Treatment of radiation-induced erectile dysfunction with low-intensity extracorporeal shock wave: A case report

Low-intensity extracorporeal shock wave therapy is a new treatment in treating vasculogenic erectile dysfunction. We report a case of low-intensity extracorporeal shock wave therapy used for treating radiation-induced erectile dysfunction. A 66-year-old gentleman with dyslipidemia and smoking presented with radiation-induced erectile dysfunction. Six sessions of low-intensity extracorporeal shock wave therapy were administered. Pre-treatment IIEF-5 score was 10 and post-treatment IIEF-5 score at one month was 19. Low-intensity extracorporeal shock wave therapy has the potential to treat radiation-induced erectile dysfunction

Chondrosarcoma of the spine: A case report in Sarawak General Hospital

Introduction: Chondrosarcoma represent a heterogenous group of tumors characterized by their ability of cartilage formation. Chondrosarcoma of spine is a rare condition with estimated incidence around 2% to 12% . Most frequently localized in thoracic spine followed by cervical and lumbar region. Discussion: We herein report a case of spinal chondrosarcoma over thoracic spine in 58 years old gentleman. He presented with progressive swelling over the back and incomplete neurological deficit for 3 months. MRI thoracic spine showed T6 to T18 posterior spinal soft tissues, neoplastic mass with lamina arches, spinous process, adjacent posterior ribs bony erosion and spinal cord compression. Core biopsy revealed Chondrosarcoma, Grade 1. Patient underwent excision of thoracic mass, posterior instrumentation and fusion T4 -T10 with removal of pedicle of T6, T7,T8. Intraoperatively, noted tumor measuring 20cm x 20cm extending from T6-T8, involving spinous process, lamina and pedicle. Laminectomy done and tumor was excised in 1 piece together with lamina and spinous process. Postoperatively, muscle power improves to 5 from L3 to S1. Patient was discharge home well with wheelchair ambulation on day 14 post operation. Conclusion: Chondrosarcoma is known to be resistance to both chemotherapy and radiotherapy. So, surgery is critically importance in managing spinal chondrosarcoma. En-block resection of chondrosarcoma with disease free margin reduce recurrence as low as 3-8%. Knowing the facts, the stability will be greatly affected due to extensive involvement to spinal column, we decided to proceed with posterior instrumentation. Surgery should aim at preserving or even improving functionality, relieving pain and controlling local tumor recurrence, promising a prolonged survival

Single-Bone Forearm Salvage Procedure for a Child with Acquired Radial Clubhand in a Resource Limited Centre: A Case Report

Acquired radial clubhand deformity can be a consequence of large bone gap left by premature extensive radius osteomyelitis sequestrectomy. Single-bone forearm reconstruction is a salvage procedure when other motionpreserving techniques are not feasible. Here we present a child who developed radial clubhand deformity after an untimely sequestrectomy of radius diaphysis. In view of limited microsurgical .expertise in our centre, single-bone forearm procedure was done utilising simple Kirshner wires to achieve radio-ulnar fusion. The procedure resulted in painfree stable wrist, restoration of hand function and improved cosmesi

“Not what it seems to be” : A rare case of left ulna brodie’s abscess in children

Introduction: Brodie abscess is a subacute hematogenous osteomyelitis characterized by intraosseous abscess formation. It is typically localized in the metaphysis of tubular bones, particularly in the lower limbs. The diagnosis in upper extremities is challenging and can mimics bone tumor because there is no characteristic finding on an X-ray and no obvious inflammatory response. There's very few study reporting Brodie Abscess in upper extremities especially Ulna Bone. The treatment is drainage and curettage that leaves large cavity requiring bone grafting. This a case of Brodie's abscess in the left ulna healed with spontaneous rupture and antibiotic. Discussion: A 7 year-old girl presented with a month history of left distal forearm painless swelling. There was no history of trauma, constitutional symptom or febrile illness prior to presentation. At first presentation, the examination revealed a well defined swelling 4x3 cm, firm to hard consistency, fixed to the underlying structures but not to the overlying skin. The plain X-ray of left radius ulna showed radiolucent expansile lytic lesion of the diaphysis of ulna bone with nidus formation with distal ulna cortical destruction. Blood tests showed normal white count and inflammatory markers. While waiting for scheduled MRI, she had a painless sinus discharging pus of the left distal forearm and a reduction in the size of the swelling. She was otherwise well. The second left ulna plain radio-graph shows less lucency with improved distal ulnar cortex appearance. Diagnosis of brodie's abscess is obtained following radiographic nidus formation with self-drained abscess. She was treated with cefuroxime for eight weeks. Conclusion: Brodie's abscess of the ulna is rare and never been reported before in the literature. The Xray may mimic bone tumor presentations. MRI and tissue biopsy is required to confirm diagnosis. In our case, she had a spontaneous ruptured swelling while waiting for MRI and treated non operatively

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

Leiomyosarcoma with partial rhabdomyoblastic differentiation

Leiomyosarcoma (LMS) is a malignant neoplasm showing pure smooth muscle differentiation. LMS with rhabdomyoblastic component in the soft tissue is a rare entity described in only few cases in the literature. Previous studies of LMS with rhabdomyoblastic differentiation have indicated a poorer prognosis of this tumour compared to the classical LMS. Case Report: A 78-year-old male patient presented with a painful mass at the right scapula for 4 years. Excision was performed and histopathological diagnosis was LMS grade 2 with involvement of the surgical margins. Subsequent serial radiological scans revealed no disease progression. However, he developed recurrence one year after the initial excision. A second wide local excision was performed with right total scapulectomy. The tumour showed hypercellularity with a mixture of caldesmon and desmin positive spindled cells arranged in fascicles and desmin positive large multinucleated cells with abundant cytoplasm (rhabdomyoblastic cells). Areas of positivity towards myogenin were also seen. Thus, a diagnosis of recurrent LMS with partial rhabdomyoblastic changes was rendered. Discussion: Leiomyosarcoma of the soft tissue account for 5 to 10% of soft tissue sarcoma. The presence of rhabdomyoblastic cells has been reported in various types of malignancy and has been determined to be a predictor of aggressive behaviour of neoplasms regardless of tumour histogenesis. The coexistence of rhabdomyoblastic component within LMS represent a poorer prognostic parameter