Zeitschrift für klinische Fallberichte

Objective: Our objective is to explain precocious puberty, type, etiology, investigation, how to differentiate between central and peripheral precocious puberty, and focus on one of the rarest causes of precocious puberty.

Case report: In our case of precocious puberty, a two-year-old female presented with bilateral breast enlargement, vaginal secretion, pubic hair, and abdominal swelling. An abdominal and pelvic CT shows a very large ovarian mass. Asalpino-oophorectomy was carried out with regression of symptoms and signs and improvement in laboratory exams. The biopsy showed Juvenile Granulosa Cell Tumors (JGCT).

Discussion: Due to an increase in the levels of estradiol and no increase in the gonadotropins (LH, FSH), advanced bone age and height age are compatible with the chronic age of 2 years old, so we think about peripheral precocious puberty. Due to abdominal swelling and patient age (small age), we suspect malignancy, so we did a CT scan and sonography of the pelvis.

Conclusion: Every patient with signs and symptoms of precocious puberty must do all the investigation that leads to diagnosis, especially when there is a red flag like in our patient (very small age).

Background: Lipofilling is a common aesthetic and reconstructive procedure. Embolism is a possible complication of every filler, which can be lethal. We describe the case of a 56 years old man who had a fat embolism in the common carotid artery with fatal issue.

Case presentation: Our patient initially had a left oropharynx cancer, treated by surgery and adjuvant radiotherapy. Many flaps and graft procedure has been tried to treat an ankyloglossia sequelae, and the effective procedure was a forearm free flap. Lipofilling was performed for a temporal defect after a temporal myocutaneous flap. A common carotid embolism was the source of a severe unilateral stroke, leading patient to the death 15 days after initial surgery.

Discussion and conclusion: Reverse-flow mechanism explains the artery tropism of fat embolism in the face, contrary to veinous tropism for fat embolism in the body. Pressure of injection, needle (in contrast to blunt end cannula) and large syringe use are the factors of fat embolism in lipofilling procedure. Volume is not a significative factor.

Intravenous Bisphosphonates (BPs) are used to treat cancer-related conditions, including hyperkalemia of malignancy, Skeletal-Related Events (SREs) associated with bone, and for management of lytic lesions in the setting of multiple myeloma. Bisphosphonate-Related Osteonecrosis of the Jaw (BRONJ) is a severe complication of BPs, which affects the patient's quality of life. In the treatment of BRONJ, soft tissue coverage for coverage of the debrided bone is essential. In severe soft tissue deficiency, the use of local or distant soft tissue flap is necessary this case report; a massive BRONJ was described in which a submental flap was used to cover the mandibular bone.

Nasal tuberculosis is a rare clinical entity even in areas with high incidence of tuberculosis. Due to its rarity and no specific clinical presentation its timely diagnosis as well as proper management often gets delayed. Therefore here we report a case of primary nasal tuberculosis in a 40-year-old male presented with nasal obstruction, epistaxis and recurrent cold since past 2 years. This case report would further emphasize that Nasal tuberculosis should always be kept as one of the differential diagnosis in chronic nasal symptoms and in granulomatous lesions of the nose; so that patient may be given appropriate and timely treatment.

In children, Extra Medullary Hematopoiesis (EMH) is a compensatory response to severe chronic anemia, particularly in the context of B thalassemia. Its localization, variable, is mainly hepatic, splenic and ganglionic but all the other organs, including the skin, can be reached. Rare, most often asymptomatic, EMH can be manifested by a mass syndrome. The anamnesis and the imaging bring arguments in favor of the diagnosis, sometimes difficult to establish, without resorting to invasive examinations. Thanks to therapeutic progress, the surgical treatment has become rare, reserved for certain special cases. We report the case of a patient with major B thalassemia, in whom the appearance of an abscessed abdominal mass has revealed several foci of EMH.

Hemifacial Spasm (HSF) refers to the intermittently involuntary clonic twitch or painless rigidity of one or two sides of facial muscles. Patients with hemifacial spasm generally have a decline in quality of life, accompanied by anxiety, depression and other emotional problems, which further aggravate hemifacial spasm symptoms. BTX-A injection is the first choice for treatment of HFS, which can not only relief the symptoms of HFS but also improve the mood problems. There have been no reported cases of HFS cured by drugs or BTX-A. Here we reported two HFS patients recovered after multiple BTX-A treatments without recurrence for 3-8 years, which might provide a clue for further exploration of the pathogenesis of HFS.

Extracutaneous melanomas are in the majority of cases reported in the literature as secondary lesions of a primary skin tumor. Far more rarely do they present themselves as primitive. Extracutaneous melanomas can be grouped into three categories: Ocular; Mucosal, Metastatic. Obviously, the greatest number of lesions is represented by metastatic forms. The Mucosal Melanomas preferably arise in peripheral districts of the gastrointestinal tract (mouth, pharynx, esophagus, anorectal mucosa), respiratory (nose, larynx) and urogenital (Vulva, vagina, cervix).