North American Journal of Medicine and Science
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Primary Large Cell Neuroendocrine Carcinoma of the Uterus: A Case Report and Literature Review
Get PDFLarge cell neuroendocrine carcinomas (LCNEC) of the uterus is a rare and very aggressive neoplasm. Herein we report a case of large cell neuroendocrine carcinoma arising from the uterus with extensive carcinomatosis. The patient was a 51-year-old African-American female who presented with increasing worsening abdominal distension and abdominal pain over a period of one month. A computed tomography (CT) imaging study disclosed a 20 x 15 x 10 cm heterogeneous uterine mass with significant ascites and omental thickening. The patient subsequently underwent a total hysterectomy with bilateral salpingo-oophorectomy and omental resection. Histological examination showed a large cell neuroendocrine carcinoma with extensive necrosis and numerous abnormal mitosis. No associated surface epithelial component was identified. Immunohistochemical staining pattern was consistent with the neuroendocrine origin. The patient’s condition rapidly deteriorated postoperatively, and she died one month later due to multi-organ complications. In light of the rarity of LNEC arising from the uterus, a comprehensive review of the literature is discussed. [N A J Med Sci. 2018;11(1):39-42. DOI: 10.7156/najms.2018.1101039
Colonic Mucosal Schwann Cell Hamartoma: A Case Report and Literature Review
Get PDFColonic mucosal Schwann cell hamartoma is an extremely rare entity, presenting as small colonic polyp, associating with no clinical symptoms and harboring no clinical significance. However, its mimics, such as GI neurofibroma/neurofibromatosis, ganglioneuroma, etc. are possible GI manifestations of hereditary syndromes and therefore are integral part of the patient workup and disease diagnosis. Here we report a case of mucosal Schwann cell hamartoma, with description of its morphology and immunophenotype. We also reviewed literature and differentially described some important mimics.[N A J Med Sci. 2018;11(1):19-21. DOI: 10.7156/najms.2018.110119
New Onset Epilepsia Partialis Continua Presenting as Complex Visual Hallucinations associated with Voltage-Gated Potassium Channel Antibody
Get PDFA 54-year old female with past medical history significant for rheumatoid arthritis on immunosuppressant therapy presented with episodes of left-sided shaking and left gaze deviation with decreased level of consciousness. A preceding one-month history of complex visual hallucinations was subsequently elicited. Brain Computed Tomography (CT) perfusion and Magnetic Resonance Imaging (MRI) showed changes in the right parieto-occipital lobe that were consistent with possible seizure activity. Electroencephalogram (EEG) subsequently confirmed electrographic seizures originating from the right occipital region during active hallucinations. Patient’s right occipital lobe epilepsia partialis continua was refractory to as many as 5 concomitantly administered antiepileptic medications. Patient was subsequently treated for presumed autoimmune encephalitis, but demonstrated no response to IV steroids, and showed only marginal improvement to IVIG infusion. Serum testing ultimately showed a high titer of voltage-gated potassium channel (VGKC) antibodies; and after a 5-day course of plasma exchange the patient finally achieved better control of her partial seizures, requiring long-term therapy with multiple antiepileptic medications for seizure control.[N A J Med Sci. 2018;11(1):28-33. DOI: 10.7156/najms.2018.110128]
Autoimmune Hepatitis: Clinical Overview and Pathological Findings
Get PDFAutoimmune hepatitis (AIH) is an uncommon cause of severe chronic hepatitis with a female predilection and affecting all ages and ethnic groups. Although its pathogenesis is still not completely clear, the condition has been linked to dysimmunoregulation of T lymphocytes, which attack and damage the hepatic parenchyma. Characteristic autoantibodies are produced against hepatocytes leading to cell injury and necrosis, eventually progressing to cirrhosis in a subset of patients. The goal of treatment is to prevent or halt disease progression by immunosuppressive therapy. Liver transplantation is the choice of treatment in selected patients with end stage liver disease, acute liver failure or hepatocellular carcinoma. Up to a third of post-transplanted patients have AIH recurrence in the allograft. The overall prognosis is good with high mortality in untreated cases.[N A J Med Sci. 2018;11(1):6-10. DOI: 10.7156/najms.2018.110106
