Journal of Clinical Case Reports

Invasive Lobular Cancer (ILC) of the breast accounts for about 15% of breast malignancies and tend to present as multiple lesions and involve bilateral breasts compared to Invasive Ductal Cancer (IDC). Because of its subtle symptoms, ILC would present late in terms of age and disease stage. This is a case of an otherwise healthy, middle aged women presenting with progressive abdominal distention and dyspepsia. Later she was found to have multiple widespread malignancies originating from the breast. Breast cancer metastasis to Gastrointestinal Tract (GIT) occurrence is rare and is more commonly observed among ILCs. There are few cases reported of ILC with GIT metastasis and even less with multiple GIT metastasis. Here we report a case with multiple GIT, and other site of metastasis with initial presentation of late stage breast cancer disease.

Invasive Lobular Cancer (ILC) of the breast accounts for about 15% of breast malignancies and tend to present as multiple lesions and involve bilateral breasts compared to Invasive Ductal Cancer (IDC). Because of its subtle symptoms, ILC would present late in terms of age and disease stage. This is a case of an otherwise healthy, middle aged women presenting with progressive abdominal distention and dyspepsia. Later she was found to have multiple widespread malignancies originating from the breast. Breast cancer metastasis to Gastrointestinal Tract (GIT) occurrence is rare and is more commonly observed among ILCs. There are few cases reported of ILC with GIT metastasis and even less with multiple GIT metastasis. Here we report a case with multiple GIT, and other site of metastasis with initial presentation of late stage breast cancer disease.

The use of endosseous implants provides dentistry, the solution in many problems. Someone who worked
in early 90’s may remember, the full arch reconstructions in periodontal teeth, the heroic attempts for endodontic
treatments, root-end resections (palatal roots of molars, mandibular premolars), root resections/root separations
of molars. Today no uses these approaches, because our patients after spending time, effort, and money, want
solutions with proven durability, solutions that only endosseous implants can provide. In fixed prosthodontics,
natural bone, late loading, good surgery, the failure rate is something like 2%. Friberg et al. conducted a study
comprising of 4641 Branemark dental implants for a period of 3 years and reported a failure rate of 1.5%. My
statistics in these conditions are 1%. Failure rate in immediate loading rise (9%), also in maxillary overdentures with
4 implants freestanding (15%), and when I use implants to salvage removable partial dentures (20%) (my statistics).
It is believed that in the field of general dentistry the failure rate is bigger. Also, when we use removable interim
rehabilitations, we have to expect high failure rates. I had a patient with a removable interim rehabilitation, and he
gave me in the hand the implant after one week, (was inserted with torque 55 N-cm and closed with the gingiva).

Purpose: Chordomas arise from embryonic notochordal remnants along the length of the neuraxis at
developmentally active sites. They constitute less than 1% of CNS tumors and r: rely occur in extra-axial locations.
Chordoma in the thoracic spine is considered rare and comprises less than 15% of all chordomas.
Case study: A healthy, 42-year-old male presented with radiculating low back pain, with a sudden onset four
weeks prior to this examination. He complained of paresthesias, unstable walk patterns and difficulties in urination;
however, no neurologic deficits were reported. On CT and MRI, an occupying soft tissue lesion was detected with
pressure on the thecal sac at the level of D6-D9 vertebrae. The lesion was irregular and diagnosed initially as a
dermoid tumour. After primary debalking and fixation, the pathological biopsy revealed a chordoma. The patient had
a second surgery to change the primary fixators to carbon made rods prior to Proton Beam Therapy.
Discussion: According to the imaging and location of the lesion, chordoma was not the suggested diagnosis.
Surprisingly, based on the histopathological results, a chordoma was diagnosed. Due to the multidisciplinary
treatment approach, the patient was prepared for following radiotherapy treatment. Two years after treatment, there
are no signs of a lesion or clinical signs of thecal sac involvement.
Conclusion: When suspicion of an irregular space-occupying lesion arises, always act as if a malignancy is
present. We recommend a multidisciplinary approach in coordination with oncologists, pathologists, the surgical
team and the radiation centre for management of such cases.

Pseudocyst is a common complication of acute and chronic pancreatitis, which occurs in about 30-40% of adult
patients with chronic pancreatitis. We present the case of a 43-year-old male diagnosed with chronic pancreatitis
(alcohol related) complicated by a pseudocyst located in the head of the pancreas and manifested with abdominal
pain and loss of weight. Management of chronic pancreatitis with pseudocyst depends on pancreatic pathology,
diameter of the main pancreatic duct, size of the pseudocyst, and the expertise of the department. Non-surgical
treatment, which is the basic therapy, is inferior to endotherapy and operation. The obstruction of the main pancreatic
duct being resolved, the abdominal pain and insufficiency of exocrine and endocrine function could be alleviated.
Our drainage procedure described herein, making the pseudocyst and main pancreatic duct fusion and function like
a hollow organ, may be a useful, even a simpler surgical technique, that could relieve symptoms and offer quality
of life to patients.

The diagnosis of congenital heart disease in adulthood is not unusual, but Eisenmenger syndrome is a rare
complication associated with substantial morbidity and mortality. It occurs mostly in patients with post tricuspid
defect or complex lesions. Exceptionally found in patients with pre-tricuspid defect, especially in the case of the
ostium secundum atrial septal defect. While lung (plus defect repair) or combined heart and lung transplantation is
thought be the definitive treatment for Eisenmenger syndrome, transplant organs are a limited resource and longterm
results are still suboptimal. Eisenmenger syndrome patients have benefitted greatly from recent advances in
the management of this condition, especially the introduction of pulmonary artery hypertension therapies. We report
the case of a 39-year-old woman who was admitted with signs of progressive dyspnea who was diagnosed with
ostium secundum atrial septal defect complicated by Eisenmenger syndrome.

Central serous retinopathy is one of relatively common clinical conditions, it is an idiopathic disorder characterized
by a localized serous detachment of the sensory retina at the macula due leakage from the choriocapillaris through
focal or diffuse retinal pigment epithelial defects. Usually affects the middle age people. Risk factors include type A
personality, use of systemic steroids, stress, pregnancy and autoimmune diseases. The acute course of the disease
(ACSR) usually spontaneously resolved within 3-6 months in 80% of cases, while the chronic course (CSCR)
lasting more than 12 months. Multimodal new imaging techniques like Swept Source OCT (SS-OCT), FAF (Fundus
Autofluorescence), FA (Fluorescein Angiography) and ICG (Indocyanine Green) are necessary to diagnose atypical
cases of CSCR that may be misdiagnosed as an inflammatory sensory detachment that leading to inappropriate
treatment and visual loss.

The Hepatitis A (HA) infection that occurs is usually resolved within a few weeks after the onset of the disease.
Some rare cases of Autoimmune Hepatitis have been reported after acute viral infections including HA. The aim of
this report is to describe a well-documented case of Autoimmune Hepatitis which was triggered by a protracted HA
to report published cases and to discuss the mechanism of such a disease.