Multifocal Primary Pancreatic Adenocarcinoma With No Precursor Lesion: A Report of Two Cases.

The aim of this clinical case report is to highlight the unusual presentation of pancreatic malignancy in which multiple foci of primary adenocarcinoma involving the body and tail of the pancreas are associated with another primary pancreatic mass of adenocarcinoma in the pancreatic head with no precursor lesions in two cases. A retrospective medical chart review was performed at a tertiary hospital in Riyadh, Saudi Arabia, to identify cases with confirmed multifocal pancreatic adenocarcinoma. Data collected include clinical evaluations and laboratory and imaging results. Informed consent was waived. There was no evidence of multifocal cancer on imaging. The unexpected intraoperative findings and pathology report necessitated a total pancreatectomy for both cases. A negative imaging does not rule out a multifocal pancreatic adenocarcinoma. Such awareness may help in the early detection of pancreatic cancer. Moreover, the presence of more than one primary cancer in one organ is a distinctive phenomena that needs further study.

Hidden in the Rash: A Sneddon Syndrome Case Report.

This clinical case report aims to highlight the unusual presentation of Sneddon syndrome with a possible association with paroxysmal hemicrania. A medical record review was performed at a tertiary hospital in Riyadh, Saudi Arabia. Data collected include clinical evaluations and laboratory and imaging results. Informed consent was obtained. Hereby, we present a 27-year-old female who presented with multiple stroke attacks, along with severe headaches involving right retro-orbital pain with an eight-year history of spotted skin lesions. Initial unenhanced computed tomography (UCT) brain in the emergency showed left insular cortex hypodensity, revealing acute ischemic insult. Subsequent magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) revealed acute ischemic infarct in the territory of the left middle cerebral artery (MCA) involving the insula and frontoparietal lobe. Further investigations were done, including cerebrospinal fluid (CSF) analysis and autoimmune and infectious workup, which were unrevealing. Skin biopsy of the lesions showed subcutaneous fat necrosis with nonspecific scattered fibrinogen positivity and was labeled as livedo reticularis vs. livedo racemosa. A Sneddon syndrome diagnosis can be very challenging, needing a high index of suspicion to direct the diagnostic investigations. Moreover, the presence of a severe headache is an unusual phenomenon that needs further study.