Metastatic erector spinae tumor underlying primary lung adenocarcinoma with paraneoplastic secreting beta-human chorionic gonadotropin hormone: A rare case report

Introduction: Beta-human chorionic gonadotropin (β-HCG) hormone is physiologically produced by syncytiotrophoblast cells in the placenta during pregnancy. It is also a specific marker for trophoblastic tumors of placenta and gestational tumors. In rare case, a rise in serum β-HCG may be due to ectopic secretion especially in epithelial carcinoma namely lung CA and other tumors. Here, we report a case of a middle-age woman presenting with rapid growing back swelling with amenorrhea and high serum β-HCG with underlying primary lung cancer. Discussion: 48 year-old single lady, ex-smoker and nulliparous presented with painful rapid growing back swelling for 3 months associated with marked loss of weight and appetite for 9 months. She was amenorrheic for 3 months. A firm mass located at left paraspinal area with 6x6cm in size, fixed to the underlying muscle and skin, irregular surface and border. Other systemic examinations was unremarkable. Serum β-HCG was high 1142mIU/ml. Transvaginal Ultrasonography was normal. Chest X-Ray showed consolidation over left middle zone of the lung. CT-TAP had left lung mass measuring 5.6x4.6x2.8cm with left hilar lymphadenopathy. MRI of whole spine revealed left erector spinae intramuscular lesion with adjacent inflammatory changes with no intraspinal extension. Tissue HPE showed fragments of fibrocollagenous tissue with malignant cell infiltration arranged in cords and glandular pattern. The malignant cells displayed mild pleomorphism with hyperchromatic nuclei and eosinophilic cytoplasm. Immunohistochemical study has positive CK7 and GATA3 with negative CK20 and TTF-1. These features are consistent with metastatic adenocarcinoma likely primary lung adenocarcinoma. Bronchoscopy-guided biopsy was performed and confirmed the diagnosis. She was then referred to oncology for further management. Conclusion: Ectopic secretion of β-HCG in lung carcinoma is not well understood and has not been well reported in literature. Therefore, such presentation may mimic various condition and this may result in delay of diagnosis. More studies are required for better understanding

A rare case of sacrococcygeal squamous cell carcinoma

Introduction: Sacrococcygeal neoplastic lesions are extremely rare. Primary benign or malignant lesion are lesser than 7% of all intraspinal lesions. Patients with sacral tumors present with non-specific symptoms, including pain, palpable mass, and neurologic deficits. Despite the advancement of imaging modalities, it is still a diagnostic and therapeutic challenge. Squamous cell carcinoma (SCC) of this area is very rare. A few case reported with acquired condition or underlying congenital or developmental remnants. A chronic sacrococcygeal pilonidal disease with SCC transformation is described by Michalopoulos et al. Demirel AH et al reported the incident of SCC with underlying tailgut cyst in 73 yearold female. CT-scan and MRI is done to define the anatomic origin, extent, and radiologic features of a given lesion. Biopsy is commonly performed to obtain histologic diagnosis. In this paper we report a primary squamous cell carcinoma in this region. Discussion: A 52 year-old lady who presented with five months history of painless right-sided sacral swelling associated with right radicular pain, urinary incontinence and constipation. No constitutional symptoms. The swelling is 8x8 cm in size, firm to hard consistency, non-mobile, smooth surface, illdefined border and not fixed to the overlying skin. Plain X-Ray of Pelvis revealed right sided sacrococcygeal expensile lytic lesion with ill-defined margin. CT-Scan of pelvis showed sacrococcygeal heterogenous mass associated with bony destruction and compression on bladder and rectum. MRI revealed aggressive sacrococcygeal mass with local bony invasion and sacral nerve root S2-S5 involvement. Biopsy was performed and HPE result was consistent with Squamous Cell Carcinoma (SCC). Systemic staging showed metastases to bilateral lungs. Palliative Care was planned with multidisciplinary team involvement. Conclusion: Sacrococcygeal Squamous Cell Carcinoma is very rare. Diagnosis remained challenging even with advancement of imaging modalities. Biopsy is required to confirm tissue diagnosis. Treatment requires multi-disciplinary team approach to ensure survival of the patien

Extraskeletal soft tissue chondroma of right thumb : A rare case

Introduction: Extraskeletal soft tissue chondroma (ESSC) is a rare benign cartilaginous soft tissue tumour. It represents around 1.5% of all benign soft tissue tumours. ESSC is slow growing tumour arising from extra-osseous and extra-synovial location. Predominantly occurs in hands and feet especially in the fingers. We report a rare case of ESSC of right thumb treated with marginal excision. Discussion: A 31 years-old gentleman presented with progressively increasing painless swelling over his right thumb past 7 months. The swelling is 3x3cm in size, volar aspect of right thumb interphalangeal joint. Swelling was lobulated, firm in consistency, mobile and non-tender. No neurological involvement. Plain radiograph of the right thumb demonstrated well demarcated soft tissue swelling palmar side of right thumb with internal calcification and no underlying bony erosion. Marginal excision was performed. Intra operatively found that tumour is arising from flexor tendon sheath. Macroscopically tumour is greyish, firm, lobulated measuring 2.5x2x1.5cm. Histopathological examination revealed cartilaginous matrix with occasional binucleation of chondrocytes. There is presence of myxoid change areas, calcification and ossification. Conclusion: Clinical diagnosis might be challenging given the rarity of the disease. Combination of clinical, radiological and histopathology examination are necessary to diagnose ESSC. Marginal en-bloc excision is the first line of treatment to prevent local recurrenc

A NOVEL NEWBORN CLUBFOOT SCREENING CHECKLIST TO IMPROVE DISEASE DETECTION : A PILOT STUDY

Clubfoot also known as Congenital Talipes Equino Varus (CTEV) is a common foot deformity with the prevalence rate of 4.5 per 1000 live birth in Malaysia. Early initiation of treatment has shown to have favorable outcome. Screening for foot deformities including clubfoot is often done by non-orthopaedic trained personnel during routine neonatal checkup. Hence, early detection plays an important role in treatment and outcome of this disease. In this study, we examined the detection of clubfoot with and without an objective assessment screening tool. This study has the potential to raise awareness regarding clubfoot amongst health care personnel and provide a guide to diagnose clubfoot especially in primary health care centers. This prospective study was conducted in Sarawak General Hospital, Kuching from November 2020 till June 2021. A total of 596 new-borns (n (number of foot) = 1192) were recruited in this study. 306 (n=612) were screened with Newborn Clubfoot Screening Checklist (NCSC) and 290 (n=580) were screened without checklist. 2 cases (n=2) of clubfoot were detected using the checklist and no case of inaccurate diagnosis in the checklist group. 14 cases (n=28) of inaccurate diagnosis in the group without checklist was identified with no cases of true positive clubfoot. Sensitivity of the NCSC was 100% (95% Confidence Interval (CI) 15.81% to 100%) and specificity was 97.7% (95% CI 96.69% to 98.47%). Newborn Clubfoot Screening Checklist aids in detecting CTEV and reduce inaccurate diagnosis