Cerebrospinal fluid ascites following ventriculo- peritoneal shunting for hydrocephalus is a very rare complication. We present the first case at our hospital. A 3year old female with communicating hydrocephalus presented with massive ascites. It recurred with 2-3weeks of ascitic tap to dryness. Other possible causes of ascites were excluded by normal renal and liver function tests and clinically normal cardiac function. Tests done on the ascitic fluid showed that it was consistent with cerebrospinal fluid with no signs of infection. CT abdomen excluded abdominal masses and CSF pseudo-cyst. A ventriculo-Atrial shunt was done and the ascites slowly regressed over the next 2-3 weeks with no recurrence. The reason why the peritoneum failed to absorb the CSF was not established.
Dermatofibrosarcoma protuberans (DFSP) is uncommon but represents one of the most common dermal sarcomas, which is said to be a locally aggressive, low grade, and relatively uncommon cutaneous tumour, which has a high propensity for local relapse with low metastatic potential. Over 90% DFSPs are genetically characterized by chromosomal rearrangements (translocation t(17;22) (q22; q13), resulting in the collagen type-1 alpha 1 (COL1A1)-platelet-derived growth factor â (PDGFB) fusion gene with well-known risk factors for developing DFSP, some cases develop at the site of previous trauma and reports have included a burn scar and the site of vaccination. The mainstay mode of treatment of DFSPs is wide local excision with traditionally 3-cm gross margins excision surgery. Mohs Micrographic Surgery (MMS) is highly recommended surgery for DFSP and is very useful treatment choice for recurrent DFSP. This case report discusses two patients with confirmed DFSP and have received adequate therapy. It also reviews salient features of evaluation and prompt management of DFSP and much emphasis on long-term follow-up of patients. Key Messages: Early diagnosis of pediatric DFSP is critical to minimize surgical disfiguration. We emphasize early evaluation of any suspicious skin lesion should not be ignored and should be excised and sent for histopathology. Undertreating a DFSP is even more problematic, as the tumour is locally destructive, can metastasize, and can prove fatal without treatment. A full metastatic workup should be done and patient should be regularly followed up, if it turns out to be malignant.
Cervical spine meningiomas are uncommon. They present with motor, sensory and other nonspecific symptoms like pain. We present a first case at our hospital. A 33yr old female presented with 5months history of spastic quadriparesis, gait ataxia and pain and forceful contractions of the left upper limb. She had been seen in different health centres and diagnosed as conversion disorder. Brain CT was normal, C-spine CT showed a 2*3cm homogenous lesion at C2-C3.Simpsons 2 resection was done with no complications. Post-operative physical rehabilitation with physiotherapy was instituted with good recovery. By 6 weeks' post-operative, she was ambulating without support.
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