Acute myocardial infarction due to giant coronary artery aneurysm and arteriovenous fistula: a challenging case report and review of the literature.

BACKGROUND: A coronary artery aneurysm (CAA) is an abnormal dilation of a coronary artery segment often accompanied by coronary artery fistula (CAF), leading to communication between a coronary artery and a cardiac chamber or a part of the coronary venous system. Both CAAs and CAFs can present with symptoms and signs of myocardial ischemia and infarction. CASE PRESENTATION: We describe the case of a 46-year-old woman with non-ST-elevation myocardial infarction (NSTEMI) caused by a "giant" CAA. Various imaging modalities revealed a thrombus-containing aneurysm located at the right-posterior cardiac border, with established arteriovenous communication with the distal part of left circumflex artery (LCx). After initial treatment with dual antiplatelet therapy, a relapse of pain was reported along with a new increase in troponin levels, electrocardiographic abnormalities, reduced left ventricular ejection fraction (LVEF) and thrombus enlargement. Surgical excision of the aneurysm was favored, revealing its true size of 6 cm in diameter. Τhe aneurysm was excised without complications. The patient remained asymptomatic during follow-up. CONCLUSIONS: Management of rare entities such as "giant" CAAs and CAFs can be challenging. Cases such as this can serve as precedents to facilitate treatment plans and develop consistent recommendations, emphasizing the importance of personalized strategies for future patients.

Giant malignant phyllodes tumor with distant metastases: a case report and review of the literature.

BACKGROUND: Phyllodes tumors (PTs) represent a rare type of breast tumor and are classified into benign, borderline, and malignant. Giant PTs, meaning those sized more than ten cm, are even rarer, most commonly malignant, and usually have a dismal prognosis due to the high metastatic potential. CASE REPORT: We report the case of a 55-year-old woman who underwent modified radical mastectomy and left axillary lymphadenectomy for a rapidly growing, giant, ulcerated mass of the left breast. Histopathologic examination revealed a malignant phyllodes tumor (MPT). Over one year after the initial surgery, the patient was found to have extensive thoracic and retroperitoneal metastases. CONCLUSION: Although giant PTs are uncommon, clinical suspicion should be high in rapidly growing breast mass patients. A comprehensive review of all metastatic giant MPT cases reported in the English literature emphasizes the lack of consensus regarding appropriate treatment. In the case of metastatic foci, pathologists need to be aware of the previous history to make a definitive diagnosis. Also, a comparative histopathologic study of the primary and metastatic tumors is sometimes necessary. HIPPOKRATIA 2022, 26 (1):41-45.

Severe gastrointestinal cryptosporidiosis three years after multi-visceral transplantation.

BACKGROUND: Cryptosporidia are known to cause opportunistic gastrointestinal tract infections with variable severity. Such infections can be life-threatening in transplant recipients. We report the evolution of cryptosporidiosis in a multi-visceral transplant recipient with repeated endoscopic biopsies until specific therapy was instituted. CASE DESCRIPTION: A 40-year-old woman with a history of multi-visceral (stomach, duodenum, small bowel, liver, and pancreas) transplantation presented with severe acute diarrhea three years after transplantation. Endoscopic biopsies of the stomach, duodenum, and lower small bowel were performed and submitted for histologic examination to assess the possibility of rejection. Microscopic examination of the lower small bowel biopsy specimens revealed mild to moderate inflammation and the presence of microorganisms with features of Cryptosporidia in the intestinal crypts. No evidence of rejection was found. While waiting for the availability of nitazoxanide, the patient was initiated on metronidazole, but her diarrhea worsened. Eleven days later, new biopsies were obtained, revealing abundant Cryptosporidia in the lower small bowel and duodenal specimens and few Cryptosporidia in the gastric biopsy specimen. Nitazoxanide was soon administered, leading to clinical improvement. Six weeks later, new biopsies showed complete resolution of inflammation and the absence of microorganisms. CONCLUSION: Histological examination of biopsy specimens is crucial for the diagnosis of cryptosporidiosis, which can threaten the life of immunocompromised individuals. The importance of specific antiprotozoal treatment must be emphasized. HIPPOKRATIA 2022, 26 (3):121-123.