RESUMEN
Giant bullous emphysema, also known as "vanishing lung syndrome", is a rare manifestation of chronic obstructive pulmonary disease (COPD) that is associated with high mortality. Cigarette smoking and alpha-1 antitrypsin deficiency (A1AD) are two main causes that result in permanent enlargement of airspaces, inefficient gas exchange, fibrosis of the airways, and collapse of the alveoli. A typical presentation can be found in a long-term smoker with dyspnea on exertion and progressive shortness of breath that may be associated with a productive cough. One of the clinical difficulties in diagnosing giant bullous emphysema is separating it from other etiologies like pneumothorax. It is paramount to differentiate giant bullous emphysema from pneumothorax as the management is completely different; both can, however, have similar clinical presentations and radiographic manifestations on initial assessment. In this report, we present the case of a 39-year-old African American male who presented with worsening shortness of breath and productive cough and was found to have bullous emphysema but was misdiagnosed and treated for pneumothorax in the initial encounter. The purpose of this case report is to raise awareness of this condition in the medical literature and discuss the similarity of bullous emphysema and pneumothorax in clinical presentation and radiographic findings, as well as the differences in treatment options.
RESUMEN
Lymphoma of the breast accounts for 0.4-0.5% of all breast-located cancers and is found in a similar fashion to breast cancers. Here we present a 74-year-old woman who presented for a biopsy of a breast mass found on a routine mammogram, which was found to be a primary breast lymphoma. According to current practice guidelines, medical therapy is favorable for the definitive management of primary breast lymphomas. However, biopsy specimen cytology found neoplastic cells positive for human germinal center-associated lymphoma, a nonspecific marker for various types of lymphomas. Without a definitive classification of lymphoma, optimal medical therapy could not be achieved. Therefore, a decision was made to undergo a lumpectomy of the mass, which yielded a specimen that was found pathologically favorable for diffuse large B-cell lymphoma. With this information, the patient was referred to follow-up oncology for adjuvant chemotherapy and radiotherapy.
RESUMEN
Secondary distal plasmacytoma that arise from multiple myeloma is a common hematological malignancy that manifests in later stages of the disease. These plasmacytomas are known to cause extensive systemic organ damage. When extramedullary plasmacytomas reach the gallbladder or biliary ducts, expansion can mimic acute acalculous cholecystitis or cholangiocarcinoma. We report a case of a 56-year-old female with a history of aggressive course IgA κ chain multiple myeloma who presented with right upper quadrant abdominal pain with nausea and vomiting for one week duration. Her laboratory panel revealed liver function tests consistent with gallbladder etiology. Abdominal ultrasound and CT showed no evidence of cholelithiasis precluding to acute acalculous cholecystitis. Initial medical management did not show any improvement. A robotic cholecystectomy was performed, and a pathology review of the specimen found a neoplastic stricture of the gallbladder fundus, the histological evaluation of which revealed plasmacytoid cells originating from her primary multiple myeloma diagnosis. The patient's condition declined following surgery, postoperative presentation included metastatic liver thrombosis mimicking cholangiocarcinoma and the patient later expired with palliative care.
