Primary hepatic Hodgkin's lymphoma: A case report.

Introduction: Hodgkin lymphoma (HL) is an uncommon hematological malignancy that primarily occurs in young adults and less frequently in elderly individuals. HL has characteristics cells derived from B lymphocytes (known Reed-Sternberg (HRS) cells). Primary hepatic Hodgkin disease is very rare presentation accounting for less than 0.4% of the cases. Due to its rare occurrence, the pathogenesis of PHL is still unclear, Clinical manifestations, laboratory findings, and imaging features are usually nonspecific, making it difficult to diagnose. Patient Concerns: 69 years old Saudi Female, known case of Hypertension presented to our hospital with history of fever, jaundice, and poor appetite for about 2 weeks with significant weight loss. Diagnosis: Laboratory findings showed cholestatic pattern with total bilirubin 107.2 mg/dl, alkaline phosphatase 2076 IU/l, AST 153 IU/l and ALT 73 IU/l. Imaging with US revealed normal liver size with diffuse increase echogenicity, MRCP showed multiple stones within the gallbladder without evidence of obstruction or CBD dilatation and pan-computed tomography (CT) revealed mildly enlarged and fatty liver. CT-guided fine needle aspiration cytology (FNAC) and biopsy from the liver were consistent with primary hepatic Hodgkins lymphoma. Intervention: The patient received 5 cycles of ABVD. Outcomes: After the completion of the 5 cycles patient showed good response to the treatment with normalization of her liver function and regression in the size of liver on CT. Conclusion: PHL is a rare disease. The clinical presentation is variable and radiological features are not specific. Histology is mandatory for definitive diagnosis. The optimal therapy and outcomes for PHL is still unclear. ABVD is the most frequently used chemotherapy regimen. Multidisplinary approach including surgery and radiotherapy is another option.

Spontaneous epidural hematoma: A case report of rare crisis of sickle cell disease.

INTRODUCTION: Sickle cell disease (SCD) is defined as an autosomal recessive disorder characterized by the production of abnormal hemoglobin S and is correlated with high morbidity and mortality. The clinical consequences of SCD include pain crisis, acute chest syndrome, and strokes. Spontaneous epidural hematoma is a rare manifestation in sicklers with few cases reported in the literature.[6] The pathophysiology is not completely understood. However, a few explanations have been reported over the years that include vaso-occlusion of the bone resulting in bone infarction, microfracture due to rapid expansion of hematopoiesis of the inner cortex, and sludging of the sickle cells in the diploic veins-all result in leaking of blood in the epidural or in the subgalea space. PATIENT CONCERNS: A 14-year-old boy known to have SCD (Hb SS) presented to the Security Forces Hospital with a history of diffuse headache associated with nausea that started 12 h prior to presentation. DIAGNOSIS: Computed tomography (CT) showed bilateral frontal epidural hematoma and subgaleal space. INTERVENTION: A multidisciplinary team was created (hematology, neurology, neurosurgery, and interventional radiology) and a plan was formulated as follows: Continuous monitoring of the patient's neuro vital signs and transfuse the patient with blood and platelets in addition with Levetiracetam. OUTCOMES: The patient was discharged after 9 days of hospital admission. He has remained symptom-free post-transfusion. Post-discharge CT scan showed a reduction in the hematoma size. CONCLUSION: A high index of suspicion is needed for a prompt diagnosis and treatment of this rare complication of SCD. The management strategy of EDH depends on the level of consciousness of the patient upon presentation. Surgical approach with craniotomy and evacuation or conservative management have been used with full recovery of the patients.

Internal jugular vein aneurysm: A case report.

INTRODUCTION: Aneurysm is a localized dilatation of an artery of at least 1.5 times the normal diameter that occurs when part of an artery wall weakens or is injured, allowing it to widen abnormally. In practice, an arterial aneurysm is more common in comparison to a venous aneurysm. Because of the rare incidence of venous aneurysms, treatment guidelines are not clearly established and thus treatment strategies vary. This is a case of a 57-year-old Saudi woman, with no significant medical history, who presented to Prince Sultan Military Hospital complaining of swelling in the right side of the neck that started 3 years ago. The patient reported that the swelling enlarged with coughing and straining, but there was no pain, change in skin color, dysphagia, change in voice, neurological defect, shortness of breath, history of any trauma to the neck, surgical intervention, or any lump. The condition can be diagnosed via ultrasonography, computed tomography, or magnetic resonance imaging. CONCLUSION: Despite the lack of guidelines, intervention was necessary because the patient was anxious regarding the increase in the size of the swelling, which she felt had a negative psychosocial impact. Moreover, because the sizable venous aneurysm harbored a mural thrombus that increased the risk of embolization and pulmonary embolism, surgery was offered.Indication for surgery includes pain, swelling, and cosmetic concerns. Conservative management of the condition is described in the literature.

Association Between Race/Ethnicity and Survival of Melanoma Patients in the United States Over 3 Decades: A Secondary Analysis of SEER Data.

UNLABELLED: Melanoma is a treatable and preventable skin cancer. It is responsible for 75% of deaths among all skin cancers. Previous studies have found that race/ethnicity may play a role in survival among melanoma patients. However, there are no studies that cover 30 years and take race into account for the U.S. POPULATION: This study is a secondary analysis of the National Cancer Institute's Surveillance, Epidemiology, and End Result (SEER) Program. Adults with primary cutaneous melanoma from 1982 to 2011 were included; the final sample size was 185,219. The outcome was survival; both cause-specific and all-cause mortality were examined. The main exposure was race/ethnicity. Kaplan-Meier survival analysis was used to estimate overall survival. Cox proportional hazards regression was used to estimate unadjusted and adjusted hazard ratios (HRs). A P-value less than 0.05 was considered statistically significant.More than 50% of patients in all races/ethnicities were diagnosed at the in situ or localized stage. Non-Hispanic White patients were more frequently diagnosed at the in situ stage. Overall, more men were diagnosed than women. The majority of cases among all races were men. Non-Hispanic Black females represented the smallest percentage of melanoma cases among all races. The smallest number of diagnoses across all races/ethnicities was made from 1982 to 1991. Median follow-up was 81 months and no collinearity was observed in the adjusted models. When examining cause-specific mortality and controlling for site and stage at diagnosis, gender, age and decade of diagnosis, the HR for non-Hispanic Black patients was lower than that for non-Hispanic White patients (HR 0.7; 95% confidence interval (CI): 0.6-0.8). However, when examining all-cause mortality, this difference disappeared (HR 1.1; 95% CI: 1.0-1.2). Stage at diagnosis impacted HR; patients diagnosed with distant metastases had significantly worse survival.When taking cause-specific mortality into consideration and after controlling for stage and site at diagnosis, gender, and age and decade of diagnosis, non-Hispanic Black patients had a lower HR compared to non-Hispanic White patients. However, this difference disappeared when examining all-cause mortality. Further research is needed to explore this finding and to determine what factors may be associated with late-stage melanoma diagnosis.