Category Archives: Case Report

Oral manifestations of amyloidosis in a multiple
myeloma patient: A case report

Jayachandran Sadaksharam¹, Sophia Jeba Priya¹, Sripriya Subramaniam¹, Archana Muralidharan²

1. Department of Oral Medicine and Radiology, Tamil Nadu Government Dental College and Hospital, Chennai, India
2. Department Oral Medicine and Radiology, Manipal College of Dental Science Mangalore, Manipal Academy of Higher Education, Manipal, India

DOI: 10.2478/amma-2023-0019

The term amyloidosis refers to a wide range of diseases in which amorphous, extracellular, eosinophilic proteinaceous deposits form at various locations. In this article, we describe a case of amyloidosis with multiple myeloma in which the oral symptoms of the disease served as the main diagnostic clues. A male patient in his early 60s who had multiple tongue swellings presented to our department. Following an incisional biopsy, histological analysis revealed the presence of eosinophilic, amorphous hyaline-like material that was positive for Congo red staining and was indicative of amyloidosis. The presence of abnormal plasma cells in the patient’s bone marrow aspiration after the biopsy was done was suggestive of multiple myeloma. The patient is currently undergoing the CyBorD (Cyclophosphamide, Bortezomib, and Dexamethasone) treatment for multiple myeloma that has just been diagnosed. We offer this instance to demonstrate that, although uncommon, amyloidosis can initially only manifest as numerous swellings on the tongue.

Keywords: tongue, amyloidosis, amyloid, multiple myeloma

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Vincristine, doxorubicin and cyclophosphamide chemotherapy induced oral chronic hyperplastic candidiasis and xerostomia in a young patient with Ewing’s sarcoma: A case report

Harshita Sharma, Charisma Thimmaiah, Almas Binnal, Manoj Kumar Golla, BS Suprabha

Manipal College of Dental Sciences, Mangalore Manipal Academy of Higher Education, Manipal, India

DOI: 10.2478/amma-2023-0018

A common primary bone malignancy in childhood and adolescence is Ewing’s sarcoma. Here we report multidisciplinary approach in the management of chronic hyperplastic candidiasis and xerostomia secondary to chemotherapy with vincristine, doxorubicin and cyclophosphamide (VDC) in a pediatric male patient with Ewing’s sarcoma of Ethmoid sinus. The initial diagnosed oral lesion was treated with topical clotrimazole 1%w/v for two weeks and Sucralfate 1g/10mL oral rinse for one month. Upon subsequent VDC chemotherapy cycle, the patient developed grade IV oral mucositis, severe neutropenia and associated oesophageal candidiasis. Treatment included combination of topical clotrimazole 1%w/v and Fluconazole 300mg/day (IV for 5 days and Tablet for 14 days). To prevent caries risk, pit and fissure sealants were applied and topical fluoride therapy was given; patient was encouraged to have frequent sips of water and prescribed kids xylitol gum for 15 days to minimize xerostomia. At 5-week follow up, reduction in burning sensation and resolution of white lesion was noted.

Keywords: mandible, Ewing's tumour, antineoplastic chemotherapy protocol, opportunistic infections, oral candida

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The importance of early diagnosis and surveillance in Peutz-Jeghers Syndrome: A case report

Marina-Georgia Balosin

3^rd Department of Gastroenterology, “Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania

DOI: 10.2478/amma-2023-0017

Introduction: Peutz-Jeghers syndrome is a rare autosomal dominant inherited disorder characterized by hamartomatous intestinal polyps and mucocutaneous pigmentation. Most cases appear to be linked to the mutation of the STK11 gene. Patients are at a lifetime risk of gastrointestinal and non-gastrointestinal cancers.
Case Presentation: The present study offers the case of this rare disorder in a young woman revealed by jejunal obstruction caused by intussusception. A 32-year-old woman was referred to the surgical department with symptoms suggestive of an obstructive syndrome. On examination, there were multiple perioral pigmented lesions. An urgent exploratory laparotomy revealed bowel obstruction caused by an intussusception with a large polyp. The patient suffered another similar episode 4 years before leading to the diagnosis of Peutz-Jeghers Syndrome, however she was under no surveillance. Patients with pigmented lesions and a family member suffering from the mentioned syndrome should perform endoscopy and genetic tests to diagnose early and avoid complications.
Conclusion: Peutz-Jeghers Syndrome is difficult to treat due to its nonspecific symptomatology and late diagnosis. Life-threatening complications such as intussusception and various types of cancer are unanticipated. It is vital to diagnose and perform routine screening, which will make it possible to prolong the survival of many patients.

Keywords: anemia, family history, screening, intussusception, hamartomatous polyps

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Air guns: An underestimated danger – case presentation, literature review and legal interpretation

Cosmin Carasca¹, Timur Hogea¹, Katalin Siklodi Palfi², Carmen Corina Radu¹

1. George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2. Institute of Forensic Medicine, Targu Mures, Romania

DOI: 10.2478/amma-2023-0013

Introduction: The compressed air weapon is a type of arm to which the projectile is propelled due to the compression of air in a sealed chamber. These types of weapons belong to the category of non-lethal weapons and ammunition subject to authorization. However, accidental fatal cases, suicides or even deaths with intention attributed to these types of weapons are described in the literature.
Case presentation: We are discussing the case of a 5-year-old boy who, at a picnic with several families, is shot and killed with a compressed air rifle, left unattended. The medical crew arrived at the scene could not save the boy’s life. Necroptic examination revealed a gunshot wound through the heart, with the projectile stuck in the lateral-internal wall of the right ventricle. The projectile identified was a metal type projectile (lead), with a length of 8.5 mm and a diameter of 4.5 mm.
Conclusions: Compressed air weapons, although considered non-lethal, have proven over time their extremely dangerous potential through the fatal injuries produced. Raising public awareness, limiting use and enforcing strict legislation could prevent tragic events.

Keywords: forensics, air gun, fatal heart injury

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Post maxillectomy definitive rehabilitation in post-covid mucormycosis patients using conventional and 3D printed obturator: A twin case report

Manu Rathee, Santhanam Divakar, Prachi Jain, Sandeep Singh, Sujata Chahal

Department of Prosthodontics, Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India

DOI: 10.2478/amma-2022-0032

Maxillectomy is the surgical removal or resection of the maxilla or upper jaw bone. Maxillectomy may be total or partial. It is performed during surgical treatment of cancer and infections (bacterial. fungal) of the oral cavity, nasal cavity and maxillary sinuses. Patient affected from post-Covid mucormycosis require local debridement or surgical resection resulting in maxillectomy. After surgery, patient has difficulty in mastication, speech, and swallowing because of communication between oral and nasal cavity. This may also give rise to psychological challenges and social exclusion. The prosthodontic rehabilitation of such patient using obturator provide a separation between oral and nasal cavity and improve the quality of life of the patient. There are various techniques and materials used for fabrication of definitive obturator. This article discusses the prosthodontic rehabilitation after maxillectomy in post-covid mucormycosis patients using obturator by conventional and 3D printed techniques.

Keywords: mucormycosis, rehabilitation, 3D printing, obturator, conventional technique

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Non-surgical approach to a paediatric pilocytic astrocytoma with MRI follow-up. Case report and brief literature review

Andrei-Cristian Fülöp¹, Zeno Opriș¹, Eugen-Francisc Fülöp², Ioana-Geanina Ghilință³, Catalin Andrei Zagan⁴, Attila Kövecsi⁵

1. Department of Radiology, Emergency County Hospital, Targu Mures, Romania
2. George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
3. Department of Paediatric Cardiology, Emergency County Hospital, Targu Mures, Romania
4. Department of Neurosurgery, Emergency County Hospital, Targu Mures, Romania
5. Department of Pathology, Emergency County Hospital, Targu Mures, Romania

DOI: 10.2478/amma-2022-0022

Introduction: Pilocytic astrocytoma is a common tumour in paediatric patients. A low-grade glioma, it is most commonly treated by surgery, with various post-surgical side effects. New methods of treatment and follow-up are constantly evolving to offer alternative options to paediatric patients whose nerve structures are developing.
Case presentation: A 9-year-old patient diagnosed with a pilocytic astrocytoma by MRI and histopathological examination underwent a biopsy and evacuation procedure of the cystic component after which the patient’s condition improved significantly. The ‘wait-and-see’ approach using MRI instead of total surgical excision of the tumour was preferred, and the patient had favourable results on control imaging.
Conclusions: Paediatric patients suffering from pilocytic astrocytoma with favourable imaging and histopathological features may consider MRI follow-up instead of surgical excision until the character of the tumour changes or until the brain has reached full development.

Keywords: low-grade glioma, paediatric brain tumour, magnetic resonance imaging, pilocytic astrocytoma

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Digitally designed fixed dental prosthesis with stress breaking effect using non-rigid connector for pier abutment: A case report

Manu Rathee, Santhanam Divakar, Prachi Jain, Sandeep Singh, Sujata Chahal, Sarthak Singh Tomar

Department of Prosthodontics, Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India

DOI: 10.2478/amma-2022-0033

Rigid connectors between pontic and retainer are preferred way of fabricating fixed partial dentures for many decades as they provide desirable strength, retention and stability to the prosthesis. However, it is not ideal for cases such as lone-standing abutments (pier abutment), maligned teeth where occlusal stress can extrude the restoration. This may lead to marginal leakage and secondary caries on the abutment teeth. Conversely, it is recommended to use non-rigid connectors which act as a stress breaker, where the tensile stresses are concentrated on the surrounding bone and not on the connectors. With advancement in digital technology in dentistry, the non-rigid connectors can be fabricated using additive manufacturing technology. The present case report discusses the Direct Metal Laser Sintering (DMLS) designed fixed dental prosthesis with key and keyway (Tenon and Mortise) non-rigid connector for rehabilitation of pier abutment in maxillary posterior region.

Keywords: direct metal laser sintering, fixed dental prosthesis, non-rigid connectors, 3D printing, pier abutment

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Single-plaque psoriasis: a single-clue diagnostic challenge

Luminita Emilia Decean¹, Roxana Flavia Ilies², Andreea Sasu³, Iulia Barsan⁴, Adriana Mihai¹

1. George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2. Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
3. First Psychiatric Clinic, Targu Mures County Hospital, Romania.
4. Elitemed Anatomical Pathology Laboratory, Targu Mures, Romania

DOI: 10.2478/amma-2022-0019

Introduction: Psoriasis is a chronic, common immune inflammatory condition of the skin, affecting 2-3% of the population, with regional variability. Classically, psoriasis presents as one of the following types: plaque, guttate, inverse, pustular or erythrodermic psoriasis. Typically, the patient will present with several symmetric psoriatic plaques on typical areas of the body, leading the clinician towards the diagnosis of psoriasis.
Case report: The present case report series focuses on an atypical presentation of psoriasis noted in 2 patients who presented to our office with a single large, erythematous plaque located on the lower leg. Due to poor response to previous treatment, a biopsy was performed and upon analysis, revealed a diagnosis of psoriasis. The lesions showed significant improvement under local therapy.
Conclusion: In spite of significant research on such a common and seemingly well-understood dermatosis, the present case reports plead for further study with regards to atypical presentations of psoriasis.

Keywords: single plaque, unilateral, psoriasis, histopathology

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Reattachment of coronal tooth fragments: Aesthetic management of a complicated anterior maxillary crown fracture

Preethesh Shetty¹, Raksha Bhat¹, Arjun Kini²

1. Nitte (Deemed to be University), AB Shetty Memorial Institute Of Dental Sciences (ABSMIDS), Department of Conservative Dentistry and Endodontics,
Mangalore, India
2. New York University College of Dentistry, New York, NY, USA.

DOI: 10.2478/amma-2022-0027

Keywords: tooth fractures, incisors, esthetics, trauma, endodontics

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Unusual case of infrarenal pheochromocytoma developed on ectopic adrenal tissue: An autopsy case report

Rebeca Chiciudean¹, Ioan Jung², Tivadar Bara³, Simona Gurzu^1,2,4

1. Department of Pathology, Clinical County Emergency Hospital, Targu-Mures, Romania
2. Department of Pathology, George Emil Palade University of Medicine, Pharmacy, Science and Technology, Targu-Mures, Romania
3. Department of Surgery, Clinical County Emergency Hospital, Targu-Mures, Romania
4. Research Center of Oncopathology and Translational Medicine (CCOMT), George Emil Palade University of Medicine, Pharmacy, Science and Technology, Targu Mures, Romania

DOI: 10.2478/amma-2022-0025

Introduction: Pheochromocytomas are catecholamine-secreting tumors arising from the chromaffin cells of the adrenal medulla. We describe an unusual case of pheochromocytoma located in the infrarenal area and associated with bilateral adrenal hyperplasia.
Case presentation: A 70-year-old patient was admitted for syncope, diaphoresis, and high blood pressure. Computed tomography showed a 73x70x72 mm retroperitoneal mass of the left infrarenal area. High levels of metanephrine and noradrenaline were found in the urine. A tumor resection was performed. A few days after surgery, the blood pressure suddenly decreased and could not be restored, resulting in the death of the patient. Histopathological examination of the surgical specimen revealed a proliferation of monotonous cells, with eosinophilic cytoplasm, round nuclei with prominent nucleoli arranged in clusters, and capsular and vascular invasion. The tumor cells expressed synaptophysin and chromogranin, without positivity for inhibin A or S100 protein. At the autopsy, both adrenal glands showed hyperplasia but unrelated to the tumor mass. The histological aspect, location, and immunophenotype indicated an ectopic infrarenal pheochromocytoma.
Conclusions: In patients with pheochromocytoma developed on ectopic adrenal tissue, clinical management might be difficult, and diagnosis can be sometimes established only based on post-mortem histopathological examination. Autopsy can be extremely useful in such cases with unexplained evolution.

Keywords: adrenal hyperplasia, pheochromocytoma, metanephrine

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