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1.  Prompt recognition of stump appendicitis is important to avoid serious complications: a case report 
Cases Journal  2009;2:7415.
Introduction
Stump appendicitis is a rare complication of appendectomy due to recurrent inflammation of the residual appendix. The diagnosis is often delayed due to low index of suspicious, which may result in serious complications.
Case presentation
We describe a case of stump appendicitis occurred 12 months after appendectomy in 25 years old man. Despite past medical history of appendectomy the diagnosis was made by means of ultrasound scan and an high degree of clinical suspicion.
Conclusions
Stump appendicitis is a rare but important complication of appendectomy, often misdiagnosed. Prompt recognition is important to avoid serious complications. This pathologic entity should always be kept in mind on case of right lower quadrant pain.
doi:10.4076/1757-1626-2-7415
PMCID: PMC2740171  PMID: 19829956
2.  Benign myoepithelioma of the lung - a case report and review of the literature 
Cases Journal  2010;3:25.
Introduction
Benign myoepithelioma is extremely rare in the lung, to the best of our knowledge; only five cases have been reported in the literature.
Case Report
An 18-years woman complained from tiredness and fever during four months. Laboratory findings and fibroscopies were normal. CT of the thorax demonstrated a nodule in the left segment of the Fowler. Left inferior lobectomy was performed comporting a firm nodule of 25 mm, lifting the bronchial mucous membrane. Histologically, there was a proliferation of small cells of a plasmocytoid-type, with a predominantly whorled pattern. No mitotic activity or necrosis was seen in the tumor. Immuhistochemically, the tumor cells positive for smooth muscle actin, vimentine, and S100 protein. They were negatives for cytokeratine, chromogranine and HMB45. The diagnosis of benign myoepithelioma of the lung is so confirmed. The patient recovered well at 6 months follow-up.
Conclusion
Benign myoepithelioma is a rare pulmonary neoplasm distinct from pleomorphic adenoma, which should be considered in the differential diagnosis of lung nodules.
doi:10.1186/1757-1626-3-25
PMCID: PMC2828429  PMID: 20180958
3.  Celiac disease with a mixed pattern: a case report 
Cases Journal  2009;2:9330.
Introduction
Celiac disease can be severe and associated with progressive malabsorption and death. A subset of patients may develop subepithelial collagen deposition, a condition referred to as collagenous sprue.
Case presentation
We report a case of a 46-year-old female who was previously diagnosed as having seronegative arthritis and inflammatory bowel disease, and three years later after the initial diagnosis she was histologically confirmed to have celiac disease in association with collagenous sprue, another underlying malabsorptive disorder.
Conclusion
Although the precise relationship between celiac disease and collagenous sprue has been debated and remains controversial, it should be considered among the differential diagnoses of chronic diarrhea with progressive malabsorption.
doi:10.1186/1757-1626-2-9330
PMCID: PMC2803990  PMID: 20062590
4.  Safety of trastuzumab (Herceptin®) during pregnancy: two case reports 
Cases Journal  2009;2:9329.
We report on two cases of women on trastuzumab therapy for breast cancer who became pregnant and delivered healthy live infants. At the time of reporting the children are growing and developing normally (ages 3 and 2).
doi:10.1186/1757-1626-2-9329
PMCID: PMC2803989  PMID: 20062589
5.  Glycogen storage disease type III presenting with secondary diabetes and managed with insulin: a case report 
Cases Journal  2009;2:6891.
Introduction
Reports of secondary diabetes in glycogen storage disease type III have been very limited, where the pathogenesis and management have not been clear. Here we report on a rare case of secondary diabetes in glycogen storage disease type III that has been successfully managed with insulin.
Case presentation
This is a 19-year-old female of Egyptian ethnicity, born of a consanguineous marriage and known to have glycogen storage disease type III since the age of 2½ years. She presented to us with a history of polyuria, polydipsia, and loss of weight of a few days duration. Physical exam showed stunted growth, hepatomegaly, myopathy and mild dehydration. Emergency labs revealed a fasting blood glucose of 276 mg/dl, but with no ketonuria and arterial blood gases were essentially normal. Her liver transaminases were mildly elevated at the time. Review of her records revealed that the diagnosis of glycogen storage disease type III was made at the age of 2½ when the mother reported repeated attacks of afebrile (hypoglycemic) convulsions, increasing abdominal girth and failure to thrive. The diagnosis was confirmed by demonstration of debrancher enzyme deficiency on enzymatic assay. Over the years she developed liver dysfunction along with other complications and subsequently her hypoglycemic attacks disappeared a few years prior to her current presentation. After careful consideration of different treatment options, and considering she had been free of hypoglycemic attacks for a few years and had liver dysfunction, we chose to cautiously initiate the patient on insulin therapy. She was still poorly controlled and we gradually increased her total daily dose to 0.8 u/kg. She continued to be free of hypoglycemic attacks and her average daily blood glucose is about 160 mg/dl.
Conclusion
We report a rare case of secondary diabetes mellitus in a patient with glycogen storage disease type III managed with insulin. We recommend insulin therapy over oral hypoglycemics to avoid further hepatotoxicity, provided hypoglycemia has resolved. We also recommend serial follow up of glycogen storage disease type III patients with an oral glucose tolerance test for early detection and management of glucose intolerance.
doi:10.4076/1757-1626-2-6891
PMCID: PMC2740253  PMID: 19829878
6.  Rupture of urinary bladder: a case report and review of literature 
Cases Journal  2009;2:7004.
Introduction
Spontaneous rupture of the urinary bladder is a rare event. Patients usually present with features of peritonitis and diagnosis is usually made at operation. The morbidity and mortality rate is very high in these groups of patients.
Case presentation
We present a case of a 47-year-old caucasian woman who was known to have transitional cell carcinoma of the urinary bladder who presented with features of peritonitis. An exploratory laparotomy revealed free perforation of the urinary bladder. The perforation was closed. However, on the second post-operative day she started draining urine from the abdominal drain and was taken back to the operating theatre. The stitches in the urinary bladder had given off and she underwent radical cystectomy along with double barrel cutaneous ureterostomies. Peritoneal biopsies revealed disseminated transitional cell carcinoma in the peritoneum. She made a slow postoperative recovery.
Conclusion
Perforation of the urinary bladder should be considered in patients presenting with peritonitis particularly with a previous history of urinary bladder cancer.
doi:10.1186/1757-1626-2-7004
PMCID: PMC2740071  PMID: 19829892
7.  Metastatic follicular thyroid carcinoma to the mandible: a case report 
Cases Journal  2009;2:6533.
Introduction
Metastatic lesions to the oro-facial region may be the first evidence of dissemination of an unknown tumour from its primary site.
Case presentation
We described a case of metastatic follicular thyroid carcinoma to the mandible presenting with pain and loosening of teeth in a 70 years old female patient leading to extraction of the loose teeth.
Conclusion
The present case emphasizes the importance of considering metastasis in the differential diagnosis of swelling related to loosening of teeth, even though the patient had no history of any malignant disease.
doi:10.1186/1757-1626-2-6533
PMCID: PMC2709969  PMID: 19829820
8.  Primary lymphoma of the head and neck: two case reports and review of the literature 
Cases Journal  2008;1:426.
Background
The head and neck is the second most common region for the extra-nodal lymphomas after that of gastrointestinal tract. Approximately 2.5% of malignant lymphoma arises in the oral and para-oral region. In this paper we report two cases of early stage head and neck lymphoma which were managed successfully with chemotherapy and a review of the related literature.
Cases presentation
The first case concerns a 48 years male patient having a diffuse large B-Cell lymphoma of the oropharynx at early bulky stage. This patient was managed successfully with 7 of Rituximab 375 mg/m2, Cyclophosphamide 750 mg/m2 d1, Doxorubicine 50 mg/m2 d1, Vincristine 1.4 mg/m2 d1, and prednisone 50 mg/m2 d1-5 (RCHOP) regimen. The second case concerns a 50 years female patient having the nasal natural killer (NK)/T-cell lymphoma of the left nasal pit at early stage. This case was managed successfully with 6 of Cyclophosphamide 750 mg/m2 d1, Doxorubicine 50 mg/m2 d1, Vincristine 1.4 mg/m2 d1, and prednisone 50 mg/m2 d1-5 (CHOP) regimen.
Conclusion
These two cases highlight the important role of CHOP based chemotherapy for achieving successful treatment cure for patients having an early stage head and neck lymphoma.
doi:10.1186/1757-1626-1-426
PMCID: PMC2639388  PMID: 19116013
9.  A postmenopausal women presenting with atypical symptoms and cervical cancer: a case report 
Cases Journal  2008;1:401.
Background
Globally cervical cancer kills millions of women every year. There is a wealth of evidence suggesting that cervical screening is one of the best defences against the development of cervical cancer. Lives could be saved if medical practitioners make a point of routinely enquiring about the date and result of the patient's last cervical smear test and if they repeatedly emphasize the importance of attendance for cervical smear tests, especially in post-menopausal women.
Case presentation
A 66 year old caucasian woman presented with symptoms of a lower respiratory tract infection, weight loss, anorexia and night sweats. There was no history of post menopausal bleeding. She was admitted for intravenous antibiotics. A few days later she developed vomiting, abdominal pain and a brown vaginal discharge.
She then had a CT scan which showed a pyometra extending to the umbilicus, with an intrauterine contraceptive device noted inside. After re-taking the history, it emerged that a Lippes loop was inserted 25 years previously. The patient was not given relevant information at the time and then unfortunately was lost to follow up.
The pyometra was drained and the coil removed. However, at operation cervical cancer was suspected and biopsies taken. The patient's sepsis improved after pyometra drainage but histology subsequently confirmed stage 1B squamous cell cervical carcinoma. She was referred for a radical hysterectomy.
Conclusion
Every consultation is an opportunity for health education and promotion. Patients need to be encouraged to utilize cervical screening programmes. It is also important to remember that cervical cancer can present with non-specific symptoms, thus the onus is on all doctors to take a good history and perform a thorough examination. Failing to do so may delay making the right diagnosis, with associated morbidity and mortality.
doi:10.1186/1757-1626-1-401
PMCID: PMC2615766  PMID: 19087324
10.  Massive gastrointestinal haemorrhage due to gastritis cystica profunda 
Cases Journal  2008;1:85.
Introduction
Gastritis Cystica Profunda is a well recognized entity which may occur several years after previous gastric surgery. This is a premalignant condition and may lead on to carcinoma of the stomach.
Case presentation
We report a case of a 50-year-old man with epigastric pain and haematemesis. 28 years ago he had undergone partial gastrectomy and gastroenterostomy for benign gastric ulcer. An Upper gastrointestinal endoscopy showed a possible bleeding vessel on the anterior wall lesser curve of the stomach. The lesion was injected with adrenaline 1 in 100,000. In spite of the intervention he continued to have haemetemesis with significant haemodynamic impairment. At exploratory laparotomy, an oedematous ridge on the posterior wall with a bleeding point on the posterior gastric wall. Histology showed features consistent with gastritis cystica profunda. He made an excellent post-operative recovery.
Conclusion
We suggest that patients who are diagnosed with gastritis cystica profunda should be regularly followed up as this is a premalignant condition.
doi:10.1186/1757-1626-1-85
PMCID: PMC2531171  PMID: 18699997
11.  Misleading menorrhagia in a peri-menopausal woman with underlying bowel cancer: a case report 
Cases Journal  2008;1:36.
A peri-menopausal woman presented with symptoms and signs suggestive of fibroids. She was fit and healthy with no significant past medical history. She consented to having a hysterectomy but her surgery was performed prior to any diagnostic imaging being done.
At surgery there was an unexpected finding of disseminated carcinoma, diffusely infiltrating the uterus, fallopian tubes and ovaries. There was an omental cake that was biopsied. Frozen section showed signet ring cells, suggesting bowel carcinoma. Further intra-operative examination revealed a caecal tumour. After surgery she was investigated further and eventually referred for palliation, due to her advanced disease.
doi:10.1186/1757-1626-1-36
PMCID: PMC2488321  PMID: 18627620
12.  Pyometra presenting in conjunction with bowel cancer in a post-menopausal women: a case report 
Cases Journal  2008;1:24.
This case describes a 71 year old, post-menopausal woman who developed vaginal discharge. This complaint ultimately led to the discovery of bowel cancer in conjunction with a large sterile pyometra.
The pyometra was not due to genital malignancy. The most likely conclusion is that the pyometra may have arisen as an inflammatory response to the adjacent bowel pathology. This case report highlights the need for clinicians to consider non-gynaecological cancer as a possible cause for otherwise unexplained pyometra.
doi:10.1186/1757-1626-1-24
PMCID: PMC2474575  PMID: 18606021

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