AME Case Reports最新文献

{"title":"Urogenital abscess with a complex etiology: a case report.","authors":"Natalie Grace Narcelles, Afolabi David Akinpelu, Michael Duke Sarap","doi":"10.21037/acr-2026-0132","DOIUrl":"https://doi.org/10.21037/acr-2026-0132","url":null,"abstract":"<p><strong>Background: </strong>Scrotal abscesses requiring hospitalization are uncommon, with progression to sepsis being even rarer. A feared complication of a scrotal abscess is Fournier gangrene, an uncommon type of necrotizing fasciitis that starts in the scrotum or perineum. Fournier gangrene is associated with a mortality rate of about 40% and accounts for less than 0.02% of all hospital admissions. The patient in this report was hospitalized for a complex scrotal abscess and, during repeat incision and drainage (I&D), was found to have Fournier gangrene.</p><p><strong>Case description: </strong>The patient was a 49-year-old male who presented with acute left-sided perineal pain. His medical history was significant for severe obesity, uncontrolled diabetes mellitus (DM) type 2, and hypertension (HTN). Physical examination showed no superficial signs of an abscess. Computed tomography (CT) of the abdomen and pelvis was inconclusive. Further workup revealed borderline tachypnea [20 breaths per minute (bpm)], elevated white blood cell count (WBC) (27.60 K/mcL), tachycardia (128 bpm), and a probable source of infection. The patient met septic criteria according to the Systemic Inflammatory Response Syndrome Criteria (SIRS). He was started on intravenous (IV) vancomycin [1,750 mg every 12 hours (q12h) ×2 days to 2,000 mg q12h ×7 days], and IV piperacillin-tazobactam (3.375 mg q8h ×9 days). Clinical decision-making warranted a surgical consult and, thus, immediate I&D. The patient's infection failed to improve. Additional imaging, transfer to a tertiary hospital, and repeat I&D led to more advanced findings. The patient was found to have a scrotal abscess that tracked through the perineum to the ischium. He was diagnosed intraoperatively with Fournier gangrene and was admitted for continued monitoring and IV antibiotics. After discharge and multiple follow-up visits with wound care, the patient made a full recovery.</p><p><strong>Conclusions: </strong>This case report showcased an uncommon presentation of a male with a urogenital abscess. A patient presenting with a urogenital abscess complicated by sepsis should prompt a clinician to have a high index of suspicion for Fournier gangrene. Broad-spectrum IV antibiotics should be initiated as quickly as possible, and a general surgery consult should be placed for I&D. This case highlights the importance of urgent intervention in reducing mortality secondary to Fournier gangrene as well as maintaining the function of urinary and sex organs.</p>","PeriodicalId":29752,"journal":{"name":"AME Case Reports","volume":"10 ","pages":"169"},"PeriodicalIF":0.6,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13659120/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pralsetinib-induced interstitial pneumonitis in a patient with metastatic pulmonary sarcomatoid carcinoma harboring <i>RET</i> fusion: a case report.","authors":"Jing Zhang, Jie Huang, Xin Li, Yao Qiu, Jingjing Xiang, Shenglin Ma, Xueqin Chen","doi":"10.21037/acr-2026-0160","DOIUrl":"https://doi.org/10.21037/acr-2026-0160","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary sarcomatoid carcinoma (PSC), an exceptionally rare subtype of non-small cell lung cancer (NSCLC), remains poorly characterized in terms of molecular alterations, rendering targeted therapy a promising option. <i>RET</i> gene fusions act as oncogenic drivers across multiple tumor types, and the emergence of selective RET tyrosine kinase inhibitors (TKIs) like pralsetinib has transformed the treatment of <i>RET</i>-fusion positive malignancies. However, their expanding clinical use underscores the need to better understand adverse event (AE) profiles, particularly severe toxicities.</p><p><strong>Case description: </strong>This report describes a 60-year-old male who presented with progressive hemoptysis. Bronchoscopic biopsy, combined with pathological evaluation, immunohistochemical staining, and next-generation sequencing (NGS), confirmed the diagnosis of metastatic PSC (favor spindle cell type, cT4N2M1a, stage IVa) harboring a <i>KIF5B-RET</i> fusion. The patient was initiated on pralsetinib, achieving a sustained partial response (PR) for 25 months. Subsequently, he developed pralsetinib-induced grade 3 interstitial pneumonitis, which resolved following immediate drug discontinuation and systemic glucocorticoid intervention. A pralsetinib rechallenge at a reduced dose was attempted but resulted in recurrent pneumonitis, mandating permanent treatment cessation. The patient's condition rapidly deteriorated, leading to his unfortunate demise.</p><p><strong>Conclusions: </strong>Pralsetinib is effective for <i>RET</i>-fusion positive PSC, achieving long-term disease control. However, its risk of severe interstitial pneumonitis highlights the need for close monitoring. Clinicians should balance risks and benefits, especially for rechallenge, to optimize outcomes.</p>","PeriodicalId":29752,"journal":{"name":"AME Case Reports","volume":"10 ","pages":"172"},"PeriodicalIF":0.6,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13659157/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Possible Epstein-Barr virus-associated central nervous system involvement with reversible electroencephalographic abnormalities in a child: a case report.","authors":"Rui-Han Lian, Bin Yi, Ping-An Qi","doi":"10.21037/acr-2026-0141","DOIUrl":"https://doi.org/10.21037/acr-2026-0141","url":null,"abstract":"<p><strong>Background: </strong>Epstein-Barr virus (EBV)-associated central nervous system (CNS) involvement in children is uncommon and may present with nonspecific neurological symptoms. Brain magnetic resonance imaging (MRI) may remain normal, making diagnosis challenging. Cerebrospinal fluid (CSF) targeted next-generation sequencing (tNGS) has emerged as a useful diagnostic tool, although positive EBV results require careful clinical interpretation.</p><p><strong>Case description: </strong>A previously healthy 5-year-old boy presented with fever (38.5 ℃), headache, dizziness, and nausea for 3 days without seizures, altered consciousness, focal neurological deficits, or ataxia. Laboratory tests showed leukocytosis and elevated inflammatory markers. Brain MRI was unremarkable. CSF examination revealed an opening pressure of 120 mmH₂O and mild pleocytosis (13×10⁶/L, 100% mononuclear cells), with normal glucose and protein levels. CSF tNGS detected EBV (24,002 sequence reads; estimated pathogen concentration <10³ copies/mL), while no other pathogens were identified and autoimmune encephalitis antibodies were negative. Serum EBV DNA was positive, and EBV serology demonstrated viral capsid antigen (VCA)-IgM positivity during the acute phase followed by VCA-IgG seroconversion during recovery. Electroencephalography (EEG) showed sharp and sharp-slow wave discharges in the left parietal, occipital, and posterior temporal regions despite normal MRI. The patient received intravenous ganciclovir (10 mg/kg twice daily for 2 weeks) and empirical ceftriaxone for 4 days. Clinical symptoms resolved completely, follow-up EEG normalized, and no neurological sequelae were observed at 1-month follow-up.</p><p><strong>Conclusions: </strong>This case highlights that possible EBV-associated CNS involvement may occur in children despite normal brain MRI and only mild CSF abnormalities. The combination of CSF tNGS, dynamic EBV serology, EEG findings, exclusion of alternative etiologies, and clinical follow-up may facilitate diagnosis. Because EBV detected in CSF does not necessarily indicate causation, results should always be interpreted in the context of the overall clinical presentation.</p>","PeriodicalId":29752,"journal":{"name":"AME Case Reports","volume":"10 ","pages":"173"},"PeriodicalIF":0.6,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13659133/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical stabilization of rib fractures in patients with open flail chest results in improved clinical outcomes: a report of three cases.","authors":"Yongkun Wu, Yufei Wang, Zheng Yang, Qinyu Meng, Zhanlin Guo","doi":"10.21037/acr-2026-0104","DOIUrl":"10.21037/acr-2026-0104","url":null,"abstract":"<p><strong>Background: </strong>Open flail chest is a rare but life-threatening condition characterized by severe chest wall instability and contaminated wounds, which increase the risk of postoperative hardware infection. Surgical stabilization of rib fractures (SSRF) has shown benefits in blunt thoracic trauma; however, its application in open flail chest remains controversial due to infection concerns. Evidence guiding the decision to perform SSRF in this setting is limited.</p><p><strong>Case description: </strong>We retrospectively analyzed three patients with open flail chest who underwent SSRF. Clinical data were collected, including demographics, injury characteristics, surgical management, postoperative recovery, and long-term outcomes. All patients underwent timely debridement and internal fixation. Postoperatively, all patients showed favorable recovery with restoration of chest wall stability. No hardware-related infections or chest wall deformities were observed during follow-up periods of 19, 72, and 122 months.</p><p><strong>Conclusions: </strong>For selected patients with open flail chest, when the time from injury to surgery is no more than 8 hours, the open wound contamination is mild, and thorough debridement is performed, chest wall reconstruction and internal fixation surgery may be relatively safe. This approach can help save patients' lives in the early stage and may lead to favorable long-term outcomes. However, caution should be exercised when considering primary surgery for patients with open contaminated wounds and an injury-to-surgery time exceeding 8 hours. Admittedly, our conclusions need to be validated with more cases.</p>","PeriodicalId":29752,"journal":{"name":"AME Case Reports","volume":"10 ","pages":"156"},"PeriodicalIF":0.6,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13466878/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148725024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Isolated IgG4-related lung disease: a case report.","authors":"Jiayuan Pu, Panpan Gou, Wanchun Qiu, Fabing Tang, Caiyun Wang","doi":"10.21037/acr-2026-0130","DOIUrl":"10.21037/acr-2026-0130","url":null,"abstract":"<p><strong>Background: </strong>IgG4-related disease (IgG4-RD) represents a chronic, immune-driven fibroinflammatory condition capable of affecting diverse organ systems; within this spectrum, pulmonary involvement (IgG4-RLD) remains comparatively uncommon. This case report outlines the clinical, imaging and pathological features of a patient with IgG4-related lung disease.</p><p><strong>Case description: </strong>We report a 60-year-old male patient with recurrent fever, chest pain, and cough with hemoptysis. Chest computed tomography (CT) initially showed right upper lobe lesions suggestive of pneumonia, but the patient failed to respond to multiple courses of antibiotics including levofloxacin, nemonoxacin malate, ceftizoxime, and amoxicillin. Further investigations revealed significantly elevated serum IgG4 level (266 mg/dL). Endobronchial ultrasound-guided transbronchial lung cryobiopsy (EBUS-GS-TBLC) confirmed dense lymphoplasmacytic infiltration in the lung tissue, with IgG4-positive plasma cells >50 per high powered field (HPF) and IgG4-positive/IgG-positive cell ratio >50%, consistent with the diagnosis of IgG4-related interstitial lung disease. The patient was treated with oral cyclosporine and mycophenolate mofetil, resulting in significant clinical and radiological improvement.</p><p><strong>Conclusions: </strong>IgG4-RLD should be considered in the differential diagnosis of patients with pulmonary lesions unresponsive to antibiotic therapy. Comprehensive evaluation including serum IgG4 measurement and targeted pathological biopsy is essential for accurate diagnosis. Early initiation of immunosuppressive therapy can effectively improve outcomes and prevent disease progression.</p>","PeriodicalId":29752,"journal":{"name":"AME Case Reports","volume":"10 ","pages":"152"},"PeriodicalIF":0.6,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13466743/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148722422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Conservative management of a retained bullet in the right atrioventricular groove following a penetrating thoracic gunshot wound: a case report.","authors":"Sira Laohathai, Jakraphan Yu, Thanga Saravanan","doi":"10.21037/acr-2026-0140","DOIUrl":"https://doi.org/10.21037/acr-2026-0140","url":null,"abstract":"<p><strong>Background: </strong>Penetrating cardiac injuries from firearms are highly lethal, with the majority of victims dying at the scene from exsanguination. A minority of patients who reach hospital alive harbor a retained intracardiac or pericardial projectile, posing a clinical dilemma: while extraction has historically been favored to prevent migration, embolization, infective endocarditis, conduction abnormalities, and lead toxicity, contemporary evidence supports selective conservative management in hemodynamically stable patients without active hemorrhage, structural cardiac injury, or arrhythmia. Bullets retained within the atrioventricular (AV) groove are particularly hazardous to extract because of adjacent coronary arteries and conduction tissue, and reports of conservatively managed AV-groove projectiles are rare. This case adds to the limited literature describing successful non-operative management of a retained AV-groove bullet.</p><p><strong>Case description: </strong>A 25-year-old previously healthy man sustained a single gunshot wound to the right chest and remained hemodynamically stable throughout inter-hospital transfer. Imaging suggested a projectile near the right atrium, but localization was limited by metal artifact. Transthoracic echocardiography demonstrated mild apical pericardial effusion with preserved biventricular function and no valvular injury. Right video-assisted thoracoscopic surgery (VATS) with pleuro-pericardial window drained 100 mL of serosanguineous fluid but did not identify the projectile. Conversion to median sternotomy revealed a bullet within the right AV groove without active hemorrhage. Intraoperative transesophageal echocardiography demonstrated normal biventricular function with no regional wall motion abnormality and no tricuspid regurgitation. Following multidisciplinary discussion, the family elected to forgo extraction. The pericardium was closed and chest drains placed. Postoperative echocardiography, electrocardiography, and serial serum lead levels remained within normal limits. The patient was discharged on postoperative day 7 and remained well at 6-month follow-up.</p><p><strong>Conclusions: </strong>Conservative management of a retained bullet within the AV groove is a reasonable option in hemodynamically stable patients with intact cardiac function, no active bleeding, and no evidence of mechanical or electrical compromise. Avoidance of extraction in this anatomically sensitive region minimizes procedural risk to the right coronary artery and conduction tissue, but mandates structured long-term surveillance for migration, infection, conduction abnormalities, and lead toxicity.</p>","PeriodicalId":29752,"journal":{"name":"AME Case Reports","volume":"10 ","pages":"167"},"PeriodicalIF":0.6,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13659163/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Congenital knee deformity: rare case report and unexpected finding in the delivery room.","authors":"Shaikha Almheiri, Asma Musa","doi":"10.21037/acr-2026-0114","DOIUrl":"10.21037/acr-2026-0114","url":null,"abstract":"<p><strong>Background: </strong>Congenital knee dislocation (CKD), or genu recurvatum, is an uncommon congenital deformity marked by knee hyperextension and restricted flexion. It may occur either as an isolated finding or in association with other conditions. CKD can be diagnosed prenatally or postnatally. Most of the cases are treated during infancy by manipulation and serial casting or splinting without surgical intervention. This case report aims to enhance the understanding of this condition and its associations, improving the process of early diagnosis and management to prevent long-term functional impairment.</p><p><strong>Case description: </strong>We report a case of a full-term female newborn with bilateral passive fixed hyperextension of the knees, limited flexion, and a full range of motion. She was born via lower segment caesarean section (LSCS) to a 28-year-old G3P1A1 (gravida 3, para 1, abortus 1) Emirati patient. The pregnancy was complicated by iron deficiency anemia, frequent micturition, vulvovaginitis, and gestational diabetes mellitus. The patient underwent knee reduction-manipulation and received serial casting and repeated radiographic evaluation for improvement. After 1 year of physiotherapy and serial casting followed by splinting, the patient exhibited an excellent prognosis and is walking normally with no pain or progressive deformity; however, a small degree of hyperextension remains.</p><p><strong>Conclusions: </strong>Early recognition is crucial to enable prompt treatment and improve the likelihood of a favorable outcome. Management should be tailored to the condition of the joint and any associated abnormalities.</p>","PeriodicalId":29752,"journal":{"name":"AME Case Reports","volume":"10 ","pages":"149"},"PeriodicalIF":0.6,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13466658/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148723852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiogenic shock associated with stress-induced cardiomyopathy in the setting of diabetic ketoacidosis initially suspected to be septic shock: a case report.","authors":"Shun Nakahara, Kridhitach Ngarmukos, Adivitch Sripusanapan, Osman Rahimi, Abdulelah Nuqali","doi":"10.21037/acr-2026-0100","DOIUrl":"10.21037/acr-2026-0100","url":null,"abstract":"<p><strong>Background: </strong>Shock associated with diabetic ketoacidosis (DKA) is commonly hypovolemic or distributive in nature, reflecting its underlying pathophysiology and precipitating factors. However, in rare cases, DKA can precipitate stress-induced cardiomyopathy, which may lead to cardiogenic shock. In addition, DKA causes metabolic derangements, increasing the risk of additional cardiac complications.</p><p><strong>Case description: </strong>A 30-year-old woman with no known past medical history presented with acute onset of fever and altered mental status. Laboratory evaluation demonstrated hyperglycemia, metabolic acidosis, elevated anion gap, increased beta-hydroxybutyrate, and elevated lactate. Diabetic ketoacidosis and hyperosmolar hyperglycemic state (DKA/HHS) overlap was diagnosed, and possible sepsis was also considered. Standard management was initiated. However, the patient continued to require high-dose vasopressors. Further evaluation revealed diffuse ST-segment elevations on electrocardiography and a reduced left ventricular ejection fraction (LVEF) with mid-distal anteroseptal and apical hypokinesis on transthoracic echocardiography. Right and left heart catheterization demonstrated low-output cardiogenic shock with biventricular failure, requiring intra-aortic balloon pump (IABP). With hemodynamic stabilization and treatment of DKA/HHS, IABP was successfully weaned off. Serial echocardiography demonstrated normalization of LVEF, which was consistent with stress-induced cardiomyopathy.</p><p><strong>Conclusions: </strong>Shock in the setting of DKA is not necessarily hypovolemic or distributive. In cases of persistent shock in DKA, clinicians should pursue early cardiac evaluation and consider mechanical circulatory support for possible cardiogenic shock due to stress-induced cardiomyopathy. Early hemodynamic stabilization alongside rigorous treatment of DKA is important for favorable outcomes.</p>","PeriodicalId":29752,"journal":{"name":"AME Case Reports","volume":"10 ","pages":"150"},"PeriodicalIF":0.6,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13466919/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148722621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case report: retentive fibroid tumor of the ileocecal region during pregnancy.","authors":"Hongying Ma, Weiwei Zhang, Hong Liu, Lei Liang","doi":"10.21037/acr-2026-0054","DOIUrl":"10.21037/acr-2026-0054","url":null,"abstract":"<p><strong>Background: </strong>Desmoid type fibromatosis (DTF) is a rare, non-metastasizing but locally invasive intermediate soft tissue tumor. With an annual incidence of 2-4 per million, it is particularly rare during pregnancy. The particularity of this case is that the patient is pregnant, 14 weeks gestation, placenta previa, and a large mass is found in the abdominal pelvic cavity. The patient requests to terminate the pregnancy and remove the abdominal pelvic cavity mass. The large mass originates from ileocecal area, which is extremely rare and can be an excellent supplement to the literature.</p><p><strong>Case description: </strong>A 32-year-old woman found out she was pregnant 6 weeks after her last period and had no discomfort. At 14 weeks of pregnancy, ultrasound and magnetic resonance imaging (MRI) showed: there was a huge hypoechoic mass above the uterus, accompanied by connecting blood vessels. It was misdiagnosed as uterine fibroids. Through multidisciplinary team (MDT) assessment, formulated a surgical plan. The patient and her family signed the informed consent form and decided to undergo the surgery. Following termination of pregnancy, exploratory laparotomy uncovered a mass originating from the ileocecal region, with vascular connections to the uterine surface but no significant adhesions. The patient underwent successful tumor resection with ileocecal resection. Histopathological examination of the mass confirmed a diagnosis of DTF, characterized by spindle cells without significant atypia. Immunohistochemistry was pivotal, showing nuclear positivity for β-catenin and a Ki-67 index of <10%, while being negative for markers like CD117, effectively ruling out gastrointestinal stromal tumor (GIST). Through this case, we recognize that there is a vascular connection between the tumor and the uterus, and its origin is not necessarily the uterus; it could be of intestinal origin. The uniqueness of this case lies in: a huge mass was found in the pregnant woman's abdominal and pelvic cavity, without intestinal obstruction, and there is a vascular connection with the uterus.</p><p><strong>Conclusions: </strong>This case underscores the diagnostic difficulty of DTF. A clear diagnosis depends on postoperative pathological examination and immunohistochemistry, and multidisciplinary collaboration is of vital importance.</p>","PeriodicalId":29752,"journal":{"name":"AME Case Reports","volume":"10 ","pages":"148"},"PeriodicalIF":0.6,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13466663/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148722675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Conservative management leading to delivery of a twin pregnancy complicated by previable preterm premature rupture of membranes: a case report.","authors":"Wen-Zhen Wang, Xiao-Guohui Zhang, Jing-Zhen Zhou, Xiao-Yan Lv, Li-Li Meng","doi":"10.21037/acr-2026-0092","DOIUrl":"10.21037/acr-2026-0092","url":null,"abstract":"<p><strong>Background: </strong>The threshold of neonatal viability is established at a gestational age of 22-23 weeks. Previable preterm premature rupture of membranes (pPPROM) occurring prior to this period is frequently associated with recommendations for pregnancy termination due to exceedingly high rates of neonatal mortality and maternal infectious morbidity. The objective of this study is to provide a therapeutic reference for patients who experience premature rupture of membranes before 22 weeks of gestation and opt to continue their pregnancy.</p><p><strong>Case description: </strong>This report describes the case of a 35-year-old multiparous woman. A twin gestation [dichorionic diamniotic (DCDA)] was achieved via <i>in vitro</i> fertilization and embryo transfer (IVF-ET) secondary to tubal factor infertility. At 18 weeks and 6 days of gestation, protrusion of the amniotic sac to the vaginal introitus occurred, resulting in pPPROM. A multidisciplinary team conducted a comprehensive assessment. After detailed counseling, an active conservative management strategy was implemented. This encompassed targeted antibiotic therapy, emergent cervical cerclage, planned administration of fetal lung maturation agents, and intensive maternal-fetal surveillance. The pregnancy was successfully prolonged for nearly 10 weeks, during which infection was controlled and normal fetal growth was maintained. At 28 weeks and 3 days of gestation, preterm labor necessitated cesarean delivery. Two live neonates were delivered; notably, Fetus B was delivered using the en caul cesarean delivery technique.</p><p><strong>Conclusions: </strong>This case illustrates that, with meticulous patient selection and individualized intervention, management of pPPROM occurring before the established limit of viability can yield favorable perinatal outcomes. These findings challenge the conventional paradigm of relying solely on gestational age criteria for decision-making.</p>","PeriodicalId":29752,"journal":{"name":"AME Case Reports","volume":"10 ","pages":"151"},"PeriodicalIF":0.6,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13466744/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148725143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}