A document by Laurie-Anne De Pauw. Click on the document to view its contents.

Key Clinical Message: Primary breast MALT lymphoma is an extremely rare and indolent malignancy with favorable outcomes. This case report aims to report typical imaging and pathologic findings to improve understanding and awareness of the presentation, diagnosis, and management of this uncommon entity.IntroductionPrimary breast lymphomas (PBL) are uncommon, having been reported to represent up to 1% of all cases of non-Hodgkin lymphoma [1,3] and only 0.4-1% of all breast malignancies [2,3]. Mucosa-associated lymphoid tissue (MALT) lymphoma is an extranodal B-cell lymphoma and a subtype of marginal zone lymphoma (MZL), which is a classically indolent form of non-Hodgkin’s lymphoma (NHL) with an average age of presentation above 65 years of age with a slight female predilection. MALT lymphomas are more commonly associated with mucosal sites such as the gastrointestinal tract, lungs, and salivary glands, with the stomach being the most frequent extranodal site. As such, primary involvement of the breast is extremely unusual, only accounting for up to 9% of primary breast lymphomas and therefore fewer than 0.1% of all breast malignancies [4]. The clinical presentation of primary breast MALT lymphoma can be subtle, often manifesting asymptomatically as a painless, palpable mass. Due to its rarity and nonspecific presentation on mammography, this entity may not be considered in the initial differential, potentially leading to delays in diagnosis.Case HistoryThe patient is a 65-year-old female with no significant past medical history who presented to her primary care physician for routine healthcare maintenance. No concerning breast symptoms were identified, with the patient denying breast pain, nipple discharge, or palpable mass. She had no personal history of breast or ovarian cancer, no family history of breast cancer, with a low lifetime Tyrer-Cuzick score of 12%. Given her age, she underwent routine screening mammography, with identification of a new asymmetry in the anterior lateral left breast. This was categorized as BI-RADS 0 and callback for diagnostic mammography was performed. On diagnostic mammogram, the asymmetry persisted on spot compression views (Figure 1A-B), although no sonographic correlate was definitively identified. This was classified as BI-RADS 4, with a recommendation for tissue sampling.

Acute remission of acromegaly after a cocaine-induced apoplexy of a GH-secreting pituitary tumorDalia Cuenca. Department of Medicine, American British Cowdray Medical Center.Latife Salame-Khouri. Department of Neurology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán.Daniela Shveid-Gerson. Department of Medicine, American British Cowdray Medical Center.Marco Antonio Alegría-Loyola. Department of Medicine, American British Cowdray Medical Center.Corresponding author: Moises Mercado. Endocrine Research Unit, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, IMSS, Mexico City, mmercadoa@yahoo.com

Addition of multi-level technologies to evaluate eggs and embryos and improve endometrial quality applied for in vitrofertilization to achieve pregnancy: a case studyTania G. Rojas-Pérez1*, Yúvika Reyes-Albarracín2*, Ortiz Ginna1, Juan José Suárez1, Vilchis Reyes Diego1, Cordero Oropeza Jacqueline1, Dinorah Hernández-Melchor1,2 and López-Bayghen Esther3**

A document by Bibek Shrestha. Click on the document to view its contents.

Tittle: Megaprosthesis Infection by Bacteroides fragilis in a patient with Ewing’s Sarcoma: a case report and literature review.Authors: Yoleidys Martínez-Ysasis1. Antonella Francesca Simonetti2. Ferran Navarro1,3,4.e-mail address: ymartinezy@santpau.cat1Microbiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain;2Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain;3Genetics and Microbiology Department. Universitat Autònoma de Barcelona, Spain;4Sant Pau Institute of Biomedical Research (IIb Sant Pau), Barcelona, Spain.Corresponding author: Ferran Navarro.email address : fnavarror@santpau.cat

IntroductionAmeloblastic fibroma (AF) is a rare, benign odontogenic tumor, accounting for approximately 1.5% to 4.5% of all odontogenic tumors. It was first described by Krause in 1891, but it was later recognized as a distinct entity by Thoma and Goldman in 1946.1 It is more commonly seen in children and adolescents, especially within the first two decades of life. There is a slight predilection for males,2 and the posterior mandible is the most frequent site of involvement. It is often associated with impacted or unerupted teeth.3Clinically, AF typically presents as a slow-growing, painless swelling, which may remain undetected until incidental discovery during routine radiographic examination. Radiographically, it often appears as a well-defined, unilocular or multilocular radiolucent lesion often with sclerotic radiopaque borders.1 Although considered benign, AF has the potential for recurrence and, in rare instances, malignant transformation into ameloblastic fibrosarcoma, emphasizing the importance of early diagnosis and appropriate management.Histopathologically, ameloblastic fibroma consists of both epithelial and connective tissue components. The epithelial component shows proliferating islands, cords, and strands of odontogenic epithelium with a peripheral layer of cuboidal or columnar cells and a central area resembling the stellate reticulum. The connective tissue component, resembling dental papilla, contains spindle and angular cells within a myxomatous stroma of delicate collagen. 2,3 Treatment options typically involve enucleation and curettage, surgical excision, partial resection and reconstruction. This case report discusses a rare presentation of ameloblastic fibroma in an 8-year-old female child, who presented with a painless swelling in the right posterior region of the mandible, which was histologically characterized by dentinoid formation.

A document by Anjali Joshi. Click on the document to view its contents.

A case of hereditary spastic paraplegia type 50 with a novel AP4M1 variant and brief review of the literature

Case report

A document by zaid khamis. Click on the document to view its contents.

Title: Acute Cerebrovascular Accident, Renal Failure, and Thrombotic Microangiopathy in a 27-Year-Old Male with Malignant Hypertension

Title PageManuscript type: Case Image

Title:

Delayed Hypoglossal Nerve Injury After Traumatic Skull Base Fracture: A Case Report and Literature ReviewMalik S. Obeidallah BA, Max Fleisher, MD, Peter Harris, MD, Khashayar Mozaffari BS, Michael Rosner, MDGeorge Washington University Department of Neurosurgery, Washington, DC, USAShort Title: Delayed Hypoglossal Nerve Injury After Traumatic Skull Base Fracture   Corresponding Author:Malik S. ObeidallahDepartment of Neurological SurgeryThe GW School of Medicine & Health SciencesTel: 201-452-8872Email: Malik.Obeidallah@gmail.comKeywords: hypoglossal, delayed, trauma, palsy   Data availability: The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.Conflict of Interest: The authors have no conflicts of interest to disclose.Key Clinical MessageOur case demonstrates that delayed hypoglossal palsy secondary to trauma can be resolved with conservative, non-operative management with a team-based approach.IntroductionThe authors discuss a case of a delayed hypoglossal nerve (HGN) injury arising three months after occipital condyle fracture (OCF) caused by a motor vehicle accident. Delayed HNP is a rare complication following OCF. Management of OCF often fails to prevent or relieve HNP over time with chronic persistence of tongue deviation and atrophy, dysphagia, and dysarthria. To date, there are only 11 cases of delayed isolated HNP after skull base trauma in the literature. Of the 11 reported cases, only three report a complete resolution of hypoglossal nerve injury [1,2,3]. While the exact mechanism for the delayed onset palsy remains unclear, it has been suggested that callus formation during normal healing can impinge on the nerve as it exits the canal [2,4,5]. Herein, the authors present the case of a patient who developed HNP three months following the initial presentation at our institution. This case illustrates considerations when dealing with OCFs, as well as management of delayed HNP, a documented but rare complication of skull base fractures adjacent to the hypoglossal canal.Case History and ExaminationA 25-year-old female presented to the emergency department (ED) after a car accident, sustaining an Anderson and Montesano type III occipital condyle fracture. Other injuries included fractures of the left thumb and radius, the latter treated surgically. Initially neurologically intact, she chose a non-surgical approach with a cervical-thoracic orthosis (CTO) brace. Three months later, she developed dysphagia and tongue weakness and atrophy without deviation. Imaging revealed a healing fracture affecting the right hypoglossal canal and nerve edema. Treatment with methylprednisolone was initiated, alongside multidisciplinary care involving neurosurgery, otolaryngology, speech language pathology (SLP), and physical medicine and rehabilitation (PMR). Subsequent evaluations indicated modest improvement in tongue paresis, and she eventually experienced complete symptom resolution over the next three months.MethodsA 25-year-old female with no significant past medical history presented to the ED in 2022 following a car accident in which she was a restrained passenger. Imaging was performed in light of facial abrasions, neck pain, and tingling in both hands. Computerized tomography (CT) revealed an occipital condyle fracture, classified as Anderson and Montesano type III. (Figures 1-3). Other injuries included fractures of the left thumb and radius, which were treated surgically.  She was otherwise intact neurologically. An magnetic resonance image (MRI) of the cervical spine did not show any ligamentous disruption or cord compromise, and discussion of various treatment options including surgical fixation versus halo immobilization versus cervicothoracic orthosis (CTO), the patient elected for CTO brace for eight to ten weeks. At two month follow up, she noted gradual improvement in her presenting symptoms, and after confirmation on X-ray that the fracture had healed, her brace was discontinued.At the three month mark, she presented to the ED with complete resolution of her initial symptoms but noted new dysphagia and tongue weakness over the past week. She had severe atrophy on the right side of her tongue and had great difficulty moving it to the left. She had no other cranial nerve dysfunctions. Speech was fluent without dysarthria. She had dysphagia without signs of aspiration. Imaging demonstrated a healing fracture causing obscuration of the internal opening of the right hypoglossal canal as well as perineural edema of the intracanalicular portion of the nerve (Figures 1-4). The options of observation, steroids, or surgical decompression of the right hypoglossal canal were discussed with the patient, who preferred conservative management. She underwent a trial of methylprednisolone and was advised to make appointments with ENT and SLP as well.  Laryngoscopy performed by ENT confirmed no other palate deformities or swallowing malfunctions indicative of additional lower cranial nerve injuries. SLP evaluation noted modest, gradual improvement in tongue paresis. Via telehealth encounter at the one year mark, the patient stated that her HNP had completely resolved three months after its delayed onset.Conclusion and ResultsThis case describes a unique situation in which the delayed HNP successfully resolved following conservative management. Moreover, it underscores the need for clinicians to be vigilant for delayed nerve palsies in skull base fractures. We present a case of delayed hypoglossal nerve palsy caused by the healing process of an occipital condyle fracture.  his case illustrates the delayed fashion in which the palsy can present, and represents, to our knowledge, the only reported case of a true delayed HNP from OCF that completely resolved without surgical intervention. Through a multidisciplinary approach including neurosurgery, ENT, and SLP, a complete recovery is possible from this rare secondary injury.DiscussionIsolated hypoglossal nerve palsy is a rare complication of traumatic occipital condyle fracture, and can evade diagnosis by presenting in a delayed fashion. Atraumatic cases are even rarer, and occasionally involve cervical vertebral junction tuberculosis [2,6,7]. Moreover, HNPs that result as a consequence of OCFs are notoriously difficult to treat. In fact, from 1989 to 2024, only 11 cases of isolated HNP have been reported with only three achieving complete resolution (see Table 1). Traumatic cases of OCFs more commonly result in Collet-Sicard syndrome (unilateral palsy of the lower cranial nerves) and it has been suggested that isolated hypoglossal nerve palsy are less common because the anterior condylar canal is located near the jugular foramen, within 7 mm on the intracranial side and 3 mm on the extracranial side [1]. Vadivelu et al were the first to demonstrate a causal relationship between decompression of the canal and resolution of neuropraxia and HNP. This supports the idea that callus formation over the nerve during the healing process is responsible for the delayed presentation of the HNP.Management of OCF is often conservative, and relies on the use of a rigid cervical collar for 6 weeks or longer [8]. However, to our knowledge, there is no other reported evidence of complete resolution of HNP through conservative management alone. In one notable exception, Ucler et al. report the use of methylprednisolone to treat HNP 3 days following OCF. However, the rapid onset and resolution of the HNP suggests that the palsy was a result of edema and not callus formation or permanent damage to the hypoglossal nerve. Our patient achieved complete resolution of HNP through conservative treatment, but also with the use of an interdisciplinary team of ENT and SLP.Author Contributions:Author 1: conceptualization, formal analysis, writing – original draftAuthor 2: conceptualization, data curation, formal analysis, writing – review and editingAuthor 3: writing – review and editingAuthor 4: writing – review and editingAuthor 5: supervision, validationAuthor Consent Statement: I, Malik Sameer Obeidallah, affirm that written informed consent has been collected from the patient by the authors and proof of consent is available upon request.ReferencesLegros B, Fournier P, Chiaroni P, Ritz O, Fusciardi J. Basal fracture of the skull and lower (IX, X, XI, XII) cranial nerves palsy: four case reports including two fractures of the occipital condyle–a literature review. J Trauma. 2000;48(2):342-348. doi:10.1097/00005373-200002000-00031Vadivelu S, Masood Z, Krueger B, et al. Long-term resolution of delayed onset hypoglossal nerve palsy following occipital condyle fracture: Case report and review of the literature. J Craniovertebr Junction Spine. 2017;8(2):149-152. doi:10.4103/jcvjs.JCVJS_34_17Ucler N, Yucetas SC. Occipital Condyle Fracture Extending to the Inferior Part of the Clivus. Pediatr Neurosurg. 2018;53(4):282-285. doi:10.1159/000487512Noble ER, Smoker WR. The forgotten condyle: the appearance, morphology, and classification of occipital condyle fractures. AJNR Am J Neuroradiol. 1996;17(3):507-513.Demisch S, Lindner A, Beck R, Zierz S. The forgotten condyle: Delayed hypoglossal nerve palsy caused by fracture of the occipital condyle. Clin Neurol Neurosurg. 1998;100(1):44-45. doi:10.1016/s0303-8467(97)00111-xBasu S, Gohil K. Delayed Hypoglossal Nerve Palsy After Halo-Vest Immobilization in a Patient With C1-C2 Tuberculosis: A Case Report. JBJS Case Connect. 2022;12(3):e22.00053. Published 2022 Aug 12. doi:10.2106/JBJS.CC.22.00053Dattatreya Sitaram C, Nishanth A, Bhat SN, Kundangar RS. Delayed hypoglossal nerve palsy following occipital condyle fracture. BMJ Case Rep. 2019;12(12):e232645. Published 2019 Dec 2. doi:10.1136/bcr-2019-232645Nwachuku E, Njoku-Austin C, Patel KP, et al. Isolated traumatic occipital condyle fractures: Is external cervical orthosis even necessary?. Surg Neurol Int. 2021;12:524. Published 2021 Oct 19. doi:10.25259/SNI_748_2021Orbay T, Aykol S, Seçkin Z, Ergün R. Late hypoglossal nerve palsy following fracture of the occipital condyle. Surg Neurol. 1989;31(5):402-404. doi:10.1016/0090-3019(89)90076-1Wasserberg J, Bartlett RJ. Occipital condyle fractures diagnosed by high-definition CT and coronal reconstructions. Neuroradiology. 1995;37(5):370-373. doi:10.1007/BF00588014Castling B, Hicks K. Traumatic isolated unilateral hypoglossal nerve palsy–case report and review of the literature. Br J Oral Maxillofac Surg. 1995;33(3):171-173. doi:10.1016/0266-4356(95)90292-9Muthukumar N. Delayed hypoglossal palsy following occipital condyle fracture–case report. J Clin Neurosci. 2002;9(5):580-582. doi:10.1054/jocn.2001.1067Rué M, Jecko V, Dautheribes M, Vignes JR. Delayed hypoglossal nerve palsy following unnoticed occipital condyle fracture. Neurochirurgie. 2013;59(6):221-223. doi:10.1016/j.neuchi.2013.05.003

Klippel-Feil syndrome is a rare congenital condition characterized by the fusion of cervical vertebrae, presenting unique challenges for airway management. We report the case of a 38-year-old male with Klippel-Feil syndrome who required a tracheostomy due to respiratory failure and sepsis. The patient's anatomical anomalies, including a short, immobile neck and

Title page:Conservative Management of Thrombotic Microangiopathy in a Renal Transplant Recipient: The Importance of Early RecognitionAuthors:Ahmad S. Matarneh (1), Sundus Sardar (1), Abdel-rauof Akkari (1), Pankhuri Mohan (2) Naman Trivedi (1), Gurwant Kaur (1), Nasrollah Ghahramani (1)Affiliations: 1. Department of Nephrology, Pennsylvania state Milton S Hershey Medical Center, United States of America2. Department of medicine-pediatrics, Pennsylvania state Milton S Hershey Medical Center, United States of AmericaCorresponding authorAhmad MatarnehAffiliation: Penn State health , Milton S.hershey medical centerContact: Email ahmadmatarneh99@gmail.comPhone # 717-708-6754Keywords:TMA, Immunosuppressed, transplant

Tirelizumab-induced immune encephalitis:An Unusual Case Report