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Uterine myoma as a rare cause of acute lower extremity ischemia — case report
No full textUterine myoma is a common benign tumor, originating from the smooth muscle of the uterus, with a prevalenceof approximately 25% among women of reproductive age. In rare cases, it can lead to severe complicationslike thromboembolic events or lower limb ischemia. We describe a case of a 67-year-old woman with an acutelower extremity ischemia. The computed tomography angiography scan showed a gigantic mass originating fromthe genital tract, with compression of the right common iliac artery — histopathologically confirmed uterinemyoma. This case highlights the role of thorough diagnostics of unobvious causes of lower limb ischemia
Pseudoaneurysm at the origin of the vertebral artery, iatrogenic damage to the vessel in a patient with multiple diseases: a case report
No full textIntroduction: Iatrogenic injury is one of several potential injuries to the subclavian artery, often causedby complicated central venous catheterization. Endovascular intervention is the primary treatment optionin such cases. Analyzing the medical literature, we found seven cases of iatrogenic pseudoaneurysmsof the subclavian artery at the origin of the vertebral artery, with only one case occurring in a patient withmultimorbidity.
Case report: A 65-year-old man with multiple organ failure due to septic and hemorrhagic shock presentedwith a pseudoaneurysm of the left subclavian artery at the vertebral artery outlet on follow-up radiography.A right femoral artery puncture procedure was performed under a necessity protocol. The intervention consistedof implantation of a stent into the subclavian artery. A follow-up angiography from the left subclavian arteryconfirmed no inflow into the aneurysm. Interlock coil implantation into the right vertebral artery was performeddue to the retrograde inflow seen at late stage on angiography into the pseudoaneurysm. The success of theprocedure was confirmed by follow-up angiography.
Discussion: Percutaneous central venous access is a frequently used procedure that is associated with severalcomplications. One of the complications presented by the patient described is arterial vessel damage leadingto pseudoaneurysm formation. Endovascular techniques allow, as in the case described, for the effective andminimally invasive management of such complications.
Conclusions: The patient presented herein suffered an iatrogenic injury to the subclavian artery due to implantationof a vascular access to the central vein
Hemochromatosis — the impact of different HFE gene mutation variants on the clinical course of the disease
No full textHemochromatosis is an autosomal recessive disease. Due to the genetic background of hemochromatosis, it cannot be avoided or prevented from developing in any way. The most common forms of hereditary hemochromatosis include hemochromatosis with mutations in both alleles of the HFE gene — homozygotes with the C282Y mutation and C282Y/H63D heterozygotes. The disease is progressive and usually manifests itself after the age of 40, and most cases affect men. Type 1 with a homozygous variant of the C282Y mutation is considered the most severe form of hemochromatosis due to its symptoms and course of the disease. Early diagnosis and introduction of effective treatment allows patients to maintain the length and quality of life at a satisfactory level
Inferior polar renal artery arising just above the aortic bifurcation: case report and brief literature review
No full textBackground: Multiple renal arteries (MRAs) are common anatomical variants; however, inferior polar arteries (IPAs) remain rare and clinically significant. Their presence may influence surgical procedures, transplantation outcomes, and diagnostic imaging. Therefore, detailed anatomical descriptions of such variants remain important. Case report: A rare case of right inferior polar artery (RIPA) was identified during routine cadaveric dissection of an 86-year-old female cadaver. Morphometric measurements of the vessel were performed using an electronic caliper with an accuracy of ± 0.02 mm. Results: The RIPA originated 6.88 mm above the aortic bifurcation and 77.30 mm below the origin of the inferior mesenteric artery. Its diameter at the origin was 3.07 mm and its length measured 75.53 mm. The artery coursed anterior to the inferior vena cava and posterior to the ureter before entering the inferior pole of the right kidney. According to the classification of Cases Clara et al., this variant corresponded to type d and pattern II. No vascular anomalies were observed on the left side. Conclusions: Inferior polar arteries, although uncommon, have important clinical implications in surgical, interventional, and transplant settings. Accurate anatomical knowledge and careful morphometric documentation of such variants are essential for anatomists, radiologists, and surgeons to optimize patient safety and outcomes
Development and validation of a mobile application assisting oncologists with prescribing appropriate thromboprophylaxis for ambulatory cancer patients with high risk of thromboembolism — a pilot study
Full text linkIntroduction. Cancer significantly increases the risk of venous thromboembolism (VTE), with approximately one in five VTE events associated with malignancy. Although VTE can be prevented through appropriate prophylaxis, under-prophylaxis remains prevalent, particularly in Middle Eastern countries. Technology, particularly mobile applications, offers a promising solution for supporting decision-making in VTE management.
This study aimed to develop a mobile application to assist oncologists in making informed decisions regarding thromboprophylaxis for ambulatory cancer patients.
Material and methods. The scientific content of the application was developed in accordance with the latest thromboprophylaxis guidelines and validated by a panel of three experts. For pilot testing of the application, it was given to all four oncologists working in the main oncology center at Al-Diwaniya Teaching Hospital. To assess the advantages and disadvantages of the application, each participant was asked to provide feedback using a 3-point Likert scale (good, fair, and poor).
Results. Three of the studied parameters received good ratings from all four participating oncologists (application’s ease of use, accuracy in detecting VTE risk, and recommending a suitable [safe] thromboprophylactic agent). Meanwhile, the other two parameters (reducing the time needed for assessing VTE risk and accuracy of deciding a suitable anticoagulant dose) were rated as good by 75% of participants and fair by 25% of participants.
Conclusions. The newly developed mobile application gained high acceptance from all oncologists at Al-Diwaniya Teaching Hospital. These oncologists considered the application an effective tool in supporting clinical decision-making and enhancing patient care in this critical area of oncology
When you can’t see the wood for the trees — rare and not so rare malignancies in Nijmegen breakage syndrome: a review
Full text linkIntroduction and purpose. Nijmegen breakage syndrome (NBS) is a rare genetic disease with numerous complications during its course. Patients with NBS present such clinical features as musculoskeletal abnormalities, cardiovascular impairments, microcephaly, as well as recurrent respiratory infections, and a significantly high risk of developing malignant tumors. This article aims to highlight the importance of creating guidelines and a more standardized approach to cancer prevention in NBS patients.
Malignancies in the Nijmegen syndrome. Individuals affected by NBS show a strong predisposition to develop malignancies, especially at an early age. The most frequent are those of hematopoietic origin, but solid tumors (also rare ones like medulloblastoma and rhabdomyosarcoma) are also common, as are precancerous conditions.
Conclusions. As NBS patients are prone to show the symptoms of not only lymphoid malignancies but also solid tumors and immunodeficiency-related diseases, a holistic preventive approach is strongly advised. The screening and treatment for cancer can be extremely difficult due to the radio- and chemosensitivity of individuals with NBS, followed by more common therapy-related side effects
Cancer of an unknown primary with PDZRN3-RAF1 fusion and ATR splice site mutation, with atypical chemosensitivity pattern
Full text linkA cancer of an unknown primary (CUP) is diagnosed when the primary tumor cannot be identified using standard diagnostic methods. Worldwide, CUP constitutes 1.8% of all cancers, with annual mortality reaching 80%. This study describes a 54-year-old man who presented with fever and epigastric pain. Computed tomography detected multiple liver, peritoneal, and mediastinal metastases. Histopathology confirmed the presence of G3 adenocarcinoma, but its origin remained unclear. The patient was diagnosed with CUP and was treated with cisplatin and paclitaxel therapy with moderate effect. The second-line regimen with gemcitabine and capecitabine resulted in remarkable disease stabilization lasting over 2 years. A next-generation sequencing test was performed, revealing the presence of two pathogenic variants (PDZRN3-RAF1 fusion and ATR splice site), but no targeted therapy could be selected based on the findings. The subsequent treatment regimen with irinotecan and cyclophosphamide brought stabilization that lasted 6 months. FOLFOX7 therapy did not provide a response. Sorafenib resulted in 5-month disease control. Simultaneously, expanded histopathology indicated that the cancer could be hepatocellular carcinoma with an atypical immunophenotype. After starting cabozantinib, the patient developed a severe nephrotic syndrome and died after 4 years of oncological treatment.
The complex and unique nature of each CUP makes both diagnosis and optimal management a great challenge. There is an ongoing need to improve workups to identify the primary. As a heterogeneous and poorly investigated entity, CUP may require treatment beyond established guidelines. More research is needed to establish new therapeutic options for CUP patients
Pulmonary pleomorphic carcinoma treated with immune checkpoint inhibitors — a case series
Full text linkPulmonary pleomorphic carcinoma (PPC) is a rare subtype of primary lung cancer, accounting for less than 2% of annual diagnoses. It is characterized by a low response rate to systemic treatment, an unusual molecular profile, an average high tumor mutation burden score, and poor prognosis. This article presents four cases of patients with PPC treated with immune checkpoint inhibitors.
Two patients were women diagnosed with spindle cell carcinoma, while the other two were men diagnosed with pleomorphic carcinoma. The mean age was 68.75 years, and the clinical stage varied between II and IV. Two patients received immunotherapy as a second-line treatment, while the other two received it as a first-line therapy. Most patients had a history of smoking, with half of the patients smoking during the treatment. Only one patient experienced disease progression during treatment, while three achieved partial response, and two patients maintained response for over 40 treatment cycles. The toxicity of the treatment in patients reached up to grade 3 according to the Common Terminology Criteria for Adverse Events, and involving multiple sites.
Given the highly specific molecular landscape and the promising results observed in the majority of patients, immunotherapy appears to be a favorable viable treatment option for the management of this rare neoplasm
