We have inferred that in patients with breast cancer, various biological parameters such as tumor size, grade, histology, and hormonal receptor status have different impact on tumor metabolic activity.
Transitional cell carcinoma (TCC) urinary bladder is known to metastasize to regional lymph nodes (LNs), liver, lung, bone, adrenal glands, and intestine. However, an asymptomatic TCC bladder manifesting as metastatic axillary LN mass and extensive retroperitoneal lymphadenopathy is rarely heard of. A 46-year-old male, smoker, presented with 8 cm × 6 cm right axillary swelling of 1-month duration. Aspiration cytology revealed metastatic deposits of poorly differentiated carcinoma favoring TCC. Metastatic evaluation with 18F-fluorodeoxyglucose positron emission tomography (18FDG-PET) scan showed mass lesion urinary bladder, conglomerate right axillary mass and extensive retroperitoneal LNs with significant metabolic activity, biopsy from which revealed deposits of TCC. Transurethral-resection of bladder confirmed TCC and was exhibited palliative chemotherapy on which he progressed. Received palliative radiotherapy to axilla to which he showed significant symptomatic clinical response. He developed obstructive uropathy and was kept on supportive care. Review of literature reveals that our case may be the second case of TCC bladder with generalized lymphadenopathy and the first case of asymptomatic bladder carcinoma manifesting with upfront disseminated abdominopelvic lymphadenopathy detected by 18FDG-PET scan ever reported in world literature.
Frostbite or cold burn is the medical condition in which localized damage is caused to exposed skin and subcutaneous tissue due to freezing. Frostbite most likely involves body parts farthest from the heart and those with large exposed areas. At or below 0 °C (32 °F), blood vessels close to the skin start to constrict, and blood is shunted away from the extremities via the physiological feedback action of glomus bodies. This peripheral vasoconstriction helps to conserve core body temperature. In extreme cold, or when certain parts of the body are exposed to cold conditions for long periods, this protective mechanism can reduce blood flow in some areas of the body to dangerously low levels. This is followed by crystallisation of water in the tissue and subsequent death of tissues in the affected areas. In this case series, we highlight the importance of a 99mtechnetium methylene diphosphonate (99mTc MDP) triple phase bone scan in cases of severe frostbite to precisely delineate the ischaemic and reperfusion zones, so as to help the surgeons in carefully deciding if amputation is required and the level of amputation in such cases.
A 1-year-old male child presented with progressive jaundice. Investigations were suggestive of an obstructive pathology with a suspected choledochal cyst on imaging. Intraoperative cholangiogram demonstrated runoff of contrast from the cystic duct into the common bile duct with no opacification of the biliary system proximal to this. Intraoperatively, the right hepatic artery was found anteriorly crossing the common hepatic duct (CHD) causing extrinsic compression leading to complete obstruction. Following stricture excision and anastomosis of the dilated bulbous CHD to a Roux-en-Y jejunal loop, the child recovered completely. An anteriorly crossing right hepatic artery causing obstruction to the biliary duct is a rare occurrence, more so in infancy. An excision with a hepaticojejunostomy is straight forward and curative.
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