Giant Macroadenoma with an Unusual Extension: A Case Report and Literature Review
Faten Hadj Kacem,
Kawthar El Arbi,
Abdalla Mrabet,
Khouloud Boujelben,
Souha Kallel,
Slim Charfi,
Mouna Elleuch,
Ilhem Charfeddine,
Taheya Boudawara,
Mohamed Abid
Issue:
Volume 1, Issue 1, December 2020
Pages:
1-4
Received:
18 August 2020
Accepted:
27 August 2020
Published:
3 September 2020
DOI:
10.11648/j.wjmcr.20200101.11
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Abstract: Giant prolactinomas are rare tumors, representing only 2-3% of all prolactin (PRL)-secreting tumors. The management of giant prolactinomas remains a major challenge. Here we report the case of a young man aged 31 years old, followed up for a giant and invasive pituitary macroadenoma of 5cm discovered during a neuro-ophthalmic syndrome. The initial hormonal exploration and follow-up evaluation concluded hyperprolactinemia at 138.5ng/mL, anterior pituitary insufficiency and bilateral blindness related to optic atrophy. Incomplete surgical resection was performed after one month of medical treatment with a dopaminergic agonist. Histologic examination showed an aspect of an invasive macro-adenoma with no signs of malignancy. Despite therapeutic escalation, the evolution was marked by the persistence of resistant hyperprolactinemia. A control MRI was done showing a voluminous extra-axial expansive process measuring 9cm with significant anterolateral and inferior extension in the cavum and nasal fossae. A biopsy of the tumour in the nasal fossae was done showing morphological aspects and an immuno-histochemical profile of an aggressive lactotropic adenoma of the type "Acidophilic stem Cell adenoma" with an over expression of p53. External radiotherapy was indicated, but the patient died rapidly in a brain engagement table. This case illustrates the difficulty in the management and control of invasive and aggressive pituitary adenomas and their unpredictable course.
Abstract: Giant prolactinomas are rare tumors, representing only 2-3% of all prolactin (PRL)-secreting tumors. The management of giant prolactinomas remains a major challenge. Here we report the case of a young man aged 31 years old, followed up for a giant and invasive pituitary macroadenoma of 5cm discovered during a neuro-ophthalmic syndrome. The initial ...
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Complete Non-puerperal Uterine Inversion in a Nulliparous Woman Due to Sub Mucous Fibroid – A Case Report
Innocent Anayochukwu Ugwu,
Boniface Uwaezuoke Odugu,
Celestine Chukwudi Obiora,
Perpetua Kelechi Enyinna,
Chude Chukwuka Eze,
Innocent Igwebueze Okafor
Issue:
Volume 1, Issue 1, December 2020
Pages:
5-8
Received:
11 August 2020
Accepted:
26 August 2020
Published:
7 September 2020
DOI:
10.11648/j.wjmcr.20200101.12
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Abstract: Uterine inversion which commonly occurs during the puerperium is the descent of the fundus of the uterus into or through the cervix thereby keeping the uterus in an ‘inside out’ position. Other structures such as the ovaries and fallopian tubes may also be displaced from the pelvis and restricted within the inverted uterus. However, non puerperal uterine inversion is very rare and represents about one-sixth of all inversion. The most common implicating factor in non-puerperal inversion is prolapsed fibroid with occasional reports of endometrial polyp and uterine neoplasia. Diagnosis of non-puerperal uterine in version may pose a major problem and treatment in women of reproductive age who desire future fertility may involve conservative surgeries. Case Report: We report a case of a 35 year old nulliparous woman with complaints of sudden protrusion of a mass from her vagina with associated cramping lower abdominal pain and vaginal bleeding. A diagnosis of non puerperal uterine inversion due to sub mucous uterine fibroid was made. Surgical interventions done included excision of fibroid and rectification of the uterus through Haultain’s procedure. Histology confirmed uterine fibroid and patient had resumed normal menstrual flow. Conclusion: High index of suspicion is essential for proper diagnosis of non-puerperal uterine in version. In the setting of fertility sparing surgeries, malignancy need to be ruled out, and the woman must be counseled on interval to next pregnancy and risks associated with different modes of delivery.
Abstract: Uterine inversion which commonly occurs during the puerperium is the descent of the fundus of the uterus into or through the cervix thereby keeping the uterus in an ‘inside out’ position. Other structures such as the ovaries and fallopian tubes may also be displaced from the pelvis and restricted within the inverted uterus. However, non puerperal u...
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Moyamoya Disease in a 70 Year Old Nigerian Male: A Case Report
Edeh Samuel,
Fintan Ekochin,
Okafor Umezurike,
Ugwu Chidiebube
Issue:
Volume 1, Issue 1, December 2020
Pages:
9-12
Received:
21 September 2020
Accepted:
5 October 2020
Published:
13 October 2020
DOI:
10.11648/j.wjmcr.20200101.14
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Abstract: Moya-moya disease is a very rare disease characterized by a progressive vasculopathy leading to stenosis of the main intracranial arteries. Cerebral blood flow is usually impaired by constriction of the vessels with collateral circulation developing around the blocked vessels to compensate for the blockage. This may lead to an ischaemic stroke as observed on the index case. The aim of this case report is to highlight moyamoya disease as a rare cause of ischaemic stroke in an elderly male. We report a case of a 70 year old Nigerian male who has hypertension and diabetes mellitus, and presented with features of right hemispheric ischaemic stroke. The patient was investigated further with cerebral angiography and was found to have moyamoya disease. Angiography of the index case showed numerous abnormal hazy looking vessels arising from the level of the circle of willis and equivalent non filling in the posterior supratentorial and infratentorial spaces typical of moya moya pattern. He responded to medical therapy administered in the acute phase and subsequently followed-up at hospice care. Patient showed some clinical improvement with significant residual motor deficit on the left side of the body. The acute management was mainly symptomatic and directed towards reducing elevated intracranial pressure, improving cerebral blood flow, and controlling seizures. The index patient was frail, unfit and therefore could not benefit from surgical revascularization procedure which is the main treatment option for moyamoya disease.
Abstract: Moya-moya disease is a very rare disease characterized by a progressive vasculopathy leading to stenosis of the main intracranial arteries. Cerebral blood flow is usually impaired by constriction of the vessels with collateral circulation developing around the blocked vessels to compensate for the blockage. This may lead to an ischaemic stroke as o...
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