Whole­body MRI for metastatic workup in patients diagnosed with cancer.

Early diagnosis and appropriate staging workup are crucial for cancer patients. Whole-body magnetic resonance imaging (WB-MRI) has been proposed as another practical whole-body approach for assessing local invasiveness and distant metastases in patients newly diagnosed with cancer. The current study aimed to evaluate the efficacy of WB-MRI in assessing metastasis in patients newly diagnosed with cancer using histopathologic data as the reference method. A prospective observational study was performed from April 2018 to July 2020. MRI sequences were utilized to acquire anatomical and functional images in three orthogonal planes. The discovery was classified as nodal, skeletal and visceral metastases. Patient-based analysis was used for visceral metastasis and region-based for skeletal, systemic and lymph node metastases. A total of 43 consecutive patients (mean age, 56±15.2 years) were assessed successively. In 41 patients, there was a concordance between the WB-MRI and histological confirmation. The most prevalent site of metastasis was the skeletal system (18 patients). There were 12 individuals with liver metastasis, 10 with lung metastasis and 4 with peritoneal metastasis, with just one brain metastatic lesion found. On WB-MRI, 38 lymph node groups were deemed positive. Out of the total, 66 skeletal locations contained metastases. The accuracy of WB-MRI for nodal, skeletal and visceral metastases was (98.45, 100 and 100%, respectively). In conclusion, WB-MRI in three orthogonal planes, including the diffusion-weighted MRI with background body signal suppression sequence, may be utilized efficiently and accurately for assessing metastasis staging and may thus be utilized in patients with newly diagnosed cancer.

Accelerated heparin-induced thrombocytopenia in a COVID-19 patient; a case report with literature review.

Introduction: Heparin-induced thrombocytopenia (HIT) is a rare and serious immune-mediated complication of heparin therapy which is seldom reported in association with COVID-19. This report aims to present a case of accelerated HIT in a severe COVID-19 patient. Case report: A 63-year-old man presents with symptoms of COVID-19 for one week. He was conscious, ordinated, feverish, and had diffused chest crackles. Initial laboratory tests revealed elevated C-reactive protein of 87.66 mg/dL, elevated D-dimmer of 1258.9 ng/ml, elevated ferritin of 1020 ng/ml, and his platelet count was within the normal range. Polymerase chain reaction (PCR) confirmed the diagnosis of COVID-19. On the 9th day of admission, he developed a progressive worsening of dyspnea. His D-dimmer level significantly increased to 7020 ng/ml, and his interleukin-6 was 27.3 pg/ml. Hence, we started him on unfractionated heparin (UFH) for thromboprophylaxis. On the 12th day of hospitalization, the platelet count dropped from 258000 to 111000 cells/µL. He had a high probability of HIT (4Ts score = 6). As a result, we discontinued UFH and switched him to apixaban. His platelet count normalized (174000 cells/µL) within two weeks of ceasing UHF. Discussion: HIT results from the production of antibodies against platelet factor 4/heparin complexes. It is associated with a diminished platelet count within 5-10 days post heparin initiation. Because thrombocytopenia can occur in COVID-19 patients, HIT is seldom suspected. Conclusion: HIT should be considered a differential diagnosis in COVID-19 patients with thrombocytopenia.

Ductal carcinoma in situ arising from fibroadenoma; a rare case with review of literature.

Introduction: ibroadenoma (FA) is a common benign breast mass representing a group of hyperplastic breast lobules due to the deviation of normal development. This study aims to present a rare case of ductal carcinoma in situ (DCIS) associated with fibroadenoma. Case report: A 49-year-old married female presents with a right breast mass for five years. Core needle biopsy diagnosed the specimen as cellular complex fibroadenoma. A breast-lumpectomy and the histopathological examination of the surgical specimen confirmed ductal carcinoma in-situ. Discussion: Malignant changes within fibroadenomas typically happen at an older age, with the age of detection in the fifth decade. Complex fibroadenomas are more related to malignant transformation. Old age and strong family history are risk factors for malignant transformation of fibroadenomas. Conclusion: Fibroadenomas are common benign tumors. They can rarely be associated with DCIS. Therefore, the risk of malignancy should always be kept in mind.

Breast cancer recurrence 27 years after full recovery; A case report with literature review.

INTRODUCTION: Breast cancer can recur after a decade of healthy life. The purpose of this study is to describe a rare case of breast cancer recurrence after 27 years of full recovery. CASE REPORT: A 67-year-old married nulliparous (G1P0A1) female presented with a few weeks of left axillary swelling. She is a known case of left breast cancer that was identified and treated in 1994 with a standard mastectomy without axillary intervention. An ultrasound and mammography imaging revealed a normal right breast and a clear left breast bed. Fine needle aspiration cytology (FNAC) revealed metastasized ductal carcinoma of the breast. The patient underwent general anesthesia and axillary dissection for level I and II axillary lymph node groups. DISCUSSION: The incidence of recurrence in axillary lymph nodes following excision of the original tumor in breast cancer patients varies according to the surgical approach, ranging from 0.8% to 8.6%. Patients with breast cancer who have a positive estrogen receptor are at a higher risk of delayed recurrence. CONCLUSION: Breast cancer can recur even 27 years after being diagnosed and treated. This demonstrates the significance of continuing follow-up in patients diagnosed with breast cancer throughout their lives.

The diagnostic challenge of juvenile hyaline fibromatosis, a case report with literature reviews.

INTRODUCTION: Juvenile hyaline fibromatosis (JHF) is a rare genetic condition characterized by impaired collagen production or metabolism. This study aims to present a rare case of JHF. CASE REPORT: An 11-year-old boy presented with bilateral keloid-like lesions on his ears and admitted intermittent reappearance of such lesions since he was seven. He was born to second-degree relative consanguineous parents. Physical examination revealed bilateral soft pink masses on the ears, multiple scars on the scalp, severe gingival hypertrophy, multiple small soft white papules on the anterior neck, broadly shaped enlargements on the ends of the fingers and toes, and multiple reticulated hard livedoid and hyperpigmented macules on the back and anterior lower extremities. A 5 mm biopsy was taken from the lesion on the ear and histopathological examination of the specimen revealed a normal epidermis but dermal and subcutaneous deposits of nodules composed of abundant amorphous eosinophilic hyaline material with sparse embedded fibroblast associated with areas of congestion and focal hemorrhage. The ear lesions were managed by surgical excision with intraregional steroid injections to prevent relapse. To improve eating ability and oral hygiene, a gingivectomy was planned. DISCUSSION: JHF presents with bone lesions, gingival hypertrophy, joint contractures, and skin lesions. The clinical features usually appear late in infancy and up to 5 years. The condition occurs mostly sporadically. A portion of the cases can be in siblings born to consanguineous parents. CONCLUSION: JHF is a rare genetic disorder that can present even beyond five years. There is no standard treatment for these cases.