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1.  Herpes Encephalitis Masquerading as Tumor 
ISRN Neurology  2011;2011:474672.
A 54 year old lady presented with lethargy and 15 kg weight loss over the past year. CT scan of the head revealed left temporal lobe hypodensity with a discrete area of hemorrhage within the left mesial temporal lobe. Due to concerns about impending central herniation, lumbar puncture was not performed. MRI of the brain showed a large lesion of the left temporal lobe, extending to the left frontal lobe, and very patchy meningeal enhancement. There was a noncontiguous lesion of the right insula. A differential diagnosis of herpes simplex encephalitis (HSE) and multifocal infiltrative glioma was entertained. MR spectroscopy demonstrated an increased choline peak at the level of the medial left temporal lobe and MR perfusion demonstrated patchy areas of hyperperfusion within the left anterior temporal lobe, both suggestive of neoplastic disease. Following open brain biopsy, pathology revealed herpes simplex virus (HSV) positive nuclei in the cortex and subcortical white matter. As both herpes simplex encephalitis and low-grade glioma demontrate MRI findings of hypointensity on T1 images and hyperintensity on T2 images, the diagnosis of herpes encephalitis can be clouded by confounding factors, especially when cerebrospinal fluid (CSF) cannot be obtained.
doi:10.5402/2011/474672
PMCID: PMC3263546  PMID: 22389820
2.  Preoperative Sclerotherapy Using Sodium Tetradecyl Sulphate (Fibro-Vein™) Can Assist in the Management of Vertebral Hemangiomas 
Global Spine Journal  2012;2(3):169-174.
Vertebral hemangiomas are benign lesions accounting for 2 to 3% of all spinal tumors. They are usually asymptomatic and found incidentally on imaging. Uncommonly, vertebral hemangiomas with significant epidural extension can result in radiculopathy or spinal cord compression. Decompressive surgery with or without stabilization is often required when neurological deficits are present. However, surgery can be associated with massive hemorrhage as these tumors are hypervascular. Preoperative embolization and sclerotherapy are well-known management strategies used to minimize intraoperative bleeding and improve symptoms. Recently, the use of sclerosants such as ethanol has decreased, due to reported complications such as Brown–Sequard syndrome. We describe the use of sodium tetradecyl sulfate (Fibro-Vein™, STD Pharmaceutical, Hereford, UK) as an effective alternative to ethanol in the preoperative management of vertebral hemangiomas. To our knowledge, this has not been previously reported. In three patients, we demonstrated minimal intraoperative blood loss using a combination of preoperative embolization of arterial feeders and sclerotherapy with sodium tetradecyl sulfate to control and secure venous drainage. No patients developed complications related to the procedure. In addition to minimal blood loss, a clear dissection plane was also noted intraoperatively.
doi:10.1055/s-0032-1315451
PMCID: PMC3864480  PMID: 24353964
vertebral hemangioma; sclerotherapy; Fibro-Vein™
3.  Multilevel vertebral hemangiomas: two episodes of spinal cord compression at separate levels 10 years apart 
European Spine Journal  2005;14(7):706-710.
This case report presents a 66-year-old woman with multiple vertebral hemangiomas causing spinal cord compression at different levels with a long symptom-free interval between episodes of compression. She presented with back pain and progressive weakness and numbness in her lower limbs for 3 months. Ten years earlier, she had had a symptomatic T4 vertebral hemangioma operated successfully, and had made a full recovery. Magnetic resonance imaging (MRI) of the thoracic and lumbar spine revealed multiple thoracic and lumbar vertebral hemangiomas. Extraosseous extension of a hemangioma at T9 was causing spinal cord compression. Selective embolization was performed preoperatively, and cord decompression was achieved via anterior T9 corpectomy. The patient’s neurological status improved rapidly after surgery. After a course of radiotherapy, she was neurologically intact and could walk independently. One year later, MRI showed complete resolution of the cord edema at T9, and showed regression of the high signal intensity that had been observed at unoperated levels. These findings indicated diminished vascularity and reduced aggression of the tumor.
doi:10.1007/s00586-005-0885-7
PMCID: PMC3489226  PMID: 15856339
Vertebral hemangioma; Cord compression; Embolization; Corpectomy
4.  Intramedullary Spinal Cord Metastasis of Choriocarcinoma 
The authors describe a case of choriocarcinoma that metastasized to the cerebral cortex, vertebral body, and intramedullary spinal cord. A 21-year-old woman presented with sudden headache, vomiting and a visual field defect. Brain computed tomography and magnetic resonance examinations revealed an intracranial hemorrhage in the left temporo-parietal lobe and two enhancing nodules in the left temporal and right frontal lobe. After several days, the size of the hemorrhage increased, and a new hemorrhage was identified in the right frontal lobe. The hematoma and enhancing mass in the left temporo-parietal lobe were surgically removed. Choriocarcinoma was diagnosed after histological examination. At 6 days after the operation, her consciousness had worsened and she was in a state of stupor. The size of the hematoma in the right frontal lobe was enlarged. We performed an emergency operation to remove the hematoma and enhancing mass. Her mental status recovered slowly. Two months thereafter, she complained of paraplegia with sensory loss below the nipples. Whole spine magnetic resonance imaging revealed a well-enhancing mass in the thoracic intramedullary spinal cord and L2 vertebral body. Despite chemotherapy and radiotherapy, the patient died 13 months after the diagnosis.
doi:10.3340/jkns.2012.51.3.141
PMCID: PMC3358599  PMID: 22639709
Choriocarcinoma; Intracerebral hematoma; Intramedullary spinal cord metastasis; Spinal metastasis
5.  AB 35. Dyspnoea and wheezing don’t always indicate asthma: a case of bronchial typical carcinoid 
Journal of Thoracic Disease  2012;4(Suppl 1):AB35.
Background
Bronchial carcinoids are classified among the pulmonary neuroendocrine tumors. They account for 1-2% of pulmonary tumors and 25% of carcinoid tumors. Due to their clinical presentation they can be falsely diagnosed as asthma.
Patients and methods
We present the case of a 42 year old woman who suffered from a typical carcinoid tumor which was successfully treated with lobectomy with bronchoplasty. The patient visited the emergency department because of fever and left chest pain, as well as paroxysmal cough. She reported a previous history of “pneumonia” 8 months ago. She was diagnosed with asthma since then, and followed systematic treatment with bronchodilators and ICS without any relief from her symptoms. At physical examination, breath sounds were decreased at the base of the left lung and the chest X-ray showed left lower lobe atelectasis. The CT chest scan that followed confirmed the presence of endobronchial tissue in the left main bronchus, without pathologically enlarged mediastinal or axillary lymph nodes. A bronchoscopy revealed a tumor, arising from the left lower lobe bronchus that caused its complete obstruction and almost complete blockage of the left main bronchus. A biopsy of the lesion was compatible with bronchial typical carcinoid.
Results
The patient experienced sudden deterioration of respiratory function and intense chest pain. She was urgently taken to the operating room where she underwent left lower lobectomy with bronchoplasty. The surgical specimen confirmed the histological diagnosis (limited number of mitosis <1/10 and immunophenotype: synaptophysin + chromogranin +, CD56+, CK8/18+, TTF-). Lymph node metastases were not detected. The postoperative course was smooth and the endoscopic control of the bronchial stump excellent.
Conclusions
In patients with persistent asthma symptoms that do not respond to medication, diagnosis should be revised. Lobectomy with bronchoplasty is a successful method of surgical removal of typical carcinoids and the long-term effects are comparable to those of pneumonectomy.
doi:10.3978/j.issn.2072-1439.2012.s035
PMCID: PMC3537440
6.  Right middle lobectomy for a primary pulmonary leiomyoma: a case report 
Cases Journal  2009;2:8673.
Introduction
Primary leiomyoma of the lung is a rare benign tumor that usually presents as a solitary lesion predominantly in young females. Fewer than 100 cases have been reported. Common symptoms include fever, chronic cough, hemoptysis, chest pain, shortness of breath, and pneumonias.
Case presentation
A 34-year-old, non-smoker female who presented with recurrent pneumonias. She was found to have a primary leiomyoma of the right middle lobe. This was treated by right middle lobectomy. 6-month follow up showed patient doing well without evidence of residual disease on computerized tomography.
Conclusion
Primary pulmonary leiomyoma is a rare tumor distinct from benign metastasizing leiomyoma. Histologic features include absence of mitotic count, low cellularity, lack of cytologic atypia and pleomorphism. Treatment is by conservative surgical resection and carries a favorable prognosis.
doi:10.4076/1757-1626-2-8673
PMCID: PMC2827106  PMID: 20184689
7.  Early Onset of Metastatic Gestational Trophoblastic Disease after Full-Term Pregnancy 
Choriocarcinoma is a curable malignancy that occurred approximately 50% after term pregnancies, and prognosis in this form of gestational trophoblastic Disease (GTD) is Poor. The earliest onset choriocarcinoma after term pregnancy in one study was reported 3 weeks after delivery, but in current study, choriocarcinoma was diagnosed 2 weeks after delivery. 28 years-old women gravidity 2, parity 2 delivered a healthy infant at term. Frequent episodes of vaginal bleeding occurred after 10 days of delivery. On admission to hospital, she had lesions in the lungs. The pretreatment human chorionic gonadotropin (HCG) level was 84,000 mIU/ml and her FIGO risk factor score was 8 (high risk group). The EMA/CO regimen was administered as first line chemotherapy and the patient achieved complete remission after 7 courses. Although early onset postpartum hemorrhage is due to complication of delivery, but gestational trophoblastic disease (GTD) may be occurred and assessment of human chorionic gonadotropin could be help to early diagnose of GTD.
PMCID: PMC3614675  PMID: 23675070
GTD; Choriocarcinoma; vaginal bleeding after delivery; EMA/CO
8.  Multiple peripheral typical carcinoid tumors of the lung: associated with sclerosing hemangiomas 
Diagnostic Pathology  2013;8:97.
Abstract
This study presents a first case of multiple peripheral typical carcinoid tumors associated with sclerosing hemangiomas in the lung. A 52-year-old male presented with incidentally detected multiple pulmonary nodules on a simple chest X-ray during routine health check-up. A computed tomography (CT) scan of the chest showed multiple nodular lesions in the middle and lower lobes of the right lung. These were initially suspected as inflammatory lesions due to miliary tuberculosis. However, possibility of malignancy could not be excluded and right lower lobe lobectomy was performed. Histopathologically, some nodules including two largest nodules were composed of small round to spindle shaped cells with fine chromatin pattern, whereas the rest of the sclerotic nodules were composed of two epithelial cell types- surface cells and round cells. The final diagnosis of this case was multiple peripheral typical carcinoid tumors associated with sclerosing hemangiomas of the lung. For past three years of post-surgery follow up period, no new lesions or changes in the right middle lobe have been identified.
Virtual Slides
The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1511610609725790.
doi:10.1186/1746-1596-8-97
PMCID: PMC3728223  PMID: 23773456
Carcinoid tumors; Sclerosing hemangiomas; Lung
9.  Ileal malignant hemangioendothelioma as a hypervascular lesion on computed tomography scan☆ 
INTRODUCTION
Malignant epithelioid hemangioendothelioma (EHE) is an uncommon and grave vascular tumor. EHE is frequently angiocentric and is associated with a medium sized vessel, especially a vein. No definite etiological associations have been ascribed to this tumor so far, except an association with oral contraceptives in EHE of liver.
PRESENTATION OF CASE
A 47 year old man presented with the complaint of intermittent black stool over the past two weeks. Occasionally, he experienced pain in left lower abdomen. On Computed Tomography (CT), it showed hypervascular lesion in the ileum with persistent enhancement. An exploratory laparotomy was performed with short segmental resection and functional end-to-end anastomosis. It was diagnosed finally with the histopathological and immunohistochemical analysis as a malignant EHE.
DISCUSSION
EHE is an uncommon endothelial tumor that most frequently arises in soft tissue, liver, lung and skeleton. It behaves biologically in between benign epithelioid hemangioma and the more aggressive epithelioid angiosarcoma. Although a standard systemic treatment for malignant EHE has not been fully established, complete surgical excision is strongly recommended if feasible.
CONCLUSION
EHE has a variable presentation and CT is helpful in identifying ileal EHE timely in the early stage, even when there is no obvious mass formation, however the diagnosis can be confirmed only after histopathological and immunohistochemical studies.
doi:10.1016/j.ijscr.2013.09.019
PMCID: PMC3907202  PMID: 24394857
Computed tomography (CT); Epithelioid hemangioendothelioma; Ileum; Immunohistochemical study; Prognosis
10.  Incidental placental choriocarcinoma in a term pregnancy: a case report 
Introduction
Gestational choriocarcinoma occurs in 1 in 40,000 pregnancies. Of all forms of gestational choriocarcinoma, placental choriocarcinoma is the most rare. Maternal choriocarcinoma is usually diagnosed in symptomatic patients with metastases. The incidental finding of a choriocarcinoma confined to the placenta with no evidence of dissemination to the mother, or infant is the least common scenario.
Case presentation
The patient is an 18 year-old Gravida 1 Para 1 African American female who delivered a viable 3641 g female infant at 39 weeks gestation. Her pregnancy course was complicated by gestational hypertension during the third trimester. Her placenta revealed intraplacental choriocarcinoma. She was then followed closely by the Gynecologic Oncology service with a weekly serum beta human chorionic gonadotropin value. Beta human chorionic gonadotropin values dropped from 3070 mIU/ml to less than 2 mIU/ml two months post partum. No chemotherapy was initiated. Metastasis was ruled out by chest x-ray and whole body computed tomography scan. To date, both mother and baby are well.
Conclusion
Due to the potential fatal outcome of placental choriocarcinoma, careful evaluation of both mother and infant after the diagnosis is made is important. The incidence of placental choriocarcinoma may actually be higher than expected since it is not routine practice to send placentas for pathological evaluation after a normal spontaneous delivery. The obstetrician, pathologist, and pediatrician should have an increased awareness of placental choriocarcinoma and its manifestations.
doi:10.1186/1752-1947-2-330
PMCID: PMC2577684  PMID: 18922186
11.  Infantile Hemangiomas Masquerading as Other Periocular Disorders 
Case Reports in Pediatrics  2012;2012:290645.
Periocular tumors are common in infancy. The most common periocular tumors are capillary hemangiomas, which are present in 1-2% of newborns and develop in 10%–12% of children by the age of 1 year old. Deep capillary hemangiomas may be more challenging to diagnose than superficial capillary hemangiomas and can be confused with other orbital lesions. Deep orbital hemangiomas can mimic teratoma, lymphangioma, rhabdomyosarcoma, metastatic neuroblastoma, and granulocytic sarcoma. In this paper, we describe 2 pediatric cases where previously diagnosed dermoid cyst and dacrocystocele were found to be capillary hemangiomas upon biopsy. Approaches to distinguish capillary hemangiomas from other periocular tumors are further discussed. To our knowledge, this is the first case report of periocular hemangiomas imitating a dermoid cyst and a dacrocystocele. These cases emphasize the importance of including infantile hemangiomas in the differential diagnosis of subcutaneous periocular abnormalities.
doi:10.1155/2012/290645
PMCID: PMC3350251  PMID: 22606529
12.  Post-traumatic pulmonary pseudocyst with hemopneumothorax following blunt chest trauma: a case report 
Introduction
Post-traumatic pulmonary pseudocyst is an uncommon cavitary lesion of the lung and develops after blunt chest trauma and even more rarely following penetrating injuries. It is generally seen in young adults presenting with cough, chest pain, hemoptysis, and dyspnea. Post-traumatic pulmonary pseudocyst should be included in the differential diagnosis of cavitary pulmonary lesions. We describe the case of a 60-year-old Caucasian Greek woman who sustained traumatic pulmonary pseudocyst with hemopneumothorax due to a blunt chest trauma after a traffic accident.
Case presentation
After a traffic accident, a 60-year-old Caucasian Greek woman sustained a hemopneumothorax due to a blunt chest trauma. There was evidence of an extensive contusion in the posterior and lateral segments of the right lower lobe, a finding that was attributed to an early sign of a cavitation, and the presence of a thin-walled air cavity was detected on the anterior segment of the right lower lobe in the control computed tomography taken 24 hours after admission. Our patient was treated by catheter aspiration, and the findings of computed tomography evaluation about one month later showed complete resolution of one of the two air-filled cavitary lesions. The second pseudocyst also disappeared completely, as shown by the control computed tomography scan performed six months later.
Conclusions
Traumatic pulmonary pseudocyst is a rare complication of blunt chest trauma, and computed tomography is a more valuable imaging technique than chest radiograph for early diagnosis.
doi:10.1186/1752-1947-6-356
PMCID: PMC3485102  PMID: 23083130
Traumatic pulmonary pseudocyst; lung cyst; blunt chest trauma; pulmonary contusion
13.  Infradiaphragmatic Extralobar Pulmonary Sequestration: Masquerading as Suprarenal Mass 
Journal of Clinical Neonatology  2013;2(3):146-148.
Pulmonary sequestration is a rare malformation, wherein a portion of lung is non-functional and is not in normal continuity with the tracheo-bronchial tree, and may derive its blood supply from systemic vessels. Two types are described: Intralobar and extralobar types. Intralobar sequestration is more common type, which shares visceral pleura of the involved lobe and is localized within the normal pulmonary parenchyma. Whereas extralobar forms are uncommon and are totally separate from the lung and usually have own covering. Infra-diaphragmatic pulmonary sequestration is of extralobar type and is extremely rare, and usually is associated with other congenital malformations. We present an extremely rare case of isolated infra-diaphragmatic pulmonary sequestration which was antenatally detected and followed up with postnatal CT scan, where it masqueraded as suprarenal mass, and was surgically treated. This case emphasises to add a differential diagnosis of malformation in congenital supra-renal masses, which remain stable in size and appearance, and hence avoid immediate surgery.
doi:10.4103/2249-4847.120009
PMCID: PMC3830153  PMID: 24251262
Extralobar; intralobar; sequestration; sub-diaphragmatic; suprarenal mass
14.  Primary lung cancer presenting with metastasis to the colon: a case report 
Although about 50% of lung cancers have distant metastasis at the time of initial diagnosis, colonic metastases are extremely rare. This report presents a rare clinical case of colonic metastasis from primary squamous cell carcinoma of the lung.
A 60-year-old female with anorexia and fatigue was referred to the department of pulmonary surgery in our hospital. The patient was diagnosed with primary squamous cell carcinoma of the lung, T2b N3 M1b Stage IV, and chemoradiotherapy was initiated. This treatment led to a good partial response in the primary lung lesion without any new metastatic lesions.
The patient developed left abdominal pain due to a bulky sigmoid colon tumor 6 months later, and was preoperatively diagnosed with primary colon cancer. She underwent colonic resection, and the pathology specimen demonstrated poorly differentiated squamous cell carcinoma that was suspected to be colonic metastasis from the primary lung cancer. The postoperative course was uneventful, and she was discharged. Chemotherapy for the lung cancer was scheduled in the department of pulmonary surgery.
This report presented a rare case of colonic metastasis from lung cancer. When patients with advanced primary lung cancer complain of abdominal symptoms, we should consider gastrointestinal tract metastasis from lung cancer.
doi:10.1186/1477-7819-10-127
PMCID: PMC3433337  PMID: 22741562
Colonic metastasis; Primary lung cancer; Squamous cell carcinoma
15.  Thoracic extraosseous, epidural, cavernous hemangioma: Case report and review of literature 
A 40-year-old male presented with mid-thoracic backache and progressive, ascending, spastic, paraparesis for one year. Magnetic resonance imaging demonstrated an extraosseous, extradural mass, without any bone invasion at the T2-T4 vertebral levels, located dorsal to the thecal sac. The spinal cord was compressed ventrally. The lesion was totally excised after a T2-T4 laminectomy. Histopathological examination revealed a cavernous hemangioma. The authors reported this case and reviewed the literature, to explain why extraosseous, extradural, cavernous hemangiomas should be considered in the differential diagnosis of extradural thoracic compressive myelopathy.
doi:10.4103/0976-3147.118772
PMCID: PMC3821420  PMID: 24250167
Cavernous hemangioma; epidural; magnetic resonance imaging; myelopathy; thoracic spine
16.  Demyelinating disease masquerading as a surgical problem: a case series 
Introduction
We report three cases of demyelinating disease with tumor-like presentation. This information is particularly important to both neurosurgeons and neurologists who should be aware that inflammatory demyelinating diseases can present as a mass lesion, which is indistinguishable from a tumor, both clinically and radiologically, especially when there is no evidence of temporal dissemination of this disease.
Case presentation
The first patient was a 42-year-old Malay woman who developed subacute onset of progressive quadriparesis with urinary incontinence. Magnetic resonance imaging of her spine showed an intramedullary lesion at the C5-C7 level. She was operated on and biopsy was suggestive of a demyelinating disease. Retrospective history discovered two episodes of acute onset of neurological deficits with partial recovery and magnetic resonance imaging of her brain revealed demyelinating plaques in the centrum semiovale.
The second patient was a 16-year-old Malay boy who presented with symptoms of raised intracranial pressure. A computed tomography brain scan revealed obstructive hydrocephalus with a lesion adjacent to the fourth ventricle. An external ventricular drainage was inserted. Subsequently, a stereotactic biopsy was taken and histopathology was reported as demyelination. Retrospective history revealed similar episodes with full recovery in between episodes.
The third case was a 28-year-old Malay man who presented with acute bilateral visual loss and confusion. Magnetic resonance imaging of his brain showed a large mass lesion in the right temporoparietal region. Biopsy was consistent with demyelinating disease. Reexamination of the patient revealed bilateral papillitis and not papilledema. Visual evoked potential was prolonged bilaterally. In all three cases, lumbar puncture for cerebrospinal fluid study was not carried out due to lack of patient consent.
Conclusions
These cases illustrate the importance of considering a demyelinating disease in the differential diagnosis of a mass lesion. Critical analyses of clinical presentations coupled with good physical examination are vital in assisting clinicians to reach the correct diagnosis.
doi:10.4076/1752-1947-3-7407
PMCID: PMC2737773  PMID: 19830201
17.  Multiple Pulmonary Metastases following Total Removal of a Bilateral Parasagittal Meningioma with Complete Occlusion of the Superior Sagittal Sinus: Report of a Case 
Pulmonary metastases of benign meningiomas are extremely rare. The case of a 34-year-old man with bilateral parasagittal meningioma who developed pulmonary metastases is described. The meningioma was an enormous hypervascular tumor with invasion of the superior sagittal sinus. The tumor was resected completely and histologically diagnosed as transitional meningioma. The Ki-67 labeling index was 5%. Four months after operation, the patient subsequently developed bilateral multiple lung lesions later identified as metastases. The lung lesions were partially removed surgically and histologically diagnosed as meningothelial meningioma WHO grade I. The Ki-67 labeling index was 2%. The histological findings demonstrated that the tumor occupied the arterial lumen and the perivascular space, suggesting that pulmonary tumors might metastasize via the vascular route. The histopathological features and mechanisms of metastasizing meningiomas are reviewed and discussed.
doi:10.1155/2012/121470
PMCID: PMC3420403  PMID: 22934204
18.  Choriocarcinoma with lung metastases during pregnancy with successful delivery and outcome after chemotherapy. 
Thorax  1990;45(5):416-418.
A patient with an intrauterine pregnancy of 27 weeks had a coexisting pulmonary metastatic choriocarcinoma. On the chest radiograph the lung metastases appeared as pulmonary infiltrates, simulating atypical pneumonia. Serum human chorionic gonadotrophin levels were normal for gestational age. Treatment with methotrexate was successful. This is the first reported case of choriocarcinoma in a woman with a pregnancy of less than 35 weeks in which both mother and child survived. The case emphasises the need to consider choriocarcinoma in any pregnant woman who presents with haemoptysis and pulmonary nodules or infiltrates.
Images
PMCID: PMC462498  PMID: 2382249
19.  Metastatic endometrial stromal sarcoma masquerading as pulmonary lymphangioleiomyomatosis. 
Journal of Clinical Pathology  1999;52(2):147-148.
A 39 year old female presented with bilateral pneumothoraces and interstitial shadowing on chest x ray. A diagnosis of lymphangioleiomyomatosis was made following an open lung biopsy. Over the next eight years she developed respiratory failure leading to single lung transplantation but she died in the immediate postoperative period. Necropsy examination and review of the previous open lung biopsy revealed multiple pulmonary metastases from a low grade endometrial stromal sarcoma of the uterus. This case high-lights the importance of an accurate diagnosis before transplantation.
Images
PMCID: PMC501062  PMID: 10396245
20.  Multidrug resistant tuberculosis co-existing with aspergilloma and invasive aspergillosis in a 50 year old diabetic woman: a case report 
Cases Journal  2008;1:303.
Aspergilloma and invasive aspergillosis coexisting with multidrug resistant Mycobacterium tuberculosis (MDR-TB) in the same patient is a rare entity. We report a 50 year old South Indian woman, a diabetic, who presented to us with complaints of productive cough and hemoptysis for the past 2 months. She was diagnosed to have pulmonary tuberculosis 2 years ago for which she took irregular treatment. Lung imaging showed features of a thick walled cavity in the right upper lobe with an indwelling aspergilloma. She underwent a right lung upper lobe resection. Biopsy and culture of the resected specimen showed the coexistence of Aspergillus fumigatus and multi-drug resistant Mycobacterium tuberculosis. 2 blood cultures grew Aspergillus fumigatus. She was successfully treated with Voriconazole and anti tuberculous therapy against MDR-TB.
doi:10.1186/1757-1626-1-303
PMCID: PMC2585581  PMID: 18992166
21.  Massive hemoptysis and deep venous thrombosis presenting in a woman with Hughes-Stovin syndrome: a case report 
Introduction
Hughes-Stovin syndrome is a very rare disease with fewer than 30 cases reported in the literature. The disease is thought to be a variant of Behcet's disease and is defined by the presence of pulmonary artery aneurysm in association with peripheral venous thrombosis.
Case presentation
A previously healthy 23-year-old Saudi woman presented with massive hemoptysis a day prior to her admission to our hospital. She had a six-month history of recurrent fever, cough, dyspnea, and recurrent oral ulceration. Contrast-enhanced computed tomography scan of her chest and pulmonary angiogram demonstrated a single right-lower lobe pulmonary artery aneurysm. She underwent thoracotomy and right lower lobe resection. Her postoperative course was complicated by deep vein thrombosis. She also developed headache and papilledema, while a magnetic resonance imaging of her brain suggested vasculitis. Based on these clinical presentations, she was diagnosed and treated with Hughes-Stovin syndrome.
Conclusion
The majority of cases of Hughes-Stovin syndrome are reported among men, with only two cases occurring in women. A case of Hughes-Stovin syndrome occurring in a woman is presented in this report. She was treated successfully with multimodality treatment that includes surgery, steroids and cytotoxic agents.
doi:10.1186/1752-1947-4-109
PMCID: PMC2864281  PMID: 20409300
22.  Resection of giant liver hemangioma in a pregnant woman with coagulopathy: Case report and literature review 
Journal of Prenatal Medicine  2011;5(4):93-96.
Background
Hemangioma is a common benign tumor in the liver and usually asymptomatic. Scanty evidence concerning treatment modality of symptomatic hemangioma during pregnancy exists.
Case
A 35 year-old woman with giant hepatic cavernous hemangioma developed consumption coagulopathy due to the enlarged tumor, and underwent danaparoid therapy from 5 weeks of gestation (GW). Magnetic resonance image revealed giant hemangioma with 20 cm in diameter in the right lobe of the liver. A surgical operation of liver resection was successfully performed at 16 GW. Thereafter, the coagulopathy disappeared. She delivered a healthy male infant at 36 GW.
Conclusion
This is the first case report of surgical resection therapy for giant liver hemangioma during pregnancy.
PMCID: PMC3399053  PMID: 22905301
liver hemangioma; pregnancy; resection; danaparoid
23.  Systemic dissemination of chronic necrotizing pulmonary aspergillosis in an elderly woman without comorbidity: a case report 
Introduction
Chronic necrotizing pulmonary aspergillosis usually occurs in mildly immune-compromised hosts or those with underlying pulmonary disease. The radiographic pattern of chronic necrotizing pulmonary aspergillosis is typically a progressive upper lobe cavitary infiltrate with pleural thickening. We report here an atypical case of chronic necrotizing pulmonary aspergillosis mimicking lung cancer, which developed into a disseminated fatal disease in an older woman with no comorbidity.
Case presentation
An 80-year-old Japanese woman was referred to our hospital for a chest roentgenogram abnormality. Repeated fiber-optic bronchoscopy could not confirm any definite diagnosis, and she refused further examinations. Considering the roentgenogram findings and her age, she was followed-up as a suspected case of lung cancer without any treatment. Then, 10 months later, she complained of visual disturbance and was admitted to our department of ophthalmology. She was diagnosed as having endophthalmitis. After treatment with corticosteroids for 20 days, she developed acute encephalitis and died four weeks later. Autopsy revealed dissemination of Aspergillus hyphae throughout her body, including her brain.
Conclusions
In older patients, even if they do not have any comorbidity, chronic necrotizing pulmonary aspergillosis should be added to the differential diagnosis of solitary pulmonary lesions in a chest roentgenogram.
doi:10.1186/1752-1947-6-270
PMCID: PMC3470993  PMID: 22938191
24.  Cutaneous Metastasis of Choriocarcinoma : A Case Report 
Journal of Korean Medical Science  2005;20(4):683-686.
Choriocarcinoma is one of the malignant tumors of trophoblastic cells characterized by the secretion of human chorionic gonadotrophin (hCG) (1-3). Cutaneous metastasis is a rare presentation of choriocarcinoma but a poor prognostic sign because it is associated only with widespread disease (3-5). A 52-yr-old female complaining of dyspnea for 2 months, presented with fingertip sized erythematous nodules on the left side of the neck and the right side of the upper back of 1 month duraton. She has suffered from Behçet's disease since 1999. Microscopic examination of a nodule of upper back demonstrated biphasic pattern of cytotrophoblasts and hCG-positive syncytiotrophoblasts, and the typical histologic features of choriocarcinoma. She was referred to the gynecological oncology department. After 17 cycles of combination chemotherapy, the serum hCG level has fallen from 700,000 to under 2.0 mIU/mL and the skin lesions have almost disappeared. However, after 3 months, total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed due to elevated serum hCG level (4,447.7 mIU/mL), and she is scheduled to receive post-operative adjuvant chemotherapy.
doi:10.3346/jkms.2005.20.4.683
PMCID: PMC2782171  PMID: 16100467
Choriocarcinoma; Neoplasm Metastasis
25.  Hemoptysis in a patient with congestive heart failure and pulmonary emboli. 
This article reports a case of profuse hemoptysis in pulmonary embolism and reviews the literature. A 74-year-old patient with hypertension and dilated cardiomyopathy was admitted to the hospital for exacerbation of congestive heart failure and hemoptysis. During hospitalization, the patient had hemoptysis of 270 cc during a 24-hour period. Chest radiograph showed bilateral lower lobe infiltration. Fiberoptic bronchoscopy was performed and revealed active bleeding from both lower lobes of the lungs. An endobronchial lesion was not seen, and the patient had an open lung biopsy. Histological examination of the lung tissue revealed an organized thrombus.
Images
PMCID: PMC2607681  PMID: 8046768

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