Ewing Sarcoma of the Kidney: A Case Report

Title:A novel finding of hair growth like vellus hairs on glabrous skin of distal phalanx of thumb in Vogt-Koynagi-Harada DiseaseAuthors:1 Dr. Muhammad Mateen Amir dr.mateen61@gmail.comAl- Khidmat teaching hospital UCMD.2 Bilal Aslamdrbilalaslamsheikh@gmail.comUniversity of Lahore3 Javed IqbalJiqbal3@hamad.qaHamad Medical Corporation Doha4 Syed Muhammad AliSAli35@hamad.qaHamad Medical Corporation Doha

Title: A Rare Clinical Scenario of papillary renal cell carcinoma type 2

A RARE CASE OF CONJUNCTIVAL AND SCLERAL NECROSIS FOLLOWING ANTERIOR SUB-TENON TRIAMCINOLONE ACETONIDE INJECTION IN A PEDIATRIC PATIENT

IntroductionRhinophyma represents a severe, disfiguring manifestation of phymatous rosacea, characterized by progressive glandular hypertrophy and fibroplasia of the nasal soft tissues [1]. Pathologically, it is defined by marked sebaceous hyperplasia, which can precipitate significant aesthetic distortion and, in advanced stages, functional airway obstruction [1, 2]. While primarily localized to the nose, phymatous changes can occasionally involve adjacent facial structures [3]. The clinical presentation varies in severity, a spectrum which often guides the therapeutic strategy [4].Although surgical excision is the definitive treatment for advanced rhinophyma, recurrence remains a formidable therapeutic challenge. Relapse is frequently attributed to the incomplete extirpation of deep-seated sebaceous follicular units that serve as a nidus for regrowth. The literature, however, offers limited guidance on optimal strategies for managing patients after multiple surgical failures. In this case, we present a rare case of triple-recurrent rhinophyma to illustrate the profound therapeutic challenges involved and to delineate the meticulous surgical principles essential for achieving a durable aesthetic and functional outcome in such recalcitrant scenarios.

A document by Fazeela Bibi. Click on the document to view its contents.

Amlodipine-Induced Gingival hyperplasia in Renal failure

IntroductionThe widespread use of high-resolution, cross-sectional imaging has led to a dramatic increase in the incidental detection of pancreatic cystic lesions (PCLs), confronting clinicians with a high-stakes diagnostic challenge [1]. The central task is to accurately risk-stratify these lesions, distinguishing benign, non-neoplastic entities from pancreatic cystic neoplasms (PCNs) that harbor malignant potential [2]. This distinction is critical, as misclassification can lead either to unnecessary, high-morbidity pancreatectomy for benign cysts or, conversely, a missed opportunity to resect a pre-malignant or early-stage malignant tumor [3].Among the most frequent and consequential diagnostic dilemmas is the differentiation between a pancreatic pseudocyst (PPC)—a non-neoplastic, encapsulated fluid collection arising from pancreatitis—and a mucinous cystic neoplasm (MCN). PPCs are the most common PCL, accounting for approximately 75% of cases, and are defined by a fibrous wall devoid of an epithelial lining [5]. In contrast, MCNs are true neoplasms characterized by mucin-producing epithelial cells and an underlying ovarian-like stroma, carrying a significant risk of malignant transformation that prompts recommendations for surgical resection [6]. Despite these distinct pathologies, their radiological features can overlap substantially; large or complex PPCs containing debris can mimic the septations, wall thickening, and internal complexity characteristic of an MCN, creating significant diagnostic ambiguity from imaging alone [5].When initial imaging is inconclusive, a multimodal diagnostic algorithm is essential [3]. Endoscopic ultrasound (EUS) with fine-needle aspiration (FNA) allows for high-resolution morphologic assessment and cyst fluid acquisition [7]. Subsequent analysis of the cyst fluid for tumor markers, such as carcinoembryonic antigen (CEA), and cytology provides critical data to resolve the differential [8]. While high levels of CEA are strongly suggestive of a mucinous lesion, elevated amylase points towards a pseudocyst, and cytology can confirm malignancy, each test has known limitations [8].However, extreme clinical presentations, such as a cyst of massive size, can heavily bias initial interpretation towards neoplasia, creating a significant diagnostic pitfall that may lead to premature closure. In this report, we present the case of a patient with a 1.85-liter pancreatic cyst whose immense size and complex features on imaging were highly suggestive of an MCN. We detail the systematic application of a multimodal diagnostic approach that successfully averted a misdiagnosis, underscoring the principle that even in the face of atypical features, a stepwise, evidence-based evaluation is paramount to ensure correct diagnosis and guide appropriate management.

IntroductionThe presence of a single abdominal wall hernia is a common surgical problem, but the synchronous presentation of multiple, distinct hernias in a single patient represents a significant diagnostic and therapeutic challenge [1]. Such cases may signal an underlying systemic predisposition to fascial weakness, a concept increasingly described as ”abdominal wall failure,” rather than a series of coincidental events [2]. There is substantial evidence that a deficiency in type 1 collagen, inadequate collagen cross-linking, or other connective tissue abnormalities may underpin the development of multiple hernias, creating a generalized vulnerability to herniation [2]. This perspective shifts the clinical paradigm from treating an isolated defect to managing a systemic condition with local manifestations.While reports of double or even triple hernias exist, they often involve bilateral presentations of a single type, such as inguinal hernias [3]. The combination of hernias across different anatomical zones—such as the groin, the umbilical region, and a prior surgical site—is less commonly documented and complicates surgical planning [4]. A key clinical pitfall is the presence of occult or ”hidden” hernias, where a larger, more symptomatic hernia obscures the detection of smaller, concurrent defects during physical examination [5]. Failure to identify all existing hernias preoperatively can lead to persistent patient symptoms, the need for repeat operations, and an increased risk of recurrence [6].Herein, we present the rare case of a 56-year-old male with three concurrent hernias: a right indirect inguinal hernia, an umbilical hernia, and an incisional hernia at the site of a previous appendectomy. This case highlights the critical importance of maintaining a high index of suspicion for multiple defects and underscores the utility of preoperative imaging for comprehensive surgical planning. Furthermore, we use this case to explore the potential for a unifying pathophysiological mechanism and discuss the surgical strategy for managing such complex abdominal wall disease in a single operative setting.

IntroductionThe escalating use of high-resolution, cross-sectional abdominal imaging has led to a substantial increase in the detection of pancreatic cystic lesions (PCLs), which are estimated to be present in up to 45% of the general population [1]. This rising prevalence presents a formidable clinical challenge: differentiating the vast majority of indolent or benign cysts, such as serous cystadenomas (SCAs), from neoplasms with malignant potential, including intraductal papillary mucinous neoplasms (IPMNs) and mucinous cystic neoplasms (MCNs) [1-3]. This challenge is most acute when diagnostic modalities provide conflicting data, creating a clinical dilemma between observation and high-morbidity surgery. Current management guidelines from major international societies therefore recommend a multimodal approach to risk stratification, integrating patient demographics, symptomology, and specific morphologic features on imaging to guide decisions between surveillance and surgical resection [1].Central to this diagnostic algorithm is the serum biomarker Carbohydrate Antigen 19-9 (CA 19-9), a well-established marker for pancreatic ductal adenocarcinoma where profoundly elevated levels often correlate with advanced disease [4]. While its utility is limited by elevations in benign obstructive pancreatobiliary conditions, levels exceeding 1000 U/mL are viewed as having a high specificity for pancreatobiliary malignancy and are rarely observed in the absence of malignancy [4]. Conversely, SCAs, which are benign in over 99% of cases, are characteristically associated with normal serum CA 19-9 levels [5]. In a multinational study of over 2600 patients with SCA, this serological quiescence was a consistent feature, reinforcing its role as a low-risk entity [6].This report details a rare case that directly challenges this established diagnostic paradigm, presenting a profound discordance between classic benign imaging and a malignant-range tumor marker. The purpose of this case is to document this instructive presentation, explore the potential biologic mechanisms underlying such a paradoxical finding, and underscore the limitations of relying on a single, discordant biomarker in the complex evaluation of PCLs.

not-yet-known not-yet-known not-yet-known unknown Introduction. Acute Pancreatitis is a widespread condition, considered by health care professionals that impacts the pancreas and is regarded to be the most intricate disease of gastrointestinal tract. Diagnosing and treating diseases of this glandular organ is critical for maintaining well-being of digestive and endocrine system impacting the overall health of the body1. The cause of acute pancreatitis (AP) should be determined upon admission and is achieved through a comprehensive medical history, physical exam, lab tests, and imaging. Additionally, assessing risk factors and the patient’s response to initial treatment helps forecast the AP outcome2. This potentially life threatening condition typically triggered by factors such as alcohol use, gallstones, acute on chronic pancreatitis, or idiopathic cause. It can also occur as a complication following surgeries, particularly those involving the pancreas, including hepatobiliary, gastric surgeries, splenorenal shunts, splenectomies and certain cardiac procedures3-6. Research indicates that microlithiasis and sludge could be responsible for a large proportion of idiopathic acute pancreatitis (IAP). These small stones and sludge, particularly when located in the common bile duct, are often challenging to detect with transabdominal ultrasound. Consequently, patients initially diagnosed with IAP may actually have biliary pancreatitis. Lower the risk of recurrent acute pancreatitis, performing Laparoscopic/Open Cholecystectomy during the same hospital admission is recommended for cases of mild biliary pancreatitis7. Endoscopic retrograde cholangiopancreatography (ERCP) is associated with a 2-10% risk of post-ERCP pancreatitis (PEP), which can increase to 30-50% in high-risk individuals. In up to 5% of cases, PEP may become severe, leading to potentially fatal complications such as multi-organ failure, acute peripancreatic fluid collections, and, in rare instances, death, which occurs in about 1% of cases8. We are reporting the case after Laparoscopic cholecystectomy pancreatitis which is a very rare entity. Acute pancreatitis essentially requires the presence of at least two of the three mentioned criteria: (A) abdominal pain (More on epigastric region) characteristic of the condition, (B) Three folds elevation of serum amylase and/or lipase, and (C) typical results from abdominal radiological studies9. Serum pancreatic enzymes are considered the most reliable method for diagnosing acute pancreatitis10.

”MASSIVE PANCREATIC PSEUDOCYST MIMICKING MUCINOUS CYSTIC NEOPLASM: A DIAGNOSTIC MAZE”