Notes

A legacy involving peace and quiet: the particular crossing points of health care sociology along with impairment reports.
In rare instances, pediatric Langerhans cell histiocytosis (LCH) may manifest as lung disease. While the imaging features at presentation have been reported, we present sequential computed tomography (CT) scans of a 3-year-old boy with pulmonary LCH, revealing the evolution and regression of the disease. Sequential CT scans during treatment demonstrated variable evolution of pulmonary cysts, including changes in size, thinning of walls, and a pattern of collapse into irregular nodules and involution. Our case represents a rare opportunity to examine sequential CT findings of pediatric pulmonary LCH regression.Histiocytic glomerulopathy, an entity characterized by glomerular infiltration by foamy histiocytes with endothelial injury, has recently been reported as a manifestation of hemophagocytic syndrome. We report a case of histiocytic glomerulopathy in a woman receiving chemotherapy for ovarian serous carcinoma with proteinuria in whom hemophagocytic syndrome was not clinically suspected.Although it typically presents with cough and dyspnea due to pulmonary involvement, sarcoidosis is a multisystem granulomatous disease and therefore may present with extrapulmonary manifestations. Cutaneous manifestations are common, while hepatic sarcoidosis is uncommon and osseous manifestations are exceedingly rare. This article describes osseous, hepatic, and cutaneous manifestations due to sarcoidosis. The patient was diagnosed with sarcoidosis, treated with a dynamic hip screw implant with a derotational screw, and discharged on a new medication regimen vitamin D, calcium supplements, alendronate, methotrexate, and hydroxychloroquine.Laryngopharyngeal reflux (LPR) is a difficult disease to treat and can result in mucosal injury in the pharynx and larynx. This typically results in symptoms such as cough, hoarseness, and globus sensation, but the manifestation of cancer is a possibility. We present a patient with a squamous cell cancer of the larynx who was diagnosed with gastroesophageal reflux disease (GERD) and found to have LPR. The cancer was treated locally and GERD was eradicated with magnetic sphincter augmentation. After 15 months of follow-up, there was no residual cancer. This case highlights the role that untreated LPR may play in patients' risk of developing laryngeal cancer.Laryngeal cysts are rare lesions of the larynx that are often described on incidental discovery. We report an unusual presentation of a large ductal cyst located on the laryngeal surface of the epiglottis. The patient presented with a low tone voice while displaying bilateral normal appearing vocal cords with normal mobility. Computed tomography scans and flexible laryngoscopy showed a round supraglottic mass approximately 2 cm in diameter on the right lateral laryngeal surface of the epiglottis. The mass was removed surgically during microsuspension laryngoscopy with excision of the mucocele utilizing a gold laser. Postoperatively, the patient's voice returned to baseline with no complications.Primitive neuroectodermal tumors (PNETs) are rare small round cell malignancies closely related to Ewing's sarcoma. Involvement of the abdominal cavity, specifically the pancreas, is extremely rare. PNETs affect predominantly children and young adults. The clinical presentation is mostly vague, with a short history of symptoms even in metastatic disease. Findings on imaging studies are nonspecific. The diagnosis can be suggested by the microscopic appearance of the tumor cells, but should be confirmed by histology, immunohistochemistry, fluorescence in situ hybridization, immunoreactivity evaluation of MIC2-protein (CD99) expression, and when possible testing for the chromosome translocation t(11;22) (q24,q12). In adults, the prognosis is poor with no standard treatment. Here, we present a case of pancreatic PNET in a 61-year-old man who presented with persistent abdominal pain and weight loss.Giant cell tumor of the sacrum is a rare primary tumor in a challenging anatomical location without clear consensus on treatment. We present a case of giant cell tumor of the sacrum and subsequent treatment with preoperative embolization, L5 to S4 laminectomy, partial sacrectomy, intraoperative thermal ablation, and L4 to pelvis stabilization and fusion.Chylous ascites occurs due to processes that elevate pressures within or obstruct the lymphatics in the retroperitoneum. In cirrhosis, spontaneous chylous ascites can occur but is uncommon. We describe a case of a 74-year-old man with cirrhosis from nonalcoholic steatohepatitis who presented with worsening abdominal distension and chylous ascites on paracentesis; an infiltrating retroperitoneal lymphoma was subsequently detected on computed tomography imaging.Necrotizing soft tissue infections (NSTIs) are highly aggressive and may be lethal if untreated. Polymicrobial infections of the groin and lower limb have been documented secondary to invasive colorectal cancer (CRC). We present a case of CRC diagnosed more than 4 years after the development of NSTI. There are documented cases of NSTIs concomitant with a preexisting CRC. In this case, however, the patient's initial presentation was an NSTI followed by later diagnosis of CRC. A previously treated NSTI that is not healing appropriately may be an early indicator for CRC.Metastases to soft tissues are rarely reported in the initial presentation and diagnosis of lung cancer. We report a case of a 77-year-old white man who presented with a 9-day history of a painful, rapidly growing mass on his left buttock in the gluteal cleft. The deep dermal location of the neoplasm and the lack of epidermal involvement led to suspicion of a metastatic carcinoma. Imaging showed a lung lesion suspected to be a primary malignancy with distant liver and gastric fundus metastases. Lung pathology showed primarily adenocarcinoma with squamous differentiation, whereas the skin biopsy showed poorly differentiated squamous cell carcinoma. Clinically, we concluded the skin carcinoma was a metastasis of a primary lung adenocarcinoma with squamous differentiation. This case highlights the importance of appropriate preventative screening.Image-guided cryoablation has low procedure-related morbidity and mortality rates, with the complications usually being self-limiting. The most common complications include pneumothorax, hemoptysis, pleural effusion, cough, phrenic nerve injury, and tumor implantation. Bronchopleural or bronchocutaneous fistula formation is a rare but severe complication of lung cancer ablation. We report a patient with non-small cell lung cancer who developed a bronchocutaneous fistula, persistent empyema, and chest wall abscess a month after cryoablation. read more With this case report, we aim to sensitize physicians to such complications.Tumor lysis syndrome (TLS) is an oncologic emergency, more commonly occurring in patients with hematologic malignancies receiving cancer-directed therapy due to massive cellular breakdown. Spontaneous TLS is rare and occurs in the absence of cancer-directed therapy. Herein, we present a case of spontaneous TLS associated with squamous cell carcinoma.Langerhans cell histiocytosis is a rare hematologic disorder caused by the proliferation of specialized dendritic cells. Pulmonary manifestations occur in 20% to 50% of multisystem disease, but isolated pulmonary disease is rare. Spontaneous pneumothorax occurs in up to 10% of pediatric pulmonary cases. We present the case of a 3-year-old boy who presented for tachypnea and chest pain with cough, rhinorrhea, and congestion. He was discharged with a diagnosis of upper respiratory infection. The patient returned to the emergency department and was found to have a tension pneumothorax, which was emergently treated with thoracostomy. The subsequent workup revealed Langerhans cell histiocytosis with pulmonary disease and jaw involvement. Although tension pneumothorax is often associated with trauma, several medical conditions are predispositional.Polymyalgia rheumatica is a disease characterized by systemic inflammation of the proximal muscles and pain in the hips and shoulders, but when this disease occurs contemporaneously with malignancy, there is a possibility of it being a paraneoplastic syndrome. With the advent of immunotherapies to treat various cancers, immune-related adverse events from these therapies are recognized as de novo findings or as flares of an underlying existing rheumatic disease. In this report, we present a case of polymyalgia rheumatica presenting as a paraneoplastic syndrome that was exacerbated during therapy with immune checkpoint inhibitors for recurrent melanoma.Immune checkpoint inhibitor (ICI) therapies activate the immune system to unmask cancer cells that the body might otherwise not detect. These cancer therapies alter the immune system at different "checkpoint" proteins such as PD-1, PD-L1, or CTLA-4 to better target tumor cells, but also have the potential to affect normal tissues. In patients receiving ICI therapy, cutaneous reactions have been frequently documented, ranging from mild urticarial rashes to widespread cutaneous necrosis. Proper identification and management of ICI therapy side effects is essential to the care of these patients. Here, we present an unusual granulomatous cutaneous reaction in a patient receiving anti-CTLA-4 therapy for chronic myelomonocytic leukemia.Cancer immunotherapy has impacted the treatment of numerous tumor types, including skin, lung, and colon cancers. Immune checkpoint inhibitors (ICI) activate the immune system to attack cancer cells, but this mechanism can also impact healthy cells. Dermatomyositis, an autoimmune syndrome affecting multiple organ systems, is often associated with cancer as a paraneoplastic syndrome, but this syndrome can also be induced by ICI. Here, we describe a case of dermatomyositis in a patient receiving pembrolizumab for treatment of squamous cell carcinoma of the lung and discuss the importance of recognizing complications of ICI.A 53-year-old woman with known localized uveal melanoma presented with pain from a large destructive lesion of the left iliac bone. Biopsy confirmed metastatic melanoma, and positron emission tomography scan showed extensive osseous destruction. Because her uveal melanoma was successfully treated with brachytherapy 15 years earlier, next-generation sequencing was performed, and a GNAQ mutation proved the lesion to be of uveal origin. Uveal melanoma has a worse prognosis than cutaneous melanoma. We initiated treatment with the combination of nivolumab and ipilimumab, and after four cycles of treatment a positron emission tomography scan showed resolution of all prior lesions. The patient was then placed on maintenance therapy.Dermatomyositis is an autoimmune condition that commonly presents in the form of an overlap syndrome with other rheumatic diseases. The overlap between syndromes with highly variable symptomology makes treatment difficult. We present a case of a 39-year-old woman who presented with a facial rash, arthralgias, and lower-extremity edema and steadily progressed to develop severe proximal muscle weakness and hair loss over the course of a 2.5-month hospitalization. After diagnostic testing, she was found to have a dermatomyositis-systemic lupus erythematosus overlap syndrome. Her symptoms were refractory to initial medical management but finally resolved once she was switched to tofacitinib.
Website: https://www.selleckchem.com/products/INCB18424.html