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1.
BMJ Case Rep ; 15(8)2022 Aug 02.
Article in English | MEDLINE | ID: covidwho-1992986

ABSTRACT

We present a rare complication of microwave ablation (MWA) in a male patient in his 80s. His massive pulmonary necrosis and tension pneumothorax required urgent surgery. However, the damage to the lung tissue was too large, deep and fragile. We failed to suture or conduct wedge resection on the lung lesion, so, left upper lobectomy was necessary. Therefore, we suggest that it is probably possible to reduce the frequency and time threshold when performing MWA for the elderly with comorbidities.


Subject(s)
Catheter Ablation , Lung Neoplasms , Aged , Aged, 80 and over , Catheter Ablation/adverse effects , Humans , Lung/diagnostic imaging , Lung/pathology , Lung/surgery , Lung Neoplasms/pathology , Lung Neoplasms/surgery , Male , Microwaves/adverse effects , Necrosis/etiology , Necrosis/surgery , Octogenarians
2.
BMJ Case Rep ; 15(3)2022 Mar 16.
Article in English | MEDLINE | ID: covidwho-1745765

ABSTRACT

Non-bacterial thrombotic endocarditis (NBTE) is a rare condition related to a state of hypercoagulability in advanced neoplastic disease. Most of the time, arterial thromboembolic event precedes the diagnosis of NBTE. We report here a case of NBTE responsible for multiple ischaemic strokes, which leads to the diagnosis of metastatic pancreatic adenocarcinoma. Aortic and mitral valvular regurgitations secondary to NBTE appeared within 6 weeks despite therapeutic anticoagulation with direct oral anticoagulant (DOAC) in stroke prevention of paroxysmal atrial fibrillation. Bivalvular regurgitations resolved 8 weeks after therapeutic switch to low-molecular-weight heparin (LMWH) and chemotherapy. DOACs are a possible alternative to LMWH for the prevention of venous thromboembolism in patients with active neoplasia. There is a lack of evidence for a clinical efficiency for the prevention of arterial thromboembolism in NBTE. We propose here a short review of the efficacy of anticoagulant therapy for the prevention of arterial thromboembolism in NBTE.


Subject(s)
Adenocarcinoma , Endocarditis, Non-Infective , Pancreatic Neoplasms , Adenocarcinoma/drug therapy , Anticoagulants/therapeutic use , Endocarditis, Non-Infective/diagnosis , Endocarditis, Non-Infective/drug therapy , Endocarditis, Non-Infective/etiology , Heparin , Heparin, Low-Molecular-Weight/therapeutic use , Humans , Pancreatic Neoplasms/complications , Pancreatic Neoplasms/drug therapy
3.
BMJ Case Rep ; 15(2)2022 Feb 08.
Article in English | MEDLINE | ID: covidwho-1723591

ABSTRACT

A woman in her 80s was referred as an emergency case with a large oedematous and ulcerating lesion of the right breast. There was a 5-month history of increasing breast volume with new onset skin breakdown and discharge. Imaging revealed an extensive heterogeneous mass requiring drainage. No diagnosis was received from multiple biopsies and immediate surgical resection of the breast and axillary sampling was prioritised given the deteriorating patient condition. Postoperative histology identified a biphasic Adenomyoepithelioma of low malignant potential, a rare presentation compounding the complexity of management. The diagnostic uncertainty of this case highlighted the importance of MDT collaboration and the flexibility of current management pathways when dealing with cases requiring urgent surgical intervention. Axillary sampling in the context of unsuccessful preoperative biopsy represented a comprehensive means for assessing the need for further surgical or systemic management in the context of unconfirmed malignancy in a deteriorating patient.


Subject(s)
Adenomyoepithelioma , Breast Neoplasms , Adenomyoepithelioma/diagnostic imaging , Adenomyoepithelioma/surgery , Biopsy , Breast/diagnostic imaging , Breast/surgery , Breast Neoplasms/diagnosis , Breast Neoplasms/surgery , Female , Humans , Uncertainty
4.
BMJ Case Rep ; 15(2)2022 Feb 07.
Article in English | MEDLINE | ID: covidwho-1673377

ABSTRACT

Oxaliplatin is a chemotherapeutic agent used in a variety of malignancies such as colorectal cancer and pancreatic cancer. It is a platinum derivative that results in direct cell cytotoxicity with resultant cell death. The most common side effects often noted are neurotoxicity, nausea, vomiting, diarrhoea, hepatotoxicity and myelosuppression. Oxaliplatin induced digital ischaemia and necrosis is a rare side effect that was observed in our patient. In general, digital ischaemia is a rare vascular disorder that is often associated with autoimmune disease. A patient with digital ischaemia due to oxaliplatin will be described in this case report.


Subject(s)
Antineoplastic Agents , Colorectal Neoplasms , Antineoplastic Agents/adverse effects , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Colorectal Neoplasms/drug therapy , Humans , Ischemia/chemically induced , Necrosis/chemically induced , Organoplatinum Compounds/adverse effects , Oxaliplatin/adverse effects
5.
BMJ Case Rep ; 15(1)2022 Jan 07.
Article in English | MEDLINE | ID: covidwho-1612960

ABSTRACT

Mesenchymal chondrosarcoma (MC) is a rare cartilaginous tumour that occurs in the extraskeletal locations in about one-third of cases. It is aggressive in behaviour and may involve the lower extremities, central nervous system or spine. Mesenchymal tumours are known for distant metastasis; however, metastasis to bilateral kidneys after treatment has not been reported earlier. We present a case of a soft-tissue intramuscular MC of the thigh in a 38-year-old patient which had been surgically excised after neoadjuvant chemotherapy. The patient presented with bilateral dense calcified renal masses after 6 years, which were cytologically proven as MC metastases. In the evaluation of bilateral calcified renal masses in patients with a history of MC, metastasis should be considered.


Subject(s)
Chondrosarcoma, Mesenchymal , Chondrosarcoma , Neoplasms, Connective Tissue , Adult , Chondrosarcoma, Mesenchymal/diagnostic imaging , Chondrosarcoma, Mesenchymal/surgery , Humans , Thigh
6.
BMJ Case Rep ; 14(12)2021 Dec 01.
Article in English | MEDLINE | ID: covidwho-1546476

ABSTRACT

We describe the case of a 30-year-old man who presented to our institution with hypoxia and widespread pulmonary infiltrates managed initially as COVID-19 before receiving a new diagnosis of HIV-associated Kaposi sarcoma (KS) with widespread pulmonary and skeletal involvement. Initial differential diagnoses included Pneumocystis jirovecii pneumonia, disseminated mycobacterial infection and bacillary angiomatosis. A bone marrow biopsy showed heavy infiltration by spindle cells, staining strongly positive for human herpes virus-8 (HHV-8) and CD34, suggesting symptomatic, disseminated KS as the unifying diagnosis. The patient commenced cytotoxic therapy with weekly paclitaxel, with a clinical and radiological response. To our knowledge, this case is among the most severe described in the literature, which we discuss, along with how COVID-19 initially hindered developing a therapeutic allegiance with the patient.


Subject(s)
COVID-19 , HIV Infections , Herpesvirus 8, Human , Sarcoma, Kaposi , Adult , HIV Infections/complications , HIV Infections/drug therapy , Humans , Male , SARS-CoV-2 , Sarcoma, Kaposi/diagnosis , Sarcoma, Kaposi/drug therapy
7.
BMJ Case Rep ; 14(8)2021 Aug 17.
Article in English | MEDLINE | ID: covidwho-1361975

ABSTRACT

This is a case of a 75-year-old man who presented with a 7-month history of a reducible rectal mass. The patient came to the emergency department with a prolapsed necrotic bowel involving a strangulated segment with the rectal mass. He underwent an abdominotransanal resection through a combined abdominal and perineal approach. His postoperative course was unremarkable. Histopathological and immunohistochemical studies showed a rectal carcinosarcoma. Because of a state-mandated lockdown due to the COVID-19 pandemic, the patient failed to follow-up. He was later seen to have metastatic progression. Owing to the poor functional status of the patient, the shared decision of the multidisciplinary team, the patient and his family was to manage him with palliative intent.


Subject(s)
COVID-19 , Carcinosarcoma , Rectal Neoplasms , Aged , Communicable Disease Control , Humans , Male , Pandemics , Rectal Neoplasms/surgery , SARS-CoV-2
8.
BMJ Case Rep ; 14(3)2021 Mar 02.
Article in English | MEDLINE | ID: covidwho-1115111

ABSTRACT

We describe a case of retrovesical liposarcoma in a male patient with concurrent COVID-19. A 50-year-old man had lower urinary tract symptoms and dull pain along his right gluteus. Due to COVID-19 infection, management was delayed. During self-isolation, the patient developed urinary retention and his pain level was an eight on the Visual Analogue Scale. A urinary catheter and an epidural catheter were inserted without any difficulty. Abdominal-pelvic MRI revealed a retrovesical mass suspected of liposarcoma with clear borders from surrounding organs. Following two consecutive negative SARS-CoV-2 PCR tests, we proceeded with surgery. Histopathology was dedifferentiated liposarcoma. Postoperatively, the patient suffered reactivation of COVID-19, and he was eventually discharged after two consecutive negative results on the PCR test on Post Operative Day (POD)-10. Retrovesical dedifferentiated liposarcoma is rare and considered as high-grade liposarcoma. Although surgery may exacerbate COVID-19 infection, surgical resection of symptomatic high-grade sarcoma is prioritised and performed as soon as no infection detected.


Subject(s)
COVID-19/diagnosis , Liposarcoma , Lower Urinary Tract Symptoms , Pelvic Neoplasms , SARS-CoV-2/isolation & purification , Surgical Procedures, Operative/methods , Urinary Retention , COVID-19/therapy , Chemoradiotherapy, Adjuvant/methods , Dissection/methods , Humans , Liposarcoma/pathology , Liposarcoma/physiopathology , Lower Urinary Tract Symptoms/diagnosis , Lower Urinary Tract Symptoms/etiology , Magnetic Resonance Imaging/methods , Male , Middle Aged , Neoplasm Grading , Pelvic Neoplasms/pathology , Pelvic Neoplasms/physiopathology , Time-to-Treatment , Treatment Outcome , Urinary Retention/diagnosis , Urinary Retention/etiology
10.
BMJ Case Rep ; 13(12)2020 Dec 10.
Article in English | MEDLINE | ID: covidwho-971145

ABSTRACT

A 70-year-old man presented with gradually worsening throat discomfort. He had no prior diagnosis of cancer and no travel history of note. Examination revealed a right-sided painless neck lump. He underwent an MRI of the neck, revealing a gadolinium-enhancing tonsillar mass and two brain lesions. Biopsy of the tonsil lesion was in keeping with an epithelial neoplasm, suggesting metastatic renal cell carcinoma. This was confirmed following a staging CT, which revealed a left renal mass and lung metastases. Due to his brain metastases, the patient has been started on the tyrosine kinase inhibitor cabozantinib. A brief discussion on the diagnostic evaluation of a tonsil mass as a rare presentation of renal cell cancer follows this report.


Subject(s)
Brain Neoplasms/secondary , Carcinoma, Renal Cell/pathology , Kidney Neoplasms/secondary , Lung Neoplasms/secondary , Palatine Tonsil/pathology , Aged , Anilides/therapeutic use , Brain Neoplasms/drug therapy , Carcinoma, Renal Cell/drug therapy , Humans , Kidney Neoplasms/drug therapy , Lung Neoplasms/drug therapy , Magnetic Resonance Imaging , Male , Palatine Tonsil/drug effects , Pyridines/therapeutic use , Receptor Protein-Tyrosine Kinases/therapeutic use , Tomography, X-Ray Computed , Treatment Outcome
11.
BMJ Case Rep ; 13(11)2020 Nov 30.
Article in English | MEDLINE | ID: covidwho-949262

ABSTRACT

Primary leiomyosarcoma of the breast is an extremely rare neoplasm accounting for less than 0.0006% of all breast malignancies, with fewer than 80 cases reported in the literature to date. Here, we present a case of leiomyosarcoma of the breast in a 61-year-old woman without traditional risk factors. This case was treated with lumpectomy requiring wide margins due to the high rate of local recurrence. A planned breast reduction surgery was deemed adequate postlumpectomy therapy to prevent cancer recurrence, negating the need for chemotherapy or radiation therapy. To our knowledge, this is the first case in which cosmetic breast reduction surgery will be used as postlumpectomy cancer recurrence risk mitigation for primary leiomyosarcoma of the breast. Patients with this malignancy have a relatively poor prognosis compared with other breast cancer types, with a 5-year disease-free survival of 33%-52%. As such, frequent follow-up and monitoring for postresection recurrence is essential.


Subject(s)
Breast Neoplasms/surgery , Breast/surgery , Leiomyosarcoma/surgery , Mammaplasty , Mastectomy, Segmental , Breast Neoplasms/diagnostic imaging , Female , Humans , Leiomyosarcoma/diagnostic imaging , Margins of Excision , Middle Aged , Ultrasonography
12.
BMJ Case Rep ; 13(7)2020 Jul 08.
Article in English | MEDLINE | ID: covidwho-640059

ABSTRACT

A 17-year-old man with osteosarcoma of the proximal humerus was planned for possible limb salvage surgery after standard neoadjuvant chemotherapy. However, during the surgical phase of treatment, the COVID-19 or SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) outbreak occurred changing the healthcare landscape due to uncertainty regarding the virus, risk of COVID-19 infection and complications, and implementation of an enhanced community quarantine restricting movement of people within cities. Instead of limb salvage surgery, the patient underwent a forequarter amputation. Exposure to the virus in a high-risk hospital setting was minimised with patient discharge after a short hospital stay and home convalescence monitored by video conferencing. Multidisciplinary sarcoma team meetings with family members and a sarcoma navigator nurse were crucial in managing expectations and deciding on appropriate treatment in the setting of a novel infectious disease causing a pandemic.


Subject(s)
Amputation/methods , Bone Neoplasms , Cisplatin/administration & dosage , Coronavirus Infections , Doxorubicin/administration & dosage , Humerus , Limb Salvage/methods , Osteosarcoma , Pandemics , Pneumonia, Viral , Adolescent , Antineoplastic Agents , Betacoronavirus , Bone Neoplasms/pathology , Bone Neoplasms/therapy , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Humans , Humerus/diagnostic imaging , Humerus/surgery , Magnetic Resonance Imaging/methods , Male , Neoplasm Staging , Osteosarcoma/pathology , Osteosarcoma/therapy , Pandemics/prevention & control , Patient Selection , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , SARS-CoV-2
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