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Volume 6

Volume 6

An Unlucky Case or a Lucky Follow-Up?

Clinical Image

Dear Editor,
Primary melanoma of the eyelid represents a small proportion of melanomas. In literature, only few cases have been reported, probably because its location and the resistance of patients to surgery make its diagnosis difficult. We present a peculiar case of an 80-years-old patient with a lesion of the left lower eyelid. The lesion had appeared a few months before as a millimetric blue macule. A dermoscopic examination showed an ill-defined lesion with fine irregular vessels on bluish background (figure 1). Differential diagnosis was between blue nevus and melanoma. The histologic exam confirmed the diagnosis of blue nevus. Due to the several nevi and the fair phototype, the patient underwent the usual follow up at our clinic. Four years later, the patient showed two new suspected pigmented lesions on the left lower eyelid and on the left cheekbone (figure 2). Dermoscopy of the first lesion revealed structureless gray and white color, remnants of pigmentation, teleangectasie and lack of cilia. Differential diagnoses included pigmented basal cell carcinoma (pBCC) and melanoma. Physical examination of the lesion of the left cheekbone showed a variable pigmented macule with irregular shape, longer than 6 mm in diameter. On dermoscopy, it revealed a pseudo network, structureless areas, gray and concentric circles on sun-damaged skin. Histopathological reports revealed lentigo maligna. It was a case of multifocal melanoma. As a result, radical excision and skin grafting were performed by colleagues of plastic surgery.

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Studies on Endolichenic fungi in Myelochroa (Lichenized fungi, Ascomycota) in Jeju Island, Korea

Research Article

1. Abstract
In this study, the endolichenic fungi were isolated from lichen of Myelochroa spp. in Jeju Island, Korea. The taxonomic placement of the isolated endolichenic fungi was studied using a combination of morphological and phylogenetic approaches. Morphological differences among the fungal isolates indicated that diverse distinct morphotypes might be present within the Myelochroa. Fifty-six fungal isolates were selected for further molecular phylogenetic analysis using nuclear ribosomal DNA sequences, including both the internal transcribed spacers and the 5.8S gene region. The 23 endophytes were identified to various taxonomic levels, and some to the species level based on morphological description and comparison. Taken together, our results suggested that Xylaria and Hansfordia were the dominant fungal endophytes in Myelochroa, and some of these endolichenic fungi exhibited host specificity. The importance of host-endolichenic fungal interactions was supported by data showing that the overlap of endolichenic fungi in Myelochroa species by pairwise comparisons was low (0–20%). Multivariate analysis of the data obtained from direct observations confirmed the finding that endolichenic fungi assemblages were strongly affected by host and site factors.

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Colonic Stricture in Ulcerative Colitis: Diagnosis Out-of-the-Way

Clinical Image

1. Abstract
A 51-year Asian man, with Ulcerative Colitis (UC) for 10 years, presented as 8 months history of intermittent abdominal pain and change in bowel habits, feeling of lump-in-abdomen, tenesmus, bleeding per rectum and significant weight loss for 2 months. He was never on immunosuppressant for UC. MRI abdomen showed circumferential enhancing thickening (up to 6.8cm) of the left colon (figures 1, 2) extending from splenic flexure distally for a length of 24 cm. Colonoscopy showed loss of normal vascular pattern, mucosal friability and nodularity with luminal narrowing in the descending colon. Biopsy showed clusters of atypical lymphoid cells with expression of lymphoid surface antigens (CD45, CD20 and CD3) negative for cytokeratin (Figure 3A). Additionally, tumour cells showed Bcl-2, Bcl-6, and focal c-MYC positivity (Figure 3B) with Ki67 proliferative index of 50% and no MUM1 expression, suggestive of non-Hodgkin diffuse large B-cell lymphoma of germinal origin. Primary Colorectal Lymphoma (PCL) [1] occurs more commonly in patients of inflammatory bowel disease who are on long term immunosuppressant and carries a poorer prognosis than NHL of other gastrointestinal sites. Its occurrence de novo in an untreated patient of ulcerative colitis is extremely rare. Histologically, Non-Hodgkin’s Lymphoma (NHL) is more common than Hodgkin’s lymphoma. The exact aetiology is not known, although infection with Epstein-Barr virus may play a role [2]. This patient the Dawson criteria [3] for PCL and was started on chemotherapy after WHO staging fulfilled. Better imaging and advances in IHC techniques made this diagnosis possible.

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Comparison of the Treatment Outcome Data of Patients with May-Thurner Syndrome in Tan Tock Seng Hospital, Singapore: Is Anticoagulation as Effective as Thrombolysis?

Research Article

1. Abstract
May-Thurner Syndrome (MTS), which is a condition wherein the left iliac vein is compressed by the right iliac artery against the vertebral body, is usually diagnosed when a patient present with deep vein thrombosis. There are different treatment options in treating patients with MTS.

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Ectopic Opening of the Common Bile Duct: A Case Report

Case Report

1. Abstract
1.1. Background: Ectopic opening of the common bile duct (EOCBD) is a rare congenital biliary anomaly. Herein, we herein presented a case of duodenal stenosis with EOCBDectopic ope- ning of the common bile duct into the lesser curvature of stomach.
1.2. Case Presentation: A 47-year-old man had dull pain in the right upper abdomen for a week without obvious inducement, pre- senting paroxysmal dull pain.

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Glycogenic Acanthosis: Just an Incidental Finding?

Clinical Image

1. Clinical Image
A 15-year-old girl, with a previous allergic asthma diagnosis, was evaluated because of progressive dysphagia and heartburn over the last two months. An upper gastrointestinal endoscopy was performed and showed an apparent trachealization of all segments of the oesophageal mucosa (Figure 1 and 2). Histological analysis of three-level biopsies revealed hyperplasia of the squamous epithelium and intracellular glycogen compatible with Glycogenic Acanthosis (GA) and no eosinophilic infiltration. Laboratory studies excluded coeliac or thyroid disease. Motility studies comprised 24-hour pH oesophageal monitoring and High-Resolution-oesophageal Manometry (HRM): the pH study did not show pathological acid reflux and HRM showed normal peristalsis and normal median lower oesophageal sphincter pressure (19.8 mmHg) position and relaxation. Another endoscopic evaluation was done several months later with similar findings.

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Transjugular Intrahepatic Portosystemic Shunt in Children with Cirrhosis of Unknown Origin: A Case Report and Literature Review

Case Report

1. Abstract
1.1. Objective: To investigate the safety and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) in children with cirrhotic portal hypertension.
1.2. Methods: We retrospectively analyzed the clinical data of a child with cirrhosis and portal hypertension, and reviewed the literature.
1.3. Results: A 12-year-old boy with a height of 167 cm and a weight of 60 kg was admitted to hospital for hematemesis for 2 days, and his physical examination showed liver cirrhosis. Multiple visits to an external hospital in the past 6 months, with bone marrow and liver puncture undertaken for exclusion of leukemia and other lesions, suggested cirrhosis of unknown origin. Hematemesis and melena occurred many times in the past 6 months, bleeding stopped after medical treatment and he was admitted to the hospital for hematemesis 2 days ago. TIPS was performed after medical treatment, and the patient recovered and was discharged from hospital.

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Rokitansky-Mayer-Kuster-Hauser Syndrome

Clinical Image

1. Clinical Medical Image
The patient was 18 years old, followed for Hodgkin’s lymphoma at puberty stage under treatment, admitted for absence of menarche and pelvic pain. Pelvic ultrasound revealed uterine agenesis, confirmed by pelvic MRI which showed uterine agenesis with hypoplasia of the upper 2/3 of the vagina continuing with elongated T2 hypointense structures in the shape of a corncob in connection with Muller’s ducts. The ovaries were without abnormality and the kidneys were unremarkable.

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Hemoptysis on False Rasmussen Aneurysm

Clinical Image

1. Clinical Medical Image
A 65 old man, with a history of heavy smoking was diagnosed with pulmonary tuberculosis. Admitted to the emergency room for respiratory distress with hemoptysis and stage III dyspnea, the biological workup revealed a hemoglobin of 9 with d-dimer of 10000, The thoracic angioscanner showed a distal right pulmonary embolism with an aneurysmal dilatation of a branch of the right superior lobar artery in relation to a Rasmusen aneurysm (figure 2) with foci of tuberculous bronchiolitis in the parenchymal window (figure 1).

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Prompt Need to Access the Maternal Effect(s) of COVID Vaccination on Her Young against Corresponding Strain

Research Article

1. Abstract
The major interest in materno-fetal relation is why fetus is not rejected by the mother, even in a different genetic background from the father. But in this article we have been investigating about the effect(s) of maternal antigenic stimulation or infection upon the active immune responses in her offspring. The results of various researchers have certainly pose significant problems as to the defense of infants against infectious agents, especially those introduced by their mothers. But we have already reported that maternal antigenic stimulation greatly suppresses the specific immune response of the offspring in a system of mouse vs heterologous erythrocytes and other T-dependent antigens. This suppression was antigen specific and effective on 1/6 life of rodents. The mechanisms that concerned in this suppression was not antigen administered nor antibody produced in the mother. The supporting evidence were that this suppression was MHC restricted and limited in during pregnancy between mother and her young. The system examined was separating genetic backgrounds that the haplotype was different in F2 family where half of the young were identical but not in remainder to the F1 mother mouse. Moreover, cytokine level in both mother and her young, IFN-γ levels was up-regulated in such a young whose mother was immunized with antigen. The significance of this phenomenon were accessed as biological and medical intervention e hypersensitivities, autoimmune syndrome for her young after birth. Especially for the mother and infant health care and prevention of Corona Virus pandemic.

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