Double cystic duct, a review of literature with report of a new case.

INTRODUCTION: Although cystic duct variation is quite common, duplication of cystic duct is an extreme rare variant. We report a case of double cystic duct with literature review. A 33-year old female presented with right upper quadrant pain of three day duration, associated with nausea and poor appetite. The patient reported previous three attacks of right upper quadrant pain within the last two years. On examination: Murphy's sign was positive and the right upper quadrant was tender. Abdominal ultrasound showed multiple gall stones. Oesophago-gastro- duodenoscopy was normal. Under general anesthesia, four port formal laparoscopy was done, double cystic duct was found. Histopathological examination showed features of chronic cholecystitis. CONCLUSION: double cystic duct is a very rare variant of the cystic duct anomaly. Identification pre or intraoperatively is very important to prevent ductal injury.

Porocarcinoma; presentation and management, a meta-analysis of 453 cases.

BACKGROUND: porocarcinoma is a rare sort of skin cancer developing from sweat glands. Its clinical course and management are not well understood. OBJECTIVES: the current meta-analysis is to address the presentation and management of porocarcinoma. DATA SOURCES: Web of Science, PubMed, MEDLINE on OVID and Google scholar were searched for English-language studies published before December 1, 2016. RESULTS: The review of literature revealed 453 cases. From which 222 (49%) cases were male and female were 231 (51%). The mean age was 67.57 years. The mean duration of presentation was 5.57 years ranging from 4 days to 60 years of age. The most common site of affection is the head and neck (39.9%) followed by lower extremity (33.9%). Mass and nodule are the most common modes of presentation. Metastasis occurred at presentation in 110 (31%) cases. The most common organ to which porocarcinoma metastizes is the nearby lymph node (57.7%). CONCLUSIONS: Porocarcinoma is an aggressive skin cancer. Surgery is the main modality of treatment. SYSTEMATIC REVIEW REGISTRATION NUMBER: reviewregistry233.

Abdominal wall Hydatid cyst: A review a literature with a case report.

INTRODUCTION: Hydatid cyst (HC) disease is a serious health problem in endemic areas. It is a parasitic infection that commonly involves liver and lungs while muscular HC is rare. HC of abdominal wall was reported only six times. We reported a 39-year-old male presented with HC of the right loin who was managed surgically with brief literature review. CONCLUSION: HC should be put in the differential diagnosis of the abdominal wall masses. Its pre-operative diagnosis is important to prevent rupture with subsequent anaphylaxis and recurrence. Surgery is the main modality of treatment.

Subacute thyroiditis causing thyrotoxic crisis; a case report with literature review.

INTRODUCTION: Subacute thyroiditis is a self-limited, inflammatory viral thyroid disease which presents with neck pain, usually accompanied by systemic symptoms. On the other hand, thyroid storm is a clinical condition of severe sudden hyperthyroidism accompanied by physiologic de-compensation. We presented a 29-year-old male with features of subacute thyroiditis and thyroid storm who is the third reported case managed by steroid, beta-blocker and analgesics. CONCLUSION: subacute thyroiditis may present with thyrotoxic crisis which respond dramatically to corticosteroid therapy.

Metaplastic breast carcinoma with osseous differentiation: A rare case report.

INTRODUCTION: Metaplastic breast carcinoma (MBC) is a rare type of breast cancer. Osseous differentiation is a very rare subtype. Reporting this kind of case is important because its clinical course and line of management are poorly mentioned in the literatures. We present a very rare case of MBC with osseous differentiation. A 48-year-old female presented with painless hard mass of the left breast. Examination and investigations showed MBC with osseous differentiation. She was managed by operation with adjuvant chemotherapy. CONCLUSION: MBC with osseous differentiation is a very rare type of breast carcinoma presenting with hard mass and managed by mastectomy, axillary lymph node sampling and adjuvant chemotherapy.

Porocarcinoma: A systematic review of literature with a single case report.

INTRODUCTION: Eccrine porocarcinoma is a very rare type of skin cancer. It is an aggressive dermatological malignancy. We presented a 62-year-old male with long history of a mass in left forearm complicated by distant metastasis and death. A rapid review of literature has been presented. CONCLUSION: Eccrine porocarcinoma is a rare but aggressive type of skin disease. It may arise de novo or complicate a benign skin lesion. Wide local resection is recommended.

Isolated hydatid cyst of the diaphragm, a case report.

INTRODUCTION: Hydatid disease mainly affect lung and liver. We report a very rare case of hydatid cyst of the diaphragm. PATIENT INFORMATION: A 25-year-old female presented with vague right hypochondrial pain for 2 months. Clinical Findings showed mild tenderness at right hypochondrial region, Ultrasound showed segment 7 hepatic cystic lesion of about 5×6×7 centimeters, relatively thick wall, with eccentrically coarse calcification. Computed tomography showed cystic lesion affecting segment 7 of the liver with rims of calcification, appearance is consistent with hydatid cyst of the liver. At laparascopy the liver was found to be normal with a bulging from the lateral border of the diaphragm. Postero-lateral mini-thoracotomy was performed and cyst was found to be inside. Resection was done with direct repair of the diaphragm. The histopathogical examination confirmed hydatid cyst of the diaphragm. CONCLUSION: Isolated hydatid cyst of the diaphragm is a very rare entity. Pre-operative diagnosis is mandatory to prevent unnecessary excessive incisions.

Basal cell carcinoma mimicking pilonidal sinus: A case report with literature review.

INTRODUCTION: Pilonidal sinus is a common benign disease that accounts for almost 15% of anal suppurations while basal cell carcinoma is the most common malignancy of the sun-exposed area occurring mainly on the head and neck. We report a case of basal cell carcinoma presented with signs and symptoms of PNS. A 40-year-old male presented with swelling of the lower back for 2 years. On examination, there was a round, mobile, soft 4×2.5cm mass on the sacrococcygeal area. Ultrasound showed subcutaneous cystic lesion. Clinical diagnosis of PNS was done and excisional biopsy was performed under local anesthesia. The result of the histopathological examination was suggestive for basal cell carcinoma. CONCLUSION: Basal cell carcinoma should not be forgotten in differential diagnosis of superficial mass and abscesses.

Hyperfuctioning insular thyroid carcinoma: A rare case report.

INTRODUCTION: Insular carcinoma of thyroid (ICT) is a rare pattern of thyroid tumor. Being hyperfunctioning makes the condition rarer. Here we reported a case of ICT associated with hyperthyroidism. CASE REPORT: A 65-year-old female presented with neck mass for 4 years. She had symptoms of thyrotoxicosis and received antithyroid treatment. She was referred for surgical management. She had multiple, non tender, mobile masses in the neck. Ultrasound showed midline multiple heterogenous mass lesions with multiple lymph nodes in right side of the neck largest one measuring 2×2cm. The patient was prepared for total thyrodectomy with radical neck dissection. The result of histopathology confirmed unifocal, poorly differentiated ICT. The post operative course was uneventful. CONCLUSION: Insular carcinoma is a rare disease. It may present with long history of signs and symptoms of hyperthyroidism. Total thyroidectomy is the main line of treatment.

Hyperfunctioning papillary thyroid carcinoma: A case report with literature review.

INTRODUCTION: Thyroid malignant tumors are rarely associated with hyperfunctioning thyroid. The incidence of this co-incidence is highly variable. Here we report a rare case of papillary thyroid cancer associated with hyperthyroidism with brief literature review. CASE REPORT: A 40-year-old male, presented with palpitation, excess sweating and weight loss for one month duration. There was asymmetrical swelling of the neck, more on right side, mobile. Free T3: 11.09pmol/L, free T4: 34.41pmol/L, TFT: less than 0.005mIU/ml, Neck ultrasound showed features of background thyroiditis. Left lobe contained 9×7×5mm nodule with irregular outline and multiple dots of calcification, other nodules are of the same features. Under ultrasound guide, fine needle aspiration cytology showed features of papillary carcinoma. After preparation, total thyrodectomy done and the result of histopathological examination confirmed papillary thyroid carcinoma. The patient was put on 0.2mg thyroxine daily. DISCUSSION: Literature review has showed an increasing number of papers reporting the association of high level of thyroid function tests and thyroid malignancy. The cause of high level of TH in thyroid malignancy is thought to be due to an active mutation of the gene of TH receptor. Niepomniszcze and colleagues found that a combination of TSH receptor mutations and Ki-RAS was the main etiological factor for hyperfunction of the thyroid malignancy. CONCLUSION: Although the coexistence of them is rare, thyroid malignancy should be put in the differential diagnosis of hyperthyroid goiter.

Spontaneous infarction of fibroadenoma of breast-A case report with literature review.

INTRODUCTION: Infarction of breast fibroadenoma is a very rare complication which is either spontaneous or secondary to trauma. It poses a diagnostic dilemma of inflammatory carcinoma. We report a case of spontaneous infarction of fibroadenoma with different clinical presentation. CASE REPORT: A 26-year-old female presented with right breast lump with sudden increase in size for 2 week duration. On examination, well defined, irregular lump measuring 6×3cm and firm to hard in consistency was found. The clinical diagnosis of benin fibroadenoma of the breast was made. Ultrasound confirmed the diagnosis. biopsy was planned. Macroscopical and microscopical examination showed pictures consistent with spontaneous infarction of benign fibroadenoma of breast. DISCUSSION: Fibroadenomas are the most common benign tumor of breast among female gender. Spontaneous infarction within fibroadenoma is a very rare. To our knowledge, only 33 cases have been reported in literatures. CONCLUSION: Spontaneous infarction of the fibroadenoma is a benign condition of the breast with features either inflammatory carcinoma or the same presentation of benign fibroadenoma.

Sarcoidosis mimicking metastatic papillary thyroid cancer.

INTRODUCTION: Sarcoidosis is a multisystemic, idiopathic disease. It has a highly variable clinical course. It has been reported to present in association with malignancy. Coexistence of sarcoidosis and thyroid cancer is rarely reported in the literature. PRESENTATIOIN OF THE CASE: We present a case with neck swelling for 3 months, and symmetrical painless thyroid enlargement without fixation to deep tissues of the neck. Multiple nodules on the both thyroid lobes, hard irregular, grade two goiter with lymphadenopathy all over anterior neck compartments. Fine needle aspiration cytology was done under ultrasound guide from right thyroid nodule and showed papillary thyroid carcinoma. Excisional biopsy of the neck lymphnode showed picture typical for sarcoidosis. DISCUSSION: Most researchers believe that patients with pulmonary sarcoidosis are predisposed to develop malignancies, less than a dozen of cases are reported in the literature to be associated with PTC with a very wide range of presentations and clincal coarses. An interesting finding of our case is that in contrast to what is reported, both diseases were not known by the physician until the time of presentation. CONCLUSION: Cervical lymphadenopathy in association with goiter could be metastasis, sarcoidosis or mixed, therefore should be seperately biopsied.