Angiomatoid Fibrous Histiocytoma: A Series of Three Cases.

Angiomatoid fibrous histiocytoma (AFH) is a rare, slow-growing soft tissue tumor with an intermediate biologic potential and uncertain line of differentiation, and minimal metastatic potential. AFH may mimic both the clinical, histological, and radiological findings of several tumors; therefore, it is frequently misdiagnosed.  Three cases of AFH were included in this study. A six-year-old male and two females with an age of 12 and 17 years are presented. The primary locations were in the right shoulder (case 1), left medial proximal thigh (case 2), and left lateral knee (case 3). Two cases (cases 2&3) were presented with a painful mass. In the three patients, the masses were firm, mobile, and not attached to the skin.  Magnetic resonance imaging (MRI) was done, illustrating unspecific findings to reach a diagnosis. Needle biopsies were performed in all patient, and the diagnosis of AFH was reached. All three patients underwent wide surgical excision of the tumor. Patients were followed up routinely every three to four months with imaging studies to rule out recurrence and metastasis, for a period of 15 months (case 1), 26 months (case 2), and 19 months (case 3), which all resulted negatively.

Volar Radiocarpal Dislocation: A Case Report and Review of Literature.

Radiocarpal dislocations (RCDs) are one of the rare injuries that happen to the wrist in which there is a partial or complete loss of contact between the carpus and distal radius. We present the case of volar RCD in a 25-year-old male patient. He reported to the ED with pain on the wrist of his left forearm. The patient had met with a motor vehicle accident and was put on forearm cast in the previous hospital. Initial clinical examination showed swelling with no visible deformity with good capillary fill; X-ray images showed no fracture, and he was again put on forearm cast giving an orthopedic clinic appointment. A missed diagnosis of left wrist complete volar RCD was found when we reviewed the X-ray, and the patient was called for immediate surgical treatment. He was treated under general anesthesia with closed reduction, and three parallel percutaneous Kirschner wires were pinned to the left radiocarpal joint. Occupational therapy to improve the range of motion and muscle strengthening were done, and clinical follow-up showed improvement in the extension, flexion, and muscle power. The patient was satisfied with the outcome and after three months of follow-up showed no new problems.

A Rare Case of Melorheostosis in the Hand of a Saudi Woman.

Melorheostosis is a very rare bone dysplasia, especially in the hand. Most cases were diagnosed incidentally, with the lower limbs being the most affected. This is the first Saudi woman with hand melorheostosis. A 33-year-old Saudi female had mild to moderate right-hand pain that started six years ago. Hand examination showed a full range of motion and full hand grip, and there was no tenderness upon palpation. Plain X-ray, unenhanced CT scan, and MRI of the hand showed an appearance resembling dripping candle wax as melorheostosis. The bone scan showed a nonvascular and nonacute lesion. An unenhanced CT scan demonstrated cortical and endosteal hyperostosis involving the proximal, middle, and distal third and fourth phalanges. Multi-sequential MRI of the hand demonstrated cortical hyperostosis involving the ulnar and radial aspect of the right fourth proximal, middle, and distal phalanges. Features in the X-ray, CT scan, bone scan, and MRI confirmed a diagnosis of melorheostosis with associated flexor tenosynovitis.

First Case of Brucella Pneumonia in a Lung Transplant Patient: Case Report and Review of the Literature.

Brucella is one of the most common zoonotic diseases worldwide. It is endemic in the Mediterranean basin. Brucella pneumonia is a rare complication of brucellosis that can present with a variety of clinical and radiological manifestations. It was described only once previously in the setting of solid organ transplant. A 32-year-old female from Saudi Arabia with cystic fibrosis and bronchiectasis presented five weeks after a bilateral lung transplant with fever and cough. Investigation showed high inflammatory markers in addition to a pulmonary infiltrate in the chest imaging. All microbiological workups were negative including bronchoalveolar lavage cultures. Brucella serology was positive and she was started on anti-Brucella therapy which resulted in complete resolution of her symptoms and radiological changes. This case demonstrates an unusual presentation of Brucellosis. It highlights the importance of epidemiology in evaluating post-transplant infections. We reviewed and summarized the literature on brucellosis post solid organ transplant and the various treatment regimens for Brucella pneumonia. This is the first case report of Brucella pneumonia in a lung transplant patient. Brucella is a rare complication post solid organ transplant but it has a good prognosis.