Intrathyroidal Thymoma: A Diagnostic Challenge.

Intrathyroidal thymoma is a rare tumor that can be challenging to diagnose due to its unusual location and resemblance to more common thyroid conditions. We present the case of a 58-year-old woman with an incidentally discovered thyroid nodule during evaluation for an upper respiratory infection. Ultrasonography revealed an exophytic nodule in the left thyroid lobe, categorized as TR 3. Fine-needle aspiration cytology suggested a neoplastic process, leading to a left hemithyroidectomy. Histopathology confirmed a diagnosis of intrathyroidal thymoma, Type B2, with extensive necrosis, and immunohistochemistry validated the findings. This case underscores the diagnostic challenges of intrathyroidal thymoma, emphasizing its consideration in the differential diagnosis of atypical thyroid nodules. Despite the difficulties in preoperative identification, surgical resection and subsequent histopathological examination remain essential for a definitive diagnosis. The patient is currently under surveillance, and there is no evidence of residual thymic tissue or abnormalities in the remaining thyroid tissue.

Computed tomography features and surgical treatment of wandering spleen torsion: A case report.

Wandering spleen is a rare clinical entity characterized by the laxity, absence, or abnormal attachment of splenic supporting ligaments leading to hypermobility and abnormal positioning of the spleen in the abdominal cavity. The abnormally increased mobility of the spleen predisposes it to torsion and infarction. Authors present a case of wandering spleen complicated to torsion and infarct in a middle aged lady. The patient presented with acute abdominal pain, diagnosed by abdominal computed tomography and underwent surgery and splenectomy.

Ectopic urethral opening in herlyn-werner-wunderlich syndrome: A rare finding.

Recorded findings of Herlyn-Werner-Wunderlich Syndrome (HWWS) remain sparse due to low statistical incidence. Ours is also the first known case to present with an ectopic urethral opening, an even rarer complication. A 27-year-old nulliparous woman presented with complaints of cyclical hematuria, and burning micturition with intermittent episodes of urinary retention suprapubic and pelvic pain. After extensive radiological examination, the MRI findings concluded the presence of a uterine didelphys with 2 cervixes and vaginal duplication marked by the compression of the left hemivagina and dilation of the right hemivagina, pointing towards HWWS. The case strongly suggests that the presence of an ectopic urethral opening may be the cause of urinary incontinence and discomfort in an otherwise asymptomatic patient of HWWS.

Hyperthyroidism in thyroid carcinoma originating in struma ovarii.

Summary: Thyroid carcinoma originating in Struma Ovarii (SO) is a rare thyroid ectopic cancer that accounts for 0.01% of all ovarian malignancies and is associated with hyperthyroidism in less than 15% of cases. In a 44-year-old patient with pelvic pain, the CT scan revealed a solid-cystic formation in the ovarium. A left oophorectomy was performed and showed a borderline serous tumor and papillary thyroid carcinoma ('thyroid carcinoma originating in Struma Ovarii') measuring 10 cm. Thyroid function was assessed, and hyperthyroidism was diagnosed. Surgical complementation and a pelvic re-approach were performed. The histological findings showed a papillary thyroid carcinoma in the uterine serosa and the right adnexa. Thyroid function was re-evaluated, and despite normal thyroid function, the TRAb test remained positive. The patient underwent total thyroidectomy and radioiodine therapy (RIT), after which the TRAb test became negative. During 3 years of follow-up, no evidence of tumor was observed. In our case of thyroid carcinoma originating in SO, hyperthyroidism was treated with ovarian surgery, total thyroidectomy, and RIT. It is worth noting that thyroid function was normalized after ovarian surgery, but the TRAb test only became negative after total thyroidectomy. We hope to draw attention to the importance of evaluating thyroid function in patients with SO and treating high-risk SO patients with RIT after total thyroidectomy to achieve disease remission. Learning points: Struma ovarii can cause hyperthyroidism. Thyroid carcinoma can originate in Struma Ovarii. Differentiated thyroid carcinoma and hyperthyroidism originating in Struma Ovarii are rare conditions.

Tubal ectopic pregnancy: comparative management between pre and Covid-19 pandemic periods.

Objective: To evaluate whether there were differences in the presentation of patients with tubal ectopic pregnancy (EP) during the first year of the COVID-19 pandemic. Methods: We performed a retrospective cohort study of all cases of tubal EP between March 2019 and March 2020 (pre-pandemic) and between March 2020 and March 2021 (pandemic). We compared between these two groups the risk factors, clinical characteristics, laboratory data, sonographic aspects, treatment applied and complications. Results: We had 150 EP diagnoses during the two years studied, of which 135 were tubal EP. Of these, 65 were included in the pre-pandemic and 70 in the pandemic period. The prevalence of lower abdominal pain was significantly higher in the pandemic compared to the pre-pandemic period (91.4% vs. 78.1%, p=0.031). There was no significant difference in shock index, initial beta-hCG level, hemoglobin level at diagnosis, days of menstrual delay, aspect of the adnexal mass, amount of free fluid on ultrasound, and intact or ruptured presentation between the groups. Expectant management was significantly higher during the pandemic period (40.0% vs. 18.5%, p=0.008), surgical management was lower during the pandemic period (47.1% vs. 67.7%, p=0.023), and number of days hospitalized was lower in the pandemic period (1.3 vs. 2.0 days, p=0.003). Conclusion: We did not observe a significant difference in patient history, laboratory and ultrasound characteristics. Abdominal pain was more common during the pandemic period. Regarding treatment, we observed a significant increase in expectant and a decrease in surgical cases during the pandemic period.

The Effectiveness of Letrozole Alone or in Combination with Methotrexate in the Management of Ectopic Pregnancy, A Systematic Review and Meta-Analysis.

This systematic review and meta-analysis aimed to investigate the effect of letrozole alone or in combination with Methotrexate on the management of ectopic pregnancy. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were applied for reporting. The EMBASE, PubMed, Scopus, and Web of Science databases were searched for relevant studies focused on women diagnosed with ectopic pregnancy and managed non-surgically with letrozole alone or in combination with methotrexate (MTX) until April 2024. The success rate, laboratory findings, and complications were analyzed and reported. Meta-analysis was done using RevMan 5.4.1 software. Out of 129 unique studies obtained, 7 of them were found eligible for final review; of which, 3 were nonrandomized prospective cohort studies, 2 were randomized clinical trials, and 2 study were case studies. In 5 studies letrozole was used as monotherapy. While in another study letrozole was used with MTX. The meta-analysis showed a significantly lower level of ß-HCG in the letrozole group compared to MTX, 7 days after initiation of treatment (Fixed effect model, MD = -92.22, 95%CI: [-159.39, -25.04], P = 0.007, I2 = 0%). There was no significant difference in the level of anti-mullerian hormone (AMH) between groups (Fixed effect model, MD = 0.18, 95%CI: [-0.09, 0.45], P = 0.20, I2 = 0%). Success rate, platelet count, and level of liver enzymes seemed to be better or similar among patients receiving Letrozole compared to patients receiving Methotrexate. Letrozole exhibits potential as a therapeutic option for ectopic pregnancies; however, further randomized clinical trials are necessary to establish strong evidence.

Primi at 16 weeks and 5 days of Gestation with Hypovolemic Shock Secondary to Ruptured Rudimentary Horn Ectopic Pregnancy: A Case Report.

ABSTRACT: Developmental anomalies of genital tract result from defective fusion and absorption of various parts of Mullerian ducts in fetal life. Rudimentary horn pregnancy (RHP) is a rare occurrence of one in 76,000 and one in 160,000. We present a case of a 24-year-old primigravida with ruptured RHP initially managed in the line of an intrauterine pregnancy with severe anemia. Hemodynamic instability made us suspect ruptured RHP and lifesaving laparotomy was performed for the same. A 1.5-liter hemoperitoneum was encountered with a right RHP. Multiple adhesions were present with necrotic tissue adherent and clumped together as tubo-ovarian mass. Resection of rudimentary horn was performed. We report this case to emphasize the need to consider rare uterine anomalies as a possibility in patients presenting with acute abdomen in early pregnancy. So, Obstetricians can consider these rare entities in differential diagnosis and management.

Diagnostic and management challenges of a rare case of caesarean scar pregnancy in a low-resource setting: a case report.

Caesarean scar pregnancy is a rare type of ectopic pregnancy with the potential for catastrophic outcomes. A high index of suspicion is required for prompt diagnosis and intervention to improve outcomes. This report describes a rare case of Caesarean scar pregnancy, which was initially misdiagnosed as a threatened miscarriage and cervical ectopic pregnancy. A 35-year-old multiparous lady with two previous caesarean sections presented to the Gynaecology Unit of the Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nigeria, at an estimated gestational age of 10 weeks, with recurrent vaginal bleeding of eight weeks' duration. She was referred to our facility from a private hospital, where she had first been managed as a case of threatened miscarriage and later as a cervical ectopic pregnancy. The transvaginal ultrasound in our facility was in keeping with a viable Caesarean scar pregnancy. The urine pregnancy test was positive, and the quantitative serum beta human chorionic gonadotropin was 75.6 mIU/ml. She had initial medical treatment with a combination of systemic multidose and intrauterine sac methotrexate and, subsequently, hysterotomy. Following systemic and local methotrexate, there was the demise of the foetus, which was evacuated at hysterotomy, and the uterine scar defect was repaired. She was discharged home in stable clinical condition one week after surgery. Her serum beta human chorionic gonadotropin dropped to 51.6 mIU/mL two weeks post-hysterotomy, and her urine pregnancy test became negative three weeks later. Though rare, caesarean scar pregnancy should be considered a differential diagnosis in reproductive-aged women with a previous caesarean section who present with vaginal bleeding in the first trimester.

Bilateral Tubal Ectopic Pregnancy: A Case Report and Review.

A bilateral ectopic pregnancy is a rare condition, and even more so with spontaneous conception. The known risk factors and clinical presentation are shared by both unilateral and bilateral ectopic pregnancy. This poses a risk for misdiagnosis, treatment failure, and, ultimately, maternal mortality. The current standard for diagnostics is not discernible for a bilateral ectopic pregnancy, thus, medical management tends to be sub-therapeutic. In fact, it is fairly common for the correct diagnosis and efficient treatment to be achieved by surgical intervention. As there are no established diagnostic or treatment guidelines for this rare condition, the possibility of a bilateral ectopic pregnancy should not be ruled out lightly.

Pancreatic Heterotopia Presenting as a Mimic of Fistulizing Crohn's Disease: Expanding the Differential Diagnosis of Inflammatory Bowel Disease.

Pancreatic heterotopia (PH) involves pancreatic tissue located outside its typical anatomical position, lacking vascular or ductal communication with the pancreas. Despite frequently having acini with the capacity to produce digestive enzymes, PH is usually asymptomatic. When symptoms do occur, they typically present in middle to late adulthood and include abdominal pain, nausea, and diarrhea. This clinical presentation is similar to that of Crohn's disease, an autoimmune inflammatory bowel disease (IBD). The presentation of symptomatic PH varies depending on the location of the ectopic pancreatic tissue and its microanatomical constituents, including exocrine and endocrine tissue as well as a duct system. We present a case of a patient who came to medical attention with abdominal pain and was found on colonoscopy to have a non-obstructing stricture of the transverse colon without an associated mass. Biopsies of the area revealed chronic active colitis, leading to a diagnosis of Crohn's disease. Her gastroenterological symptoms remained stable for several years while receiving infliximab infusions until she presented to the emergency department with severe abdominal pain, diarrhea, and sepsis, meeting the criteria for systemic inflammatory response syndrome. Imaging studies revealed a fistula between the previous colonic stricture and the jejunum, again attributed to Crohn's disease. She underwent surgery to remove the fistula between the small and large bowels. Unexpectedly, the resection specimen showed a mass insinuated between the loops of the large intestine, which histological review revealed to be ectopic pancreatic tissue. Following the resection of the ectopic pancreatic tissue, her symptoms resolved without the need for further treatment. In retrospect, the ectopic pancreatic tissue, which contained acini with digestive enzymes, ducts, and islets, may have also caused seemingly unrelated pathology in the patient. Symptomatic PH should be recognized as a pathology that can mimic IBD, prompting reconsideration of the diagnosis in cases of refractory disease while on biologics.

INVESTIGATION THE EXPRESSION LEVELS OF MIR-181 AND HOXA11 GENE IN EUTOPIC AND ECTOPIC ENDOMETRIAL TISSUE.

Objectives: The exact pathogenesis of the endometriosis is not apparent. MicroRNAs (miRNAs/miRs) are non-coding RNAs that regulate gene expression at the post-transcriptional level. MicroRNAs can be used a diagnostic and therapeutic tools in different disorders such as endometriosis. MiR-181 has a function in embryo implantation. The main aim of this study is to evaluate the expression of miR-181 and its relationship with HOXA11 gene expression in ectopic and eutopic endometrium tissues in women with endometriosis. Study design: Thirty-four women participated in this study. Ectopic tissue samples (N=17) were collected via laparoscopic surgery, and eutopic tissue samples (N=17) were obtained from an endometrial biopsy. Endometrial tissue samples without endometriosis were considered the control group. Tissue samples were placed in RNase-free microtube with RNAlater™ Stabilization Solution (Thermo Fisher Scientific) and were kept at -80 °C. Quantitative real time-PCR for MiR-181 and HOXA11 genes were performed. Results: MiR-181 expression level increased in eutopic tissue samples compared to the control group. This expression showed a significantly decrease in an ectopic group compared to the eutopic group. It was observed that HOXA11expression decreased remarkably in eutopic group compared to the control group and increased in ectopic group compared to the eutopic group. Conclusion: MiR-181 and HOXA11 are promising strategies in endometriosis disease. Understanding this relation and regulation roles contribute to realizing the etiology of endometriosis.

A Rare Case of Diaphragmatic Rupture Due to Ectopic Pregnancy Leading to Haemorrhagic Shock in a Multipara: A Case Report.

Abdominal pregnancy is a rare and life-threatening form of ectopic pregnancy. Although the underlying mechanism of this abnormal disorder is unknown, a number of risk factors have been identified, including pelvic inflammatory disease, history of pelvic surgery, intrauterine device use and previous ectopic pregnancy. Diaphragmatic rupture due to ectopic pregnancy is a rare and life-threatening condition that can lead to massive intraperitoneal haemorrhage and haemorrhagic shock. This report presents the case of a 21-year-old woman who presented with 7 weeks and 4 days of amenorrhoea and 14 hours of acute abdominal pain. On examination, she was in haemorrhagic shock with signs of acute abdomen. Emergency exploratory laparotomy revealed a haemoperitoneum of 1500 mL and active bleeding from a 3×2 cm rupture in the right hemidiaphragm. Haemostasis was achieved and the patient recovered well post-operatively. This case highlights the importance of considering diaphragmatic rupture in the differential diagnosis of acute abdomen and haemorrhagic shock, especially in patients with ectopic pregnancy.

Cerebellopontine angle craniopharyngioma in familial adenomatous polyposis.

Background: Craniopharyngiomas are benign tumors arising in the sellar and suprasellar regions. Although ectopic tumors do occur, it is usually due to local spread or recurrent tumors. Purely ectopic cerebellopontine angle (CPA) or 4th ventricle tumors are extremely rare and have been found to be significantly associated with familial adenomatous polyposis (FAP), a genetic disorder. Case Description: Only four cases of ectopic CPA craniopharyngioma associated with FAP have been reported to date. Here, we present the 5th case of ectopic CPA craniopharyngioma on a background of FAP. The previously described cases have been elaborated as well. Conclusion: CPA tumor with a background of FAP should raise a differential diagnosis of craniopharyngioma, and similarly, a CPA primary ectopic craniopharyngioma may raise suspicion of underlying APC gene mutation.

Outcome and treatment of cesarean scar ectopic pregnancy under ultrasound-guided vacuum aspiration.

OBJECTIVE: This study aimed to describe cases of cesarean scar pregnancies that were successfully treated with suction curettage under ultrasound guidance and their outcome. METHODS: This retrospective, descriptive case-series study was performed on 17 patients diagnosed with cesarean scar ectopic pregnancy in Sulaimani Maternity Teaching Hospital from May 2022 to April 2023. The patients' sociodemographic and clinical data were collected. The patients were treated with suction curettage alone or in combination with local injection of methotrexate under ultrasound guidance. RESULTS: Patients with a viable fetus (n = 4) received local intrinsic methotrexate injection into the gestational sac and suction curettage, while those in whom the fetus had died (n = 13) underwent only suction curettage. Five patients required intrauterine balloon insertion to stop bleeding without further treatment, and only three required a blood transfusion owing to severe bleeding. CONCLUSIONS: Cesarean scar ectopic pregnancy is a dangerous and complex disorder with an increasing occurrence in recent years. Accurate early diagnosis and effective management are essential to reduce maternal mortality and mortality of this type of pregnancy.

Endometriotic lesions and their recurrence: A Study on the mediators of immunoregulatory (TGF-ß/miR-20a) and stemness (NANOG/miR-145).

Endometriosis is a common estrogen-dependent disease that involves various cellular processes. Additionally, miRNAs play a crucial role in the development of the disease as an important component of the microenvironment. In this study, tissue specimens of eutopic and ectopic lesions of 20 women, whose endometriosis was later approved by the pathology laboratory, were biopsied through laparoscopy. As a control group, endometrial tissue specimens were collected from 20 women who underwent curettage for reasons unrelated to endometriosis. The expression levels of miR-20A and miR-145 and their target genes, TGF-ß and NANOG, were measured in these samples as markers of stemness and immunomodulatory properties, respectively. The study also aimed to compare the expression levels of target genes and miRNAs in ectopic lesions regarding endometriosis recurrence post-surgery. The study revealed that the expression of TGF-ß and NANOG genes was significantly upregulated in endometriotic tissues compared to the control group. There was also a notable increase in miR-20A and miR-145 expression in the endometriotic tissues compared to the control group. While there was no significant correlation between the expression of miR-20a and TGF-ß, we observed a negative correlation between the expression level of miR-145 and NANOG. Additionally, the ROC curve analysis emphasized miR-14 as a potential biomarker for endometriosis over miR-20a. However, our findings on disease recurrence underscore the importance of miR-20a in the early detection of endometriosis recurrence.

Effects of straws on greenhouse gas emissions in the ectopic fermentation system.

Straws are commonly used padding materials in the ectopic fermentation system, but their effects on greenhouse gas emissions are not well understood. This study compared the effects of rape, rice and corn straws on the fermentation performance of the ectopic fermentation system. Compared with corn straw, the treatment groups with rape straw and rice straw significantly increased the alpha diversity of the fermentation system, and simultaneously mitigated the cumulative emissions of CO2 and N2O by up to 32.4% and 93.9%, respectively. The CO2 and N2O peak emission in the treatment group with corn straw reached 1.4 × 106 and 36.2 mg/m2/d, respectively. CH4 peak emission was one order of magnitude lower than that of N2O in the ectopic fermentation system. Redundancy analysis showed that Pseudoxanthomonas sp000510725 was the key specie that positively affect the fermentation temperature, CO2 and N2O emissions in the fermentation system. Nitrogen metabolism genes, such as nosZ, nirK, and nirS were more abundant in the surface layer of the fermentation system, indicating more active nitrogen metabolism in this region, and the core zone could be the primary source of N2O emissions. Those findings indicated that rape and rice straw can be potential padding materials for mitigating greenhouse gas emissions in large-scale ectopic fermentation system.

Hepatic ectopic pregnancy with hemorrhage secondary diaphragmatic adhesion: A case report.

BACKGROUND: Primary abdominal pregnancy is an extremely rare form of ectopic pregnancy. Ectopic pregnancies that occur in the liver and diaphragm are even rarer, limited case reports are available in the literature. CASE SUMMARY: A woman of childbearing age was transferred to the emergency department due to lumbar and abdominal pain radiating to the back toward the lower right. After a series of physical and auxiliary examinations, she was clinically diagnosed with hepatic ectopic pregnancy. Laparoscopic surgery was performed to remove the pregnancy tissue and achieve hemostasis. After a period of follow-up, the patient was successfully cured. CONCLUSION: Paying attention to the patient's signs and utilizing imaging examination methods can help avoid missed diagnoses of liver pregnancy.

Beyond Epistaxis: A Rare Case of Ectopic Sinonasal Adamantinomatous Craniopharyngioma.

Adamantinomatous craniopharyngioma (ACP) is one of the two types of craniopharyngioma recognized by the World Health Organization (WHO), the other being papillary craniopharyngioma (PCP). These rare, benign tumours of the pituitary region are classified as Grade 1 central nervous system (CNS) tumours. ACP predominantly affects adolescents aged 5-15 years and adults over 50 years. It is usually located in the sellar and suprasellar regions. We present the case of an 18-year-old Malaysian female with a six-year history of persistent epistaxis and progressive nasal obstruction, an atypical presentation of ACP. This report highlights an entirely ectopic location of ACP in the sinonasal region. The tumour encompassed the left nasal cavity, the left anterior and posterior ethmoid sinuses, and the bilateral frontal sinuses. The unusual presentation of this tumour was detected with the aid of CT and MRI and confirmed by histopathological examination. In this case report, we discuss a rare presentation, an unusual location, and the strategies employed to overcome these challenges.

Abdominal Ectopic Pregnancy: A Case Report of an Uncommon Complication of Pregnancy Without Prenatal Care.

Ectopic pregnancy (EP) is a life-threatening condition requiring a high clinical suspicion. This diagnosis must be considered in all female patients of reproductive age presenting with abdominal pain or discomfort who may possibly be pregnant. Ectopic pregnancies occur in a small percentage of all pregnancies and are a significant cause of maternal morbidity and mortality. Abdominal ectopic pregnancy (AEP) is a rare and potentially fatal form of ectopic pregnancy where the implantation occurs in the abdominal cavity. We present the following case of a 23-year-old female who was transferred following an initial workup for abdominal pain and subsequently found to have an abdominal ectopic pregnancy at 37 weeks gestation. After transferring to our emergency department, the patient continued to have abdominal pain and her presenting FAST exam was positive for free fluid concerning for active hemorrhage and hematoma. Her clinical presentation was consistent with ruptured abdominal ectopic pregnancy, and she was taken to the operating room for emergent exploratory laparotomy and delivery. Her clinical course was complicated by adherent placenta and re-bleeding with significant hemoperitoneum requiring re-entry laparotomy and transfusion. We present the details of this case along with the diagnostic imaging and management of the rarely seen and life-threatening condition of secondary abdominal ectopic pregnancy (AEP).

Multimodal management of ectopic hepatic pregnancy: a systematic review of the literature.

PURPOSE: Ectopic pregnancies with implantation in the upper abdomen are exceptionally rare. Here we provide a systematic review of hepatic ectopic pregnancies and the corresponding management strategies. Furthermore, this report details a case of ectopic hepatic pregnancy, successfully treated with primary methotrexate (MTX) followed by a two-staged robotic-assisted resection. METHODS: Two independent investigators performed a systematic review using the online search engine PubMed and MEDLINE database. The search utilized the following terms: 'Hepatic Ectopic Pregnancy,' 'Hepatic Extrauterine Pregnancy,' 'Hepatic Abdominal Pregnancy,' and 'Ectopic Liver Pregnancy.' Cross-referencing was employed to identify possible additional publications. FINDINGS: Forty-seven case reports on hepatic pregnancies were identified. Of these, 40 provided manuscripts in the English language. Most patients with hepatic pregnancy presented with mild to moderate abdominal pain, while only a minority exhibited signs of hemodynamically relevant intraperitoneal hemorrhage. Most cases were managed through open surgical removal, although in recent years, there has been an increase in laparoscopically managed cases. Conservative approaches using methotrexate are seldom employed. CONCLUSION: Hepatic pregnancies present a rare and challenging clinical scenario. Until now, these cases have usually been treated primarily with open explorative surgery. As reported in this case, primary conservative treatment approaches with MTX before surgery hold promise as a strategy to reduce surgery-related bleeding and morbidity, particularly for asymptomatic or oligosymptomatic patients.