Osteoid osteoma of the pisiform bone: A rare cause of wrist pain.

Non-traumatic wrist pain remains a diagnostic challenge. An accurate diagnosis is crucial in order to choose the appropriate treatment. We report the case of a 23-year-old female with a four-month history of mainly nocturnal wrist pain. There was no history of trauma or prior surgery. Radiographs and CT scans showed a lytic lesion with central nidus and sclerotic margins in the pisiform bone. Bone scan showed increased uptake in the pisiform bone. The diagnosis of osteoid osteoma was confirmed by histopathological analysis after complete surgical resection. Osteoid osteoma of the carpal bones is a rare cause of wrist pain and can raise diagnostic issues. Diagnosis is based on both clinical and radiological features; histopathological analysis can confirm the diagnosis. Treatment depends on several criteria and multiple options are possible, but surgical excision is often preferred for the wrist. Osteoid osteoma should always be considered in young patients presenting with chronic unexplained wrist pain.

Sensitivity of mGROWA-simulated groundwater recharge to changes in soil and land use parameters in a Mediterranean environment and conclusions in view of ensemble-based climate impact simulations.

This study examines the impact of changing climatic conditions on groundwater recharge in the Riu Mannu catchment in southern Sardinia. Based on an ensemble of four downscaled and bias corrected combinations of Global and Regional Climate Models (GCM-RCMs), the deterministic distributed water balance model mGROWA was used to simulate long-term mean annual groundwater recharge in the catchment for four 30-year periods between 1981 and 2100. The four employed GCM-RCM combinations project an adverse climatic development for the study area: by the period 2071-2100, annual rainfall will decrease considerably, while grass reference evapotranspiration will rise. Accordingly, ensemble results for our base scenario showed a climate-induced decrease in the median of annual groundwater recharge in areas covered by Macchia from 42-48mm/a to 25-35mm/a between the periods 1981-2010 and 2071-2100, corresponding to a reduction of 17-43%. To take into account the influence of additional plant available water storage in weathered bedrock on groundwater recharge generation, the model was extended by a regolith zone for regions covered by Mediterranean Macchia. In a set of model runs ("scenarios"), parameter values controlling the water storage capacity of this zone were increased step-wise and evaluated by comparison to the base scenario to analyze the sensitivity of the model outcome to these changes. The implementation of a regolith zone had a considerable impact on groundwater recharge and resulted in a decrease of the median in annual groundwater recharge: by 2071-2100, the 35% scenario (available water content in the regolith of 3.9 to 5.7vol.%) showed a reduction of 67-82% as compared to the period 1981-2010 in the base scenario. In addition, we also examined the influence of changes in the crop coefficients (Kc) as well as different soil texture distributions on simulated groundwater recharge.

Fatal multiple coronary involvements in a young woman with systemic lupus erythematosus.

We report a rare case of fulminant congestive heart failure with fatal outcome in a 21-year-old girl with systemic lupus erythematosus (SLE). A young woman was admitted in the intensive care unit for pericardial tamponade associated with disseminated coagulopathy and refractory shock secondary to multiple coronary aneurysms. Post-mortem examination revealed significant multiple coronary lesions with aneurysms of the interventricular and right coronary arteries, responsible of muscular necrosis, thrombosis of the coronary sinus, and significant pericardial infiltration with hemorrhagic fluid. We describe a refractory cardiac failure with extensive coronary artery involvements, which is very uncommon in young patients with SLE: few cases have been previously described in the literature. We report a rare case of fulminant congestive heart failure with fatal outcome in a young woman with SLE related to extensive coronary involvements.

Coexistence of renal malakoplakia and myelodysplastic syndrome.

Malakoplakia is a protean systemic chronic granulomatous disease that usually targets the genito-urinary system and most particularly the bladder. Only in rare occasions do the kidneys get involved. Myelodysplastic syndrome is a heterogeneous clonal haematopoietic disorder characterised by either a hyper- or hypocellular bone marrow dysmyelopoiesis and peripheral blood pancytopenia. The synchronous association of these two unrelated disorders has never been reported. We report a 62-year-old woman who initially developed vague, relapsing gastrointestinal symptoms synchronous with renal malakoplakia and myelodysplastic syndrome.

Spontaneous rupture of the spleen in relation to a non-Hodgkin lymphoma.

A 35-year-old man was admitted for surgery with complaints of left upper abdominal quadrant pain, tachycardia and hypotension with no history of trauma. A splenomegaly had just been diagnosed one week before, during, the work up for asthenia. An immediate CT scan revealed an intraperitoneal haemorrhage with splenic rupture. During emergency laparotomy, a splenic rupture was found and a splenectomy was performed. Histopathology of the spleen confirmed the diagnosis of a non-Hodgkin lymphoma.

Intra-abdominal lymphatic malformation.

Intra-abdominal lymphangioma is a rare congenital lymphatic vascular malformation. It is found, most commonly, in adult patients who present with abdominal pain, and whom medical imaging (ultrasound, endoscopy and tomography) reveals a cystic intra-abdominal mass. Such masses may be on the mesentery, in contact with abdominal viscera or may be part of the visceral wall. Diagnosis of intra-abdominal lymphangioma is difficult because of its rarity, and because other pathologies may have the same radiological signs. The diagnosis is confirmed by anatomopathological examination with immunohistochemistry. The treatment is complete surgical excision, in order to prevent recurrence.

[Metastatic sternal mass]. / Masse sternale métastatique.

Sternal masses are rare and their differential diagnosis is relatively unknown by most of us. The management of such masses mobilize often a lot of expensive radiological means. We expose the case of a patient, where a lung carcinoma is diagnosed by a surgical biopsy of a sternal mass. We discuss the different diagnoses and the management of sternal masses.

Perianal Paget's disease: case report and review of the literature.

Cutaneous Paget's disease (PD) is a rare entity, predominantly involving the breasts. Anal involvement is rather exceptional, and can be associated with underlying malignancies, among which prostate and rectal adenocarcinoma. We report the case of a 71-year-old man suffering from a long history of anal itching, associated with an erythematosquamous lesion of the right buttock extending up to the anus. The diagnosis of perianal PD (PAPD) was confirmed by histopathological demonstration of Paget's cells from a biopsy performed after ineffective topical treatment. Radiological and further clinical inspections allowed us to exclude any synchronous malignancy. A first-step surgery consisted in coelioscopic diverting sigmoid colostomy, along with multiple perianal, anal and rectal biopsies revealing an anal canal involvement. Coelioscopic abdominoperineal surgery and a wide cutaneous excision were then performed. Histopathological analysis revealed positive posterior margin, requiring further excision. No adjuvant therapy was prescribed, and to this day, after a one-year and a half follow-up, the patient remains disease-free. Our case report and review of PAPD stress that appropriate management is required to improve the poor prognosis of this rare affection.

Metastasis of a renal cell carcinoma to the nose and paranasal sinuses.

We present a case of a metastasis of a renal cell carcinoma to the nose and paranasal sinuses. A 66 year old male patient developed a mass in his left nasal cavity and paranasal sinuses, five years after he underwent a left sided nefrectomy for a renal cell carcinoma. The histopathologic examination of the nasal mass showed metastasis of a renal cell carcinoma. A craniofacial resection was performed followed by radiotherapy.