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INTRODUCTION AND IMPORTANCE: Colonic tuberculosis may masquerade colonic carcinoma. Also, intestinal tuberculosis may mimic colonic carcinoma, Crohn's disease, ulcerative colitis, etc. CASE PRESENTATION: A 40 years female was diagnosed with cervical carcinoma FIGO Stage IIB underwent chemo-radiotherapy. She was symptom-free for a few months and then she developed right-sided abdominal pain and abdominal fullness for 4 months. She underwent a colonoscopy that showed ulcerative growth and friable tissue in hepatic flexure of colon and histopathology and immunohistochemistry findings suggested non-Hodgkin's lymphoma or poorly differentiated carcinoma. Then right standard hemicolectomy was performed and histopathology showed tuberculosis. The patient received medications for tuberculosis and the patient improved. CLINICAL FINDINGS AND INVESTIGATIONS: Preoperatively suspected colonic carcinoma in developing countries (where the prevalence of tuberculosis is high) may sometimes come out as colonic tuberculosis in histopathology. The biopsy sample taken from colonoscopy was examined by histopathology, which showed nonspecific results, and the case was mistakenly thought of as colonic carcinoma preoperatively. INTERVENTIONS AND OUTCOMES: The case underwent right standard hemicolectomy and to the surprise, the excised specimen came out as tuberculosis. The patient received anti-tubercular drugs and the patient is symptomatically better. RELEVANCE AND IMPACT: Colonic tuberculosis can mimic colonic carcinoma. Histopathology will confirm colonic tuberculosis and response to anti-tuberculosis drugs will verify the diagnosis. Though a patient undergoing chemotherapy may develop lymphoma, colonoscopic biopsy may not be conclusive. In any symptomatic patient with colonic stricture, surgery is the treatment of choice.
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INTRODUCTION AND IMPORTANCE: Aneurysmal Subarachnoid hemorrhage (SAH) can be associated with various other conditions like Polycystic kidney disease, Ehler Danlos syndrome, Co-arctation of the aorta, etc. CASE PRESENTATION: Here we have reported a 21-year young lady with IgA nephropathy and aneurysmal SAH managed successfully. CLINICAL FINDINGS AND INVESTIGATIONS: The patient was a known case of IgA nephropathy diagnosed 18 months back from a kidney biopsy. She came to the emergency with a headache and vomiting for 2 weeks. Her initial headache was the worst she has had experienced and then the headache was continuous and not relieved by medications. Then she underwent a noncontrast CT scan of the head which showed Subarachnoid hemorrhage (SAH). INTERVENTIONS AND OUTCOMES: Left pterional craniotomy and microsurgical clipping of left ICA aneurysm performed. The patient was discharged without deficits. RELEVANCE AND IMPACT: Aneurysmal Subarachnoid hemorrhage(SAH) can be due to histopathological changes to the vessels following IgA nephropathy. These correlations could be studied further or else it could be only a mere coincidence.
RESUMO
INTRODUCTION AND IMPORTANCE: Choledochal cyst is an important risk factor for cholangiocarcinoma. Concomitant hilar cholangiocarcinoma with choledochal cyst with cholelithiasis is a rare finding. CASE PRESENTATION: A 52-year-old male presented with non-specific complaints of generalized weakness for 3 months. Transabdominal ultrasound showed dilated common bile duct with hyperechoic mass at hilar region; further evaluation with magnetic resonance cholangiopancreatography and contrast-enhanced computer tomography of abdomen and pelvis revealed concomitant intraductal hilar cholangiocarcinoma (Bismuth Corlette type 1) with Choledochal cyst (type IVa) with cholelithiasis. After optimization patient underwent left hepatectomy with common bile duct excision with cholecystectomy with Roux-en-Y hepaticojejunostomy. Histopathological examination confirmed it to be well-differentiated adenocarcinoma, intestinal type at the hilar confluence. CLINICAL DISCUSSION: An asymptomatic male patient with the concomitant finding of perihilar cholangiocarcinoma (Bismuth Corlette type I) with choledochal cyst type IVa with cholelithiasis is a rare finding. The patient was managed with surgical excision of the common bile duct with Roux-en-Y hepaticojejunostomy and cholecystectomy. Diagnostic evaluation should be proper not to miss or overlook such a synchronous lesion. CONCLUSION: Incidental finding of concomitant perihilar cholangiocarcinoma with the choledochal cyst is rare. Proper evaluation of the patient with CECT abdomen and pelvis and MRCP is necessary for the diagnosis. Proper surgical resection with adequate lymph node removal is important for surgical clearance.
