Gastric schwannomas (GS) are rare mesenchymal tumors from Schwann cells in the gastrointestinal (GI) tract, representing 2-6% of such tumors. We report a 52-year-old woman who experienced abdominal pain, hematemesis, and melena, initially suspected of having a GI stromal tumor through ultrasound and computed tomography abdomen. Despite no active bleeding found during an upper endoscopy, she underwent a successful open subtotal gastrectomy, with histopathology confirming GS. The diagnosis of GS, which may mimic other GI conditions, relies heavily on imaging and histopathological analysis due to its nonspecific symptomatology, including the potential for both upper and lower GI bleeding. This case underscores the diagnostic challenges of GS and highlights surgical resection as the preferred treatment, generally leading to a favorable prognosis.
INTRODUCTION: Neuroendocrine tumors (NETs) of the appendix are rare and are often discovered incidentally during surgery for acute appendicitis or other unrelated conditions (Modlin et al. in Gastroenterology 128:1717-1751, 2005, Alsaad et al. in Oncol Rep 16:1105-1109, 2006, Frilling et al. in Lancet Oncol 15:e8-e21, 2014). These tumors can range from asymptomatic incidental findings to clinically significant tumors with metastases (Alsaad et al. in Oncol Rep 16:1105-1109, 2006, Gomes et al. in World J Emerg Surg 10:60, 2015, Paiva et al. in Eur J Cancer 38:702-705, 2002, Burke et al. in Am J Surg Pathol. 9:661-674, 1985). This case report presents a rare case of a NET of the appendix presenting as acute appendicitis. CASE DESCRIPTION: A 23-year-old male presented with right lower quadrant abdominal pain, nausea, and vomiting for 2 days. A CT scan revealed a mucocoele of the appendix. The patient underwent laparoscopic appendectomy, and the appendix was sent for histopathological examination. The final pathological report confirmed a NET of the appendix with a Ki-67 index of 1% and no lymphovascular invasion. Due to tumor invasion to the cecum and its large size (3-4 cm), the patient underwent right hemicolectomy. The final histopathology report of the resected specimen confirmed the diagnosis of NET of the appendix. DISCUSSION: The clinical diagnosis of NETs of the appendix can be challenging due to their rarity and non-specific presentation. Symptoms of NETs of the appendix can mimic those of acute appendicitis, making it difficult to differentiate between the two conditions. Imaging studies, such as CT scans, can provide valuable information about the size and location of the tumor (Gomes et al. in World J Emerg Surg 10:60, 2015, Maggard et al. in Ann Surg 240:117-122, 2004, Burke et al. in Am J Surg Pathol. 9:661-674, 1985, Frilling et al. in Lancet Oncol 15:e8-e21, 2014). However, the definitive diagnosis is made through histopathological examination of the resected specimen. The treatment of NETs of the appendix depends on factors such as the size, location, and grade of the tumor. Small tumors confined to the appendix with no lymph-vascular invasion can be treated with appendectomy alone, while larger tumors or those that have spread beyond the appendix may require more extensive surgery, such as right hemicolectomy (Gomes et al. in World J Emerg Surg 10:60, 2015, Mestier et al. in Dig Liver Dis 52:899-911, 2020, Maggard et al. in Ann Surg 240:117-122, 2004, Burke et al. in Am J Surg Pathol. 9:661-674, 1985, Frilling et al. in Lancet Oncol 15:e8-e21, 2014, Pavel et al. in Neuroendocrinology 103:172-185, 2016). In some cases, additional treatments such as chemotherapy or radiation therapy may be recommended. CONCLUSION: This case report emphasizes the importance of considering NETs of the appendix in the differential diagnosis of acute appendicitis. Imaging studies can provide valuable information, but the definitive diagnosis is made through histopathological examination. The treatment approach for NETs of the appendix depends on various factors and requires a multidisciplinary approach for optimal management.
Undifferentiated carcinoma with osteoclast-like giant cells (UC-OGC) is a rare tumor type of pancreatic cancer. Paraneoplastic syndromes, an idiopathic inflammatory myositis characterized by various skin manifestations (such as dermatomyositis (DM)), cannot be attributed to the primary tumor itself. Here, we report an unusual case of UC-OGC presenting as a paraneoplastic syndrome, the first reported from Saudi Arabia and the Arabian Gulf states. A 49-year-old Eritrean woman with known DM was referred to our hospital with a left-sided pleural effusion. Computed tomography of the abdomen revealed a large necrotic splenic mass (~17 × 12.9 × 18.2 cm). The patient underwent exploratory laparotomy with en bloc resection of the mass (splenectomy, distal pancreatectomy, and partial excision of the left hemidiaphragm). Following a histopathological examination of the mass, UG-OGC of the pancreas, presenting as a paraneoplastic syndrome, was diagnosed. To our knowledge, this case is the first to present a paraneoplastic syndrome associated with UC-OGC. The identification of an exceedingly rare tumor presenting atypically as a paraneoplastic syndrome shows the importance of conducting comprehensive examinations of patients with malignancies, emphasizing the need for more reports of similar cases.
Appendicular diverticulitis (AD) is a rare entity characterized by the inflammation of the arising diverticulum of the appendix. It has been reported to carry a high risk of perioperative complications, such as bleeding and perforation. Furthermore, multiple articles have highlighted the importance of diagnosing AD early due to its strong association with malignancies. Limited published cases concerning AD in our country and globally are available in the literature. Hence, we present in this article a case series of five exciting cases of incidental findings of AD that were initially diagnosed as acute appendicitis based on clinical evaluation and imaging findings. In our series, we performed a retrograde evaluation of the computed tomography scans of all five cases that showed diverticula. In conclusion, histopathological evaluation remains the method of choice to reach the definitive diagnosis; however, it is essential to highlight the relevance of imaging in diagnosing AD preoperatively in the early stages to reduce morbidity and mortality.
A penetrating injury to the thoracic aorta is an extremely rare, life-threatening condition, with a high overall mortality rate. The incidence of a penetrating injury to the aortic arch is unknown because the majority of patients die before receiving adequate treatment due to excessive bleeding. Through a literature review, 23 cases of favorable outcomes were found. We report the first case from the Arab Gulf states. We present the extremely rare case of a 23-year-old male who presented to the emergency department with stable hemodynamics after being stabbed in the left supraclavicular region. The investigation revealed that he suffered from aortic arch transection and contrast extravasation. The patient was rushed to the operating room, where a primary repair was performed through a median sternotomy approach. The patient was discharged on the 14th postoperative day without complications. Penetrating chest trauma (aortic arch injury) is uncommon, and it is typically fatal at the scene or time of injury, even in patients who arrive at the emergency department alive or while undergoing surgery. CT aortography should be performed on patients with normal vital signs but abnormal clinical findings suggestive of a vascular injury. For injuries of types II to IV without concomitant injuries, immediate surgical repair is recommended. Aortic arch penetrating injuries continue to be extremely lethal. Emergency surgical repair remains the standard of care and is associated with high morbidity and mortality rates. However, managing such uncommon injuries remains a formidable challenge. We encourage additional studies.
BACKGROUND: The aims of this study were to create a method for estimation of dental age in Saudi children and adolescents based on the Willems model developed using the Belgian Caucasian (BC) reference data and to compare the ability of the two models to predict age in Saudi children. METHODS: Development of the seven lower left permanent mandibular teeth was staged in 1146 panoramic radiographs from healthy Saudi children (605 male, 541 female) without missing permanent teeth and without all permanent teeth fully developed (except third molars). The data were used to validate the Willems BC model and to construct a Saudi Arabian-specific (Willems SA) model. The mean error, mean absolute error, and root mean square error obtained from both validations were compared to quantify the variance in errors in the sample. RESULTS: The overall mean error for the Willems SA method was 0.023 years (standard deviation, ± 0.55), indicating no systematic underestimation or overestimation of age. For girls, the error using the Willems SA method was significantly lower but still negligible at 0.06 years. A small but statistically significant difference in total mean absolute error (11 days) was found between the Willems BC and Willems SA models when the data were compared independent of sex. The overall mean absolute error for girls was slightly lower for the Willems BC method than for the Willems SA method (1.33 years vs. 1.37 years). CONCLUSIONS: The difference in ability to predict dental age between the Willems BC and Willems SA methods is very small, indicating that the data from the BC population can be used as a reference in the Saudi population.
Age Determination by Teeth , Tooth , Adolescent , Belgium , Child , Female , Humans , Male , Molar, Third , Radiography, Panoramic , Saudi Arabia
BACKGROUND: Malocclusion is a deviation from an anatomical norm that occurs in various populations. Evidence shows that it has physical and psychological implications as well as an influence on the patient's oral health-related quality of life (OHRQoL). Self-perception of oral health plays an important role in the understanding of malocclusion's influence on the quality of life. Malocclusion has been reported to impair a patient's function, appearance, interpersonal relationships and psychological well-being. OBJECTIVES: The aim of this study was to investigate whether adolescents aged between 11 and 18 years with malocclusion are at increased risk for having a high level of OHRQoL compared with those without malocclusion. SEARCH METHODS: The Ovid Medline, Embase and Scopus databases were used to identify studies measuring the association between malocclusion and HRQoL. SELECTION CRITERIA: Only cross-sectional studies were included, and the following inclusion criteria were used: subjects were systemically healthy; data were available for untreated malocclusion and OHRQoL; malocclusion was measured by Dental Aesthetic Index and Index of Orthodontic Treatment Needs; OHRQoL was assessed by Child Perception Questionnaire, Child Oral Health Impact Profile and Child Oral Health Impact Profile; and the paper was published in English. DATA COLLECTION AND ANALYSIS: Data were extracted by two independent reviewers. The Appraisal tool for Cross-Sectional Studies (AXIS) was used to establish the risk of bias, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) evidence quality assessment tool was used to assess the impact of malocclusion on adolescents across studies. RESULTS: The initial search yielded 530 papers. Eleven cross-sectional studies were included in the meta-analyses, and all data describing the relationship between malocclusion and OHRQoL were gathered via a structured questionnaire. Our results showed that malocclusion is linked to decreased OHRQoL in children and adolescents aged between 11 and 18 years in continuously analysed studies. However, in dichotomously analysed studies, it was shown that young people without malocclusion are linked to decreased OHRQoL. CONCLUSIONS: Adolescents with severe levels of malocclusion might have among the worst levels of OHRQoL. The effects of malocclusion on OHRQoL were influenced by the age of the adolescents as well as by their culture and environment. REGISTRATION: PROSPERO (CRD42020178657).
Malocclusion , Quality of Life , Adolescent , Child , Cross-Sectional Studies , Humans , Oral Health , Surveys and Questionnaires
AIM: The aim of the present study was to evaluate the bond integrity of bioactive cement (BAc) in contrast to conventional cement Calibra (C) after dentin treated with different surface conditioners (PDT, EYL, ECL) MATERIALS AND METHODS: Sixty non-carious permanent mandibular molars were disinfected and embedded in acrylic resin till cement-o-enamel junction. For homogeneity the buccal surface were grounded and polished. Samples were categorized into three main groups based on conditioning technique. Samples in group 1 and 2 dentin conditioned with Er,Cr:YSGG (ECL), group 3 and 4 surface treated with Er:YAG (EYL) and group 5 and 6 treated with photodynamic therapy (PDT).On conditioned surface bonding agent was applied and light cured. Samples from group 1,3,5 were bonded to Calibra (C). Whereas, specimens in group 2,4,6 were conditioned with bioactive cement (BAc) and subjected to ageing followed by shear bond strength testing (SBS) in universal testing machine. To detect significance difference between means of different groups analysis of variance (ANOVA) was performed followed by Tukey's post-hoc tests. RESULTS: The maximum SBS was displayed in group 1, dentin conditioned with ECL and bonded to C (20.23⯱â¯0.47â¯MPa). Whereas, group 6, PDT of dentin to BAc demonstrated lowest bond integrity among experimental groups (12.97⯱â¯0.25â¯MPa). Bond strength of group 1, ECL-C (21.55⯱â¯3.08â¯MPa) and group 3 EYL-C (19.11⯱â¯0.65â¯MPa) were comparable (pâ¯>â¯0.05). Group 5 samples treated with PDT, MB-C (13.41±0.32 MPa) and group 6, MB-BAc (12.97⯱â¯0.25â¯MPa) were also comparable (pâ¯>â¯0.05) CONCLUSION: BAc bonded to dentin after surface conditioning with ECL, EYL and PDT presented lower SBS in comparison to conventional cement C. Further studies are required to extrapolate the current findings.
Lasers, Solid-State , Photochemotherapy , Dentin , Materials Testing , Photochemotherapy/methods , Photosensitizing Agents/pharmacology
BACKGROUND: Blunt thoracic trauma can rarely result in coronary artery injury. Blunt trauma can result in occlusion of any of the coronary arteries or can lead to its rupture and bleeding. Traumatic coronary artery occlusion can lead to myocardial infarction, while its rupture and bleeding can result in hemopericardium and cardiac tamponade, and can be rapidly fatal. Survival after coronary artery rupture in blunt thoracic trauma is exceedingly rare. CASE PRESENTATION: We present a case of a young male who sustained a blunt thoracic trauma in a motor vehicle collision, that resulted in rupture of the left anterior descending (LAD) coronary artery and subsequent cardiac tamponade. Prompt surgical intervention with pericardiotomy and ligation of the artery has resulted in survival of the patient. CONCLUSIONS: In cases of traumatic coronary artery rupture, early surgical intervention is crucial to avoid mortality. Ligation of the injured coronary is a viable option in selected cases, and can be the most expeditious option in patients in extremis.
Cardiac Tamponade/surgery , Coronary Vessels/injuries , Coronary Vessels/surgery , Thoracic Injuries/complications , Wounds, Nonpenetrating/complications , Accidents, Traffic , Adult , Cardiac Tamponade/etiology , Humans , Ligation , Male , Pericardiectomy , Rupture
OBJECTIVES: This cross-sectional study was conducted to explore the specialty chosen by the dental students for postgraduate studies and the future aspirations of students in a Saudi Arabia dental college. MATERIALS AND METHODS: Of the total number of 120 questionnaires that were distributed, 107 subjects responded with selective responses and a response rate of 89%. A descriptive survey was conducted using one of the questionnaires among the students of dentistry at the dental college, Prince Sattam Bin Abdulaziz University, Al-Kharj among male students (men's college) for a period of 2 months. The data were analyzed using the statistical software program, predictive analytics software Statistics version 22.0 (SPSS Inc., Chicago, IL, USA). RESULTS: A hundred and seven of the 120 students took part in the study. A passion for orthodontics (42.9%) was reported to be the most important factor that influenced the decision to pursue specialty training in orthodontics followed by intellectual stimulation/challenge (25%). The decision to pursue orthodontics was made by 32.1% of the respondents while in dental school; 35.7% took the decision after completing dental school during private practice and 14.3% during a dental residency, whereas 3.6% had already decided before initiating their dental school studies. Working in a private practice environment was preferred by 11 residents (39.3%). Only four residents indicated that they would most likely be practicing in an academic setting while 10 were undecided. CONCLUSIONS: The zest for nonclinical specialties is less among students at Prince Sattam Bin Abdulaziz University's dental college, Saudi Arabia.
