spontaneous TLS.

Spontaneous rupture of a pancreatic pseudocyst

This is a case of a 50-year-old woman with medical history significant for chronic pancreatitis secondary to alcohol abuse who initially presented with a 3-week history of progressively worsening epigastric pain. The patient described the pain as sharp, radiating to the back, worsened with intake of both solid foods and liquids and relieved with self-induced emesis. On admission, the patient was hypertensive, but other vitals were within normal limits. The abdomen was soft; however, there isxa0a firm palpable mass extending from the epigastric to the right and left upper quadrants. Labs were remarkable for hypokalaemia with potassium (K) 3 meq/L (normal range 3.5–4.9 meq/L), mildly elevated lipase 132u2009U/L (7–60u2009U/L) and an elevated alkaline phosphatase of 164u2009U/L (41–108u2009U/L). CT of the abdomen with contrast (figures 1 and 2) showed a large cystic structure measuring 12.9×21.2u2009cm directly adjacent to the body of the pancreas and a fluid collection with enhancing rim measuring 4.8×6.6u2009cm near the pancreatic tail with subsequent displacement of the stomach. Gastroenterology recommended cyst-gastrostomy at a tertiary care centre. However, surgery recommended surgical cyst-gastrostomy in the facility. The patient was made nil per os …

Mycobacterium ChelonaeDeveloping Multidrug Resistance

Mycobacterium chelonae is a rapidly growing mycobacterium which is known to respond well to standard antibiotic treatment regimen. There are no specific guidelines for treatment. Antibiotics are chosen based on the bacterial sensitivity. Here we present a 47-year-old man with hip replacement who developed bright red papular generalised skin lesions and bilateral hip abscess. On workup, it was confirmed that M. chelonae was the causative organism. He was given 8u2009weeks of antibiotics; however, there was worsening of the hip abscess on interval imaging. The progression was most likely due to M. chelonae developing antibiotic resistance. Physicians should be aware of the rising resistance of this organism, and guide antibiotic therapy based on bacterial sensitivity to yield better outcomes.

Role Of Conservative Management In Emphysematous Gastritis

Emphysematous gastritis (EG) is a rare disease of the stomach that is caused by gas-forming bacteria, and it can be lethal. There have been <70 reported cases in the English literature of this disease which carries a mortality rate up to 60%. Early recognition and treatment through conservative management have been a popular and successful choice in today’s medicine. Studies have shown that surgical intervention does not confer a statistical benefit on mortality in this condition. We present another case of EG in a 33-year-old woman who was successfully managed conservatively.

Alveolar rhabdomyosarcoma presenting as a lung mass: an uncommon presentation of a less common tumor

Case: a male in his early 20s presented to the emergency department with back pain and abdominal pain for 1u2009month. The patient also complained of progressively worsening cough and shortness of breath. CT of the chest showed a very large enhancing destructive right lung mass with massive right pleural effusion, which caused a shift of mediastinal structures to the left as well as the significant mass effect on organs in the upper abdomen (figures 1 and 2). CT-guided biopsy of the mass and thoracocentesis was then performed. Histopathology showed nests of small round cells with hyperchromatic nuclei and surrounded by fibrous trabeculae. The tissue had areas of loss of cellular cohesion forming spaces suggestive of an alveolar pattern (figures 3 and 4). It containedPeriodic Acid-Schiff (PAS)positive glycogen as well. According to the TNM Classification of malignant tumours (TNM), it was categorised as stage III, T2b N0 M0. Immunohistochemical studies showed positive nuclear staining for myogenin and MyoD1 (figure 5). Thecytoplasmstainied strongly …