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Nath, Reema; Gogoi, Rajendra Nath
Sparganosis is caused by plerocercoid larvae of the Pseudophyllidea tapeworms of the genus Spirometra. Though prevalent in East Asian and south east Asian countries like China, Japan, Korea, Taiwan, Vietnam, Thailand; yet very few cases are reported from India. We report a case of migrating sub-conjunctival ocular sparganosis mimicking scleritis which later on developed into orbital cellulitis from Dibrugarh, Assam, North-eastern part of India. This case is reported for its rarity. PMID:25709957
Cheng, Ke-Bin; Gao, Bei-Lan; Liu, Jin-Ming; Xu, Jin-Fu
Sparganosis mansoni is a parasitic disease caused by the larva of Spirometra mansoni. It occurs worldwide, but only a few patients show pulmonary involvement. Here, we present a case of pulmonary sparganosis mansoni in a non-endemic region. A 32-year-old Chinese woman presented with intermittent bloody phlegm, peripheral blood eosinophilia, and migratory patch shadows in both lungs. She had been misdiagnosed with eosinophilic pneumonia. She had a history of eating raw frogs, and the sparganum mansoni antibody was positive in both her blood and bronchoalveolar lavage fluid. Several sparganum mansoni were found in a frog sample that the patient provided. Consequently, she was diagnosed with pulmonary sparganosis mansoni. After two oral courses of praziquantel were administered, her symptoms and radiological lesions improved significantly. To our knowledge, this is the first case of pulmonary sparganosis mansoni occuring in Shanghai. Oral praziquantel is effective for the treatment of sparganosis mansoni, although its course of therapy may need to be repeated.
... of the Vulva: Common Causes of Vulvar Pain, Burning, and Itching • What is the vulva? • When should ... of the vulva, or if you have itching, burning, or pain, contact your health care provider. What ...
Liu, Quan; Li, Ming-Wei; Wang, Ze-Dong; Zhao, Guang-Hui; Zhu, Xing-Quan
Human sparganosis is a food borne zoonosis caused by the plerocercoid larvae (spargana) of various diphyllobothroid tapeworms of the genus Spirometra. Human infections are acquired by ingesting the raw or undercooked meat of snakes or frogs, drinking untreated water, or using raw flesh in traditional poultices. More than 1600 cases of sparganosis have been documented worldwide, mostly in east and southeast Asia. Sporadic cases have been reported in South America, Europe, and Africa, and several cases have been described in travellers returning from endemic regions. Epidemiological data suggest that the increased effect of sparganosis on human health is because of greater consumption of raw meat of freshwater frogs and snakes. This Review provides information about the Spirometra parasites and their lifecycles, summarises clinical features, diagnosis, and treatment of human sparganosis, and describes geographical distribution and infection characteristics of Spirometra parasites in host animals.
Kim, Jeung Il; Kim, Tae Wan; Hong, Sung Min; Moon, Tae Yong; Lee, In Sook; Choi, Kyung Un
Sparganosis is a parasitic infection caused by the plerocercoid tapeworm larva of the genus Spirometra. Although the destination of the larva is often a tissue or muscle in the chest, abdominal wall, extremities, eyes, brain, urinary tract, spinal canal, and scrotum, intramuscular sparganosis is uncommon and therefore is difficult to distinguish from a soft tissue tumor. We report a case of intramuscular sparganosis involving the gastrocnemius muscle in an elderly patient who was diagnosed using ultrasonography and MRI and treated by surgical excision. At approximately 1 cm near the schwannoma at the right distal sciatic nerve, several spargana worms were detected and removed. PMID:24623885
Background Cerebral sparganosis in children is an extremely rare disease of central nervous system, and caused by a tapeworm larva from the genus of Spirometra. In this study, we discussed and summarized epidemiological, clinical and MR imaging characteristics of eighteen children with cerebral sparganosis for a better diagnosis and treatment of the disease. Methods Eighteen children with cerebral sparganosis verified by pathology, serological tests and MR presentations were retrospectively investigated, and the epidemiologic and clinical characteristics of the disease were studied. Results Twenty-seven lesions were found in the eighteen children. Twelve lesions in twelve patients were solitary while the lesions in the rest six patients were multiple and asymmetrical. The positions of the lesions were: seven in frontal, eleven in parietal, four in temporal and two in occipital lobes, one in basal ganglia, one in cerebella hemisphere and one in pons. The lesions were presented as slight hypointensity on T1-weighted images but moderate hyperintensity on T2-weighted images with perilesional brain parenchyma edema. Enhanced MR scans by using Gadopentetic Acid Dimeglumine Salt were performed in the patients, and the images demonstrated abnormal enhancements with the patterns of a peripheral ring, or a tortuous beaded, or a serpiginous tubular shape. Follow-up MR scans were preformed for eight patients, and three out of the eight cases exposed migrations and changes in shapes of the lesion areas. Conclusions The MR presentations in our study in general were similar to those in previous studies. However serpiginous tubular and comma-shaped enhancements of lesions have not been previously reported. The enhanced MR imaging and follow-up MR scans with the positive results from serological tests are the most important methods for the clinical diagnosis of cerebral sparganosis in children. PMID:23006504
Kavana, Nicholas; Sonaimuthu, Parthasarathy; Kasanga, Christopher; Kassuku, Ayub; Al-Mekhlafi, Hesham M.; Fong, Mun Yik; Khan, Mohammad Behram; Mahmud, Rohela; Lau, Yee Ling
In this study, the seroprevalence of sparganosis and its relationship with sociodemographic factors in northern Tanzania have been assessed. A total of 216 serum samples from two rural districts, Monduli and Babati, were tested for sparganosis using an enzyme-linked immunosorbent assay. The seroprevalence of anti-sparganum IgG antibodies was 62.5% (95% confidence interval [CI] = 56.1–68.9) in all age groups. There were significant associations between district (relative risk [RR] = 1.95, 95% CI = 1.42–2.69), education (RR = 1.40, 95% CI = 1.15–1.70), and pet ownership with seropositivity (RR = 1.48, 95% CI = 1.02–2.16) based on univariate analysis. However, only the district was significantly associated with seropositivity (odds ratio = 4.20, 95% CI = 1.89–9.32) in binary logistic regression analysis. Providing health education to people residing in sparganosis-endemic areas is likely to improve the efficacy of preventative measures and reduce human disease burden. PMID:27481059
Noiphithak, Raywat; Doungprasert, Gahn
Background: Sparganosis is a very rare parasitic infection in various organs caused by the larvae of tapeworms called spargana. The larva usually lodges in the central nervous system (CNS) and the orbit. However, lumbar spinal canal involvement, as noted in the present case, is extremely rare. We report a rare case of disseminated CNS sparganosis involving the brain and spinal canal and review the literature. Case Description: A 54-year-old man presented with progressive low back pain and neurological deficit at the lumbosacral level for 2 months. Imaging indicated arachnoiditis and an abnormal lesion at the L4-5 vertebral level. The patient underwent laminectomy of the L4-5 with lesionectomy and lysis of adhesions between the nerve roots. Microscopic examination indicated sparganum infection. Further brain imaging revealed evidence of chronic inflammation in the left parieto-occipital area without evidence of live parasites. In addition, an ophthalmologist reported a nonactive lesion in the right conjunctiva. The patient recovered well after surgery, although he had residual back pain and bladder dysfunction probably due to severe adhesion of the lumbosacral nerve roots. Conclusion: CNS sparganosis can cause various neurological symptoms similar to those of other CNS infections. A preoperative enzyme-linked immunosorbent assay is helpful for diagnosis, especially in endemic areas. Surgical removal of the worm remains the treatment of choice. PMID:28031991
Wong, Samson S.Y.; Lai, Christopher K.C.; Poon, Rosana W.S.; Chan, Helen S.Y.; Wu, Tak Chiu; Cheung, Yuk-Fai; Poon, Tak-Lap; Tsang, Yi-Po; Tang, Wai-Lun; Wu, Alan K.L.
Human sparganosis is a foodborne zoonosis endemic in Asia. We report a series of 9 histologically confirmed human sparganosis cases in Hong Kong, China. All parasites were retrospectively identified as Spirometra erinaceieuropaei. Skin and soft tissue swelling was the most common symptom, followed by central nervous system lesions. PMID:28322697
Kim, Joong Keun; Baek, Dong Hoon; Lee, Bong Eun; Kim, Gwang Ha; Song, Geun Am; Park, Do Youn
Human sparganosis is a rare parasitic disease caused by infection with the tapeworm Sparganum, the migrating plerocercoid (second stage) larva of Spirometra species. Sparganosis usually involves subcutaneous tissues and/or muscles of various parts of the body, but involvement of other sites such as the brain, eye, peritoneopleural cavity, urinary track, scrotum, and abdominal viscera has also been documented. Infections caused by sparganum have a worldwide distribution but are most common in Southeast Asia such as China, Japan, and South Korea. Rectal sparganosis is an uncommon disease but should be considered in the differential diagnosis of unusual and suspicious rectal submucosal tumors. We report a case of rectal sparganosis presenting as rectal submucosal tumor. We performed endoscopic submucosal dissection of the rectal submucosal tumor. The sparganosis was confirmed based on the presence of calcospherules in the submucosal layer on histological examination. Moreover, the result of the immunoglobulin G antibody test for sparganosis was positive but became negative after endoscopic submucosal dissection. Though rare, rectal sparganosis should be considered in the differential diagnosis of rectal submucosal tumor-like lesions. This case suggests that physicians should make effort to exclude sparganosis through careful diagnostic approaches, including detailed history taking and serological tests for parasites. In this report, we aimed to highlight the clinical presentation of Sparganum infection as a rectal submucosal tumor.
Lescano, Andres G; Zunt, Joseph
Many cestodes are capable of invading the central nervous system (CNS), and several are highly prevalent in the developing world. Neurocysticercosis due to Taenia solium and echinococcosis due to Echinoccocus granulosus are two of the most common parasitic infections affecting humans, but other less well-known parasites can also infect the nervous system. Coenurosis, caused by Taenia spp. such as T. multiceps, T. serialis, or T. brauni; sparganosis, caused by Spirometra spp., and neurocysticercosis caused by T. crassiceps are three less frequent zoonotic conditions that should be considered in the differential diagnosis of patients presenting with CNS infection - especially if they have lived in or traveled through areas where these infections are endemic. Diagnosis of these infections is typically made through a combination of serological testing, histopathology, and neuroimaging.
Asia, Anand J; Tapre, Vaibhav N
Actinomycosis is a chronic suppurative granulomatous infection of subcutaneous tissues caused by bacterium Actinomyces israelii. It is a normal commensal of the oral cavity, gastrointestinal tract, respiratory tract, and vagina. Infection is first established locally by breach of mucosal barrier during various procedures, aspiration, trauma, or human bite. Rarely, it may spread through hematogenous and lymphatic system. We present a case of actinomycosis involving the vulva, extending to the inguinal region along with inguinal lymphadenopathy. Involvement of vulva by actinomycosis is uncommon in literature. PMID:27730039
Tappe, Dennis; Berger, Luise; Haeupler, Alexandra; Muntau, Birgit; Racz, Paul; Harder, Yves; Specht, Katja; Prazeres da Costa, Clarissa; Poppert, Sven
We report a case of subcutaneous sparganosis in a 68-year-old female Japanese immigrant in Germany. The patient complained of a painless erythema caudal of the umbilicus with a palpable subcutaneous cherry-sized lump. Polymerase chain reaction on formalin-fixed parasite tissue identified Spirometra erinaceieuropaei as the causative agent; the proliferative form of sparganosis, which is caused by the branching and disseminating Sparganum proliferum, could, thus, be excluded. From the excised sparganum, an immunofluorescence test was established and revealed an antibody response directed against the parasite's tegument. Histological key features of the plerocercoid that facilitate diagnosis with different stains are presented. PMID:23166198
Schindler, Adam J
Understanding how cells move, change shape, and alter cellular behaviors to form organs, a process termed morphogenesis, is one of the great challenges of developmental biology. Formation of the C. elegans vulva is a powerful, simple, and experimentally accessible model for elucidating how morphogenetic processes produce an organ. In the first step of vulval development, three epithelial precursor cells divide and differentiate to generate 22 cells of seven different vulval subtypes. The 22 vulval cells then rearrange from a linear array into a tube, with each of the seven cell types undergoing characteristic morphogenetic behaviours that construct the vulva. Vulval morphogenesis entails many of the same cellular activities that underlie organogenesis and tissue formation across species, including invagination, lumen formation, oriented cell divisions, cell-cell adhesion, cell migration, cell fusion, extracellular matrix remodelling and cell invasion. Studies of vulval development have led to pioneering discoveries in a number of these processes and are beginning to bridge the gap between the pathways that specify cells and their connections to morphogenetic behaviors. The simplicity of the vulva and the experimental tools available in C. elegans will continue to make vulval morphogenesis a powerful paradigm to further our understanding of the largely mysterious mechanisms that build tissues and organs. PMID:23418408
Jo, Gyeong Deok; Lee, Jae Young; Hong, Sung-Tae; Kim, Jung Hoon; Han, Joon Koo
A 60-year-old man was admitted due to rectosigmoid colon cancer, and a hepatic mass was incidentally found during the staging work-up. The mass appeared cystic with a thick wall and contained multiple bizarre cord-like structures on ultrasound, computed tomography and magnetic resonance imaging. The differential diagnoses included organizing abscess/hematoma, foreign body granuloma and parasite infestation. Serologic study revealed anti-sparganum antibodies. Over 4-year follow-up, the patient did not complain of symptoms, and no changes in the characteristics of the liver mass were observed. Hepatic sparganosis is rare; only two cases have been clinically reported, and no detailed radiologic description was available until now. This case report presents a detailed radiologic description of a hepatic mass that could most likely represent hepatic sparganosis. PMID:27843543
Chiu, C-H; Chiou, T-L; Hsu, Y-H; Yen, P-S
The authors report the case of a 46-year-old woman with cerebral sparganosis resulting from infection with a larva of Spirometra. Computed tomography and magnetic resonance imaging revealed a mass lesion with prominent perifocal oedema in the left parietal lobe. Advanced imaging pulse sequences, including MR spectroscopy and MR perfusion, were performed. During surgery for the removal of a granuloma, the parasite was discovered and excised. Following treatment, the patient's neurological deficits markedly improved. PMID:20139254
Lu, G; Shi, D-Z; Lu, Y-J; Wu, L-X; Li, L-H; Rao, L-Y; Yin, F-F
In this study, epidemiological factors of sparganosis cases reported in mainland China from 1959 to December 2012 were analysed. A total of 1061 valid cases were distributed throughout most of the provinces of mainland China, with most cases occurring in Southern and Eastern China. The average age of patients was 29 years (range 0-80 years). Modes of transmission to humans were via contact (54·6%), mainly by application of frog meat as a poultice, foodborne (33·8%), mainly through ingesting frogs or snakes, and waterborne (11·5%) through drinking raw water. The tissue/organs involved were subcutaneous/muscle (43·1%), eyes (31·0%), central nervous system (CNS) (17·9%), urogenital system (3·9%) and visceral organs (3·2%). Obvious differences existed in main risk factors for different areas. Close correlation was found between tissue/organs and risk factors. Main modes of transmission changed during the past decades, from contact (83·8% pre-1979) to foodborne (63·9% post-2000). The tissue/organs involved also changed at the same time. Cases involving eyes fell from 50·0% pre-1979 to 8·3% post-2000, and cases involving CNS increased from 0% pre-1979 to 47·8% post-2000. These results illustrate that China is one of the main epidemic countries of sparganosis in the world. Consumption of frog/snake meat was the main risk factor, although application of frog flesh as a poultice was the main risk factor before 2000. Sparganosis has become one of the neglected but important foodborne/waterborne parasitic diseases in mainland China.
Danys, Donatas; Poskus, Tomas; Mikalauskas, Saulius; Poskus, Eligijus; Jotautas, Valdemaras; Beisa, Virgilijus; Strupas, Kestutis
Abstract Objective The optimal diagnostics and treatment of acute appendicitis continues to be a challenge. A false positive diagnosis of appendicitis may lead to an unnecessary operation, which has been appropriately termed negative appendectomy. The aim of our study was to identify the effectiveness of preoperative investigations in preventing negative appendectomy. Methods A retrospective study was performed on adult patients who underwent operation for suspected acute appendicitis from 2008 to 2013 at Vilnius University Hospital Santariskiu Klinikos. Patients were divided into two groups: group A underwent an operation, where appendix was found to be normal (non-inflamed); group B underwent an appendectomy for inflamed appendix. Groups were compared for preoperative data, investigations, treatment results and pathology findings. Results 554 patients were included in the study. Preoperative laboratory tests results of hemoglobin, hematocrit concentrations and white blood cell count were significantly higher in group B (p<0.001). Ultrasonography was performed for 78 % of patients in group A and 74 % in group B and did not provide any statistically significant results. Comparing Alvarado score results, there were more patients with Alvarado score less than 7 in group A than in group B. In our large series we could find only four independent risk factors, and they could only account for 24 % of cases. Conclusions In summary, acute appendicitis is still often misdiagnosed and the ratio of negative appendectomies remains rather high. Additional investigations such as observation and computed tomography should be used to prevent this.
Özbudak, Irem Hicran; Akkaya, Hampar; Akkaya, Bahar; Erdoğan, Gülgün; Peşterelı, Hadice Elif; Karavelı, Fatma Şeyda
Ectopic breast tissue can occur anywhere along the primitive embryonic milk line and can be the site of the same pathologic processes found in the normal breast. Phyllodes tumor is an extremely rare fibroepithelial neoplasm that occurs in ectopic breast tissue of the vulva. To date, only 8 cases of phyllodes tumor in the vulva have been reported in the literature. This paper presents two additional case of benign phyllodes tumor in the vulva. The first patient was a 43-year-old woman, presenting with a lesion on the left anterior mons pubis that had increased in size in the last three months. The second patient was a 50-year-old woman, presenting with a two-month history of a mass in the right labium majus. The patients underwent excisional biopsy. The histological examination of both specimens revealed a characteristic pattern of benign phyllodes tumor. In conclusion, the pathologists need to be aware that the lesion can occur in this location. Herein, the concepts about the histogenesis of phyllodes tumor in the vulva are discussed and a brief review of the previously reported cases is given.
Background Fibroepithelial stromal polyps are site-specific mesenchymal lesions that are commonly found in the vulvovaginal region in premenopausal females. These polyps usually are less than 5 cm in diameter and are most commonly identified during routine gynecological examination. Although the stromal polyp is benign, its differential diagnosis includes some malignant vulva lesions making it critical to ensure that an accurate pathologic diagnosis is made. Case We present a case of a 21 year old female with a giant fibroepithelial stromal polyp of the vulva. Upon review of the literature this is the largest reported fibroepithelial stromal polyp to date. Conclusion Fibroepithelial stromal polyps can grow as large as 390 grams and can be 18.5-cm in diameter. Microscopic evaluation of the polyp is critical in the exclusion of malignancy with this diagnosis. PMID:23842282
Yeung, Jennifer; Pauls, Rachel N
The female vulva is an intricate structure comprising several components. Each structure has been described separately, but the interplay among them and physiologic significance remain controversial. The structures extend inferiorly from the pubic arch and include the mons pubis, labia majora, labia minora, vestibule, and clitoris. The clitoris is widely accepted as the most critical anatomic structure to female sexual arousal and orgasm. The female sexual response cycle is also very complex, requiring emotional and mental stimulation in addition to end organ stimulation.
Clerico, C; Larry, A; Mojallal, A; Boucher, F
Female genital cosmetic surgery is becoming more and more widespread both in the field of plastic and gynaecological surgery. The increased demand for vulvar surgery is spurred by the belief that the vulva is abnormal in appearance. What is normal in terms of labial anatomy? Labia minora enlargement or hypertrophy remains a clinical diagnosis which is poorly defined as it could be considered a variation of the normal anatomy. Enlarged labia minora can cause functional, aesthetic and psychosocial problems. In reality, given the wide variety of vulvar morphology among people, it is a very subjective issue to define the "normal" vulva. The spread of nudity in the general media plays a major role in creating an artificial image and standards with regard to the ideal form. Physicians should be aware that the patient's self-perception of the normal or ideal vulva is highly influenced by the arguably distorted image related to our socio-psychological environment, as presented to us by the general media and internet. As physicians, we have to educate our patients on the variation of vulvar anatomy and the potential risks of these surgeries. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Aksu Çerman, Aslı; Aktaş, Ezgi; Kıvanç Altunay, İlknur; Demirkesen, Cuyan
Pyoderma vegetans, a rare disorder of the skin, is considered a highly specific marker for inflammatory bowel disease, especially ulcerative colitis. It is clinically characterized by large verrucous plaques with elevated borders and multiple pustules. Here, the authors report the case of a 33-year-old man who was misdiagnosed as having verrucous carcinoma for 4 years.
Koonmee, Supinda; Intapan, Pewpan M; Yamasaki, Hiroshi; Sugiyama, Hiromu; Muto, Maki; Kuramochi, Toshiaki; Kularbkeaw, Jurairat; Kanpittaya, Jaturat; Maleewong, Wanchai; Nawa, Yukifumi
PCR-based molecular diagnosis was made for the identification of causative agents of the clinically suspected pulmonary proliferative sparganosis case found in Thailand using formalin-fixed paraffin-embedded (FFPE) biopsy specimens. As a reference, FFPE biopsy specimen from a typical cutaneous sparganosis case was examined together. DNA samples were extracted from tissues and two partial fragments of cytochrome c oxidase subunit 1 (cox1) gene were amplified for the detection of Spirometra DNA. Two cox1 fragments were amplified successfully for both specimens. After alignment of nucleotide sequences of the PCR-amplicons, the causative agents of both cases were identified as Spirometra erinaceieuropaei.
Amavi, Ayi Kossigan; Kouadio, Laurent; Adabra, Komlan; Tengue, Kodjo; Tijami, Fouad; Jalil, Abdelouahed
To analyze our surgical management and the result of squamous cell carcinoma (SCC) of vulva. Retrospectively, we collected 38 cases of SCC; 17 cases of them were early SCC and 21 cases were locally advanced. The patients underwent primary surgery. The survival was estimated using Kaplan-Meier analysis and the log rank test. The mean age was 60.78 years. Total vulvectomy was performed in all patients. Superficial and deep incision of bilateral inguinal lymphadenectomy was performed by separates incisions for SCC infiltrating more than 1mm. The average tumor size was 53 mm (10 to 140mm). Morbidity was 42.1%. Lateral resection margin ≥8mm was obtained in 57.1%. Eighteen patients benefited from adjuvant radiotherapy. The follow-up median was 19.4 months (6 to 61.5 month) with 05 recurrences in 12 months. The survival using the Kaplan-Meyer analysis at 5 years, was 62.1% (71.2%N- vs 46.7%N+; p = 0.13). We identified two groups for locally advanced vulva cancer. Primary surgery keeps its place. Neo adjuvant radio chemotherapy followed by surgery is the alternative treatment for locally extensive lesions. PMID:27642483
Park, Jin Hoon; Park, Young Soo; Kim, Jong Sung
Sparganosis is a rare parasitic infection affecting various organs, including the central nervous system, especially the lumbar epidural space. This report describes the identification of disease and different strategies of treatments with preoperative information. A 42-year-old man presented with a 2-year history of urinary incontinence and impotence. He had a history of ingesting raw frogs 40 years ago. Magnetic resonance (MR) imaging showed an intramedullary nodular mass at conus medullaris and severe inflammation in the cauda equina. A 51-year-old woman was admitted with acute pain in the left inguinal area. We observed a lesion which seemed to be a tumor of the lumbar epidural space on MR imaging. She also had a history of ingesting inadequately cooked snakes 10 years ago. In the first patient, mass removal was attempted through laminectomy and parasite infection was identified during intra-operative frozen biopsy. Total removal could not be performed because of severe arachnoiditis and adhesion. We therefore decided to terminate the operation and final histology confirmed dead sparganum infection. We also concluded further surgical trial for total removal of the dead worm and inflammatory grannulation totally. However, after seeing another physician at different hospital, he was operated again which resulted in worsening of pain and neurological deficit. In the second patient, we totally removed dorsal epidural mass. Final histology and enzyme-linked immunosorbent assay (ELISA) confirmed living sparganum infection and her pain disappeared. Although the treatment of choice is surgical resection of living sparganum with inflammation, the attempt to remove dead worm and adhesive granulation tissue may cause unwanted complications to the patients. Therefore, the result of preoperative ELISA, as well as the information from image and history, must be considered as important factors to decide whether a surgery is necessary or not. PMID:21607186
Stanton, J; Simpson, A
AIMS—Child murder misdiagnosed as sudden infant death syndrome (SIDS) is a difficult area to study. We present a perpetrator's descriptions to enrich clinicians' knowledge of possible presenting features of this phenomenon. METHODS—Interview material was collected as part of a qualitative study of maternal filicide performed from a naturalistic paradigm in order to access the perpetrators' view of events. The woman participant has been convicted for three child murders and two attempted murders which were initially misdiagnosed as SIDS. Interviews were done in the participant's home with her partner present, while she was on leave from prison. Semi-structured interviews were conducted, recorded, transcribed, and analysed for themes. Specific ethical permission was gained to present this case in isolation and the paper was written in consultation with the woman described. RESULTS—She described initial intense attachment to her first victim and described killing her because she was unable to bear her apnoea attacks and her fear of losing her. She described difficulty grieving for this child and subsequent failure to attach to her next child or feel for the other victims. CONCLUSIONS—Expressions of intense attachment to an infant and description of intense grief over a death in a way which engages compassion should not deter a paediatrician from considering the possibility of the parent having killed the child. PMID:11719326
Kawamura, Masataka; Matsumoto, Fumi; Matsui, Futoshi; Yazawa, Koji; Shimada, Kenji
Aggressive angiomyxoma (AAM) is a rare soft tissue tumor of mesenchymal origin that chiefly involves the vulvar and perineal region. In 90% of cases, AAM presents in women of reproductive age with a peak incidence in the fourth decade of life. To date, AAM of the vulva in young children and infancy has never been reported. We present a case of AAM of the vulva that was initially interpreted as clitoromegaly in a 3-year-old girl.
Rudman Spergel, Amanda; Walkovich, Kelly; Price, Susan; Niemela, Julie E; Wright, Dowain; Fleisher, Thomas A; Rao, V Koneti
Autoimmune lymphoproliferative syndrome (ALPS) is a rare inherited disorder of apoptosis, most commonly due to mutations in the FAS (TNFRSF6) gene. It presents with chronic lymphadenopathy, splenomegaly, and symptomatic multilineage cytopenias in an otherwise healthy child. Unfortunately, these clinical findings are also noted in other childhood lymphoproliferative conditions, such as leukemia, lymphoma, and hemophagocytic lymphohistiocytosis, which can confound the diagnosis. This report describes a 6-year-old girl with symptoms misdiagnosed as hemophagocytic lymphohistiocytosis and treated with chemotherapy before the recognition that her symptoms and laboratory values were consistent with a somatic FAS mutation leading to ALPS. This case should alert pediatricians to include ALPS in the differential diagnosis of a child with lymphadenopathy, splenomegaly, and cytopenias; obtain discriminating screening laboratory biomarkers, such as serum vitamin B-12 and ferritin levels; and, in the setting of a highly suspicious clinical scenario for ALPS, pursue testing for somatic FAS mutations when germ-line mutation testing is negative.
Sweetman, Laura L; Ng, Yu-Tze; Kerrigan, John F
Gastroesophageal reflux disease can have variable manifestations including regurgitation, irritability, arching, choking, and apnea. The disorder is also frequently mistaken for seizures (Sandifer syndrome). We report 6 patients in whom the opposite phenomenon occurred: their seizures were mistaken for gastroesophageal reflux disease. Six of 77 patients (6.8%) with gelastic seizures and epilepsy symptomatic of hypothalamic hamartomas were noted to be misdiagnosed with gastroesophageal reflux disease in infancy. As is typical in these patients, gelastic seizures were not diagnosed until months, or often years, later. Delayed diagnosis of hypothalamic hamartomas can lead to a potentially deleterious syndrome involving refractory epilepsy, developmental problems, and precocious puberty. Gelastic seizures should be considered among the conditions that can mimic reflux symptoms.
Schwartz, Jessica L; Clinton, Tony S
Darier's disease is a rare autosomal disorder resulting in characteristic findings of the skin, nails, and mucous membranes. Darier's disease is commonly misdiagnosed as seborrheic dermatitis or eczema. We present the case of a young adult active duty Air Force member with 5 years of skin complaints. The 23-year-old patient had been treated for seborrheic dermatitis and eczema with a variety of oral and topical treatments, which did not result in improvement of his symptoms. Upon referral to dermatology, the dermatologist noted skin, nail, and mucous membrane findings consistent with Darier's disease. A skin biopsy histologically confirmed the presence of Darier's disease and treatment was started. Although the course of the disease cannot be stopped, the patient's symptoms did reduce with the appropriate treatment. This case highlights the importance of revisiting the original diagnosis when conventional treatment fails to improve the disease course.
Scalco, Renata Siciliani; Chatfield, Sherryl; Junejo, Muhammad Hyder; Booth, Suzanne; Pattni, Jatin; Godfrey, Richard; Quinlivan, Ros
Patient: Female, 44 Final Diagnosis: McArdle disease Symptoms: Exercise intolerance • muscle contracture • myalgia • myoglobinuria • recurrent rhabdomyolysis Medication: — Clinical Procedure: — Specialty: Neurology Objective: Rare disease Background: McArdle disease is a glycogen storage disorder mainly characterized by exercise intolerance. Prolonged muscle contracture is also a feature of this condition and may lead to rhabdomyolysis (RM), which is a serious event characterized by acute skeletal muscle damage. Case Report: A 44-year-old female patient presented with an acute contracture of the posterior neck muscles, causing severe nuchal rigidity. The contracture was induced during a dental extraction as she held her mouth open for a prolonged period, with her neck in a rigid position. She presented with severe pain in her ear and head, as well as fever, vomiting, and confusion. Based on her symptoms, she was initially misdiagnosed with bacterial meningitis and experienced an acute allergic reaction to the systemic penicillin she was subsequently administered. Lumbar puncture results were normal. High serum creatine kinase (CK) levels, recurrent exercise-related muscle symptoms, and a previous history of recurrent myoglobinuria raised the suspicion of an underlying neuromuscular condition. McArdle disease was confirmed by muscle biopsy and a genetic test, which revealed that the patient was homozygous for the R50X mutation in the PYGM gene. Conclusions: This case illustrates that even seemingly innocuous movements, if rapid isotonic or prolonged isometric in nature, can elicit a muscle contracture in McArdle disease patients. Here, we highlight the need for careful management in this patient population even during routine healthcare procedures. The allergic reaction to antibiotics emphasises that misdiagnoses may result in iatrogenic harm. PMID:27899787
Kang, Ho Song; Hur, Jae; Lee, Jung Woo; Oh, Dae Heon; Yeo, Kwang Yeoll; Kim, Joung Soo
Dowling-Degos disease (DDD) is an autosomal dominant genodermatosis and this disease is a genetically determined disturbance of epidermal proliferation. It is characterized by acquired, slowly progressive pigmented lesions that primarily involve the great skin folds and flexural areas such as the axilla, neck, limb flexures, the inframammary area and the inguinal folds. The vulva is an unusual location for DDD. A 41-year-old woman presented with a 10-year history of multiple, small, reticulated and brownish macules distributed symmetrically on the bilateral external genital regions. We found no other similarly pigmented skin lesions on her body, including the flexural areas. There was no known family history of similar eruptions or pigmentary changes. The histologic examination showed irregular rete ridge elongation with a filiform or antler-like pattern and basilar hyperpigmentation on the tips. Fontana-Masson staining showed increased pigmentation of the rete ridges and the S100 protein staining did not reveal an increased number of melanocytes in the epidermis. From these findings, we diagnosed this lesion as DDD. PMID:21747621
Gonçalves Amorim, Andressa; Batista Fraga Mendes, Brunelle; Neves Ferreira, Rodrigo; Chambô Filho, Antônio
The objective of this paper is to report a case of extramammary Paget disease of the vulva, to describe its diagnosis, surgical treatment, and outcome, and to discuss the general characteristics of this pathology. This is a rare neoplasm, found principally in areas in which apocrine and eccrine glands are numerous. This case report is relevant to the literature since the differential diagnosis of extramammary Paget disease is difficult to be done only with the macroscopic appearance of the lesion and even with the microscopic characteristics, requiring further studies, immunohistochemistry, as to differentiate pathologies. The present report describes the case of a 63-year-old patient at the Santa Casa de Misericórdia Hospital in Vitória, Espírito Santo, Brazil, who presented with a hardened, ulcerated, and purplish lesion with hyperchromic and hypochromic spots, measuring 4 cm in diameter, located on the lower third of right labium majus, close to the vaginal fourchette. A right hemivulvectomy was performed, leaving wide margins all around. The patient progressed satisfactorily following surgery. Although extramammary Paget disease is rare, its incidence increases as a function of the patient's age. Patients should be followed up closely because of the risk of persistence and/or recurrence of the disease.
Torres Lobatón, A; Plata Nuñez, P; Román Bassaure, E; Hernández Aten, D; García González, H
An analysis of 113 patients with malignant tumors of the vulva seen at The Gynecology Service, Oncology Unit, General Hospital of Mexico, is reported. Mean age the group was 65 years, 91.1% had epidermoid carcinomas and 74.3% were in stages III and IV. Seventy six patients of the overall group, (67.2%) received treament, 67 with surgery, (88.1%) and 9, (11.8%) with palliative radiotherapy. Fifty seven of these, (75.0%) had a follow up that was without evidence of disease from 1 to 10 years (mean 3 year) in 27 patients, (47.3%). Survival by clinical stages was: 1/1 for carcinoma in situ, 3/3 for stage I; 8/10, (80.0%) for stage II; 13/30, (48.3%) for stage III and 1/10. (10.0%) for stage IV. When radical procedures were performed, cancer free survival was: 8/14, (57.1%) for radical vulvectomies and inguinal lymph node dissection, 3/7, (42.8%) for radical vulvectomies combined with inguinal and pelvic lymph nodedissection and 1/6, (16.6%) for more radical procedures. Fifty five per cent of the radiated patients finished their treatment without evidence of cancer. The most important prognostic factors in this series were presence or abscence of lymph node metastases, (7/78, 38.8% vs. 10/10, 76.9%; p less than 0.05) and diameter of the primary lesion. Evolutioned without cancer, 9/12, (75.0%) patients with tumors of 5 cm. or less, versus 8/23, (34.7%) of the others, p less than 0.05.
Anane, Sonia; Chtourou, Olfa
Introduction Favus of the scalp or tinea capitis favosa is a chronic dermatophyte infection of the scalp. In almost cases, favus is caused by Trichophyton schoenleinii, anthropophilic dermatophyte. It is characterized by the presence of scutula and severe alopecia. Besides the classic clinical type of tinea capitis favosa, there are many variant of clinical form which may persist undiagnosed for many years. In this work, we report an atypical form of favus to Trichophyton schoenleinii which was misdiagnosed as tinea amiantacea. Case-report An 11-year old girl came to the outpatient department of dermatology (day 0) with history of tinea amiantacea treated unsuccessfully with keratolytic shampoo (day – 730). She presented a diffuse scaling of the scalp with thick scaly patches and without scutula or alopecia. A diagnosis of tinea favosa by T. schoenleinii was made by mycological examination. She was treated with griseofulvin and ketoconazole in the form of foaming gel for twelve weeks. Despite treatment, clinical evolution was marked by appearance of permanent alopecia patches. The follow-up mycological examination was negative. Conclusion Because of ultimate evolution of favus into alopecia, we emphasize the importance of mycological examination in case of diffuse scaling. PMID:24432210
Lai, Liying; Yao, Dongmei
Brucellosis is far more frequent in a pasturing area in the northern part of our country and it has many clinical manifestations. It may cause multiple organ damage and its features lack specificity. It is rare in the south, so it is extremely easy to be misdiagnosed or overlooked. The retrospective analysis of a case with Brucellosis misdiagnosed as osteoarthrosis provides a guide for clinical doctors to understand Brucellosis, so that early diagnosis would be accessible, and prognosis could be improved.
Núñez-Troconis, José; Viloria de Alvarado, María Elena
The case of a 34-year-old woman, who consulted because she observed the appearance of numerous yellow-white asymptomatic papules on the vulva, is presented. Clinical diagnosis of syringoma of vulva was established. The pathological and immunohistochemical studies confirmed the diagnosis. Vulvar syringoma usually occurs as a multiple flesh-colored or brownish papules on both sides of labia majora of women in their third decade. Its diagnosis should be considered when the patient complaints of vulvar pruritus and/or sweating.
Bouquet de Jolinière, Jean; Khomsi, F.; Gothuey, J. M.; Guillou, L.; Fadhlaoui, A.; Dubuisson, J. B.; Feki, A.
Verrucous carcinoma of the vulva is a rare lesion (1). Affecting essentially postmenopausal women, this lesion is a distinct and particular entity in vulval carcinoma classification and its scalability is uncertain and unpredictable. Here, we present a case concerning a 48-year-old patient, without follow-up after a condyloma acuminate of the vulva (large left lip). The origin of this case will be discussed in this article. The treatment decided was only surgical. A review of literature shows the rarity of this lesion of the female genital tract. PMID:26904547
Meher, Susanta; Rath, Satyajit; Sharma, Rakesh; Sasmal, Prakash Kumar; Mishra, Tushar Subhadarshan
Torsion of the appendix testis is not an uncommon cause of acute hemiscrotum. It is frequently misdiagnosed as acute epididymitis, orchitis, or torsion of testis. Though conservative management is the treatment of choice for this condition, prompt surgical intervention is warranted when testicular torsion is suspected. We report a case of torsion of a large appendix testis misdiagnosed as pyocele. Emergency exploration of it revealed a large appendix testis with torsion and early features of gangrene. After excision of the appendix testis, the wound was closed with an open drain. The patient had an uneventful and smooth postoperative recovery. PMID:25861514
Lee, Ji Hye; Kim, Tae Hyung; Kim, Soo-Chan; Kim, You Chan; Roh, Mi Ryung
Pigmented mammary Paget disease is a very rare clinicopathologic variant of mammary Paget disease. Diagnosis is often difficult because its clinical and histological features are very similar to those of malignant melanoma. Herein, we report a case of pigmented mammary Paget disease misdiagnosed as malignant melanoma.
Sohn, Hyung Rae; Song, Bong Gun; Jeong, Seong Yeon; Hong, Su-Min; Jung, Hyun Gul; Jung, Hye-Jin; Cho, Wook-Hyun; Choi, Suk-Koo
Cardiac infiltration of amyloid fibril results in progressive cardiomyopathy with a grave prognosis and results in cardiac diseases such as congestive heart disease, cardiomyopathy, valvular heart disease, and arrhythmias. We present a rare case of cardiac amyloidosis initially misdiagnosed as syndrome X in which recurrent chest pain and progressive heart failure could be managed finally by heart transplantation.
Wang, Fumin; Zhou, Lihua; Gong, Shiping; Deng, Yanzhong; Zou, Jiejian; Wu, Jun; Liu, Wenhua; Hou, Fanghui
Wild-caught snakes are a popular and traditional food in China. However, little known to the public, snakes are also intermediate hosts of Spirometra erinaceieuropaei, a food- and water-borne pathogen of sparganosis. Therefore, we investigated the prevalence of S. erinaceieuropaei in 10 popular species of wild-caught snakes in Guangzhou City (Guangdong Province) between July 2009 and July 2010. One hundred and twenty-four specimens of 10 species (including Enhydris plumbea, Zoacys dhumnades, Elaphe radiate, Elaphe taeniura, Elaphe carinata, Ptyas mucosus, Ptyas korros, Naja naja atra, Bungarus fasciatus, and Bungarus multicinctus) were randomly selected from a total of 1,160 wild-caught snakes. They were obtained from food markets in 5 representative districts (Huadou, Panyu, Tianhe, Haizhu, and Conghua). The specimens were killed, necropsied, and examined for parasitic helminths. Of the snakes examined, 29.8% were infected by spargana and the worm burden per infected snake ranged from 1 to 221. Most species were infected except for En. plumbea, B. fasciatus, and B. multicinctus. Prevalence even reached 100% in Zoacys dhumnades. More than half (53.5%) of the spargana were located in muscular tissue, 36.4% in subcutaneous tissue, and 10.1% in the coelomic cavity. The study revealed the potential risk for the zoonotic sparganosis by eating wild-caught snakes and will be helpful in arousing public health concern about the consumption of snake meat.
Silva, C V; Gonçalves, A L R; Cruz, L; Cruz, M C; Ueta, M T; Costa-Cruz, J M
Little is known about the actin cytoskeleton architecture in female Strongyloides venezuelensis and thus to investigate the distribution and concentration of actin, female worms were labelled with phalloidin-rhodamine and visualized under confocal microscopy. Our results demonstrate that filamentous actin accumulates in the vulva and the concentration of F-actin at this site suggests its important role, especially during oviposition, in the life cycle of S. venezuelensis.
Tapisiz, Omer Lutfi; Topcu, Onur; Gungor, Tayfun; Ozdal, Bulent; Sirvan, Levent; Yesilyurt, Ahmet
Two types of gynecologic tumors are commonly described in the Turner syndrome, the first one is gonadoblastoma, which occurs in patients with Y chromosome abnormalities, and the second one is endometrial carcinoma which is mostly related with exogenous estrogen usage. Here, we describe an extremely rare case of squamous cell carcinoma of the vulva in a virgin woman with Turner syndrome. A 35-years old single, virgin woman referred to our Oncology Department with warty, necrotized, exophytic 6-7 cm vulvar mass. She had a history of primary amenorrhea and mosaic Turner syndrome was determined in her karyotype analysis. Biopsy specimen of the vulvar mass revealed squamous cell carcinoma of the vulva, and total vulvectomy with inguinal femoral lymphadenectomy was performed. The postoperative course was uneventful and there has been no recurrence of the disease up to date. Women with Turner syndrome have streak ovaries that produce very low estrogen and the squamous cell carcinoma of the vulva may have developed at an early age with Turner syndrome because of this low estrogen value similar to postmenopausal women. The current case is a special case due to its age of occurrence, virgin and Turner syndrome status.
Pootrakul, Llana; Nazareth, Michael R; Cheney, Richard T; Grassi, Marcelle A
Lymphangioma circumscriptum (LC) results from the development of abnormal lymphatic vasculature and is characterized by the presence of grouped vesicles filled with clear or colored fluid. Vulvar localization is uncommon. Abnormalities of the lymphatic system, such as lymphedema and cystic hygroma, are well-known features of genetic disorders such as Noonan syndrome (NS) and Turner syndrome. We report the case of a patient with NS who presented with LC of the vulva. We also discuss the expanding spectrum of clinical anomalies associated with the presentation of NS.
Torres, Kara Melissa Tiangco; Junkins-Hopkins, Jacqueline M.
Acantholytic dyskeratosis (AD) is a histologic pattern seen in Darier's disease or dyskeratosis follicularis, warty dyskeratoma, and transient AD. This pattern is characterized by suprabasilar clefting, acantholysis, and formation of corps ronds and grains. We present a case of AD that is unique based on its genital location and cystic architecture. A 53-year-old woman presented with an otherwise asymptomatic cyst on her left vulva of uncertain duration. On microscopic examination, there were fragments of cystic epithelium with areas of hypergranulosis, acantholysis, corps ronds, and corps grains formation. These features are felt by the authors to be a unique presentation of a follicular adnexal neoplasm. PMID:27559500
Carman, Kursat Bora; Belgemen, Tugba; Yis, Uluc
Seizures and epilepsy are a common problem in childhood. Nonepileptic paroxysmal events are conditions that can mimic seizure and frequent in early childhood. Nonepileptic paroxysmal events can be due to physiological or exaggerated physiological responses, parasomnias, movement disorders, behavioral or psychiatric disturbances, or to hemodynamic, respiratory, or gastrointestinal dysfunction. Vitamin B12 deficiency is a treatable cause of failure to thrive and developmental regression, involuntary movements, and anemia. Involuntary movements rarely may appear a few days after the initiation of vitamin B12 treatments and might be misdiagnosed as seizure. Here, we report 2 patients who presented with involuntary movements with his video image.
Kardhashi, Anila; Assunta Deliso, Maria; Renna, Alessandra; Trojano, Giuseppe; Zito, Francesco Alfredo; Trojano, Vito
Granular cell tumors (GCTs) are uncommon soft tissue tumors of neural derivation, as supported by immunohistochemical and ultrastructural evidence. Vulvar involvement has been reported in 7-16%. This paper presents the cases of a 60-year-old woman and her 32-year-old niece with a strong family history of cancer, both presenting with an enlarging mass on their left labia majora. The lesions were treated by simple surgical excision. Histopathological examination revealed a benign vulvar GCT in both lesions. This is the first reported case of GCT of the vulva in the same family. The possible familial component of GCT needs further investigation. A systematic review of the literature on vulvar GCTs is carried out, the most complete one to date. This review unexpectedly reveals that there have been more than 130 cases of GCT of the vulva reported to date, only 7 of which were malignant. Since 5-25% of patients have multiple lesions, before planning treatment, clinicians should exclude multicentric lesions. After surgical treatment, if there is any evidence of tumor in the surgical margin, wider local excision should be performed. Regular follow-up is important for diagnosing a possible recurrence or a new lesion.
Sexual health is vital to overall well-being. Orgasm is a normal psycho-physiological function of human beings and every woman has the right to feel sexual pleasure. The anatomy of the vulva and of the female erectile organs (trigger of orgasm) is described in human anatomy textbooks. Female sexual physiology was first described in Dickinson's textbook in 1949 and subsequently by Masters and Johnson in 1966. During women's sexual response, changes occur in the congestive structures that are essential to the understanding of women's sexual response and specifically of their orgasm. Female and male external genital organs arise from the same embryologic structures, i.e. phallus, urogenital folds, urogenital sinus and labioscrotal swellings. The vulva is formed by the labia majora and vestibule, with its erectile apparatus: clitoris (glans, body, crura), labia minora, vestibular bulbs and corpus spongiosum. Grafenberg, in 1950, discovered no "G-spot" and did not report an orgasm of the intraurethral glands. The hypothetical area named "G-spot" should not be defined with Grafenberg's name. The female orgasm should be a normal phase of the sexual response cycle, which is possible to achieve by all healthy women with effective sexual stimulation. Knowledge of the embryology, anatomy and physiology of the female erectile organs are important in the field of women's sexual health.
Motta, A; Feliciani, C; Toto, P; De Benedetto, A; Morelli, F; Tulli, A
Cutaneous tuberculosis is a rare form of extrapulmonary tuberculosis primarily occurring in developing countries. The recent increase in the incidence of tuberculosis, especially due to human immunodeficiency virus (HIV) infections, has led to a resurgence of extrapulmonary forms of this disease. We describe a case of lupus vulgaris in a 33-year-old woman who had a 5-year history of a slowly growing plaque on her neck. The lesion was located at the site of surgery repairing the scar resulting from the incision of a subcutaneous abscess during childhood. This lesion was misdiagnosed as bacterial abscess. Histopathologic examination of the plaque revealed non-caseating tuberculoid granulomas consisting of lymphocytes, epithelioid and giant cells. Staining for acid-fast bacilli and culture from biopsied tissue was negative. Polymerase chain reaction (PCR) for detection of Mycobacterium tuberculosis DNA, performed on a skin biopsy specimen, was positive. A diagnosis of lupus vulgaris developing at the site of a previous misdiagnosed scrofuloderma was made. Conventional antitubercular therapy with rifampicin, isoniazid and ethambutol was administered for 6 months, resulting in resolution of the lesion.
Bradsher, Robert W
One of the endemic fungi, Blastomyces dermatitidis, can cause epidemics of infection with multiple persons involved in a point source outbreak but more commonly causes sporadic cases of infection within the areas of endemicity. Blastomycosis can present as an acute pneumonia which is often misdiagnosed as acute pneumococcal pneumonia or the infection may present as a chronic pneumonia along with weight loss, night sweats, hemoptysis, and a lung mass suggesting tuberculosis or carcinoma of the lung. Extrapulmonary infection with B. dermatitidis is protean with many different manifestations. Most commonly, skin or subcutaneous lesions are found with either a verrucous or warty appearance or in an ulcerative form. Cases have been misidentified as keratoacanthoma, pyoderma gangrenosum, carcinoma, or as Weber-Christian panniculitis if there are nodular subcutaneous lesions. Essentially any site or organ can have lesions of disseminated blastomycosis. In our series, cases of laryngeal carcinoma, adrenal insufficiency, thyroid nodules, granulomatous hypercalcemia, abnormal mammograms thought to represent breast carcinoma, otitis media with cranial extension, immune thrombocytopenic purpura, and hemolytic anemia of unknown cause have been misdiagnosed and blastomycosis subsequently identified as the cause. This infection causes manifestations which mimic many other more commonly diagnosed conditions and must always be considered by clinicians practicing in the endemic region.
... Cancer - perineum; Cancer - vulvar; Genital warts - vulvar cancer; HPV - vulvar cancer ... is rare. Risk factors include: Human papilloma virus (HPV, or genital warts ) infection in women under age ...
Kudur, Mohan H; Hulmani, Manjunath
Angiokeratoma of Fordyce occurring over vulva is rare. Angiokeratoma of Fordyce commonly occurs in males over scrotum or penile shaft and presents as multiple verrucous reddish papules. They are usually asymptomatic and noticed accidentally. In the present article, we present and review the literature of giant angiokeratoma of Fordyce in middle-aged women due to its rarity. PMID:23723496
Aminimoghaddam, Soheila; Mahmoudzadeh, Fatemeh; Maghsoudnia, Andisheh
Background: Cervical cancer is the second most common malignancy in women worldwide. Vaginal bleeding and vaginal discharge are the most common symptoms. Although ascites has been reported in cases with cervical cancer, it is due to other causes such as ovarian metastasis. Case Presentation: A 78-year-old diabetic woman who presented with ascites and abdominopelvic mass was misdiagnosed with ovarian cancer and treated with neoadjuvant chemotherapy followed by radical hysterectomy and adjuvant radiotherapy. However, pathology confirmed locally advanced cervical cancer stage IV in this patient. She was discharged from the hospital three weeks after surgery with no serious complications. Discussion: Considering all signs and symptoms to reach a verdict would reduce such malpractices and consequently lead to select the best management and treatment. PMID:26913238
Kurashige, Yuta; Kishida, Kosuke; Kurashige, Kumiko; Minemura, Tokuya; Nagatani, Tetsuo
Hidradenoma papilliferum (HP) is a benign adnexal neoplasm which preferentially develops in the anogenital region of women. Although the origin of HP was previously thought to be an apocrine sweat gland, recent studies have suggested that it may derive from the anogenital mammary-like gland (MLG). In this paper, we present a 43-year-old Japanese woman with hidradenoma papilliferum of the vulva. The lesion developed 7 years prior to her visit, and clinically appeared as a skin-colored cystic nodule. Histopathological examination revealed that the neoplasm was formed by the tubular structures consisting of two types of pleomorphic cells, columnar cells in the luminal layer and cuboidal cells in the basal layer. Further, the surgical specimen contained a wide, divergent, lobular ductal structure located in the vicinity of the neoplastic lesion, which was consistent with MLG.
Bergman, A; Karram, M; Bhatia, N N
Fifteen women complaining of vulvar pruritus of at least three months' duration were evaluated clinically and noted to have white lesions of the vulva consistent with hyperplastic dystrophy. Histologic evaluation confirmed the diagnosis, and all the patients were treated with local application of halocidine cream and crotamiton cream. After six weeks of therapy a repeat clinical and histologic evaluation revealed 13 of the 15 patients to be completely relieved of the vulvar pruritus, and 12 of the 13 were histologically demonstrated to have complete reversal of the hyperplastic process to normal skin. The other two denied any improvement in their pruritus and were histologically noted to have persistence of the hyperplastic process. A good clinical and histologic correlation was noted following local steroid application in patients with histologically proven hyperplastic dystrophy.
Bairwa, Shilpa; Kalhan, Shivani; Sharma, Puja; Satarkar, Rahul N
Trichoadenoma is a rare benign, slowly growing, cutaneous tumour of the hair follicle first described by Nikolowski in 1958. It presents as a non-specific nodule over the face or buttocks. However, unusual sites such as the neck, upper arm, thigh, shoulder, and shaft of the penis may also be affected. The tumour is less mature than a trichofolliculoma and is more differentiated than a trichoepithelioma with a differentiation towards the infundibular portion of the pilosebaceous canal. Histologically, it consists of numerous infundibulocystic structures present throughout the dermis, few of which are lined by eosinophilic epidermal cells with attempted glandular formation and contain laminated keratin, without evidence of hair follicle formation. We report a case of trichoadenoma over the vulva of 25-year-old female showing typical histological features. PMID:28273976
Bradgate, M G; Rollason, T P; McConkey, C C; Powell, J
A clinicopathological review of 50 primary malignant melanomas of the vulva in the West Midlands region of England is presented. The overall 5-year-survival rate was 35%, when adjusted for age. Significant predictors of survival were clinical stage, patient age, tumour ulceration, cell type and mitotic rate. Tumour thickness was of prognostic importance but as a prognostic variable it did not operate independently of stage and as most lesions were deeply invasive at presentation vulval tumours must be separated for prognostic purposes into bands at greater overall thicknesses than those used for skin melanomas generally. There was no significant relation between survival and type of surgery performed as a primary therapeutic procedure.
Gaudineau, A; Weitbruch, D; Quetin, P; Heymann, S; Petit, T; Volkmar, P; Bodin, F; Velten, M; Rodier, J F
Alternative therapies have been sought to alleviate mutilation and morbidity associated with surgery for vulvar neoplasms. Our prime objective was to assess tumor absence in pathological vulvar and nodal specimens following neoadjuvant chemoradiotherapy in locally advanced vulvar neoplasms. Data were retrospectively collected from January 2001 to May 2009 from 22 patients treated with neoadjuvant therapy for locally advanced squamous cell carcinoma of the vulva. Neoadjuvant treatment consisted of inguino-pelvic radiotherapy (50 Gy) in association with chemotherapy when possible. Surgery occurred at intervals of between 5 to 8 weeks. The median age of patients at diagnosis was 74.1 years. All patients were primarily treated with radiotherapy and 15 received a concomitant chemotherapy. Additionally, all patients underwent radical vulvectomy and bilateral inguino-femoral lymphadenectomy. Tumor absence in the vulvar and nodal pathological specimens was achieved for 6 (27%) patients, while absence in the vulvar pathological specimens was only achieved for 10 (45.4%) patients. Postoperative follow-up revealed breakdown of groin wounds, vulvar wounds and chronic lymphedema in 3 (14.3%), 7 (31.8%) and 14 cases (63.6%), respectively. Within a median follow-up time of 2.3 years [interquartile range (IQR), 0.6-4.6], 12 (54.6%) patients experienced complete remission and 6 cases succumbed to metastatic evolution within a median of 2.2 years (IQR, 0.6-4.6), with 1 case also experiencing perineal recurrence. Median survival time, estimated using the Kaplan-Meier method, was 5.1 years (IQR, 1.0-6.8). We suggest that neoadjuvant chemoradiotherapy may represent a reliable and promising strategy in locally advanced squamous cell carcinoma of the vulva.
GAUDINEAU, A.; WEITBRUCH, D.; QUETIN, P.; HEYMANN, S.; PETIT, T.; VOLKMAR, P.; BODIN, F.; VELTEN, M.; RODIER, J.F.
Alternative therapies have been sought to alleviate mutilation and morbidity associated with surgery for vulvar neoplasms. Our prime objective was to assess tumor absence in pathological vulvar and nodal specimens following neoadjuvant chemoradiotherapy in locally advanced vulvar neoplasms. Data were retrospectively collected from January 2001 to May 2009 from 22 patients treated with neoadjuvant therapy for locally advanced squamous cell carcinoma of the vulva. Neoadjuvant treatment consisted of inguino-pelvic radiotherapy (50 Gy) in association with chemotherapy when possible. Surgery occurred at intervals of between 5 to 8 weeks. The median age of patients at diagnosis was 74.1 years. All patients were primarily treated with radiotherapy and 15 received a concomitant chemotherapy. Additionally, all patients underwent radical vulvectomy and bilateral inguino-femoral lymphadenectomy. Tumor absence in the vulvar and nodal pathological specimens was achieved for 6 (27%) patients, while absence in the vulvar pathological specimens was only achieved for 10 (45.4%) patients. Postoperative follow-up revealed breakdown of groin wounds, vulvar wounds and chronic lymphedema in 3 (14.3%), 7 (31.8%) and 14 cases (63.6%), respectively. Within a median follow-up time of 2.3 years [interquartile range (IQR), 0.6–4.6], 12 (54.6%) patients experienced complete remission and 6 cases succumbed to metastatic evolution within a median of 2.2 years (IQR, 0.6–4.6), with 1 case also experiencing perineal recurrence. Median survival time, estimated using the Kaplan-Meier method, was 5.1 years (IQR, 1.0–6.8). We suggest that neoadjuvant chemoradiotherapy may represent a reliable and promising strategy in locally advanced squamous cell carcinoma of the vulva. PMID:23205089
Souza Teixeira, Marcelo; Dos Santos Lima, Caren; De Abreu Neves Salles1, Simone; Luz, Flávio Barbosa; Roberta Duarte Bezerra Pinto, Roberta; Pantaleão, Luciana
Fordyce angiokeratoma is a benign skin neoplasm, characterized by erythematous-violet keratotic papules with mamillated surface, which follows a chronic and minimally symptomatic course. However, symptoms can be related such as itching, burning, bleeding, dyspareunia; aesthetic and social concerns may prompt request for treatment. The condition mainly affects men and usually occurs in the scrotum, but rarely may occur in women. A 30-year-old woman with liver cirrhosis and portal hypertension is described. Over a period of two years she developed multiple angiokeratomas of the vulva, complicated by frequent bleeding. Histopathologic analysis of the lesion confirmed the diagnosis of angiokeratoma and all lesions were surgically removed. The results of the treatment were very satisfactory, with no relapses or complications.Angioqueratoma de Fordyce é uma dermatose incomum que compõe o grupo das neoplasias cutâneas benignas, caracterizando-se pelo aparecimento de lesões papuloceratósicas, eritemato-violáceas de superfície mamilonada, que apresentam curso crônico e oligossintomático. No entanto, outros sintomas podem estar associados, como prurido, ardência, sangramento e dispareunia, além de problemas estéticos e de ordem social. Afeta principalmente homens, acometendo a região escrotal, sendo raro seu surgimento em mulheres. Relata-se caso de uma paciente com 30 anos de idade, portadora de cirrose hepática e hipertensão portal evoluindo há 2 anos com múltiplos angioqueratomas na vulva de sangramento frequente. A análise histopatológica confirmou o diagnóstico de angioqueratoma e a paciente foi submetida à exérese cirúrgica das lesões. Os resultados terapêuticos foram satisfatórios, sem recidivas ou complicações.
Mishra, Vineet V; Pritti, Kumari; Aggarwal, Rohina; Choudhary, Sumesh
We present a patient with nonclassic congenital adrenal hyperplasia (NCAH) misdiagnosed as mosaic Turner syndrome. She presented with complaints of primary infertility. Short stature, the presence of facial hair and hoarse voice was also noted. She had primary amenorrhea and was advised for karyotype at 16 years of age, which was reported as 45, X/46, XX, stating her as a case of mosaic Turner syndrome. Clitoroplasty was done at 21 years of age for clitoromegaly, which was noticed during puberty. The diagnosis of mosaic Turner could not explain the virilization. Therefore, we repeated the karyotype, which revealed 46, XX in more than 100 metaphases and was sufficient to exclude mosaicism. Furthermore, the endocrinological evaluation revealed high testosterone level with a normal 17 alpha-hydroxyprogesterone (17-OHP). The presence of pubertal onset virilization with a karyotype of 46, XX and raised testosterone level with normal 17-OHP level, raised the suspicion of NCAH for which adrenocorticotropic hormone stimulation test was done which confirmed the diagnosis of NCAH.
Mishra, Vineet V.; Pritti, Kumari; Aggarwal, Rohina; Choudhary, Sumesh
We present a patient with nonclassic congenital adrenal hyperplasia (NCAH) misdiagnosed as mosaic Turner syndrome. She presented with complaints of primary infertility. Short stature, the presence of facial hair and hoarse voice was also noted. She had primary amenorrhea and was advised for karyotype at 16 years of age, which was reported as 45, X/46, XX, stating her as a case of mosaic Turner syndrome. Clitoroplasty was done at 21 years of age for clitoromegaly, which was noticed during puberty. The diagnosis of mosaic Turner could not explain the virilization. Therefore, we repeated the karyotype, which revealed 46, XX in more than 100 metaphases and was sufficient to exclude mosaicism. Furthermore, the endocrinological evaluation revealed high testosterone level with a normal 17 alpha-hydroxyprogesterone (17-OHP). The presence of pubertal onset virilization with a karyotype of 46, XX and raised testosterone level with normal 17-OHP level, raised the suspicion of NCAH for which adrenocorticotropic hormone stimulation test was done which confirmed the diagnosis of NCAH. PMID:26751945
Ma, Jingyuan; Shi, Fang; Huang, Chongya; Gu, Shanzhi
Bipartite patella is recognized as a developmental anomaly of ossification. Most of them are asymptomatic and are discovered incidentally. Bipartite patella is sometimes misdiagnosed as a patella fracture, because the x-ray images of both these conditions may appear very similar. In this case, the patient complained of left knee pain after x-ray films revealed a fracture-like line in the left patella. The patient was then diagnosed as having a patella fracture. In China, the injury degree is categorized as serious injury, minor injury, and trivial injury. As the injury degree of patellar fracture is identified as minor injury, the defendant who injured the patient will be sentenced to prison for ≤3 years. However, the defendant objected to this judgment and applied for the second evaluation of injury degree. On the basis of the site of injury, clinical manifestations, and imaging findings, we diagnosed the patient with bipartite patella which belongs to normal anatomic variant. Therefore, the injury degree of the patient was not minor injury.
Song, Seung-Yoon; Park, Jong-Tae; Kang, Sung-Don
An intracranial saccular aneurysm is uncommonly diagnosed in a patient with closed head trauma. We herein present a patient with delayed rebleeding of a cerebral aneurysm misdiagnosed as traumatic subarachnoid hemorrhage (SAH). A 26-year-old female visited our emergency department because of headache after a motorcycle accident. Brain computed tomography (CT) showed a right-side dominant SAH in Sylvian fissure. Although traumatic SAH was strongly suggested because of the history of head trauma, we performed a CT angiogram to exclude any vascular abnormalities. The CT angiogram showed no vascular abnormality. She was discharged after conservative treatment. One day after discharge, she returned to the emergency department because of mental deterioration. Brain CT showed diffuse SAH, which was dominant in the right Sylvian fissure. The CT angiogram revealed a right middle cerebral artery bifurcation aneurysm. During operation, a non-traumatic true saccular aneurysm was found. The patient recovered fully after successful clipping of the aneurysm and was discharged without neurologic deficit. Normal findings on a CT angiogram do not always exclude aneurysmal SAH. Follow-up vascular study should be considered in trauma patients who are highly suspicious of aneurysmal rupture. PMID:27847770
Sasaki, Ryosuke; Negishi, Kei; Akita, Hirotaka; Suzuki, Kayoko; Matsunaga, Kayoko
A 16-year-old girl presented with a 9-year history of vesicles on the vulva. She had initially taken a wait-and-see approach, but required treatment because of bleeding. Histological examination of a biopsied vesicle revealed dilated lymph channels in the upper dermis, suggesting lymphangioma circumscriptum (LC). The challenge for this pathology has been to find a conservative treatment with low morbidity and better results than those reported for surgical excision, which has been the mainstay of therapy. In this case, LC of the vulva was successfully treated using a 10,600-nm CO2 laser and long-pulsed Nd:YAG laser. Use of the 10,600-nm CO2 laser and long-pulsed Nd:YAG laser appeared effective for treating LC.
Rossel, Felipe; Nooh, Anas; Jarzem, Peter
Congenital absence of cervical spine pedicle can be easily misdiagnosed as facet dislocation on plain radiographs especially in the acute trauma setting. Additional imaging, including computed tomography (CT)-scan with careful interpretation is required in order to not misdiagnose cervical posterior arch malformation with subsequent inappropriate management. A 39-year-old patient presented to the emergency unit of our university hospital after being trampled by a cow over her back and head followed by loss of consciousness, retrograde amnesia and neck pain. Her initial cervical CT-scan showed possible C5-C6 dislocation, then, it became clear that her problem was a misdiagnosed congenital cervical abnormality. Patient was treated symptomatically without consequences. The congenital absence of a cervical pedicle is a very unusual condition that is easily misdiagnosed. Diagnosis can be accurately confirmed with a CT-scan of the cervical spine. Symptomatic conservative treatment will result in resolution of the symptoms. PMID:26605026
Mao, Jun-Feng; Xia, Xiao-Bo; Tang, Xiang-Bo; Zhang, Xue-Yong; Wen, Dan
AIM To investigate clinical features of optic nerve sheath meningioma (ONSM) that was misdiagnosed, and to find methods to reduce the misdiagnoses. METHODS Retrospective series study. Twenty-five misdisgnosed patients with unilateral ONSM were collected from Jan. 2008 to Jan. 2015 and the clinical records reviewed. RESULTS Patients were misdiagnosed with acute papillitis most frequently (n=17), immediately followed by optic atrophy (n=8), ischemic optic neuropathy (n=5), acute retrobulbar optic neuritis (n=5), optic disc vasculitis (n=3). For each patient, the minimum frequency of misdiagnoses was once and the maximum was 4 times. As for the lasting time of being misdiagnosed, the shortest was 1.5mo and the longest was 45mo. Twenty-one cases (84%) were once treated with glucocorticoids, and its side effects was found in seventeen patients. Twenty patients (80%) complained with varying degree of vision loss. When a definite diagnosis was made, sixteen cases (64%) showed slight exophthalmos and eighteen cases (72%) had the tubular ONSM. CONCLUSION ONSM without loss obvious exophthalmos is easily misdiagnosed in clinic, and for most of these ONSMs are tubular. PMID:27672598
Lee, Seung Hyun; Han, Myoungseok; Bae, Jong Woon; Park, Jung-Woo; Oh, So Ra; Kim, Sujin
Superficial angiomyxomas (SAMs) are rare benign cutaneous tumors that involve the subcutaneous layer. They are commonly located in the trunk, lower limbs and head or neck of women of reproductive age. SAMs in the vulva of postmenopausal women are especially rare case. Herein, we report a vulvar SAM in a postmenopausal 60-year-old woman. The patient presented with a palpable cutaneous mass in the right labium majora that had appeared 3 months earlier. The mass was slow growing and approximately 5 cm in size and resembled a soft tissue malignancy. It appeared as a well-defined multilocular cystic mass in magnetic resonance images. The preoperative diagnosis was a benign cystic lesion such as an epidermoid cyst. Grossly, the completely excised mass was 6 × 5 cm in size and well circumscribed with a multilocular outer surface, a yellowish-gray gelatinous cut surface, and a smooth rubbery inner surface. Histologic review revealed that the mass contained small to moderate amount of cellular angiomyxoid nodules and bland-looking spindle-shaped to ovoid cells without atypia. Neutrophil infiltration, which is a diagnostic feature of SAMs, was observed. Immunohistochemistry showed expression of CD34, but not of estrogen receptors, progesterone receptors, or desmin in the SAM. The patient has been followed up for 12 months without recurrence. PMID:28119899
Aoyama, Kohei; Sawada, Morio; Mori, Taisuke; Yasukawa, Satoru
Primary vulvar adenocarcinomas are very rare. We describe the rare case of primary vulvar apocrine adenocarcinoma, a histologically rare subtype of vulvar adenocarcinoma. A 57-year-old Japanese woman presented with an enlarging vulvar mass. A dark-red, hemorrhagic, ulcerated tumor was on the right side of the anterior labial commissure measuring approximately 3.5 × 3.5 cm. Preoperative biopsy showed poorly differentiated carcinoma with partial differentiation to adenocarcinoma. Systemic examination revealed lymph node metastases in both inguinal regions and no other primary source. We performed radical vulvectomy and bilateral inguinal and pelvic lymphadenectomy. Histopathologic diagnosis was apocrine adenocarcinoma of the vulva with inguinal lymph node metastases, pT1bN2bM0. Surgical margins were negative. The patient received no adjuvant chemotherapy or radiation. Inguinal lymph node recurrence occurred after six months. Reresection and adjuvant tomotherapy were performed. After a further 12 months of observation, no rerecurrence was observed. The patient is now on follow-up. PMID:27668109
Villada, Gabriel; Farooq, Uzma; Yu, Wendong; Diaz, John Paul; Milikowski, Clara
Extramammary Paget disease of the vulva accounts for 1%–2% of the neoplasms of the anogenital area. Very rarely, extramammary Paget disease of the vulva has been associated with an underlying mammary-like carcinoma, usually ductal, extremely rarely mixed ductal and lobular. We report the case of a 60-year-old female with a recurrent extramammary Paget disease of the vulva. Pathological examination of the wide excision of the vulva revealed an extramammary Paget disease with an underlying invasive carcinoma composed of medium size cells organized in single files, a morphology similar to that of an invasive lobular breast carcinoma. Immunohistochemical staining showed a comparable profile in the Paget cells and in the invasive tumoral cells: CEA and CK7 positivity; GCDFP-15, ER focal positivity. E-cadherin and HER2 were diffusely positive. S100 and CK20 were negative. HER2-CISH was amplified. The diagnosis of extramammary Paget disease of the vulva with an underlying mammary-like lobular carcinoma was made. Despite the characteristic lobular features, the immunohistochemical profile differs from the typical profile of a lobular carcinoma of the breast. The implications in term of prognostic and therapeutic significance need to be further studied.
Clinical Manifestations and Therapeutic Management of Vulvar Cellulitis and Abscess: Methicillin-resistant Staphylococcus aureus, Necrotizing Fasciitis, Bartholin Abscess, Crohn Disease of the Vulva, Hidradenitis Suppurativa.
Wood, Sara C
Infections of the vulva can present a complex differential to the gynecologist, ranging from superficial skin infections to life-threatening necrotizing fasciitis. Recognition and timely treatment remain universal to skin and soft-tissue infections as the subcutaneous anatomy of the vulva can facilitate rapid spread to other tissues with significant morbidity and mortality. Ineffective antibiotics or deferring necessary surgical debridement have proven to be costly to the patient, and the gynecologist must maintain an appropriately high index of suspicion. Employing a multidisciplinary team approach to care for vulvar cellulitis can guide treatment from antibiotic therapies to more aggressive surgical debridement.
Alici, Ibrahim Onur; Kar Kurt, Ozlem; Dursun, Adile Berna; Yilmaz, Aydin; Erkekol, Ferda Oner
Initial management of patients with difficult-to-treat asthma must begin with confirmation of the diagnosis. We present 2 cases of tracheal disease misdiagnosed as difficult-to-treat asthma. After systemic evaluation, tracheomalacia and tracheobronchial narrowing due to diffuse calcification of the cartilaginous rings were found as mimicking asthma.
Osamu, Soma; Murasawa, Hiromi; Yoneyama, Takahiro; Koie, Takuya; Ohyama, Chikara
Solitary fibrous tumor (SFT) of the prostate is a very rare tumor. We report a case of 65-year-old man with SFT of the prostate which was initially misdiagnosed as prostate cancer. Finally, we performed total prostatectomy and the tumor was histologically diagnosed as SFT of the prostate. The patient's clinical course has progressed favorably with no obvious recurrence 18 months postoperatively.
Jeon, Soo Jin; Cunha, Federico; Ginn, Amber; Jeong, KwangCheol Casey
ABSTRACT Escherichia coli is involved in the pathogenicity of metritis in cows. We report here the genome sequences of E. coli strains isolated at calving from the uterus, vagina, vulva, and rectoanal junction of a dairy cow that later developed metritis. The genomic similarities will give an insight into phylogenetic relationships among strains. PMID:28302783
Mishra, Pranshu; Sen, Sumit; Sharma, Neha; Sen, Debasish
Malignant eccrine poroma is a rare malignancy of the eccrine sweat glands, occurring most frequently on the lower extremities. It affects both sexes equally usually in the 6th to 7th decade of life. Metastasis to regional lymph nodes may occur in 20% that may be fatal in 60% cases. Its aggressive nature, rarity of occurrence, and unusual presentations make it very important to be evaluated properly by the clinician. We hereby report a case of a 75-year-old female presenting with two exophytic tumors over her vulva with local extension. On histopathological examination, it was diagnosed as malignant eccrine poroma. On magnetic resonance imaging of the pelvic region, metastatic extension in regional lymph nodes was found. She was treated by radical vulvectomy with bilateral inguinal and femoral lymph node dissection followed by radiotherapy. PMID:27512190
Mishra, Pranshu; Sen, Sumit; Sharma, Neha; Sen, Debasish
Malignant eccrine poroma is a rare malignancy of the eccrine sweat glands, occurring most frequently on the lower extremities. It affects both sexes equally usually in the 6(th) to 7(th) decade of life. Metastasis to regional lymph nodes may occur in 20% that may be fatal in 60% cases. Its aggressive nature, rarity of occurrence, and unusual presentations make it very important to be evaluated properly by the clinician. We hereby report a case of a 75-year-old female presenting with two exophytic tumors over her vulva with local extension. On histopathological examination, it was diagnosed as malignant eccrine poroma. On magnetic resonance imaging of the pelvic region, metastatic extension in regional lymph nodes was found. She was treated by radical vulvectomy with bilateral inguinal and femoral lymph node dissection followed by radiotherapy.
Sumanont, Sermsak; Boonard, Manusak; Boonrod, Arunnit
Superior dislocation of the patella with intact patellar tendon is a rare condition. Most cases in literatures were diagnosed by clinical examination and plain radiography; however there are many cases that were misdiagnosed as patellar tendon rupture. In this case, we demonstrate the use of ultrasound for diagnosis of superior dislocation of the patella in the emergency department. We also include a literature review of similar cases and discuss the advantages of different types of imaging for diagnosis in this condition. PMID:28101389
Um, Yoo Jin; Kim, Hyoun Ah; Jung, Jin Hee; Cho, Hundo; Kang, Joon Koo
Amyloidosis is a rare disease defined by extracellular deposits of amorphous fibrillar proteins, derived from aggregations of misfolded proteins. Localization of amyloidosis in the gallbladder is uncommon; only eight cases have been reported. We describe a case of amyloidosis diagnosed by cholecystectomy, which possibly also affected the liver and kidney. The patient was misdiagnosed with polymyalgia rheumatica, but after a cholecystectomy to treat chronic cholecystitis, we ultimately diagnosed him with amyloidosis. We review amyloidosis with gallbladder involvement in the literature.
Ting, Li Yu; Shrestha, Bikash; Lu, Yi Lu; Ping, Fu
Tuberculosis is a common infectious mycobacterial disease having a wide range of clinical and serological manifestations that are similar to rheumatic disease. Differential diagnosis is a crucial aspect in any rheumatic disease as many other infectious diseases portray clinical similarities and autoantibody positivity. Our case report illustrates of a young woman just after the delivery of a child presented an unusual case of extrapulmonary tuberculosis infection initially misdiagnosed as systemic lupus erythematosus (SLE).
Ngamkham, Jarunya; Boonmark, Krittika; Phansri, Thainsang
Vulva and Vaginal cancers are rare among all gynecological cancers worldwide, including Thailand, and typically affect women in later life. Persistent high risk human papillomavirus (HR-HPV) infection is one of several important causes of cancer development. In this study, we focused on HPV investigation and specific type distribution from Thai women with abnormality lesions and cancers of the vulva and Vaginal. A total of ninety paraffin-embedded samples of vulva and Vaginal abnormalities and cancer cells with histologically confirmed were collected from Thai women, who were diagnosed in 2003-2012 at the National Cancer Institute, Thailand. HPV DNA was detected and genotyped using polymerase chain reaction and enzyme immunoassay with GP5+/ bio 6+ consensus specific primers and digoxigenin-labeled specific oligoprobes, respectively. The human β-globin gene was used as an internal control. Overall results represented that HPV frequency was 16/34 (47.1%) and 8/20 (40.0%) samples of vulva with cancer and abnormal cytology lesions, respectively, while, 3/5 (60%) and 16/33 (51.61%) samples of Vaginal cancer and abnormal cytology lesions, respectively, were HPV DNA positive. Single HPV type and multiple HPV type infection could be observed in both type of cancers and abnormal lesion samples in the different histological categorizes. HPV16 was the most frequent type in all cancers and abnormal cytology lesions, whereas HPV 18 was less frequent and could be detected as co-infection with other high risk HPV types. In addition, low risk types such as HPV 6, 11 and 70 could be detected in Vulva cancer and abnormal cytology lesion samples, whereas, all Vaginal cancer samples exhibited only high risk HPV types; HPV 16 and 31. In conclusion, from our results in this study we suggest that women with persistent high risk HPV type infection are at risk of developing vulva and Vaginal cancers and HPV 16 was observed at the highest frequent both of these, similar to the cervical
Aragona, Alejandro M; Soderini, Alejandro H; Cuneo, Nicasio A
The phrase "locally advanced carcinoma of the vulva" has often been mentioned in the literature, though not accurately defined, or even leading to the interpretation overlapping. Grounded on cervical cancer experience, we are able to state that designing a tailored primary strategy based on clinically measurable adverse prognostic factors represents the cornerstone of therapy. This fact urged us to rethink about the real usefulness of the concept of locally advanced squamous cell carcinoma of the vulva. We will refer to this concept as a clinical entity emerging from a rigorous workup which is a valuable guiding tool in the context of a thorough debate about the best primary treatment approach to be used. Furthermore, bulky tumors of the vulva have been associated with a worse prognosis on several occasions. Some authors have questioned the fact that tumor size has not been considered in the staging system. Finally, a standardized definition will help us compare the results obtained, which is extremely necessary given the worldwide low prevalence of this disease.
Soderini, Alejandro H.; Cuneo, Nicasio A.
The phrase "locally advanced carcinoma of the vulva" has often been mentioned in the literature, though not accurately defined, or even leading to the interpretation overlapping. Grounded on cervical cancer experience, we are able to state that designing a tailored primary strategy based on clinically measurable adverse prognostic factors represents the cornerstone of therapy. This fact urged us to rethink about the real usefulness of the concept of locally advanced squamous cell carcinoma of the vulva. We will refer to this concept as a clinical entity emerging from a rigorous workup which is a valuable guiding tool in the context of a thorough debate about the best primary treatment approach to be used. Furthermore, bulky tumors of the vulva have been associated with a worse prognosis on several occasions. Some authors have questioned the fact that tumor size has not been considered in the staging system. Finally, a standardized definition will help us compare the results obtained, which is extremely necessary given the worldwide low prevalence of this disease. PMID:25142626
Ha, Gi Won; Lee, Min Ro; Kim, Jong Hun
Cholecystocolic fistula secondary to gallbladder carcinoma is extremely rare and has been reported in very few studies. Most cholecystocolic fistulae are late complications of gallstone disease, but can also develop following carcinoma of the gallbladder when the necrotic tumor penetrates into the adjacent colon. Although no currently available imaging technique has shown great accuracy in recognizing cholecystocolic fistula, abdominopelvic computed tomography may show fistulous communication and anatomical details. Herein we report an unusual case of cholecystocolic fistula caused by gallbladder carcinoma, which was preoperatively misdiagnosed as hepatic flexure colon carcinoma.
Yang, Liu; Li, Wen; Du, Jintao
Paraneoplastic syndromes (PS) occur less commonly in association with otolaryngologic neoplasms than other carcinomas such as those of lung or breast. Piriform sinus carcinoma with PS is extremely rare. We here report a case of piriform sinus carcinoma accompanied by PS that was initially misdiagnosed as adult onset Still's disease and describe our diagnosis and treatment. One lesson we have drawn from the experience of this misdiagnosis is that PS symptoms may manifest before the primary tumor is evident and complicate the diagnostic process.
Park, Jong Myung; Kim, Chang Wan; Kim, Do Hyung
A pharyngeal diverticulum is a rare complication of an anterior cervical discectomy and fusion (ACDF). We present a case of a pharyngeal diverticulum after an ACDF, which was misdiagnosed as a typical Zenker diverticulum. A 54-year-old woman presented with dysphagia and a sense of irritation in the neck following C5 through C7 cervical fusion 3 years prior. The patient underwent open surgery to resect the diverticulum with concurrent cricopharyngeal myotomy. An ACDF-related diverticulum is difficult to distinguish from a typical Zenker diverticulum. PMID:27525244
Gupta, Saurabh Kumar; Saxena, Payal
General dentists should be aware that extraoral dental cutaneous lesions can be confused with dermatologic lesions. We report two cases of cutaneous lesions of dental origin that were initially misdiagnosed as being dermatologic in origin. Multiple treatments were performed, including plastic surgery, but the lesions did not resolve. Then, the lesions' dental etiology was identified. Endodontic intervention resulted in resolution of the problem, confirming the initial misdiagnosis. A dental etiology, as part of a differential diagnosis, should be kept in mind with orofacial skin lesions.
Kuz Tekşut, Tuba; Özcan, Halil; Işık, Mein; Karslı, Fatih
Chorea gravidarum (CG) is a rare movement disorder characterized by rapid, irregular randomly distributed involuntary movements during pregnancy. Similar to Sydenham chorea, psychiatric symptoms may be observed in cases of CG. CG may be idiopathic or secondary to an underlying cause. One of the most common causes of CG is antiphospholipid syndrome. Herein we present a case of recurrent CG that was considered to be due to antiphospholipid syndrome. The patient had a history of 3 pregnancy losses and her fourth pregnancy was treated appropriately, resulting in the birth of healthy full-term baby. During the patient's first pregnancy CG was accompanied by psychotic symptoms and was misdiagnosed as conversion disorder.
Zhao, Xiongfei; Yu, Yingxin; Zhao, Zhiru; Xu, Jiaping
Definite accurate diagnosis for Creutzfeldt-Jakob disease (CJD) depends on neuropathologic examination of brain biopsy or autopsy. However, transmissible nature makes the invasive examination dangerous. This study was set to determine that the clinical features are for the diagnosis of CJD through a comparison study. We compared clinical features of two cases with initial diagnosis of sporadic CJD. One case was finally diagnosed as definite sporadic CJD. According to World Health Organization diagnosis criteria, the other one, which had been diagnosed as probable sporadic CJD, was confirmed as limbic encephalitis after long-term follow-up. Compared with the case of definite sporadic CJD, the misdiagnosed case did not present typical electroencephalogram (EEG) and diffusion-weighted in magnetic resonance images (DWI) of CJD. However, cerebrospinal fluid in the misdiagnosed patient showed 14-3-3 protein positivity. The patient conditions improved after treatment. Through this case comparison, we conclude that EEG and DWI are necessary for accurate diagnosis of sporadic CJD. Further, long-term follow-up is crucial to diagnosis and treatment of CJD.
Li, Yanzhuo; Cai, Quanyu; Jia, Ningyang; Chen, Dong; Lu, Lun
Background To investigate the clinical features of undifferentiated embryonal sarcoma of the liver (UESL) to improve its preoperative diagnostic accuracy. Methods The clinical, imaging, and histopathologic findings of 16 UESL patients whose disease was pathologically confirmed but preoperatively misdiagnosed were retrospectively analyzed. Results Among these 16 patients, 9 were clinically misdiagnosed as primary liver cancer, 3 as hepatoblastoma, and 4 as malignant hepatic mass. In 12 patients who were presented due to abdominal discomfort, ultrasound showed that predominantly solid lesions, whereas computed tomography (CT) and magnetic resonance imaging (MRI) demonstrated predominantly cystic masses within irregular soft tissue. Contrast-enhanced imaging showed enhancement intralesional foci, multiple internal septations, and edges. The postoperative pathology showed the cutting surface of tumors was variegated, with solid and cystic gelatinous areas, hemorrhage, and necrosis. Intracytoplasmic hyaline globules were commonly present among cancer cells. Conclusions UESL is a rare clinical condition without specific clinical manifestations. The inconsistencies between ultrasound and CT/MRI findings may be helpful to improve the preoperative diagnosis accuracy. PMID:26807408
Ventolini, Gary; Patel, Ravi; Vasquez, Robert
Objective Lichen sclerosus (LS) is a chronic progressive inflammatory autoimmune-induced disease that primarily affects the epidermis and dermis of the external genital-anal region. Intense and recalcitrant pruritus is the hallmark of LS. Physical exam reveals thinning, hyperkeratosis, and parchment-like appearance. However, the classic symptom and signs of LS may not always be present and patients may be asymptomatic for pruritus. Hence, we describe 15 misdiagnosed cases with atypical clinical presentations. We believe that the absence of pruritus contributed to their initial misdiagnosis. The purpose of this paper is to increase awareness of atypical presentations of LS. Methods Data base review of de-identified clinical case pictures was performed. All patients had histopathology-confirmed diagnoses of LS. The data base file contains 800 cases of vulvovaginal disorders. The Institutional Review Board (IRB) considered that searching a de-identified data base of pictures did not require IRB approval. Results We identified 15 different atypical clinical cases. Patient ages were 18–75 years old. These patients were asymptomatic for pruritus and were misdiagnosed before they presented to the vulvovaginal specialized clinic. Conclusion Fifteen patients asymptomatic for pruritus with histopathology-confirmed diagnosis of LS were identified. They illustrate atypical clinical presentations that LS may have. PMID:26056492
Cimino, Luca; Coassin, Marco; Chan, Chi-Chao; Marchi, Sylvia; Belpoliti, Matteo; Fanti, Andrea; Iovieno, Alfonso; Fontana, Luigi
Purpose: To present challenging cases of vitreoretinal lymphoma (VRL) that was misdiagnosed as uveitis because of the apparent intraocular inflammation. At the light of the new classification of intraocular lymphomas, we detail the characteristics that masqueraded the tumors and the clinical aspects that guided us to the correct diagnosis. Materials and Methods: We retrospectively reviewed the patients referred to our uveitis service between January 2006 and December 2014. Results: Seven patients referred with a presumptive diagnosis of idiopathic uveitis received a final diagnosis of VRL. The median time between the onset of symptoms and definitive diagnosis was 25 months for these complex cases. The median time from presentation at our clinic to final diagnosis was 1 month. The described clinical features including dense vitreous cells and subretinal infiltrates were characteristic and tend to be present in all these chronically ill patients. Vitreous samples were collected, and all demonstrated the pathognomonic tumor cells, the specific immunoglobulin heavy chain gene rearrangements, and an interleukin (IL)-10 to IL-6 ratio >1. Conclusion: VRLs are severe diseases with a poor prognosis that may be misdiagnosed as idiopathic inflammatory conditions of the eye. Treatment with steroids may occult the tumors and delay the correct diagnosis. Appropriate evaluation may prompt to a timely vitreous sampling and therefore to a faster diagnosis in these peculiar cases where the correct diagnosis was delayed by several months. PMID:27380976
Şahin, Soner; Atabey, Cem; Şimşek, Mehmet; Naderi, Sait
Background: Textile products commonly used in surgery (e.g., sponges or gauze) have been known to cause complications after spinal surgery. Associated complications usually arise months or even years after the primary surgery. In case of spine surgery, these bodies are often detected during neuroradiological evaluations to investigate reported back pain; however, this complication often remains asymptomatic. Aims: The research is intended to increase awareness among both spinal surgeons and neuroradiologists of this potential complication. Study Design: Retrospective study. Methods: This study is a retrospective case series of three patients with retained surgical textile products who had been misdiagnosed with spinal tumour. The medical records of the patients were reviewed and demographic data, clinical aspects, initial diagnosis, surgical procedures, time interval between previous operation and onset of symptoms, laboratory findings, radiological findings, treatment, and outcome were analysed. Results: The three patients included two women and one man aged between 64 and 67 years. All patients had a previous surgery for lumbar disc herniation. The time from the previous surgical procedures to presentation ranged from 3 to 17 years. All patients presented with non-specific lower back pain and/or radiculopathy without clinical findings of infection. Laboratory parameters were otherwise normal. All three cases had been misdiagnosed as a spinal tumor based on magnetic resonance imaging findings. During new surgical procedures, gauze bandages, i.e., surgical textiles left during a previous operation, were found. Conclusion: Textiloma is an important and rarely mentioned potential neurosurgical complication that may remain asymptomatic for years. They are more common in obese patients, after emergency surgery, and with unplanned changes in surgical procedure such as bleeding and unintended neurosurgical complications. Neuroradiological findings are variable and non
Wen, Bing; Yang, Junya; Jiao, Zhouyang; Fu, Guowei; Zhao, Wenzeng
The current study describes a case of right coronary artery fistula (CAF) misdiagnosed as right atrial myxoma (RAM). A 33-year-old man presented with a 13-year history of intermittent chest pain, and aggravation for 3 days. Echocardiography revealed an occupying lesion in the right atrium producing a partial dynamic tricuspid obstruction. The initial diagnosis was RAM, which causes partial right ventricular inflow tract obstruction. During cardiopulmonary bypass surgery, a giant mass was detected in the anterior wall of the right ventricle and an abnormal vascular fistula was observed at the bottom of the mass. Successful excision of the mass and closure of the fistula completely relieved the patient's presenting symptoms. The disease was subsequently diagnosed as right CAF draining to the myocardial void. The surgical management and misdiagnosis of the case are discussed herein.
Cai, Si-Yu; Ye, Shen-Feng; Wu, Xiang; Xiang, Mei-Xiang; Wang, Jian-An
A case of torsade de pointes (TdP) with complete atrioventricular block and pacemaker failure that was misdiagnosed as epilepsy is presented herein. An 82-year-old female with recurrent seizure-like attacks showed epileptiform discharge during an electroencephalogram recording. A long QT interval and severe hypokalemia induced runs of TdP, which was related to pacemaker lead fracture, was detected during Holter recording and accompanied with episodes of seizures. After a DDD pacemaker with a new ventricular lead was replaced, there was no recurrence of any seizure-like attacks. Bradycardia-mediated TdP associated with complete atrioventricular block should not be missed in patients with recurrent seizure-like attacks even after pacemaker implantation.
Koob, Mériam; Durckel, Jean; Dosch, Jean-Claude; Entz-Werle, Natacha; Dietemann, Jean-Louis
Myositis ossificans (MO) is a rare benign cause of heterotopic bone formation within soft tissue. It most commonly affects adolescents and young adults, typically in the limbs and following trauma. Very few cases have been reported in children. We report here a case of nontraumatic MO occurring in a 10-year-old girl with an uncommon location in the 5th right intercostal space; it was initially misdiagnosed and treated as osteosarcoma. Imaging findings including plain radiographs, CT, MRI, bone scintigraphy and PET-CT are described. This case highlights the central role played by imaging in diagnosis, thus avoiding biopsy that can erroneously suggest osteosarcoma as the diagnosis, as occurred in this case.
Börjesson, S; Gómez-Sanz, E; Ekström, K; Torres, C; Grönlund, U
The purpose of this study was to investigate whether S. pseudintermedius is misdiagnosed as S. aureus by clinical laboratories when isolated from humans with dog bite wounds. In addition, we attempted to determine whether S. pseudintermedius isolates related to dog bite wounds share phenotypic and genotypic traits. S. pseudintermedius was identified by PCR targeting the nuc gene. Isolates were tested for antibiotic susceptibility using VetMIC GP-mo microdilution panels. The occurrence of genes encoding leukocidins, exfoliatins, pyrogenic toxin superantigens and enterotoxins was determined by PCR. The relatedness of S. pseudintermedius isolates was investigated using Multi Locus Sequence Typing (MLST). Out of 101 isolates defined as S. aureus by human clinical microbiology laboratories, 13 isolates were re-identified as S. pseudintermedius and one isolate was confirmed to carry the mecA gene, i.e. methicillin-resistant (MRSP). The MRSP isolate was also defined as multi-resistant. Two methicillin-susceptible S. pseudintermedius isolates were also multi-resistant and five were susceptible to all antibiotics tested. With the exception of three S. pseudintermedius isolates belonging to multi locus sequence type (MLST) 158, all the isolates belonged to unique STs. All isolates contained lukS/F-I, siet and se-int, and expA were identified in two isolates and expB and sec canine-sel in one isolate respectively. S. pseudintermedius is frequently misdiagnosed as S. aureus from humans with dog bite wounds showing that it can act as an opportunistic pathogen in humans. No common phenotypic and genotypic traits shared by the S. pseudintermedius isolates could be identified.
Mogensen, Trine H; Christiansen, Jens J; Eivindson, Martin V; Larsen, Carsten S; Tøttrup, Anders
We present a case of amoebic colitis, misdiagnosed as inflammatory bowel disease and treated with corticosteroids, leading to severe necrotizing enterocolitis. We review the literature on the epidemiology, pathogenesis, diagnosis, and treatment of amoebic dysentery, with special emphasis on the association between immunosuppressive treatment and the development of severe invasive amoebiasis.
Walsh, Maureen Y.; Hoey, Susannah E.; O'Kane, Donal
Pyoderma gangrenosum (PG) is a rare inflammatory neutrophilic dermatosis often misdiagnosed. It is uncommon in infants and children accounting for 4% of cases. A one-year-old male in paediatric ICU ventilated for bronchopneumonia was referred with ulcerated areas on his neck and axilla corresponding to sites of recent removal of central and arterial lines. Examination revealed areas of deep ulceration with violaceous undermined borders in keeping with PG. This was supported by a skin biopsy showing a neutrophilic infiltrate in the deeper dermis. Topical clobetasol propionate was commenced and a dramatic improvement within 24 hours noted. Blood results showed a leucocytosis of 29.7; a differential WCC showed toxic granulation in neutrophils with myeloid left shift; immunoglobulins showed elevated IgG 23 and IgA 4.86. The elevated WCC made us consider a leukaemic trigger; however, they settled with treatment of the underlying infection. PG in children is more likely to have an atypical distribution involving the head and neck (26.6%) or buttocks (15%). An interesting feature in this case is the presence of pathergy, a term used to describe the induction or exacerbation of PG at sites of iatrogenic or incidental trauma. It is seen in 31% of patients with PG. PMID:27738542
Szymańska, Magdalena; Czarnecka-Operacz, Magdalena
We report a case of a woman with diffuse large B-cell lymphoma (DLBCL). Primary cutaneous lymphomas (PCLs) represent distinct clinical and histopathologic subtypes of extranodal T- and B-cell lymphomas. Cutaneous B-cell lymphomas comprise 20–25% of all primary cutaneous lymphomas. The patient presented an erythematous tumour mass of the left nasolabial fold, nose and left cheek as well as disseminated infiltrative plagues on the trunk, arms and left lower leg. Skin biopsy revealed a diffuse infiltrate of lymphocytes around hair follicles and blood vessels within dermis and subcutaneous tissue. An immunohistochemistry showed a diffuse infiltrate of large non-cleaved B-cells, with a high proportion of centroblast-like cells within dermis. Tumor cells expressed CD20, bcl-2 protein and did not express CD10. The patient was misdiagnosed as the erysipelas of the face and unsuccessfully treated with long-term antibiotic therapy by a laryngologist and a dermatologist. The correct diagnosis was delayed and established after 6 months’ history of DLBCL lesions. Therefore, we would like to strongly stress the importance of considering diagnosis of cutaneous lymphomas in chronic skin lesions non-responsive to adequate therapies. PMID:24278087
Gill, P.; Uhrich, S.; Cheng, E.; Disteche, C.
We report a case of 45,XY,-5,-21,+der (5)t(5;21) (p13 or p14;q11.2 or q21) that was prenatally misdiagnosed as complete monosomy 21 and terminated at 24 weeks of gestation. Subsequent fluorescence in situ hybridization studies with a chromosome 21 painting probe documented the cryptic unbalanced translocation. 17 refs., 2 figs., 1 tab.
Nachev, A; Vasilev, N; Ivanov, S; Meziad, S
The authors describe three cases of large vulvar lesions caused by HPV. One patient has condylomata covering entirely the labia majora and minora, the clitoris, the perineum and the perianal area. The lesions made the structures of the vulva hard to distinguish. She was treated with podophyllin, Solcoderm and diathermy without effect. After 2 applications of Laser vaporisation 40 days apart she was completely cured. The other patient had two big squamous papillomata 3.5 by 3.5 cm and 0.5 cm thick situated on both sides of commissura posterior. She was also treated unsuccessfully with Podophyllin, Solcoderm and surgical excision. She was completely cured by a single-stage CO2-laser treatment. The third patient had condylomata acuminata of the labia minora and majora, fossa navicularis, the perineum and the perianal area. No other treatment had been attempted before. After two sessions of laser vaporisation she was cured, too.
Almiş, Habip; Yakıncı, Cengiz
Brucellosis which is a zoonotic infection, is an important public health problem in Turkey and all over the world. The disease may involve many organs and systems. Since the symptoms of brucellosis are non-specific, difficulties in differential diagnosis and misdiagnosis are frequent. In this case report we present a case of brucellosis, misdiagnosed as Crimean-Congo hemorrhagic fever (CCHF). A 13-year-old boy was referred from another medical center with preliminary diagnosis of CCHF and admitted to our clinic with fever and a history of presence of a tick on his back. His physical observation only included splenomegaly. The laboratory results on admission were anemia, thrombocytopenia, elevation of acute phase reactants and liver transaminase levels. Abdominal ultrasonography revealed splenomegaly. Since the patient had anemia, epistaxis, fever and thrombocytopenia, he was initially diagnosed as CCHF. Meantime serum sample of the patient had been sent to Refik Saydam National Public Health Agency for CCHF PCR test. The fever of the patient could not be controlled. His detailed medical history revealed stockbreeding and consumption of raw milk products. Patient's signs and symptoms were also compatible with brucellosis and standard tube agglutination test for brucellosis was positive at 1/1280 titer in serum. The patient was diagnosed as brucellosis and the treatment was started with combination of rifampicin (1 x 600 mg/day) and doxycycline (2 x 100 mg/day). Blood cultures yielded negative result. The PCR tests for CCHF was found also negative. His fever and other complaints improved with treatment which was completed in six weeks and the follow-up was without complications. Turkey is endemic both for brucellosis and CCHF. This case was reported to emphasize that the cases of brucellosis could mimic other diseases and brucellosis should also be considered in the differential diagnosis of CCHF.
As rare condition, mucoepidermoid carcinoma may occur in liver although its etiology and pathogenesis is still unclear. We report here a case of intrahepatic mucoepidermoid carcinoma misdiagnosed as cholangiocarcinoma and squamous cell carcinoma by preoperative radiologic and intraoperative histological examinations, respectively. A 60-year-old woman presented with a 1-month history of progressive jaundice, epigastric discomfort, and weight loss with slightly increased carbohydrate antigen 19-9 (CA19-9). Computed tomography (CT) showed a large tumor, 8.0 cm in diameter, in the left lobe of the liver. A preliminary diagnosis of a cholangiocarcinoma of the liver was made. In the intraoperative histological examination, a diagnosis of squamous cell carcinoma was made based on predominantly invasive epidermoid cells with abundant keratinization and absence of mucin-producing cell component. However, postoperative histological diagnosis of the lesion was mucoepidermiod carcinoma of liver by thoroughly microscopical inspection and the presence of mucin-producing cells confirmed by Alcian blue staining. Despite surgical excision and chemotherapy, the tumor showed very aggressive malignancy with tumor recurrence. The patient died shortly afterward, surviving 6 months after surgery. Due to its rarity and distinct morphological features, mucoepidermoid carcinoma might be erroneously interpreted as squamous cell carcinoma by those who were not familiar with this condition in unusual locations. Therefore, removal of sufficient tissue from different portions of the lesion is essential for the surgeons and pathologists to make a precise diagnosis in the intraoperative histological examination. Virtual slide The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/4956311271136060 PMID:24475740
Sonne, C; Leifsson, P S; Dietz, R; Born, E W; Letcher, R J; Kirkegaard, M; Muir, D C G; Andersen, L W; Riget, F F; Hyldstrup, L
A 23-year-old female polar bear (Ursus maritimus) killed in an Inuit hunt in East Greenland on July 9, 1999 had a significantly enlarged clitoris resembling, in size, form and colour, those of previously reported 'pseudohermaphroditic' polar bears from Svalbard. It has been suggested that an enzyme defect (21-hydroxylase deficiency), androgen producing tumour or high exposure to organochlorines during the foetal stage or early development could be the reason for the supposed pseudohermaphroditism observed for Svalbard bears. Except for the enlarged clitoris, all dimensions of the external and internal reproductive organs of the present were similar to a reference group of 23 normal adult female polar bears from East Greenland collected in 1999-2002. The aberrant bear was a female genotype, and macroscopic examination of her internal reproductive organs indicated that she was reproductively functional. A histological examination of the clitoral enlargement in the present East Greenland specimen allows a first-time histological evaluation of the earlier macroscopic field diagnosis from Svalbard. This examination revealed intense chronic ulcerative and perivascular clitoriditis similar to "acral lick dermatitis" frequently seen in domestic dogs (i.e., we did not find any signs of pseudohermaphroditic hyperplasia of clitoral tissue due to androgenic or antiestrogenic endocrine disruption). The levels of organohalogens and TEQ values were lower than concentration thresholds of toxicological risk. It is hence possible that the previously reported adult female polar bear pseudohermaphrodites from Svalbard are in fact misdiagnoses. Therefore, future studies examining pseudohermaphroditism in wildlife should consider that certain occurrences are natural events, e.g., enlarged clitoris in the present East Greenland polar bear. Furthermore, caution should be exercised in suggesting linkages of such inflammatory abnormalities with correlations to anthropogenic pollutant
Wang, Y; Yang, L; Zhang, Z L
Here we reported two patients who presented with panuveitis and were transferred from ophthalmologists to rheumatologists, for both the patients had oral and genital ulcers. They were misdiagnosed with Behcet's disease at first glance. Two young males presented with acute uveitis with history of recurrent oral and genital ulcers. They initially presented with symptoms and signs resembling Behcet's disease and were treated with systemic steroids with suboptimal responses. Routine laboratory test revealed syphilis and human immunodeficiency virus (HIV) infection. After treatment of penicillin and anti HIV virus therapy, the panuveitis was relived. The other patient was lost in the follow up. Recently epidemiological data indicate that syphilis and HIV infection increase, which can mimic the manifestation of Behcet's disease. Diagnosis of sexual transmitted diseases, such as HIV or syphilis needs to be ruled out in all cases that mimic the clinical feature of Behcet's disease, especially for those who had a history of high risk behaviors. Every patient should have history analysis in detail. Screening of sexual transmitted diseases, such as HIV or syphilis is important especially in those rapid progressive panuveitis. Also, other virus infections, such as cytomegalovirus, epstein-barr virus or Herpes simplex virus can cause mucosa ulcers and uveitis. CD4 T cell count is a very important marker to indicate that the patient has immunodeficiency. Erythema nodosa and pseudofolliculitis are the third common clinical manifestation in Chinese Behcet's disease patients. Rheumatologist should watch out for patients without skin involvement when making the diagnosis of Behcet's disease. Syphilis-associated uveitis usually has a good prognosis. Treatment of antibiotics can get good response, 92% uveitis can be relieved, with 67% improved vision. Acute syphilitic posterior placoid chorioretinitis (ASPPC) is a clinically and angiographically distinct manifestation of ocular
Ozkaya, Esen; Topkarci, Zeynep; Ozarmağan, Güzin
A 29-year-old Turkish woman with allergic contact cheilitis from a lipstick was misdiagnosed as herpes labialis and subsequently worsened with the application of Zovirax cream. Patch tests were positive to Zovirax cream, propylene glycol, the patient's favourite lipstick and propyl gallate. No reaction was seen with Zovirax ophthalmic ointment and Zovirax tablet. The propylene glycol component of the Zovirax cream and the propyl gallate component of the lipstick were regarded as the responsible contact sensitizers. The differential diagnosis was challenging due to concomitant contact sensitization with these agents.
Sacknoff, Eric J.; Schweitzer, Jay; Slatkine, Michael; Mead, Douglass S.
The ability to vaporize extremely thin layers of epithelial tissue without any char and with minimal thermal necrosis is extremely advantageous in the treatment of superficial lesions of the external genitalia. We present a novel CO2 laser `SwiftLase' flashscan technology capable of providing char free ablation of 3 mm diameter lesions with only 150 micron residual thermal necrosis depth at power level as low as 10 watts. These power levels are achievable with a small transportable CO2 laser. The SwiftLaser is a miniature opto- mechanical scanner which homogeneously covers a 3 mm diameter surface with a 0.1 mm spot size focused beam within 0.1 seconds. The instantaneous beam's dwelling time is 1 millisecond. The instantaneous power density level at the focal point is higher than the threshold for char free ablation, thus providing a large char free ablation crater. Since depth of each ablated layer is 0.1 mm, the depth of treatment can be precisely controlled. The SwiftLaser technology has extensively and successfully been used in the last two years for the treatment of HPV in female lower tracts (Vulvectomy). The same technique may be performed with extramammary Paget's disease of the vulva, penile condylomata, and other epithelial disorders of the external genitalia without damage to surrounding healthy tissue. Technique and clinical results will be discussed.
Wolf, Jeffrey C; Baumgartner, Wes A; Blazer, Vicki S; Camus, Alvin C; Engelhardt, Jeffery A; Fournie, John W; Frasca, Salvatore; Groman, David B; Kent, Michael L; Khoo, Lester H; Law, Jerry M; Lombardini, Eric D; Ruehl-Fehlert, Christine; Segner, Helmut E; Smith, Stephen A; Spitsbergen, Jan M; Weber, Klaus; Wolfe, Marilyn J
Differentiating salient histopathologic changes from normal anatomic features or tissue artifacts can be decidedly challenging, especially for the novice fish pathologist. As a consequence, findings of questionable accuracy may be reported inadvertently, and the potential negative impacts of publishing inaccurate histopathologic interpretations are not always fully appreciated. The objectives of this article are to illustrate a number of specific morphologic findings in commonly examined fish tissues (e.g., gills, liver, kidney, and gonads) that are frequently either misdiagnosed or underdiagnosed, and to address related issues involving the interpretation of histopathologic data. To enhance the utility of this article as a guide, photomicrographs of normal and abnormal specimens are presented. General recommendations for generating and publishing results from histopathology studies are additionally provided. It is hoped that the furnished information will be a useful resource for manuscript generation, by helping authors, reviewers, and readers to critically assess fish histopathologic data.
Wolf, Jeffrey C.; Baumgartner, Wes A.; Blazer, Vicki; Camus, Alvin C.; Engelhardt, Jeffrey A.; Fournie, John W.; Frasca, Salvatore; Groman, David B.; Kent, Michael L.; Khoo, Lester H.; Law, Jerry M.; Lombardini, Eric D.; Ruehl-Fehlert, Christine; Segner, Helmut E.; Smith, Stephen A.; Spitsbergen, Jan M.; Weber, Klaus; Wolfe, Marilyn J.
Differentiating salient histopathologic changes from normal anatomic features or tissue artifacts can be decidedly challenging, especially for the novice fish pathologist. As a consequence, findings of questionable accuracy may be reported inadvertently, and the potential negative impacts of publishing inaccurate histopathologic interpretations are not always fully appreciated. The objectives of this article are to illustrate a number of specific morphologic findings in commonly examined fish tissues (e.g., gills, liver, kidney, and gonads) that are frequently either misdiagnosed or underdiagnosed, and to address related issues involving the interpretation of histopathologic data. To enhance the utility of this article as a guide, photomicrographs of normal and abnormal specimens are presented. General recommendations for generating and publishing results from histopathology studies are additionally provided. It is hoped that the furnished information will be a useful resource for manuscript generation, by helping authors, reviewers, and readers to critically assess fish histopathologic data.
Onuigbo, Macaulay Amechi Chukwukadibia; Agbasi, Nneoma; Achebe, Jennifer; Odenigbo, Charles; Oguejiofor, Fidelis
Portal hypertensive gastropathy (PHG) is a gastric mucosal lesion complicating portal hypertension, with higher prevalence in decompensated cirrhosis. PHG can sometimes complicate autosomal dominant polycystic kidney disease (ADPKD) due to the presence of multiple liver cysts. Besides, PHG is known to present as chest pain, with or without hematemesis. Other causes of chest pain in ADPKD include referred chest pain from progressively enlarging kidney cysts, and rare pericardial cysts. Chest pain, especially if pleuritic, in end-stage renal disease (ESRD) patients, is often ascribed to uremic pericarditis. We present recurrent pleuritic chest pain in a 24-year old ESRD patient with ADPKD that was initially misdiagnosed as uremic pericarditis. It was ultimately shown to represent symptomatic PHG with excellent therapeutic response to proton pump inhibitors. PMID:27069969
Zheng, Xiaodan; Xie, Jianlan; Zhou, Xiaoge
Epstein-Barr virus (EBV)-associated T-cell lymphoproliferative disease (LPD) is not uncommon in China, but gastrointestinal involvement is very rare. We report on an immunocompetent patient with EBV-associated T-cell LPD of the colon. The 26-year-old man was initially misdiagnosed with ulcerative colitis (UC). A colon biopsy revealed the presence of small to medium-sized lymphoid cells infiltrating the intestinal wall. The neoplastic cells expressed CD3, CD5, and granzyme B, not CD56. EBV-encoded small ribonucleic acid was detected in the tumor cells of the colon as well as the lymph node, and the T-cell receptor gene rearrangement result displayed δ gene monoclonal rearrangement. The patient died 2 moths after the diagnosis. The clinical course of EBV-associated T-cell LPD is aggressive and the prognosis is poor, the wrong diagnosis may delay treatment. Therefore, we should be very careful to prevent misdiagnosis. When patients have multiple intestinal ulcers that are not typical of UC and the clinical course is unusual, although morphology looks like inflammatory change, pathologist should consider the possibility of EBV-associated LPD. The treatment strategy and prognosis of these two diseases are different. PMID:26339440
Rekhi, Bharat; Agarwal, Archi
A 28-year-old lady presented with multiple swellings in her left shoulder, associated with intermittent pain since last one and a half years. Radiologic imaging revealed multiple, well-defined, subcutaneous lesions in her left supraclavicular region. Fine needle aspiration cytology (FNAC) smears were initially reported as Ewing sarcoma, elsewhere. On review, the smears showed cohesive clusters of round-to-oval cells with scant cytoplasm, which were focally arranged in an acinar-rosetting pattern around hyaline “droplets/bodies,” along with few scattered lymphocytes against a background of red blood cells. The diagnosis considered was adnexal tumor. Subsequent biopsy from the multiple lesions confirmed the diagnosis of eccrine spiradenoma. By immunohistochemistry, tumor cells were positive for CK7, epithelial membrane antigen (focally), S100 protein, and tyrosine-protein kinase Kit(C-KIT) /Cluster of differentiation (CD117). This case underscores the value of FNAC in skin adnexal tumors and constitutes as the first case report of multiple eccrine spiradenomas, initially misdiagnosed as Ewing sarcoma. Literature review of similar reported cases with treatment implications are presented. PMID:28182081
Shivali, Vaid; Pandey, Anil; Khanna, Vidhi D; Khanna, Prateek; Singh, Ashish; Ahuja, Tarun
Adenomatoid odontogenic tumor is a relatively uncommon distinct odontogenic neoplasm. It is an uncommon tumor of odontogenic origin with varying number of ductlike structures and inductive changes in the stroma. It is a benign and slow growing epithelial tumor and represents 3% of all odontogenic tumors. Its occurrence is more common in anterior region of the maxilla than mandible. Most of the adenomatoid odontogenic tumors occur intra-osseously but few peripheral variant have been reported which are attached to the gingival structures. The intra-osseous Adenomatoid odontogenic tumor may be related to unerrupted tooth (follicular varient) or may not (extrafollicular varient) be related to unerrupted tooth. This paper is to present a rare case of an extrafollicular Adenomatoid odontogenic tumor occurring in the body of the mandible in a male patient which is distinct and secondly it was clinically and radiographically diagnosed as residual cyst. The diagnosis of Adenomatoid odontogenic tumor was confirmed by Histopathological investigation. How to cite this article: Shivali V, Khanna VD, Khanna P, Singh A, Pandey A, Ahuja T. A Rare Case of Extrafollicular Adenomatoid Odontogenic Tumour in the Posterior Region of the Mandible: Misdiagnosed as Residual Cyst. J Int Oral Health 2013; 5(5):124-8. PMID:24324316
Zheng, Xiaodan; Xie, Jianlan; Zhou, Xiaoge
Epstein-Barr virus (EBV)-associated T-cell lymphoproliferative disease (LPD) is not uncommon in China, but gastrointestinal involvement is very rare. We report on an immunocompetent patient with EBV-associated T-cell LPD of the colon. The 26-year-old man was initially misdiagnosed with ulcerative colitis (UC). A colon biopsy revealed the presence of small to medium-sized lymphoid cells infiltrating the intestinal wall. The neoplastic cells expressed CD3, CD5, and granzyme B, not CD56. EBV-encoded small ribonucleic acid was detected in the tumor cells of the colon as well as the lymph node, and the T-cell receptor gene rearrangement result displayed δ gene monoclonal rearrangement. The patient died 2 moths after the diagnosis. The clinical course of EBV-associated T-cell LPD is aggressive and the prognosis is poor, the wrong diagnosis may delay treatment. Therefore, we should be very careful to prevent misdiagnosis. When patients have multiple intestinal ulcers that are not typical of UC and the clinical course is unusual, although morphology looks like inflammatory change, pathologist should consider the possibility of EBV-associated LPD. The treatment strategy and prognosis of these two diseases are different.
Thrombotic thrombocytopenic purpura misdiagnosed as autoimmune cytopenia: Causes of diagnostic errors and consequence on outcome. Experience of the French thrombotic microangiopathies reference centre.
Grall, Maximilien; Azoulay, Elie; Galicier, Lionel; Provôt, François; Wynckel, Alain; Poullin, Pascale; Grange, Steven; Halimi, Jean-Michel; Lautrette, Alexandre; Delmas, Yahsou; Presne, Claire; Hamidou, Mohamed; Girault, Stéphane; Pène, Frédéric; Perez, Pierre; Kanouni, Tarik; Seguin, Amélie; Mousson, Christiane; Chauveau, Dominique; Ojeda-Uribe, Mario; Barbay, Virginie; Veyradier, Agnès; Coppo, Paul; Benhamou, Ygal
Thrombotic thrombocytopenic purpura (TTP) has a devastating prognosis without adapted management. Sources of misdiagnosis need to be identified to avoid delayed treatment. We studied 84 patients with a final diagnosis of severe (<10%) acquired ADAMTS13 deficiency-associated TTP from our National database that included 423 patients, who had an initial misdiagnosis (20% of all TTP). Main diagnostic errors were attributed to autoimmune thrombocytopenia, associated (51%) or not (37%) with autoimmune hemolytic anemia. At admission, misdiagnosed patients were more frequently females (P = .034) with a history of autoimmune disorder (P = .017) and had organ involvement in 67% of cases; they had more frequently antinuclear antibodies (P = .035), a low/undetectable schistocyte count (P = .001), a less profound anemia (P = .008), and a positive direct antiglobulin test (DAT) (P = .008). In multivariate analysis, female gender (P = .022), hemoglobin level (P = .028), a positive DAT (P = .004), and a low schistocytes count on diagnosis (P < .001) were retained as risk factors of misdiagnosis. Platelet count recovery was significantly longer in the misdiagnosed group (P = .041) without consequence on mortality, exacerbation and relapse. However, patients in the misdiagnosed group had a less severe disease than those in the accurately diagnosed group, as evidenced by less organ involvement at TTP diagnosis (P = .006). TTP is frequently misdiagnosed with autoimmune cytopenias. A low schistocyte count and a positive DAT should not systematically rule out TTP, especially when associated with organ failure.
van der Linden, M; Meeuwis, K A P; Bulten, J; Bosse, T; van Poelgeest, M I E; de Hullu, J A
In this review, we provide an overview of the clinical aspects, histopathology, molecular genetics, and treatment options for Vulvar Paget's Disease (VPD), a rare skin disease, most commonly found in postmenopausal Caucasian women. The underlying cause of VPD remains not well understood. VPD is rarely associated with an underlying urogenital, gastrointestinal or vulvar carcinoma. In approximately 25% of the cases, VPD is invasive; in these cases, the prognosis is worse than in non-invasive cases. Recurrence rates in invasive VPD are high: 33% in cases with clear margins, and even higher when surgical margins are not clear, regardless of invasion. Historically, surgical excision has been the treatment of choice. Recent studies show that imiquimod cream may be an effective and safe alternative.
MA, JING; JIANG, YONGFANG; CHEN, XIANGYU; GONG, GUOZHONG
Langerhans cell histiocytosis (LCH) is a rare proliferative disorder in which pathological Langerhans cells accumulate in a variety of organs. LCH usually affects the bone, skin and lymph nodes of children; however, LCH occasionally affects vital organs, including the liver, spleen and pituitary gland. The present study reports a case of an adult LCH patient with marked liver damage, splenomegaly and pituitary damage treated using a new therapeutic strategy. This case was misdiagnosed as liver cancer and pituitary tumor on the basis of abdominal ultrasound, abdominal magnetic resonance imaging (MRI) and head MRI. The final diagnosis was established by identifying the proliferation of cluster of differentiation 1a-positive LCs in liver tissues. A new regimen of combined 12-week therapy of prednisolone/desmopressin/vincristine and 10 months of maintenance therapy of prednisolone/vinblastine/6-mercaptopurine improved symptoms, liver function and blood cell tests. PMID:24765185
Ribeiro, José Carlos Castelo Branco; Vieira, Sabas Carlos; da Silva, Benedito Borges; dos Santos, Lina Gomes; Costa, Pedro Vítor Lopes; da Fonsêca, Lia Andréa Costa
Female patient, 42-years-old, complaining of difficulty in urinating and swelling in the vulvar area for one year. Her gynecological examination showed extensive injury in the vulvar region and the biopsy done was inconclusive. The removal of the lesion was conducted. After the procedure, the patient remains free of recurrence for 15 months. This case highlights the need to consider angiomyxoma in the differential diagnosis for tumors of unknown cause in the vulvar region. PMID:26061077
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Three-Day Combination Treatment for Vulvovaginal Candidosis with 200 mg Clotrimazol Vaginal Suppositories and Clotrimazol Cream for the Vulva is Significantly Better than Treatment with Vaginal Suppositories Alone - an Earlier, Multi-Centre, Placebo-Controlled Double Blind Study.
Mendling, W; Schlegelmilch, R
Problem: According to the guidelines, acute vulvovaginal candidosis (VVC) may be treated vaginally, through a combination of vaginal treatment and cream for the vulva or orally. However, there is a lack of investigations into whether combined treatment for the vagina and vulva achieves better results than vaginal treatment alone. Method: In 1999, 160 patients with vulvovaginal candidosis from ten German gynaecological practices were included in a study and treated on a randomised basis with three 200 mg clotrimazol vaginal suppositories = clotrimazol 2 % cream (verum n = 79) or + placebo (active-ingredient-free cream base n = 79). The examinations took place before treatment (T1), six to eight days following the end of treatment (T2) and approximately four weeks following the end of treatment (T3). In addition to demographic data, the clinical findings of each investigation were documented in a standardised way and a native preparation and a fungal culture were taken. The doctor and patient evaluated the healing process and tolerance. The main efficacy variables were the pre/post difference scores for extravaginal redness. Results: On T1, there was no difference between the two groups. By T2, there was a significant difference in the extent of extravaginal redness between the verum and the placebo groups (p = 0.0002), as well as in the subgroup of the per-protocol analysis (verum 64, placebo 70 patients, p = 0.0015). Genital itching or burning had entirely disappeared in 51 % and 56 % of patients respectively in the verum group and in only 30 % and 45 % of patients in the placebo group on T2 (p = 0.0181). There was no difference in intravaginal redness on T1 and T2 in either group. The overall assessment by the doctor went accordingly (p = 0.0004). On T1, the extravaginal fungal culture was positive in 75 women in the verum group and in 76 women in the placebo group. On T2, however, this was positive in 51.9 % (verum) and
Three-Day Combination Treatment for Vulvovaginal Candidosis with 200 mg Clotrimazol Vaginal Suppositories and Clotrimazol Cream for the Vulva is Significantly Better than Treatment with Vaginal Suppositories Alone – an Earlier, Multi-Centre, Placebo-Controlled Double Blind Study
Mendling, W.; Schlegelmilch, R.
Problem: According to the guidelines, acute vulvovaginal candidosis (VVC) may be treated vaginally, through a combination of vaginal treatment and cream for the vulva or orally. However, there is a lack of investigations into whether combined treatment for the vagina and vulva achieves better results than vaginal treatment alone. Method: In 1999, 160 patients with vulvovaginal candidosis from ten German gynaecological practices were included in a study and treated on a randomised basis with three 200 mg clotrimazol vaginal suppositories = clotrimazol 2 % cream (verum n = 79) or + placebo (active-ingredient-free cream base n = 79). The examinations took place before treatment (T1), six to eight days following the end of treatment (T2) and approximately four weeks following the end of treatment (T3). In addition to demographic data, the clinical findings of each investigation were documented in a standardised way and a native preparation and a fungal culture were taken. The doctor and patient evaluated the healing process and tolerance. The main efficacy variables were the pre/post difference scores for extravaginal redness. Results: On T1, there was no difference between the two groups. By T2, there was a significant difference in the extent of extravaginal redness between the verum and the placebo groups (p = 0.0002), as well as in the subgroup of the per-protocol analysis (verum 64, placebo 70 patients, p = 0.0015). Genital itching or burning had entirely disappeared in 51 % and 56 % of patients respectively in the verum group and in only 30 % and 45 % of patients in the placebo group on T2 (p = 0.0181). There was no difference in intravaginal redness on T1 and T2 in either group. The overall assessment by the doctor went accordingly (p = 0.0004). On T1, the extravaginal fungal culture was positive in 75 women in the verum group and in 76 women in the placebo group. On T2, however, this was positive in 51.9 % (verum) and
Papakonstantinou, Danai; Riste, Michael J; Langman, Gerald; Moran, Ed
Whipple's disease is considered an infection of middle-aged white men of European ancestry. Cases are rare and disproportionately associated with occupational exposure to soil or animals. We report the case of a man aged 22 years with no risk factors, erroneously diagnosed with, and treated for, toxoplasmosis on the basis of consistent lymph node histology. The correct diagnosis was delayed by the dramatic symptomatic improvement resulting from this therapy. Whipple's disease should be considered in cases of granulomatous lymphadenopathy of unknown cause, even if the age of the patient does not fit the classic presentation of the disease.
Conde Montero, Elena; Sánchez-Albisua, Begoña; Guisado, Soledad; Ángeles Martín-Díaz, María; Balbín-Carrero, Eva; Valdivelso-Ramos, Marta; de la Cueva Dobao, Pablo
Dermatitis artefacta may represent a real challenge for the clinician. As the patient does not admit self-inflicting the lesions, misdiagnosis with other diseases, such as pyoderma gangrenosum, is common. Consequently, these patients normally go through unnecessary tests and receive potentially harmful treatments as clinicians determine their diagnosis. The authors present the case of a recurrent factitious abdominal ulcer that was initially diagnosed and treated as pyoderma gangrenosum. This report focuses on the necessity of suspecting dermatitis artefacta when morphology, history, and treatment failures are difficult to explain. It is essential to establish a supportive and confident approach and avoid initial confrontation. In-patient treatment may be useful and long-term followup may prevent recurrences.
Aljfout, Qais; Saraireh, Mohammad; Maita, Abdullah
Foreign body neglected in the nasal cavity for many years leads to the formation of a rhinolith, which gradually increases in size. Nasal obstruction and persistent foul smelling nasal discharge usually are the main presenting symptoms, although some might be silent. This paper presents and discuss a case of 19-year-old female patient whose main complaint was nasal obstruction for many years and treated as allergic rhinitis. Diagnosis was confirmed with computed tomography scan, and it was removed endoscopically without complications. We think that proper examination, which includes endoscopic evaluation, should be done to reach the diagnosis. A computed tomography scan confirmed the diagnosis and helped in planning the best treatment option. PMID:27053994
Lim, Tae Ha; Choi, Soo Il; Yoo, Jee In; Choi, Young Soon; Lim, Young Su; Sang, Bo Hyun; Bang, Yun Sic; Kim, Young Uk
Thalamic pain is a primary cause of central post-stroke pain (CPSP). Clinical symptoms vary depending on the location of the infarction and frequently accompany several pain symptoms. Therefore, correct diagnosis and proper examination are not easy. We report a case of CPSP due to a left acute thalamic infarction with central disc protrusion at C5-6. A 45-year-old-male patient experiencing a tingling sensation in his right arm was referred to our pain clinic under the diagnosis of cervical disc herniation. This patient also complained of right cramp-like abdominal pain. After further evaluations, he was diagnosed with an acute thalamic infarction. Therefore detailed history taking should be performed and examiners should always be aware of other symptoms that could suggest a more dangerous disease.
Strommen, Joshua; Shirazi, Farshad
The authors present a case report of a 17-month-old female child who ingested a large amount of methamphetamine that looked very similar clinically to a scorpion envenomation specific to the southwestern United States by the species Centruroides sculpturatus. The child was initially treated with 3 vials of antivenom specific for that scorpion species and showed a transient, though clinically relevant neurologic improvement. Her clinical course of sympathomimetic toxicity resumed and she was treated with intravenous fluids and benzodiazepines after blood analysis showed significant levels of d-methamphetamine. This case report is to specifically underline the clinical confusion in discerning between these two conditions and the realization of limited and/or expensive resources that may be used in the process. PMID:25649670
Eberhard, Mark L; Thiele, Elizabeth A; Yembo, Gole E; Yibi, Makoy S; Cama, Vitaliano A; Ruiz-Tiben, Ernesto
Thirty-seven unusual specimens, three from Ethiopia and 34 from South Sudan, were submitted since 2012 for further identification by the Ethiopian Dracunculiasis Eradication Program (EDEP) and the South Sudan Guinea Worm Eradication Program (SSGWEP), respectively. Although the majority of specimens emerged from sores or breaks in the skin, there was concern that they did not represent bona fide cases of Dracunculus medinensis and that they needed detailed examination and identification as provided by the World Health Organization Collaborating Center (WHO CC) at Centers for Disease Control and Prevention (CDC). All 37 specimens were identified on microscopic study as larval tapeworms of the spargana type, and DNA sequence analysis of seven confirmed the identification of Spirometra sp. Age of cases ranged between 7 and 70 years (mean 25 years); 21 (57%) patients were male and 16 were female. The presence of spargana in open skin lesions is somewhat atypical, but does confirm the fact that populations living in these remote areas are either ingesting infected copepods in unsafe drinking water or, more likely, eating poorly cooked paratenic hosts harboring the parasite.
Eberhard, Mark L.; Thiele, Elizabeth A.; Yembo, Gole E.; Yibi, Makoy S.; Cama, Vitaliano A.; Ruiz-Tiben, Ernesto
Thirty-seven unusual specimens, three from Ethiopia and 34 from South Sudan, were submitted since 2012 for further identification by the Ethiopian Dracunculiasis Eradication Program (EDEP) and the South Sudan Guinea Worm Eradication Program (SSGWEP), respectively. Although the majority of specimens emerged from sores or breaks in the skin, there was concern that they did not represent bona fide cases of Dracunculus medinensis and that they needed detailed examination and identification as provided by the World Health Organization Collaborating Center (WHO CC) at Centers for Disease Control and Prevention (CDC). All 37 specimens were identified on microscopic study as larval tapeworms of the spargana type, and DNA sequence analysis of seven confirmed the identification of Spirometra sp. Age of cases ranged between 7 and 70 years (mean 25 years); 21 (57%) patients were male and 16 were female. The presence of spargana in open skin lesions is somewhat atypical, but does confirm the fact that populations living in these remote areas are either ingesting infected copepods in unsafe drinking water or, more likely, eating poorly cooked paratenic hosts harboring the parasite. PMID:26055739
Galeana, Cuauhtémoc; Casas, Donovan; Rodríguez, Alejandra; Cantú, Marco Antonio; Aguilar, Fabiola; Moreno, Víctor; Galindo, María Estela; Gutiérrez, Eduardo Ernesto
The vulvovaginal region is a very complex area because of its anatomy and the fact that it can be source of a large number of benign tumors and less frequent malignant tumors. In recent decades, there have been significant gains in the diagnosis and treatment of vulvovaginal tumors, thanks to the contributions of cellular and molecular biology. The purpose of this review article is to serve as a practical reference for clinical and pathological diagnosis as well as in the outpatient treatment and monitoring of these benign tumors.
Haidopoulos, Dimitrios; Bakolas, George
Summary Turner syndrome (TS) has been linked to a number of autoimmune conditions, including lichen sclerosus (LS), at an estimated prevalence of 17%. LS is a known precursor to vulvar cancer. We present a case of vulvar cancer in a 44-year-old woman, who had previously complained of pruritus in the area, a known symptom of LS. Histology confirmed a squamous cell carcinoma with underlying LS. Vulvar assessment for the presence of LS should be undertaken regularly as part of the routine assessments proposed for adult TS women. If LS is identified, then the patient should be warned of the increased risk of vulvar cancer progression and should be monitored closely for signs of the condition. Learning points Patients with TS are at increased risk of developing LS.LS is a known precursor to vulvar cancer.TS women with LS may be at risk of developing vulvar cancer and should be offered annual vulvar screening and also be aware of signs and symptoms of early vulvar cancer. PMID:27252865
Snell, Luke Blagdon; Bakshi, Dinkar
We present a case of adverse neurological effects of methylphenidate therapy for attention deficit and hyperactivity disorder (ADHD). A 7-year-old boy presented to the emergency department (ED) having developed ataxic gait, orofacial dyskinesias and choreoathetosis of the limbs. The results of all blood investigations, EEG and CT scan of the head were unremarkable. Subsequently, a detailed history revealed he was being treated for ADHD, being started on methylphenidate in the past 3 months. Discontinuation of methylphenidate led to significant and rapid amelioration of neurological adverse effects.
Ingersoll, Richard M.
This issue of CPRE Policy Briefs summarizes the findings on issues related to teacher quality in the chapter by the author in the book, "The State of Education Policy Research" (Cohen, Fuhrman, Mosher, Eds., 2007). This report also draws on discussions that took place during a summer, 2006, policy briefing on teacher labor-market issues…
Hirschhorn, Norbert; Longsworth, Polly
Lyndall Gordon's recent biography, Lives Like Loaded Guns: Emily Dickinson and Her Family's Feuds (2010), tells with high verve the story of generational infighting over poet Emily Dickinson's posthumous presentation to the world. Equally dramatic is Gordon's hypothesis that Dickinson suffered from epilepsy, which led Gordon to seemingly solve the ineffable mystery of Dickinson's reclusion, a conundrum in her own time and still so in ours. Gordon's startling diagnosis has been commended by book reviewers and on talk shows. Her hypothesis is based on two lines of inquiry. First, she avers that a compound called glycerine, which Dickinson took regularly in the early 1850s, was an anti-epileptic, basing this notion on its presence in a mixture containing the soporific chloral hydrate, a prescription first advised for epilepsy some two decades later. Second, Gordon proposes a genetic strain of epilepsy in the Dickinson family. In the process, Gordon recruits Dickinson's various illnesses to her hypothesis. This article refutes Gordon's claims on scientific, clinical, and biographical grounds. It reviews Dickinson's medical history to establish a differential diagnosis, in which epilepsy is considered and rejected.
O'Hear, Kelley E; Ingrande, Jerry; Brodsky, Jay B; Morton, John M; Sung, Chih-Kwang
We describe a patient with Wegener granulomatosis whose complaint of wheezing was incorrectly attributed to asthma. Anesthesiologists must recognize that tracheal stenosis is extremely common in Wegener granulomatosis and can mimic other causes of wheezing.
Della Casa, Roberto; Ungaro, Carla; Acampora, Emma; Pignata, Claudio; Vajro, Pietro; Salerno, Mariacarolina; Santamaria, Francesca; Parenti, Giancarlo
We report on a female patient affected by galactosemia in whom the diagnosis was obscured by the concomitant presence of manifestations suggesting a cow's milk intolerance. This case exemplifies the problems in reaching a correct diagnosis in patients with metabolic diseases.
Johnson, G S; Guly, H R
Thirteen patients presented to an accident and emergency (A&E) department with acute calcific periarthritis of joints other than the shoulder. In only three patients was the correct diagnosis made on the initial attendance with inappropriate treatment and delay in recovery as a result. The specific features and guidelines for management of this condition are reviewed. Images Fig. 1 PMID:7804591
Ahmed, Syed Tausif; Ranjan, Rajeev; Saha, Subhendu Bikas; Singh, Balbodh
Acute appendicitis is one of the most common emergencies handled by a surgeon. Various aetiologies of acute appendicitis have been proposed but none have been proved. Trauma too has been proposed as a cause of acute appendicitis. Here we present a case of blunt trauma abdomen which was explored to rule out a perforation of hollow viscous organ and haemoperitoneum, but at the time of exploration a perforated appendicitis was found. The chronological order of events points towards blunt trauma as the probable cause of this appendicitis. This case also highlights the fact that even if trauma was not the cause of acute appendicitis, acute appendicitis should still be kept in the differential diagnosis of a patient presenting with pain in the right lower abdomen and a history of trauma. PMID:24759158
Objective The purpose of this case report is to describe a patient who presented with a case of peroneal neuropathy that was originally diagnosed and treated as a L5 radiculopathy. Clinical features A 53-year old female registered nurse presented to a private chiropractic practice with complaints of left lateral leg pain. Three months earlier she underwent elective left L5 decompression surgery without relief of symptoms. Intervention and outcome Lumbar spine MRI seven months prior to lumbar decompression surgery revealed left neural foraminal stenosis at L5-S1. The patient symptoms resolved after she stopped crossing her legs. Conclusion This report discusses a case of undiagnosed peroneal neuropathy that underwent lumbar decompression surgery for a L5 radiculopathy. This case study demonstrates the importance of a thorough clinical examination and decision making that ensures proper patient diagnosis and management. PMID:23618508
Ponte, Marta; Dias, Adelaide; Dias Ferreira, Nuno; Fonseca, Conceição; Mota, João Carlos; Gama, Vasco
We present the case of a 47-year-old man with hypertension for over 20 years, referred to our hospital due to mild aortic dilatation detected on a transthoracic echocardiogram. On physical examination weak lower limb pulses and a blood pressure differential of >50 mmHg between arms and legs were detected. Complete interruption of the aortic arch below the left subclavian artery was diagnosed by computed tomography angiography. With this case we aim to draw attention to aortic coarctation and interrupted aortic arch as potential causes of hypertension and to highlight the importance of the physical examination in the diagnosis of secondary causes of hypertension.
Wang, Chih-Jung; Wu, Ta-Jen; Lee, Chung-Ta; Huang, Shih-Ming
Riedel's thyroiditis, known as invasive fibrous thyroiditis, is a very rare form of chronic thyroiditis. It is hard to make the diagnosis without surgical biopsy. We present a case of Riedel's thyroiditis in a 52-year-old female with past history of Hashimoto's thyroiditis. She suffered from bilateral neck pain, which radiated to both lower jaws. The erythrocyte sedimentation rate was 125 mm/hour. Subacute thyroiditis superimposed on Hashimoto's thyroiditis was diagnosed and treated with steroid. However the response was poor and she had a history of severe peptic ulcer. To avoid inducing the peptic ulcer by steroid, she received bilateral subtotal thyroidectomy. During surgery, the thyroid had severe adhesion to surrounding soft tissue and the pathology showed Riedel's thyroiditis. The neck pain improved after thyroidectomy. Tamoxifen has been given for 8 months and the size of remnant thyroid decreased to 8 mm. We concluded that combined thyroidectomy and tamoxifen successfully cured a patient with Riedel's thyroiditis.
Mirabelli-Badenier, M; Biancheri, R; Morana, G; Fornarino, S; Siri, L; Celle, M E; Veneselli, E; Vincent, A; Gaggero, R; Mancardi, M M
Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a well-defined autoimmune disorder. Hashimoto's encephalopathy (HE) is a still controversial entity, lacking definite diagnostic criteria. We described a 14-year-old-girl presenting with a clinical picture consistent with the diagnosis of anti-NMDAR encephalitis, confirmed by NMDAR antibody testing. Four years earlier, she had presented a similar episode of acute encephalopathy diagnosed as HE. Anti-NMDAR encephalitis and HE share similar clinical features so that the differential diagnosis can be difficult if specific antibodies are not tested. The correct diagnosis of anti-NMDAR encephalitis is crucial to plan the appropriate management and follow-up, namely in term of oncological screening, since it can be paraneoplastic in origin. We suggest to re-evaluate the clinical history of all subjects with previous HE diagnosis in order to evaluate the possible diagnosis of anti-NMDAR encephalitis and plan the appropriate management of these patients.
Serarslan, Gamze; Akçalý, Cenk; Atik, Esin
The incidence of acral lentiginous melanoma (ALM) varies in different ethnic groups. Volar skin is a relatively infrequent site of malignant melanoma in Caucasian patients, although the foot is the most common site of involvement in Asian and African populations. Diagnosis of ALM is usually delayed and melanomas can be diagnosed at advanced clinical stages, so the prognosis is often poor. We present a Caucasian Turkish man with ALM on the interdigital site of his foot, however, as a result of maceration of the surrounding skin, it seemed to be tinea pedis.
Manrai, Arjun K.; Funke, Birgit H.; Rehm, Heidi L.; Olesen, Morten S.; Maron, Bradley A.; Szolovits, Peter; Margulies, David M.; Loscalzo, Joseph; Kohane, Isaac S.
BACKGROUND For more than a decade, risk stratification for hypertrophic cardiomyopathy has been enhanced by targeted genetic testing. Using sequencing results, clinicians routinely assess the risk of hypertrophic cardiomyopathy in a patient’s relatives and diagnose the condition in patients who have ambiguous clinical presentations. However, the benefits of genetic testing come with the risk that variants may be misclassified. METHODS Using publicly accessible exome data, we identified variants that have previously been considered causal in hypertrophic cardiomyopathy and that are overrepresented in the general population. We studied these variants in diverse populations and reevaluated their initial ascertainments in the medical literature. We reviewed patient records at a leading genetic-testing laboratory for occurrences of these variants during the near-decade-long history of the laboratory. RESULTS Multiple patients, all of whom were of African or unspecified ancestry, received positive reports, with variants misclassified as pathogenic on the basis of the understanding at the time of testing. Subsequently, all reported variants were recategorized as benign. The mutations that were most common in the general population were significantly more common among black Americans than among white Americans (P<0.001). Simulations showed that the inclusion of even small numbers of black Americans in control cohorts probably would have prevented these misclassifications. We identified methodologic shortcomings that contributed to these errors in the medical literature. CONCLUSIONS The misclassification of benign variants as pathogenic that we found in our study shows the need for sequencing the genomes of diverse populations, both in asymptomatic controls and the tested patient population. These results expand on current guidelines, which recommend the use of ancestry-matched controls to interpret variants. As additional populations of different ancestry backgrounds are sequenced, we expect variant reclassifications to increase, particularly for ancestry groups that have historically been less well studied. (Funded by the National Institutes of Health.) PMID:27532831
Das, Bishnu Prasad; Baruah, Dipankar; Medhi, Kaberee Bhuyan; Talukder, Bharat
Aggressive angiomyxoma is a rare, locally invasive mesenchymal tumor predominantly presenting in women of reproductive age and also having a moderate-to-high risk for local relapse. Hence, it needs to be differentiated from other mesenchymal tumors occurring in this region. We present here a case of a 40-year-old female presenting with a large, fleshy, pedunculated mass on the right labia majora. PMID:27721642
Sanderson, P; Innamaa, A; Palmer, J; Tidy, J
Extramammary Paget's disease (EMPD) is a rare intraepidermal adenocarcinoma that can affect the vulval skin. Surgical excision is the gold-standard treatment, however, recurrence rates are high and extensive excisions can produce long-lasting cosmetic and functional defects. We describe one of the largest case series to-date (n = 6) on the use of topical 5% imiquimod cream as a novel treatment option and discuss our experiences. With the addition of our six cases to the literature, there are now 29 documented cases of vulval EMPD treated with 5% imiquimod cream. Of these, 50% of primary disease cases and 73% of recurrent primary disease cases have achieved clinical resolution with 5% imiquimod therapy alone. These findings suggest that imiquimod provides a viable alternative to surgical excision for vulval EMPD. However, we acknowledge that this is a simple retrospective analysis and that treatment scheduling and follow-up needs investigation in a trial setting.
Abdelbaqi, Maisoun; Shackelford, Rodney E; Quigley, Brian C; Hakam, Ardeshir
An 82-year-old Caucasian woman had a long-standing history of recurrent Paget’s disease of the right perianal region that was documented by multiple skin biopsies. Histological examination of a skin biopsy from an erythematous raised right perianal area revealed large rounded cells with ample pale staining cytoplasm scattered throughout the epidermis in multifocal nests and a flattened basal layer. A second lesion showed tongues of basaloid cells with peripheral palisading in continuity with the undersurface of the epidermis at multiple points. The individual tumor nests had cytoplasmic melanization and slit-like stromal separation. The tumor cells in the epidermis showed positive immunoreactivity for carcinoembryonic antigen while the basaloid cells were negative. A diagnosis of combined vulvar Paget’s disease and basal cell carcinoma of an infundibulocystic type was rendered. Concurrent involvement of the same area by Paget’s disease and Basal cell carcinoma (BCC) has been reported only once. Here we report a second case of BCC concurrent with vulvar Paget’s disease. PMID:22949943
Edwards, Lisa R; Privette, Emily D; Patterson, James W; Tchernev, Georgi; Chokoeva, Anastasiya Atanasova; Wollina, Uwe; Lotti, Torello; Wilson, Barbara B
A 67-year-old woman presented with a firm plaque in the perineal region, 16 months after diagnosis of a high-grade basaloid squamous cell carcinoma of the vagina and treatment by external beam radiation therapy and vaginal cuff brachytherapy. The differential diagnosis included radiation-induced morphea, radiation dermatitis, or, possibly, radiation-induced lichen sclerosus. Biopsy findings, including special staining, confirmed the diagnosis of radiation-induced lichen sclerosus. To our knowledge, this is the first report of radiation-induced lichen sclerosus of the vulvar region.
Pekka, Nieminen; Anttila, Ahti; Bützow, Ralf; Heikkilä, Elina; Hiltunen-Back, Eija; Mäenpää, Johanna; Puistola, Ulla; Rantanen, Virpi; Rintala, Marjut; Räisänen, Ilkka; Santalahti, Anne; Talvensaari-Mattila, Anne; Vartiainen, Juhani; Vuento, Maarit; Yliskoski, Merja
Approximately 150 cervical cancer cases are diagnosed in Finland annually. Both incidence and mortality have decreased by 80% since organised screening began. Recently, screening based on primary HPV-testing with Pap-smear triage has been shown to be more sensitive and more specific among women over 35 years old in randomised studies and thus may be implemented in routine. Abnormal findings in Pap smears indicate management. Confirmed CIN1 lesions are followed up and CIN2 and worse lesions treated. Follow-up after treatment should be reliably arranged, because elevated risk of cancer remains over 20 years after treatment. Quality control is of utmost importance.
Abbott, Jared J; Ahmed, Iftikhar
Mammary-like glands are a poorly recognized structure of normal vulvar skin. Adenocarcinomas arising from these glands are rare and represent a distinct clinicopathologic entity that must be distinguished from metastatic tumors. We reviewed 19 cases reported in the literature and describe a 51-year-old patient with a long-standing nodule on her right interlabial sulcus. Excisional biopsy and Mohs micrographic surgery demonstrated an infiltrating adenocarcinoma of the mammary-like glands involving the dermis and subcutis. On review of all 20 cases, the mean age at diagnosis was 59.6 years, the labia majora were involved in 13 cases (65%), and the mean lesional size was 2.5 cm. The tumor's histologic patterns varied greatly, although the histomorphologic similarity among this neoplasm, sweat gland carcinomas, and invasive extramammary Paget disease suggested a morphologic spectrum among these tumors. Criteria for establishing the diagnosis of adenocarcinoma of mammary-like glands include identifying transition zones between normal mammary-like glands and adenocarcinomatous areas. This tumor is best categorized as a locally aggressive neoplasm with a low risk for widespread metastasis. Use of aggressive surgical therapeutic regimens, particularly in the case of tumors localized to the skin, must be reassessed, especially given the likelihood of long-term morbidity with such regimens. In our patient, successful Mohs micrographic surgery suggests that alternate management may be adopted for tumors localized to the skin, especially in elderly patients.
Krokidis, Miltiadis; Venetucci, Pietro; Hatzidakis, Adam; Iaccarino, Vittorio
We report five cases of female patients affected by symptomatic focal external genital venous malformations treated with percutaneous direct intralesional injection of sodium tetradecyl sulphate (STS). All patients were referred because of discomfort and pain when sexual intercourse was attempted. Direct sclerotherapy with 3% STS was performed on a day-hospital basis with the patient under local anesthesia. Complete resolution of the symptoms was achieved in all cases. No major adverse effects were reported. Direct intralesional sclerotherapy with STS may be considered a safe and effective method for the treatment of female external genital malformation without the necessity of general anesthesia for pain control.
Shaco-Levy, Ruthy; Bean, Sarah M; Vollmer, Robin T; Papalas, John A; Bentley, Rex C; Selim, Maria Angelica; Robboy, Stanley J
The Duke experience with 56 vulvar Paget disease patients was analyzed emphasizing pathologic features and controversial issues. Nearly all patients were Caucasian, and their mean age was 69 years. The average length of follow-up was 5.6 years. For each case, the following histologic features were evaluated and their association with disease course was examined: pseudo-invasion, adnexal involvement, signet-ring cells, cytologic atypia, glands formation, epidermal acantholysis, parakeratosis, hyperkeratosis, and chronic inflammation. The recurrence rate after surgical management was 32%, with epidermal acantholysis being the only statistically significant risk factor. Stromal invasion occurred in 10 patients (18%), and was not a statistically significant adverse prognostic indicator, although the single patient who died of the disease had the deepest stromal invasion. Recurrence was more common after resections with positive surgical margins, but this correlation was not statistically significant. Intraoperative frozen section analysis of the margins did not reduce recurrence rate, nor was it useful in attaining permanent free margins. The Paget cells were consistently reactive with cytokeratin-7 and carcinoembryonic antigen and unreactive with S-100 protein, HMB-45, and Mart-1. In addition, the tumor cells were usually positive for mucin stains. This profile helps distinguish vulvar Paget disease from its mimics, Pagetoid squamous cell carcinoma and malignant melanoma.
Straaton, K.V.; Lopez-Mendez, A.; Alarcon, G.S. )
We describe 3 patients with rheumatoid arthritis who presented with diffuse pain, swelling, and erythema of the distal aspect of the lower extremity, suggestive of either cellulitis or thrombophlebitis, but were found to have insufficiency fractures of the distal tibia. The value of technetium-99m diphosphonate bone scintigraphy in the early recognition of these fractures and a possible explanation for the associated inflammatory symptoms are discussed.
Lee, Hyun Ho; Park, Sung Hee; Choi, Hye Young; Park, Heung Kyu
Eccrine spiradenomas are rare, benign, cutaneous tumors that originate in the sweat glands. Eccrine spiradenomas in the breast are very rare and only a few cases have been reported. We report here on the case of a 47-year-old woman with superficial masses in the breast and these masses had gradually increased in size during follow-up. They were confirmed to be an eccrine spiradenoma on pathologic examination. There have been a few reports about the radiologic findings of eccrine spiradenomas of the breast. This is the first case of an eccrine spiradenoma in the breast that was characterized by multiple imaging modalities, including mammography, ultrasonography and MRI. The lesion in our patient was first diagnosed as an epidermal inclusion cyst based on the imaging findings and the mass's superficial location. Although the mammographic and ultrasonographic imaging findings of eccrine spiradenomas and epidermal inclusion cysts are similar, the MRI findings are different between epidermal inclusion cysts and eccrine spiradenomas. Eccrine spiradenomas should be considered in the differential diagnosis of cutaneous and subcutaneous lesions of the breast.
Li, Hong-Jiang; Han, Hong-Xiu; Feng, Dong-Fu
Reports describing a rapid increase in the cystic volume of anaplastic astrocytoma (AA) in a short time frame are rare. The present study reports the case of a 68-year-old male who was admitted to the No. 9 People's Hospital, Shanghai Jiaotong University School of Medicine (Shanghai, China), with a small cystic brain lesion and positive immunological testing for cysticercosis. Head magnetic resonance imaging (MRI) showed a cystic lesion, 6 mm in diameter, in the left frontal lobe. Neurocysticercosis was suspected and the patient was treated with a clinical trial of albendazole and steroids. A period of 25 days later, the patient's condition had deteriorated, and MRI revealed a cystic lesion in the left frontal lobe; thereafter, the cystic lesion was removed and a diagnosis of AA was established. The tumor was soft, ivory white and gelatinous due to myxoid degeneration. In this case, tumor-related angiogenesis and microvascular extravasation (blood-brain barrier disruption) may have been the main cause of the rapid increase in the cystic volume in such a short time frame. The similarity of the glioma and cysticercus antigens may have been the cause of the positive reactions in the cystic fluid. The present study reports the rare occurrence of a rapid increase of cystic volume and potential diagnostic difficulties. PMID:27698865
Meng, Xubiao; Li, Zhiming; Liu, Tingting; Wen, Zhiming
A 21-year-old woman with a short stature presented with primary amenorrhoea and a 45X karyotype, and comparative genomic hybridization revealed 1p36 deletion and abnormal genes in multiple chromosomes to support the diagnosis of Turner syndrome and monosomy 1p36 deletion syndrome. The main clinical features of this condition include microsomia, poor sexual development, menoschesis, gigantorectum, absence of internal genitalia, sometimes with thyropenia and low intelligence. This disease can be easily diagnosed for its heterogeneous clinical manifestations.
Mandal, S N; Jha, R; Fatima, R; Swarnalata, G
A 19-year-old male presented with persistent macroscopic hematuria for last 3 months. On initial evaluation, he was found to have minimal proteinuria, normal renal function, and normal complement with negative lupus serology. Light microscopy, immunofluorescence and electron microscopy of renal tissue confirmed the presence of C1q nephropathy. Because of poor response to immunosuppressive agent (prednisolone and mycophenolate mofetil), passage of urinary clot once and vexing persistent macroscopic hematuria, alternative diagnosis was considered. Cystourethroscopy showed urethritis of prostatic urethra. Immunosuppressives were stopped and doxycycline started to which hematuria responded dramatically. This case report illustrates that hematuria in this patient was because of undiagnosed urethritis rather than incidental C1q nephropathy.
Vazquez-Lopez, Francisco; Fueyo-Casado, Alejandro; Gonzalez-Lara, Leire
A small percentage of patients with tuberculosis present with cutaneous findings, which may be difficult to diagnose. We present a patient diagnosed with a rare, non-scarring form of cutaneous tuberculosis (CTB), classically termed as lupus vulgaris erythematoides.
D’Eufemia, Patrizia; Palombaro, Marta; Lodato, Valentina; Zambrano, Anna; Celli, Mauro; Persiani, Pietro; De Bari, Maria Pia; Sangiorgi, Luca
Summary Osteogenesis imperfecta (OI) is a rare hereditary disease caused by mutations in genes coding for type I collagen, resulting in bone fragility. In literature are described forms lethal in perinatal period, forms which are moderate and slight forms where the only sign of disease is osteopenia. Child abuse is an important social and medical problem. Fractures are the second most common presentation after skin lesions and may present specific patterns. The differential diagnosis between slight-moderate forms of OI and child abuse could be very challenging especially when other signs typical of abuse are absent, since both could present with multiple fractures without reasonable explanations. We report a 20 months-old female with a history of 4 fractures occurred between the age of three and eighteen months, brought to authorities’ attention as a suspected child abuse. However when she came to our department physical examination, biochemical tests, total body X-ray and a molecular analysis of DNA led the diagnosis of OI. Thus, a treatment with bisphosphonate and a physical rehabilitation process, according to Vojta method, were started with improvement in bony mineralization, gross motor skills and absence of new fracture. In conclusion our case demonstrates how in any child presenting fractures efforts should be made to consider, besides child abuse, all the other hypothesis even the rarest as OI. PMID:23289038
Benndorf, G.; Assmann, U.; Bender, A.; Lehmann, T. N.; Lanksch, W. R.
Summary A 59-year-old man with neurofibromatosis type 1 (NF1) presented with bruits and neck pain due to a space occupying lesion in the right neck tissue. Digital subtraction angiography (DSA) showed an arteriovenous fistula (AVF) of the right extracranial vertebral artery (VA) with a giant venous pouch and an intracranial berry aneurysm of the right middle cerebral artery (MCA). First, the MCA aneurysm was surgically clipped, then the patient was treated by embolisation with coils. The coils were placed transarterially from the left VA resulting in a partial thrombosis of the venous pouch. Complete closure was achieved secondarily by retrograde transvenous catheterization. Etiology and treatment modalities are discussed. PMID:20667184
Medford, Beth A; Bos, J Martijn; Ackerman, Michael J
Cardiogenic seizures are common and could be the sentinel event heralding the presence of congenital long QT syndrome (LQTS). Distinguishing a cardiogenic seizure from a neurogenic one is of the utmost importance. Herein, we present the case of a 12-year-old boy with recurrent episodes of syncope and seizures. Despite absence of QT prolongation on electrocardiogram, absence of documented arrhythmias, a negative LQTS genetic test, and recurrent episodes while on nadolol beta-blocker therapy, he was diagnosed with LQTS and implanted with an implantable cardioverter defibrillator (ICD). When syncope and seizure occurred with normal sinus rhythm documented on the ICD, he was referred to neurology, and an electroencephalogram was positive for numerous bursts of bilaterally synchronous generalized discharges. He was started on antiepileptic treatment after which his seizures resolved. His LQTS diagnosis was removed, beta-blocker therapy discontinued, and his ICD was explanted. He has been seizure-free for over 2 years.
Nørby, S; Lestienne, P; Nelson, I; Nielsen, I M; Schmalbruch, H; Sjö, O; Warburg, M
We have investigated a 15 year old girl with progressive external ophthalmoplegia, including bilateral ptosis and retinal rod and cone cell dysfunction with atypical retinal pigmentation, complicated by cerebellar ataxia, partial cardiac conduction block, and diabetes mellitus. In infancy she had a severe crisis of bone marrow depression, and as a child she suffered from hypersensitivity to light, increasing fatigue, and vertigo, signs that were initially though to be psychosomatic. Histological examination showed mitochondrial myopathy, and subsequent mitochondrial DNA (mtDNA) analysis showed a deletion of approximately 5500 base pairs in 35 to 40% of her muscle mtDNA. We therefore conclude that this patient has developed the Kearns-Sayre syndrome after a Pearson syndrome-like crisis in her first year of life.
Katsukawa, Chihiro; Kushibiki, Chieko; Nishito, Atsumi; Nishida, Rikou; Kuwabara, Norimitsu; Kawahara, Ryuji; Otsuka, Nao; Miyaji, Yusuke; Toyoizumi-Ajisaka, Hiromi; Kamachi, Kazunari
We report a case of a bronchitis caused by Bordetella holmesii in a 2-year-old girl with asthma. The patient had a moderate fever and productive cough, and her condition was initially diagnosed as mycoplasmal bronchitis on the basis of her clinical symptoms and rapid serodiagnosis of mycoplasmal infection. She was treated with a bronchodilator and clarithromycin, which resulted in complete recovery. However, after the initial diagnosis, nucleic acid amplification tests of her sputum showed the absence of both Mycoplasma pneumoniae and Bordetella pertussis infections. Sputum culture showed the presence of a slow-growing, gram-negative bacillus in pure culture on Bordetella agar plates; the bacillus was later identified as B. holmesii. B. holmesii infection is rare in immunocompetent children; however, the organism is a true pathogen that can cause bronchitis in young children with asthma.
Nelson, Fred R T; Bhandarkar, Varun S; Woods, Tammy A
In the early phases, subchondral insufficiency fractures and rapidly destructive osteoarthritis of the hip are often mistaken for osteonecrosis of the hip. Three hip measures were used comparing combined subchondral insufficiency fractures and rapidly destructive 18 osteoarthritis patients to 18 osteonecrosis patients. Due to the rarity of these conditions there was no statistical power. Initial diagnoses for the osteoarthritis patients were recorded. The osteoarthritis group had significantly higher means for Tönnis angle (P < 0.001), lateral center edge angle (P = 0.006), and acetabular extrusion index (P = 0.014). Only 7 of the 18 patients were initially diagnosed without reservation as subchondral insufficiency fracture or rapidly destructive osteoarthritis. Using hip measures will reduce the misdiagnosis of rapid onset osteoarthritis of the hip for osteonecrosis.
Katiyar, Richa; Kumar, Sandip; Khanna, Rahul
Male breast cancers constitute less than 1% of all the breast cancers. Papillary carcinoma is a very rare tumour of the male breast. Due to rarity, Fine Needle Aspiration Biopsy (FNAB) findings of papillary carcinoma in male breast are seldom reported. A 55-year-old male presented with a lump in the left breast of two years’ duration. FNAB was reported as fibroadenoma. Histopathological examination of the excised breast lump revealed invasive papillary carcinoma. Immunohistochemistry showed expression of pancytokeratin, oestrogen receptor, and progesterone receptor. Negative immunostaining was seen for HER2, p53, 34βE12, and CD34. Ki-67 proliferative index was 5%. We have discussed cytological findings of invasive papillary carcinoma and its differential diagnoses. Cytopathologists must be aware of cytologic findings of invasive papillary carcinoma of the male breast. PMID:28384872
Upala, Sikarin; Yong, Wai Chung; Sanguankeo, Anawin
Context: Autoimmune polyglandular syndrome is a rare condition that causes a variety of clinical symptoms due to autoimmune processes involving multiple endocrine organs. Its vague presentation can cause missed or delayed treatment for adrenal insufficiency, resulting in a life-threatening adrenal crisis. Case Report: A 21-yr-old man presented with lethargy, hypotension, hyponatremia, hypoglycemia, and an elevated thyroid-stimulating hormone level. He was binge drinking the day before presentation. No significant response to initial treatment with levothyroxine and dextrose occurred. Diagnostic workup later revealed primary adrenal insufficiency. All initial symptoms completely resolved following treatment with hydrocortisone, fludrocortisone, and levothyroxine. Conclusion: Autoimmune polyglandular syndrome causes dysfunction of multiple endocrine organs such as the thyroid gland, adrenal gland, and pancreas. Initial diagnosis of APS is crucial and difficult because of its vague, acute presentation, which often involves hypothyroidism and adrenal insufficiency. Delayed treatment of adrenal insufficiency can result in a life-threatening adrenal crisis. A diagnostic workup for adrenal insufficiency should be performed in patients who do not respond to hypothyroidism treatment. PMID:27298818
Evison, Matthew; Crosbie, Philip; Chaturvedi, Anshuman; Shah, Rajesh; Booton, Richard
This case illustrates a rare but important differential diagnosis of pulmonary emboli in the field of thoracic oncology, that of pulmonary artery sarcoma. It describes particular clinical features that may raise suspicion of this tumor in cases of suspected pulmonary emboli, and highlights novel radiological modalities and tissue sampling techniques in such cases. Surgical resection, as part of multi-modality therapy, is the cornerstone of treatment that has seen survival dramatically improve in recent years for patients with this rare cancer. PMID:26557921
Evison, Matthew; Crosbie, Philip; Chaturvedi, Anshuman; Shah, Rajesh; Booton, Richard
This case illustrates a rare but important differential diagnosis of pulmonary emboli in the field of thoracic oncology, that of pulmonary artery sarcoma. It describes particular clinical features that may raise suspicion of this tumor in cases of suspected pulmonary emboli, and highlights novel radiological modalities and tissue sampling techniques in such cases. Surgical resection, as part of multi-modality therapy, is the cornerstone of treatment that has seen survival dramatically improve in recent years for patients with this rare cancer.
Nett, Randall J; Book, Earl; Anderson, Alicia D
We describe the case of a man presumptively diagnosed and treated for Rocky Mountain spotted fever following exposure to multiple ticks while riding horses. The laboratory testing of acute and convalescent serum specimens led to laboratory confirmation of acute Q fever as the etiology. This case represents a potential tickborne transmission of Coxiella burnetii and highlights the importance of considering Q fever as a possible diagnosis following tick exposures.
Sundal, Christina; Lash, Jennifer; Aasly, Jan; Øygarden, Sarka; Roeber, Sigrun; Kretzschman, Hans; Garbern, James Y; Tselis, Alex; Rademakers, Rosa; Dickson, Dennis W; Broderick, Daniel; Wszolek, Zbigniew K
Hereditary diffuse leukoencephalopathy with spheroids (HDLS) was originally described in a large Swedish pedigree. Since then, 22 reports describing a total of 13 kindreds and 11 sporadic cases have been published. Inheritance is autosomal dominant, albeit the gene is unknown. Here we report on the clinical findings, genealogical data, brain MRI data, and autopsy/biopsy findings of four probands from three independently ascertained novel families from Norway, Germany and US. We identified a 39-year-old female and her twin sister, a 52-year-old male and a 47-year-old male with progressive neurological illness characterized by personality changes, cognitive decline and motor impairments, such as gait problems, bradykinesia, tremor and rigidity. Brain MRI showed white matter abnormalities with frontal prominence. Brain biopsy/autopsies were consistent with HDLS. HDLS is an under-recognized disease and in reporting these cases, we aim to increase the awareness of the disorder. Due to varied and wide phenotypic presentations, which may imitate several neurodegenerative diseases, HDLS can be difficult to diagnose. Definitive diagnosis can be established only by direct brain tissue examination. Familiarity with the clinical presentation and typical neuroimaging findings may be helpful in narrowing the diagnosis.
TATANGELO, FABIANA; CANTILE, MONICA; COLLINA, FRANCESCA; BELLI, ANDREA; DE FRANCISCIS, SILVIA; BIANCO, FRANCO; BOTTI, GERARDO
Schwannomas are tumors derived from Schwann cells. Generally, they are benign and their typical site of origin is the subcutaneous tissue of the distal extremities or of the head and neck region. Gastrointestinal localization of schwannomas is extremely rare, and the stomach is the prevalent site. The present study describes the case of a gastric schwannoma in a 61-year-old male who underwent subtotal gastrectomy following a clinical diagnosis of a gastrointestinal stromal tumor (GIST). A histological, immunohistochemical and molecular study was performed to exclude the misdiagnosis of GIST. The histomorphological features of the lesion and absence of c-Kit and PDGFRA mutations indicated the diagnosis of gastric schwannoma. PMID:27073505
Aghaghazvini, Leila; Sharifian, Hashem; Rasuli, Bahman
Primary hyperparathyroidism is an endocrine disorder recognized by hyperfunction of parathyroid gland, which can result in persistent bone absorption and brown tumor. Facial involvement of brown tumor is rare and usually involves the mandible. Giant cell tumor ( GCT) is an expansile osteolytic bone tumor which is very similar in clinical, radiological and histological features to brown tumor. Herein, we present a 35-year-old woman with an 11-month history of gradually swelling of the right maxilla and buccal spaces began during pregnancy two years ago. No other clinical or laboratory problems were detected. Postpartum CT scan demonstrated a lytic expansile multi-septated mass lesion containing enhancing areas, which initially described as GCT of the right maxillary sinus following surgery. Four months later, gradual progressive swelling of the bed of tumor was recurred and revised pathological slices were compatible with GCT. Regarding patient recent paresthesia, repeated laboratory tests were performed. Finally, according to laboratory results (elevation of serum calcium and parathyroid hormone), ultrasonographic findings and radioisotope scan (Sestamibi), probable parathyroid mass and brown tumor of maxilla was diagnosed. Pathology confirmed hyperplasia of right inferior parathyroid gland. Our case was thought-provoking due to its interesting clinical presentation and unusual presentation of brown tumor in parathyroid hyperplasia. PMID:27127572
Geramizadeh, Bita; Khademi, Bijan; Karimi, Mehran; Shekarkhar, Golsa
Infantile fibrosarcoma of head and neck is rare and the presence of this tumor in ethmoid sinus is even more uncommon. To the best of our knowledge, <5 cases have been reported in the last 20 years in the English literature, so far, only one of which has been infantile type in a 15 months old girl. In this case report, we will explain our experience with a rare case of infantile fibrosarcoma originating from ethmoid sinus in a 5-year-old boy who presented with dyspnea and epistaxis. After biopsy, it was diagnosed as fibrosarcoma of sinus origin. PMID:26604519
Estol, P C; Poseiro, J J; Schwarcz, R
Four hundred and forty seven pregnant women with ruptured membranes, were prospectively studied in order to assess the diagnostic capacity of Phosphatidylglycerol (PhG) determination in amniotic fluid recovered from vulval pads in the diagnosis of Hyaline Membrane Disease (HMD). The identification of PhG was performed using one dimensional silica gel thin layer chromatography. The sensitivity of PhG determination in the diagnosis of HMD in newborns of the total population was found to be 88.2%, with a specificity of 76.9%. In the study population, the incidence of HMD was 7.6%, the negative predictive value was 98.8% and, the positive predictive value was 24.0%. When the 265 newborns of the gestational age group of less than or equal to 34 weeks is considered, we observed an incidence of HMD of 12.1%. The diagnostic capacity of PhG in this group was shown by a sensitivity of 87.5%, a specificity of 76.4%, a positive predictive value of 33.7% and a negative predictive value of 97.8%. This method of assessment of fetal lung maturity has a diagnostic capability similar to that described by other authors, who used amniotic fluid obtained vaginally or transabdominally. The procedure described here of amniotic fluid collection is non-invasive, harmless to the mother and fetus and simple to perform. The characteristics of this method, allow serial studies of the amniotic fluid to be carried out.
Konstantinova, Anastasia M; Kacerovska, Denisa; Michal, Michal; Kazakov, Dmitry V
Anogenital mammary-like glands (AGMLG) are nowadays considered a normal component of the anogenital area. Lesions affecting AGMLG are similar to those seen in breast. We present a case of a complex neoplastic lesion of the AGMLG with mixed features of fibroadenoma and hidradenoma papilliferum combined with pseudoangiomatous stromal hyperplasia. Multinucleated cells were detected in the pseudoangiomatous stromal hyperplasia areas as seen in some patients with neurofibromatosis type 1. The neoplasm is similar to rare mammary composite neoplasms that feature simultaneously patterns of a fibroepithelial neoplasms and intraductal papilloma.
Jeffus, Susanne K; Gehlot, Ashita; Holthoff, Emily; Stone, Rebecca; Spencer, Horace; Kelly, Thomas; Post, Steven R; Quick, Charles M
Patterns of invasion and stromal response are understudied in vulvar squamous cell carcinoma. The aim of this study was to explore whether histologic features such as an infiltrative pattern of invasion and fibromyxoid stromal response (FMX-SR) are meaningful prognostic factors. We reviewed 143 vulvar squamous cell carcinoma resections and correlated patterns of invasion and stromal response with patient age, ethnicity, depth of invasion, tumor size, perineural invasion (S100/AE1/3 stain), lymph node involvement (LNI), extranodal extension, margin status, pathologic stage, and recurrence. Univariate analyses of continuous variables were performed using t tests, whereas Pearson χ tests were used for categorical variables. Logistic regression analyses examined the relationship between histopathologic characteristics and clinical outcomes. There was a statistically significant association between infiltrative tumors and an FMX-SR in comparison with noninfiltrative tumors (P<0.001). Tumors with FMX-SR were significantly more deeply invasive (P=0.0025) and more likely to have LNI (P=0.0364), extranodal extension (P=0.0227), and perineural invasion (P=0.0011) compared with tumors without FMX-SR. For cases with negative surgical margins, the association between tumors with FMX-SR and LNI was significantly strengthened (odds ratio=4.73, P=0.0042), even after adjustments for age, race, and depth of invasion (odds ratio=4.34, P=0.0154). The presence of both FMX-SR and an infiltrative pattern of invasion in tumors with negative margins was significantly associated with LNI (P=0.0235) and recurrence (P=0.0124). These results suggest that interactions between nerve, tumor, and stromal cells play a role in tumor progression and represent additional prognostic factors that help stratify those patients at highest risk for LNI, extranodal extension, and recurrence.
Sato, Toshihisa; Suenaga, Hideyuki; Igarashi, Masaki; Hoshi, Kazuto; Takato, Tsuyoshi
Introduction Odontogenic cutaneous sinus tract is a relatively rare occurrence that can be complicated to diagnose. The presence of a cutaneous lesion is often not even partly associated with a dental etiology because of the less frequency of occurrence in the case of dental symptoms. Consequently, the underlying dental cause is often missed leading to inappropriate diagnosis and treatment. Case presentation Here, we report the case of a 45-year-old man who presented with a persistent lesion of the cervical region. At the time of presentation, the lesion had been present for approximately one year with a gradual increase in size but no specific symptoms. The patient had previously undergone punch resection under local anesthesia, which resulted in a histopathological diagnosis of inverted follicular keratosis. A diagnosis was made of an odontogenic cutaneous sinus tract secondary to chronic apical periodontitis of the left mandibular second molar. Discussion Cutaneous sinus tract in the face and neck is most likely to develop intraorally. Root canal treatment or surgical extractions are the common treatment choices. A previously reported review of 137 cases found that 106 (77%) were treated by extraction and 27 (20%) were treated by surgical or conservative nonsurgical endodontic therapy. Conclusion Early diagnosis of cutaneous sinus tract using proper aid is responsible for shortening the treatment duration and avoiding unnecessary treatment. PMID:26413920
Czaika, Viktor A
There have been few published reports on the human transmission of Trichophyton mentagrophytes, a zoophilic fungus frequently occurring in pets. Here we report on 2 girls, living with a pet dwarf rabbit, who presented with inflammatory skin lesions positive for T. mentagrophytes and subsequently diagnosed as zoophile tinea faciei and tinea corporis. The patients were successfully treated with systemic terbinafine and 2-week therapy with Travocort cream containing isoconazole nitrate 1% and diflucortolone valerate 0.1%.
Min, Kyung-Keun; Min, Byung-Woo; Choi, Jung-Hoon
Periprosthetic joint infection (PJI) of the hip can be difficult to treat and can lead to a number of problems including: i) severe functional decline of the hip joint and ii) increasing financial burden for patients due to long treatment periods and the need for repeated surgical interventions. Because there is risk of inadequate control of infection or relapse of a preexisting infection following the treatment of PJI through surgery, it is important to closely observe clinical symptoms such as systemic fever. Kikuchi-Fujimoto disease is usually a self-limiting disease characterized by fever and cervical lymphadenopathy. We report one case of Kikuchi-Fujimoto disease, with literatures review, that was mistaken for an infection relapse after surgical treatment of the PJI due to sustained fever postoperatively. PMID:28097116
Andreadis, Panagiotis; Theodoridou, Stamatia; Pasakiotou, Marily; Arapoglou, Stergios; Gigi, Eleni; Vetsiou, Evaggelia; Vlachaki, Efthymia
We herein would like to report an interesting case of a patient who presented with anemia and thrombocytopenia combined with high serum Lactic Dehydrogenase where Thrombotic Thrombocytopenic Purpura was originally considered. As indicated a central venous catheter was inserted in his subclavian vein which led to mediastinal hematoma and finally intubation and Intensive Care Unit (ICU) hospitalization. After further examination patient was finally diagnosed with B12 deficiency in a setting of H hemoglobinopathy. There have been previous reports where pernicious anemia was originally diagnosed and treated as Thrombotic Thrombocytopenic Purpura but there has been none to our knowledge that was implicated with hemothorax and ICU hospitalization or correlated with thalassemia and we discuss the significance of accurate diagnosis in order to avoid adverse reactions and therapy implications.
Andreadis, Panagiotis; Theodoridou, Stamatia; Pasakiotou, Marily; Arapoglou, Stergios; Gigi, Eleni; Vetsiou, Evaggelia; Vlachaki, Efthymia
We herein would like to report an interesting case of a patient who presented with anemia and thrombocytopenia combined with high serum Lactic Dehydrogenase where Thrombotic Thrombocytopenic Purpura was originally considered. As indicated a central venous catheter was inserted in his subclavian vein which led to mediastinal hematoma and finally intubation and Intensive Care Unit (ICU) hospitalization. After further examination patient was finally diagnosed with B12 deficiency in a setting of H hemoglobinopathy. There have been previous reports where pernicious anemia was originally diagnosed and treated as Thrombotic Thrombocytopenic Purpura but there has been none to our knowledge that was implicated with hemothorax and ICU hospitalization or correlated with thalassemia and we discuss the significance of accurate diagnosis in order to avoid adverse reactions and therapy implications. PMID:26609455
Schwingenschuh, Petra; Ruge, Diane; Edwards, Mark J; Terranova, Carmen; Katschnig, Petra; Carrillo, Fatima; Silveira-Moriyama, Laura; Schneider, Susanne A; Kägi, Georg; Dickson, John; Lees, Andrew J; Quinn, Niall; Mir, Pablo; Rothwell, John C; Bhatia, Kailash P
Summary Approximately 10% of subjects thought clinically to have early Parkinson’s disease (PD) have normal dopaminergic functional imaging (SWEDDs – Scans Without Evidence of Dopaminergic Deficit). SWEDDs are a heterogeneous group. Here we aimed to delineate clinical and electrophysiological characteristics of a distinct subgroup of SWEDDs patients from PD and to clarify the underlying pathophysiology of this subgroup as a form of parkinsonism or dystonia. Therefore we compared clinical details of 25 patients referred with a diagnosis of tremor-dominant PD but with normal DaT SPECT scans (SWEDDs) with 12 tremor-dominant PD patients with abnormal DaT SPECT scans. We performed tremor analysis using accelerometry in the following patients with 1) SWEDDs, 2) PD, 3) primary segmental dystonia with dystonic limb tremor and 4) essential tremor (ET). We used transcranial magnetic stimulation with a facilitatory paired associative stimulation (PAS) paradigm to test if sensorimotor plasticity in SWEDDs resembled the pattern seen in PD, dystonia or ET. Although PD and SWEDDs patients shared several clinical features, the lack of true bradykinesia, occurrence of dystonia, and position- and task-specificity of tremor favoured a diagnosis of SWEDDs, whereas re-emergent tremor, true fatiguing or decrement, good response to dopaminergic drugs as well as presence of nonmotor symptoms made PD more likely. Basic tremor parameters overlapped between SWEDDs, PD, segmental dystonia and ET. However, a combination of re-emergent tremor and highest tremor amplitude in the resting condition was characteristic of PD tremor, while SWEDDs, dystonia and ET subjects had the highest tremor amplitude during action. Both SWEDDs and segmental dystonia patients exhibited an exaggerated pattern of sensorimotor plasticity in response to the PAS paradigm, with spread of excitation to an adjacent hand muscle. In contrast, PD patients showed no response to PAS, and the response of ET patients was no different from controls. Taken together, these results may help differentiate these SWEDDs patients from PD and support our hypothesis that adult-onset dystonia is the underlying diagnosis in this sub-group of patients with SWEDDs. PMID:20131394
Fenu, S; Carmini, D; Mancini, F; Guglielmi, C; Alimena, G; Riccioni, R; Barsotti, P; Mancini, M; Avvisati, G; Mandelli, F
From 1990 to 1994, 3 patients with de novo acute myeloid leukemia (AML) in whom light microscopy and cytochemistry suggested a FAB subtype M3 variant were observed at our Institute. Immunophenotype showed HLA-DR-, CD13+, CD33+, CD2+, CD9+; promyelocytic features were also detected by electron microscopy. However, leukemic cells lacked both translocation t(15;17) and RAR alpha/PML genes rearrangement. These cases were considered to be 'M2 atypical' subtypes and they contribute to point out how cytogenetics and molecular biology are mandatory for a correct diagnosis of acute promyelocytic leukemia (APL) particularly because therapy with all trans retinoic acid (ATRA) is now the best treatment for APL. Nevertheless these 3 cases indicate that the atypical M2 subtype may be confused with the M3v if only cytochemistry, immunophenotype and electron microscopy are used in the defining the FAB subtypes.
Seseke, S; Schweyer, S; Reissig, K; Seseke, F
Leiomyomas are benign neoplasms arising from smooth muscle cells. We describe the case of a 17-year-old boy admitted with progressive severe obstructive voiding symptoms. Retrograde urethrography showed a bulbous urethral stricture which was resected with primary urethral anastomosis. Histopathological examination confirmed the very rare case of a leiomyoma of the urethra. In patients with urethral stricture, leiomyoma should be included in the diagnostic considerations.
Yu, M.T.; Leiber, E.; Qazi, Q.
Insertion translocations are rare. A carrier with a balanced insertion translocation is most likely to be detected through offspring with an unbalanced translocation. We with to report a case where a correct diagnosis, made prenatally with FISH, corrected the initial misdiagnosis of the mother in another institute. PDL received an amniotic fluid sample from a 28 y.o. woman (G5P2Sab1TOP1) at 19 wks gestation. The indications were a reported balanced translocation, t(6;13), in the mother and a previous daughter with an unbalanced translocation. Chromosome analysis of the amniocytes showed a female karyotype with an abnormal chr. 13. Since the mother was diagnosed as having t(6;13)(q21;q34), the der(13) in the amniocytes was initially assumed to result from an adjacent segregation of the t(6;13). However, the banding patterns of this abnormal chr. 13 did not fit into the above defined translocation. With FISH and a chr. 13 painting probe, this der(13) was painted in the proximal and the distal thirds, but NOT in the middle region. This indicates that the middle section of the der(13) must have originated from 6q. The banding pattern is compatible with a direct insertion of 6q15 to 6q23.3 into 13q21.2. Thus, the fetus has partial trisomy 6q. After counseling, the mother elected to terminate the pregnancy but later changed her mind. An 8 lb 12 oz baby girl was born at 36 wks. (mother diabetic). Chromosome analysis of the newborn blood confirmed the dx. The mother was studied, using multicolor painting probes for chromosomes 13 and 6, a balanced direct insertion of 6q15 to 6q23.3 into chr. 13q21.2 was clearly shown. The previous affected daughter with a 13q+ is now 4 y.o. (a restudy is planned). She has microcephaly, severe developmental delay and other dysmorphic features. This case illustrates the advantage of using FISH to arrive at a definitive diagnosis of an insertion translocation.
Santra, Avradip; Dutta, Pravati; Pothal, Sudarsan; Manjhi, Rekha
A 59-year-old male smoker presented with persistent wheezing and occasional coughing that had been ongoing for two years and had been unsuccessfully treated with an inhalational β2 agonist, an anticholinergic and an inhalational steroid in the last year. On clinical examination, a left-sided wheeze was detected. The initial chest X-ray was normal. A computed tomography (CT) scan of thorax demonstrated a mass lesion in the left main bronchus. On subsequent bronchoscopy, an endobronchial polypoid mass was detected in the left main bronchus, completely occluding the bronchial lumen. A biopsy taken from the mass revealed features of bronchial carcinoid. Bronchial carcinoid can present uncommonly with wheezes, resulting in misdiagnosis as bronchial asthma or chronic obstructive pulmonary disease (COPD). If an asthma or COPD patient does not respond to conventional therapy, a CT scan and subsequent bronchoscopy is warranted. PMID:23966830
Thammachantha, Samasuk; Kunnatiranont, Ratana; Polpong, Pongwat
Cysticercosis and sparganosis are not uncommon parasitic infections in the developing world. Central nervous system infection by both cestodes can present with neurological signs and symptoms, such as seizure and mass effect, including brain hernia. Early detection and accurate diagnosis can prevent a fatal outcome. Histological examinations of brain tissues can confirm the diagnosis of cerebral cysticercosis, which differs from sparganosis by the presence of a cavitated body. We report here a case of cerebral cysticercosis which has the similar clinical and imaging findings as sparganosis. PMID:28095665
... the mouth and the penis, vulva, or anus; (3) Penetration of the anal or genital opening of another... the mouth and the penis, vulva, or anus; (3) Contact between the mouth and any body part where...
Satoh, Masataka; Yamamoto, Toshiyuki
Pyoderma gangrenosum is an ulcerative skin disorder showing characteristic non-infectious ulcers and affects the lower extremities in approximately 70% of cases. Pyoderma gangrenosum is commonly associated with systemic diseases such as inflammatory bowel disease, rheumatoid arthritis and hematological malignancies. Herein, we report two cases of Japanese patients diagnosed with genital pyoderma gangrenosum. Case 1 was a 74-year-old woman without associated systemic complications, whose skin lesion resembled a squamous cell carcinoma and was limited to the vulva. Case 2 is an 89-year-old man, who suffered from myelodysplastic syndrome and acute myeloid leukemia, and presented with penile and leg ulcers mimicking pressure sores. Both cases responded well to systemic steroids. We review 13 genital pyoderma gangrenosum cases (76.9% male; aged 30-89 years) from 1996 to 2012 in Japan, including 11 previously reported cases and the present study's two cases. Four of the 13 genital pyoderma gangrenosum cases had associated systemic diseases and their skin lesions spread to the extragenital areas. Eight of the remaining nine genitalia-localized pyoderma gangrenosum cases had no associated systemic diseases. In conclusion, genital pyoderma gangrenosum is rare and may be misdiagnosed. It should therefore be considered in cases of refractory genital ulcers. In addition, genitalia-localized pyoderma gangrenosum tends to be without systemic complications.
Bell, Diana; Kane, Philip B; Liang, Sharon; Conway, Christine; Tornos, Carmen
Varicose veins in the vulvar and perivulvar area are seen in 4% of women. Most of them are secondary to pregnancy and usually regress spontaneously. Vulvar varicose veins are rare in nonpregnant women. When present, they can be seen alone, associated with leg varices or associated with venous malformations of the labia, clitoral area, or vagina with or without arteriovenous malformations on the limbs or trunk (Klippel-Trenaunay-Weber syndrome and Parkes-Weber syndrome). In some cases, vulvar varices are seen as part of the so-called "pelvic congestion syndrome." Clinically, vulvar varices may present as small isolated protrusions, mainly in the labia majora, or as large masses, involving the vulva and even the perivulvar area. The treatment of choice of vulvar varices seen during pregnancy is conservative and symptomatic. Surgical pathologists need to be aware of the existence of vulvar varicose veins and its possible presence in biopsy specimens. Vulvar varicose veins can be misdiagnosed clinically as cysts or masses mainly in the Bartholin gland area. Correct diagnosis of the lesion is important to determine appropriate therapy and to recognize the possibility of associated anatomical or pathological problems.
Femur chondrosarcoma misdiagnosed as acute knee arthritis and osteomyelitis--further developing a hitherto unreported complication of tumor embolic ischemic ileal perforation after arthroscopic lavage.
Chow, Louis Tsun Cheung
The differentiation between osteomyelitis and bone tumor may be difficult due to their overlapping clinical and radiological features. A 25-year-old lady presented with left knee pain and joint effusion associated with redness and hotness. A sub-optimally taken plain radiograph showed mixed osteolytic and osteoblastic lesion in the left lower femur with surrounding soft tissue swelling. Since the clinical diagnosis was acute osteomyelitis and arthritis, arthroscopic lavage was performed as a diagnostic and therapeutic procedure. The removed loose bodies and fibrinous tissue showed pathological features suspicious of chondrosarcoma. Subsequent MRI revealed an infiltrative tumor eroding through the cortex and joint cartilage. En bloc excision of the left lower femur, upper tibia including the knee joint and patella was performed, and the final diagnosis was grade 2 chondrosarcoma. The patient developed bilateral pulmonary metastasis 33 months after operation. Five months later, she suffered from a hitherto undescribed complication of ischemic perforation of the terminal ileum secondary to tumor embolic arterial obstruction with no macroscopic intestinal or peritoneal tumor deposit. The patient developed multiple brain metastases and died 43 months after initial presentation. Our case illustrates that malignant bone tumor as a differential diagnosis of acute osteomyelitis and arthritis merits recognition and exclusion before arthroscopic lavage, which may enhance tumor dissemination and in our patient results in embolic ischemic ileal perforation.
Tuominen-Eriksson, Alli-Marie; Svensson, Yvonne; Gunnarsson, Ronny K.
Disabilities in a child may lead to low self-esteem and social problems. The lives of parents and siblings are also affected. Early intervention may decrease these consequences. To promote early intervention early referral to adequate resources is essential. In a longitudinal retrospective observational study it was found that children with…
Zahir, Shokouh Taghipour; Sharahjin, Naser Sefidrokh; Dadgarnia, Mohammad Hossein
Synovial sarcoma is a rare form of malignant tumour and accounting approximately for 8% of all soft tissue sarcomas. Head and neck synovial sarcomas are uncommon and parapharyngeal space involvement is extremely rare. We report a case of synovial sarcoma in the parapharyngeal space of a 13-year-old boy with a history of neurofibromatosis presented with odynophagia, ptosis and left submandibular mass. The lesion extended from retrostyloid parapharyngeal space to the skull base and foramen jugular superiorly. The first clinical and radiological impressions were carotid jugular related tumours such as schwannoma and paraganglioma.
Differentiating salient histopathologic changes from normal anatomic features or tissue artifacts can be decidedly challenging, especially for the novice fish pathologist. As a consequence, findings of questionable accuracy may be reported inadvertently, and the potential negativ...
Carter, Corey A.; Browning, Robert; Oronsky, Bryan T.; Scicinski, Jan J.; Brzezniak, Christina
A case report of a 47-year-old woman with triple-negative breast cancer on a clinical trial called PRIMETIME (NCT02518958) who received the anti-PD-1 inhibitor nivolumab and the experimental anticancer agent RRx-001 is presented. Although initially diagnosed and treated for anti-PD-1-induced pneumonitis, clinical and radiological abnormalities triggered further investigation, leading to the diagnosis of pulmonary tumor thrombotic microangiopathy (PTTM). This example highlights the importance of exercising due diligence in determining immune-related adverse events and suggests that PD-1-induced pneumonitis should be a diagnosis of exclusion rather than a diagnosis by default. A case history and review of the literature are presented for PTTM, which we propose to define as a paraneoplastic syndrome. PMID:26933422
Differentiating salient histopathologic changes from normal anatomic features or tissue artifacts can be decidedly challenging, especially for the novice fish pathologist. As a consequence, findings of questionable accuracy may be reported inadvertently, and the potential negative impacts of publish...
Carter, Corey A; Browning, Robert; Oronsky, Bryan T; Scicinski, Jan J; Brzezniak, Christina
A case report of a 47-year-old woman with triple-negative breast cancer on a clinical trial called PRIMETIME (NCT02518958) who received the anti-PD-1 inhibitor nivolumab and the experimental anticancer agent RRx-001 is presented. Although initially diagnosed and treated for anti-PD-1-induced pneumonitis, clinical and radiological abnormalities triggered further investigation, leading to the diagnosis of pulmonary tumor thrombotic microangiopathy (PTTM). This example highlights the importance of exercising due diligence in determining immune-related adverse events and suggests that PD-1-induced pneumonitis should be a diagnosis of exclusion rather than a diagnosis by default. A case history and review of the literature are presented for PTTM, which we propose to define as a paraneoplastic syndrome.
Ishikawa, Takuya; Haruta, Jun-Ichi; Yamaguchi, Takeo; Doisaki, Masao; Yama, Tsuyoki; Murate, Kentarou; Hattori, Shun; Hayakawa, Fumihiro; Yamada, Kenta; Yashika, Jun
A 44-year-old woman was referred to our hospital because of a cystic lesion in the pancreatic body that was found by computed tomography (CT) as a result of a screening for impaired liver function after the patient presented with a high fever in 2011. Trans-abdominal ultrasonography (US) revealed a 33-mm unilocular cyst within the pancreatic body and a 5-mm hypoechoic mass in the pancreatic neck. Contrast-enhanced CT showed a slight enhancement around the cyst and a mild dilation of the main pancreatic duct, but neither septum nor nodule was detected inside. Contrast-enhanced endoscopic ultrasonography (CE-EUS) revealed a hyperechoic elevated lesion inside the cystic lesion without enhancement in the pancreatic body; CE-EUS also revealed a 5-mm homogeneous hypoechoic mass with a remarkable enhancement in the pancreatic neck with the use of Sonazoid(®) as a contrast medium. These lesions were diagnosed as a pancreatic pseudocyst and a neuroendocrine tumor (NET), respectively, and were followed up with periodic examinations. The cystic lesion showed contraction 6 months after the initial exam. However, US revealed an enlargement of the cystic lesion to 40 mm in diameter 2 years after the initial exam, and EUS showed irregular thickening of the wall with a cyst-in-cyst appearance. The diagnoses of a mucinous cystic neoplasm (MCN) and a concomitant small NET were made after a distal pancreatectomy. We herein report a rare case of MCN that showed various morphological changes over 2 years of observation.
Sampanis, Nikolaos; Gavriilaki, Eleni; Paschou, Eleni; Kalaitzoglou, Asterios; Vasileiou, Sotirios
Summary Parathyroid carcinoma represents an extremely rare neoplasm with diverse clinical manifestations. Herein we aimed at presenting an unique case of a young patient with late manifestations of parathyroid cancer and reviewing the relevant literature. A 45-year-old male patient presented in the Outpatient Clinic with an episode of nephrolithiasis. His personal medical history includes: recurrent episodes of nephrolithiasis, laminectomy in the cervical spine due to ossification of the cervical ligamentum flavum and surgical resection of a giant cell tumor of the brain. Laboratory testing revealed findings of primary hyperparathyroidism (serum calcium 16,0 mmol/l phosphorus 1,46 mg/dl and parathyroid hormone/PTH 8560 pg/ml). Neck ultrasound and technetium-99 m sestamibi scan were performed showing a parathyroid tumor. Due to the persistently high serum calcium and PTH levels, the high alkaline phosphatase levels (440 IU/L) and the late manifestations of HPT, surgical excision of the tumor was performed. The tumor was identified as parathyroid carcinoma. Immediately after surgery serum calcium and phosphorus levels were normalized. The patient is on a regular follow-up program with no signs of recurrence or metastasis one year after the excision. We describe the coexistence of rare late manifestations of HPT, which had not been adequately investigated at their onset in this young patient. Therefore, increased awareness is needed in order to recognize and further investigate signs or symptoms of HPT. PMID:27252748
Gemigniani, Franco; Hernández-Losa, Javier; Ferrer, Berta; García-Patos, Vicente
Focal epithelial hyperplasia (FEH) or Heck's disease is a rare, benign and asymptomatic mucosal proliferation associated with human papillomavirus (HPV) infection, mainly with genotypes 13 and 32. We report a florid case of FEH in an 11-year-old Haitian girl with systemic lupus erythematosus receiving immunosuppressive therapy. Cryotherapy was previously performed on numerous occasions with no results. We decided to prescribe a non-invasive and more comfortable treatment. A combination of topical retinoid and imiquimod cream was well tolerated and led to an important improvement. The evidence of infection by HPV-16 detected by polymerase chain reaction (PCR) technique, prompted us to prescribe the quadrivalent HPV vaccine (types 6, 11,16 and 18). Subsequent PCR sequencing with generic primers GP5-GP6 and further BLAST comparative analysis confirmed that genomic viral sequence in our case truly corresponded with HPV-32. This molecular misdiagnosis can be explained by the similarity between genomic sequences of both HPV-16 and -32 genotypes. At the 1-year follow up, we observed total clinical improvement and no recurrences of the disease. Complete healing in this case may correspond to a potential action of topical retinoid, imiquimod and the cross-protection mechanism of the quadrivalent HPV vaccine.
HU, Dan Dan; CUI, Jing; WANG, Li; LIU, Li Na; WEI, Tong; WANG, Zhong Quan
Background Sparganosis is caused by the invasion of Spirometra sparganum into various tissues/organs. Subcutaneous sparganosis can be diagnosed by biopsy, while visceral/cerebral sparganosis is not easy to be diagnosed. The diagnosis depends largely on the detection of specific anti-sparganum antibodies. The specificity of the ELISA could be increased by using S. mansoni sparganum excretory–secretory (ES) antigens, but it also had the cross-reactions with sera of patients with cysticercosis or paragonimiasis. The aim of this study was to identify early specific diagnostic antigens in S. mansoni sparganum ES proteins. Methods The sparganum ES proteins were analyzed by two-dimensional electrophoresis (2-DE) and Western blot probed with early sera from infected mice at 14 days post-infection. The immunoreactive protein spots were characterized by MALDI-TOF/ TOF-MS. Results A total of approximately 149 proteins spots were detected with isoelectric point (pI) varying from 3 to 7.5 and molecular weight from 20 to 115 kDa and seven protein spots with molecular weight of 23-31 kDa were recognized by the infection sera. Three of seven spots were successfully identified and characterized as the same S. mansoni protein (cysteine protease), and the proteins of other 4 spots were not included in the databases. Conclusion The cysteine protease from S. mansoni ES proteins recognized by early infection sera might be the early diagnostic antigens for sparganosis. PMID:24454434
Pruritus vulvae; Itching - vaginal area; Vulvar itching; Yeast infection - child ... vagina or the skin around the vagina. Vaginal yeast infection . Vaginitis . Vaginitis in girls before puberty is ...
Câmara, S.; Reis, F.; Gaspar, H.; Cordeiro, M.
Lobular capillary hemangioma, or pyogenic granuloma, is an acquired hemorrhagic benign vascular lesion of the skin and mucous membranes. The pyogenic granuloma of the vulva is a rare finding and a limited number of case reports are available in the literature. To the best of our knowledge this is the first case described as a single pyogenic granuloma on the vulva. PMID:28127485
... is often misdiagnosed as Parkinson’s disease, multiple sclerosis, fibromyalgia, psychosomatic illness, or anxiety and phobia. A definitive ... is often misdiagnosed as Parkinson’s disease, multiple sclerosis, fibromyalgia, psychosomatic illness, or anxiety and phobia. A definitive ...
Bracaglia, Giorgia; Ranno, Stefania; Mancinelli, Livia; Santoro, Maristella; Cerroni, Lorenzo; Massone, Cesare; Sangueza, Omar; Bravo, Francisco G.; Diociaiuti, Andrea; Nicastri, Emanuele; Muraca, Maurizio; El Hachem, May; Boldrini, Renata; Callea, Francesco
Many waterborne helminthes are opportunistic parasites that can travel directly from animals to man and may contain forms capable of penetrating the skin. Among these, Sparganum is the pseudophyllidean tapeworm that belongs to the genus Spirometra, which is responsible for parasitic zoonosis; it is rarely detected in Europe and is caused by the plerocercoid infective larva. Thus far, only six cases of cutaneous and ocular sparganosis have been reported in Europe; two and four cases have occurred in France and Italy, respectively. Herein, we describe a new case of sparganosis in Italy that affected a male diver who presented to the Bambino Gesù Children’s Hospital of Rome. The patient’s skin biopsy was submitted to the Parasitology department who, in consultation with Pathology, concluded that the morphologic and microscopic findings were those of Sparganum spp. larvae. The patient recovered following a single dose of 600 mg praziquantel. PMID:26751512
... most common cancer in women in the United States and it is the most commonly diagnosed gynecologic cancer. Fallopian Tubes Ovaries Uterus Cervix Vagina Vulva www. cdc. gov/ cancer/ knowledge 800-CDC-INFO Inside Knowledge is an initiative ...
... and have not grown into the tissues below. Melanoma Melanomas are cancers that develop from the pigment-producing ... in other areas, such as the vulva. Vulvar melanomas are rare, making up about 6 of every ...
... this test, the health care provider uses a cotton swab to touch areas of the vulva and ... and products containing deodorants, perfumes, and dyes. Wear cotton underwear and switch to cotton menstrual products if ...
... 13th ed. Philadelphia, PA: Elsevier; 2016:chap 17. Katz VL. Benign gynecologic lesions: vulva, vagina, cervix, uterus, ... ovary. In: Lentz GM, Lobo RA, Gershenson DM, Katz VL, eds. Comprehensive Gynecology . 6th ed. Philadelphia, PA: ...
... Information Clinical Trials Resources and Publications How do health care providers diagnose vaginitis? Skip sharing on social media ... out the cause of a woman's symptoms, her health care provider will Examine the vagina, the vulva, and ...
... that might irritate your vulva such as harsh soaps, bubble baths, long bike or horseback rides, or ... dance and gymnastics), then loose fitting bottoms. Scented soaps, bubble bath, feminine hygiene sprays and other perfumed ...
... A make up remover that contains mineral oil, petroleum jelly, and paraffin also can be used (example: ... washcloth and put it against your vulva. Refrigerated petroleum jelly (Vaseline) and cold plain yogurt put on ...
Choi, Won-Hyung; Chu, Jong-Phil; Jiang, Meihua; Lee, Yun-Sik; Kim, Bum-Shik; Kim, Deog-Gon; Park, Yong-Koo
We analyzed parasitic diseases diagnosed by tissue biopsy specimens at KyungHee Medical Center (KMC) from 1984 to 2005. The total number of parasite infection cases was 150 (0.07%) out of the total 211,859 biopsy specimens submitted for histopathological examinations. They consisted of 62 cysticercosis, 23 sparganosis, 16 paragonimiasis, 15 amebiasis, 11 anisakiasis, 11 clonorchiasis, 3 ascariasis, 2 scabies, 2 enterobiasis, 2 trichuriasis, 1 leishmaniasis, 1 taeniasis, and 1 thelaziasis. Out of 62 cysticercosis cases, 55 were detected in subcutaneous tissues or the central nerve system. Eighteen out of 23 sparganosis cases were involved in muscular and subcutaneous tissues. In most anisakiasis cases, the involved organ was the stomach. The lung and the pleura were the most common site of paragonimiasis. The incidence of parasitic diseases during the first 5 years (1984-1988) was the highest of all observed periods. After 1989, similar incidences were shown throughout the period. Whereas cysticercosis was diagnosed in 34 cases during 1984-1988, no case has been diagnosed since 2000. In the case of sparganosis, the chronological incidence was almost uniform throughout the period 1984-2005. Paragonimiasis showed a similar tendency to cysticercosis. In gender and age distribution of parasitic diseases, men showed higher incidence rates than females, and the age groups of the 40s or older indicated higher infection frequencies than other age groups. Therefore, these results are a significant report to appear the tendency of human parasitic disease diagnosed by tissue biopsy in association with parasitosis at KMC in Seoul.
Magnaval, J F
Parasitic dead-ends occur when a parasite is unable to establish a permanent interaction in an unnatural host. Although the likelihood of successful reproduction by the pathogenic agent is nul, parasitic dead-end heralds capture of new parasites and therefore expansion of the host range. Angiostrongyliasis due to A. cantonensis or A. costaricensis, anisakiasis, Ancylostoma caninum infection, gnathostomiasis and sparganosis are undoubtedly emerging zoonoses of particular medical interest. Prevention of these diseases relies on abstinence from eating raw meat from invertebrates or cold-blooded (poikilotherm) vertebrates (e.g. used in exotic dishes). These guidelines must be included in recommendations to travelers.
Walker, M.D.; Zunt, J.R.
Parasitic infection of the nervous system can produce a variety of symptoms and signs. Because symptoms of infection are often mild or nonspecific, diagnosis can be difficult. Familiarity with basic epidemiological characteristics and distinguishing radiographic findings can increase the likelihood of detection and proper treatment of parasitic infection of the nervous system. This article discusses the clinical presentation, diagnosis, and treatment for some of the more common infections of the nervous system caused by cestodes, trematodes and protozoans: Echinococcus spp., Spirometra spp. (sparganosis), Paragonimus spp., Schistosoma spp., Trypanosoma spp., Naegleria fowlerii, Acanthamoeba histolytica, and Balamuthia mandrillaris. PMID:16170739
Chen, Fengming; MacKerell, Alexander D.; Luo, Yuan
We have recently identified several novel ATP-independent inhibitors that target the extracellular signal-regulated kinase-2 (ERK2) protein and inhibit substrate phosphorylation. To further characterize these compounds, we describe the use of C. elegans as a model organism. C. elegans is recognized as a versatile and cost effective model for use in drug development. These studies take advantage of the well characterized process of vulva development and egg laying, which requires MPK-1, the homolog to human ERK2. It is shown that treatment of C. elegans eggs or larvae prior to vulva formation with a previously identified lead compound (76) caused up to 50% reduction in the number of eggs produced from the adult worm. In contrast, compound 76 had no effect on egg laying in young adult or adult worms with fully formed vulva. The reduction in egg laying by the test compound was not due to effects on C. elegans life span, general toxicity, or non-specific stress. However, compound 76 did show selective inhibition of phosphorylation of LIN-1, a MPK-1 substrate essential for vulva precursor cell formation. Moreover, compound 76 inhibited cell fusion necessary for vulva maturation and reduced the multivulva phenotype in LET-60 (Ras) mutant worms that have constitutive activation of MPK-1. These findings support the use of C. elegans as a model organism to evaluate the selectivity and specificity of novel ERK targeted compounds. PMID:19105050
Aulmann, Sebastian; Sinn, Hans P; Penzel, Roland; Gilks, C Blake; Schott, Sarah; Hassel, Jessica C; Schmidt, Dietmar; Kommoss, Friedrich; Schirmacher, Peter; Kommoss, Stefan
Malignant melanoma of the vulva and vagina is relatively uncommon and accounts for <5% of all melanomas in women. The aim of our study was to establish the biological properties and evaluate potential therapeutic targets in these tumors. We collected a series of 65 cases from three centers and re-evaluated the tumor tissue for predominant growth pattern (superficial spreading, nodular, and mucosal lentiginous) and tumor thickness. KIT (CD117) expression was detected immunohistochemically. In addition, tumors were screened for BRAF, NRAS, and KIT mutations by PCR and DNA sequencing as well as for KIT amplifications by fluorescence in situ hybridization. None of the cases contained BRAF mutations. NRAS mutations and KIT amplifications were detected in similar frequency (∼12%) in tumors of the vulva and vagina. In contrast, KIT mutations were present in 18% of primary melanomas of the vulva, but in none of the tumors arising in the vagina. Moderate or strong KIT protein expression was detected in 30 cases, including all tumors with KIT mutations and 6 of the 7 with KIT amplifications. In conclusion, BRAF mutations are virtually absent in melanomas originating from the vulva or vagina, whereas NRAS mutations and KIT amplifications occur in both locations. KIT mutations appear to be specific for melanomas of the vulva, suggesting that in spite of the anatomic proximity, the development of vulvar and vaginal melanomas involves different molecular alterations which may be targeted by novel treatment approaches.
Delgado-García, Silvia; Palacios-Marqués, Ana; Martínez-Escoriza, Juan Carlos; Martín-Bayón, Tina-Aurora
Acute genital ulcers, also known as acute vulvar ulcers, ulcus vulvae acutum or Lipschütz ulcers, refer to an ulceration of the vulva or lower vagina of non-venereal origin that usually presents in young women, predominantly virgins. Although its incidence is unknown, it seems a rare entity, with few cases reported in the literature. Their aetiology and pathogenesis are still unknown. The disease is characterised by an acute onset of flu-like symptoms with single or multiple painful ulcers on the vulva. Diagnosis is mainly clinical, after exclusion of other causes of vulvar ulcers. The treatment is mainly symptomatic, with spontaneous resolution in 2 weeks and without recurrences in most cases. We present a case report of a 13-year-old girl with two episodes of acute ulcers that fit the clinical criteria for Lipschütz ulcers. PMID:24473429
Güner, Mehmet Derviş; Kamburoğlu, Haldun Onuralp; Bektaş, Umut; Ay, Şadan
Hands, especially lunatum, are involved very rarely with osteoid osteoma. This report presents an osteoid osteoma of the lunatum, which was previously misdiagnosed as Kienböck's disease and had undergone surgery. Magnetic resonance imaging may lead the clinician to misdiagnose because of the excessive bone edema around the carpus. The operation should be planned according to radiography and computed tomography findings.
Grants, Jennifer M.; Ying, Lisa T. L.; Yoda, Akinori; You, Charlotte C.; Okano, Hideyuki; Sawa, Hitoshi; Taubert, Stefan
Cell signaling pathways that control proliferation and determine cell fates are tightly regulated to prevent developmental anomalies and cancer. Transcription factors and coregulators are important effectors of signaling pathway output, as they regulate downstream gene programs. In Caenorhabditis elegans, several subunits of the Mediator transcriptional coregulator complex promote or inhibit vulva development, but pertinent mechanisms are poorly defined. Here, we show that Mediator’s dissociable cyclin dependent kinase 8 (CDK8) module (CKM), consisting of cdk-8, cic-1/Cyclin C, mdt-12/dpy-22, and mdt-13/let-19, is required to inhibit ectopic vulval cell fates downstream of the epidermal growth factor receptor (EGFR)-Ras-extracellular signal-regulated kinase (ERK) pathway. cdk-8 inhibits ectopic vulva formation by acting downstream of mpk-1/ERK, cell autonomously in vulval cells, and in a kinase-dependent manner. We also provide evidence that the CKM acts as a corepressor for the Ets-family transcription factor LIN-1, as cdk-8 promotes transcriptional repression by LIN-1. In addition, we find that CKM mutation alters Mediator subunit requirements in vulva development: the mdt-23/sur-2 subunit, which is required for vulva development in wild-type worms, is dispensable for ectopic vulva formation in CKM mutants, which instead display hallmarks of unrestrained Mediator tail module activity. We propose a model whereby the CKM controls EGFR-Ras-ERK transcriptional output by corepressing LIN-1 and by fine tuning Mediator specificity, thus balancing transcriptional repression vs. activation in a critical developmental signaling pathway. Collectively, these data offer an explanation for CKM repression of EGFR signaling output and ectopic vulva formation and provide the first evidence of Mediator CKM-tail module subunit crosstalk in animals. PMID:26715664
Koh, Kyunghee; Peyrot, Sara M; Wood, Cricket G; Wagmaister, Javier A; Maduro, Morris F; Eisenmann, David M; Rothman, Joel H
Development of the vulva in C. elegans is mediated by the combinatorial action of several convergent regulatory inputs, three of which, the Ras, Wnt and Rb-related pathways, act by regulating expression of the lin-39 Hox gene. LIN-39 specifies cell fates and regulates cell fusion in the mid-body region, leading to formation of the vulva. In the lateral seam epidermis, differentiation and cell fusion have been shown to be regulated by two GATA-type transcription factors, ELT-5 and -6. We report that ELT-5 is encoded by the egl-18 gene, which was previously shown to promote formation of a functional vulva. Furthermore, we find that EGL-18 (ELT-5), and its paralogue ELT-6, are redundantly required to regulate cell fates and fusion in the vulval primordium and are essential to form a vulva. Elimination of egl-18 and elt-6 activity results in arrest by the first larval stage; however, in animals rescued for this larval lethality by expression of ELT-6 in non-vulval cells, the post-embryonic cells (P3.p-P8.p) that normally become vulval precursor cells often fuse with the surrounding epidermal syncytium or undergo fewer than normal cell divisions, reminiscent of lin-39 mutants. Moreover, egl-18/elt-6 reporter gene expression in the developing vulva is attenuated in lin-39(rf) mutants, and overexpression of egl-18 can partially rescue the vulval defects caused by reduced lin-39 activity. LIN-39/CEH-20 heterodimers bind two consensus HOX/PBC sites in a vulval enhancer region of egl-18/elt-6, one of which is essential for vulval expression of egl-18/elt-6 reporter constructs. These findings demonstrate that the EGL-18 and ELT-6 GATA factors are essential, genetically redundant regulators of cell fates and fusion in the developing vulva and are apparent direct transcriptional targets of the LIN-39 Hox protein.
Grants, Jennifer M; Ying, Lisa T L; Yoda, Akinori; You, Charlotte C; Okano, Hideyuki; Sawa, Hitoshi; Taubert, Stefan
Cell signaling pathways that control proliferation and determine cell fates are tightly regulated to prevent developmental anomalies and cancer. Transcription factors and coregulators are important effectors of signaling pathway output, as they regulate downstream gene programs. In Caenorhabditis elegans, several subunits of the Mediator transcriptional coregulator complex promote or inhibit vulva development, but pertinent mechanisms are poorly defined. Here, we show that Mediator's dissociable cyclin dependent kinase 8 (CDK8) module (CKM), consisting of cdk-8, cic-1/Cyclin C, mdt-12/dpy-22, and mdt-13/let-19, is required to inhibit ectopic vulval cell fates downstream of the epidermal growth factor receptor (EGFR)-Ras-extracellular signal-regulated kinase (ERK) pathway. cdk-8 inhibits ectopic vulva formation by acting downstream of mpk-1/ERK, cell autonomously in vulval cells, and in a kinase-dependent manner. We also provide evidence that the CKM acts as a corepressor for the Ets-family transcription factor LIN-1, as cdk-8 promotes transcriptional repression by LIN-1. In addition, we find that CKM mutation alters Mediator subunit requirements in vulva development: the mdt-23/sur-2 subunit, which is required for vulva development in wild-type worms, is dispensable for ectopic vulva formation in CKM mutants, which instead display hallmarks of unrestrained Mediator tail module activity. We propose a model whereby the CKM controls EGFR-Ras-ERK transcriptional output by corepressing LIN-1 and by fine tuning Mediator specificity, thus balancing transcriptional repression vs. activation in a critical developmental signaling pathway. Collectively, these data offer an explanation for CKM repression of EGFR signaling output and ectopic vulva formation and provide the first evidence of Mediator CKM-tail module subunit crosstalk in animals.
Okino, Tetsuya; Ushirogawa, Hiroshi; Matoba, Kumiko; Nishimatsu, Shin-Ichiro; Saito, Mineki
Methods to maintain the life cycle of pathogenic organisms become powerful tools for studying molecular and cellular bases of infectious diseases. Spirometra erinaceieuropaei is a parasitic tapeworm that causes sparganosis in humans. Because S. erinaceieuropaei has a complex life cycle with different stages and host species requirements, there have been no reports to establish the complete life cycle in the laboratory. In this study, using Cyclops as the first intermediate host, mouse as the experimental second intermediate host, and dog as the final host, we succeeded in maintaining S. erinaceieuropaei in the laboratory. By repeating the established life cycle five times, we obtained a clonal population of S. erinaceieuropaei from a single adult worm. A karyotype study showed that the chromosome of this clone is triploid (3n=27), indicating that a genetically uniform strain is established by apomictic reproduction. The strain was named Kawasaki triploid (Kt). A partial sequence of mitochondrial cytochrome c oxidase subunit 1 gene of the strain Kt showed more than 98% similarity with those of S. erinaceieuropaei isolates from Australia, China, and South Korea, and the resultant phylogeny indicated that the strain Kt is a member of a distinctive clade from East Asia and Oceania. Our system will be particularly useful for studies of S. erinaceieuropaei infection and human sparganosis.
Headley, S A; Gillen, M A; Sanches, A W D; Satti, M Z
The occurrence of platynosomiasis and intestinal sparganosis is described in feral cats from Grand Cayman, Cayman Islands. Spirometra spp. was observed within the intestine of 18.18% (10/55) of cats; 1.18% (1/55) of cats demonstrated gross and histological manifestation of parasitism by Platynosomum fastosum, but 14.5% (8/55) of cats had the characteristic pathological manifestations of P. fastosum-induced intrahepatic cholangitis without the concomitant presence of the intraductal trematode. Combined parasitism (Spirometra spp. and P. fastosum) was observed in 9.09% (5/55) of feral cats. Significant pathological findings were only associated with the hepatic fluke, P. fastosum, and were grossly characterized by moderate hepatomegaly with enlarged and dilated bile ducts. Examples of cestodes with morphological features characteristic of Spirometra spp. were observed within the small intestine without any associated pathological lesion. The histopathological evaluation of liver fragments revealed chronic intrahepatic cholangitis with and without the associated intraductal trematode, and was characterized by marked periductal fibrosis, adenomatous proliferation of bile duct epithelium, dilation of intrahepatic bile ducts and portal accumulations of inflammatory cells. The occurrence of the cestode in feral cats coupled with factors that are unique to Grand Cayman makes this island the ideal location for sporadic cases of human sparganosis.
Sparganosis is a zoonotic disease caused by the spargana of Spirometra, and snake is one of the important intermediate hosts of spargana. In some areas of China, snake is regarded as popular delicious food, and such a food habit potentially increases the prevalence of human sparganosis. To understand the prevalence of Spirometra in snakes in food markets, we conducted a study in two representative cities (Guangzhou and Shenzhen), during January–August 2013. A total of 456 snakes of 13 species were examined and 251 individuals of 10 species were infected by Spirometra, accounting for 55.0% of the total samples. The worm burden per infected snake ranged from 1 to 213, and the prevalence in the 13 species was 0∼96.2%. More than half (58.1%) of the spargana were located in muscular tissue, 25.6% in subcutaneous tissue, and 16.3% in coelomic cavity. The results indicated that Spirometra severely infected snakes in food markets in Guangzhou and Shenzhen, implying that eating snakes has great health risk and improper cooking methods may increase the risk of Spirometra infection in humans in China. Additional steps should be considered by the governments and public health agencies to prevent the risk of snake-associated Spirometra infections in humans. PMID:24558340
Wang, Fumin; Li, Weiye; Hua, Liushuai; Gong, Shiping; Xiao, Jiajie; Hou, Fanghui; Ge, Yan; Yang, Guangda
Sparganosis is a zoonotic disease caused by the spargana of Spirometra, and snake is one of the important intermediate hosts of spargana. In some areas of China, snake is regarded as popular delicious food, and such a food habit potentially increases the prevalence of human sparganosis. To understand the prevalence of Spirometra in snakes in food markets, we conducted a study in two representative cities (Guangzhou and Shenzhen), during January-August 2013. A total of 456 snakes of 13 species were examined and 251 individuals of 10 species were infected by Spirometra, accounting for 55.0% of the total samples. The worm burden per infected snake ranged from 1 to 213, and the prevalence in the 13 species was 0∼96.2%. More than half (58.1%) of the spargana were located in muscular tissue, 25.6% in subcutaneous tissue, and 16.3% in coelomic cavity. The results indicated that Spirometra severely infected snakes in food markets in Guangzhou and Shenzhen, implying that eating snakes has great health risk and improper cooking methods may increase the risk of Spirometra infection in humans in China. Additional steps should be considered by the governments and public health agencies to prevent the risk of snake-associated Spirometra infections in humans.
Pantchev, Nikola; Tappe, Dennis
Reptiles are growing in popularity as pets.The colonization of reptiles and amphibians by parasites and the resulting disease conditions are the most common problems seen in captive animals.This review focuses on pentastomiasis and sparganosis, important parasitic zoonoses of reptiles and amphibians, respectively, and free living-amoebae. Humans are suitable accidental hosts for some pentastomid species (particularly Armillifer and Porocephalus). In geographical areas with special ethnics, such as in West and Central Africa, and East Asia, 8-45% of the human population can be affected. Usually the larvae are coincidentally found during abdominal surgeries. However, fatalities have been described. Extreme caution is necessary when handling infected reptiles. Ocular or cerebral sparganosis is not uncommonly found in humans in East Asia. This disease is caused by spargana, tapeworm larvae (plerocercoids) of Spirometra sp. The infection occurs when uncooked meat from reptiles or amphibians is applied to wounds or eyes and the parasites migrate directly to human tissue, or by consumption of contaminated food or water. As a consequence of the reptile's predatory behaviour, the full spectrum of endo- and ectoparasites from potential prey animals can be found as transiting parasites in the intestinal tract, e. g. Hymenolepis nana, Cryptosporidium (C.) muris, C parvum or Capillaria hepatica. Occasionally, free-living amoebae are also found in reptile faeces (Acanthamoeba, Naegleria, Hartmanella, Vahlkampfia or Echinamoeba sp.).
Ayadi-Kaddour, A; Khadhar, A; Mlika, M; Braham, E; Ismail, O; Zegal, D; El Mezni, F
Ectopic breast tissue is defined as glands located outside of the breast. It can be found anywhere along the milk line extending from the axilla to the groin, and can occur in the vulva. Ectopic breast tissue should be excised because it may develop benign or malignant pathologic processes. Less than 40 cases of fibroadenoma in the vulva have been reported in the literature. We report a case of a 37-year-old woman presenting a solitary vulvar mass. The mass was excised completely, and histology demonstrated an ectopic breast fibroadenoma. This is one of the few reports on the benign pathologies of vulvar mammary glands.
Kim, Tae-Hee; Kim, Soo Ah; Heo, Gyeong-Eun
Infections of the vulva can present a complex differential to the gynecologist, ranging from superficial skin infections to lifethreatening necrotizing fasciitis. Recognition and timely treatment remain universal to skin and soft-tissue infections as the subcutaneous anatomy of the vulva can facilitate rapid spread to other tissues with significant morbidity and mortality. Employing a multidisciplinary team approach to care for vulvar cellulitis and abscess can guide treatment from antibiotic therapies to more aggressive surgical debridement. In this report, we describe a case of vulvar abscess caused by Methicillin-resistant staphylococcus aureus (MRSA) in a postmenopausal woman with underlying diseases of bronchiectasis and atelectasis. PMID:27617247
Zia, Asif; Zareen, Nabila
Extramammary Paget's disease is a rare disease, which mainly occurs in postmenopausal women. The case of Paget's disease of vulva, in a 40 year old Asian woman, who presented with a history of intense itching in vulva for 1 year is being reported. After being medically treated, she was diagnosed on Vulval biopsy. Local excision of the vulval lesion was performed, and histopathology revealed Paget's disease, extending close to the surgical margins. Therefore, a re-excision was performed and patient remained disease free at six months follow up.
Wu, Yinhua; Qiao, Jianjun; Fang, Hong
Vulvovaginal-gingival syndrome is characterized by erosions and desquamation of the vulva, vagina, and gingiva. We reported a case of a 32-year-old woman presenting with an 8-year history of damage to the vulval and perianal anatomy and limitation of mouth opening. The patient's symptoms were relieved after treatment with topical tacrolimus cream.
Gumber, Sanjeev; Baia, Petrisor; Wakamatsu, Nobuko
A 15-year-old female gray Appaloosa horse was presented with history of a mass over the right dorsal commissure of vulva for the past 7 months. Based on histopathological examination, and positive staining with factor VIII-related antigen, vimentin, and Verhoeff-van Gieson stain, the vulvar mass was diagnosed as hemangiosarcoma with marked solar elastosis.
38500 Retroperitoneal Lymphadenectomy 38780 Dentoalveolar Structures 41899 Tonsillectomy /Adenoidectomy, 42820 Under 12 Tonsillectomy /Adenoidectomy...42821 12 or over Tonsillectomy , Under 12 42825 Tonsillectomy , 12 & Over 42826 Adenoidectomy, Under 12 42830 Excision Submandibular Gland 42440...CASE CODE Laser Destruction Vulva 56507 Anterior Colporrhaphy 57240 Cerclage of Utrine Cervix 57700 Biopsy of Cervix 57520 Dilation and Curettage
Pratylenchus lentis n. sp. parasitizing roots of lentil in Sicily, Italy, is described and illustrated. The new species is characterized by a high lip region with three annuli, stylet mean length of 16 micrometers with anteriorly flattened knobs, cylindrical body with a relatively anterior vulva, l...
Normal Vulval Skin; Lichen Sclerosus; High Grade Dysplasia - Usual Type ('VIN 2-3'); High Grade Dysplasia - Differentiated Type ('VIN 2-3'); Squamous Cell Carcinoma; Epithelial Hyperplasia Without Atypia; Atypia Not Otherwise Specified/ Low Grade Dysplasia ('VIN 1'); Pagets Disease of the Vulva
and Lymphatic System Gastroscopy Hemorrhoidectomy Cervical Node (lymph node) biopsy Herniorrhaphy Liver Biopsy, percutaneous Integumentary System...excision ocular muscles, strabismus procedure) 31 Musculoskeletal System Respiratory System Arthrodesis Antral Window (puncture) Arthroplasty (Sinusotomy...Vulva biopsy Hemic and Lymphatic System Cervical node/lymph node biopsy Integumentary System Aspirational biopsies Augmentation mammoplasty Benign lesion
Ribas, Alexis; Casanova, Joan Carles
A new species of Soboliphyme from the endemic Iberian mole (Talpa occidentalis) is described. Soboliphyme occidentalis sp. nov. can be readily distinguished from all of its congeners primarily by the position of the vulva, which clearly shows a posterior oesophageal location, and the number of male caudal papillae. S. occidentalis sp. nov. is the only species that has four pairs of caudal papillae. S. abei, S. caucasica and S. jamesoni can be distinguished from S. occidentalis sp. nov. by not having a notched sucker, the anterior position of the vulva and two polar plugs in the eggs. S. jamesoni has an armate oral sucker and longer spicule; S. caucasica a longer spicule and shorter eggs, and S. abei has shorter eggs, which separate these species from S. occidentalis sp. nov. In the rest of the species with a notched oral sucker, S. baturini and S. hirudiniformis are differentiated from S. occidentalis sp. nov. by the anterior position of the vulva, two polar plugs in the egg and the spicule length in S. baturini and S. hirudiniformis and the size of eggs in S. baturini and S. hirudiniformis. S. ataahai, S. soricis and S. urotrichi have the vulva at the oesophago-intestinal junction, 9-10 male caudal papillae (S. ataahai and S. urotrichi), absence of male caudal papillae (S. soricis), armate oral sucker and long spicule in S. ataahai and one row of six circumoral spines in S. urotrichi. A key to the species of Soboliphyme is presented.
Mack-Detlefsen, B.; Banaschak, S.; Boemers, T. M.
Background: Female genital mutilation (FGM) occurs mainly in Africa, parts of the Arabian Peninsula and parts of Asia. It is commonly associated with acute complications as well as diverse late/delayed complications. One of the most common of these late complications is progressively enlarging painless cysts of the vulva. Case Report: An 8-year-old girl from Eritrea presented to our paediatric emergency department with a progressively enlarging mass of the vulva. She had undergone a clitoridectomy and partial removal of the labia minora as an infant in Eritrea. We performed surgical excision of the cyst and reconstruction of the labia. Histology showed a traumatic squamous epithelial inclusion cyst of the vulva. Conclusion: Epithelial or dermoid cysts of the vulva following FGM are extremely rare. Symptoms often require surgical intervention. Through increasing migration, more girls and female youths with FGM are likely to present to practices and hospitals in Germany. Thus increased knowledge and awareness of the medical complications of FGM and their treatment will be necessary in years to come. PMID:26500372
An overview is provided for veterinary care of urogenital tumors in companion animals, especially the dog. Neoplasms discussed include tumors of the kidney, urinary bladder, prostate, testis, ovary, vagina, vulva and the canine transmissible venereal tumor. Topics addressed include description, diagnosis and treatment.
Mihmanli, V; Ózkan, T; Genc, S; Cetinkaya, N; Uctas, H
Endometriosis is characterized by the presence of histologically normal endometrial glands and stroma outside the uterine cavity. Endometriosis predominantly locates on peritoneal surfaces, but it also affects the vagina, vulva, and perineum, usually secondary to surgical or obstetric trauma. Endometriosis in an episiotomy scar is a fairly rare phenomenon. The authors present a case of endometriosis in an episiotomy scar.
... body or any object. (a) By force (i) That the accused committed a sexual act upon another person by... body or by any object; (ii) That the accused did so with unlawful force; and (iii) That the accused did... the vulva, anus, or mouth of another person by any part of the body or by any object; (ii) That...
Bansal, Anshuma; Singh, Mini P; Rai, Bhavana
Human papillomavirus (HPV) infection is linked with several cancers such as cancer cervix, vagina, vulva, head and neck, anal, and penile carcinomas. Although there is a proven association of HPV with these cancers, questions regarding HPV testing, vaccination, and treatment of HPV-related cancers continue to remain unanswered. The present article provides an overview of the HPV-associated cancers. PMID:27127735
Understanding the pelvic floor anatomy and all of its components is crucial when performing pelvic floor examination and assessing patients suffering from urinary incontinence. It is important for urology nurses to understand the pelvic floor, including the muscle, nerve, and fascia involved; external and internal examination of the vulva; and global assessment of the patient.
Lee, Hanjing; Yap, Yan Lin; Low, Jeffrey Jen Hui
Defects involving specialised areas with characteristic anatomical features, such as the nipple, upper eyelid, and lip, benefit greatly from the use of sharing procedures. The vulva, a complex 3-dimensional structure, can also be reconstructed through a sharing procedure drawing upon the contralateral vulva. In this report, we present the interesting case of a patient with chronic, massive, localised lymphedema of her left labia majora that was resected in 2011. Five years later, she presented with squamous cell carcinoma over the left vulva region, which is rarely associated with chronic lymphedema. To the best of our knowledge, our management of the radical vulvectomy defect with a labia majora sharing procedure is novel and has not been previously described. The labia major flap presented in this report is a shared flap; that is, a transposition flap based on the dorsal clitoral artery, which has consistent vascular anatomy, making this flap durable and reliable. This procedure epitomises the principle of replacing like with like, does not interfere with leg movement or patient positioning, has minimal donor site morbidity, and preserves other locoregional flap options for future reconstruction. One limitation is the need for a lax contralateral vulva. This labia majora sharing procedure is a viable option in carefully selected patients. PMID:28194353
Two new species of Paurodontella collected around the roots of wheat (Triticum aestivum L.) are described and illustrated. One new species is characterized by having a short cylindrical, robust body markedly tapering at both ends with an anteriorly located vulva, short post-uterine sac, lateral fiel...
Autism is not a mental health disorder, but it sometimes is misdiagnosed as one--and can bring its own mental health issues. Dr Judith Gould explains how a mental health problem may mask an undiagnosed autistic spectrum disorder.
Malagù, Michele; Marcantoni, Lina; Scalone, Antonella; Toselli, Tiziano; Pratola, Claudio; Bertini, Matteo
We report the case of 70-year-old woman with Reel syndrome and cardiac resynchronization therapy device who experienced severe device malfunction. Reel syndrome was misdiagnosed for several months and the patient manifested fatigue, discomfort and diaphragmatic stimulation.
The Testicular Cancer Resource Center Questions for your Doctor: Your First Visit This list of questions is intended to help ... cancer, be happy, but also be aware that testicular cancer is misdiagnosed as epididymitis or something similar almost ...
... head and the voice. Dystonic tremors are quite variable in their presentation and on some occasions can ... Oromandibular dystonia may be misdiagnosed as TMJ. Accelerating Research & Inspiring Hope The Dystonia Medical Research Foundation (DMRF) ...
Veskitkul, J; Ruangchira-urai, R; Charuvanij, S; Pongtanakul, B; Udomittipong, K; Vichyanond, P
We herein report a case of antiphospholipid syndrome (APS) primarily presenting with asthma-like symptoms that had been misdiagnosed as severe asthma. Patients presenting with severe asthma symptoms along with systemic thrombosis should be systematically evaluated for APS.
Schlozman, Steven C.
Asserts the obsessive-compulsive disorder is often misdiagnosed in children and adolescents; describes characteristics of obsessive-compulsive disorder; differentiates between normal and abnormal obsessions; suggests ways teachers can help students diagnosed with the disorder. (PKP)
... family history of the disorder. However, because the genetic test for CADASIL was not available before 2000, many cases were misdiagnosed as multiple sclerosis, Alzheimer's disease, or other neurodegenerative diseases. × Definition CADASIL (Cerebral ...
McClarren-Curry, C; Shaughnessy, K
Acute thoracic aortic dissection is frequently misdiagnosed, and even with surgical intervention, the mortality rate is 50%. This article focuses on assessment, interventions, and postoperative care of patients with aortic dissection.
... please visit this page: About CDC.gov . Chronic Fatigue Syndrome (CFS) Share Compartir Symptoms On this Page ... Symptoms What's the Clinical Course of CFS? Chronic fatigue syndrome can be misdiagnosed or overlooked because its ...
misdiagnosed or missed altogether. Traditionally, physicians and scientists have viewed and interpreted diseases at the ‘visual’ clinical level. With the...exposure. Mild TBI can be dif- ficult to diagnose and, when coupled with psy- chological illness, can be either misdiagnosed or missed altogether...HBII52 small nucleolar RNA in the regulation of alternative splicing of the serotonin 2c receptor , and that patients with autism and Prader
coupled with psychological illness, can be either misdiagnosed or missed altogether. Traditionally, physicians and scientists have viewed and interpreted...and, when coupled with psy- chological illness, can be either misdiagnosed or missed altogether. Traditionally, physicians and scientists have viewed...alternative splicing of the serotonin 2c receptor , and that patients with autism and Prader-Willi-like characteristics are found to have
Wright, Amanda; Gerhart, Ann E
Injuries of the tarsometatarsal, or Lisfranc, joint are rarely seen. Lisfranc fractures and fracture dislocations are among the most frequently misdiagnosed foot injuries in the emergency department. A misdiagnosed injury may have severe consequences including chronic pain and loss of foot biomechanics. Evaluation of a foot injury should include a high level of suspicion of a Lisfranc injury, and a thorough work-up is needed for correct diagnosis.
Güner, Mehmet Derviş; Kamburoğlu, Haldun Onuralp; Bektaş, Umut; Ay, Şadan
Abstract Hands, especially lunatum, are involved very rarely with osteoid osteoma. This report presents an osteoid osteoma of the lunatum, which was previously misdiagnosed as Kienböck’s disease and had undergone surgery. Magnetic resonance imaging may lead the clinician to misdiagnose because of the excessive bone edema around the carpus. The operation should be planned according to radiography and computed tomography findings. PMID:27252961
Gilabert Rodríguez, R; Berenguer, B; González Meli, B; Marín Molina, C; de Tomás Palacios, E; Buitrago Weiland, G; Aguado del Hoyo, A
First branchial arch cysts are uncommon. Therefore, together with its variable clinical and age presentation they are often misdiagnosed at first. The treatment is surgical, requiring a correct procedure to avoid future recurrences. In this paper we describe a typical case of first branchial arch cyst in which as described in other reports, we first made several misdiagnoses and therefore an inadequate treatment and lastly, with the correct diagnosis, we performed a meticulous complete excision under facial nerve monitoring.
Byun, Sun-Ju; Moon, Kyung Chul; Suh, Kyung-Suk; Han, Joon Koo; Chai, Jong-Yil
Echinococcus granulosus, an intestinal tapeworm of dogs and other canids, infects humans in its larval stage and causes human echinococcosis or hydatid disease. In the Republic of Korea, 31 parasite-proven human echinococcosis cases have been reported, most of which were imported from the Middle East. We recently examined a 61-year-old Korean man who had a large cystic mass in his liver. ELISA was negative for tissue parasitic infections, including echinococcosis, cysticercosis, paragonimiasis, and sparganosis. The patient underwent surgery to remove the cyst, and the resected cyst was processed histopathologically for microscopic examinations. In sectioned cyst tissue, necrotizing protoscolices with disintegrated hooklets of E. granulosus were found. In some areas, only freed, fragmented hooklets were detected. The patient had traveled to western and central Europe in 1996, and had no other history of overseas travel. We report our patient as a hepatic echinococcosis case which was probably imported from Europe.
Oh, Youngmin; Kim, Jeong-Tae; Kim, Mi-Kyeong; Chang, You-Jin; Eom, Keeseon; Park, Jung-Gi; Lee, Ki-Man; Choe, Kang-Hyeon; An, Jin-Young
Sparganosis is a rare parasitic disease caused by migrating plerocercoid tapeworm larva of the genus Spirometra. Infection in humans is mainly caused by the ingestion of raw or inadequately cooked flesh of infected frogs, snakes, and chickens. Here, we report a rare case of a 45-year-old man who was admitted to our hospital with left lower chest pain. The chest radiograph and computed tomography (CT) scan revealed localized pleural effusion in the left lower lobe; further, peripheral blood eosinophilia and eosinophilic pleural effusion were present. Percutaneous catheter drainage was performed, which revealed long worm-shaped material that was identified as a sparganum by DNA sequencing. The patient showed clinical improvement after drainage of the sparganum. This study demonstrates the importance of considering parasitic diseases in the differential diagnosis of eosinophilic pleural effusion.
Lupi, Omar; Downing, Christopher; Lee, Michael; Pino, Livia; Bravo, Francisco; Giglio, Patricia; Sethi, Aisha; Klaus, Sidney; Sangueza, Omar P; Fuller, Claire; Mendoza, Natalia; Ladizinski, Barry; Woc-Colburn, Laila; Tyring, Stephen K
In the 21st century, despite increased globalization through international travel for business, medical volunteerism, pleasure, and immigration/refugees into the United States, there is little published in the dermatology literature regarding the cutaneous manifestations of helminth infections. Approximately 17% of travelers seek medical care because of cutaneous disorders, many related to infectious etiologies. This review will focus on the cutaneous manifestations of helminth infections and is divided into 2 parts: part I focuses on nematode infections, and part II focuses on trematode and cestode infections. This review highlights the clinical manifestations, transmission, diagnosis, and treatment of helminth infections. Nematodes are roundworms that cause diseases with cutaneous manifestations, such as cutaneous larval migrans, onchocerciasis, filariasis, gnathostomiasis, loiasis, dracunculiasis, strongyloidiasis, ascariasis, streptocerciasis, dirofilariasis, and trichinosis. Tremadotes, also known as flukes, cause schistosomiasis, paragonimiasis, and fascioliasis. Cestodes (tapeworms) are flat, hermaphroditic parasites that cause diseases such as sparganosis, cysticercosis, and echinococcus.
Millan, J M; Purdie, J L; Melville, L F
The farming of crocodiles in the Northern Territory of Australia is a rapidly growing industry. The saltwater crocodile produces a premium quality skin which is sought world-wide for the lucrative leather trade and manufacture of finished articles. Flesh is considered to be a by-product of skin production. Several procedures are used in abattoirs to prevent the risk of cross contamination of flesh. The public health risks linked to the production of crocodile flesh are described for the two main diseases of concern, namely: sparganosis and salmonellosis. The slaughter and hygienic processing procedures and local laboratory evidence indicate that the consumption of crocodile flesh produced in the Northern Territory carries a negligible public health risk.
Almeida, Gregório Guilherme; Coscarelli, Daniel; Melo, Maria Norma; Melo, Alan Lane; Pinto, Hudson Alves
Species of the genus Spirometra are diphyllobothriid tapeworms with complex life cycles and are involved in human sparganosis, a neglected disease that affects individuals worldwide. Although some species were reported in wild felids and human cases of sparganosis were described in Brazil, the biology and taxonomy of these parasites are poorly understood. In the present study, samples of diphyllobothriids (eggs and/or proglottids) obtained from the stools of wild carnivores (Leopardus pardalis and Lycalopex vetulus) and plerocercoid larvae found in a snake (Crotalus durissus) from Brazil were analysed by amplifying a fragment of the gene cytochrome c oxidase subunit 1 (cox 1). The DNA sequences obtained here for the first time from the Spirometra spp. from Brazil were used to evaluate the phylogenetic relationships with other species. Molecular data identified two species in the Brazilian samples (evolutionary divergence of 17.8-19.2%). The species were identified as Spirometra sp. 1, found in Le. pardalis, and Spirometra sp. 2 found in Ly. vetulus and C. durissus, and they differed from Asian isolates of Spirometra erinaceieuropaei (17.5-20.2% and 12.2-15.6%, respectively), a species previously considered to be distributed worldwide. Moreover, Spirometra sp. 1 is genetically distinct from Sparganum proliferum from Venezuela (19.6-20.4%), while Spirometra sp. 2 is more closely related with the Venezuelan species (6.1-7.0%). Sequences of Spirometra sp. 2 revealed that it is conspecific with the Argentinean isolate of Spirometra found in Lycalopex gymnocercus (1.9-2.2%). Taxonomic and phylogenetic aspects related to New World species of Spirometra are briefly discussed.
Young, Sam; Skerratt, Lee F; Mendez, Diana; Speare, Rick; Berger, Lee; Steele, Mike
We analyzed submission data from a wildlife care group during amphibian disease surveillance in Queensland, Australia. Between January 1999 and December 2004, 877 white-lipped tree frogs Litoria infrafrenata were classified according to origin, season and presenting category. At least 69% originated from urban Cairns, significantly more than from rural and remote areas. Total submissions increased during the early and late dry seasons compared with the early wet season. Frogs most commonly presented each year with injury, followed by 'other', sparganosis and irreversible emaciation of unknown aetiology. This is the first report of Spirometra erinacei infection in this species. A high prevalence (28%) of visible S. erinacei infection was found in emaciated frogs, but this was not statistically different from that in non-emaciated diseased frogs (25%). However, 14 emaciated specimens that were necropsied all had heavy S. erinacei infections, and the odds of visible sparganosis were statistically greater in emaciated frogs compared with injured, non-diseased frogs. We provide a detailed case definition for a new endemic disease manifesting as irreversible emaciation, for which S. erinacei may be the primary aetiological agent. The lack of significant spatial or temporal patterns in case presentation suggests that this is not a currently emerging disease. We show that community wildlife groups can play a valuable role in monitoring disease trends, particularly in urban areas, but identify a number of limitations associated with passive syndromic surveillance. We conclude that it is critical that professionals be involved in establishing syndromic case definitions, diagnostic pathology, complementary active disease surveillance, and data analysis and interpretation in all wildlife disease investigations.
Effects of Feeding Barley Naturally Contaminated with Fusarium Mycotoxins on Growth Performance, Nutrient Digestibility, and Blood Chemistry of Gilts and Growth Recoveries by Feeding a Non-contaminated Diet
Kong, C.; Shin, S. Y.; Park, C. S.; Kim, B. G.
The objectives of this study were to investigate the effects of feeding barley naturally contaminated with Fusarium mycotoxins on growth performance, vulva swelling, and digestibility of dry matter, organic matter, and crude protein of gilts and the recovery of gilts fed normal diets immediately after the exposure to contaminated diets by measuring growth performance and vulva swelling. In Exp. 1, four diets were prepared to contain 0%, 15%, 30%, or 45% contaminated barley containing 25.7 mg/kg deoxynivalenol and 26.0 μg/kg zearalenone. Sixteen gilts with an initial body weight (BW) of 33.3 kg (standard deviation = 3.0) were individually housed in a metabolism crate and assigned to 4 diets with 4 replicates in a randomized complete block design based on BW. During the 14-d feeding trial, individual BW and feed consumption were measured weekly and the vertical and horizontal lengths of vulva were measured every 3 d. From d 10, feces were collected by the maker-to-marker method for 4 d. Blood samples were collected on d 14. During the overall period, the average daily gain, average daily feed intake, and gain:feed of pigs linearly decreased (p<0.01) as the dietary concentration of contaminated barley increased. However, the digestibility of crude protein was linearly increased (p = 0.011) with the increasing amounts of contaminated barley. Increasing dietary Fusarium mycotoxin concentrations did not influence vulva size, blood characteristic as well as immunoglobulin level of pigs. In the Exp. 2, a corn-soybean meal-based diet was formulated as a recovery diet. Pigs were fed the recovery diet immediately after completion of the Exp. 1. During the 14-d of recovery period, the individual BW and feed consumption were measured weekly and the vertical and horizontal length of vulva were measured every 3 d from d 0. On d 7, the feed intake of pigs previously fed contaminated diets already reached that of pigs fed a diet with 0% contaminated barley and no significant
Fabis, J J; Szkudlarek, L; Risatti, G R; Sura, R; Garmendia, A E; Van Kruiningen, H J
A 14-month-old heifer with a 17-day history of unresponsive bloody diarrhea was necropsied. There were focal, pink-red erosions of the nares and hard palate; ulcers and fissures of the tongue; and multiple ulcerative lesions of the alimentary canal. Interdigital skin of both rear limbs was ulcerated and bleeding; and the margins of the vulva contained punctiform red ulcers. The gross lesions were consistent with mucosal disease. Histopathology and laboratory testing ruled out rinderpest, foot-and-mouth disease, and vesicular stomatitis, and identified bovine virus diarrhea virus to be the cause of this disease. Lesions of the vulva similar to those seen in some stages of infectious pustular vulvovaginitis were negative for bovine herpesvirus-1 and tested positive for bovine viral diarrhea virus antigen by immunohistochemistry.
Zhang, Jian; Chen, Yue; Wang, Kana; Xi, Mingrong; Yang, Kaixuan; Liu, Hui
Prepubertal vulval fibroma and ectopic breast fibroadenoma of the vulva are two rare tumors, and they are very difficult to distinguish from other vulval masses, both clinically and pathologically. The complication of the two diseases is extremely rare. We report the case of an extremely large and progressively enlarging mass in the vulva of an 18-year-old Chinese girl. The mass was excised completely and pathologically diagnosed as a prepubertal vulval fibroma and ectopic breast fibroadenoma. The patient was followed up for 10 months and no evidence of recurrence was observed. Prepubertal vulval fibroma and vulval ectopic breast fibroadenoma should be considered in their preoperative differential diagnosis of a vulval mass, especially in prepubertal girls. Pathologically, immunohistochemical staining for vimentin and CD34 is valuable for diagnosis. Complete surgical excision is effective and long-term follow up is necessary.
51 women with urinary schistosomiasis underwent gynecological examinations, including colposcopy and photographic documentation of lesions, in a study conducted in 1994 at Mangochi Hospital near Lake Malawi. Microscopy of genital biopsies determined that 33 women had S. haematobium eggs in their cervix, vagina, and/or vulva. A significant correlation was identified between the size of genital lesion and the number of ova counted. Women with genital pathology had significantly more tumors in the vulva than women with schistosomiasis of the urinary tract only. Most of the observed pathology could be seen with the unaided eye. Even though the sample was very small, significantly more cases of genital schistosomiasis were found in women who had fewer children than desired and whose husbands had children with other women. Reasons for that observation were not investigated. The findings of this pilot study indicate that more research is needed to provide a better understanding of the implications of the disease upon marital and sexual lives.
Camino, Nora B; de Villalobos, Cristina
A new species of the genus Protrellus, P. blatta sp. nov. parasitizing a field cockroach Blatella vaga Hebard, 1919, from El Tala river, Catamarca, Argentina, is described and illustrated. It is characterized by having the mouth opening circular, the buccal capsule with eight very small teeth, the nerve ring around oesophageal corpus, the excretory pore anterior to vulva, the vulva anterior to base of oesophagus, didelphic, the posterior ovary reflexed anterior to rectum, about one third of a body length from posterior end, the egg ellipsoidal, colourless, bearing a lateral cuticular crest, tail conical, with long filiform projection, the male with testis single, outstretched, one spicule, very small, short and straight, gubernaculums absent, the genital papillae arranged in three pairs of ventrolateral papillae, of which the first pair are close together and preanal position, two pairs postanal, tail conical and short, less than one twentieth of total body. A taxonomic key of Protrellus species is given.
Tielemans, Hanneke J.P.; Ulrich, Dietmar J.O.
Summary: In this case report we describe the use of a 2-stage approach to treat severe recurrent vulvar lymphangiectasia in a patient with Noonan syndrome. First, 3 functional lymphatic vessels were identified and anastomosed to venules in an end-to-end fashion. Then, in a second surgical procedure, the vulvar lesions were resected as much as possible and the vulva was reconstructed. By the 12-month follow-up the patient had recovered well. Although there were still some small vesicles on the left labia there was no more ooze, itch, and pain. Lymphatic mapping using indocyanine green showed improvement of the edema of her vulva region and patent LVA. In addition to the demonstration of this 2-stage approach, this case report also demonstrates the benefits of preemptive LVA before performing surgery that may be at high risk for postoperative lymph edema. PMID:27622088
Sal Moyano, María P; Luppi, Tomás; Medesani, Daniel A; McLay, Colin L; Rodríguez, Enrique M
Most brachyuran females become receptive during the intermolt period, a condition considered "derived". However, as far as we know, studies testing the existence and function of pheromones in decapods are based on species which have mating linked to molting, a condition considered as "ancestral". For the first time, we studied some physiological and morphological processes involved in Neohelice granulata intermolt female crabs becoming receptive and potentially attracting males. We found that receptive females have mobile vulvae opercula due to a softening process of the cuticle hinge which showed lower calcium levels compared to the hinge of unreceptive females. Local softening of the hinge was stimulated by a low concentration of ecdysone during the intermolt period. A putative pheromone liberated by receptive females to attract males is presumed to be released through the mobile vulvae and not through the urine.
Hakariya, Tomoaki; Nakanishi, Hiromi; Asai, Akihiro; Kanokoki, Katsura; Kihara, Toshiharu; Takehara, Kosuke; Igawa, Tsukasa; Sakai, Hideki; Tou, Kazuo; Takeshita, Hiroaki; Miura, Kiyonori; Tanaka, Katsumi; Kashima, Shiro; Matsuo, Manabu
Extramammary Paget's disease occurring in the female vulva is occasionally associated with invasive disease to urethra and bladder mucosa. For such cases, ensuring adequate surgical margin is essential. Not only adequate removal of tumor, but also urinary diversion is important for patient's quality of life. A 77- year-old woman was treated with excision of vulvar tumor, urethra, vagina, rectum and anus. The determination of excision area was decided according to the result of mapping biopsy including urethra and bladder. Then she received reconstruction of vulva using the gracilis muscle skin flap. We applied a technique of channel formation for intermittent catheterization using the retubularized sigmoid colon based on the Monti principle. The tube was implanted submucosally into the bladder to prevent the reflux of urine. Fifteen days after operation, self-intermittent catheterization was started successfully. Surgical margins were negative in urethra, skin, vagina and rectum. There are no obvious recurrence or metastasis 1 year after surgery.
Psilodimitrakopoulos, Sotiris; Santos, Susana; Amat-Roldan, Ivan; Mathew, Manoj; Thayil K. N., Anisha; Artigas, David; Loza-Alvarez, Pablo
Second harmonic generation (SHG) imaging has emerged in recent years as an important laboratory imaging technique since it can provide unique structural information with submicron resolution. It enjoys the benefits of non-invasive interaction establishing this imaging modality as ideal for in vivo investigation of tissue architectures. In this study we present, polarization dependant high resolution SHG images of Caenorhabditis elegans muscles in vivo. We imaged a variety of muscular structures such as body walls, pharynx and vulva. By fitting the experimental data into a cylindrical symmetry spatial model we mapped the corresponding signal distribution of the χ (2) tensor and identified its main axis orientation for different sarcomeres of the earth worm. The cylindrical symmetry was considered to arise from the thick filaments architecture of the inside active volume. Moreover, our theoretical analysis allowed calculating the mean orientation of harmonophores (myosin helical pitch). Ultimately, we recorded and analysed vulvae muscle dynamics, where SHG signal decreased during in vivo contraction.
Background Influenza (flu) surveillance using Twitter data can potentially save lives and increase efficiency by providing governments and healthcare organizations with greater situational awareness. However, research is needed to determine the impact of Twitter users’ misdiagnoses on surveillance estimates. Objective This study establishes the importance of Twitter users’ misdiagnoses by showing that Twitter flu surveillance in the United States failed during the 2011-2012 flu season, estimates the extent of misdiagnoses, and tests several methods for reducing the adverse effects of misdiagnoses. Methods Metrics representing flu prevalence, seasonal misdiagnosis patterns, diagnosis uncertainty, flu symptoms, and noise were produced using Twitter data in conjunction with OpenSextant for geo-inferencing, and a maximum entropy classifier for identifying tweets related to illness. These metrics were tested for correlations with World Health Organization (WHO) positive specimen counts of flu from 2011 to 2014. Results Twitter flu surveillance erroneously indicated a typical flu season during 2011-2012, even though the flu season peaked three months late, and erroneously indicated plateaus of flu tweets before the 2012-2013 and 2013-2014 flu seasons. Enhancements based on estimates of misdiagnoses removed the erroneous plateaus and increased the Pearson correlation coefficients by .04 and .23, but failed to correct the 2011-2012 flu season estimate. A rough estimate indicates that approximately 40% of flu tweets reflected misdiagnoses. Conclusions Further research into factors affecting Twitter users’ misdiagnoses, in conjunction with data from additional atypical flu seasons, is needed to enable Twitter flu surveillance systems to produce reliable estimates during atypical flu seasons. PMID:28210419
Martínez Luna, Eduwiges; Rebollo Domínguez, Natalia; Vega Memije, Maria Elisa; Arenas, Roberto
Syringoma is a benign neoplasm of eccrine origin. Lesions often arise around the eyes and on the upper cheeks of middle-aged women. Syringomas involving the genitalia are rare, they present as multiple, bilateral, skin-colored papules over the labia majora. The lesions should therefore be considered in the differential diagnosis of multiple papular lesions of the vulva. We report two females of 37 and 62 years of age, both observed in a dermatological service.
LaPolla, J.; Foucar, E.; Leshin, B.; Whitaker, D.; Anderson, B.
The clinical and pathological features of a case of multifocal lymphangioma circumscriptum of the vulva are reported in a patient with chronic lymphedema of a lower extremity. Ten years previously the patient had been treated for squamous cell carcinoma of the cervix. Although lymphangioma circumscriptum is an extremely rare complication of altered lymphatic drainage, the presence of multiple noninflammatory vesicular appearing lesions in this setting should suggest the correct diagnosis.
Karamisheva, V; Nachev, A
Infections of the vulva and vagina are one of the most common gynecological diseases. They can be determined by a variety of physical, chemical and biological factors. The main risk factors contributing to vaginitis are aerobic and anaerobic bacterias, fungal and viral infections, and irritants. Subjective complaints are pruritus, vulvar and/or perivulvar erytema and different in volume and characterization discharge. Excepting etiological treatment in most cases it is necessary to use additional agents, for example Saforelle.
Shah, Ali Asghar; Vaid, Shavish; Hussain, Abid; Ahmad, Rakeeb
Distorhabditis poonchiana n. gen., n. sp. from humus in Jammu and Kashmir, India, is described and illustrated. The new genus is characterized by a small body; slightly setoff labial region; long tubular gymnostom; prominently cuticularized cheilostom; absence of glottoid apparatus; monoprodelphic reproductive system; vulva (V) = 81 to 84; spicules with trifurcated distal ends, simple gubernaculum, peloderan bursa with eight pairs of bursal papillae arranged in 1 + 1 + 1 + 2 + 1 + 2 arrangement. PMID:26941466
Farmer, Melissa A; Taylor, Anna M; Bailey, Andrea L; Tuttle, Alexander H; MacIntyre, Leigh C; Milagrosa, Zarah E; Crissman, Halley P; Bennett, Gary J; Ribeiro-da-Silva, Alfredo; Binik, Yitzchak M; Mogil, Jeffrey S
Provoked vestibulodynia, the most common form of vulvodynia (unexplained pain of the vulva), is a prevalent, idiopathic pain disorder associated with a history of recurrent candidiasis (yeast infections). It is characterized by vulvar allodynia (painful hypersensitivity to touch) and hyperinnervation. We tested whether repeated, localized exposure of the vulva to a common fungal pathogen can lead to the development of chronic pain. A subset of female mice subjected to recurrent Candida albicans infection developed mechanical allodynia localized to the vulva. The mice with allodynia also exhibited hyperinnervation with peptidergic nociceptor and sympathetic fibers (as indicated by increased protein gene product 9.5, calcitonin gene-related peptide, and vesicular monoamine transporter 2 immunoreactivity in the vaginal epithelium). Long-lasting behavioral allodynia in a subset of mice was also observed after a single, extended Candida infection, as well as after repeated vulvar (but not hind paw) inflammation induced with zymosan, a mixture of fungal antigens. The hypersensitivity and hyperinnervation were both present at least 3 weeks after the resolution of infection and inflammation. Our data show that infection can cause persistent pain long after its resolution and that recurrent yeast infection replicates important features of human provoked vulvodynia in the mouse.
Photos, Andreas; Gutierrez, Arturo; Sommer, Ralf J
Evolutionary comparisons between Caenorhabditis elegans and the satellite organism Pristionchus pacificus revealed major differences in the regulation of nematode vulva development. For example, Wnt signaling is part of a negative signaling system that prevents vulva formation in P. pacificus, whereas it plays a positive role in C. elegans. We wondered if the genetic control of the second major part of the nematode egg-laying system, the sex muscles, has diverged similarly between P. pacificus and C. elegans. The sex muscles derive from the mesoblast M, which has an identical lineage in both species. Here, we describe a large-scale mutagenesis screen for mutations that disrupt the M lineage and the sex myoblast (SM) sublineage. We isolated and characterized mutations that result in a failure of proper SM fate specification and SM migration and showed that the corresponding genes encode Ppa-sem-4 and Ppa-egl-17, respectively. Ppa-sem-4 mutants have additional defects in the specification of the vulva precursor cells P(5, 7).p and experimental studies in the Ppa-egl-17 mutant background indicate a complex set of gonad-dependent and gonad-independent mechanisms required for SM migration. Mutations in Cel-sem-4 and Cel-egl-17 cause similar defects. Thus, the molecular mechanisms of SM cell specification and migration are conserved between P. pacificus and C. elegans.
Chokoeva, A; Tchernev, G; Wollina, U
Malignant melanoma of the vulva is a rare disease with aggressive behavior and poor prognosis. It consist < 5% of all cases of melanoma in females, as the ratio of its manifestation, compared with the cutaneous melanoma is 1:71. Higher risk of developing melanoma of the vulva is established in white women, as the peak of the incidence is between 60 and 70 years of age. Clinically, MM of the vulva manifests as asymptomatic pigmented, rarely a pigmented lesion, as the usual clinical form is superficial spreading MM and much less common nodular MM, which is associated with a poorer prognosis in. general. The diagnosis is confirmed by histological examination. Conduction of PCR and DNA analysis for detection of BRAF mutations, NRAS mutations and KIT amplification is also appropriate. Advanced age, black race, tumor size, tumor thickness, ulceration, presence of satellite lesions, involvement of adjacent organs (vagina, urethra), and the presence of regional or distant metastases are identified as the most important prognostic markers. Radical wide excision followed by bilateral lymphadenectomy id considered as the optimal therapeutic approach.
Yanazume, Shintaro; Douzono, Haruhiko; Kubo, Hidemichi; Nagata, Tomomi; Douchi, Tsutomu; Kobayashi, Hiroaki
Vulvar lymphatic leakage is a severe complication associated with gynecological cancer treatments. However, standard treatment strategies have not yet been determined. We encountered a rare case of a 76-year-old multiparous woman suffering from massive lymphatic fluid leakage from the entire vulva, and papules developed and were identified as lymphangiomas. A large amount of straw-colored discharge continued from all vulvar papules, which extended over the mons pubis. Nine years ago, the patient had undergone a radical hysterectomy with concurrent chemoradiation for uterine cervical cancer treatment. Her serum albumin level was 1.9 mg/dl, which was attributed to the loss of a large amount of lymph fluid due to leakage from the vulva. Her quality of life gradually decreased because of general fatigue and the need for frequent diaper exchanges every 2 h. The patient received a less-invasive treatment with cryotherapy using liquid nitrogen. She also received a multimodality treatment consisting of the intravenous administration of albumin, massage of the lower limbs and intensive rehabilitation. Cryotherapy was administered once a week for 3 months. Her discharge almost stopped and vulvar lymphangiomas decreased without any major complications. To the best of our knowledge, this is the first case report of massive lymphatic leakage complicated with vulvar lymphangiomas. Additionally, this case may represent the first successful treatment of vulva lymph leakage by cryotherapy without recurrence. Cryotherapy may have the potential to improve the quality of life as a less-invasive treatment for gynecological cancer survivors without serious complications.
Vulvar neoplasms represent four percent of all gynecological cancers. While most cases of vulvar neoplasms are benign, two percent of patients present with malignant disease. We present the case of a 37-year-old premenopausal female who presented to an outside institution with a lump in her left vulva, which had progressively enlarged to the size of an egg. A wide local excision of the left vulva was performed, and the pathology revealed a high-grade sarcoma, not otherwise specified (NOS), with negative margins. Imaging showed enlarged bilateral external iliac lymph nodes, likely metastatic. After discussion at a multidisciplinary gynecology oncology tumor board, she was treated with gemcitabine/docetaxel chemotherapy, followed by a left inguinal lymph node dissection and a left radical vulvectomy after being referred to our centre. The final pathology at that time showed a residual sarcoma of 3.5 mm in the left vulva with no lympho-vascular invasion (LVI) and negative margins, with the closest, laterally, at 2 mm. A total of three lymph nodes were negative. She received additional chemotherapy postoperatively. Approximately one year later, she returned to her gynecologist with a 1 cm mass on the left vulva. She underwent a left hemi-vulvectomy and lymph node dissection, and pathology confirmed the presence of a high-grade sarcoma with close margins. She received adjuvant radiotherapy. Three months later, she presented with persistent cough and pneumonia. Imaging revealed a 10 cm lung mass, which was believed to be metastasis from the vulva. This was confirmed with biopsy and was completely resected. Any mass in the Bartholin gland area should be investigated carefully. Poorly differentiated vulvar leiomyosarcoma in the Bartholin gland can recur locally but may also lead to distant metastasis. Despite surgical and systemic treatment, as well as adjuvant radiation, the tumor recurred. Due to the rarity of this condition, there are no clear recommendations for
Ikeda, Yuji; Oda, Katsutoshi; Matsuzawa, Naoki; Shimizu, Ken
Vaginal calculi are rarely encountered and are often misdiagnosed as bladder calculi because of the difficulty in achieving an appropriate diagnosis. Most vaginal calculi result from the presence of a urethrovaginal fistula; those occurring in the absence of such fistulas are extremely rare. We present a case of a 42-year-old bedridden woman with mental and physical disabilities who had been misdiagnosed for a decade as having a bladder calculus. We removed the calculus nonsurgically and the analyzed the components. Results demonstrated the presence of a primary vaginal calculus. Vaginal calculi may occasionally occur in disabled women, but further investigation of the etiology of such calculi is required.
Guo, Chenglin; Liu, Chengwu; Pu, Qiang; Lin, Feng
Primary pulmonary synovial sarcoma (PPSS) is a relatively rare neoplasm with highly progressive potential. We present an extremely rare case of PPSS presenting as recurrent pneumothorax with bullous lesions. Bullectomy was performed at the local hospital. Unfortunately, the patient was initially misdiagnosed as atypical carcinoid. Although a negative resection margin was obtained during the first surgery and a remedial operation and chemotherapy followed, the patient developed severe disease progression and died soon after. This report demonstrates that PPSS can easily be misdiagnosed and should be seriously considered in the differential diagnosis of pneumothorax. PMID:27995774
Zhao, Tie-Mei; Gao, Jie; She, Dan-Yang; Chen, Liang-An
Blastomycosis is a fungal disease that is endemic in parts of North America. It is very rare in China and also commonly misdiagnosed, often as cancer or other infectious diseases. The clinical profile of a case of disseminated blastomycosis with pulmonary changes and skin ulcers was described. He had been misdiagnosed with tuberculosis, after adequate therapy with a lipid formulation of amphotericin B, followed by itraconazole, the lung and skin lesions improved. Then the five cases reported in China and literatures were reviewed. The aim of this report was to improve the knowledge regarding blastomycosis for physicians in China to avoid delaying adequate therapy.
Gutiérrez, Alejandra; Sauler, Maor; Mitchell, James M; Siegel, Mark D; Trow, Terence K; Bacchetta, Matthew; Fares, Wassim H
Pulmonary artery sarcomas (PAS) are rare tumors with a poor prognosis. They are often misdiagnosed as pulmonary embolism (PE) leading to futile anticoagulation treatment and delay in proper diagnosis. We present a case of a patient who was initially misdiagnosed and anticoagulated for presumed pulmonary embolism. Progressive symptoms and additional imaging led to the diagnosis of intimal pulmonary artery sarcoma for which he underwent surgical resection. This case serves as a reminder to consider pulmonary artery sarcoma in the differential diagnosis of patients with dyspnea and filling defects on CT pulmonary angiogram offering the potential for resection prior to metastasis.
Xu, Xiaoling; Zhang, Ruifeng; Hu, Huihui; Ye, Wu; Wang, Jin; Chen, Liying; Qiu, Lijun; Ying, Kejing
Pulmonary artery intimal sarcoma (PAIS) is a rare malignant tumor that presents with nonspecific symptoms and may be misdiagnosed as thromboembolic disease. We report a case of a 40-year-old female who presented with diarrhea as the initial symptom, was misdiagnosed and received thrombolytic therapy for presumed pulmonary embolism. Progressive symptoms and subsequent surgery led to the diagnosis of PAIS, and early relapse after pulmonary endarterectomy. Her survival time was 17 months after pulmonary endarterectomy. To our knowledge, diarrhea as initial manifestation of PAIS has not been described.
Xu, Xiaoling; Zhang, Ruifeng; Hu, Huihui; Ye, Wu; Wang, Jin; Chen, Liying; Qiu, Lijun; Ying, Kejing
Pulmonary artery intimal sarcoma (PAIS) is a rare malignant tumor that presents with nonspecific symptoms and may be misdiagnosed as thromboembolic disease. We report a case of a 40-year-old female who presented with diarrhea as the initial symptom, was misdiagnosed and received thrombolytic therapy for presumed pulmonary embolism. Progressive symptoms and subsequent surgery led to the diagnosis of PAIS, and early relapse after pulmonary endarterectomy. Her survival time was 17 months after pulmonary endarterectomy. To our knowledge, diarrhea as initial manifestation of PAIS has not been described. PMID:26425101
Memon, Sarfaraz; Chhabra, Lovely; Krainski, Felix; Parker, Matthew W; Swales, Heather
Caseous calcification of the mitral annulus (CCMA) is a rare variant of mitral annular calcification that maybe easily misdiagnosed or confused with an abscess, a tumor, or infective vegetation. The main pathophysiological mechanism leading to CCMA involves degeneration and calcium deposition on the mitral valve. We present a case of CCMA to help understand this clinical entity.
Dieme, Constentin; Parola, Philippe; Guernier, Vanina; Lagadec, Erwan; Le Minter, Gildas; Balleydier, Elsa; Pagès, Frederic; Dellagi, Koussay; Tortosa, Pablo; Raoult, Didier; Socolovschi, Cristina
Rickettsia felis, Rickettsia typhi, and Bartonella DNA was detected by molecular tools in 12% of Rattus rattus fleas (Xenopsylla species) collected from Reunion Island. One-third of the infested commensal rodents captured during 1 year carried at least one infected flea. As clinical signs of these zoonoses are non-specific, they are often misdiagnosed. PMID:25646263
misdiagnosed or missed altogether. Traditionally, physicians and scientists have viewed and interpreted diseases at the ‘visual’ clinical level. With the... autism and Prader-Willi-like characteristics are found to have reduced levels of HBII52 in the brain (Hogart et al., J Med Genet 46(2):86-93, 2009
Nash, Mitchell; Burn, Juliet; Chan, Simon
Abstract Digital papillary adenocarcinoma (DPAca) is an aggressive lesion with high metastatic potential, which is easily misdiagnosed. We present a 55-year-old male with a cystic lesion on his right thumb. Above all else, lesions of the digits should be sent for histopathology routinely, regardless of their history or appearance. PMID:27990456
Shen, Tao; Liu, Rongjiao; Lin, Jing; Huang, Huiqun; Li, Xiuling; Yan, Jianhua
Retinoblastoma is a curable intraocular malignancy in children. However, in clinical practice, retinoblastoma can sometimes be misdiagnosed and mismanaged, leading to extraocular extension and even death. In this report, a series of 3 cases are related that emphasize the conditions and consequences resulting from misdiagnosis and mismanagement of retinoblastoma. The clinical features, imaging findings, histopatholigical examination, and management in 3 case reports of children with misdiagnosed retinoblastoma are presented. Two of the cases received pars plana vitrectomy after being misdiagnosed with Coats disease or ocular blunt trauma, whereas the third case received evisceration after being misdiagnosed with suppurative endophthalmitis. When the diagnosis of retinoblastoma had been confirmed after a second surgery was performed in our hospital, only 2 of the cases received adjuvant orbital radiotherapy. All 3 cases died of systemic tumor metastases. Intraocular surgical procedures should be avoided in any equivocal case until the possibility of latent retinoblastoma is eliminated.We strongly recommend that early enucleation be executed as soon as possible followed by postoperative adjuvant therapy under conditions wherein an intraocular surgery was inadvertently performed in an eye with retinoblastoma.
En, Lydea Gn Wei; Brebner, Chris; McCormack, Paul
Background: There are no published data on typical phonological development for Singaporean children. There is therefore the risk that children's speech in Singapore may be misdiagnosed or that clinicians may set goals erroneously. Aims: This paper reports a preliminary study on the English phonology of typically developing 4;0-4;5-year-old…
Panfeng, Xu; Zheying, Zhang; Jie, Wang; Jianying, Zhou; Xiaodong, Teng
Pulmonary artery sarcoma is a rare tumor of the cardiovascular system. We reported a case of primary pulmonary artery sarcoma. In this case, the patient was misdiagnosed with tuberculosis for nearly 1 year and diagnosed by contrast-enhanced computed tomography and histopathologic examination at last.
Landau-Kleffner syndrome (LKS) is a rare childhood disorder that is often misdiagnosed as autism or childhood psychosis because of overlapping symptom presentation. Favorable prognoses in LKS depend on early diagnosis and treatment. While much is known about the clinical basis for LKS diagnosis, little is known about parents' lived experience with…
Tourette Syndrome has a history of being misdiagnosed or undiagnosed due to its unusual and complex symptoms. This paper describes: the symptoms of Tourette Syndrome; its etiology; age of onset; therapeutic methods, such as drug therapy, psychotherapy, diet control, and hypnosis; educational implications; and employment prospects. Several…
Kwong, Jason C; Druce, Julian D; Leder, Karin
Zika virus infection closely resembles dengue fever. It is possible that many cases are misdiagnosed or missed. We report a case of Zika virus infection in an Australian traveler who returned from Indonesia with fever and rash. Further case identification is required to determine the evolving epidemiology of this disease.
Crosscope-Happel, Cindy; Hutchins, David E.; Getz, Hildy G.; Hayes, Gerald L.
Although anorexia nervosa affects over one million males yearly, it is often misdiagnosed or overlooked by mental health and medical practitioners. This article brings the problem to the forefront and outlines features that are unique to these males. Greater recognition of the disorder can lead to more accurate diagnoses and, subsequently, better…
Baumann, B. L.; Pelham Jr., W. E.; Lang, A. R.; Jacob, R. G.; Blumenthal, J. D.
Some researchers who have studied children with behavior problems have suggested that depressed mothers distort reports of deviance in their children, perhaps contributing to misdiagnoses; however, investigations studying mothers with current or past depression have not clearly indicated such a bias. Because some of this equivocation may be due to…
Hyponatremia (severe sodium depletion) has symptoms similar to heat exhaustion and heat stroke and can easily be misdiagnosed. The number of wilderness users and extreme adventure activities has increased in recent years, and more cases are being diagnosed. Given that a 1993 study found that 1 in 10 cases of heat-related illnesses were…
Carbon monoxide (CO) may be the cause of more than one-half of the fatal poisonings reported in many countries: fatal cases also are grossly under-reported or mis-diagnosed by medical professionals. Therefore, the precise number of individuals who have suffered from CO intoxicat...
Putnam, Frank W.
Clinical research has established a connection between childhood trauma and the development of dissociative disorders in adults. Pathological dissociation produces a range of symptoms and behaviors such as amnesias, rapid shifts in mood and behavior, and auditory and visual hallucinations. Many of these symptoms are misdiagnosed as attention,…
Maltoni, Giulio; Minardi, Raffaella; Cristalli, Carlotta Pia; Nardi, Laura; D'Alberton, Franco; Mantovani, Vilma; Zucchini, Stefano
WS diagnosis is often delayed since misdiagnosed as autoimmune diabetes. The rarity of the condition and the absence of other diseases at diabetes diagnosis might make extremely challenging the recognition of WS. However the novel compound heterozygosity for the here reported mutations, seems to confer a mild phenotype among the spectrum of WS manifestations.
Sankar, D.; Muthusubramanian, Veerabahu; Nathan, J. A.; Nutalapati, Ravi Sankar; Jose, Yasmin Mary; kumar, Y. Naren
Nasopalatine duct cyst is the nonodontogenic developmental cyst, frequently occurring in the midline of the anterior maxillary region. The clinical presentation of the cyst is often varied and presents a diagnostic difficulty and frequently misdiagnosed as developmental or inflammatory odontogenic cystic lesion. This paper represents a large infected nasopalatine duct cyst presenting with complete destruction of anterior palate and pyriform rim. PMID:27829777
Bartolome, Miguel A Hernandez; Ruiz, Sagrario Fuerte; Romero, Israel Manzanedo; Lojo, Beatriz Ramos; Prieto, Ignacio Rodriguez; Alvira, Luis Gimenez; Carreño, Rosario Granados; Esteban, Manuel Limones
The diagnosis of cystadenoma is rare, even more so when located in the extrahepatic bile duct. Unspecific clinical signs may lead this pathology to be misdiagnosed. The need for pathological anatomy in order to distinguish cystadenomas from simple biliary cysts is crucial. The most usual treatment nowadays is resection of the bile duct, together with cholecystectomy and Roux-en-Y reconstruction. PMID:19630118
Brooks, Brian L.; Holdnack, James A.; Iverson, Grant L.
Clinicians can use the base rates of low scores in healthy people to reduce the likelihood of misdiagnosing cognitive impairment. In the present study, base rates were developed for the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) and Wechsler Memory Scale-Fourth Edition (WMS-IV) using 900 healthy adults and validated on 28 patients…
Bonnefoy-Mazure, A.; Turcot, K.; Kaelin, A.; De Coulon, G.; Armand, S.
Hereditary spastic paraplegia (HSP) and spastic diplegia (SD) patients share a strong clinical resemblance. Thus, HSP patients are frequently misdiagnosed with a mild form of SD. Clinical gait analysis (CGA) has been highlighted as a possible tool to support the differential diagnosis of HSP and SD. Previous analysis has focused on the lower-body…
Babar, Masood Uz Zaman; Hakeem, Haris; Khan, Sara
A man aged 22 years misdiagnosed as suffering from recurrent abdominal tuberculosis, in view of recurrent abdominal pain was treated for abdominal tuberculosis in the past. The patient was prescribed antituberculous therapy. 2 months after starting treatment, he developed progressive weakness of all 4 limbs. Electrodiagnostic examination revealed an acute severe motor axonal neuropathy. Further workup revealed elevated porphyrin precursors in urine.
Mehta, Zarin; Stakiw, Daria B.
There is a growing body of evidence that childhood disorders affecting the vestibular system, although rare, do exist. Describing symptoms associated with the vestibular mechanism for children may be difficult, resulting in misdiagnosing or under-diagnosing these conditions. The pathophysiology, symptoms, and management options of the more common…
Tentoni, Stuart C.
This paper discusses Minnesota Multiphasic Personality Inventory (MMPI) data obtained from individuals exposed to chlorine dioxide in the workplace who developed Multiple Chemical Sensitivity Syndrome. The paper explores current research on chlorine dioxide exposed persons who were misdiagnosed on the basis of MMPI interpretations. Difficulties…
Clinical decision-making is challenging mainly because of two factors: (1) patient conditions are often complicated with partial and changing information; (2) people have cognitive biases in their decision-making and information-seeking. Consequentially, misdiagnoses and ineffective use of resources may happen. To better support clinical…
Eiserman, William; Shisler, Lenore
Hearing loss can too easily be misdiagnosed or overlooked by providers serving young children. Parents and professionals may observe a language delay--an "invisible" condition--while failing to identify the underlying cause. Otoacoustic emissions (OAE) hearing screening technology, used extensively with newborns, is becoming an essential tool,…
Marco de Lucas, Enrique Pagola, Miguel Angel; Fernandez, Fidel; Lastra, Pedro; Delgado, M. Luisa Ruiz; Sadaba, Pablo; Pinto, Jesus; Ballesteros, Ma Angeles; Ortiz, Antonio
Primary tumors of the heart are extremely rare.Clinical manifestations are nondiagnostic and the patients are often misdiagnosed. Magnetic resonance imaging and echocardiography are standard in this diagnostic workup. We report a case of a man with acromegaly, dysphagia, chest pain and weight loss. An invasive cardiac mass was diagnosed by helical-CT. Autopsy demonstrated a B-cell aggressive lymphoma.
Bacterial blight, caused by the phytopathogen Pseudomonas cannabina pv. alisalensis, is an emerging disease afflicting important members of the Brassica family. The disease is often misdiagnosed as peppery leaf spot, a much less severe disease caused by the closely related pathogen Pseudomonas syrin...
Tan, Huan; Lan, Xue-Mei; Zhou, Cun-Jian; Yang, Xi-Chuan
Microsporum gypseum is a geographically widespread geophilic fungus that infects animals and humans. M. gypseum infection on the scrotum is very rare and can be easily misdiagnosed because of a lack of inflammatory reaction. Here we describe a patient with pseudomembranous-like tinea of the scrotum resulting from M. gypseum. PMID:26288444
Singla, Komal; Preet Malhotra, Kiran; Rathore, Ruchi; Arora, Deepshikha; Sharma, Sonal
Leiomyosarcoma of the scrotum is a rare tumor. We report the case of a 60-year-old man who presented with bilateral testicular enlargement that was clinically misdiagnosed as a testicular tumor. The tumor was excised by bilateral inguinal orchiectomy. Histopathologic examination revealed a scrotal wall leiomyosarcoma with bilateral epididymo-orchitis.
Ansari, Hossein; Robertson, Carrie E; Lane, John I; Viozzi, Christopher F; Garza, Ivan
Synovial cysts of the temporomandibular joint are rare, and to our knowledge, only 14 cases have been reported. The most common presentation is local pain and swelling. We present a case of a synovial cyst presenting with neuralgia in the distribution of the auriculotemporal nerve, initially misdiagnosed as trigeminal neuralgia.
Merlo, Lisa J.; Storch, Eric A.; Murphy, Tanya K.; Goodman, Wayne K.; Geffken, Gary R.
Obsessive-compulsive disorder (OCD) is a relatively common disorder among children and adolescents, and is associated with increased risk for concurrent and future distress and impairment. Many youth who suffer from OCD go undiagnosed or misdiagnosed, and do not attain appropriate treatment in a timely manner. As a result, researchers have focused…
Wu, Chan; Dong, Fang-tian; Chen, You-xin; Wang, Qian; Dai, Rong-ping; Zhang, Hua
Making accurate and timely diagnosis is often challenging when patients with a systemic disease first present with ocular manifestations. The possibility that vasculitis associated with systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS) can be misdiagnosed as cysticercosis has not been discussed in the literatures.
Neospora caninum is a protozoan parasite of animals. Until 1988, it was misdiagnosed as Toxoplasma gondii. Since its first recognition in 1984 and the description of a new genus and species Neospora caninum in 1988, neosporosis has emerged as a serious disease of dogs and cattle worldwide. Additiona...
Moodley, Krishnee; Govind, Chetna N.; Peer, Abdool K.C.; van der Westhuizen, Marissa; Parbhoo, Dharmesh; Sun, Lisa Ming; du Plessis, Desiree C.; Frean, John A.
Humans are occasionally inadvertently infected with dirofilariae, the zoonotic nematodes. We report two cases of human dirofilariasis in South Africa, an area apparently non-endemic for this infection. Dirofilariasis is frequently misdiagnosed, so increased awareness of this entity in areas that are non-endemic is essential for prevention of inappropriate investigations and invasive therapy. PMID:25874068
Kirit C. Shah, M.D. v. Stan Harris and Nancy Harris. "Construction of Legal Arguments, Statutes of Limitations, and Medical Malpractice." Lesson Plans for Secondary Teachers on How Lawyers Prepare Their Arguments. Courts in the Classroom: Curriculum Concepts and Other Information on Indiana's Courts for the K-12 Educator.
Stan and Nancy Harris filed a complaint against Kirit C. Shah, M.D., for misdiagnosing Mr. Harris's illness, charging Dr. Shah with negligence and asking for damages. A medical malpractice action in Indiana is governed by a two year statute of limitations. Because the Harrises failed to bring their action against Dr. Shah within this two year…
Harbit, Maryanne Drake; Willis, Dawn
Lyme disease may be one of the most commonly misdiagnosed diseases of this decade. Health educators should be knowledgeable about this new disease and be able to share with the public information about prevention, early signs and symptoms, and treatment of the disease (Author/IAH)
Budd, Linda S.
Bright, controlling, fearful, and highly energetic, active alert children are frequently misdiagnosed as hyperactive or learning disabled. This book offers guidance for the special challenge of parenting the active alert infant, child, and adolescent. Part 1 of the book profiles the active alert child and examines 11 traits that characterize…
Azhough, Ramin; Barband, Ali Reza; Motayagheni, Negar; Niafar, Mitra; Pourfathi, Hojjat
Spontaneous rupture of an adrenal pheochromocytoma is extremely rare and can be lethal because of dramatic changes in the circulation. We describe a 35-year-old Iranian female with previously diagnosed von Recklinghausen's disease who suffered spontaneous rupture of an adrenal pheochromocytoma, misdiagnosed as renal colic followed by an extensive retroperitoneal hematoma, irreversible hemodynamic shock, and death. PMID:19881191
Kaushik, Shivani B; Kwatra, Shawn G; McLean, Thomas W; Powers, Alexander; Atala, Anthony J; Yosipovitch, Gil
We report a case of PELVIS (perineal hemangioma, external genital malformations, lipomyelomeningocele, vesicorenal abnormalities, imperforate anus and skin tag) syndrome in which hemangioma in the perineal area was misdiagnosed at birth as diaper rash. Investigations revealed associated vesicorenal and spinal abnormalities. We emphasize careful diagnosis of suspicious lesions at birth and confirm the successful use of propranolol in treating ulcerated segmental hemangiomas.
Webb, James T.
Many gifted and talented children are often misdiagnosed by psychologists and other health professionals as having Attention Deficit Hyperactivity Disorder (ADHD), Oppositional Disorder (OD), Obsessive Compulsive Disorder (OCD), or another of the mood disorders. The misdiagnosis can stem from mistaken assumptions being made about the social and…
Jeong, Nari; Seol, Sang-Hoon; Kim, Il Hwan; Kim, Ji Yeon
Pulmonary artery sarcoma (PAS) is a rare and fatal disease. PAS can often be misdiagnosed as pulmonary thromboembolism. Moreover, the correct diagnosis is frequently delayed due to nonspecific signs and symptoms. The prognosis of patients with PAS is poor. We report a case of a woman with a primary PAS who was initially diagnosed with pulmonary thromboembolism.
Jeong, Nari; Seol, Sang-Hoon; Kim, Il Hwan; Kim, Ji Yeon
Pulmonary artery sarcoma (PAS) is a rare and fatal disease. PAS can often be misdiagnosed as pulmonary thromboembolism. Moreover, the correct diagnosis is frequently delayed due to nonspecific signs and symptoms. The prognosis of patients with PAS is poor. We report a case of a woman with a primary PAS who was initially diagnosed with pulmonary thromboembolism. PMID:27833785
Rodríguez-Zentner, H; Castañeda-Argáiz, R; Tapia, H; Vergara-Fernandez, O; González, Q H
Hemangiomas are rare vascular tumors. They most commonly appear in the small bowel, as well as the colon and the rectum. Here, we report two cases of male patients who were admitted to our hospital for low rectal painless bleeding, misdiagnosed of hemorrhoid bleeding. Colonoscopy reported vascular tumors in both cases, which we surgically removed.
van Egmond, Pim W; van de Rest, Hendrik J M; Nolte, Peter A
A 31-year-old woman came to the Emergency Department with a painful ankle 2 days after a fall off a horse. On the day of the accident, she was misdiagnosed with a lateral ankle sprain. A lateral X-ray of the ankle showed a positive 'V-sign', which is pathognomonic for a fracture of the lateral process of the talus.
Fein, Deborah; Barton, Marianne; Eigsti, Inge-Marie; Kelley, Elizabeth; Naigles, Letitia; Schultz, Robert T.; Stevens, Michael; Helt, Molly; Orinstein, Alyssa; Rosenthal, Michael; Troyb, Eva; Tyson, Katherine
Background: Although autism spectrum disorders (ASDs) are generally considered lifelong disabilities, literature suggests that a minority of individuals with an ASD will lose the diagnosis. However, the existence of this phenomenon, as well as its frequency and interpretation, is still controversial: were they misdiagnosed initially, is this a…
Phytophotodermatitis, otherwise known as 'Strimmer's Rash' is an unusual cause of a widespread rash. We present a case of phytophotodermatitis, which was initially misdiagnosed as chickenpox; the correct diagnosis was made after further careful history taking and illustrates the importance of taking a thorough history when presented with what appears to be a spot diagnosis.
College students may be misdiagnosed as personality disordered when in fact their problems are better explained by their upbringing. Growing up with a personality disordered parent may cause them to initially present with what appear to be personality disordered traits due to issues such as not learning adequate coping skills. Accurate diagnosis…
Komeili, Mariam; Marshall, Chloe R.
Bilingual children are frequently misdiagnosed as having Specific Language Impairment (SLI). Misdiagnosis may be minimized by tests with high degrees of sensitivity and specificity. The current study used a new test, the School-Age Sentence Imitation Test-English 32 (SASIT-E32), to investigate sentence repetition in monolingual and bilingual…
Varvenne, David; Retornaz, Karine; Metge, Prune; De Haro, Luc; Minodier, Philippe
Serious to fatal toxicity may occur with amanitin-containing mushrooms ingestions. A Lepiota brunneoincarnata familial poisoning with hepatic toxicity is reported. In such poisonings, acute gastroenteritis may be firstly misdiagnosed leading to delay in preventing liver dysfunction by silibinin or penicillin G. Mushroom picking finally requires experience and caution.
Jung, Hae Il; Lee, Hyoung Uk; Ahn, Tae Sung; Lee, Jong Eun; Lee, Hyun Yong; Mun, Seong Taek; Baek, Moo-Jun
Alimentary tract duplications are uncommon congenital anomalies that usually present during the first decade of life. Complete duplication of the colon in adults is very rare and difficult to diagnose preoperatively. We report a case of a 40-year-old female with complete tubular duplication which was initially misdiagnosed as a salpingeal abscess due to colovaginal fistula. PMID:27757399
... gene. In contrast, the most common types of diabetes—type 1 and type 2—are caused by multiple genes ( ... some children with monogenic diabetes are misdiagnosed with type 1 diabetes and are given insulin. When correctly diagnosed, some ...
Mannino, Courtney M; Salhab, Mohammed; Schmidhofer, Sarah; Pop-Vicas, Aurora
We present a case of iliopsoas abscess in an immunocompetent patient. She experienced three weeks of worsening right hip pain, which was initially misdiagnosed as degenerative joint disease. This led to admission to the Intensive Care Unit for severe sepsis. The patient improved with intravenous antibiotics and percutaneous abscess drainage.
Obiakor, Festus E.
This paper examines problems faced by youngsters at risk of failure in school, and discusses methods for helping them succeed in educational programs. At-risk youngsters confront many problems in school and in mainstream society, and are frequently misidentified, misdiagnosed, and improperly instructed. Problems faced by at-risk youngsters…
Zabalegui, B; Gil, J; Zabalegui, I
Treatment of endodontically involved teeth requires accurate diagnosis of the clinical pulpal condition to determine the primary cause of pathosis. The case presented shows the differential diagnosis between a desmoplastic fibroma and a failure of a misdiagnosed endodontic treatment. The initial direction of treatment should had never been the endodontic therapy but local surgical curettage of the lesion.
Dieme, Constentin; Parola, Philippe; Guernier, Vanina; Lagadec, Erwan; Le Minter, Gildas; Balleydier, Elsa; Pagès, Frederic; Dellagi, Koussay; Tortosa, Pablo; Raoult, Didier; Socolovschi, Cristina
Rickettsia felis, Rickettsia typhi, and Bartonella DNA was detected by molecular tools in 12% of Rattus rattus fleas (Xenopsylla species) collected from Reunion Island. One-third of the infested commensal rodents captured during 1 year carried at least one infected flea. As clinical signs of these zoonoses are non-specific, they are often misdiagnosed.
Santhosh, Sampath; Guha, Poonam; Bhattacharya, Anish; Bawa, Monika; Mittal, Bhagwant Rai
Scintigraphic differentiation between acute torsion, hydrocele and testicular or scrotal abscess can be difficult. Doppler sonography may provide useful complimentary information toward diagnosis. The authors describe a 5-year-old child where epididymitis with hydrocele was misdiagnosed as testicular torsion on scrotal scintigraphy.
Dunbar, James; Cooper, Ben; Hodgetts, Tim; Yskandar, Halabi; van Thiel, Pieter; Whelan, Steve; Taylor, Justin; Woods, David R
Oestrus ovis is the most common cause of human ophthalmomyiasis, and infection is often misdiagnosed as acute conjunctivitis. Although it typically occurs in shepherds and farmers, O. ovis ophthalmomyiasis has also been reported in urban areas. We report the first case study of O. ovis infection from Afghanistan.
van der Meij, E H; Becking, A G; van der Waal, I
A 9-year-old girl is presented who was initially misdiagnosed and finally diagnosed with fibrodysplasia ossificans progressiva only after presentation with progressive limitation of her mouth opening. The clinical, histopathological, and molecular biological aspects of this uncommon disorder will be discussed. Furthermore, dental and surgical guidelines will be described.
Zvijac, John E; Sheldon, Daniel A; Schürhoff, Matthias R
Suprascapular nerve entrapment is a frequently misdiagnosed phenomenon. In this case report, we describe a benign lipomatous tumor causing suprascapular nerve entrapment in the spinoglenoid notch, and we describe the history, clinical examination, and radiographic evaluation. Benign lipomatous tumor compressing the suprascapular nerve is mentioned in the literature, but we believe this is the first case report.
In clinical practice, differentiation of COPD and asthma is difficult. A case report of an asthma patient with a drifter type of asthma imitating COPD is presented. In this context differences and similarities of both diseases are high-lighted. The definitions of asthma and COPD in international guidelines leave some space to misdiagnosing.
Neospora caninum is a protozoan parasite of animals. Until 1988, it was misdiagnosed as Toxoplasma gondii. Since its first recognition in 1984 in dogs and the description of a new genus and species Neospora caninum in 1988, neosporosis has emerged as a serious disease of cattle and dogs worldwide. ...
Sal Moyano, María Paz; Luppi, Tomás; Gavio, María Andrea; Vallina, Micaela; McLay, Colin
The extent of the receptive period may determine the mating strategies employed by female crabs to obtain mates. Here, we studied the receptivity of female Neohelice granulata (Dana, 1851) in the laboratory, including the form of the vulvae and the anatomy of the seminal receptacle (SR). We examined the factors that influence the duration of receptivity by comparing two populations inhabiting contrasting habitats: Mar Chiquita Coastal lagoon (MCL), which is an oligo-polyhaline estuary, and San Antonio Oeste (SAO), which is an eu-hyperhaline marine bay. Non-receptive females have immobile vulva opercula, while receptive females have mobile opercula. Histological sections of the SR showed that the degree of epithelium secretions was associated with the receptive stage of females, and they may be involved in the maintenance of viable sperm and in the dehiscence of spermatophores. The existence of a special tissue at the junction of the oviduct and the SR was described and proposed as an internal mechanism influencing the timing of ovulation. The duration of receptivity was dependent on the SR load and the capacity to lay eggs. Thus, females with empty SR exhibited longer receptivity and did not lay eggs, while those with full SR exhibited shorter receptivity and always laid eggs. Interpopulation differences showed that females from SAO had shorter receptivity and heavier SR and laid eggs more frequently than females from MCL. Based on our results, we suggest that N. granulata females can adjust the duration of their receptivity and control the moment of fertilization according to different internal mechanisms related to the morphology of the vulvae, the fullness of the SR and anatomical attributes of the SR. An important consequence of this control is greater sperm competition. The extent of the receptive period and the number of times that a female could become receptive in a single reproductive season may also depend on the habitat characteristics.
Zhang, Luping; Brooks, Daniel R
Two species of Skrjabinura Gnedina, 1933, were collected in the intestines of birds from the Area de Conservación Guanacaste (ACG), Costa Rica. Skrjabinura mesoamericana n. sp. inhabits Dendrocincla homochroa, Calocitta formosa, Dendrocolaptes certhia, Basileuterus rufifrons, and Chordeiles acutipennis. The new species differs from all species of the genus by having dissimilar spicules, the right having a distinctive thin and bent handle on the proximal end. The new species can be further distinguished from Skrjabinura pomatostomi and Skrjabinura brevicaudatum by having subequal versus equal spicules. Skrjabinura mesoamericana resembles S. brevicaudatum in the number and arrangement of male caudal papillae but differs in the vulva position and in having smaller eggs. The new species differs from S. potamostomi in having 6 versus 8 pairs of postcloacal papillae. Among those species having subequal spicules, the new species further differs from Skrjabinura spiralis in having 1 pair of paracloacal papillae and 6 pairs of postcloacal papillae, versus no paracloacal papillae and 4 pairs of postcloacal papillae, and in the vulva position. The new species is perhaps most similar to Skrjabinura vali, from which it further differs by having 3 pairs of precloacal, 1 pair of paracloacal, and 6 pairs of postcloacal versus 2 pairs of precloacal, 2 pairs of paracloacal, and 6 pairs of postcloacal papillae in the vulva position and in the shape of the eggs. Skrjabinura vali (Guerrero, 1971) Chabaud, 1978, originally described in Piaya cayana from Venezuela, occurs in the small intestine of P. cayana, as well as the new hosts, Crotophaga sulcirostris and Myiarchus tyrannulus, in the ACG, a new locality. Our specimens differ from the original description in the body length of the female, the numbers of postanal papillae of male tail, and the size of eggs.
Green, M; Brackmann, K H; Sanders, P R; Loewenstein, P M; Freel, J H; Eisinger, M; Switlyk, S A
The DNA genome of a human papillomavirus (HPV), tentatively designated HPV-EV, was molecularly cloned from hand to leg lesions of a patient with epidermodysplasia verruciformis, a chronic skin disease associated with a 30% risk of developing cancer. Using stringent hybridization conditions, we observed less than 5% homology between HPV-EV and the cloned genomes of HPV-1, HPV-4, HPV-5, and HPV-5a. HPV-EV DNA showed approximately 6% homology with HPV-2 and 36% homology with HPV-3. These data suggest that HPV-EV is partially related to HPV-3. Using 32P-labeled cloned HPV-EV as probe in Southern blot hybridization experiments, we detected HPV-EV-related DNA in the carcinoma in situ (Bowenoid lesion) of the vulva of the patient from which HPV-EV was isolated. HPV-EV-related DNA was detected in 2 of 10 vulva carcinomas and in 2 of 31 cervical carcinomas. Related DNA sequences were found in papillomas from each of two patients with condyloma acuminata (anogenital warts), which is of interest considering that condylomas have been reported to convert occasionally to carcinomas. The positive vulva DNAs were also probed with other cloned HPV DNAs: HPV-1, HPV-4, and HPV-5a-related sequences were not detected; HPV-3 and HPV-2 DNA probes detected strong and weak DNA bands, respectively, of the same size as found with HPV-EV. The HPV DNA sequences were present in the positive tumors mainly as free viral DNA molecules; no evidence for integration into cellular DNA was found. The emerging biological picture with papillomaviruses is that cells transformed by these viruses are maintained in a transformed state by free episomal genomes. Thus, our findings are consistent with the idea, but by no means establish, that HPVs play a role in human cancer by a similar mechanism. Images PMID:6289302
Nowaday, zoonoses are an important cause of human parasitic diseases worldwide and a major threat to the socio-economic development, mainly in developing countries. Importantly, zoonotic helminths that affect human eyes (HIE) may cause blindness with severe socio-economic consequences to human communities. These infections include nematodes, cestodes and trematodes, which may be transmitted by vectors (dirofilariasis, onchocerciasis, thelaziasis), food consumption (sparganosis, trichinellosis) and those acquired indirectly from the environment (ascariasis, echinococcosis, fascioliasis). Adult and/or larval stages of HIE may localize into human ocular tissues externally (i.e., lachrymal glands, eyelids, conjunctival sacs) or into the ocular globe (i.e., intravitreous retina, anterior and or posterior chamber) causing symptoms due to the parasitic localization in the eyes or to the immune reaction they elicit in the host. Unfortunately, data on HIE are scant and mostly limited to case reports from different countries. The biology and epidemiology of the most frequently reported HIE are discussed as well as clinical description of the diseases, diagnostic considerations and video clips on their presentation and surgical treatment. Homines amplius oculis, quam auribus credunt Seneca Ep 6,5 Men believe their eyes more than their ears PMID:21429191
Status and emerging issues in the use of praziquantel for treatment of human trematode and cestode infections are briefly reviewed. Since praziquantel was first introduced as a broadspectrum anthelmintic in 1975, innumerable articles describing its successful use in the treatment of the majority of human-infecting trematodes and cestodes have been published. The target trematode and cestode diseases include schistosomiasis, clonorchiasis and opisthorchiasis, paragonimiasis, heterophyidiasis, echinostomiasis, fasciolopsiasis, neodiplostomiasis, gymnophalloidiasis, taeniases, diphyllobothriasis, hymenolepiasis, and cysticercosis. However, Fasciola hepatica and Fasciola gigantica infections are refractory to praziquantel, for which triclabendazole, an alternative drug, is necessary. In addition, larval cestode infections, particularly hydatid disease and sparganosis, are not successfully treated by praziquantel. The precise mechanism of action of praziquantel is still poorly understood. There are also emerging problems with praziquantel treatment, which include the appearance of drug resistance in the treatment of Schistosoma mansoni and possibly Schistosoma japonicum, along with allergic or hypersensitivity reactions against praziquantel treatment. To cope with and overcome these problems, combined use of drugs, i.e., praziquantel and other newly introduced compounds such as triclabendazole, artemisinins, and tribendimidine, is being tried. PMID:24265948
Choi, Sung-Chul; Lee, Soo-Young; Song, Hyun-Ouk; Ryu, Jae-Sook
We analyzed 320 clinical samples of parasitic infections submitted to the Department of Environmental Biology and Medical Parasitology, Hanyang University from January 2004 to June 2011. They consisted of 211 nematode infections, 64 trematode or cestode infections, 32 protozoan infections, and 13 infections with arthropods. The nematode infections included 67 cases of trichuriasis, 62 of anisakiasis (Anisakis sp. and Pseudoterranova decipiens), 40 of enterobiasis, and 24 of ascariasis, as well as other infections including strongyloidiasis, thelaziasis, loiasis, and hookworm infecions. Among the cestode or trematode infections, we observed 27 cases of diphyllobothriasis, 14 of sparganosis, 9 of clonorchiasis, and 5 of paragonimiasis together with a few cases of taeniasis saginata, cysticercosis cellulosae, hymenolepiasis, and echinostomiasis. The protozoan infections included 14 cases of malaria, 4 of cryptosporidiosis, and 3 of trichomoniasis, in addition to infections with Entamoeba histolytica, Entamoeba dispar, Entamoeba coli, Endolimax nana, Giardia lamblia, and Toxoplasma gondii. Among the arthropods, we detected 6 cases of Ixodes sp., 5 of Phthirus pubis, 1 of Sarcoptes scabiei, and 1 of fly larva. The results revealed that trichuriasis, anisakiasis, enterobiasis, and diphyllobothriasis were the most frequently found parasitosis among the clinical samples. PMID:24850969
Cui, Jing; Wang, Ye
The present study reports a human case of cutaneous gnathostomiasis with recurrent migratory nodule and persistent eosinophilia in China. A 52-year-old woman from Henan Province, central China, presented with recurrent migratory reddish swelling and subcutaneous nodule in the left upper arm and on the back for 3 months. Blood examination showed eosinophila (21.2%), and anti-sparganum antibodies were positive. Skin biopsy of the lesion and histopathological examinations revealed dermal infiltrates of eosinophils but did not show any parasites. Thus, the patient was first diagnosed as sparganosis; however, new migratory swellings occurred after treatment with praziquantel for 3 days. On further inquiring, she recalled having eaten undercooked eels and specific antibodies to the larvae of Gnathostoma spinigerum were detected. The patient was definitely diagnosed as cutaneous gnathostomiasis caused by Gnathostoma sp. and treated with albendazole (1,000 mg/day) for 15 days, and the subsequent papule and blister developed after the treatment. After 1 month, laboratory findings indicated a reduced eosinophil count (3.3%). At her final follow-up 18 months later, the patient had no further symptoms and anti-Gnathostoma antibodies became negative. Conclusively, the present study is the first report on a human case of cutaneous gnathostomiasis in Henan Province, China, based on the past history (eating undercooked eels), clinical manifestations (migratory subcutaneous nodule and persistent eosinophilia), and a serological finding (positive for specific anti-Gnathostoma antibodies). PMID:24039291
Jeon, Hyeong-Kyu; Park, Hansol; Lee, Dongmin; Choe, Seongjun; Kim, Kyu-Heon; Sohn, Woon-Mok; Eom, Keeseon S
Human sparganosis is a zoonotic disease caused by infection with larval forms (procercoid/plerocercoid) of Spirometra spp. The purpose of this study was to identify Spirometra spp. of infected snakes using a multiplex PCR assay and phylogenetic analysis of mitochondrial DNA sequence data from the spargana of terrestrial snakes obtained from Korea and China. A total of 283 snakes were obtained that included 4 species of Colubridae comprising Rhabdophis tigrinus tigrinus (n=150), Dinodon rufozonatum rufozonatum (n=64), Elaphe davidi (n=2), and Elaphe schrenkii (n=7), and 1 species of Viperidae, Agkistrodon saxatilis (n=60). The snakes were collected from the provinces of Chungbuk, Chungnam, and Gyeongbuk in Korea (n=161), and from China (n=122). The overall infection rate with spargana was 83% (235/283). The highest was recorded for D. rufozonatum rufozonatum (100%), followed by A. saxatilis (85%) and R. tigrinus tigrinus (80%), with a negative result for E. davidi (0%) and E. schrenkii (0%). The sequence identities between the spargana from snakes (n=50) and Spirometra erinaceieuropaei (KJ599680) or S. decipiens (KJ599679) control specimens were 90.8% and 99.2%, respectively. Pairwise genetic distances between spargana (n=50) and S. decipiens ranged from 0.0080 to 0.0107, while those between spargana and S. erinaceieuropaei ranged from 0.1070 to 0.1096. In this study, all of the 904 spargana analyzed were identified as S. decipiens either by a multiplex PCR assay (n=854) or mitochondrial cox1 sequence analysis (n=50).
Wei, T; Zhang, X; Cui, J; Liu, L N; Jiang, P; Wang, Z Q
Sparganosis is a serious food-borne parasitic zoonosis caused by infection with Spirometra spargana. The prevalence of sparganum infection in wild frogs (Rana nigromaculata, R. limmochari, R. temporaria and Bufo gargarizans) was investigated in Henan Province of central China during 2008-2012. Of 3482 caught wild frogs, 565 (16.23%) were found to be infected with plerocercoids (spargana) of the genus Spirometra. Spargana were found in 14.85% (320/2155) of R. nigromaculata, 20.82% (233/1119) of R. limmochari and 10.91% (12/110) of R. temporaria frogs. However, no sparganum was found in B. gargarizans. To investigate the phylogenetic position of collected spargana, three mitochondrial DNA (mtDNA) regions, namely cytochrome c oxidase subunits 1 and 3 (cox1 and cox3), and NADH dehydrogenase subunit 4 (nad4), were amplified, sequenced and analysed. Sequences of cox1, cox3 and pnad4 were 417, 390 and 578 bp in length, respectively. The base composition of cox1, cox3 and pnad4 were generally AT rich with a mean of 63.5%, 68.3% and 67% AT, respectively. Phylogenetic analysis showed that all the sparganum isolates in Henan Province represented Spirometra erinaceieuropaei and were a well-supported clade. These findings demonstrated clearly the usefulness of the three mtDNA sequences for molecular identification and population genetics studies of S. erinaceieuropaei spargana of human and animal health significance.
Jin, Yan; Shen, Chenghua; Huh, Sun; Sohn, Woon-Mok; Choi, Min-Ho; Hong, Sung-Tae
Toxocariasis is a worldwide zoonosis caused by larvae of ascarid nematodes of dogs or cats, Toxocara canis or T. cati. Diagnosis of human toxocariasis currently relies on serology that uses T. canis excretory-secretory antigen to detect specific IgG antibodies by ELISA. We investigated the serodiagnostic efficacy of ELISA using crude antigen of T. canis larvae (TCLA). Serum specimens of 64 clinically confirmed toxocariasis, 115 healthy controls, and 119 other tissue-invading helminthiases were screened by ELISA using TCLA. The ELISA using TCLA showed 92.2% (59/64 patient samples) sensitivity and 86.6% (103/119) specificity. Its positive diagnostic predictivity was 78.7% and negative predictivity was 97.8%. No serum of healthy controls reacted but that of anisakiasis (45.5%), gnathostomiasis (19.2%), clonorchiasis (15.8%), sparganosis (11.1%), and cysticercosis (6.3%) cross-reacted. Immunoblot analysis on TCLA recognized antigenic proteins of 28- and 30-kDa bands in their dominant protein quantity and strong blotting reactivity. The present results indicate that the ELISA using our TCLA antigen is acceptable by the sensitivity and specificity for serodiagnosis of human toxocariasis. ELISA with TCLA is recommended to make differential diagnosis for patients with any sign of organ infiltration and eosinophilia.
Morffe, Jans; García, Nayla
Abstract Hystrignathus dearmasi sp. n. (Oxyurida: Hystrignathidae) is described from an unidentified passalid beetle (Coleoptera: Passalidae) from Panama. It resembles Hystrignathus cobbi Travassos & Kloss, 1957 from Brazil, by having a similar form of the cephalic end, extension of cervical spines and absence of lateral alae. It differs from the latter species by having the body shorter, the oesophagus and tail comparatively larger, the vulva situated more posterior and the eggs ridged. This species constitutes the first record of a nematode parasitizing a Panamanian passalid. PMID:21594186
Pudendal nerve block is a safe and effective pain relief method for vaginal birth. Providing analgesia to the vulva and anus, it is used for operative vaginal birth and subsequent repair, late second stage pain relief with spontaneous vaginal birth, repair of complex lacerations, or repair of lacerations in women who are unable to achieve adequate or satisfactory pain relief during perineal repair with local anesthesia. Key to its efficacy is the knowledge of pudendal nerve anatomy, the optimal point of infiltration of local anesthetic, and an understanding of the amount of time necessary to effect adequate analgesia.
Fernández Fernández, Jesús Ángel; Parodi Hueck, Luis
Congenital recto-urogenital type fistulas with a normal anus and rectal atresia, represent both anorectal malformations that are infrequently seen in clinical practice. We describe the case of a girl with an association of these two anomalies, together with a double vagina who, on her seventh day of life, expelled feces through her genitals. The malformations were corrected by means of a posterior sagittal approach, descending from the rectum to the anus without perineal dissection. The vaginal septum was resected thru the vulva. There is no evidence of recurrence of the recto-vaginal fistula.
Many millions of postmenopausal women continue to suffer in silence from symptoms resulting from estrogen-deficient atrophy of the vulva, vagina and urinary tract whilst the medical profession continues to debate what the condition should be called, how it should be assessed and whether it should be universally treated. It is high time that a unified approach was adopted by all medical societies to reach a consensus on definitions, recognition and management. With the development of the nomenclature for genitourinary syndrome of the menopause (GSM), advances in GSM assessment tools and quality-of-life questionnaires and novel therapeutic interventions, the signs are positive that a new era is finally dawning.
Chima, J C; Ojo, M O; Molokwu, J U; Okewole, P A
Four mycoplasma-like organisms isolated from ewes with mucopurulent vaginal discharge and swollen vulva were characterised. Biochemical tests showed three of the isolates to be negative for glucose fermentation and arginine hydrolysis, while the remaining isolate was negative for glucose fermentation but hydrolysed arginine. Serological identification using the growth inhibition, growth precipitation and indirect immunofluorescence tests indicated the three similar isolates as Mycoplasma bovigenitalium and the other isolate as Mycoplasma arginini. There are apparently no previous reports of the isolation of these organisms from the genital tract of sheep in Nigeria.
Daayana, S; Winters, U; Stern, P L; Kitchener, H C
Vulval intraepithelial neoplasia (VIN) is a premalignant condition of the vulva and its incidence is increasing. The common type of VIN is associated with oncogenic types of human papilloma virus (HPV) infection. The standard modalities of treatment for VIN, surgical excision and laser ablation, are both sub-optimal, associated with high rates of disease recurrence. There is a need for non-surgical treatment options for VIN and photodynamic therapy (PDT), by altering the local immunological parameters, has the potential to clear both VIN and HPV. This article reviews the studies of PDT treatment for VIN and discusses the clinical and immunological responses to PDT treatment in the various studies.
Thøfner, Line Buch; Kristensen, Ellids; Petersen, Christina Damsted
Vulvodynia is a chronic pain syndrome in vulva with a prevalence of nearly 15%. Due to poorly understood pathophysiology and lack of efficient treatment frustration is vastly spread among affected women and their physicians. Behavioural, medical and surgical interventions are widely used, but hardly any of them show significance compared to placebo effect. A multidisciplinary treatment is considered to be the new state of the art treatment, but evidence for such a model is hard to find. This article is a review and evaluation of the many treatment models and their evidence.
Digiani, María Celina; Kinsella, John M
Alippistrongylus bicaudatus gen. et sp. n. (Nematoda: Heligmonellidae) is described from the striped Atlantic forest rat, Delomys dorsalis (Hensel) (Rodentia: Sigmodontinae), from the province of Misiones in Argentina. The new genus and species is characterised by a synlophe of 21 unequal ridges in both sexes without a gradient in size, with two ridges weakly sclerotised and oriented perpendicularly in the dorsal left quadrant; males with a highly dissymmetrical bursa with a hypertrophied right lobe, and females with a dorsal conical appendage just posterior to the vulva, conferring a two-tailed appearance to the female worms.
Camino, Nora B; de Villalobos, Cristina
Neyraiella distinctus n. sp. was found parasitizing nymphs of the cricket Gryllodes laplatae Sauss in City Bell, Argentina. This species was characterized by having the excretory pore in the posterior end of the basal bulb, vulva protruding with one lip well developed in the 1/3 end of the body, anus of the female with wings, male with a single spicule without any sculpture, gubernaculum and bursa are absent, six pairs of genital papillae arranged in two preanal pairs, one adanal pair and three postanal pairs, and the tail appendage in both sexes was short and conic.
Tulsyan, Shruti; Tripathi, Madhavi; Das, Kalpa; Yadav, Divya; Shamim, Shamim Ahmed; Damle, Nishikant; Bal, Chandrasekhar
We describe the lymphoscintigraphy findings of a 25-year-old female patient who was undergoing presurgical workup for lymphangiomas of the vulva. She had a history of treatment for disseminated tuberculosis 6 years back and presented with herpetiform oozing vesicles in the external genitalia. Single-photon emission computed tomography/computed tomography (SPECT/CT) confirmed cutaneous tracer accumulation in the vulval lesions and demonstrated the presence of densely calcified inguinal nodes secondary to healed tuberculosis as the etiology of secondary lymphangioma. PMID:28242996
Laiyemo, Raphael; Disu, Stewart; Vijaya, Gopalar; Wise, B
Angiomyofibroblastoma (AMF) is a recently described, rare, benign soft tissue vulvovaginal tumour that occurs mainly but not exclusively in the vulval region of pre-menopausal women (Fletcher et al. in Am J Surg Pathl 16:373; 1992). The first case was diagnosed in 1992. We report a case of a post-menopausal woman with a 2-month history of a rapidly growing painless vaginal tumour and thus drawing the attention of gynaecologist as well as general practitioners to the fact that this rare phenomenon can occur outside the vulva.
Liu, Ning; Zhou, Xiao-Song; Chen, Li-Jie; Duan, Yu-Xi
Pratylenchus ekrami from maize (Zea mays) roots in Shenyang and luffa (Luffa cylindrica) roots in Dalian, China, are described in this paper. Nematodes from the two areas were identified consistently, and were characterized by a heavy cephalic sclerotization, extending posteriorly up to two body annuli, stylet 11-13 μm long, elongating conoid tail, and becoming thinner from vulva. Males were not found. Pratylenchus ekrami is close to Pratylenchus vulnus, but the most critical characteristics between the two species were the number of lip annuli, stylet size, and shape of stylet knobs. This species is the first reported in China.
Hermaphroditism was identified in a 3-year-old American Cocker spaniel with an enlarged os clitoridis that was shown as reddish finger-like structure protruding from the vulva. The urethral orifice was located cranially to the base of the os clitoridis. The gonads were situated caudal to the kidneys at the cranial tips of the uterine horns, and were composed mainly of seminiferous tubules and interstitial cells and had ovarian follicles in the cortices. The uterus was enlarged and revealed pyometra. Gross and histopathological findings of the dog suggested hermaphroditism with bilateral ovotestes and pyometra. PMID:16434857
Gupta, S.; Radotra, B. D.; Kumar, B.
A 21 year old woman presented with multiple lobulated lesions on the labia majora. The surface of most of the lesions was ulcerated revealing a glistening surface. All lesions were excised. The histopathology revealed features suggestive of lobular capillary haemangioma (pyogenic granuloma). Pyogenic granuloma is considered as a reactive hyperproliferative vascular response to trauma or other stimuli. A literature search revealed reports of a few cases of lobular capillary haemangioma of the glans penis but not on the female genitalia. This case is presented to help physicians become aware that lobular capillary haemangiomas (pyogenic granuloma) may occur at this site. Key Words: pyogenic granuloma; vulva PMID:10817071
Nontoxic nodular goiter 30 5.9 - - - Thyrotoxicosis with or without goiter 24 4.7 - - - Obesity and other hyperalimentation 17 3.3...electrolyte & acid-base balance 38 22.4 Trauma to perineum and vulva during delivery 3,895 24.5 Nontoxic nodular goiter 29 17.1 Delivery in a completely...normal case 1,174 7.4 Obesity and other hyperalimentation 28 16.5 Abnormality of forces of labor 1,074 6.8 Thyrotoxicosis with or without goiter
abscess of finger and toe 98 5.7 Nontoxic nodular goiter 40 6.8 Other disorders of skin and subcutaneous tissue 31 1.8 Thyrotoxicosis with or...without goiter 26 4.4 Other local infections of skin/subcutaneous tissue 27 1.6 Hematologic disorders (280 - 289) 326 Musculoskeletal system (710... goiter 48 19.8 Trauma to perineum and vulva during delivery 3,665 25.4 Thyrotoxicosis with or without goiter 40 16.5 Other conditions in mother
Scarabotto, Leila Barreto; Riesco, Maria Luiza Gonzalez
Many studies have been undertaken with the purpose of contributing towards the prevention of perineal trauma in normal birth. The objective of this study was to relate height of the perineum, duration of the second stage of labor, variation of the position of the head detaching, kind of effort, presence of the umbilical cord around the babies' neck, birth weight and vulva's ardor to urinate with the occurrence of perineal laceration. The study was undertaken in 2003 at the Normal Birth Center of the Amparo Maternal, with a sample consisting of 67 women in labor without previous vaginal births. The results demonstrated that there were no significant statistical differences between the variables verified.
Dhaoui, Amen; Nfoussi, Haifa; Kchir, Nidhameddine; Haouet, Slim
Ectopic breast tissue is defined as glands located outside of the breast. Ectopic breast tissue should be excised because it may develop benign (fibroadenoma) or malignant pathologic processes. Less than forty cases of fibroadenomas have been reported in the literature. Although lactation changes can occur, lactating adenoma in the vulva are extremely rare. Only four cases have been reported. We report a case of a young woman who presented with vulvar mass during her lactation. The mass was excised, and histology confirmed vulvar lactating adenoma associated with fibroadenoma. This is the first case of vulvar heterotopic breast lesion associating lactating adenoma and fibroadenoma.
Bernard, E. C.
A new species of Trichodoridae, Trichodorus elefjohnsoni, is described from undisturbed regions of Great Smoky Mountains National Park, United States. It resembles T. orientalis De Waele &Hashim, 1984, T. persicus De Waele &Sturhan, 1987, and T. taylori De Waele, Mancini, Roca, ' Lamberti, 1982 in arrangement of ventromedian cervical papillae and posterior preanal supplements, but differs by combinations of the following characteristics: body length 516-731 μm; spicule length 33-50 μm, spicules densely striated, constricted medially; vaginal sclerotizations ovate; one pair of lateral body pores near vulva. PMID:19283205
Golden, A. Morgan; López Ch., Róger; Vílchez R., Hernán
A lesion nematode, Pratylenchus gutierrezi n. sp., collected from the roots of coffee in the Central Plateau of Costa Rica, is described and illustrated. Its relationships to Pratylenchus flakkensis, P. similis, and P. gibbicaudatus, the only other species of the genus having two head annules, males, or spermatheca with sperm, and an annulated tail terminus, is discussed. Other distinctive characters are its posterior vulva (mean of 80%); its prominently rounded stylet knobs, low head, and subcylindrical tail. SEM observations provide additional details of females and males, especially face views, which show for the first time sexual dimorphism. PMID:19282999
Sander, Bente Braad; Damsgaard, Knud
We present a small review of lichen sclerosus in women and an update on the newest knowledge, e.g. on calcineurin inhibitors as a choice of treatment. The goal is to put more focus on the disease in Denmark because it is so often diagnosed only with a great delay. We further emphasize the importance of follow-up on these patients, due to the risk of cancer, the great influence of the disease on quality of life and the risk of structural changes in the vulva region.
Ning, Ye; Zhang, Feng; Zhu, Yong; Chen, Huixing; Lu, Jianqi; Li, Zheng
To present a rare case of a patient probably with complete androgen insensitivity syndrome (CAIS) and studied its potential genetic cause. A 24-year-old woman with a normal-appearing vulva and vagina presented to us because of primary amenorrhea. Imaging studies showed no uterus or ovary development but inguinal cryptorchism. Histopathologic examination revealed normal testicular structures. Sequencing the CAIS-associated androgen receptor gene revealed a novel missense mutation of T to G (F698L). A novel androgen receptor gene mutation in the ligand binding domain was detected in the present patient with CAIS, supporting the important role of an androgen receptor defect in the etiology of CAIS.
Bursey, Charles R; Goldberg, Stephen R; Kraus, Fred
Pseudabbreviata novaeguineaensis n. sp. from the stomach of Hypsilurus modestus (Agamidae) from Papua New Guinea is described and illustrated. The new species was also found in the stomach of Hypsilurus papuensis from Papua New Guinea. Pseudabbreviata novaeguineaensis n. sp. represents the sixth species assigned to the genus and the first from the Australo-Papuan Region. The new species differs from other species assigned to Pseudabbreviata by the vulva position in the female and pedunculate papillae arrangement in the male tail morphology. In addition to the new species, H. modestus harbored Meteterakis crombiei, Strongyluris gonyocephali, and larvae of Abbreviata sp. (in cysts).
Hall, Natalie H; Walsh, Mike; DeLuca, Catherine; Bukoski, Alex
A rescued female manatee was observed expelling a fetal bone from the vulva. The manatee was anesthetized and diagnosed with uterine retention of a fetal skeleton by ultrasound and hysteroscopy. Episiotomy was performed to gain manual access to the vagina and uterus for removal of the skeleton. Second intention healing of the episiotomy site produced excellent results. Rescued female manatees should receive a thorough reproductive tract evaluation since presence of retained fetal tissues might not be evident in blood or hormone analyses. Retention of a whole or partial dead fetus can be life-threatening to manatees, and retained tissues should be removed as early as possible.
Narasimhulu, Deepa M.; Khulpateea, Neekianund; Meritz, Keith; Xu, Yiquing
We report two cases of brain metastasis in patients initially diagnosed with extremely early stage UPSC after extensive staging surgery. They did not receive either adjuvant chemotherapy or adjuvant pelvic or vaginal cuff radiation. At the same time that these patients were diagnosed with systemic metastasis, they both had a local “drop” metastasis in the vulva or the vaginal cuff. After the initial response to palliative chemotherapy, they both developed brain metastasis. The pattern of recurrence with the lack of adjuvant treatment underscores the urgent need in further evaluation of the potential benefits of adjuvant treatment, including chemotherapy and possibly in combination with radiation in this highly aggressive disease. PMID:26425708
Kim, Tae Heung; Chang, In Ho; Kim, Tae-Hyoung; Lee, Shin Young; Myung, Soon Chul
Extramammary Paget's disease (EMPD) of the scrotum is extremely rare. Most cases are found on the vulva or anus. It is generally accepted that EMPD is associated with an underlying carcinoma in situ. The lesion is located deep in between the dermal to epidermal layer. EMPD must be differentiated from benign papulosquamous disease, squamous cell carcinoma and melanoma. It can be managed by local excision and reconstruction with a skin graft or skin flap. Radiation and topical chemotherapy have also been used as alternative treatment strategies and are effective for local control.
Junnila, Amy; Bohle, D Scott; Prichard, Roger; Perepichka, Inna; Spina, Carla
New fluorescein and rhodamine B-labeled antifilarial drug DEC analogues for use in drug localization studies with confocal microscopy have been prepared by a high-yield three-step synthesis. The resulting beta-amine-substituted DEC analogue has a single ethyl substituent which is beta-aminated to accommodate the fluorophore of either fluorescein isothiocyananate or rhodamine B. Confocal microscopy is used to show that the drug accumulates in the adult filarial worms in the pharynx, esophagus, and near the nerve ring of all adults, as well as in the uteri and vulva and the testes of the females and males.
According to various statistics from 4.2 to 42% of women in reproductive age, complained of a mild or severe problems in sexual function. The study presents own data on treatment of vaginismus in 14 girls and young women aged 16 to 36 years who have turned from 2007 to 2012 to the Cabinet Children and adolescent gynaecology at the University Hospital "Maychin dom". A primary examination established a high and tenacious hymen in 7 (50%) patients. The patients demonstrated fear, but still allowed careful examination. At 3 girls (21.43%) a combined cause of complaints was found. They demonstrated fear of pain during coitus and reported bad memory of the first sexual attempts; they had high and tenacious hymen and were able to tolerate touching the vulva after much persusions. In 3 (21.43%) patients consequences of puritan education were registered. They did not allowed to touch the vulva despite the declaration that would allow such. In one patients (7.14%) a unstretchable vagina was found. She demonstrated dyspareunia (avoiding intercourse and having one failed marriage) but she tolerated penetration of her vagina of one phalanx. In all cases of vaginismus we performed educational lectures and artefitial defloration.
Mayor, P; López-Béjar, M; Jori, F; Fenech, M; López-Gatius, F
In the present study, we examined certain features of the functional anatomy of the female genital tract of the wild brush-tailed porcupine (Atherurus africanus) to obtain data on the reproductive biology of this African forest rodent. Two consecutive experiments were performed. The aim of the first was to establish macroscopic and microscopic features of the genital organs, and to explore correlations between predominant ovarian structures and vaginal contents in 20 wild, mature females. In the second experiment, we inspected the external genitalia and vaginal smears of a further 10 females in captivity on a daily basis for 90 days. The uterus of the brush-tailed porcupine is bicornuate and composed of two separated uterine horns, a uterine body and cervix. The genital tract does not present a vaginal vestibule. Thus, there is no portion common to genital and urinary tracts. Females in the follicular phase of the oestrous cycle showed increased cornification of the vaginal epithelium and a high density of eosinophilic cells in vaginal smears. The vulva and vaginal opening were open, reddish and tumefacted. In luteal phase or in pregnancy, epithelial cornification and eosinophilic features were notably reduced and the vagina presented a pale, non-tumefacted vulva and a vaginal closure membrane. Females in captivity showed spontaneous cycles, a polyoestrous reproduction pattern and, based on features of the external genitalia and vaginal smears, their oestrous cycle length was 27.1+/-6.4 days (n=12).
Cerda-Molina, Ana Lilia; Hernández-López, Leonor; de la O, Claudio E.; Chavira-Ramírez, Roberto; Mondragón-Ceballos, Ricardo
Several studies have shown that a woman’s vaginal or axillary odors convey information on her attractivity. Yet, whether such scents induce psychoneuroendocrinological changes in perceivers is still controversial. We studied if smelling axillary and vulvar odors collected in the periovulatory and late luteal phases of young women modify salivary testosterone and cortisol levels, as well as sexual desire in men. Forty-five women and 115 men, all of them college students and unacquainted with each other, participated in the study. Female odors were collected on pads affixed to the axilla and on panty protectors both worn the entire night before experiments. Men provided five saliva samples, a basal one before the smelling procedure, and four more 15, 30, 60, and 75 min after exposure to odors. Immediately after smelling the odor source, men answered a questionnaire rating hedonic qualities of scents, and after providing the last saliva sample they answered questionnaire on sexual desire. We found that periovulatory axillary and vulvar odors increased testosterone and cortisol levels, with vulvar scents producing a more prolonged effect. Luteal axilla odors decreased testosterone and cortisol levels, while luteal vulva odors increased cortisol. Periovulatory axilla and vulva scents accounted for a general increase of interest in sex. These odors were also rated as more pleasant and familiar, while luteal vulvar odors were perceived as intense and unpleasant. PMID:24194730
Three known and two new species of Leptolaimoides are described from bottom sediments collected in Skagerrak off the west coast of Sweden. The following known species are redescribed: Leptolaimoides haploopis Jensen, 1978, L. tubulosus Vitiello, 1971 and L. hexatubulosus Hoang Lai-Phu et al., 2009. Leptolaimoides filicaudatus sp. n. is characterised by the 431-543 µm long body; cephalic sensilla papilliform; amphid 23-26 µm long, located 9-10 µm from anterior end; first body pore located 35-37 µm from anterior end; lateral field simple along most of body, areolated on tail, arising 36-40 µm from anterior end; female without supplements, vagina without pars refringens, vulva midventral; male without tubular and without alveolar supplements; spicules arcuate and 16 µm long. Leptolaimoides leptomicron sp. n. is characterised by the 776-847 µm long body; cephalic sensilla papilliform; amphid 15-17 µm long, located 9-13 µm from anterior end; first body pore located 40-46 µm from anterior end; lateral field areolated, arising 26-28 µm from anterior end; female without supplements, vagina without pars refringens, vulva midventral; male with three tubular and without alveolar supplements, spicules arcuate and 28-29 µm long. The diagnosis of the genus Leptolaimoides is emended and a tabular compendium and dichotomous identification key to species of the genus Leptolaimoides are provided.
Alan, M; Cetin, Y; Sendag, S; Eski, F
Frequently, vaginal fold prolapse is the protrusion of edematous vaginal tissue into and through the opening of the vulva occurring during proestrus and estrus stages of the sexual cycle. True vaginal prolapse may occur near parturition, as the concentration of serum progesterone declines and the concentration of serum oestrogen increases. In the bitch, this type of true vaginal prolapse is a very rare condition. This short communication describes a 5-year-old female, cross-breed dog in moderate condition, weighing 33 kg, with distocia and true vaginal prolapse. Abdominal palpation and transabdominal ultrasonography revealed live and dead foetuses in the uterine horns. One dead and four live fetuses were removed from uterus by cesarean section. The ovariohysterectomy was performed after repositioning the vaginal wall with a combination of traction from within the abdomen and external manipulation through the vulva. Re-occurrence of a vaginal prolapse was not observed and the bitch recovered completely after the surgical therapy. Compared to other vaginal disorders, vaginal prolapse is an uncommon condition in the bitch. In the present case, extreme tenesmus arising from distocia may have predisposed to the vaginal prolapse. The cause of dystocia was probably the disposition of the first foetus. We concluded that the vaginal prolapse was the result of dystocia in the present case.
Background Pemphigus vulgaris (PV) is an autoimmune blistering disease of the skin and mucous membranes. Genital involvement occurs when most other common sites are concurrently affected or are in remission. Systemic lupus erythematosus (SLE) is an autoimmune disease that may affect many parts of the body and the skin with occasional bullous lesions. Pemphigus vulgaris and SLE may be associated, albeit rarely. Here, we report the first case of a woman affected with SLE presenting with early invasive squamous cell carcinoma (SCC) arising from Pemphigus Vulgaris of the vulva. Case presentation A 27-year-old Caucasian woman was admitted to our Gynaecology Unit for bleeding vegetant lesions of the vulva. Her history was characterized by systemic lupus erythematosus and PV. Biopsy showed concomitant PV and vulvar intraepithelial neoplasia (VIN) grade 3. One month later a new biopsy revealed progression from VIN 3 to early SCC. Despite chemotherapy, no remission of disease was observed. She died six months after diagnosis Conclusion Our case underlines PV as another chronic inflammatory disease of the lower genital tract predisposing to VIN-SCC. It suggests the need for careful follow-up of patients with chronic inflammatory disease, especially when concomitant autoimmune disorders are present. Moreover, a biopsy should be always performed if there are PV lesions because of the possibility of neoplastic disease. PMID:20573220
Qu, Yingjie; Ren, Wenqi; Liu, Songde; Liu, Peng; Xie, Lan; Zhang, Xiaoyuan; Zhang, Shiwu; Chang, Shufang; Xu, Ronald
Vulvar lichen sclerosis (VLS) is a chronic, inflammatory and mucocutaneous disease of extragenital skin, which often goes undetected for years. The underlying causes are associated with the decrease of VEGF that reduces the blood oxygenation of vulva and the structural changes in the collagen fibrils, which can lead to scarring of the affected area. However, few methods are available for quantitative detection of VLS. Clinician's examinations are subjective and may lead to misdiagnosis. Spectroscopy is a potentially effective method for noninvasive detection of VLS. In this paper, we developed a polarized, hyperspectral imaging system for quantitative assessment. The system utilized a hyperspectral camera to collect the reflectance images of the entire vulva under Xenon lamp illumination with and without a polarizer in front of the fiber. One image (Ipar) acquired with the AOTF parallel to the polarization of illumination and the other image (Iper) acquired with the AOTF perpendicular to the illumination. This paper compares polarized images of VLS in a pilot clinical study. The collected reflectance data under Xenon lamp illumination without a polarizer are calibrated and the hyperspectral signals are extracted. An IRB approved clinical trial was carried out to evaluate the clinical utility for VLS detection. Our pilot study has demonstrated the technical potential of using this polarized hyperspectral imaging system for in vivo detection of vulvar lichen sclerosis.
Cerda-Molina, Ana Lilia; Hernández-López, Leonor; de la O, Claudio E; Chavira-Ramírez, Roberto; Mondragón-Ceballos, Ricardo
Several studies have shown that a woman's vaginal or axillary odors convey information on her attractivity. Yet, whether such scents induce psychoneuroendocrinological changes in perceivers is still controversial. We studied if smelling axillary and vulvar odors collected in the periovulatory and late luteal phases of young women modify salivary testosterone and cortisol levels, as well as sexual desire in men. Forty-five women and 115 men, all of them college students and unacquainted with each other, participated in the study. Female odors were collected on pads affixed to the axilla and on panty protectors both worn the entire night before experiments. Men provided five saliva samples, a basal one before the smelling procedure, and four more 15, 30, 60, and 75 min after exposure to odors. Immediately after smelling the odor source, men answered a questionnaire rating hedonic qualities of scents, and after providing the last saliva sample they answered questionnaire on sexual desire. We found that periovulatory axillary and vulvar odors increased testosterone and cortisol levels, with vulvar scents producing a more prolonged effect. Luteal axilla odors decreased testosterone and cortisol levels, while luteal vulva odors increased cortisol. Periovulatory axilla and vulva scents accounted for a general increase of interest in sex. These odors were also rated as more pleasant and familiar, while luteal vulvar odors were perceived as intense and unpleasant.
Arikan, Deniz Cemgil; Kiran, Gurkan; Sayar, Hamide; Kostu, Bulent; Coskun, Ayhan; Kiran, Hakan
Introduction. Although pyogenic granulomas (PG) are common and benign vascular proliferations of the skin and mucous membranes, they are relatively rare on the vulva. Case Presentation. A 57-year-old G7P7 postmenopausal woman presented with a 3-year history of a foul smell and bleeding lesions in the genital region. A gynecologic examination revealed multiple large papillomatous, pedunculated, and lobulated lesions that were cherry-red and infective in appearance. There was a 2-cm lesion at the upper intersection of the labia majora, a 2-cm lesion on the right labium majus, and a 4-cm lesion on the clitoris. The patient complained of itching, and the lesions were asymptomatic, except for occasional bleeding. All lesions were excised and sent for histopathological examination, which revealed an ulcerated polypoidal structure with extensive proliferation of vascular channels lined by a single layer of endothelium. The histopathological features were consistent with PG. Conclusion. The present case is the first case of multiple pyogenic granulomas on the vulva in a postmenopausal woman. PMID:21912553
Boechat, Viviane Cardoso; Mendes Junior, Artur Augusto Velho; Madeira, Maria de Fátima; Ferreira, Luiz Claudio; Figueiredo, Fabiano Borges; Rodrigues, Francisco das Chagas de Carvalho; Oliveira, Valéria da Costa; de Oliveira, Raquel de Vasconcellos Carvalhaes; Menezes, Rodrigo Caldas
The objectives of this study were to evaluate the occurrence of Leishmania infantum in the male and female genital tract and female mammary glands of dogs and the parasite burden and to identify histological alterations associated with this protozoan. Twenty male and 20 female Leishmania-seropositive dogs with isolation of L. infantum were examined. Tissue samples of the prepuce, glans, epididymis, testes, prostate, vulva, vagina, uterus, uterine tubes, and mammary glands were analyzed by immunohistochemistry and histopathology. For parasitological culture and in situ hybridization, samples were collected from the testis, epididymis, and uterus. Additionally, seminal fluid was aspirated from the epididymis for parasitological culture. In the genital tract, 34 (85 %) dogs, including 18 males and 16 females, were positive for Leishmania. Of these, 27 (79 %) animals were symptomatic. Leishmania was detected in the mammary glands of 13 (65 %) females. L. infantum was isolated for the first time from the seminal fluid and uterus of naturally infected dogs. The parasite burden and intensity of the inflammatory reaction were greater in the prepuce and glans of males and in the vulva and mammary glands of females. In addition to inflammation, testicular degeneration, atrophy, absence of spermatogenesis, and necrosis were observed. Detection of amastigote forms in the mammary gland lumen indicates possible elimination of this parasite in milk. The frequent parasitism observed in the genital tract of infected males and females and the viability of L. infantum in seminal fluid and uterus suggest the possibility of bidirectional venereal and vertical transmission.
Koh, Kyunghee; Bernstein, Yelena; Sundaram, Meera V
egl-18 and elt-6 are partially redundant, adjacent genes encoding GATA factors essential for viability, seam cell development, and vulval development in Caenorhabditis elegans. The nT1 reciprocal translocation causes a strong Vulvaless phenotype, and an nT1 breakpoint was previously mapped to the left arm of LGIV, where egl-18/elt-6 are located. Here we present evidence that the nT1 vulval phenotype is due to a disruption of egl-18/elt-6 function specifically in the vulva. egl-18 mutations do not complement nT1 for vulval defects, and the nT1 breakpoint on LGIV is located within approximately 800 bp upstream of a potential transcriptional start site of egl-18. In addition, we have identified a approximately 350-bp cis-regulatory region sufficient for vulval expression just upstream of the nT1 breakpoint. By examining the fusion state and division patterns of the cells in the developing vulva of nT1 mutants, we demonstrate that egl-18/elt-6 prevent fusion and promote cell proliferation at multiple steps of vulval development.
Brooks, Darren R; Appleford, Peter J; Murray, Lindsay; Isaac, R Elwyn
Genome sequence analyses predict many proteins that are structurally related to proteases but lack catalytic residues, thus making functional assignment difficult. We show that one of these proteins (ACN-1), a unique multi-domain angiotensin-converting enzyme (ACE)-like protein from Caenorhabditis elegans, is essential for larval development and adult morphogenesis. Green fluorescent protein-tagged ACN-1 is expressed in hypodermal cells, the developing vulva, and the ray papillae of the male tail. The hypodermal expression of acn-1 appears to be controlled by nhr-23 and nhr-25, two nuclear hormone receptors known to regulate molting in C. elegans. acn-1(RNAi) causes arrest of larval development because of a molting defect, a protruding vulva in adult hermaphrodites, severely disrupted alae, and an incomplete seam syncytium. Adult males also have multiple tail defects. The failure of the larval seam cells to undergo normal cell fusion is the likely reason for the severe disruption of the adult alae. We propose that alteration of the ancestral ACE during evolution, by loss of the metallopeptidase active site and the addition of new protein modules, has provided opportunities for novel molecular interactions important for post-embryonic development in nematodes.
Lin, Wu-Chou; Chang, Cherry Yin-Yi; Hsu, Yu-An; Chiang, Jen-Huai; Wan, Lei
Abstract Endometriosis results from the ectopic invasion of endometrial glands and stroma in the peritoneal cavity. The exact etiology of endometriosis is still unknown. It has, however, been shown that there are higher numbers of Escherichia coli in menstrual blood, and higher endotoxin levels in menstrual fluid, as well as, in the peritoneal fluid of patients with endometriosis. In this study, we aimed to determine whether lower genital tract infections could increase the risk of endometriosis. We used the Taiwan National Health Insurance database to conduct a population-based cohort study. We included patients diagnosed with inflammatory diseases of the cervix, vagina, and vulva, and a control group comprising patients matched by age, sex, and comorbidities but without inflammatory diseases of the cervix, vagina, or vulva. A total of 79,512 patients were included in the inflammatory disease group and an equal number of control individuals were selected. The incidence of endometriosis (hazard ratio, 2.01; 95% confidence interval, 1.91–2.12; P < 0.001) was higher among patients than controls. Cox proportional hazards models showed that irrespective of comorbidities, lower genital tract infection was an independent risk factor for endometriosis. Patients with lower genital tract infections exhibit a substantially higher risk for developing endometriosis. PMID:26962775
Pazoki, Samaneh; Rahimian, Hassan
As part of a faunistic study on helminth parasites of Iranian lizards collected from localities in the north of Isfahan province in Iran, two new nematode species belonging to two different families, Pharyngodonidae Travassos, 1919 and Physalopteroidae Railliet, 1893, were found and are, hereby, described. Spauligodon persiensis n. sp. from the large intestine of Cyrtopodion scabrum Heyden is characterised by its imperceptible lateral alae, lack of spicule, different shape of the genital curtain, position of last pair of papillae, aspinose tail in males, position of the vulva and excretory pore, and a tail filament with six to nine spines in females. Thubunea mobedii n. sp. from the stomach of Laudakia nupta nupta (De Filipi) differs from the other species in the genus by possessing a vulva at level of the posterior portion of the oesophageal-intestinal junction in females, lacking spicules, and having a different number of papillae in males. The present paper provides the results of detailed morphological examination of the two new nematode species, using both light and scanning electron microscopy. Taxonomically important characteristics for the members of the two nematode genera, Spauligodon Skrjabin, Schikhobalova & Lagodovskaja, 1960 and Thubunea Seurat, 1914, are also reviewed.
Pedram, Majid; Pourjam, Ebrahim; Atighi, Mohammad Reza; Panahandeh, Yousef
Heterodorus youbertghostai n. sp. is described and illustrated based on morphological, morphometric, and molecular data. The new species was found in two geographically distant points in northwestern Iran and is characterized by having angular lip region, separated from the rest body by a constriction, body length of 1,432.5 to 1,751.3 µm, odontostyle length of 24 to 28 µm, rod-like odontophore, 37.0 to 42.5 µm long, lacking flanges at base, double guiding ring at 14 to 16 µm distance from anterior end, pharyngeal bulb comprising 40% to 48% of pharynx, intestine usually containing green material, female reproductive system amphidelphic with less divided short uterus, specific structure of pars distalis vaginae, bluntly conical tail, dorsally convex and ventrally flat, with rounded tip and saccate bodies in ventral side. The new species comes more close to H. conicaudatus and H. irregularis by its morphology and morphometric characters. Compared to former, it has remarkable difference in vulva position and tail characters, and compared to the latter, it could be separated by shorter body, posteriorly located vulva, wider lip region, and longer tail. In phylogenetic analyses using partial sequences of 28S rDNA D2-D3, the new species formed a fully supported clade with several isolates of H. brevidentatus, prevalent in Iran. The other nordiid taxon, Enchodorus dolichurus, already reported from Iran, was also sequenced for the same genomic region and included in phylogenetic analyses.
Skorobogata, Olga; Meng, Jassy; Gauthier, Kimberley; Rocheleau, Christian E.
Epidermal growth factor receptor (EGFR) signaling is essential for animal development, and increased signaling underlies many human cancers. Identifying the genes and cellular processes that regulate EGFR signaling in vivo will help to elucidate how this pathway can become inappropriately activated. Caenorhabditis elegans vulva development provides an in vivo model to genetically dissect EGFR signaling. Here we identified a mutation in dhc-1, the heavy chain of the cytoplasmic dynein minus end–directed microtubule motor, in a genetic screen for regulators of EGFR signaling. Despite the many cellular functions of dynein, DHC-1 is a strong negative regulator of EGFR signaling during vulva induction. DHC-1 is required in the signal-receiving cell and genetically functions upstream or in parallel to LET-23 EGFR. LET-23 EGFR accumulates in cytoplasmic foci in dhc-1 mutants, consistent with mammalian cell studies in which dynein is shown to regulate late endosome trafficking of EGFR with the Rab7 GTPase. However, we found different distributions of LET-23 EGFR foci in rab-7 versus dhc-1 mutants, suggesting that dynein functions at an earlier step of LET-23 EGFR trafficking to the lysosome than RAB-7. Our results demonstrate an in vivo role for dynein in limiting LET-23 EGFR signaling via endosomal trafficking. PMID:27654944
Milloz, Josselin; Duveau, Fabien; Nuez, Isabelle; Félix, Marie-Anne
Many biological systems produce an invariant output when faced with stochastic or environmental variation. This robustness of system output to variation affecting the underlying process may allow for "cryptic" genetic evolution within the system without change in output. We studied variation of cell fate patterning of Caenorhabditis elegans vulva precursors, a developmental system that relies on a simple intercellular signaling network and yields an invariant output of cell fates and lineages among C. elegans wild isolates. We first investigated the system's genetic variation in C. elegans by means of genetic tools and cell ablation to break down its buffering mechanisms. We uncovered distinct architectures of quantitative variation along the Ras signaling cascade, including compensatory variation, and differences in cell sensitivity to induction along the anteroposterior axis. In the unperturbed system, we further found variation between isolates in spatio-temporal dynamics of Ras pathway activity, which can explain the phenotypic differences revealed upon perturbation. Finally, the variation mostly affects the signaling pathways in a tissue-specific manner. We thus demonstrate and characterize microevolution of a developmental signaling network. In addition, our results suggest that the vulva genetic screens would have yielded a different mutation spectrum, especially for Wnt pathway mutations, had they been performed in another C. elegans genetic background.
Zamirska, Aleksandra; Reich, Adam; Berny-Moreno, Joanna; Salomon, Joanna; Szepietowski, Jacek C
Approximately 80% of psoriatic individuals experience pruritus, of varying intensity. This study evaluated the frequency of vulvar itching and burning and its influence on well-being in women with psoriasis. A total of 93 women were included in the study. Psoriasis severity was assessed according to the Psoriasis Area and Severity Index, the intensity of vulvar discomfort by visual analogue scale and depressive symptoms by Beck's Depression Inventory. On admission 41 (44.1%) women experienced vulvar discomfort, 18 (19.4%) itching, 10 (10.8%) burning and 13 (14.0%) both itching and burning sensations. Psoriatic lesions on the vulva were found in 22 (23.7%) women. No significant correlation was found between burning or itching intensity and global psoriasis severity (r = 0.19, p = 0.26). Patients with vulvar discomfort had psoriatic lesions on the vulva more often than women without discomfort (43.6% vs. 8.2%, p < 0.001). In addition, patients with vulvar discomfort more frequently demonstrated depressive symptoms (p < 0.05). We conclude that vulvar discomfort is an important clinical problem in women with psoriasis and should be taken into consideration during treatment.
Kapan, Selin; Turhan, Ahmet N; Alis, Halil; Kalayci, Mustafa U; Hatipoglu, Sinan; Yigitbas, Hakan; Aygun, Ersan
Introduction Rectus sheath hematoma is an uncommon cause of acute abdominal pain. It is an accumulation of blood in the sheath of the rectus abdominis, secondary to rupture of an epigastric vessel or muscle tear. It could occur spontaneously or after trauma. They are usually located infraumblically and often misdiagnosed as acute abdomen, inflammatory diseases or tumours of the abdomen. Case presentation We reported three cases of rectus sheath hematoma presenting with a mass in the abdomen and diagnosed by computerized tomography. The patients recovered uneventfully after bed rest, intravenous fluid replacement, blood transfusion and analgesic treatment. Conclusion Rectus sheath hematoma is a rarely seen pathology often misdiagnosed as acute abdomen that may lead to unnecessary laparotomies. Computerized tomography must be chosen for definitive diagnosis since ultrasonography is subject to error due to misinterpretation of the images. Main therapy is conservative management. PMID:18221529
Lee, Yeon Ho; Joo, Moon Kyung; Lee, Beom Jae; Lee, Ji-Ae; Kim, Taehyun; Yoon, Jin Gu; Lee, Jung Min; Park, Jong-Jae
An inverted hyperplastic polyp (IHP) found in stomach is rare and characterized by downward growth of hyperplastic mucosal component into the submucosa. Because of such characteristic, IHP can be misdiagnosed as subepithelial tumor or malignant tumor. In fact, adenocarcinoma was reported to have coexisted with gastric IHP in several previous reports. Because only 18 cases on gastric IHP have been reported in English and Korean literature until now, pathogenesis and clinical features of gastric IHP and correlation with adenocarcinoma have not been clearly established. Herein, we report a case of gastric IHP which was initially misdiagnosed as gastrointestinal stromal tumor and resected using endoscopic submucosal dissection. Literature review of previously published case reports on gastric IHP is also presented.
Li, Xiaozhong; Shi, Lenian; Liu, Taiyun; Wang, Lin
Sesamoid bones and accessory ossicles are research focuses of foot and ankle surgery. Pains of the foot and ankle are related to sesamoid bones and accessory ossicles. The specific anatomical and functional relationship of sesamoid bones and accessory ossicles can cause such bone diseases as the dislocation of sesamoid bones and accessory bones, infection, inflammation and necrosis of sesamoid bones, cartilage softening, tenosynovitis of sesamoid bones and the sesamoid bone syndrome. However, these bone diseases are often misdiagnosed or mistreated. In patients with trauma history, relevant diseases of sesamoid bones and accessory ossicles as above mentioned are highly probable to be misdiagnosed as avulsion fractures. In such cases, radiographic findings may provide a basis for clinical diagnosis.
Pineault, Jérôme; Ouimet, Denis; Pichette, Vincent; Vallée, Michel
Aortic dissection is often misdiagnosed, especially among young patients, and it is associated with a high mortality rate. We present here a case of fatal acute aortic dissection in a young man who was misdiagnosed with pericarditis. We reviewed the literature of acute aortic dissection in young people and we focused particularly on clinical presentations, outcomes and investigations of aortic dissection. We report a case of a 33-year-old man with a history of uncontrolled hypertension with acute pleuretic chest pain who was transferred to our hospital for suspected pulmonary embolism and died of acute hemorragic pericardial effusion from an ascendant aortic dissection. We should never rule out aortic dissection off our differential diagnosis on the sole basis of a patient's young age.
Zhu, Guangfa; Pu, Xin; Guo, Hongjuang; Huang, Xiaoyong; Chen, Dong; Gan, Huili
Pulmonary artery sarcoma (PAS) is a rare and highly malignant tumor of pulmonary artery origin. Since 1923, when the first case was reported, <300 cases have been reported worldwide. PAS has a poor prognosis, and early diagnosis with radical surgical resection offers patients with PAS the only chance of survival. However, due to its rarity and the non-specificity of its clinical manifestations and imaging presentation, PAS is frequently misdiagnosed as a pulmonary thromboembolic disease, including pulmonary thromboembolism (PTE) and chronic thromboembolic pulmonary hypertension (CTEPH). The present study reports three cases of PAS that were initially misdiagnosed as PTE or CTEPH, and were later shown to be PAS following surgery. In addition, the clinical features of these patients are examined in order to improve the differential diagnosis of PAS during the early stages of the disease, when the prognosis of patients with PAS is at its optimum.
Zhu, Guangfa; Pu, Xin; Guo, Hongjuang; Huang, Xiaoyong; Chen, Dong; Gan, Huili
Pulmonary artery sarcoma (PAS) is a rare and highly malignant tumor of pulmonary artery origin. Since 1923, when the first case was reported, <300 cases have been reported worldwide. PAS has a poor prognosis, and early diagnosis with radical surgical resection offers patients with PAS the only chance of survival. However, due to its rarity and the non-specificity of its clinical manifestations and imaging presentation, PAS is frequently misdiagnosed as a pulmonary thromboembolic disease, including pulmonary thromboembolism (PTE) and chronic thromboembolic pulmonary hypertension (CTEPH). The present study reports three cases of PAS that were initially misdiagnosed as PTE or CTEPH, and were later shown to be PAS following surgery. In addition, the clinical features of these patients are examined in order to improve the differential diagnosis of PAS during the early stages of the disease, when the prognosis of patients with PAS is at its optimum. PMID:27446344
Hughes, John R
Many famous individuals are said to have had epilepsy, and these names often find their way into books and lectures on epilepsy. The goal of this study was to investigate in detail the histories of 43 of those people who had various kinds of attacks, but not epilepsy. They range chronologically from Pythagorus, born in 582 bc, to the actor Richard Burton, born in 1925 AD. Epilepsy was misdiagnosed in 26% who had psychogenic attacks, in 21% with attacks of anguish, nervousness, fear, agitation, or weakness; and in 12% with alcohol withdrawal seizures. In some instances no evidence of any episodic symptom could be found. One unexpected finding was that 40% of these well-known, individuals had serious, often life-threatening, physical conditions as infants or very young children. This article is an attempt to correct the record with respect to these people and also to remind us of the many reasons similar misdiagnoses are being made today.
Malkarnekar, Santoshi Balkrishna; Naveen, L
Fixed drug eruption (FDE) is an unusual adverse effect of any drug, especially antibiotics like clarithromycin. Herein we report a case of clarithromycin induced FDE in a 30-year-old man who presented with recurrent erythematous and pruritic cutaneous lesions on the lower lip, right hand and left thigh. The lesions were initially misdiagnosed as lichen planus and treated with topical steroids. Each recurrence was at the same site and the lesions faded within 2 weeks leaving behind violacceous pigmentation. All the cutaneous lesions were reproduced following an oral provocation test thus confirming the diagnosis of clarithromycin induced FDE, which is a rare occurrence. When it does occur, it is often misdiagnosed, so physicians should be aware of this condition in order to prevent future recurrences as it causes a lot of cosmetic and physical discomfort to the patient.
Altraja, Alan; Jürgenson, Katre; Roosipuu, Retlav; Laisaar, Tanel
Pulmonary foreign body granulomatosis following intravenous administration of medications meant for oral use among drug addicts has been occasionally reported. This condition is often misdiagnosed because of its rarity, but rather due to its similarity to other pulmonary diseases that are more common. Here we report a case of pulmonary intravascular talcosis mimicking miliary tuberculosis in a young male intravenous drug addict from North-Eastern Estonia, known as a hotspot for tuberculosis and drug misuse. The condition was caused by intravenous administration of crushed tablets of diphenhydramine, but miliary tuberculosis was misdiagnosed on patient's demographical, clinical and radiological grounds and a decision to start treatment with four first-line antituberculosis drugs followed. The current report refers to the importance of considering rare causes of pulmonary disseminations with attempts to identify the causative agent and warns against the use of antituberculosis treatment without confirmation of microbiological diagnosis of tuberculosis. PMID:24713715
Altraja, Alan; Jürgenson, Katre; Roosipuu, Retlav; Laisaar, Tanel
Pulmonary foreign body granulomatosis following intravenous administration of medications meant for oral use among drug addicts has been occasionally reported. This condition is often misdiagnosed because of its rarity, but rather due to its similarity to other pulmonary diseases that are more common. Here we report a case of pulmonary intravascular talcosis mimicking miliary tuberculosis in a young male intravenous drug addict from North-Eastern Estonia, known as a hotspot for tuberculosis and drug misuse. The condition was caused by intravenous administration of crushed tablets of diphenhydramine, but miliary tuberculosis was misdiagnosed on patient's demographical, clinical and radiological grounds and a decision to start treatment with four first-line antituberculosis drugs followed. The current report refers to the importance of considering rare causes of pulmonary disseminations with attempts to identify the causative agent and warns against the use of antituberculosis treatment without confirmation of microbiological diagnosis of tuberculosis.
Zhuang, Kai Wen; Dai, Ya Ling; Ran, Yu Ping; Lama, Jebina; Fan, Yi Ming
Tinea faciei is a relatively uncommon dermatophyte infection entailing atypical clinical symptoms, usually misdiagnosed and treated with corticosteroids. The authors describe a case of tinea faciei on the right eyebrow caused by Trichophyton interdigitale. The patient was an 18-year-old girl, who had an inflammatory plaque with a scaly, pustular surface on the right eyebrow and upper eyelid, which had persisted for over 1 month. She was once misdiagnosed as having eczema and was treated using corticosteroid cream. A diagnosis of tinea faciei was made based on direct microscopy and culture. The sequencing of the nuclear ribosomal ITS region and β-tubulin gene of the isolate established its T. interdigitale lineage. The patient was cured by treatment with systemic terbinafine in combination with topical application of 1% naftifine-0.25% ketaconazole cream for 2 weeks. PMID:28099612
Priyanka Akhilesh, Sali; Kamal Sunder, Yadav; Chandralekha, Tampi; Samir, Parikh; Prasad Kashinath, Wagle
Bile duct mixed adenoneuroendocrine carcinoma (MANEC) is a rare entity. It is defined as having mixed elements of both neuroendocrine tumors (NET) and an adenocarcinoma element, the lesser component forming at least 30% of the tumor. It is a subtype of neuroendocrine carcinoma (NEC) showing both gland-forming epithelial tumor cells and neuroendocrine cells. It is generally misdiagnosed as cholangiocarcinoma on imaging studies. The preoperative pathological workup from the endoscopic retrograde cholangiography brush cytology usually misses the NET/NEC component since it often lies deeper in the tumor. However, it is reported that it is the NEC component that defines the prognosis of the tumor; hence, it is vital to identify the NEC component. We present a rare case of common hepatic duct (CHD) MANEC that was preoperatively misdiagnosed as cholangiocarcinoma. PMID:27375908
Wang, Etienne Ce; Kwah, Yung Chien; Tan, Wee Ping; Lee, Joyce Ss; Tan, Suat Hoon
Extra-mammary Paget disease (EMPD) is a rare intra-epithelial carcinoma that is usually found on the apocrine-rich skin of the perineum. We report 2 cases in which EMPD was initially misdiagnosed on the initial punch biopsy as melanoma-in-situ and Bowen disease respectively. Reasons for the misdiagnoses included a rare pigmented axillary variant of EMPD in the first case and atypical bowenoid features on H&E in the second. The cases are described with a critical review of the histopathological findings, along with a review of the current literature. This highlights the necessity of a comprehensive immunohistochemical panel for the assessment of intra-epithelial pagetoid atypical cells.
Nielsen, Cheri; Sutton, Deanna A; Matise, Ilze; Kirchhof, Nicole; Libal, Melissa C
Cokeromyces recurvatus, a zygomycete, was isolated by fungal culture from the peritoneal fluid of a cat with jejunal perforation secondary to intestinal lymphosarcoma. This organism has not been recovered previously from a veterinary patient. The tissue form of C. recurvatus is morphologically similar to those of Coccidioides immitis and Paracoccidioides brasiliensis and may be misdiagnosed as 1 of these organisms on the basis of cytologic or histopathologic specimens, particularly in geographic regions where these organisms are not endemic.
Malangone, Steve; Green, Myke; Badari, Ambuga; Clarke, Kathryn; Elquza, Emad
Hepatic epithelioid hemangioendothelioma (HEHE) is a rare, often misdiagnosed vascular neoplasm with clinical behaviors that range from indolent to highly aggressive. Even when the appropriate diagnosis is achieved, the best treatment for HEHE has not been defined or standardized, further complicating the care of these patients. We present a diagnostically challenging case of HEHE where we utilized capecitabine and bevacizumab as another novel treatment option. PMID:26136854
Singh, Prateush; Tuffaha, Sami H; Robbins, Sanford H; Bonawitz, Steven C
Pyoderma gangrenosum (PG) is an uncommon disorder characterized by the development of painful cutaneous ulceration, commonly precipitated by dermal injury at surgical sites. It is a diagnostic challenge as it manifests as necrotizing wounds which are commonly misdiagnosed as postoperative wound infection or ischemia. We discuss the clinical features and histopathological findings that allow for rapid identification of PG following autologous breast reconstruction and suggest an algorithm to aid diagnosis.
Joye, Sebastien; Gao, Anja; Kayemba-Kay’s, Simon; Cotting, Jacques; Perez, Marie-Hélène
Despite good cover with 7-valent vaccination, invasive pneumococcal infections may still be misdiagnosed and may lead to lifethreatening situations or death in young children. New serotypes are emerging and, therefore, clinicians must keep a high level of suspicion in young children regardless of their vaccination status. We report three cases of invasive pneumococcal infection due to new serotypes not covered by the 7-valent conjugated vaccine, two of which led children to death. PMID:24765491
Joye, Sebastien; Gao, Anja; Kayemba-Kay's, Simon; Cotting, Jacques; Perez, Marie-Hélène
Despite good cover with 7-valent vaccination, invasive pneumococcal infections may still be misdiagnosed and may lead to lifethreatening situations or death in young children. New serotypes are emerging and, therefore, clinicians must keep a high level of suspicion in young children regardless of their vaccination status. We report three cases of invasive pneumococcal infection due to new serotypes not covered by the 7-valent conjugated vaccine, two of which led children to death.
Neuro-ophthalmology, as an interdisciplinary, covers at least three disciplines- ophthalmology, neurology and neurosurgery. With limited knowledge in each discipline, doctors often make misdiagnoses for neuro-ophthalmology diseases. Therefore, it is imperative to abandon the distinction between disciplines and combine all the knowledge to diagnose and treat patients in patterns of holistic integrated medicine in order to effectively improve the diagnosis and treatment of neuro-ophthalmology.
Xavier, Marcus Henrique de S B; Ribeiro, Lúcia Helena S; Duarte, Hélio; Saraça, Giani; Souza, Angela Cristina L
Tinea nigra is an asymptomatic superficial fungal infection caused by Phaeoannelomyces werneckii, generally affecting the skin of the palms and characterized by deeply pigmented macular non-scaly patches. These lesions are quite characteristic. However, they can be misdiagnosed as a malignant melanoma or a junctional melanocytic nevus and unnecessary biopsies may be performed. Thus, dermoscopy is a fast, useful, clinical adjunctive tool in differentiating tinea nigra from melanocytic lesion.
Diagnostic failure can be due to a variety of psychological errors on the part of the diagnostician. An erroneous diagnosis rendered by previous clinicians can lead a diagnostician to the wrong diagnosis. This report is the case of a patient who misdiagnosed herself and then led an emergency room physician and subsequent treating physicians to the wrong diagnosis. This mechanism of diagnostic error can be called patient cueing. PMID:27284538
Kaushik, Rachna; Punyani, Silky Rajesh; Raj, Vineet
The keratocystic odontogenic tumor, although a benign lesion, is peculiarly aggressive with a high recurrence rate. Its involvement with the maxillary antrum is atypical. We report the unusual case of a 20-year-old male patient with an extensive antral tumor associated with an impacted third molar, which was initially misdiagnosed as a dentigerous cyst. Clinical, radiographic, and histopathologic aspects were analyzed to provide useful information for the correct diagnosis, treatment, and prognosis within a multidisciplinary approach. PMID:27818958
Sanal, Hatice Tuba; Zor, Fatih; Kocaoğlu, Murat; Bulakbaşi, Nail
Atypical mycobacterial tenosynovitis of the wrist can easily be misdiagnosed as synovial chondromatosis. Both sonography and magnetic resonance imaging plays an important role in depicting "rice bodies" within the distended tendon sheaths and bursae of atypical mycobacterial infection. An endemic place for Mycobacterium species and the occupation of the patient should raise the suspicion for the disease. Polymerase chain reaction of the distended tendon fluid is a sensitive, specific and rapid method in identification of the mycobacteria.
Shrestha, Binod Bade; Ghimire, Pradeep; Ghartimagar, Dilasma; Jwarchan, Bishnu; Lalchan, Subita; Karmacharya, Mikesh
Complete mature brain tissue in sacrococcygeal region is a rare congenital anomaly in a newborn, which usually is misdiagnosed for sacrococcygeal teratoma. Glial tumor-like ependymoma is also common in sacrococcygeal area but mostly appears later in life. We present a case of complete heterotopic brain tissue in the sacrococcygeal region. The patient underwent total excision of mass with coccygectomy. To our knowledge it is the second case being reported. PMID:27194682
The fabella is a small sesamoid bone generally located in the tendon of the lateral head of the gastrocnemius behind the lateral condyle of the femur. Fabella syndrome is the occurrence of posterolateral knee pain associated with the fabella. It is a rare cause of knee pain that is often misdiagnosed. Fabella syndrome can be managed with conservative or surgical treatment. We applied radial extracorporeal shock wave therapy as a new treatment strategy for fabella syndrome and achieved a successful outcome. PMID:28119844
Zou, Yu; Ni, Yiming; Liu, Xiaoli; Chen, Xing
Behçet's disease involving the heart is extremely rare. Sometimes it is probable to misdiagnose as infective endocarditis when protracted fever and chill occurs. We report a case of protracted pyrexia of unknown origin after surgical excision of a cardiac tumour. Clinically and pathologically a diagnosis of infective endocarditis was probable but antibiotics had no effect. After case review the diagnosis of Behçet's disease was established and the patient was treated with glucocorticoids which resulted in resolution.
Macdonald, Andrew; Plaha, Puneet; Byrne, James
Dural arteriovenous fistulae (DAVFs) are a rare form of intracranial arteriovenous malformation. We present the case of a patient who presented in a previously undescribed manner with facial swelling and bruising initially misdiagnosed as cellulitis. He was found subsequently to have DAVFs of the sphenoparietal sinus that had hemorrhaged. The rarity of DAVFs at this location may account for this unique presentation. Successful treatment was achieved by transarterial embolization. PMID:24632907
Brescia, A; Giacomelli, L; Hadjiamiri, H; Leone, L; Franceschini, P; Messinetti, S
The authors, on the basis of a case recently observed, suggest to take into account the presence of an ovarian "microcarcinoma" when a jejunal stenosis of uncertain origin is found in a female patient. In fact, ovarian carcinoma is often misdiagnosed. A complete surgical exploration is recommended even though diagnostic techniques such as endoscopy, CT scan, ultrasonography and X-ray barium enema are negative.
Tuffaha, Sami H.; Robbins, Sanford H.; Bonawitz, Steven C.
Pyoderma gangrenosum (PG) is an uncommon disorder characterized by the development of painful cutaneous ulceration, commonly precipitated by dermal injury at surgical sites. It is a diagnostic challenge as it manifests as necrotizing wounds which are commonly misdiagnosed as postoperative wound infection or ischemia. We discuss the clinical features and histopathological findings that allow for rapid identification of PG following autologous breast reconstruction and suggest an algorithm to aid diagnosis. PMID:28210559
Lallas, Aimilios; Apalla, Zoe; Lazaridou, Elizabeth; Sotiriou, Elena; Vakirlis, Efstratios; Ioannides, Dimitrios
Dermoscopy is already considered a fairly established method for diagnosing scabies. This is because dermoscopy enables the visualization both of the burrow and the mite itself, forming the so-called “jet with a contrail” structure. In the present report we present an extraordinary case of a patient with scabies lesions on the face and neck, which was misdiagnosed during sequential visits and underwent unnecessary surgical diagnostic procedures. Finally, the diagnostic problem was solved when dermoscopy was applied. PMID:28243495
Vyas, Chirayu; Shah, Sanjay; Pancholy, Sameer; Patel, Tejas; Moussa, Isam
We report a patient who presented with takotsubo cardiomyopathy but was misdiagnosed as an anterior wall ST elevation myocardial infarction (AWMI). We illustrate how misdiagnosis led to mismanagement by initiating intravenous inotropic agents that led to further hemodynamic compromise. Subsequent withdrawal of the inotropic agents and simultaneous administration of oral metoprolol therapy led to hemodynamic and clinical improvement re-affirming the diagnosis of takotsubo cardiomyopathy.
DiBartolomeo, J R; Henry, D F
The disorder of hyperpatent eustachian tube is often unrecognized or misdiagnosed because of the ambiguous symptom of a "plugged ear." But when the patient also complains of autophony and/or hearing amphoric sounds, a patulous tube should be suspected. Persistent symptoms are distressing to most patients. This preliminary report evaluates a new nasal medication that produces closure of the tube and controls or eliminates these symptoms. It is demonstrated to be safe, predictable, and effective with little or no side effects.
Cashman, Emma Catherine; Smyth, David
Chronic rhinosinusitis (CRS) and primary headache syndromes are common disease entities and headache and facial pain are common reasons for referral to otolaryngology units. Because of an association of nasal symptoms with primary headache syndromes and considerable similarities in their clinical presentations, primary headache syndromes may be misdiagnosed as sinus disease and vice versa. In this review we examine the evidence on which otolaryngologists can base clinical diagnosis and management and offer an approach to distinguishing these common clinical entities.
Gurbuz, Orcun; Ercan, Abdulkadir; Kumtepe, Gencehan; Karal, İlker Hasan; Velioglu, Yusuf; Ener, Serdar
A forty-one-year-old man who, sought evaluation for a sudden hip flexion contracture and groin pain with a history of mechanical mitral valve replacement, had been misdiagnosed and treated as having lumbar discopathy for two days. This patient finally was diagnosed with compressive femoral neuropathy due to warfarin-induced retroperitoneal hematoma and successfully managed nonoperatively. This case is reported in order to draw attention to this rare presentation. PMID:25386195
Kim, Kyung Hyun; Song, Sang Woo; Lee, Soo Eon; Lee, Sang Hyung
A spinal epidural hemangioma is rare. In this case, a 51 year-old female patient had low back pain and right thigh numbness. She was initially misdiagnosed as having a ruptured disc with possible sequestration of granulation tissue formation due to the limited number of spinal epidural hemangiomas and little-known radiological findings. Because there are no effective diagnostic tools to verify the hemangioma, more effort should be put into preoperative imaging tests to avoid misdiagnosis and poor decisions).
Red legs (RL) is a chronic inflammatory condition often misdiagnosed as cellulitis. Antibiotic therapy is not required and does not resolve the symptoms. The main causes of RL are chronic dermatological and venous disease, including chronic oedema. Raising awareness of this condition among health professionals could prevent misdiagnosis and unnecessary costly and potentially harmful antibiotic therapy. The aim of this paper is to highlight the differential diagnoses and management of red legs, and the author also includes an example through a case history.
Bains, Anupama; Vedant, Deepak; Shanker, Vinay; Tegta, G. R.
Primary cutaneous anaplastic large cell lymphoma (pcALCL) forms 9% of the cutaneous T-cell lymphomas. It usually presents as solitary reddish brown ulcerating nodule or indurated plaque. Sometimes, it mimics other dermatological diseases such as eczema, pyoderma gangrenosum, pyogenic granuloma, morphea, and squamous cell carcinoma. Our case presented with large pyogenic granuloma like lesion with regional lymphadenopathy. Since pcALCL is rare, one can misdiagnose such cases and therefore high index of suspicion is necessary. PMID:27990392
Shehatha, Jaffar; Saxena, Pankaj; Clarke, Belinda; Dunning, John; Konstantinov, Igor E
Primary pulmonary artery sarcoma is a rare tumor that can be misdiagnosed as acute or chronic pulmonary thromboembolic disease. This article reports a patient with a preoperative diagnosis of pulmonary embolism who was found to have an extensive pulmonary artery tumor. Surgical resection of the primary pulmonary artery sarcoma and reconstruction of the central pulmonary arteries, followed by adjuvant chemoradiotherapy, provided significant improvement in his clinical symptoms.
Timmers, Liesbeth; Bové, Thierry; De Pauw, Michel
Intimal sarcoma of the pulmonary artery (PAS) is a rare but potentially lethal tumour, frequently misdiagnosed as chronic thrombo-embolic pulmonary artery disease. Despite the availability of advanced imaging technologies, its preoperative diagnosis remains difficult. We report on two patients with clinical features mimicking chronic pulmonary thrombo-embolism. Further discussion will focus on the differential diagnosis with more classical causes of obstructive pulmonary vascular disease.
Shah, Dipesh K; Joyce, Lyle D; Grogan, Martha; Aubry, Marie Christine; Miller, John A; Ding, Wei; Haddock, Michael G
Intimal sarcoma of the pulmonary artery is commonly misdiagnosed as chronic pulmonary embolism. Rarely, it can involve the right ventricular outflow tract and the pulmonary valve. We report a patient who was treated surgically for an intimal sarcoma of the pulmonary artery involving the right ventricular outflow tract and the pulmonary valve. The sarcoma recurred in about 8 weeks. It responded favorably to chemoradiation therapy and shows some signs of regression.
Jindwani, Karuna; Paharia, Y. K.; Kushwah, Atul Pratap Singh
The adenomatoid odontogenic tumour (AOT) is a relatively uncommon lesion constituting around 3% of all odontogenic tumours and often misdiagnosed as an odontogenic cyst. It manifests as a beningn growth which affects young individuals, with a female predeliction usually in the second decade of life, exhibiting more often in the anterior region of maxilla. The current article enumerates the clinical, radiographic and histopathological features of a rare case of extraosseous AOT with its therapeutic consideration PMID:25684929
Reddy Kundoor, Vinay Kumar; Maloth, Kotya Naik; Guguloth, Nagu Naik; Kesidi, Sunitha
Adenomatoid odontogenic tumor (AOT) is an uncommon tumor of odontogenic origin and often misdiagnosed as an odontogenic cyst. It is predominantly found in young female patients, located more often in maxilla, and in most cases associated with an unerupted permanent tooth. There are three variants of AOT namely follicular, extra follicular, and peripheral. We report an unusual case of extrafollicular AOT in maxilla of a 50-year old male patient. PMID:27942555
Acharya, Shivesh; Goyal, Ashima; Rattan, Vidya; Vaiphei, Kim; Kaur Bhatia, Sarabjot
Adenomatoid odontogenic tumor (AOT) is a well-recognised slow growing benign tumor derived from complex system of dental lamina or its remnants. This lesion is categorised into three variants of which the more common variant is follicular type which is often mistaken for dentigerous cyst. We present a case of AOT in a 14-year-old male who was misdiagnosed as dentigerous cyst. Clinical radiological and therapeutic characteristics of the case are commented on in detail. PMID:25097553
Pulmonary embolism is a common cardiovascular emergency, but it is still often misdiagnosed due to its unspecific clinical symptoms. Elevated troponin concentrations are associated with greater morbidity and mortality in patients with pulmonary embolism. Right ventricular ischemia due to increased right ventricular afterload is believed to be underlying mechanism of elevated troponin values in acute pulmonary embolism, but a paradoxical coronary artery embolism through opened intra-artrial communication is another possible explanation as shown in our case report. PMID:21106090
Goebels, S; Hasenfus, A K; Kellner, B K; Löw, U; Seitz, B
A 40-year-old female chemical laboratory assistant presented at our clinic with chronic conjunctivitis of 4 years' standing. We initially misdiagnosed her symptoms as giant papillary conjunctivitis. Topical treatment failed to produce an improvement and a biopsy was performed. Histopathological analysis showed bilateral follicular lymphoma, a subtype of the B-cell non-Hodgkin lymphoma. The patient was referred for radiotherapy. At follow-up 18 months later the patient was symptom-free.
Steward, Sarah C; Chauvenet, Allen R; O'Suoji, Chibuzo
Rhabdomyosarcoma (RMS) is the most common soft tissue malignancy seen in childhood and frequently occurs in the head and neck region. Pediatric head and neck RMS is often misdiagnosed as common benign conditions. Here we describe an embryonal RMS that presented as a peritonsillar abscess (PTA). Due to an incorrect initial diagnosis and lack of imaging, the patient received unnecessary medical therapy and diagnosis of RMS was delayed.
McQuiston, Jennifer H; Zemtsova, Galina; Perniciaro, Jamie; Hutson, Mark; Singleton, Joseph; Nicholson, William L; Levin, Michael L
Several spotted fever group rickettsiae (SFGR) previously believed to be nonpathogenic are speculated to contribute to infections commonly misdiagnosed as Rocky Mountain spotted fever (RMSF) in the United States, but confirmation is difficult in cases with mild or absent systemic symptoms. We report an afebrile rash illness occurring in a patient 4 days after being bitten by a Rickettsia montanensis-positive Dermacentor variabilis tick. The patient's serological profile was consistent with confirmed SFGR infection.
Baur, Xaver; Fischer, Axel; Budnik, Lygia T
Repeated inhalative exposures to antigenic material from a variety of sources, mainly from moulds, thermophilic Actinomycetes, and avians, respectively, can induce immune responses with the clinical picture of extrinsic allergic alveolitis (EAA) or hypersensitivity pneumonitis. Delays of years or even decades till the diagnosis is made are not uncommon; frequent misdiagnoses include allergic asthma, COPD, recurrent flue and other infections. We provide here the state of the art references, a detailed case description and recommend a current diagnostics schema.
Jackson, S M J S; Cooper, N K
A case of a specialist senior non-commissioned officer with cystic fibrosis (CF) is described. Partial expression of the CF trait is well known and sporadic cases are detected from time to time at recruitment, during recruit training and service. Respiratory symptoms may be mis-diagnosed as self-limiting asthma until a sweat chloride or other specific test for CF is performed.
Portal, R. W.
A case is reported in which a frontal astrocytoma occurring in a lead worker was initially misdiagnosed as lead encephalopathy. The evidence in favour of lead poisoning as a secondary diagnosis is discussed and details given of the urinary lead excretion in response to intravenous EDTA. It was concluded that though excess lead absorption had occurred, the history and findings were not such as to have made a diagnosis of lead encephalopathy tenable. PMID:13737259
Spinello, Irene M
In the United States, each year 1% to 2% of deaths are brain deaths. Considerable variation in the practice of determining brain death still remains, despite the publication of practice parameters in 1995 and an evidence-based guideline update in 2010. This review is intended to give bedside clinicians an overview of definition, the causes and pitfalls of misdiagnosing brain death, and a focus on the specifics of the brain death determination process.
Ambasta, Suruchi; Dey, Ankita; Elakkumanan, Lenin Babu; Sundararaj, Rajkumar
Bilateral vocal cord paralysis being misdiagnosed as bronchial asthma has been reported in the literature on several occasions. Diagnosing this condition needs precise clinical acumen which could lead us to make an integrated diagnostic and treatment plan. Here, we report another missed case of bilateral vocal cord paralysis and the root cause analysis of the incident. This report emphasises the need for appropriate clinical examinations and workup during the pre-operative assessment. PMID:27601744
Lee, Sang Kwon; Kim, Mi Jeong; Kwon, Sun Young
We report the imaging and pathologic findings of fishbone-associated actinomycosis of the anterior cervical space in a 57-year-old man, misdiagnosed preoperatively as a malignancy originating from thyroglossal duct cyst. CT revealed an enhancing mass containing a small abscess pocket and two sharp linear calcifications within it, which infiltrated into the strap muscle. Pathologic examination demonstrated two fishbones within the actinomycotic abscess. Fishbone-associated actinomycosis should be considered when a cervical mass contains sharp linear calcifications.
Lee, Kwangho; Park, Insung; Han, Jongwoo
Persistent primitive trigeminal artery (PPTA) is the most common carotid-basilar anastomosis; on the other hand, persistent primitive otic artery (PPOA) is extremely rare. PPTA is often misdiagnosed as PPOA on cerebral angiography. We present a case of PPTA that mimicked PPOA on cerebral angiography. We further describe the utility of brain computed tomography angiography for differential diagnosis of PPTA from PPOA, together with a review of previous literature. PMID:27790403
Yang, Xiang; Ren, Yanming; Wu, Weilu; Wang, Xiang; Liu, Xuesong; Zhang, Yuekang
Intracranial extraaxial ependymomas (IEAEs) are very rare, and extra-axial petroclival ependymoma (EAPE) has not been reported in the reviewed English-language literature by now. We present a male patient with EAPE misdiagnosed as a petroclival meningioma preoperatively, and involved recurrence at 4th months after operation though totally resection. Thereafter, we report this case and discuss the clinical characteristics of the disease by briefly review. PMID:25674289
McKee, Phillip H
This review, based on a lecture given at the 2009 Update in Dermatopathology meeting held at the Institute of Dermatology (London, UK), discusses the problem of misdiagnosing atypical benign melanocytic lesions as melanoma and the alternative problem of interpreting naevoid melanoma as a banal naevus. Consequences are considered. Brief consideration of a range of other melanoma variants that may be a source of diagnostic difficulty is also included.
Wang, Peng; Chen, Cong; Xin, Xiaotang; Liu, Bo; Li, Wei; Yin, Dezhen; Mu, Weidong
Giant intrapelvic malignant peripheral nerve sheath tumors arising in the sciatic nerve in the pelvic cavity are a rare occurrence and their symptomatology is usually misdiagnosed as intervertebral disc herniation. We herein report the case of a 46-year old woman presenting with pain, hypesthesia and weakness of the left lower extremity due to a giant intrapelvic malignant peripheral nerve sheath tumor of the sciatic nerve. Prior to being referred to our institution, the patient was misdiagnosed as a case of sciatica due to a lumbar disc herniation and underwent an operation unsuccessfully, as there was little symptomatic improvement 2 months after the surgery. A magnetic resonance imaging examination of the pelvic cavity revealed a tumor of the sciatic nerve. The mass was resected via the posterior approach and histopathological examination confirmed the diagnosis of malignant peripheral nerve sheath tumor. Intrapelvic malignant peripheral nerve sheath tumors are an uncommon cause of sciatica and are commonly misdiagnosed as lumbar intervertebral disc herniation. Accurate diagnosis and complete surgical excision prior to metastasis are crucial for effective management of this condition. PMID:27900106
Jeon, Hyeong-Kyu; Park, Hansol; Lee, Dongmin; Choe, Seongjun; Kim, Kyu-Heon; Huh, Sun; Sohn, Woon-Mok; Chai, Jong-Yil; Eom, Keeseon S
Tapeworms of the genus Spirometra are pseudophyllidean cestodes endemic in Korea. At present, it is unclear which Spirometra species are responsible for causing human infections, and little information is available on the epidemiological profiles of Spirometra species infecting humans in Korea. Between 1979 and 2009, a total of 50 spargana from human patients and 2 adult specimens obtained from experimentally infected carnivorous animals were analyzed according to genetic and taxonomic criteria and classified as Spirometra erinaceieuropaei or Spirometra decipiens depending on the morphology. Morphologically, S. erinaceieuropaei and S. decipiens are different in that the spirally coiled uterus in S. erinaceieuropaei has 5-7 complete coils, while in S. decipiens it has only 4.5 coils. In addition, there is a 9.3% (146/1,566) sequence different between S. erinaceieuropaei and S. decipiens in the cox1 gene. Partial cox1 sequences (390 bp) from 35 Korean isolates showed 99.4% (388/390) similarity with the reference sequence of S. erinaceieuropaei from Korea (G1724; GenBank KJ599680) and an additional 15 Korean isolates revealed 99.2% (387/390) similarity with the reference sequences of S. decipiens from Korea (G1657; GenBank KJ599679). Based on morphologic and molecular databases, the estimated population ratio of S. erinaceieuropaei to S. decipiens was 35: 15. Our results indicate that both S. erinaceieuropaei and S. decipiens found in Korea infect humans, with S. erinaceieuropaei being 2 times more prevalent than S. decipiens. This study is the first to report human sparganosis caused by S. decipiens in humans in Korea.
Devleesschauwer, Brecht; Ale, Anita; Torgerson, Paul; Praet, Nicolas; Maertens de Noordhout, Charline; Pandey, Basu Dev; Pun, Sher Bahadur; Lake, Rob; Vercruysse, Jozef; Joshi, Durga Datt; Havelaar, Arie H.; Duchateau, Luc; Dorny, Pierre; Speybroeck, Niko
Background Parasitic zoonoses (PZs) pose a significant but often neglected threat to public health, especially in developing countries. In order to obtain a better understanding of their health impact, summary measures of population health may be calculated, such as the Disability-Adjusted Life Year (DALY). However, the data required to calculate such measures are often not readily available for these diseases, which may lead to a vicious circle of under-recognition and under-funding. Methodology We examined the burden of PZs in Nepal through a systematic review of online and offline data sources. PZs were classified qualitatively according to endemicity, and where possible a quantitative burden assessment was conducted in terms of the annual number of incident cases, deaths and DALYs. Principal Findings Between 2000 and 2012, the highest annual burden was imposed by neurocysticercosis and congenital toxoplasmosis (14,268 DALYs [95% Credibility Interval (CrI): 5450–27,694] and 9255 DALYs [95% CrI: 6135–13,292], respectively), followed by cystic echinococcosis (251 DALYs [95% CrI: 105–458]). Nepal is probably endemic for trichinellosis, toxocarosis, diphyllobothriosis, foodborne trematodosis, taeniosis, and zoonotic intestinal helminthic and protozoal infections, but insufficient data were available to quantify their health impact. Sporadic cases of alveolar echinococcosis, angiostrongylosis, capillariosis, dirofilariosis, gnathostomosis, sparganosis and cutaneous leishmaniosis may occur. Conclusions/Significance In settings with limited surveillance capacity, it is possible to quantify the health impact of PZs and other neglected diseases, thereby interrupting the vicious circle of neglect. In Nepal, we found that several PZs are endemic and are imposing a significant burden to public health, higher than that of malaria, and comparable to that of HIV/AIDS. However, several critical data gaps remain. Enhanced surveillance for the endemic PZs identified in this
Jeon, Hyeong-Kyu; Park, Hansol; Lee, Dongmin; Choe, Seongjun; Kim, Kyu-Heon; Sohn, Woon-Mok; Eom, Keeseon S.
Human sparganosis is a zoonotic disease caused by infection with larval forms (procercoid/plerocercoid) of Spirometra spp. The purpose of this study was to identify Spirometra spp. of infected snakes using a multiplex PCR assay and phylogenetic analysis of mitochondrial DNA sequence data from the spargana of terrestrial snakes obtained from Korea and China. A total of 283 snakes were obtained that included 4 species of Colubridae comprising Rhabdophis tigrinus tigrinus (n=150), Dinodon rufozonatum rufozonatum (n=64), Elaphe davidi (n=2), and Elaphe schrenkii (n=7), and 1 species of Viperidae, Agkistrodon saxatilis (n=60). The snakes were collected from the provinces of Chungbuk, Chungnam, and Gyeongbuk in Korea (n=161), and from China (n=122). The overall infection rate with spargana was 83% (235/283). The highest was recorded for D. rufozonatum rufozonatum (100%), followed by A. saxatilis (85%) and R. tigrinus tigrinus (80%), with a negative result for E. davidi (0%) and E. schrenkii (0%). The sequence identities between the spargana from snakes (n=50) and Spirometra erinaceieuropaei (KJ599680) or S. decipiens (KJ599679) control specimens were 90.8% and 99.2%, respectively. Pairwise genetic distances between spargana (n=50) and S. decipiens ranged from 0.0080 to 0.0107, while those between spargana and S. erinaceieuropaei ranged from 0.1070 to 0.1096. In this study, all of the 904 spargana analyzed were identified as S. decipiens either by a multiplex PCR assay (n=854) or mitochondrial cox1 sequence analysis (n=50). PMID:27180576
Nithiuthai, Suwannee; Anantaphruti, Malinee T; Waikagul, Jitra; Gajadhar, Alvin
This review deals with waterborne zoonotic helminths, many of which are opportunistic parasites spreading directly from animals to man or man to animals through water that is either ingested or that contains forms capable of skin penetration. Disease severity ranges from being rapidly fatal to low-grade chronic infections that may be asymptomatic for many years. The most significant zoonotic waterborne helminthic diseases are either snail-mediated, copepod-mediated or transmitted by faecal-contaminated water. Snail-mediated helminthiases described here are caused by digenetic trematodes that undergo complex life cycles involving various species of aquatic snails. These diseases include schistosomiasis, cercarial dermatitis, fascioliasis and fasciolopsiasis. The primary copepod-mediated helminthiases are sparganosis, gnathostomiasis and dracunculiasis, and the major faecal-contaminated water helminthiases are cysticercosis, hydatid disease and larva migrans. Generally, only parasites whose infective stages can be transmitted directly by water are discussed in this article. Although many do not require a water environment in which to complete their life cycle, their infective stages can certainly be distributed and acquired directly through water. Transmission via the external environment is necessary for many helminth parasites, with water and faecal contamination being important considerations. Human behaviour, particularly poor hygiene, is a major factor in the re-emergence, and spread of parasitic infections. Also important in assessing the risk of infection by water transmission are human habits and population density, the prevalence of infection in them and in alternate animal hosts, methods of treating sewage and drinking water, and climate. Disease prevention methods, including disease surveillance, education and improved drinking water treatment are described.
Boscoe, Francis P; Schymura, Maria J
Background An inverse relationship between solar ultraviolet-B (UV-B) exposure and non-skin cancer mortality has long been reported. Vitamin D, acquired primarily through exposure to the sun via the skin, is believed to inhibit tumor development and growth and reduce mortality for certain cancers. Methods We extend the analysis of this relationship to include cancer incidence as well as mortality, using higher quality and higher resolution data sets than have typically been available. Over three million incident cancer cases between 1998 and 2002 and three million cancer deaths between 1993 and 2002 in the continental United States were regressed against daily satellite-measured solar UV-B levels, adjusting for numerous confounders. Relative risks of reduced solar UV-B exposure were calculated for thirty-two different cancer sites. Results For non-Hispanic whites, an inverse relationship between solar UV-B exposure and cancer incidence and mortality was observed for ten sites: bladder, colon, Hodgkin lymphoma, myeloma, other biliary, prostate, rectum, stomach, uterus, and vulva. Weaker evidence of an inverse relationship was observed for six sites: breast, kidney, leukemia, non-Hodgkin lymphoma, pancreas, and small intestine. For three sites, inverse relationships were seen that varied markedly by sex: esophagus (stronger in males than females), gallbladder (stronger in females than males), and thyroid (only seen in females). No association was found for bone and joint, brain, larynx, liver, nasal cavity, ovary, soft tissue, male thyroid, and miscellaneous cancers. A positive association between solar UV-B exposure and cancer mortality and incidence was found for anus, cervix, oral cavity, melanoma, and other non-epithelial skin cancer. Conclusion This paper adds to the mounting evidence for the influential role of solar UV-B exposure on cancer, particularly for some of the less-well studied digestive cancers. The relative risks for cancer incidence are similar to
Bursey, Charles R; Goldberg, Stephen R
Oswaldocruzia costaricensis n. sp. (Strongylida: Molineidae) from the intestines and Rhabdias savagei n. sp. (Rhabditida: Rhabdiasidae) from the lungs of Rana cf. forreri (Anura: Ranidae) are described and illustrated. Oswaldocruzia costaricensis represents the 77th species assigned to the genus and differs from the other Neotropical species in the genus by possessing a Type II bursa and long cervical alae. Rhabdias savagei represents the 47th species assigned to the genus and differs from other Neotropical species in the genus by possession of 4 lips and a postequatorial vulva. Rana cf. forreri was also found to harbor the trematodes, Haematoloechus parcivitellarius and Megalodiscus temperatus, the nematodes, Aplectana incerta, Aplectana itzocanensis, Cosmocerca podicipinus, Foleyellides striatus, Subulascaris falcaustriformis, and a larva of the nematode Brevimulticaecum sp. Cosmocerca panamaensis is considered to be a synonym of Cosmocerca podicipinus.
Abou, Magali; Dällenbach, Patrick
Cytomegalovirus (CMV) infection in immunocompetent hosts is generally asymptomatic or may present as a mononucleosic syndrome. Its association with acute cervicitis and vulvovaginitis has rarely been reported. A 24-year-old woman presented with pelvic pain, vulvodynia, abnormal vaginal discharge, burning with urination, fatigue, fever, vomiting and diarrhoea. The vulva and cervix were red with vesicular lesions on the cervix. Genital herpes simplex infection (HSV) was suspected and valacyclovir was given orally. However, serial viral cultures performed 7 weeks apart did not isolate HSV as suspected, but CMV was confirmed by immunofluorescence and early antigen research. Blood tests confirmed an acute CMV infection. Typical inclusions were found at histology. Symptoms resolved slowly with persistence of cervical lesions at 7 weeks from diagnosis. The frequency of CMV genital infection is probably underestimated. The infection is not always asymptomatic and might be confused with genital HSV infection. The clinical course is longer. PMID:23606387
Abou, Magali; Dällenbach, Patrick
Cytomegalovirus (CMV) infection in immunocompetent hosts is generally asymptomatic or may present as a mononucleosic syndrome. Its association with acute cervicitis and vulvovaginitis has rarely been reported. A 24-year-old woman presented with pelvic pain, vulvodynia, abnormal vaginal discharge, burning with urination, fatigue, fever, vomiting and diarrhoea. The vulva and cervix were red with vesicular lesions on the cervix. Genital herpes simplex infection (HSV) was suspected and valacyclovir was given orally. However, serial viral cultures performed 7 weeks apart did not isolate HSV as suspected, but CMV was confirmed by immunofluorescence and early antigen research. Blood tests confirmed an acute CMV infection. Typical inclusions were found at histology. Symptoms resolved slowly with persistence of cervical lesions at 7 weeks from diagnosis. The frequency of CMV genital infection is probably underestimated. The infection is not always asymptomatic and might be confused with genital HSV infection. The clinical course is longer.
Heller, Debra S
In addition to practitioners who care for male patients, with the increased use of high-resolution anoscopy, practitioners who care for women are seeing more men in their practices as well. Some diseases affecting the penis can impact on their sexual partners. Many of the lesions and neoplasms of the penis occur on the vulva as well. In addition, there are common and rare lesions unique to the penis. A review of the scope of penile lesions and neoplasms that may present in a primary care setting is presented to assist in developing a differential diagnosis if such a patient is encountered, as well as for practitioners who care for their sexual partners. A familiarity will assist with recognition, as well as when consultation is needed.
Padrnos, Leslie; Karlin, Nina; Halfdanarson, Thorvardur R.
Extramammary Paget disease (EMPD) is a rare cutaneous malignancy. The most common presentation of EMPD is the vulva followed by perianal involvement. Most cases are localized to the dermis with treatment focused on surgery, topical treatment or radiotherapy. Recurrence is frequent despite therapies utilized. Metastatic extramammary Paget disease is uncommon and, as such, standard treatment guidelines do not exist. This study sought to evaluate the treatment regimens and outcomes of patients treated at a Mayo Clinic Center from 1998-2012. Cancer registry inquiry revealed 261 patients with report advanced Paget disease during these years. Ten cases of metastatic EPMD were identified with sufficient documentation for review. This review reveals support for utilizing localized radiation therapy for bulky disease sequentially with systemic chemotherapy consisting of carboplatin and paclitaxel or irinotecan. Further studies are necessary to define the optimal treatment regimen. PMID:27994832
Murata, Koichi; Yanai, Tokuma; Agatsuma, Takeshi; Uni, Shigehiko
Three dog heartworms (Dirofilaria immitis) were detected in the lumen of the right cardiac ventriculus and of the pulmonary artery of a captive female snow leopard (Uncia uncia) that died of pancreatic carcinoma at a zoo in Japan. Neither clinical respiratory nor circulatory symptoms caused by the heartworm infection were observed. The filarial worms were identified as D. immitis from the morphologic characteristics of the esophagus, the presence of faint longitudinal ridges on the cuticular surface, the situation of vulva posterior to the esophagus, and the measurements of the body. The heartworms from the snow leopard were identical to that of D. immitis from dogs in the sequence of the cytochrome oxidase I region in the mitochondrial DNA. This host record is the first of D. immitis in U. uncia.
Fellner, V; Weiss, M F; Belo, A T; Belyea, R L; Martz, F A; Orma, A H
A urine cup for continuous and complete collection of urine from cows was constructed from Plastisol, cotton webb strapping, Velcro Brand touch fasteners [corrected], snap-fasteners, denim patches, weather stripping, and vacuum hose. The urine cup was made from Plastisol using a heated lead mold. It was large enough to enclose a 9 cm x 6 cm area around the vulva of a cow and was attached by strapping and Velcro Brand touch fasteners [corrected] to patches glued to the rump. Urine cups were used repeatedly and provided for long-term collection of urine from cows, eliminating the need for indwelling catheters. Applications include long-term nutrient balance, radioisotope, and metabolism studies.
Junker, K; Bain, O; Boomker, J
During a study conducted between 2003 and 2005 on the diet of Nile crocodiles in Botswana, two young adult nematodes, one male and one female, belonging to the genus Eustrongylides Jägerskiöld, 1909 were recovered from the stomach contents of one of these animals. The caudal bursa of the male is present and the ejaculatory duct could be identified, but the spicule could not be seen. The vulva of the female has opened and the anus is situated on a terminal protruberance. Measurements and drawings of these specimens are provided, together with some data on the occurrence and life-cycles of members of the genus Eustrongylides in crocodilians world-wide and in African hosts in particular. Piscivorous birds are the usual final hosts of these nematodes. It is probable that the specimens described herein had developed in a paratenic fish host, and that the latter had been eaten by the crocodile.
Mirahmadi, Hadi; Maleki, Alireza; Hasanzadeh, Raheleh; Ahoo, Mohammad Bagher; Mobedi, Iraj; Rostami, Ali
This report describes a rare case of ophthalmic dirofilariasis in a 2-year-old boy with redness, irritation, pain and foreign body sensation in the right eye. Slit lamp examination demonstrated a thread-like whitish nematode in the anterior chamber of the right eye that twisted around itself. The nematode worm (35mm long and 150-200μm width) was removed surgically. The presence of the smooth cuticular surface without longitudinal ridges and the vulva showed that it could be a female Diroflaria immitis. PCR amplification was done to verify the Diroflaria species. PCR amplification and sequence analysis of mitochondrial 12S rDNA confirmed that recovered worm was D. immitis. Ocular dirofilariasis caused by D. immitis is very rare, but it must be considered in humans living in endemic areas.
Markowska, J; Madry, R; Markowska, A
Procedures aimed at the treatment of precancerous lesions and ectopia on the uterine cervix are frequently linked to lesions of anatomical structures. The application of hyaluronic acid (Cicatridine vaginal ovules) promotes accelerated healing of the uterine cervix and acquisition of a normal shape in the uterine cervix canal. Local application of hyaluronic acid in the vagina following radiotherapy due to cancer in the uterine cervix or endometrium favourably affects the healing of post-irradiation lesions in the vagina and improves quality of life. Over 90% of patients responded positively to the application of hyaluronic acid in the form of a cream on dystrophic lesions in the vulva. Hyaluronic acid aids the healing process of post-procedural wounds in the uterine cervix, following radiotherapy applied due to cancer of the uterine cervix, endometrium and in vulvar dystrophy.
Kalra, J.; Cortes, E.; Chen, S.; Krumholz, B.; Rovinsky, J.J.; Molho, L.; Seltzer, V.; Papantoniou, P.; Lee, J.Y.
Fifteen patients with advanced or recurrent squamous-cell carcinoma of the cervix, vulva, vagina, and urethra were treated with simultaneous combination chemotherapy (5-fluorouracil infusion and mitomycin C) and radiotherapy (3,000 rad for a period of three weeks). Three to four weeks after completion of radiotherapy, 13 of 15 patients achieved partial or complete tumor shrinkage. Nine of 15 patients are alive, eight of whom (at a median follow-up time of 24 months) have no evidence of disease. The longest survival time was 45 + months. There was minimal toxicity associated with this therapy. The results of this pilot study suggest that the simultaneous administration of radiation and chemotherapy is an effective method of treatment of advanced female genital tract carcinoma.
Bucchi, Dania; Stracci, Fabrizio; Buonora, Nicola; Masanotti, Giuseppe
Human papillomavirus (HPV) is one of the most common sexually transmitted infections worldwide. Exposure to HPV is very common, and an estimated 65%-100% of sexually active adults are exposed to HPV in their lifetime. The majority of HPV infections are asymptomatic, but there is a 10% chance that individuals will develop a persistent infection and have an increased risk of developing a carcinoma. The International Agency for Research on Cancer has found that the following cancer sites have a strong causal relationship with HPV: cervix uteri, penis, vulva, vagina, anus and oropharynx, including the base of the tongue and the tonsils. However, studies of the aetiological role of HPV in colorectal and esophageal malignancies have conflicting results. The aim of this review was to organize recent evidence and issues about the association between HPV infection and gastrointestinal tumours with a focus on esophageal, colorectal and anal cancers. The ultimate goal was to highlight possible implications for prognosis and prevention. PMID:27672265
Rossin, M Alejandra; Malizia, Ana I
Trichuris pampeana Suriano and Navone, 1994 (Nematoda: Trichuridae) is redescribed from voucher specimens from the type host Ctenomys azarae Thomas, 1903 (Rodentia: Octodontidae) and from parasites collected from 2 populations of the subterranean rodent C. talarum Thomas, 1898 from Mar de Cobo and Necochea, Buenos Aires Province, Argentina. After a revision of these nematodes, it was confirmed that the following characters were not considered in the original description: bacillary band, cells from the esophagointestinal junction, ejaculatory duct, vas deferens, adanal papillae, vagina, oviduct, and rectum. Additional information about the spicular sheath, vulva, uteri, and ovary is provided. The morphological features given in this redescription allow to confirm the identity of T. pampeana as a valid species and also to distinguish it more clearly from other species of the genus.
Pauls, Rachel N
The clitoris may be the most pivotal structure for female sexual pleasure. While its significance has been reported for hundreds of years, no complete anatomical description was available until recently. Most of the components of the clitoris are buried under the skin and connective tissues of the vulva. It comprises an external glans and hood, and an internal body, root, crura, and bulbs; its overall size is 9-11 cm. Clitoral somatic innervation is via the dorsal nerve of the clitoris, a branch of the pudendal nerve, while other neuronal networks within the structure are complex. The clitoris is the center for orgasmic response and is embryologically homologous to the male penis. While the source of vaginal eroticism might or might not be exclusively clitoral stimulation, it is necessary to understand the intricate anatomy of the organ to assess the data in this regard. Ultimately, sexual enjoyment entails a balance of physical and emotional factors and should be encouraged.
Human papillomavirus is a common and highly contagious virus that causes genital warts, which are not only unsightly, but the treatment may also be complex and the results of such treatment variable. For the patient this may result in physical and psychological trauma. Over 100 genotypes of the virus have been identified and a number of these can result in benign tumours of the skin and mucosa. Others however, are associated with intraepithelial neoplaisa of the vulva, cervix, penis and anus and squamous cell carcinoma. The nurse can provide the patient with the physical and psychological support the patient needs only if he/she has insight and understanding regarding the infection, its natural history, the diagnosis and subsequent management. Care should be provided in a non-judgmental manner, with respect and empathy.
Johnson, Arthur A; Kleve, Maurice G
Hydromermis haggardi n. sp. (Nematoda: Mermithidae) is described from the hemocoel of chironomid imagos eclosing from Lake Alice Bog in northern Minnesota in June and July 2007. The species is distinguished from the other 27 described members of the genus by the subventral mouth, tulip shape to anterior end of esophagus, colorless vesicular trophosome, single nonbifurcated spicule, short body lengths of both males and females, structure of the S-shaped vagina, decrease in body width at vulva, brevity of postparasitic stage, and the greater development of a posterior ventral protractor muscle in the males. An anomalous adult male bearing large oval structures in the posterior testis is reported. Evidence is presented for the developmental interaction of the new species with Lanceimermis palustris Johnson and Kleve, 2004.
Massinde, Anthony N; Ngwalida, Nnhandi; Gumodoka, Balthazar
Massive vulval oedema is not common during pregnancy, but when it develops, it often is associated with patient discomfort and management challenges. Two pregnant women presented to Bugando Medical Centre in Mwanza, Tanzania, with massive swelling of the vulva at 39 weeks and 32 weeks of gestation. Both women were found to have multiple gestations. Despite medical management, there was no resolution of the oedema. In both cases, vulval oedema subsided after being delivered by caesarean section. Major vulval oedema during pregnancy is a serious issue. If not treated appropriately, it can lead to major complications of increased blood loss and poor wound healing. Abdominally delivery is the preferred mode of delivery at our institution for massive vulval oedema.
Afshan, Nida; Gokhale, Leena
Massive oedema of the vulva appears to be a sequel of an underlying systemic disease in pregnant women. Isolated vulval oedema in pregnancy is rare. Vulval oedema has been treated, depending on pathophysiology, with steroids, furosemide, albumin and continuous epidural analgaesia. We present a case of vulval oedema, where the oedema was confined to the labia minora in a healthy young pregnant woman. The patient was in pain and extreme discomfort due to the labial swelling, and caesarean section was being considered for delivery as the massive oedema would obstruct the birth canal. The swelling, however, resolved successfully by simple drainage. In the literature, there have been cases delivered by caesarean section as vulval swelling was causing an obstruction.
Pruritus is a frequent symptom in many dermatological diseases. In this review we want to focus on not only itch problems specific to women, namely, pruritic vulvodermatoses, but also the specific pruritic dermatoses of pregnancy. The specific characteristics of the vulva and the hormonal changes during the different age periods make these dermatoses very particular. It seems that vulvar diseases are still underdiagnosed and undertreated. Pruritic vulvar diseases have a huge impact on quality of life. The most common pruritic diseases will be discussed, such as atopic and contact dermatitis, psoriasis, lichen sclerosis, lichen planus, and infectious vulvaginitis. We focus on the diagnostic issue of these diseases and will consider the general principles of therapy. PMID:24711996
Notarnicola, Juliana; Ruíz, F Agustín Jiménez; Gardner, Scott L
Herein, we describe Litomosoides salazari n. sp. collected from the body cavity of the yellow bat, Lasiurus ega , from Bolivia. This new species of filarioid nematode is most closely related to the carinii group and is characterized by its relatively small size with the vulva located slightly posterior to the esophago-intestinal junction; an arrow-shaped buccal capsule; and a short, rounded tail. New host and locality records for both Litomosoides hamletti and L. chandleri in phyllostomid bats, and L. brasiliensis occurring in both phyllostomid and vespertilionid bats, are provided. The morphological variability of the specimens is documented by providing comparative measurements of 3 known species. Litomosoides brasiliensis occurs in 6 species of bats from Bolivia and was the most common species of filarioid nematode encountered. All 4 species of nematodes, including the new species, were found in sympatry at Chijchijpa, a locality in the Yungas of Bolivia.
Malysheva, Svetlana V; Van Luc, Pham
A new species of Cattiena Hunt & Spiridonov, 2001 from a diplopod (Spirobolida: Pseudospirobolellidae Brolemann) collected near Sa Pa, Lao Cai Province, Vietnam, is described. Females of Cattiena fansipanis n. sp. are closely related to females of two other known species of the genus, C. trachelomegali Hunt & Spiridonov, 2001 and C. trigoniuli Hunt & Spiridonov, 2001, but can be distinguished by the distinctly more anterior position of the vulva, abrupt constriction of the body at the vulval level, presence of two swollen portions of the oviducts, and longer body and tail. Males of new species differ by having a rounded cephalic region followed by 13-14 annules which are larger than those which follow them, a different size and shape of the spicules and gubernaculum, and body and tail length. Three size groups of juveniles were found in the host gut lumen, presumably representing second, third and fourth juvenile stages. The morphology of the juvenile stages is described.
Gómez-Laencina, Ana M; Martínez Díaz, Francisco; Izquierdo Sanjuanes, Blanca; Vicente Sánchez, Elena M; Fernandez Salmerón, Rosario; Meseguer Peña, Francisco
Neurofibromatosis within the female genital tract is uncommon. The vulva is the most frequent genital location, but it has rarely been reported in the context of the vagina, uterine cervix or ovaries. In spite of its rarity, neurofibroma is a neoplasm that should be considered in the differential diagnosis of pelvic masses, especially in patients with neurofibromatosis. In this paper we describe the case of a 71-year-old patient with pelvic pain and a uterine mass who underwent a hysterectomy after having been diagnosed with an 11-cm neurofibroma occupying the myometrium of the entire uterine corpus. There were no neurofibromas in the endometrium, serosa, fallopian tubes or ovaries. The patient had an unknown von Recklinghausen's disease.
Pabuccu, Emre; Tolunay, Harun Egemen; Kocbulut, Evren; Taskın, Salih; Ortac, Fırat; Sertcelik, Ayse; Sasmaz, Aysegul; Savas, Berna
Objective To demonstrate a unique case report about late and isolated vulvar metastasis of sigmoid adeno-carcinoma with review of the literature. Material-method 57 year old postmenopausal patient with prior sigmoid colon cancer history was admitted with isolated vulvar mass. Immunohistochemistry (IHC) and KRAS gen mutation analysis following surgery were performed to discriminate the metastasis from a vulvar primary malignancy. Further imaging techniques were also performed to exclude additional tumours. Results Immunohistochemistry (IHC) and KRAS gene mutation analysis revealed isolated metastasis of the colonic adeno-carcinoma in the vulva. Conclusion Isolated and late occurring vulvar metastasis of colonic origin is very unusual. Careful evaluation and IHC is useful for such cases. PMID:22949946
Sarrafzadeh-Rezaei, F; Saifzadeh, S; Mazaheri, R; Behfar, M
Vaginal prolapse is the protrusion of edematous vaginal tissue into and through the opening of the vulva occurring during the pro-oestrus and oestrus stages of the sexual cycle. True vaginal prolapse may occur near parturition, as the concentration of serum progesterone declines and the concentration of serum oestrogen increases. In a bitch, true vaginal prolapse is a very rare condition. This case report describes an 18-month-old crossbreed bitch, weighing 40 kg presented with type III vaginal prolapse. The patient had developed vaginal prolapse after receiving oestrogen in order to oestrus induction. Subsequent to unsuccessful attempts for repositioning, ovariohysterectomy (OHE), circumferential excision of the prolapsed tissue and finally vulvoplasty were performed. There was no evidence of recurrence of the prolapse during 30 days after surgery. This case report describes type III vaginal prolapse as an unusual side effect of oestrus induction hormonal therapy in the bitch.
Medler, Terry R.; Gunderson, Andrew J.; Johansson, Magnus; Bornstein, Sophia; Bergsland, Emily; Steinhoff, Martin; Li, Yijin; Gong, Qian; Ma, Yan; Wiesen, Jane F.; Wong, Melissa H.; Kulesz-Martin, Molly; Irving, Bryan; Coussens, Lisa M.
SUMMARY B cells foster squamous cell carcinogenesis (SCC) through deposition of immunoglobulin-containing immune complexes in premalignant tissue and Fcγreceptor-dependent activation of myeloid cells. Since human SCCs of the vulva and head and neck exhibited hallmarks of B cell infiltration, we examined B cell-deficient mice and found reduced ability to support SCC growth. Although ineffective as a single agent, treatment of mice bearing pre-existing SCCs with B cell-depleting αCD20 monoclonal antibodies improved response to platinum- and taxol-based chemotherapy. Improved chemo-responsiveness was dependent on altered chemokine expression by macrophages that fostered tumor infiltration of activated CD8+ T cells via CCR5-dependent mechanisms. These data reveal that B cells, and the downstream myeloid-based pathways they regulate, represent tractable targets for anti-cancer therapy in select tumors. PMID:24909985
Bernard, Ernest C; Handoo, Zafar A; Powers, Thomas O; Donald, Patricia A; Heinz, Robert D
A new genus and species of cyst nematode, Vittatidera zeaphila, is described from Tennessee. The new genus is superficially similar to Cactodera but is distinguished from other cyst-forming taxa in having a persistent lateral field in females and cysts, persistent vulval lips covering a circumfenestrate vulva, and subventral gland nuclei of the female contained in a separate small lobe. Infective juveniles (J2) are distinguished from all previously described Cactodera spp. by the short stylet in the second-stage juvenile (14-17 μm); J2 of Cactodera spp. have stylets at least 18 μm long. The new species also is unusual in that the females produce large egg masses. Known hosts are corn and goosegrass. DNA analysis suggests that Vittatidera forms a separate group apart from other cyst-forming genera within Heteroderinae.
Heidegger, Isabel; Borena, Wegene; Pichler, Renate
Human papillomavirus (HPV) is associated with cancer of the cervix uteri, penis, vulva, vagina, anus and oropharynx. However, the role of HPV infection in urological tumors is not yet clarified. HPV appears not to play a major causative role in renal and testicular carcinogenesis. However, HPV infection should be kept in mind regarding cases of prostate cancer, as well as in a sub-group of patients with bladder cancer with squamous differentiation. Concerning the role of HPV in penile cancer incidence, it is a recognized risk factor proven in a large number of studies. This short review provides an update regarding recent literature on HPV in urological malignancies, thereby, also discussing possible limitations on HPV detection in urological cancer.
Szczerbal, I; Nizanski, W; Dzimira, S; Nowacka-Woszuk, J; Ochota, M; Switonski, M
An infertile Siamese female cat was subjected for clinical, histological, cytogenetic and molecular studies due to ambiguous external genitalia (vulva, vagina, rudimentary penis and scrotum-like structure) and masculine behaviour. An elevated oestrogen activity and a detectable level of testosterone were found. The cat underwent laparotomy. The gonads and the uterus were removed and subjected for histological studies, which showed ovaries with corpora lutea and a some primordial follicles. Chromosome studies of lymphocyte and fibroblast cultures, with the use of Giemsa staining, G-banding and whole X chromosome painting by fluorescence in situ hybridization, revealed pure X monosomy. Molecular analysis showed the absence of the SRY gene. Our study revealed for the first time that X monosomy in cats may be associated with virilization, in spite of the lack of the SRY gene.
Kovács, Gábor; Prazsák, István; Eichardt, János; Vári, Gábor; Gyurkovics, Henrik
Abstract According to the most recent taxonomic literature, three species of the genus Eresus are known in Central Europe, Eresus kollari, Eresus sandaliatus and Eresus moravicus. We recognized a fourth distinctive species from Hungary, which is described as Eresus hermani sp. n. Eresus hermani has an early spring copulation period, females have a light grey (grizzled) cephalothorax due to a heavy cover of lightly colored setae, and an epigyne with large flat areas posterior to the epigynal pit, while males are distinguished by a broad and blunt terminal tooth of the conductor. An updated and modified comparative table of Řezáč et al. (2008) to include all four Central European Eresus species, and a simple key to the species group’s species are given. Habitus, epigyne, vulva and conductor of Eresus kollari, Eresus moravicus and Eresus sandaliatus are also illustrated. An annotated list of papers illustrating Eresus hermani due to misidentifications is presented. PMID:25901112