Pub Date : 2025-05-31DOI: 10.1016/j.sycrs.2025.100126
Raissa Dias Fares , Jonathan Ribeiro da Silva , Sylvio Luiz Costa De-Moraes
Complex facial fractures are still a challenge for maxillofacial surgeons around the world. This type of surgery requires the actuation of more than one specialty in the surgical center and is frequently associated with brain injuries. This article aims to present a case report of frontal bone resorption in an 18-year-old patient after neurosurgical and maxillofacial approaches involving craniotomy, use of frontal pericranium flap for treatment of anterior cranial fossa fracture, dura mater repair, cranialization, and open reduction and internal fixation. After 5 months of follow-up, the patient began to experience drainage in the right supraorbital rim. At that time, no cerebrospinal fluid was present, and the patient was referred for a second surgical approach to remove the osteosynthesis material. Frontal bone resorption is an infrequently reported complication. The frontal craniotomy combined with the frontal pericranium flap to seal the anterior cranial fossa possibly contributed to the resorption of the frontal bone. The combination of skeletal fixation and the lack of coverage of the frontal bone in the cranio-maxillofacial reconstruction sequence requires better evaluation from the vascular-periosteal point of view, since the loss of contour due to bone resorption generates a stigmatizing deformity for patients.
{"title":"Frontal bone resorption after craniofacial reconstruction: Post-surgical complication","authors":"Raissa Dias Fares , Jonathan Ribeiro da Silva , Sylvio Luiz Costa De-Moraes","doi":"10.1016/j.sycrs.2025.100126","DOIUrl":"10.1016/j.sycrs.2025.100126","url":null,"abstract":"<div><div>Complex facial fractures are still a challenge for maxillofacial surgeons around the world. This type of surgery requires the actuation of more than one specialty in the surgical center and is frequently associated with brain injuries. This article aims to present a case report of frontal bone resorption in an 18-year-old patient after neurosurgical and maxillofacial approaches involving craniotomy, use of frontal pericranium flap for treatment of anterior cranial fossa fracture, dura mater repair, cranialization, and open reduction and internal fixation. After 5 months of follow-up, the patient began to experience drainage in the right supraorbital rim. At that time, no cerebrospinal fluid was present, and the patient was referred for a second surgical approach to remove the osteosynthesis material. Frontal bone resorption is an infrequently reported complication. The frontal craniotomy combined with the frontal pericranium flap to seal the anterior cranial fossa possibly contributed to the resorption of the frontal bone. The combination of skeletal fixation and the lack of coverage of the frontal bone in the cranio-maxillofacial reconstruction sequence requires better evaluation from the vascular-periosteal point of view, since the loss of contour due to bone resorption generates a stigmatizing deformity for patients.</div></div>","PeriodicalId":101189,"journal":{"name":"Surgery Case Reports","volume":"5 ","pages":"Article 100126"},"PeriodicalIF":0.0,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144184422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-31DOI: 10.1016/j.sycrs.2025.100124
Grecia Fernanda Hurtado-Miranda , Ana Guadalupe Rodríguez-Aguirre , Dafne Alejandra Torres-Torres , Alan Antonio Leija-Torres
Splenic abscess is a rare but life-threatening condition, often presenting with nonspecific symptoms and occurring more frequently in immunocompromised patients. We report the case of a 68-year-old male with poorly controlled type 2 diabetes mellitus who presented with persistent abdominal pain and fever. Initial imaging suggested a renal mass and urinary tract infection; however, his condition deteriorated, and repeat imaging revealed a large splenic abscess with peritonitis. Emergency open laparotomy was performed due to extensive splenic involvement and septic presentation. Intraoperatively, a ruptured splenic abscess with 80 % parenchymal lysis and 1000 cc of purulent fluid was found. Partial splenic preservation and surgical drainage were achieved. Postoperative imaging confirmed residual abscess cavities, but the patient improved clinically and was discharged for follow-up. This case illustrates the diagnostic and therapeutic challenges of splenic abscess, particularly in diabetic patients. It emphasizes the importance of maintaining suspicion for intra-abdominal infections in immunocompromised hosts, even when initial symptoms suggest a urinary source. Timely imaging, multidisciplinary management, and individualized surgical decisions are crucial for improving outcomes. Open surgery remains a valid treatment option when minimally invasive approaches present a significant risk. This report underscores the need for early recognition and aggressive intervention in complex intra-abdominal infections, especially in patients with multiple risk factors.
{"title":"Splenic abscess secondary to pyelonephritis in a diabetic patient: A rare cause of acute abdomen requiring emergency surgery","authors":"Grecia Fernanda Hurtado-Miranda , Ana Guadalupe Rodríguez-Aguirre , Dafne Alejandra Torres-Torres , Alan Antonio Leija-Torres","doi":"10.1016/j.sycrs.2025.100124","DOIUrl":"10.1016/j.sycrs.2025.100124","url":null,"abstract":"<div><div>Splenic abscess is a rare but life-threatening condition, often presenting with nonspecific symptoms and occurring more frequently in immunocompromised patients. We report the case of a 68-year-old male with poorly controlled type 2 diabetes mellitus who presented with persistent abdominal pain and fever. Initial imaging suggested a renal mass and urinary tract infection; however, his condition deteriorated, and repeat imaging revealed a large splenic abscess with peritonitis. Emergency open laparotomy was performed due to extensive splenic involvement and septic presentation. Intraoperatively, a ruptured splenic abscess with 80 % parenchymal lysis and 1000 cc of purulent fluid was found. Partial splenic preservation and surgical drainage were achieved. Postoperative imaging confirmed residual abscess cavities, but the patient improved clinically and was discharged for follow-up. This case illustrates the diagnostic and therapeutic challenges of splenic abscess, particularly in diabetic patients. It emphasizes the importance of maintaining suspicion for intra-abdominal infections in immunocompromised hosts, even when initial symptoms suggest a urinary source. Timely imaging, multidisciplinary management, and individualized surgical decisions are crucial for improving outcomes. Open surgery remains a valid treatment option when minimally invasive approaches present a significant risk. This report underscores the need for early recognition and aggressive intervention in complex intra-abdominal infections, especially in patients with multiple risk factors.</div></div>","PeriodicalId":101189,"journal":{"name":"Surgery Case Reports","volume":"5 ","pages":"Article 100124"},"PeriodicalIF":0.0,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144221917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-12DOI: 10.1016/j.sycrs.2025.100122
Edgar Fermín Yan - Quiroz , Jessica Matheus - Sairitupac , Claudia Sofía Lavado - Briceño , Ana Camila Morales - Jara , José Richard Tenazoa - Villalobos
Benign oesophageal neoplasms are sporadic and account for 2 % of all oesophageal tumours. Oesophageal Schwannoma occurs rarely and is a diagnostic challenge through imaging, with few reports. It affects patients between the fifth and sixth decades of life, and one of the most frequent symptoms is dysphagia. Schwannoma originates in the Schwann cells of the neural plexus within the gastrointestinal tract and is most often located in the upper and middle oesophagus. The immunohistochemical profile gives the definitive diagnosis and is mainly characterised by a strong positivity for the S-100 protein, vimentin and glial fibrillary acidic protein. The prognosis of patients with schwannomas is excellent. The therapeutic approach to schwannomas depends mainly on the size of the tumour and the presence of symptoms. Through minimally invasive surgery, thoracoscopic and laparoscopic approaches, good results can be obtained with few complications. Due to its reproducibility, more and more institutions are using this approach to manage these neoplasms. We present the case of a 42-year-old man successfully treated for oesophageal Schwannoma by combining thoracoscopic and laparoscopic surgery; during the postoperative period, it was possible to control the complications, and today, the patient presents a favourable evolution with complete remission of symptoms and no alteration in the quality of life.
{"title":"Minimally invasive approach in Esophageal Schwannoma: case report and literature review","authors":"Edgar Fermín Yan - Quiroz , Jessica Matheus - Sairitupac , Claudia Sofía Lavado - Briceño , Ana Camila Morales - Jara , José Richard Tenazoa - Villalobos","doi":"10.1016/j.sycrs.2025.100122","DOIUrl":"10.1016/j.sycrs.2025.100122","url":null,"abstract":"<div><div>Benign oesophageal neoplasms are sporadic and account for 2 % of all oesophageal tumours. Oesophageal Schwannoma occurs rarely and is a diagnostic challenge through imaging, with few reports. It affects patients between the fifth and sixth decades of life, and one of the most frequent symptoms is dysphagia. Schwannoma originates in the Schwann cells of the neural plexus within the gastrointestinal tract and is most often located in the upper and middle oesophagus. The immunohistochemical profile gives the definitive diagnosis and is mainly characterised by a strong positivity for the S-100 protein, vimentin and glial fibrillary acidic protein. The prognosis of patients with schwannomas is excellent. The therapeutic approach to schwannomas depends mainly on the size of the tumour and the presence of symptoms. Through minimally invasive surgery, thoracoscopic and laparoscopic approaches, good results can be obtained with few complications. Due to its reproducibility, more and more institutions are using this approach to manage these neoplasms. We present the case of a 42-year-old man successfully treated for oesophageal Schwannoma by combining thoracoscopic and laparoscopic surgery; during the postoperative period, it was possible to control the complications, and today, the patient presents a favourable evolution with complete remission of symptoms and no alteration in the quality of life.</div></div>","PeriodicalId":101189,"journal":{"name":"Surgery Case Reports","volume":"5 ","pages":"Article 100122"},"PeriodicalIF":0.0,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144068121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-08DOI: 10.1016/j.sycrs.2025.100123
Cinthya María Quisiguiña-Salem , Juan José Guifarro-Sierra , Hugo Romero-Alvarenga , Francisco Díaz-Ayala
Introduction
Orthognathic surgery has evolved significantly. While sagittal split ramus osteotomies with rigid fixation are now the preferred technique, vertical ramus osteotomies remain beneficial in specific cases. This report details three cases where virtual surgical planning achieved excellent outcomes with vertical ramus osteotomies.
Case series presentation
This case series presents three patients with severe mandibular prognathism and facial asymmetry. All patients were treated using a combined approach of Le Fort I osteotomy and intraoral vertical ramus osteotomies, guided by virtual surgical planning. Long-term occlusal stability and aesthetic improvements were achieved at the 1- and 1.5-year follow-up.
Discussion
The selection of the surgical technique for mandibular osteotomies is a crucial aspect of orthognathic treatment planning. While the sagittal split ramus osteotomy has become the workhorse procedure in many centers, the vertical ramus osteotomy presents a distinct set of benefits that justify its consideration in carefully selected cases.
Conclusion
Vertical ramus osteotomy remains a valuable surgical option for patients with severe prognathism and significant mandibular asymmetries. The presented cases demonstrate the potential for excellent clinical outcomes with this technique, suggesting its value in the orthognathic surgeon's armamentarium.
正颌手术已经有了很大的发展。虽然矢状分叉支截骨与刚性固定是目前首选的技术，垂直支截骨在特定情况下仍然是有益的。本报告详细介绍了三例虚拟手术计划在垂直分支截骨术中取得优异效果的病例。本病例系列报告了3例严重下颌前突和面部不对称的患者。所有患者在虚拟手术计划指导下，采用Le Fort I型截骨术和口内垂直支截骨术联合入路治疗。在1年和1.5年的随访中，长期的咬合稳定性和美观性得到了改善。下颌截骨术的手术技术选择是正颌治疗计划的一个重要方面。虽然矢状分支截骨术已成为许多中心的主力手术，但垂直分支截骨术具有一系列独特的优点，值得在精心挑选的病例中加以考虑。结论垂直支截骨术对于严重前突和明显下颌不对称的患者仍然是一种有价值的手术选择。所提出的病例表明，这种技术具有良好的临床结果的潜力，表明其在正颌外科医生的装备中的价值。
{"title":"Enhancing facial aesthetics: Vertical ramus osteotomies for mandibular disproportions","authors":"Cinthya María Quisiguiña-Salem , Juan José Guifarro-Sierra , Hugo Romero-Alvarenga , Francisco Díaz-Ayala","doi":"10.1016/j.sycrs.2025.100123","DOIUrl":"10.1016/j.sycrs.2025.100123","url":null,"abstract":"<div><h3>Introduction</h3><div>Orthognathic surgery has evolved significantly. While sagittal split ramus osteotomies with rigid fixation are now the preferred technique, vertical ramus osteotomies remain beneficial in specific cases. This report details three cases where virtual surgical planning achieved excellent outcomes with vertical ramus osteotomies.</div></div><div><h3>Case series presentation</h3><div>This case series presents three patients with severe mandibular prognathism and facial asymmetry. All patients were treated using a combined approach of Le Fort I osteotomy and intraoral vertical ramus osteotomies, guided by virtual surgical planning. Long-term occlusal stability and aesthetic improvements were achieved at the 1- and 1.5-year follow-up.</div></div><div><h3>Discussion</h3><div>The selection of the surgical technique for mandibular osteotomies is a crucial aspect of orthognathic treatment planning. While the sagittal split ramus osteotomy has become the workhorse procedure in many centers, the vertical ramus osteotomy presents a distinct set of benefits that justify its consideration in carefully selected cases.</div></div><div><h3>Conclusion</h3><div>Vertical ramus osteotomy remains a valuable surgical option for patients with severe prognathism and significant mandibular asymmetries. The presented cases demonstrate the potential for excellent clinical outcomes with this technique, suggesting its value in the orthognathic surgeon's armamentarium.</div></div>","PeriodicalId":101189,"journal":{"name":"Surgery Case Reports","volume":"5 ","pages":"Article 100123"},"PeriodicalIF":0.0,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143942071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Craniopharyngiomas are among the most challenging tumors to manage in children. The tumor’s proximity to critical neural structures poses significant management challenges, as these structures are still developing and highly sensitive to intervention. We report a case of giant craniopharyngioma in a 3-year-old boy, which was managed successfully with complete excision, and the patient recovered well. The patient was admitted with a history of chronic headache and vomiting that had persisted for one month. His social, language, and cognitive developments were normal with no overt neurological deficits. Contrast-enhanced Magnetic Resonance Imaging (MRI) revealed a complex multiloculated cystic mass, measuring 52 × 53 × 51 mm and occupying sellar and suprasellar regions, with heterogeneous enhancement. The tumor compressed the hypothalamus anterosuperiorly, displaced the optic chiasm, and stretched the bilateral optic tracts. He underwent a pterional craniotomy with near-total tumor resection, removing the lesion within its capsule. In the post-operative period, he developed diabetes insipidus (DI) but otherwise did well. Histopathology confirmed adamantinomatous craniopharyngioma. Management strategies for pediatric craniopharyngiomas have dramatically changed with advances in surgical techniques, imaging modalities, and perioperative management. Substantial morbidity is still possible, and their management is best pursued in a multidisciplinary manner. Surgical technique and extent of resection must be judiciously chosen to match tumor characteristics and location.
{"title":"Surgical management of giant suprasellar craniopharyngioma in a 3-year-old: Case report with a review of the literature","authors":"Fahad Khan , Prankul Singhal , Saurav Shishir Agrawal , Kivanc Yangi , Ismail Bozkurt , Bipin Chaurasia","doi":"10.1016/j.sycrs.2025.100121","DOIUrl":"10.1016/j.sycrs.2025.100121","url":null,"abstract":"<div><div>Craniopharyngiomas are among the most challenging tumors to manage in children. The tumor’s proximity to critical neural structures poses significant management challenges, as these structures are still developing and highly sensitive to intervention. We report a case of giant craniopharyngioma in a 3-year-old boy, which was managed successfully with complete excision, and the patient recovered well. The patient was admitted with a history of chronic headache and vomiting that had persisted for one month. His social, language, and cognitive developments were normal with no overt neurological deficits. Contrast-enhanced Magnetic Resonance Imaging (MRI) revealed a complex multiloculated cystic mass, measuring 52 × 53 × 51 mm and occupying sellar and suprasellar regions, with heterogeneous enhancement. The tumor compressed the hypothalamus anterosuperiorly, displaced the optic chiasm, and stretched the bilateral optic tracts. He underwent a pterional craniotomy with near-total tumor resection, removing the lesion within its capsule. In the post-operative period, he developed diabetes insipidus (DI) but otherwise did well. Histopathology confirmed adamantinomatous craniopharyngioma. Management strategies for pediatric craniopharyngiomas have dramatically changed with advances in surgical techniques, imaging modalities, and perioperative management. Substantial morbidity is still possible, and their management is best pursued in a multidisciplinary manner. Surgical technique and extent of resection must be judiciously chosen to match tumor characteristics and location.</div></div>","PeriodicalId":101189,"journal":{"name":"Surgery Case Reports","volume":"5 ","pages":"Article 100121"},"PeriodicalIF":0.0,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143916616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-24DOI: 10.1016/j.sycrs.2025.100118
Jonathan Lutgens , Jamielou Breckenridge , Brooklyn Williams , Kristin Clark , Paul Um , Shane McNevin , Quinton Hatch
Background
Technological advancements have introduced new mechanisms of rectal injury, including hydrostatic pressure injuries from jet ski accidents. Approximately 20 cases have been reported, often involving extensive rectal, vaginal, and perineal disruption. Despite their severity, there are no established guidelines for managing these injuries or determining the optimal timing for reconstruction.
Case presentation
This case series highlights the surgical management of four patients who sustained hydrostatic perineal injuries of varying severity. All patients were healthy young women who, while riding as rear passengers on high-speed jet skis, were ejected backward during acceleration, landing in a seated position onto the powerful propulsion stream. The resulting intense hydrostatic forces caused complex injuries, including complete disruption of the vaginal and rectal wall interface, leading to a traumatic cloaca. Each patient underwent fecal diversion and perineal reconstruction during their initial hospitalization, followed by successful colostomy reversal, with restoration of rectal tone and fecal continence.
Conclusion
All four patients underwent CT imaging, rigid proctoscopy, distal rectal irrigation, colonic diversion, and anorectal repair with sphincter reconstruction during their index hospitalization. This approach led to satisfactory cosmetic outcomes, restoration of rectal tone, and maintenance of continence. The findings from this case series align with prior reports, further supporting fecal diversion and immediate perineal/sphincter reconstruction as an effective management strategy for hydrostatic perineal injuries.
{"title":"Complex perineal injuries from jet ski trauma: Case series highlighting surgical repair and reconstruction principles","authors":"Jonathan Lutgens , Jamielou Breckenridge , Brooklyn Williams , Kristin Clark , Paul Um , Shane McNevin , Quinton Hatch","doi":"10.1016/j.sycrs.2025.100118","DOIUrl":"10.1016/j.sycrs.2025.100118","url":null,"abstract":"<div><h3>Background</h3><div>Technological advancements have introduced new mechanisms of rectal injury, including hydrostatic pressure injuries from jet ski accidents. Approximately 20 cases have been reported, often involving extensive rectal, vaginal, and perineal disruption. Despite their severity, there are no established guidelines for managing these injuries or determining the optimal timing for reconstruction.</div></div><div><h3>Case presentation</h3><div>This case series highlights the surgical management of four patients who sustained hydrostatic perineal injuries of varying severity. All patients were healthy young women who, while riding as rear passengers on high-speed jet skis, were ejected backward during acceleration, landing in a seated position onto the powerful propulsion stream. The resulting intense hydrostatic forces caused complex injuries, including complete disruption of the vaginal and rectal wall interface, leading to a traumatic cloaca. Each patient underwent fecal diversion and perineal reconstruction during their initial hospitalization, followed by successful colostomy reversal, with restoration of rectal tone and fecal continence.</div></div><div><h3>Conclusion</h3><div>All four patients underwent CT imaging, rigid proctoscopy, distal rectal irrigation, colonic diversion, and anorectal repair with sphincter reconstruction during their index hospitalization. This approach led to satisfactory cosmetic outcomes, restoration of rectal tone, and maintenance of continence. The findings from this case series align with prior reports, further supporting fecal diversion and immediate perineal/sphincter reconstruction as an effective management strategy for hydrostatic perineal injuries.</div></div>","PeriodicalId":101189,"journal":{"name":"Surgery Case Reports","volume":"5 ","pages":"Article 100118"},"PeriodicalIF":0.0,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143873749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-23DOI: 10.1016/j.sycrs.2025.100116
Ovidiu Adrian Bitere , Florina Almari , Corina-Elena Minciuna , Mihai Dodot , Iulia Andrei-Bitere , Gabriela Fota , Catalin Vasilescu , Aurel Tonea , Vlad Herlea
Background
Ciliated cysts of the gallbladder are rare congenital anomalies derived from embryonic foregut remnants. These benign lesions, lined by distinctive ciliated columnar epithelium, present diagnostic challenges due to non-specific imaging findings and their extreme rarity.
Case presentation
A 51-year-old woman presented with intermittent right upper quadrant abdominal pain lasting two years. Imaging revealed a cystic lesion measuring initially 11 × 10 mm on the gallbladder's lateral wall. Due to lesion growth observed over follow-up, laparoscopic cholecystectomy was performed. Histopathology confirmed a subserosal, unilocular cyst lined with ciliated columnar epithelium, without communication to the gallbladder lumen.
Discussion
This report represents the sixteenth documented global case and the first Romanian instance of a gallbladder ciliated cyst. The lesion’s rarity and nonspecific clinical and radiological presentations hinder accurate preoperative diagnosis. Histopathological analysis remains essential to distinguish these cysts from bronchogenic cysts and biliary neoplasms. Surgical excision is advisable, especially when symptoms are present or malignancy cannot be confidently excluded.
Conclusions
Despite their rarity, ciliated gallbladder cysts should be included in the differential diagnosis of atypical cystic gallbladder lesions. Laparoscopic cholecystectomy offers a safe, definitive treatment method, providing both diagnostic confirmation and symptom resolution.
{"title":"Rare and remarkable: Exploring the enigma of ciliated cysts of the gallbladder","authors":"Ovidiu Adrian Bitere , Florina Almari , Corina-Elena Minciuna , Mihai Dodot , Iulia Andrei-Bitere , Gabriela Fota , Catalin Vasilescu , Aurel Tonea , Vlad Herlea","doi":"10.1016/j.sycrs.2025.100116","DOIUrl":"10.1016/j.sycrs.2025.100116","url":null,"abstract":"<div><h3>Background</h3><div>Ciliated cysts of the gallbladder are rare congenital anomalies derived from embryonic foregut remnants. These benign lesions, lined by distinctive ciliated columnar epithelium, present diagnostic challenges due to non-specific imaging findings and their extreme rarity.</div></div><div><h3>Case presentation</h3><div>A 51-year-old woman presented with intermittent right upper quadrant abdominal pain lasting two years. Imaging revealed a cystic lesion measuring initially 11 × 10 mm on the gallbladder's lateral wall. Due to lesion growth observed over follow-up, laparoscopic cholecystectomy was performed. Histopathology confirmed a subserosal, unilocular cyst lined with ciliated columnar epithelium, without communication to the gallbladder lumen.</div></div><div><h3>Discussion</h3><div>This report represents the sixteenth documented global case and the first Romanian instance of a gallbladder ciliated cyst. The lesion’s rarity and nonspecific clinical and radiological presentations hinder accurate preoperative diagnosis. Histopathological analysis remains essential to distinguish these cysts from bronchogenic cysts and biliary neoplasms. Surgical excision is advisable, especially when symptoms are present or malignancy cannot be confidently excluded.</div></div><div><h3>Conclusions</h3><div>Despite their rarity, ciliated gallbladder cysts should be included in the differential diagnosis of atypical cystic gallbladder lesions. Laparoscopic cholecystectomy offers a safe, definitive treatment method, providing both diagnostic confirmation and symptom resolution.</div></div>","PeriodicalId":101189,"journal":{"name":"Surgery Case Reports","volume":"5 ","pages":"Article 100116"},"PeriodicalIF":0.0,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143868732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-23DOI: 10.1016/j.sycrs.2025.100119
Tathagata Bhattacharjee, Snehanjan Sarangi, Debarati Ray, Jay Gopal Ray
Introduction
Odontogenic cysts and tumors, which develop from the structures involved in tooth formation, show a wide range of histopathological variations. Sometimes, different types of lesions can appear together within the same tissue sample, resulting in what are known as hybrid odontogenic cysts or tumors—unusual combinations that form distinct and complex pathologies.
Case report
This article outlines four unique cases of such hybrid lesions. The first case involved a mix of an Orthokeratinised Odontogenic Cyst (OOC) and a Calcifying Odontogenic Cyst (COC). The second case showed a hybrid of OOC with a Glandular Odontogenic Cyst (GOC). In the third case, the lesion was a combination of Ameloblastoma and an Odontogenic Keratocyst (OKC). The final case presented a rare hybrid tumor consisting of an Adenomatoid Odontogenic Tumor (AOT) and Desmoplastic Ameloblastoma. These diagnoses were reached through a comprehensive, multidisciplinary approach involving clinical evaluations, imaging, histopathological assessments, and immunohistochemical analyses.
Conclusion
Hybrid lesions are different from collision lesions, which occur when two separate pathologies overlap in one area. Instead, hybrid odontogenic lesions display a blend of histological traits from two or more recognized types of cysts or tumors. While their exact cause remains uncertain, it’s believed that pluripotent odontogenic epithelial cells might give rise to multiple tissue patterns simultaneously within a single lesion. These cases pose significant challenges for both diagnosis and treatment. More in-depth research—especially at the molecular and immunohistochemical levels—is needed to improve our understanding and management of these complex and rare conditions.
{"title":"Hybrid odontogenic cysts and tumors-A unique case series","authors":"Tathagata Bhattacharjee, Snehanjan Sarangi, Debarati Ray, Jay Gopal Ray","doi":"10.1016/j.sycrs.2025.100119","DOIUrl":"10.1016/j.sycrs.2025.100119","url":null,"abstract":"<div><h3>Introduction</h3><div>Odontogenic cysts and tumors, which develop from the structures involved in tooth formation, show a wide range of histopathological variations. Sometimes, different types of lesions can appear together within the same tissue sample, resulting in what are known as hybrid odontogenic cysts or tumors—unusual combinations that form distinct and complex pathologies.</div></div><div><h3>Case report</h3><div>This article outlines four unique cases of such hybrid lesions. The first case involved a mix of an Orthokeratinised Odontogenic Cyst (OOC) and a Calcifying Odontogenic Cyst (COC). The second case showed a hybrid of OOC with a Glandular Odontogenic Cyst (GOC). In the third case, the lesion was a combination of Ameloblastoma and an Odontogenic Keratocyst (OKC). The final case presented a rare hybrid tumor consisting of an Adenomatoid Odontogenic Tumor (AOT) and Desmoplastic Ameloblastoma. These diagnoses were reached through a comprehensive, multidisciplinary approach involving clinical evaluations, imaging, histopathological assessments, and immunohistochemical analyses.</div></div><div><h3>Conclusion</h3><div>Hybrid lesions are different from collision lesions, which occur when two separate pathologies overlap in one area. Instead, hybrid odontogenic lesions display a blend of histological traits from two or more recognized types of cysts or tumors. While their exact cause remains uncertain, it’s believed that pluripotent odontogenic epithelial cells might give rise to multiple tissue patterns simultaneously within a single lesion. These cases pose significant challenges for both diagnosis and treatment. More in-depth research—especially at the molecular and immunohistochemical levels—is needed to improve our understanding and management of these complex and rare conditions.</div></div>","PeriodicalId":101189,"journal":{"name":"Surgery Case Reports","volume":"5 ","pages":"Article 100119"},"PeriodicalIF":0.0,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143868733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-23DOI: 10.1016/j.sycrs.2025.100114
Violina Nacheva , Venelin Gerganov , Mihail Petrov , Branimir Penev , Tsvetelina Velikova , Georgi Angov
Endolymphatic sac tumor (ELST) is a rare pathology, with fewer than 300 cases reported worldwide. These tumors are characterized by slow but invasive growth and malignancy, primarily manifesting as local invasion, while distant metastases are rare. We report a sporadic case of a 36-year-old woman with a histologically verified ELST. There was no previous medical history or clinical data suggesting Von Hippel-Lindau disease, nor family members with the condition. The patient experienced a gradual onset of symptoms over seven years, reflecting the tumor's indolent nature. Diagnostic workup included imaging and histopathological evaluation. Surgical resection was performed, and the diagnosis was confirmed postoperatively. We discuss the diagnostic challenges, therapeutic approach, and follow-up of patients with ELST in the context of current literature and management recommendations. This case highlights the importance of early recognition and individualized care in patients with ELST, even without associated syndromic features.
{"title":"Rare sporadic endolymphatic sac tumors: A case report and literature review","authors":"Violina Nacheva , Venelin Gerganov , Mihail Petrov , Branimir Penev , Tsvetelina Velikova , Georgi Angov","doi":"10.1016/j.sycrs.2025.100114","DOIUrl":"10.1016/j.sycrs.2025.100114","url":null,"abstract":"<div><div>Endolymphatic sac tumor (ELST) is a rare pathology, with fewer than 300 cases reported worldwide. These tumors are characterized by slow but invasive growth and malignancy, primarily manifesting as local invasion, while distant metastases are rare. We report a sporadic case of a 36-year-old woman with a histologically verified ELST. There was no previous medical history or clinical data suggesting Von Hippel-Lindau disease, nor family members with the condition. The patient experienced a gradual onset of symptoms over seven years, reflecting the tumor's indolent nature. Diagnostic workup included imaging and histopathological evaluation. Surgical resection was performed, and the diagnosis was confirmed postoperatively. We discuss the diagnostic challenges, therapeutic approach, and follow-up of patients with ELST in the context of current literature and management recommendations. This case highlights the importance of early recognition and individualized care in patients with ELST, even without associated syndromic features.</div></div>","PeriodicalId":101189,"journal":{"name":"Surgery Case Reports","volume":"5 ","pages":"Article 100114"},"PeriodicalIF":0.0,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143873750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-23DOI: 10.1016/j.sycrs.2025.100117
Benjamin C. Kensing , Blake A. Johnson , Marvin Heck , Hishaam N. Ismael
Hepatic hemangiomas are benign vascular malformations thought to be of congenital origin. They are typically solitary, small, and asymptomatic. In rare cases, large tumors spontaneously rupture. We present the case of a 29-year-old female who presented with acute onset abdominal pain and nausea. Abdominal imaging showed a large mass in the liver demonstrating progressive nodular enhancement. Further imaging showed free fluid in the pelvis. A diagnostic laparoscopy was followed by an open left lateral hepatic segmentectomy. Pathology confirmed benign hemangioma. Signs and symptoms of spontaneously ruptured hepatic hemangiomas are often nonspecific. MRI is the most sensitive and specific imaging modality for diagnosing hepatic hemangiomas; however, determination of rupture requires clinical suspicion. Management is focused on maintaining hemodynamic stability and addressing the source with resection, enucleating, or embolizing the tumor. A literature review of 34 other cases revealed a mortality rate of 9 %, demonstrating a significant improvement compared to prior studies. The improvement in mortality is attributable to advancements in surgical techniques, critical care, resuscitation of unstable patients, pharmacologic safety profiles, postoperative care, and imagining modalities. In conclusion, spontaneous rupture of hepatic hemangiomas is a rare and life-threatening event. Hepatic resection remains the mainstay of treatment; although, transcatheter arterial embolization offers a minimally invasive route to control bleeding, shrink the hemangioma, and stabilize the patient.
{"title":"Spontaneously ruptured hepatic hemangioma: A case study and comprehensive review of the literature","authors":"Benjamin C. Kensing , Blake A. Johnson , Marvin Heck , Hishaam N. Ismael","doi":"10.1016/j.sycrs.2025.100117","DOIUrl":"10.1016/j.sycrs.2025.100117","url":null,"abstract":"<div><div>Hepatic hemangiomas are benign vascular malformations thought to be of congenital origin. They are typically solitary, small, and asymptomatic. In rare cases, large tumors spontaneously rupture. We present the case of a 29-year-old female who presented with acute onset abdominal pain and nausea. Abdominal imaging showed a large mass in the liver demonstrating progressive nodular enhancement. Further imaging showed free fluid in the pelvis. A diagnostic laparoscopy was followed by an open left lateral hepatic segmentectomy. Pathology confirmed benign hemangioma. Signs and symptoms of spontaneously ruptured hepatic hemangiomas are often nonspecific. MRI is the most sensitive and specific imaging modality for diagnosing hepatic hemangiomas; however, determination of rupture requires clinical suspicion. Management is focused on maintaining hemodynamic stability and addressing the source with resection, enucleating, or embolizing the tumor. A literature review of 34 other cases revealed a mortality rate of 9 %, demonstrating a significant improvement compared to prior studies. The improvement in mortality is attributable to advancements in surgical techniques, critical care, resuscitation of unstable patients, pharmacologic safety profiles, postoperative care, and imagining modalities. In conclusion, spontaneous rupture of hepatic hemangiomas is a rare and life-threatening event. Hepatic resection remains the mainstay of treatment; although, transcatheter arterial embolization offers a minimally invasive route to control bleeding, shrink the hemangioma, and stabilize the patient.</div></div>","PeriodicalId":101189,"journal":{"name":"Surgery Case Reports","volume":"5 ","pages":"Article 100117"},"PeriodicalIF":0.0,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143876519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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