Bilateral breast tuberculosis: A case report.

Key Clinical Message: Breast tuberculosis is a rare clinical condition that has the potential to imitate breast cancer or pyogenic abscess. It is crucial to consider this in patients who have resistant breast abscesses or persistent sinuses, particularly in high-risk groups or locations. The main treatment for breast tuberculosis is antitubercular treatment. Abstract: Bilateral breast tuberculosis is a rare form of the disease that affects breasts. It is most commonly seen in young females, including nulliparous and lactating women. Diagnosis of bilateral breast tuberculosis can be challenging due to its similarity to other breast diseases, such as granulomatous mastitis and breast carcinoma. Patients from high-risk groups and/or endemic locations who present with clinically suspicious breast lumps or refractory breast abscesses should have breast TB taken into consideration in their differential diagnosis. A 24-year-old Ethiopian female presented to the surgical outpatient department with a complaint of bilateral breast pain of 1-year duration associated with a low-grade fever, not associated with chills or rigor. She also has ulceration on the lower part of both breasts. It was followed by pus discharge from the right breast 6 months later. Investigations, including fine needle aspiration cytology, were suggestive of tuberculous mastitis. Later, the patient was treated with antituberculous drugs for 6 months, and the above symptoms subsided. Individuals with breast lesions who do not respond well to antibiotics should be suspected of having breast tuberculosis, especially if they are young and reside in or were born in a nation where the disease is prevalent.

Chronic osteomyelitis of the clavicle in a pediatric patient: A case report.

INTRODUCTION AND IMPORTANCE: Clavicular osteomyelitis, unlike the metaphysis of long bones, is a rare condition that poses a challenge for orthopedic surgeons in terms of diagnosis. The unique location of the clavicle makes it crucial to diagnose and effectively manage these non-traumatic clavicular lesions promptly. Localized pain and swelling are common symptoms experienced by patients with clavicular osteomyelitis. CASE PRESENTATION: A 9-year-old boy presented with swelling and pain in the left clavicular area for 6 months. There was no fever or history of trauma. Physical examination revealed a tender, 2 cm by 3 cm swelling over the left clavicular area, with no abnormal findings in other body systems. This case was treated with surgical debridement and PO cloxacillin, and his condition improved. CLINICAL DISCUSSION: To achieve an accurate diagnosis, a thorough analysis of the patient's clinical presentation, along with blood workups, radiologic studies, bacteriological studies, and histopathological studies, is essential. Treatment options for clavicular osteomyelitis may involve surgery, medical intervention, or a combination of both. Existing literature suggests that the cure rate does not significantly differ between patients who receive medical treatment and those who undergo surgery for clavicular osteomyelitis. CONCLUSION: In evaluating non-traumatic clavicular lesions, considering chronic osteomyelitis as a potential diagnosis is important. The final diagnosis is determined through analysis of the clinical presentation, laboratory and radiographic tests, and confirmation with assistance from local culture and biopsy.

Giant intraperitoneal non-pancreatic pseudocyst: a case report.

INTRODUCTION: Non-pancreatic pseudocysts are rare lesions that typically form from the omentum and mesentery. These cysts have a thick fibrotic wall made up of fibrous tissue and may show signs of calcifications and inflammatory changes. The fluid inside them can vary, ranging from hemorrhage and pus to serous or sometimes chylous content. In most cases, these cysts appear as a result of trauma, surgery, or infection. CASE PRESENTATION: A 35-year-old male patient from Ethiopia presented with swelling in his lower abdomen that had been present for 2 years. Initially, the swelling was small but gradually increased in size. The patient experienced frequent urination but no pain or difficulty during urination, urgency, intermittent urination, or blood in the urine. The swelling was initially painless but became painful 2 months prior to his presentation. Abdominal computed tomography scans revealed a well-defined, lobulated peritoneal lesion measuring 16 × 12 × 10 cm, consisting primarily of fluid-filled cysts with a thick, enhancing wall and septa. Additionally, there was a large, heterogeneous enhancing soft tissue component measuring 8 × 6 cm. As a result, the cystic mass was surgically removed in its entirety with partial removal of the bladder wall, and the patient was discharged in an improved condition. CONCLUSION: Primary non-pancreatic pseudocysts are extremely rare lesions that must be differentiated from other possible causes of cystic lesions within the peritoneal or retroperitoneal regions. Surgeons should be aware of the potential occurrence of these lesions, which may have an unknown origin.

Paraneoplastic pemphigus in a patient with T-cell lymphoma: a case report.

Introduction and importance: Paraneoplastic pemphigus (PNP) is an uncommon autoimmune mucocutaneous disease characterized by severe stomatitis, polymorphous skin eruptions, and the presence of underlying neoplasms. Unique histopathological features include suprabasal acantholysis and clefts with scattered necrotic keratinocytes. Case presentation: A 27-year-old female patient presented with a 3-month history of a painless swelling, approximately the size of a pea, on the left lateral aspect of her neck and axillary area. This swelling progressively increased in size and number. Additionally, she had reddish, itchy, raised skin lesions over her elbows bilaterally, which gradually spread to involve most of her body, including her lips, tongue, and buccal mucosa. These skin lesions were associated with difficulty swallowing both liquid and solid foods. A diagnostic test, including a biopsy, confirmed the diagnosis of PNP. Subsequently, the patient was managed with chemotherapy and other supportive measures, leading to improvement and eventual discharge. Clinical discussion: PNP is a rare blistering disorder associated with neoplasms, often presenting diagnostic and treatment challenges. Patients with PNP may develop a diverse range of lesions. It is crucial to promptly recognize and manage the underlying malignancy for improved patient outcomes. Conclusion: This case highlights the rare association between T-cell lymphoma and PNP. Clinicians should also remain vigilant for the possibility of PNP in lymphomas that are not of B-cell lineage.

Spinal schistosomiasis mimickingspinal tumour: a case report.

Introduction and importance: Schistosomiasis, a parasitic disease, is caused by blood flukes from the schistosoma genus. Neuroschistosomiasis is the most severe form of schistosomiasis, which occurs when the host's brain and spinal cord react to the deposition of eggs, leading to neurological symptoms. Neuroschistosomiasis causes various signs and symptoms, such as myelopathy, radiculopathy, and elevated intracranial pressure. Case presentation: A 12-year-old child from Ethiopia who presented with progressive weakness in his lower extremities that has been ongoing for 2 months. Alongside the weakness, the patient also experienced tingling sensations and numbness in his lower extremities. Additionally, he had bladder and bowel incontinence. Spinal MRI showed signs suggestive of myxopapillary ependymoma, but the histopathology result showed schistosomiasis. Postoperatively, the patient had a slight improvement in terms of lower extremity weakness (flickering of the digits). However, there was no improvement in his continence ability. Clinical discussion: The most common neurological manifestation of Schistosoma mansoni infection is myelopathy, which includes subacute myeloradiculopathy and acute transverse myelitis. The cauda equina and conus medullaris are the areas most frequently affected. Conclusion: When spinal schistosomiasis presents itself as a mimicking spinal tumour, it poses a complex clinical challenge that necessitates a comprehensive interdisciplinary approach to ensure accurate diagnosis and effective treatment. It is imperative for healthcare practitioners to enhance their knowledge and awareness of this uncommon parasitic infection, particularly in regions where it is prevalent.

Duodenal gastrointestinal stromal tumor presenting with life-threatening upper GI bleeding in a young patient: A case report and literature review.

Key Clinical Message: Duodenal GISTs are rare and challenging tumors. Acute life-threatening upper GI bleeding is a possible presentation of duodenal GISTs. Surgery is the standard treatment for localized duodenal GISTs. Imatinib is an effective adjuvant therapy for duodenal GISTs. Abstract: GIST is the most common mesenchymal neoplasm of the gastrointestinal tract, accounting for 1%-2% of gastrointestinal tumors. They originate from the interstitial cells of Cajal and are rare in patients younger than 30 years. The stomach is the most common site, followed by the small intestine and colon. GISTs are caused by a gain-of-function mutation in the proto-oncogene receptor tyrosine kinase, with activating mutations in KIT being the most common. Most GISTs are asymptomatic. Even if gastrointestinal bleeding is the most common complication life-threatening hemorrhage is extremely uncommon. We present a case of a 31-year-old male patient presented with massive active hematemesis and melena with hemorrhagic shock. The patient presented with massive hematemesis and melena of 1 h duration. Endoscopy showed pulsating active bleeding from the third part of the duodenum which was difficult to manage via endoscopy. Histopathologic evaluation showed spindle cell type GIST. Intraoperatively, there was a nodular mass with active bleeding on the third part of the duodenum. Duodenectomy with end-to-end anastomosis was done. Discharged with no postoperative complication and was put on imatinib. There are considerable challenges that arise in the diagnosis and treatment of duodenal gastrointestinal stromal tumors (GISTs) when they present with life-threatening upper gastrointestinal hemorrhage. In order to achieve the best possible outcomes for patients, it is crucial to have a comprehensive understanding of the clinical presentation, diagnostic methods, and treatment approaches.

Schwanoma of the cervical sympathetic chain: A case report.

INTRODUCTION AND IMPORTANCE: Any cranial, peripheral, or autonomic nerve in the body can give rise to a benign, slowly growing encapsulated nerve sheath tumor known as a schwannoma. The majority of parapharyngeal extracranial schwannomas, which typically have vagal origins, are located there. When they first appear, most swannomas are asymptomatic. Vague symptoms may be present in some people. CASE PRESENTATION: She is a 35-year-old Ethiopian female patient presented with left lateral neck swelling of 11 years duration which was initially small but gradually increases to attain the current size. Associated with the swelling she had had dull aching pain in the same area. On examination, there was a 5*4 cm non-tender hard mass over the left cervical area which had an irregular border, fixed to the underlying structure but not to the overlying skin. Investigations were suggestive of cervical schwannoma. Finally, the patient was operated on and discharged improved. CLINICAL DISCUSSION: The majority of schwannomas are solitary, however they can also be multifocal and plexiform when they are associated with neurofibromatosis. Schwannomas are typically asymptomatic until late in the course of the disease, when neurologic symptoms brought on by compression of the adjacent nerve may develop. The most popular diagnostic techniques for schwannomas include computed tomography (CT), MRI, ultrasonography, and fine-needle aspiration cytology (FNAC). CONCLUSION: Cervical sympathetic chain schwannomas are uncommon tumors that typically manifest as asymptomatic unilateral neck masses without Horner's syndrome. For the diagnosis of cervical sympathetic chain schwannoma, imaging tests are crucial.

Appendiceal duplication an unusual cause of abdominal pain: A case report.

Appendiceal duplication is exceedingly rare, with a prevalence of 0.004% to 0.009% in appendectomy specimens. Appendiceal duplications can occur alone or in conjunction with cecal duplication. The persistence of the temporary embryologic second cecal appendix is hypothesized to cause appendiceal duplications. We present a case of appendiceal duplication in a 26-year-old Ethiopian female patient who had been experiencing abdominal pain in the right lower quadrant for 1 week. She developed anorexia, a loss of appetite, and a low-grade fever as a result of this. She reported direct and rebound mild discomfort in the right lower quadrant on abdominal examination. She was then operated on and she had an appendiceal duplication intraoperatively. As a result, an appendectomy was performed, and the patient was discharged with improved health. To avoid unfavorable patient outcomes and medicolegal difficulties, surgeons and surgical trainees who conduct several appendectomies throughout their training should be aware of the likelihood of appendiceal duplication.

Extraskeletal Ewing's sarcoma of the thigh with lung and bone metastasis: Case report.

INTRODUCTION AND IMPORTANCE: Extraskeletal Ewing's sarcoma is an uncommon tumor with a devastating prognosis and a very high mortality rate, particularly in metastatic forms, it primarily affects young people mainly in the 2nd to 4th decades of life. It can affect different parts of the body, without a particular clinical presentation which delays diagnosis. CASE PRESENTATION: 12-year-old male patient presented with swelling over the left proximal thigh of 7 months duration associated with pain and limping. On physical examination, he had about 20 × 15 cm firm, tender, and erythematous proximal left thigh swelling that is fixed to the structures with an overlying scar. CLINICAL DISCUSSION: Extra skeletal Ewing's sarcoma (EES) is a member of the Ewing Sarcoma Family of tumors. EES is a rare tumor with an incidence ranging from 0.1 to 0.4 per a million people. It presented with rapidly increasing swelling mainly over the soft tissue of the proximal thigh, pelvis, paravertebral region, chest wall, upper arm and shoulder. Age at presentation ranges 10 to 30 years with no gender preference. Imaging is crucial in the diagnosis, preoperative assessment, in staging and evaluation of treatment outcomes. Histopathology study is mandatory for the definitive diagnosis of EES among competitive differential diagnoses. The management of EES includes Surgery, chemotherapy and/or radiation therapy based on the stage of the disease. CONCLUSION: EES is a rare tumor but it should be in the differential diagnosis of adolescent patients presented with soft tissue mass/swelling.

Eggshell calcified hydrocele sac: a case report.

INTRODUCTION: Hydrocele, an abnormal fluid collection between parietal and visceral layers of the tunica vaginalis, is the commonest cause of scrotal swelling, and it affects all age groups. Calcification of hydrocele sac/wall is a rare clinical entity. The etiology of calcification of hydrocele sac is not clear, but most literature proposes that calcification is secondary to chronic irritation. Trauma and infectious diseases including Schistosoma haematobium, filariasis, and tuberculosis can also cause calcification of the hydrocele sac. CASE PRESENTATION: A 74-year-old Ethiopian male patient presented with left side scrotal swelling of 3 years duration, which was initially small but progressively increased. He had no history of trauma, and he had no history of swelling on the contralateral side. Scrotal ultrasound (US) showed a large echodebrinous left-side scrotal collection with calcifications, bilateral testis appear normal in size, echogenicity, and color Doppler flow with the index of likely chronic hematocele. Therefore, with a diagnosis of left-sided calcified hydrocele, the patient was operated on and the calcified sac was excised and sent for histopathology. Finally, the patient was discharged improved after 2 days of hospital stay. CONCLUSION: Calcification of the tunica vaginalis is very rare and is probably due to chronic irritation of the wall from the coexisting hydrocele. Surgical excision of calcified hydrocele sac is the treatment of choice.

Struma Ovarii with Papillary Thyroid Carcinoma and Metastasis to the Appendix: A Case Report and Literature Review.

Struma ovarii is an infrequent type of teratoma arising from the ovary accounting for only 2% of all ovarian teratomas. These tumors have a benign biology with rare malignant transformation in about 3% of cases. The most common malignant transformation that arises from struma ovarii is papillary thyroid carcinoma. These neoplasms act in the same way as those arising from the thyroid gland, but due to the rarity of their occurrence there is still a debate over therapeutic options. We present a case of a 41-year-old Ethiopian Para IX woman presented with abdominal swelling for four years, accompanied by dull pain, satiety, and weight loss. Her vital signs were normal, and her abdominal examination revealed a large abdominopelvic mass. Her CA-125 was elevated, and her blood count, organ function tests, and serum electrolyte levels were normal. Abdominal ultrasound revealed a complex abdominopelvic mass with cystic and solid components, possibly ovarian teratoma. The patient underwent surgery, revealing a 14 by 10 cm right ovarian mass and a 3×3 cm appendiceal mass. Subsequently, total abdominal hysterectomy, bilateral salpingo-oophorectomy, total omentectomy, and appendectomy was done. Histopathologic evaluation revealed follicular proliferation of enlarged cells, with no papillary growth pattern. The case was diagnosed as malignant struma ovarii, a follicular variant of papillary thyroid carcinoma (FVPTC) with secondary deposits on the appendix. A complete thyroidectomy was done after the histopathology diagnosis. Malignant struma ovarii is rare making it challenging to treat since there are no established prognosticating histopathologic or clinical characteristics. The tumor size and metastasis determine the surgical treatment scope. Large-scale investigations are essential for prognostication and treatment options considering pathologic traits.