Mixed germ cell tumor of sacrococcygeal region; A case report with literature review.

INTRODUCTION: Mixed germ cell tumors are uncommon tumors that contain two or more types of malignant, primitive, or germ cell components. This study aims to report a rare case of extragonadal mixed germ cell tumor of the sacrococcygeal area. CASE REPORT: A 4-year-old female presented with lower back swelling for two weeks. It was associated with pain and fever. Investigations showed elevated Alpha-fetoprotein and normal beta HCG levels. Magnetic resonance imaging showed a large well defined heterogeneous mass at the midline of the lower coccygeal region, which displaced the rectum anteriorly without invasion. Surgical dissection of the mass with excision of the coccyx was performed. Afterward, the patient was referred to an oncology center for chemotherapy. DISCUSSION: The emergence of extragonadal germ cell tumors may be caused by a disruption in the migration of primordial germ cells along the urogenital ridge, which then undergo a malignant transformation as a consequence of their microenvironment. Another idea states that extragonadal germ cell tumors occur when germ cells that routinely migrate into the extragonadal region during embryogenesis undergo malignant transformation.

Post COVID-19 pulmonary complications; a single center experience.

INTRODUCTION: Although the rate and severity of complications after coronavirus 2019 disease (COVID-19) resolution is currently unknown, evidence regarding their presence is increasing in the literature. This study presents a series of cases with post COVID-19 short-term pulmonary complications. METHODS: This is a single center retrospective case series study. The demographic and clinical data were collected from the center's electronic records. All the included cases were confirmed COVID-19 patients who had pulmonary complications even after their recovery. RESULTS: Nineteen COVID-19 patients were involved in this study. Fourteen of them were male (73.7%) and only 5 (26.3%) cases were female, with a mean age of 52.05 years (26-77). All of the patients developed severe COVID-19 and were admitted to intensive care unit (ICU). The average infection duration was 13.5 days (10-21). The most common complaints after recovery from COVID-19 were shortness of breath, fever, and hemoptysis. Computed tomography scan showed different pulmonary abnormalities between the cases. Different surgical procedures were performed for the patients according to their conditions, such as decortications, lobectomy, and bullectomy. More than half of the patients (n = 10) recovered and were discharged from hospital without complications, five patients were admitted to the ICU, 3 cases developed mucormycosis, and one case passed away. CONCLUSION: Following the resolution of COVID-19, patients may experience severe pulmonary complications that may last for months and can affect quality of life, ICU admission, or even death.

Primary chest wall tuberculosis mimicking gynecomastia: A case report.

INTRODUCTION: Musculoskeletal tuberculosis (TB) is a rare variant of the disease. Involvement of the chest wall is even rarer. This paper aims to report a case of primary chest wall TB mimicking gynecomastia. CASE REPORT: An 11-year-old male presented with gradual left breast enlargement for one year duration, clinically diagnosed as a case of gynecomastia. On examination; there was a firm swelling involving left anterior chest wall elevating the nipple and areolar region. Ultrasound showed thick wall cystic lesion with internal debris and bone erosion. Computed tomography scan (CT scan) of the chest revealed a cystic lesion containing fluid with a similar cystic lesion in the substernal area. Under general anesthesia, through an anterolateral incision, a thick wall cystic lesion with a very thick pus content was found connecting to another similar lesion in the anterior mediastinum with a localized thickening of the pleura. Both of the lesions, and the fifth rib with a part of the fourth rib were resected and sent for histopathological examination which revealed multiple granulomas with caseating material, typical for tuberculosis. DISCUSSION: Pathogenesis of chest wall TB has been explained by one or more of the three mechanisms: due to direct extension from an underlying disease; hematogenous dissemination, and direct extension from neighboring affected lymph node groups in the chest wall. CONCLUSION: Chest wall TB is a rare condition. It can mimic other pathologies due to nonspecific signs and symptoms. Surgical debridement with postoperative chemotherapy is the most effective strategy of management.