Juvenile xanthogranuloma (JXG) is an uncommon condition affecting the eye. We herein report a rare case of eyelid swelling in paediatric age group. A three-year-old Malay boy presented with chronic painless left upper eyelid mass which did not resolve with topical steroid. Clinically, the mass was a non-tender and firm nodular swelling which located at the lateral 1/3 of the left upper lid. Total excisional biopsy of the swelling was done and histopathological findings were consistent with JXG. The systemic associations and the treatment options for ocular JXG are discussed.
Germinoma arising from intracranial off-midline structures is considered ectopic. Although basal ganglia germinoma is a rare occurrence, it is more commonly seen in the Asian population, particularly among boys. Here, we report a case of an adolescent boy who presented with hemiplegia and delayed diagnosis of basal ganglia germinoma with progression on serial magnetic resonance imaging (MRI). Several signal changes have been described during the early stage of the disease such as T2-weighted patchy hyperintense signal, cerebral hemiatrophy, and signal change on susceptibility-weighted imaging. 11C-methionine positron emission tomography is an additional imaging technique that can reveal ectopic germinoma. Follow-up MRI revealed small cystic changes, and the latest imaging showed progression into a large multicystic lesion with mass effect. The patient underwent surgery, and histopathological examination revealed basal ganglia germinoma. We highlight the serial MRI changes that were suggestive of basal ganglia germinoma in this case.
Chronic granulomatous mastitis is known as a benign and relatively rare disorder that is often difficult to differentiate from breast carcinoma. We highlight the case of a 34-year-old woman who had recurrent episodes of right breast swelling and abscess for 8 years. These were proven to be chronic granulomatous mastitis by tissue biopsies on 3 different occasions. Her condition improved on similar courses of antibiotics and high-dose prednisolone. However, she subsequently developed progressive loss of vision due to an orbital tumour. She then underwent a craniotomy and left orbital decompression with excision of the tumour, which proved to be a metastatic carcinoma. A trucut biopsy of the right breast was then done and showed features consistent with an infiltrating ductal carcinoma. This case illustrates the possibility that chronic granulomatous mastitis could be a precursor for malignancy and the difficulty in differentiating one from the other. The possible mechanisms of development and the implications for future management are also discussed.