Primary extraskeletal intradural Ewing sarcoma with acute hemorrhage: a case report and review of the literature.

BACKGROUND: Spinal cord tumors present a challenge in diagnosis and treatment due to their varied histopathological characteristics. While Ewing sarcoma is a rare malignant tumor typically originating from skeletal bone, cases of primary intradural extraskeletal Ewing sarcoma are exceptionally rare. The similarity of its presentation to other spinal tumors further complicates its identification and management. CASE PRESENTATION: We report a case of a 58-year-old Palestinian male with intradural extraskeletal lumbar Ewing sarcoma. The patient initially presented with lower back pain and bilateral S1 radiculopathy, with more severe symptoms on the left side. Magnetic resonance imaging revealed a 7 cm oval-shaped mass with homogeneous contrast enhancement, obstructing the spinal canal from L3/L4 to L5/S1 levels. Initially, a myxopapillary ependymoma was suspected, but the patient's sensory and motor functions suddenly deteriorated during hospitalization. Repeat magnetic resonance imaging indicated heterogeneous contrast enhancement, indicating acute intratumoral hemorrhage. Consequently, the patient underwent emergent L3-L5 laminotomy, with successful gross total resection of the tumor. Histopathological and immunohistochemical analyses confirmed the diagnosis of intradural extraskeletal Ewing sarcoma. Adjuvant therapy was administered to minimize the risk of local recurrence or distant metastasis. A systematic review of relevant literature, along with retrospective analysis of medical records, operative reports, radiological studies, and histopathological findings of similar cases, was also conducted. CONCLUSIONS: Intradural extraskeletal Ewing sarcoma is an infrequently encountered condition in adult patients, emphasizing the importance of considering it in the differential diagnosis of spinal tumors. Surgeons must possess a comprehensive understanding of this rare entity to ensure accurate staging and optimal management, particularly in the early stages when prompt intervention may improve prognosis.

Large pineal parenchymal tumor of intermediate differentiation causing compression with resultant obstructive hydrocephalus: a case report.

The epithalamus region contains the tiny, functionally endocrine pineal gland, which has the shape of a pinecone. Less than 1% of adult primary intracranial malignancies are pineal parenchymal tumors, which are incredibly uncommon brain tumors. A rare variety of pineal parenchymal tumors are those with intermediate differentiation. These tumors, whose namesake refers to a malignant pineal parenchymal tumor, are intermediate between pineoblastomas and pineocytomas (a benign pineal parenchymal tumor). Case Presentation: A female patient, age 13, who had been experiencing terrible headaches on and off for a month, went to the emergency room. Along with the headache, she experienced nausea, vomiting, dizziness, and blurred eyesight. A nonenhanced computed tomography scan was used for the initial brain neuroimaging, which showed a hypodense mass posterior to the midbrain and superior to the cerebellum. A heterogeneous bulk was visible on MRI. Clinical Outcome: The headache, vertigo, visual disturbance, nausea, and vomiting have all improved, according to the patient. Both postoperative MRIs with and without contrast revealed the resolution of the obstructive hydrocephalus and the absence of any residual enhancing mass. The patient was followed up for 2 months without any complications or adverse events. Conclusion: One should carefully investigate a headache as the early symptom of many illnesses and rule out any other potential causes. This would therefore enable us to create a management structure for such a very unusual malignancy.

Spontaneous infarction of breast fibroadenoma unrelated to any known risk factor: A case report.

INTRODUCTION AND IMPORTANCE: Fibroadenoma is one of the most common benign breast neoplasms, primarily affecting adolescents and young women. Infarction is uncommon in fibroadenomas, and when it occurs, it is usually associated with pregnancy or lactation, as well as FNA. We present a case of spontaneous infarction of breast fibroadenoma that was unrelated to the aforementioned risk factors and occurred outside of pregnancy and lactation. CASE PRESENTATION: A 22-year-old female presented with painful left breast lump with a sudden increase in size for 1 week duration. Physical examination revealed an irregular, well-defined, and mobile mass in the left breast measuring 5 cm × 4 cm. The mass was firm in consistency and showed tenderness. The clinical diagnosis of benign fibroadenoma of the breast was made and confirmed radiologically. A biopsy was planned. Microscopical examination showed pictures consistent with spontaneous infarction of benign fibroadenoma of the breast. CLINICAL DISCUSSION: One case of infarcted fibroadenoma was diagnosed after one excision biopsy. No preceding fine-needle aspiration biopsy was performed in this case, nor was the patient pregnant or lactating at the time of the diagnosis. CONCLUSION: Spontaneous infarction within fibroadenoma is a rare phenomenon in young females. The presence of painful lumps in fibroadenoma patients should be cautiously interpreted and diagnosed.

Acute severe thrombocytopenia following iodinated radiographic contrast medium infusion: a case report.

Acute contrast-induced thrombocytopenia is an unusual complication, and it is a rare event with the use of modern low-osmolarity iodinated contrast medium. There are only a few reports that exist in English literature. Case presentation: The authors report the case of a 79-year-old male patient with severe, life-threatening thrombocytopenia after administration of intravenous nonionic low-osmolarity contrast medium. His platelet count dropped from 179×109/l to 2×109/l after 1 h of radiocontrast infusion. Which has returned gradually to normal level within days with corticosteroid administration and platelet transfusion. Conclusion: Iodinated contrast-induced thrombocytopenia is a rare complication with an unknown causative mechanism. There is no definitive treatment for this condition, with corticosteroids being used in most cases. The platelet count normalizes within a few days regardless of any interventions, but supportive treatment is important to avoid any unwanted complications. Further studies are still needed for a better understanding of the exact mechanism of this condition.

Primary Extraskeletal Ewing sarcoma of the foot with extensive skeletal and pulmonary metastasis: A rare case report.

Introduction: First -degree cutaneous extraskeletal Ewing's sarcomas (ESs) are incredibly uncommon skin-specific tumors that often present as a single, tiny lesion that is restricted to the mid-to-deep dermis or involves the subcutis. ESs can be clinically and pathologically misdiagnosed because of their rarity and physical resemblance to other cutaneous cancers. Case presentation: A 47-year-old nonsmoking woman was admitted after being transferred from a nearby hospital to check her right foot pain that had been present for three months and was significantly numbing the same side. Only a few lone cases or brief series are reported in the current literature. The typical description of ESs is that they are tiny masses with positive clinical behavior. Discussion: Despite being a rather common location, only infrequent and minor ESs of the foot are present. After the recommended operation and subsequent histology analysis, we identified this uncommon sort of tumors. Conclusion: Although it's rare, it's very important to consider this tumor in the differential diagnosis of foot pain with/without visible and/or palpable cutaneous lesion.

Epidemiologic characteristics of gastric malignancies among Jordan University Hospital patients.

OBJECTIVES: To discover the epidemiologic distribution of gastric malignancies among Jordan University Hospital patients and to compare this distribution with the neighboring Arab countries. Methods: Retrospective study covering the period between  January 2006, and May 2016, in Jordan University Hospital, Amman, Jordan. All cases were retrieved from the computer system and analyzed using IBM SPSS version 23 software.  Results: One hundred and sixty-five cases were analyzed. Male-to-female ratio was 1.2:1. The mean age was 58.6 with 32.1% of patients aged 50 or younger. Primary adenocarcinoma was the most common tumor, half of which were diffuse type, followed by carcinoid tumors (15.2 %), lymphomas (10.3%), and gastrointestinal stromal tumors (8.5%). Proximally located tumors accounted for 15.4%. Helicobacter pylori were present in approximately half of the cases and 34.6% of cases contained intestinal metaplasia.  Conclusion: Jordan is a low-risk area for gastric cancer, but carcinoma occurs at a young age and is associated with gastritis, Helicobacter pylori infection, and intestinal metaplasia in a large proportion of cases. Better strategic health planning and early detection is needed, especially in young patients suffering from gastritis.