Clinical and Medical Case Reports

Duodenal tumors with gall bladder infiltration is rare as it carries high mortality and morbidity as it's difficult to manage operatively. We reported a case of a 74 years old lady with bleeding first part of duodenal tumor with gall bladder infiltration.

Signet-ring carcinoma of the breast (SRCC) is a rare form of breast cancer with high rates of axillary and distant metastases. Most prior case reports focused on the clinicopathologic features rather than management of SRCC.

Case Report: Hereby, we report a 39-year-old women who had distant recurrent of estrogen receptor positive, progesterone receptor negative and Her-2 positive signet-ring carcinoma of the breast to the lungs, liver, bones and brain. Since no standard guidelines existed, we directed her treatments according to hormonal and Her-2 receptor status and optimized supportive care. She had resolution of pulmonary lymphangitis and diffuse liver metastases on computerized tomography scan and lived for 4 years after recurrence.

Conclusion: Despite its aggressive biology, our case suggests that signet-ring carcinoma of the breast should be treated similarly to other invasive breast cancers based on hormonal and Her-2 receptor status.

Obstructive sleep apnea (OSA) is a common disorder established as an independent risk factor of cardiovascular morbidity and mortality. Cases of hearing impairment associated with sleep apnea have been described and multiple studies have tried to find a significant relationship between both disorders. Many pathophysiological pathway mechanisms have subsequently been suggested. We present a case of a 32-year-old male Tunisian patient with no relevant pathological history a part from smoking and obesity, who presented with a sudden sensorineural hearing loss (SSHL). He had a two-year-history of asthenia and daytime sleepiness. Physical examination was normal and so were the laboratory findings. Further investigations concluded that it was idiopathic sensorineural hearing loss and severe obstructive sleep apnea. The patient was treated with a continuous positive airway pressure device (CPAP). The asthenia and sleepiness notably improved. The right hearing impairment remained stable with a normal left hearing function.

Tuberculosis of female genital tract is common among the reproductive age group in developing countries. However, primary tuberculosis of cervix is a rare entity. Clinical presentation of cervical tuberculosis could be as a papillary growth on the cervix with ulceration simulating carcinoma of cervix or as a miliary lesion. In the present case the clinical appearance was that of an exophytic friable, polypoid and ulcerated lesion which created clinical suspicion of a neoplastic condition. However the cervical cytology was normal. Biopsy histopathology showed endocervical tissue with multiple well-formed caseating epithelioid cell granulomas and multinucleate Langhan’s type of giant cells. AFB was positive by Ziehl Neelsen’s stain. Hence a diagnosis of granulomatous inflammatory lesion with presence of AFB was given and the patient was referred for further management. The case is presented in view of rarity of the clinical presentation and importance of considering this lesion in the differential diagnosis of an ulcerated friable polypoid lesion of the cervix.