Category Archives: Case Report

Acute Myeloblastic Leukemia: Difficulties of Treatment, Complications and Evolution

Tilinca Mariana¹, Benedek Lázár Erzsébet², Köpeczi Judith Beáta², Bacârea Anca³, Bănescu Claudia4, Benedek I², Bățagă Simona5

1 Department of Cellular and Molecular Biology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Department of Hematology, Bone Marrow Transplantation Compartment, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
3 Department of Physiopathology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
4 Department of Genetics, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
5 Internal Medicine I, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Introduction: This paper presents a special case of an acute myeloblastic leukemia accidentally diagnosed on a 57 years old asymptomatic person without occupational exposure, without a medical history, with normal blood count, without thrombocytopenia, as a result of routine hematological tests that reveal the presence of more than 10% blasts on peripheral blood smear.
Material and method: Bone marrow aspirate revealed 80% blasts and flow cytometry confirmed the diagnosis of acute myeloblastic leukemia LAM0. Cytogenetic examination showed normal karyotype 46, XX. The treatment aims to induce, maintain and consolidate remission. Since the classical therapeutical approach with Idarubicine and Cytarabine 3+7 was not tolerated, adjustments were necessary to 2+5, four courses being administered. During the remission period Methotrexate and Purinetol maintenance treatment was administered, it was obtained a tolerable quality of life, the patient resumed his work. The first relapse occurred after approximately one year. Later medical courses were established after chemotherapy protocol with Clofarabine and Cytarabine, but after intolerance, neutropenia, sepsis and death occured.
Results: Because of the severe prognosis and infectious complications the treatment was difficult and dose ajustments were necessary according to patient’s tolerance. Bone marrow transplant was not possible due to the lack of a compatible family donor.
Conclusions: This case of acute myelogenous leukemia treatment reflects the difficulties and complications occurred during the disease evolution. However remission periods with a tolerable quality of life were obtained, duration of treatment was approximately three years until death.

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Multidisciplinary Approach of Breast Cancer. Case Reports

Podeanu Daniela1, Stolnicu Simona2, Georgescu R3, Treaba Andrada1, Șincu Nina-Ioana4, Copotoiu C5, Brînzaniuc Klara6

1 Department of Radiology and Medical Imaging, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Department of Pathology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
3 Surgery Clinic III, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
4 Clinic of Infectious Diseases I, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
5 Surgery Clinic I, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
6 Department of Anatomy, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Introduction: Breast cancer is still the world’s most common cancer in women. Multidisciplinary approach represents the gold standard in diagnosis.
Case presentation: In order to emphasize the importance of this issue, we present three of our cases. In these cases of invasive carcinoma, in women ranged from 42 to 54 years, the diagnosis tools were clinical examination, mammography, ultrasound and histopathology. Minimal invasive breast biopsy and preoperative localisation procedures, under ultrasound and stereotactic guidance contributed to preoperative planning.
Conclusions: Interdisciplinary approach in diagnosis provides optimal management of breast cancer.

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Atrial Fibrillation, the First Manifestation of Atrial Myxoma

Opriș Mihaela¹, Maier Anca², Dinesch M², Bilca V³, Moldovan Eugenia4, Mitre Adriana¹, Sîrbu Voichița¹

1 Medical Clinic V, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Clinic of Cardiology, Emergency County Hospital, Tîrgu Mureș, Romania
3 Clinic of Cardiovascular Surgery, Emergency County Hospital, Tîrgu Mureș, Romania
4 Department of Pathology, Emergency County Hospital, Tîrgu Mureș, Romania

Introduction: Atrial myxomas are the most common primary heart tumors. Although quite rare, left atrial myxomas account for 80% of all cardiac tumors. Diagnosis is often difficult due to the wide array of presenting symptoms. This case report discusses an unusual presentation of left atrial myxoma in an elderly patient.
Case presentation: A 73-year old woman with a history of hypertension, dyslipidemia and hyperthyroidism treatment presented to the emergency department with a new onset episode of palpitations. The electrocardiogram revealed atrial fibrillation. Rate control was achieved with beta-blockers and sinus rhythm transition was achieved shortly after admission. Transthoracic echocardiography revealed a heterogeneous mass in the left atria with a villous surface, occupying more than 50% of the left atrial cavity. Surgery was recommended because of the embolic potential of such a mass and tumor excision was performed. Microscopic pathology showed typical histological features of cardiac myxoma with no atypia or malignancy, and the patient was discharged in sinus rhythm 7 days after surgery.
Discussion and conclusions: Left atrial myxoma presenting in the seventh decade of life is rare. Elderly patients often present with non- specific symptoms that are often overlooked in the absence of a supporting cardiac history, which makes an early diagnosis challenging. We conclude that the majority of myxomas mimic many cardiovascular diseases and were detected in symptomatic patients, so a high index of clinical suspicion is important for its early and correct diagnosis. Two-dimensional echocardiography provides substantial advantages in detecting intracardiac tumors.

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Endoscopic Examination: a Present and Future Challenge

Boeriu Alina1, Dobru Daniela1, Mocan Simona2, Pascarenco Ofelia3, Stoian M4, Boeriu C5

1 Department of Gastroenterology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Department of Pathology, County Emergency Hospital, Tîrgu Mureș, Romania
3 Department of Gastroenterology, County Emergency Hospital, Tîrgu Mureș, Romania
4 Intensive Care Department, County Emergency Hospital, Tîrgu Mureș, Romania
5 Emergency Department, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

The detection and surveillance of patients with premalignant gastric lesions could lead to early detection and treatment of gastric cancer. These lesions are mostly diagnosed in random biopsy samples obtained during conventional endoscopy. New endoscopic techniques, such as magnification endoscopy, may help the detection of neoplastic lesions. In this case series, we intended to emphasize the current problems in the detection and surveillance of gastric neoplasic lesions in clinical practice. Four cases with gastritis-like appearance on conventional endoscopy were identified with gastric dysplasia or carcinoma on histopathologic evaluation. We discussed the subjective interpretation of endoscopic findings, the challenges in the surveillance of low-grade dysplasia and the contribution of magnifying endoscopy on diagnostic accuracy. The performance of endoscopic examination and surveillance could be improved by magnified chromoendoscopy with targeted biopsies. An understanding of diagnostic challenges of gastric dysplasia is crucial in clinical management.

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Tumors of the Oro-Facial System

Biriş Carmen1, Brînzaniuc Klara2, Cerghizan Diana1, Jánosi Kinga1, Kovács Alpárd3

1 Department of Prosthetic Dentistry and Oral Rehabilitation, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Department of Anatomy and Embriology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
3 Dentist in private practice

The increasing number of malignant cases in the oro-facial area represents by their increasing number lately a new problem regarding the treatment and diagnosis. This cases present an increased difficulty of diagnostic and treatment, because they are usually diagnosticated in lately stages. Patients are often unaware of the gravity of their situation due to the lack of specific or almost absent symptomatology.
The incriminated factors and co-factors incriminated in the development of the malignant manifestations are of multiple origins: use of tobacco products, especially associated to alcohol abuse, chronical topic irritation of the oral mucosa, genetic predisposition or some types of viruses (human papilloma virus type 16 and 18 and herpes virus). Also factors like: environmental modifications, age, alimentation or pharmaceutical drug usage can be incriminated for the increasing pathology of the last decades, especially in well developed countries both from Europe and North America.
Our presentation is based on the case of a 61 years old male, showing almost the typical premises of a malignant pathology starting from the evolution of the oral lesion and the general and dental pathology status with the correlation of the objective and subjective examination.
The lesion usually benefits of surgical treatment, followed by radiotherapy and oro-facial reconstruction, that can imply both plastic surgery and prosthetic rehabilitation, as was the case of our patient. Of most importance remains the moment of the prosthetic treatment and its correlation with radiotherapy, regarding the tissue modification that irradiation has on this level.

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Remarks on Odontogenesis in Children After Chemo-radiation Therapy

Bică Cristina1, Chinceşan Mihaela2, Păcurar Mariana¹, Molnár Enikő³, Stolnicu Simona4

1 Department of Pediatric Dentistry, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Department of Pediatric Haematology-Oncology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
3 Emergency County Hospital, Tîrgu Mureș, Romania
4 Department of Pathology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Introduction: Leukemias are the most frequent forms of neoplasias in children. The oral complications that occur in time, after the specific treatment through chemotherapy or radiotherapy, are represented by the occurrence of multiple carious lesions, disorders of dental eruptions, the premature loss of the primary teeth, anomalies in the development of teeth.
Material and method: Through the clinical examination of the oral cavity and through radiological examination, with the help of the orthopantomogram, we revealed the disorders of dental development consecutive to the cytostatic therapy and radiotherapy in the acute lymphoblastic leukemia.
Results: The specific treatment through chemotherapy and radiotherapy overlapped with important stages of the physiological process of odontogenesis. We noted ageneses, microdontias, precocious eruptions and disorders of the eruption order.
Conclusions: The cytostatic medication and radiotherapy can be followed by anomalies in the development and eruption of the dental buds. The severity of these secondary effects varies according to the patient’s age at the moment of the start of the specific therapy, the stage of dental development, the type of cytostatic medication and the dose and frequency of treatment cycles.

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Complex Multitrauma Patient: Head, Thorax, Abdomen and Limbs

Gomotîrceanu F1, Ghiga Dana2, Petrişor M3, Haifa B3, Băţagă T1

1 County Emergency Clinical Hospital, Tîrgu Mureş, Romania
2 Department of Research Methodology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
3 Department of Medical Informatics and Biostatistics, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

Introduction: Multiple trauma represents the main cause of death in 40–50 years old patients. It requires a rigorous management of the critical patient to ensure a correct order in the performed maneuvers and a maximum efficiency.
Case report: We report a case of a 27 year-old patient with multiple trauma, victim of a train accident. The patient arrives with the presumptive diagnosis of multiple trauma due to train accident, open acute craniocerebral trauma, suspicion of acute subdural hematoma. After the evaluation in the emergency service, the patient was transferred to the Tîrgu Mureş Surgery Clinic, where an emergency intervention was performed. Any of the lesions presented (abdomen, thorax, extremities and head lesions) were able to produce the patient’s death by themselves.
Conclusions: The survival chances of multiple trauma patients increase due to a rigorous management and the application of a standardized evaluation protocol.

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Livedoid and Gangrenous Dermatitis (Nicolau Syndrome)

Fekete GyL1, Fekete Júlia Edit2

1 Department of Dermatology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Public Health Center, Tîrgu Mureş, Romania

Livedoid and gangrenous dermatitis is a rare posttherapeutic accident, produced by intravenous, intramuscular or intra-arterial drug injection under an oily or suspension form. It was first described by Stefan G. Nicolau in 1925 after injections of bismuth. The progression of the disease is favorable most cases are cured after 6–8 weeks. We present a clinical case of a patient aged 74 years.

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Multifocal Sarcomatoid Carcinoma of the Small Intestine

Fülöp Emőke1, Marcu Simona Tünde1, Loghin Andrada1, Fülöp EF2, Mocan Simona3

1 Department of Histology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Department of Internal Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
3 Department of Pathology, County Emergency Clinical Hospital, Tîrgu Mureş, Romania

Sarcomatoid carcinomas (SCs) or carcinosarcomas are rare, biphasic tumors, with poor prognosis, only rarely located in the small and large intestine. The first treatment option of these tumors is surgical approach, adjuvant therapy showing no important role in the treatment protocol. We present the case of a 63 years old male patient, hospitalized in the Surgical Department II of the County Emergency Clinical Hospital Tîrgu Mureş with the diagnosis of small intestine tumor with jejunal localization. Microscopically, in hematoxylin-eosin (HE) staining, the tumor was consisting of two components, an epithelial and a mesenchymal one. From immunohistochemical point of view, tumor cells were strongly positive for cytokeratin AE1/AE3 as well as for vimentin. They were negative for epithelial membrane antigen (EMA), CD117, CD34, S100, chromogranin-A and synaptophisin. Based on the macroscopic and microscopic appearance, respectively the immunohistochemical feature of the tumor, the patient was diagnosed with multifocal sarcomatoid carcinoma of the small intestine.

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Particular Clinical-Therapeutic Aspects of Rhinophyma — Atypical Case Report

Andrei Liliana1, Bordeianu I2, Iordache IV2, Bratu I3

1 Hypocrate Medical Center, Tulcea, Romania
2 Faculty of Medicine, Ovidius University, Constanța, Romania
3 Faculty of Pharmacy, Ovidius University, Constanța, Romania

The authors present a case of pseudotumoral rhinophyma with some specific and rare clinical, evolutional and therapeutic aspects. Therapeutic indication was put on functional rather than cosmetic reasons, and surgery led to good functional and cosmetic results, accompanied by a fast spontaneous-directed epithelialization.

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