Secondary Malignancies of the Bladder: Avoiding the Diagnostic Pitfall

2017 ◽  
Vol 26 (2) ◽  
pp. 120-125 ◽  
Author(s):  
Alexander Feldman ◽  
Samuel Borak ◽  
Soroush Rais-Bahrami ◽  
Jennifer Gordetsky
Keyword(s):  
Metastatic Tumor ◽  
Clinical History ◽  
Prior History ◽  
Bladder Tumors ◽  
Diagnostic Dilemma ◽  
Secondary Tumors ◽  
Diagnostic Pitfall ◽  
Imaging Characteristics ◽  
History Of ◽  
Primary Bladder

Although rare, secondary tumors of the bladder can present a diagnostic dilemma to pathologists considering a differential diagnosis of primary bladder cancer. We investigated the clinicopathologic and imaging characteristics of metastatic tumors to the bladder. We retrospectively reviewed the surgical pathology databases from 2 sites from 2013 to 2016, identifying 66 cases of secondary bladder tumors. Clinical, pathologic, and imaging findings were reviewed. Mean age at diagnosis was 63 years (range = 25-87). Females had a significantly higher proportion (44/66, 66.7%) of secondary bladder tumors compared with males (22/66, 33.3%; P = .007). In total, 56/66 (84.8%) patients had a clinical history of an in situ or invasive malignancy in another organ, and 54/66 (81.8%) patients had imaging supporting a metastatic tumor. Only 2/66 (3.0%) patients had a prior history of urothelial carcinoma. In total, 4/66 (6.1%) cases (all females) were originally misdiagnosed as primary bladder malignancies and were corrected after clinicoradiologic correlation. Overall, colorectal origin was most common (15/66, 22.7%), followed by cervical and ovarian primaries (10/66, 15.2% each). Cervical and ovarian origins predominated in the female cohort (10/44, 22.7% each), followed by endometrial (8/44, 18.2%). Colorectal and prostate primaries were the most common among males (10/22, 45.5%, and 7/22, 31.8%, respectively). Secondary bladder tumors can mimic urothelial carcinomas. In our cohort, gynecological, colorectal, and prostatic origins were most common. Clinical history, imaging, and immunohistochemical studies can be useful in avoiding this diagnostic pitfall.

Left ventricular apical mass after myocardial infarction—not always a thrombus: a diagnostic dilemma

2021 ◽  
Vol 14 (10) ◽  
pp. e245963
Author(s):  
Jayanty Venkata Balasubramaniyan ◽  
Judah Nijas Arul ◽  
Jebaraj Rathinasamy ◽  
Thangavel Periyasamy
Keyword(s):  
Myocardial Infarction ◽  
Systolic Dysfunction ◽  
Anterior Wall ◽  
Left Ventricular ◽  
Prior History ◽  
Surgical Removal ◽  
Diagnostic Dilemma ◽  
Echocardiographic Evaluation ◽  
Lv Mass ◽  
History Of

Myxomas arising from the left ventricle (LV) are extremely rare and can be easily mistaken for a thrombus. We report a case of a 35-year-old man who presented with an acute cerebrovascular accident, having had a prior history of an anterior wall myocardial infarction 2 years back with an echocardiographic evaluation showing mild LV systolic dysfunction. His present prothrombotic workup revealed hyperhomocystinaemia and elevated levels of factor VIII. Present echocardiography revealed a mass arising from a scarred LV wall. Considering the possibility of a thrombus, he was initially started on parenteral anticoagulation. Unfortunately, consequent echocardiogram evaluation showed no reduction in size of the LV mass hence surgical removal was done. Histopathological evaluation unveiled the mass to be a myxoma.

Managing Incidentalomas Safely: Do Computed Tomography Requisitions Tell Us What We Need to Know?

2017 ◽  
Vol 68 (4) ◽  
pp. 387-391
Author(s):  
Matthew Walker ◽  
Joy Borgaonkar ◽  
Daria Manos
Keyword(s):  
Computed Tomography ◽  
Incidental Findings ◽  
Tertiary Care ◽  
Clinical History ◽  
Patient Questionnaire ◽  
Prior History ◽  
Care Hospital ◽  
History Of ◽  
Patient’S History ◽  
History Of Cancer

Purpose Technological advancements and the ever-increasing use of computed tomography (CT) have greatly increased the detection of incidental findings, including tiny pulmonary nodules. The management of many “incidentalomas” is significantly influenced by a patient's history of cancer. The study aim is to determine if CT requisitions include prior history of malignancy. Methods Requisitions for chest CTs performed at our adult tertiary care hospital during April 2012 were compared to a cancer history questionnaire, administered to patients at the time of CT scan. Patients were excluded from the study if the patient questionnaire was incomplete or if the purpose of the CT was for cancer staging or cancer follow-up. Results A total of 569 CTs of the chest were performed. Of the 327 patients that met inclusion criteria, 79 reported a history of cancer. After excluding patients for whom a history of malignancy could not be confirmed through a chart review and excluding nonmelanoma skin cancer, dysplasia, and in situ neoplasm, 68 patients were identified as having a history of malignancy. We found 44% (95% confidence interval [0.32-0.57]) of the chest CT requisitions for these 68 patients did not include the patient's history of cancer. Of the malignancies that were identified by patient questionnaire but omitted from the clinical history provided on the requisitions, 47% were malignancies that commonly metastasize to the lung. Conclusions A significant number of requisitions failed to disclose a history of cancer. Without knowledge of prior malignancy, radiologists cannot comply with current guidelines regarding the reporting and management of incidental findings.

scholarly journals Ezetimibe: An Unusual Suspect in Angioedema

2020 ◽  
Vol 2020 ◽  
pp. 1-3 ◽  
Author(s):  
Tiffany Lu ◽  
Tarundeep Grewal
Keyword(s):  
Clinical History ◽  
Prior History ◽  
African American Female ◽  
Drug Induced ◽  
Current Case ◽  
Normal Limits ◽  
Inhibitor Level ◽  
The Face ◽  
History Of ◽  
Esterase Inhibitor

We describe a case of new onset angioedema likely due to Ezetimibe therapy in an elderly patient with a prior history of drug-induced bradykinin reactions who had been on the medication for multiple years. This is the second reported incidence of Ezetimibe-associated angioedema in literature. A 90-year-old African American female presented with angioedema of the face and oral mucosa with associated difficulty speaking developing hours after taking Ezetimibe 10 mg PO. She denied adding any new or unusual foods to her diet. A thorough clinical history determined Ezetimibe was the likely culprit. Ezetimibe was immediately discontinued. The swelling subsided after administration of methylprednisolone 125 mg, epinephrine 1 mg/mL, injection 0.3 mL, diphenhydramine 25 mg, and famotidine 20 mg BID within 48 hours. The patient’s C1 esterase inhibitor level was measured to be within normal limits. Food panel allergy testing showed very low or undetectable IgE levels in all categories. Based on the limited reports in literature and our current case, we conclude that there is a likely association of angioedema with Ezetimibe. The mechanism, however, is unknown since it is not related to bradykinin or mast cell-mediated activation. Clinicians should advise patients taking Ezetimibe to report any swelling of the lips, face, and tongue and to immediately discontinue its use if these signs are present.

Ringing in the Ears and Pain in the Head

2017 ◽  
Author(s):  
M. Angela O’Neal
Keyword(s):  
Headache Disorder ◽  
Clinical History ◽  
Low Pressure ◽  
Patient Specific ◽  
Prior History ◽  
Operator Experience ◽  
Blood Patch ◽  
History Of ◽  
Low Pressure Headache ◽  
Pressure Headache

The case illustrates the classic clinical features of a low-pressure headache. The pathophysiology results from the loss of cerebrospinal fluid (CSF). This causes sagging of the brain, stretching of the bridging veins, and venodilatation. The clinical history is of a headache that is worse in the upright position and remits when the patient is supine. Due to the connection of the perilymphatic fluid and CSF, postural tinnitus is a frequent symptom. Risk factors for low-pressure headache include those that are patient-specific: female sex, low body mass index, prior history of a low-pressure headache, and an underlying headache disorder. Operator-specific factors that decrease the risk of a postdural puncture headache (PDPH) include greater operator experience and the use of a smaller-gauge, non-cutting lumbar puncture needle. The best treatment for low-pressure headache is a blood patch with resolution in over 90% of low-pressure headaches.

scholarly journals Brain and spine melanotic schwannoma: A rare occurrence and diagnostic dilemma

2019 ◽  
Vol 32 (5) ◽  
pp. 335-343
Author(s):  
Ali Alamer ◽  
Donatella Tampieri
Keyword(s):  
Brain Lesion ◽  
Clinical History ◽  
Diagnostic Dilemma ◽  
Melanotic Schwannoma ◽  
Post Surgery ◽  
Imaging Characteristics ◽  
Mri Features ◽  
Operative Notes ◽  
The Brain

Purpose Melanotic schwannoma (MS) was formerly known as a rare variant of schwannoma. The behavior of MS is unpredictable, with a tendency for recurrence and metastasis. The purpose of this study was to illustrate the imaging characteristics of these rare and misdiagnosed tumors. The prognosis of MS is discussed, along with the importance of follow-up exams to assess for recurrence and metastasis. Furthermore, we compare our results with those previously published on MS in order to have a better understanding of this rare entity. Methods Three MS cases were encountered between 2008 and 2015 at our institute. All available data were reviewed, including the clinical history, imaging findings, operative notes, and the histopathology results. A follow-up magnetic resonance imaging (MRI) scan was also reviewed up to 23 months post surgery to assess for recurrence. Results Three cases of MS are included: one in the brain and two in the spine. The brain lesion was in the occipital region. The spine lesions were thoracic intramedullary and sacral intradural. All cases were hypointense on T2-weighted imaging. Gross total resection was achieved for all lesions without adjuvant therapy. To date, the brain lesion recurred 15 months after surgery. Conclusions MS is a rare and distinct entity rather than a variant of schwannoma, and it poses both diagnostic and management dilemmas. Although MS has characteristic MRI features, including T1 and T2 shortening, the preoperative diagnosis is always challenging. Accurate diagnosis is crucial for management planning, including long-term follow-up exams to assess for recurrence and metastasis.

scholarly journals Myxedema Psychosis: Neuropsychiatric Manifestations and Rhabdomyolysis Unmasking Hypothyroidism

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Sundus Sardar ◽  
Mhd-Baraa Habib ◽  
Aseel Sukik ◽  
Bashar Tanous ◽  
Sara Mohamed ◽  
...  
Keyword(s):  
Thyroid Stimulating Hormone ◽  
Prior History ◽  
Psychomotor Slowing ◽  
Rare Presentation ◽  
Diagnostic Dilemma ◽  
Endocrine Disorder ◽  
Psychiatric Illnesses ◽  
Neuropsychiatric Manifestations ◽  
History Of

Background. Hypothyroidism is a prevalent endocrine disorder, often presenting with a spectrum of symptoms reflecting a hypothyroid state. It is also generally linked to causing mood swings, psychomotor slowing, and fatigue; however, in rare instances, it may lead to or induce acute psychosis, a condition referred to as myxedema psychosis (MP). We report a case of myxedema psychosis and present a literature review discussing its presentation, diagnosis, management, and prognosis. Case Presentation. A 36-year-old lady presented with one-week history of persecutory and paranoid delusions, along with visual and auditory hallucinations. She had no prior history of psychiatric illnesses. She underwent total thyroidectomy three years before the current presentation due to papillary thyroid cancer. She was not on regular follow-up, nor any specific therapy. On examination, she was agitated and violent. There were no signs of myxedema, and the physical exam was unremarkable. The initial workup showed a mild elevation in serum creatinine. Additional investigations revealed a high thyroid-stimulating hormone (TSH) of 56.6 mIU/L, low free T4<0.5 pmol/L, elevated creatine kinase of 3601 U/L, and urine dipstick positive for blood, suggestive of myoglobinuria. MRI of the head was unremarkable. We diagnosed her as a case of myxedema psychosis and mild rhabdomyolysis. She was started on oral thyroxine 100 mcg/day, fluoxetine 20 mg daily, and as-needed haloperidol. She was closely followed and later transferred to the Psychiatry Hospital for further management. Within one week, her symptoms improved completely, and she was discharged off antipsychotics with additional scheduled follow-ups to monitor TFTs and observe for any recurrence. Discussion and Conclusion. Myxedema psychosis is a rare presentation of hypothyroidism—a common endocrine disorder. Scarce data are describing this entity; hence, there is currently a lack of awareness amongst clinicians regarding proper identification and management. Moreover, the atypical nature of presentations occasionally adds to a diagnostic dilemma. Thus, any patient with new-onset psychosis should be screened for hypothyroidism, and awareness of this entity must be emphasized amongst clinicians and guideline makers.

scholarly journals Granulocytic Sarcoma of the Male Breast in Acute Myeloblastic Leukemia with Concurrent Deletion of 5q and Trisomy 8

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Muhammad Rizwan ◽  
Md. Monirul Islam ◽  
Zia ur Rehman
Keyword(s):  
Myeloid Leukemia ◽  
Granulocytic Sarcoma ◽  
Clinical History ◽  
The Body ◽  
Male Breast ◽  
Prior History ◽  
Trisomy 8 ◽  
Extramedullary Tumor ◽  
History Of ◽  
Improve Patient

We describe a unique case of Granulocytic Sarcoma (GS) in a male, who presented to us with a painless right breast mass without any prior history of Leukemia. GS is an extramedullary tumor of myeloproliferative precursors and may involve multiple sites of the body, but involvement of male breast is extremely rare. In the absence of clinical history or hematological abnormality, GS may be misdiagnosed, depending on the degree of myeloid differentiation present within the tumor. Often it is misdiagnosed as lymphoma. Diagnosis is made by finding eosinophilic myelocytes, myeloperoxidase, chloroacetate esterase staining, and lysozyme immunostain. Chemotherapy regimens similar to acute myeloid leukemia are recommended to treat GS. Recognition of this rare entity is important because early, aggressive chemotherapy can induce regression of the tumor and improve patient longevity.

scholarly journals Nonfatal Hyperammonemic Encephalopathy as a Late Complication of Roux-en-Y Gastric Bypass

2019 ◽  
Vol 2019 ◽  
pp. 1-5 ◽  
Author(s):  
Juan D. Salcedo ◽  
Jordan S. Goldstein ◽  
Jose M. Quinonez ◽  
Maria Antonietta Mosetti
Keyword(s):  
Gastric Bypass ◽  
Late Complication ◽  
Nutritional Deficiencies ◽  
Prior History ◽  
Time Intervals ◽  
Diagnostic Dilemma ◽  
Hyperammonemic Encephalopathy ◽  
The Us ◽  
History Of ◽  
Common Weight

Roux-en-Y gastric bypass (RYGB) is the most common weight loss procedure performed in the US. Gastric bypass–related hyperammonemia (GaBHA) is a potentially fatal entity, characterized by encephalopathy associated with hyperammonemia and various nutritional deficiencies, which can present at variable time intervals after RYGB. Twenty-five cases of hyperammonemic encephalopathy after bariatric surgery have been previously reported in the literature. We describe the case of a 48-year-old Hispanic woman with no prior history of liver disease, presenting with nonfatal hyperammonemic encephalopathy as a late postoperative complication 20 years after undergoing a RYGB. Hyperammonemic encephalopathy in the absence of known hepatic dysfunction presents a diagnostic dilemma. An early diagnosis and intervention are crucial to decrease morbidity and mortality.

Complete Response (CR) with Total Therapy 2 (TT2) for Multiple Myeloma (MM): Low Frequency in Case of Prior MGUS without Adverse Consequences for Survival - Yet Critical for Disease Control in Presumed “De Novo” MM.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 1172-1172
Author(s):  
Athanasios Fassas ◽  
Erik Rasmussen ◽  
John Shaughnessy ◽  
Guido Tricot ◽  
Maurizio Zangari ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Cox Regression ◽  
De Novo ◽  
Low Frequency ◽  
Clinical History ◽  
Complete Response ◽  
Prior History ◽  
Solitary Plasmacytoma ◽  
Kaplan Meier ◽  
History Of

Abstract Background: It is now widely accepted that stringently defined CR is a prerequisite for durable EFS and OS also in MM. Patients and Methods: The results of TT2 (4 cycles of intensive induction prior to and consolidation chemotherapy after tandem autotransplant) have recently been reported (ASCO 2005), demonstrating a significantly higher CR rate and longer EFS but not OS among those randomized to thalidomide. Baseline laboratory variables and the clinical history off 668 patients enrolled in TT2 were examined for their potential impact on CR and, in turn CR’s impact on EFS and OS. The Kaplan-Meier method was used to estimate EFS and OS. Cox regression was used to evaluate multivariate factors of CR, EFS, and OS; the prognostic value of CR and 1st and 2nd transplants were modeled as time-dependent covariates in order to adjust for the guarantee time associated with reaching these treatment markers. Results: Of 668 patients enrolled, 45 had a documented history of prior MGUS (n=22) or smoldering MM (SMM) (n=23); 20 had a prior solitary plasmacytoma (SPC) of bone. 2-yr estimates of CR (negative immunofixation, normal bone marrow) were 47% for the 588 without history of preceding SPC/MGUS/SMM, 55% for SPC and 22% for the MGUS/SMM groups. EFS and OS at 4 yrs were 57% and 71%, independent of a preceding disorder. Multivariate analysis revealed faster onset and higher frequency of CR with only light chain MM (HR, 2.6; p&lt;.001), in the absence of MGUS/SMM (HR, 1.8; p=.049), and with thalidomide (HR, 1.7: p&lt;0.001). Cytogenetic abnormalities (CA), del13q14 and amp1q21, while adversely affecting EFS/OS, did not influence CR. On multivariate analysis for EFS and OS accounting, in addition to baseline variables, also for T, CR, 1st and 2nd transplant, and pre-MM history of MGUS/SMM, we observed that patients attaining a CR had significantly improved EFS and OS independent of key baseline variables (amp1q21, del13q14, CA, LDH, albumin) and treatment markers (T, 1st and 2nd transplants). Conclusion: We confirm that documented MGUS/SMM pre-MM is associated with lower CR rate without impacting survival negatively, probably implying the re-establishment of the precursor condition. For the remainder, CR was critical for prolonged survival. Gene expression analysis is applied to recognize, in the absence of prior history, those patients likely having evolved from MGUS and thus contribute fundamentally to a distinction of “de novo” MM from “MGUS-evolved MM”. Those results will be presented at the meeting.

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