Percutaneous thermal ablation of JC tumours has similar rates of local tumour control and safety profile when compared to tumours in a NJC location. Tumours in a JC location should not be considered a contraindication for thermal ablation.
Case of cerebrofacial arteriovenous metameric syndrome (CAMS) in a 9-year-old boy is described with arteriovenous malformation simultaneously involving the brain and face, with characteristic CAMS type 1 and 2 involvement. This patient demonstrates the wide spectrum of clinical manifestations of CAMS, and in this particular case, the patient exhibits features of hypopituitarism—an association that was not previously described in the literature to our knowledge. Awareness of the underlying embryological abnormality and recognition of resultant clinical and radiological presentations are paramount for diagnosis and treatment.
Insulinomas are rare pancreatic neuroendocrine tumours and the commonest cause for endogenous hyperinsulinaemic hypoglycemia. Small tumours are not easily detected by conventional cross-sectional imaging making localization prior to surgical removal a challenge. Selective arterial calcium stimulation is an invaluable adjunct to localization in such circumstances. This is further supplemented by intraoperative ultrasonography. A 39-year-old male was referred with features of Whipple's triad of 10 months duration. Clinical and biochemical evaluation including C-peptide and serum insulin levels during supervised hypoglycemia concluded endogenous hyperinsulinaemia as the underlying aetiology. Contrast CT and MRI of the abdomen failed to localize the tumour. Selective arterial calcium stimulation localized the lesion in distal pancreas. During the surgery, tumour was further localized to the tail of the pancreas using intraoperative ultrasonography and enucleated. Histology confirmed an insulinoma and patient made an unremarkable recovery and was well more than a year after the surgery.
A 52-year-old man presented to the emergency department with progressively worsening upper abdominal pain of one week's duration. He was a heavy smoker with a history of chronic heart disease and atrial fibrillation, but was not compliant with his warfarin therapy. An echocardiogram performed two months before had shown a thrombus in the left ventricular apex and left atrial appendage.The patient's vital signs included a heart rate of 122 beats per minute (irregularly irregular), blood pressure of 123/68 mmHg, respiratory rate of 20 breaths per minute and oxygen saturation of 99% on room air. He was afebrile, alert and showed no signs of distress. Pertinent physical findings included a soft abdomen with moderate tenderness elicited in the epigastrium and left hypochondrium. There was no rebound tenderness, guarding or abdominal distension. Bowel sounds were present. The remainder of the physical examination was non-contributory. Bedsidefocused ultrasonography showed no evidence of free fluid.Initial laboratory results showed a mildly raised white blood cell count of 10.4 × 10 9 /L and serum lactate level of 2.4 mmol/L (normal range 0.5-2.2 mmol/L). The patient's liver function test results were mostly within normal limits (alanine aminotransferase 12 U/L, aspartate aminotransferase 21 U/L, bilirubin 24 µmol/L, alkaline phosphatase 97 U/L), with the exception of mildly raised gamma-glutamyl transpeptidase (GGT) (61 U/L, normal range 7-50 U/L). His international normalised ratio was normal, measuring 1.2.Contrast-enhanced computed tomography (CT) of the abdomen was performed shortly after the patient was admitted. What do the CT images (Figs. 1-3
Background The source of excess androgen can be obscure in postmenopausal women with new-onset hyperandrogenism. If serum dehydroepiandrosterone sulphate (DHEAS) is raised, it is presumed to be of adrenal origin because DHEAS is exclusively produced from adrenal cortical cells. This reports an elderly female presenting with new-onset hyperandrogenism due to an ovarian sex cord-stromal tumour, associated with increased serum DHEAS levels. Case description A 76-year-old female with long-standing diabetes and hypertension presented with hirsutism and male type alopecia for six months. She had menopause at 55 years of age. There was a pelvic mass on examination. Total testosterone was 6.106 ng/ml (0.124–0.357) and DHEAS was > 1000 µg/dL (35–430). Contrast-enhanced computed tomography of the abdomen and pelvis showed a heterogeneously enhancing complex mass measuring 11 × 8 cm in the left adnexal region. Adrenal glands were normal. She underwent total abdominal hysterectomy, bilateral salphingo-oophorectomy, and omentectomy. Both testosterone and DHEAS normalised following surgery. Histology revealed a sex cord-stromal tumour, likely a steroid cell tumour with malignant potential. Fluorodeoxyglucose-Positron emission tomography did not show any additional lesions. Conclusions Due to the lack of sulfotransferase in ovarian tissue, markedly elevated DHEAS originating from an ovarian neoplasm is unusual. This phenomenon has not been described except in a patient with a steroid cell tumour causing Cushing syndrome and hyperandrogenism. The mechanism of this rare occurrence remains elusive. Knowledge of this unusual presentation would enable the clinicians to be cautious in localising the androgen source in women with hyperandrogenism.
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