Mehtab Ahmad

Primary hyperparathyroidism having multiple Brown tumors mimicking malignancy

Primary hyperparathyroidism is a disease characterized by excessive secretion of parathormone. During the course of this disease, bone loss occurs, particularly depending on resorption of the skeletal system. One of the complications of primary hyperparathyroidism is fibrotic, cystic bony changes which is called Brown tumor. Skeletal manifestations in the form of Brown tumors are rare and according to literature occur in less than 2% of patients suffering from any form of hyperparathyroidism. Such rare and multiple benign lesions may simulate a malignant neoplasm and pose a real challenge for the clinician in its differential diagnosis. We present a case of a 23-year-old Indian woman who was evaluated for multiple lytic expansile lesions with a strong suspicion of malignancy and fibrous dysplasia but turned out to be a case of primary hyperparathyroidism.

Isolated crural hematoma mimicking retroperitoneal lymphadenopathy, a unique sign of traumatic diaphragmatic rupture: a case report.

Diaphragmatic injury following blunt thoracoabdominal trauma is rare and is usually associated with key radiological features like dependent viscera sign, collar sign, diaphragmatic thickening and defects. It may also be associated with secondary signs like intrathoracic herniation of abdominal viscera. Diaphragmatic crura, which are attached to the upper lumbar vertebra represent prominently thickened folds along the posterior diaphragm, are usually inconspicuous on routine Computed Tomography (CT) scans. We present a case of a young patient who sustained a motor vehicle accident and developed difficulty in breathing. CT scan of the patient revealed bilateral crural hematomas, with splenic and renal lacerations and no other sign of diaphragmatic injury. The patient was operated and blunt diaphragmatic rupture was confirmed at surgery.

Solitary parotid plexiform neurofibroma - diagnostic difficulty in a clinically unsuspected case.

373 Indian Journal of Cancer | July–September 2014 | Volume 51 | Issue 3 Solitary parotid plexiform neurofibroma ‐ diagnostic difficulty in a clinically unsuspected case Sir, A 15‐year‐old girl presented to the OPD with the complaints of a painless, progressively increasing swelling present at the angle of right jaw for the last two years. Patient did not have any cutaneous, ocular or skeletal manifestations of neurofibromatosis‐1 (NF‐1). None of the family member had any stigmata of NF‐1. Her physical examination revealed a large, lobulated, firm, non tender swelling at the angle of mandible. Examination of the oral cavity revealed vague fullness in the floor of mouth with healthy oral mucosa with House‐Brackman grade III ipsilateral facial palsy. There was no palpable cervical lymphadenopathy. Clinical impression of a benign parotid tumor was made.

Symmetrical peripheral gangrene due to Plasmodium falciparum malaria.

A 45-year-old man presented with a 4-day history of high-grade fever with rigours and a 2-day history of painful bluish black discolouration of extremities (acrocyanosis). He was haemodynamically stable and all peripheral pulses palpable, but the extremities were cold with gangrene involving bilateral fingers and toes. Mild splenomegaly was present on abdominal examination but rest of the physical examinations were normal. On investigating he was found to have anaemia, thrombocytopaenia with gametocytes of Plasmodium falciparum on peripheral blood smear. His blood was uncoagulable during performance of prothrombin time with a raised D-dimer. Oxygen saturation was normal and the arterial Doppler test showed reduced blood flow to the extremities. A diagnosis of complicated P. falciparum malaria with disseminated intravascular coagulation (DIC) leading to symmetrical peripheral gangrene was performed. Artemisinin combination therapy was started and heparin was given for DIC. A final line of demarcation of gangrene started forming by 12th day.

Neurocysticercosis presenting as focal hydrocephalus

A 40-year-old man presented with a 2-month history of headache, nausea and vomiting, with generalised seizures for the past 15 days. On examination he had bilateral papilloedema, visual acuity was 6/6 in both eyes but perimetry showed right homonymous inferior quadrantanopia. His MRI showed numerous small cystic lesions with eccentric nodules, diffusely distributed in bilateral cerebral and cerebellar hemispheres. There was also focal hydrocephalus involving occipital and temporal horns of the left lateral ventricle leading to its selective dilation. Stool examination showed ova of Taenia solium. He was treated with albendazole, prednisone and sustained release sodium valproate for 1 month. His headache resolved and he is free of seizures. Repeat perimetry at 1 month also showed resolution of visual field defect.

Neonatal sacrococcygeal teratoma with acute renal failure

Teratomas are germ cell tumours composed of multiple types of cells derived from more than a single germ cell layer. The most common site of an extragonadal teratoma is the sacrococcygeal region. We report a case of a 16-day-old female child with a large swelling in the sacrococcygeal region extending laterally into the buttocks with severely deranged renal functions. Ultrasonography and CT helped in making the diagnosis and, more importantly, to delineate the extent of the tumour and the involvement of adjacent organs and tissues: in our case, lower bilateral ureters. Imaging findings and clinical presentation led to the diagnosis of sacrococcygeal teratoma with renal failure.

Hydranencephaly: a rare cause of delayed developmental milestones

A 2-year-old female child presented with a history of delayed developmental milestones. According to her mother, the child was born out of a normal vaginal delivery and was apparently well after birth. However, by 6 months of age, the mother noticed that she was not interactive and did not recognise her. The child had failed to achieve head control by that time, but due to the ignorance and poverty of her family she did not get proper medical attention. At the time of presentation, she was still unable to recognise …

Encephalocraniocutaneous lipomatosis: A case report with review of literature

Encephalocraniocutaneous lipomatosis (ECCL) or Haberland syndrome is an uncommon sporadic neurocutaneous syndrome of unknown origin. The rarity and common ignorance of the condition often makes diagnosis difficult. The hallmark of this syndrome is the triad of skin, ocular and central nervous system (CNS) involvement and includes a long list of combination of conditions. Herein we report a case of a 5-month-old male child who presented to our centre with complaint of seizure. The patient had various cutaneous and ocular stigmatas of the disease in the form of patchy alopecia of the scalp, right-sided limbal dermoid and a nodular skin tag near the lateral canthus of the right eye. MRI of the brain was conducted which revealed intracranial lipoma and arachnoid cyst. The constellation of signs and symptoms along with the skin, ocular and CNS findings led to the diagnosis of ECCL.

Artery of Percheron Infarction in a Patient with Atrial Fibrillation: A Rare Stroke Syndrome.

A 47 year old male with a history of hypertension and atrial fibrillation was found unconscious by his family members. His Glasgow Coma Scale score was 8 and the left pupil was dilated and nonreactive to light with the eye deviated downwards and outwards. MRI findings were consistent with subacute infarction in bilateral thalami and left anteromedial midbrain suggesting occlusion of the artery of Percheron. Transthoracic echocardiography revealed grade 2 left ventricular diastolic dysfunction with the presence of a clot in left atrium. A diagnosis of cardioembolic stroke was made and the patient was managed conservatively with anticoagulants.

Glomus jugulare: high index of clinical suspicion is important for optimal management.

Glomus tumour is a type of extra-adrenal chemodectoma or paraganglioma, originating within the wall of jugular bulb. We report a case of a 60-year-old woman who presented with hearing loss and pulsatile tinnitus. High index of suspicion and appropriate use of imaging led to early diagnosis. However, the patient did not give consent for surgery and was managed satisfactorily with radiotherapy.