Open Access Case Report

Bilateral Huge Ovarian Mature Cystic Teratoma in a Primipara: A Case Report

E. I. Nonye-Enyidah, D. H. John, F. Horsfall, L. B. Lebara, T. N. Tamunokuro, K. Okah, L. D. Ndii

Asian Journal of Case Reports in Medicine and Health, Page 13-17

Background: Mature cystic teratoma (MCT) also known as dermoid cyst is the commonest benign neoplasm of the ovary constituting 10-20% of all the ovarian tumours. They are also the most common ovarian germ cell tumour commonly seen between 20-40 years. They are bilateral in 8-15% of cases.

Objective: To report a rare case of bilateral ovarian mature cystic teratoma occurring in a primipara.

Methods: The case note of the patient was retrieved, relevant information about the patient, her clinical presentation and management were reviewed. Relevant review of the literature on the subject was also done.

Case Report: The patient was a 23 year old primipara (alive) referred from a general hospital. She presented at the gynaecological clinic of Rivers State University Teaching Hospital (RSUTH) with a month history of abdominal distension and lower abdominal pain. There was associated nausea, vomiting and passage of watery stool. There was no history of fever, weight loss, vaginal discharge, urinary frequency or retention of urine. There was generalized abdominal tenderness more marked in the lower abdomen. She had exploratory laparotomy and bilateral ovarian cystectomy. She did well post operatively and was discharged home with a two weeks appointment to the gynaecological clinic.

Conclusion: Diagnosis of dermoid cyst is made earlier with pelvic ultrasonography when it is usually small. Unusual finding of a mature huge ovarian cystic teratoma is possible due to delayed presentation for diagnosis and treatment.

Open Access Case Report

Intensity Modulated Radiotherapy [IMRT] in a Rare Case of Infratemporal Chondrosarcoma with Intracranial Extension in a Young Adolescent Patient

Tasneem Lilamwala, Mohsin Ali, Susheela Kodandapani

Asian Journal of Case Reports in Medicine and Health, Page 23-28

Mesenchymal chondrosarcoma is a malignant neoplasm of cartilaginous origin. It is an uncommon subtype of chondrosarcoma which is described in the young adolescent population. We present a rare case of chondrosarcoma in a teenage group-a 16yr old pediatric patient. This 16 year old patient came to us with progressive, painless, right facial asymmetry of 3 months duration .MRI scan showed a large lobulated enhancing lesion in right infratemporal fossa and masticator space with destruction of right mandibular bone with intracranial extension. She underwent subtotal excision [R2 resection] followed with adjuvant radiotherapy by Intensity modulated radiotherapy technique (IMRT) and remains disease free for 1.5 years on follow up. Role of chemotherapy is not defined. Combined modality approach including surgery and radiotherapy maximizes the chances of cure despite the aggressive biology of mesenchymal chondrosarcomas.

Open Access Case Study

Thoracoomphalopagus-the Twins Sharing Heart

Meenakshi Singh, Soni Choudhary, Pikee Saxena, . Rajkiran

Asian Journal of Case Reports in Medicine and Health, Page 1-6

Conjoined twin is one the rarest and most fascinating phenomena of twinning. The incidence ranges from 1 in 50 000 to 1 in 100 000 live births. Even though the degree and location of conjunction and the shared internal organs determine the prognosis of conjoined twins, they are associated with a high perinatal mortality rate. Early prenatal diagnosis and precise characterization of conjoined twins are essential for optimal obstetric, interventional and postnatal management as well as to reduce psychological trauma to the parents. Imaging by ultrasound and MRI plays a significant role in diagnosis and further management prediction. In this report, we present a case of multigravida pregnant woman who presented at 36+2 weeks gestation with thoraco-omphalopagus twins in advanced labour in a tertiary hospital. This case report not only reports a rare case but also emphasizes on the fact that even after so many advancements in the field of medicine, there still exists a gap in timely access to the healthcare facility, especially in developing countries.

Open Access Case Study

Antiepileptic Drug-Induced Skin Rash Revealing a Cross-Reactivity between Antiepileptic Drugs in a Patient with Anticonvulsant Polypharmacy

Z. Zeggwagh, S. Kerroum, N. Ismaili, L. Benzekri, M. Meziane, K. Senouci

Asian Journal of Case Reports in Medicine and Health, Page 7-12

Aims: The cross-reactivity of antiepileptic drugs (AEDs) in the occurrence of drug eruption makes intrinsic accountability difficult. We are reporting on a case of drug eruption that occurred in a patient treated with four AEDs who had previously developed rashes with two other AEDs.

Presentation of Case: A 17-year-old epileptic patient with a history of rashes induced by phenobarbital and carbamazepine three years ago, and since ceased. Two months before admission, levetiracetam was added. Lamotrigine and clobazam were then added for generalized seizures. Two weeks later, a rash appeared on the neck, trunk and face with extension to limbs associated with pruritus and fever. On admission, the patient was febrile with tachycardia. Skin examination revealed a maculo-papular exanthema on the limbs, trunk and puffy face with negative Nikolski's sign. Biological assessment: leukopenia, thrombocytopenia and elevated CRP. The skin biopsy was in favor of toxiderma. The patient received paracetamol; imputability scores of the 4 antiepileptic drugs were calculated; and incriminated latromigine (C3S2B4) which was stopped with progressive increase of levetiracetam. The evolution was marked by a clinical and biological improvement.

Discussion: The incidence of AED-induced drug eruption ranged from 1.7 to 8.8%. The AEDs most at risk are aromatic AEDs. A high initial dose and rapid dose escalation are risk factors, especially for lamotrigine when metabolism is inhibited by valproic acid.

Conclusion: During anticonvulsant polypharmacy, caution should be taken when administering some AEDs to ensure that clinicians safely prescribe appropriate anti-epileptic medications considering the history of previous AED-related skin reactions.

Open Access Case Study

Age and Papillary Thyroid Cancer; A Perspective with Case Report

M. S. Syauqi, A. B. Zulkiflee

Asian Journal of Case Reports in Medicine and Health, Page 18-22

Background: Papillary Thyroid Cancer (PTC), is a common encountered head and neck cancers, making the majority of cases among thyroid malignancies.  It is unique since thyroid cancers are the only cancer that include age to predict the prognosis. The usage of age however is debatable albeit being still widely used in various staging systems.

Case Presentation: We report a case of a young 41years gentleman with aggressive features of PTC, presented with worsening progressive breathlessness. Clinically diffuse palpable right anterior neck swelling was noted upon examination.

CT neck showed that the mass arising from right inferior lobe of thyroid gland with regional lymphadenopathy and retrosternal extension. Total thyroidectomy and neck dissections and tracheostomy was performed, complicated with intraoperative iatrogenic injury to the subclavian vessel due to the aggressiveness of the tumour, which was ultimately secured by the assist from vascular surgeon.

Conclusions: Adopting age as a sole factor is not sufficient for preliminary prognosis and outcome for the patients.

Objective: To share our experience in managing a case of an aggressive Papillary Thyroid Cancer in a young 42-year-old patient.

Article Design and Setting: Case Report & Tertiary General Medical Centre.