Surgery Case Reports最新文献_第6页

Enhancing facial aesthetics: Vertical ramus osteotomies for mandibular disproportions 增强面部美感：垂直分支截骨术治疗下颌比例失调

Surgery Case Reports

Pub Date : 2025-05-08 DOI: 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。

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引用次数: 0

Surgical management of giant suprasellar craniopharyngioma in a 3-year-old: Case report with a review of the literature 3岁儿童巨大鞍上颅咽管瘤的手术治疗：1例报告并文献复习

Surgery Case Reports

Pub Date : 2025-05-06 DOI: 10.1016/j.sycrs.2025.100121

Fahad Khan , Prankul Singhal , Saurav Shishir Agrawal , Kivanc Yangi , Ismail Bozkurt , Bipin Chaurasia

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.

颅咽管瘤是儿童最具挑战性的肿瘤之一。肿瘤靠近关键的神经结构，这给治疗带来了重大挑战，因为这些结构仍在发育，对干预高度敏感。我们报告一例巨大的颅咽管瘤在一个3岁的男孩，这是成功的管理与完全切除，病人恢复良好。患者入院时有持续一个月的慢性头痛和呕吐史。他的社交、语言和认知发展正常，没有明显的神经缺陷。磁共振增强成像（MRI）显示一个复杂的多室囊性肿块，尺寸为52 × 53 × 51 mm，占据鞍上区和鞍上区，呈非均匀强化。肿瘤压迫下丘脑，移位视交叉，拉伸双侧视束。他接受了翼点开颅术，几乎全部切除肿瘤，切除了肿瘤囊内的病变。术后，患者出现尿崩症（DI），其他情况良好。组织病理学证实为硬瘤性颅咽管瘤。随着手术技术、影像学和围手术期治疗的进步，小儿颅咽管瘤的治疗策略发生了巨大的变化。大量的发病率仍然是可能的，他们的管理最好是在多学科的方式进行。手术技术和切除范围必须根据肿瘤的特点和部位进行明智的选择。

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引用次数: 0

Complex perineal injuries from jet ski trauma: Case series highlighting surgical repair and reconstruction principles 水上滑雪创伤引起的复杂会阴损伤：强调手术修复和重建原则的病例系列

Surgery Case Reports

Pub Date : 2025-04-24 DOI: 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.

技术的进步带来了直肠损伤的新机制，包括水上摩托艇事故造成的静水压力损伤。大约有20例报告，通常涉及广泛的直肠、阴道和会阴破裂。尽管它们很严重，但目前还没有确定的指导方针来管理这些损伤或确定重建的最佳时机。病例介绍：本病例系列强调了四例严重程度不同的会阴流体静力损伤患者的手术治疗。所有的患者都是健康的年轻女性，她们在高速喷气式滑雪板上作为后排乘客，在加速过程中被向后弹出，以坐姿降落在强大的推进流上。由此产生的强大的流体静力造成复杂的损伤，包括阴道和直肠壁界面的完全破坏，导致创伤性泄殖腔。每位患者在首次住院期间均接受了粪便分流和会阴重建，随后成功进行结肠造口逆转，恢复直肠张力和大便失禁。结论4例患者在住院期间均行CT检查、硬直肠镜检查、远端直肠冲洗、结肠改道、肛肠修复及括约肌重建。这种方法取得了令人满意的美容效果，直肠张力恢复，并维持了尿失禁。本病例系列的研究结果与先前的报道一致，进一步支持粪便转移和立即会阴/括约肌重建是会阴静水损伤的有效治疗策略。

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引用次数: 0

Rare and remarkable: Exploring the enigma of ciliated cysts of the gallbladder 罕见而非凡：探索胆囊纤毛囊肿之谜

Surgery Case Reports

Pub Date : 2025-04-23 DOI: 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.

背景胆囊纤毛囊肿是一种罕见的先天性异常，起源于胚胎前肠残余物。这些由独特纤毛柱状上皮排列的良性病变，由于非特异性影像学表现和极其罕见，给诊断带来了挑战。病例介绍：51岁女性，以间歇性右上腹腹痛两年为主诉。影像学显示胆囊侧壁有囊性病变，最初尺寸为11 × 10 mm。由于在随访中观察到病变的增长，我们进行了腹腔镜胆囊切除术。组织病理学证实为浆膜下单眼囊肿，衬有纤毛柱状上皮，未与胆囊腔连通。本报告是全球第16例记录在案的胆囊纤毛囊肿病例，也是罗马尼亚第一例。病变的罕见性和非特异性的临床和放射学表现阻碍了准确的术前诊断。组织病理学分析仍然是必要的，以区分这些囊肿与支气管囊肿和胆道肿瘤。手术切除是可取的，特别是当症状出现或恶性肿瘤不能完全排除时。结论纤毛胆囊囊肿虽罕见，但应列入非典型胆囊病变的鉴别诊断。腹腔镜胆囊切除术提供了一种安全，明确的治疗方法，提供诊断确认和症状解决。

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引用次数: 0

Hybrid odontogenic cysts and tumors-A unique case series 混合牙源性囊肿和肿瘤-一个独特的病例系列

Surgery Case Reports

Pub Date : 2025-04-23 DOI: 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.

牙源性囊肿和肿瘤是由参与牙齿形成的结构发展而来的，表现出广泛的组织病理学变异。有时，不同类型的病变可以在同一组织样本中同时出现，导致所谓的混合牙源性囊肿或肿瘤-形成独特而复杂的病理的不寻常的组合。病例报告本文概述了四个独特的病例，这种混合性病变。第一个病例涉及正形角化牙源性囊肿（OOC）和钙化牙源性囊肿（COC）的混合。第二例为OOC与腺性牙源性囊肿（GOC）的混合体。在第三例中，病变是成釉细胞瘤和牙源性角化囊肿（OKC）的组合。最后一个病例是一个罕见的混合肿瘤，由腺瘤样牙源性肿瘤（AOT）和成釉细胞瘤组成。这些诊断是通过综合的多学科方法达到的，包括临床评估、影像学、组织病理学评估和免疫组织化学分析。结论混合型病变不同于碰撞型病变，碰撞型病变发生于两种不同的病变在同一区域重叠。相反，混合型牙源性病变表现为两种或两种以上公认的囊肿或肿瘤的组织学特征的混合。虽然其确切原因尚不清楚，但据信多能性牙源性上皮细胞可能在单个病变中同时产生多种组织模式。这些病例对诊断和治疗都提出了重大挑战。需要更深入的研究——特别是在分子和免疫组织化学水平上——来提高我们对这些复杂和罕见疾病的理解和管理。

{"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}

引用次数: 0

Rare sporadic endolymphatic sac tumors: A case report and literature review 罕见散发性内淋巴囊肿瘤1例报告并文献复习

Surgery Case Reports

Pub Date : 2025-04-23 DOI: 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.

内淋巴囊瘤（ELST）是一种罕见的病理，全世界报道的病例不到300例。这些肿瘤的特点是缓慢但侵袭性生长和恶性，主要表现为局部侵袭，而远处转移是罕见的。我们报告一例散发性病例的36岁妇女与组织学证实ELST。没有既往病史或临床资料提示希佩尔-林道病，也没有家族成员患有此病。患者经历了七年的逐渐发作的症状，反映了肿瘤的惰性性质。诊断检查包括影像学和组织病理学评估。手术切除，术后确诊。我们在当前文献和管理建议的背景下讨论ELST患者的诊断挑战、治疗方法和随访。该病例强调了ELST患者早期识别和个性化护理的重要性，即使没有相关的综合征特征。

引用次数: 0

Spontaneously ruptured hepatic hemangioma: A case study and comprehensive review of the literature 肝血管瘤自发性破裂：个案研究及文献综述

Surgery Case Reports

Pub Date : 2025-04-23 DOI: 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.

肝血管瘤是一种被认为是先天性的良性血管畸形。它们通常是孤立的、小的、无症状的。在极少数情况下，大的肿瘤会自发破裂。我们提出的情况下，一个29岁的女性谁提出急性发作腹痛和恶心。腹部影像学显示肝脏内有一大肿块，呈进行性结节强化。进一步成像显示骨盆内有游离液体。诊断性腹腔镜检查后，行左外侧肝段切除术。病理证实为良性血管瘤。肝血管瘤自发性破裂的体征和症状通常是非特异性的。MRI是诊断肝血管瘤最敏感、最特异的影像学手段；然而，确定破裂需要临床怀疑。治疗的重点是维持血流动力学稳定性，并通过切除、去核或栓塞肿瘤来解决源头问题。对其他34例病例的文献回顾显示，死亡率为9 %，与以前的研究相比有显著改善。死亡率的提高可归因于手术技术、危重监护、不稳定患者的复苏、药物安全性、术后护理和想象方式的进步。总之，肝血管瘤自发性破裂是一种罕见且危及生命的事件。肝切除术仍然是主要的治疗方法；尽管如此，经导管动脉栓塞术为控制出血、缩小血管瘤和稳定患者提供了一种微创途径。

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引用次数: 0

Giant occipital encephalocele in a 20-day old neonate: A case report 20日龄新生儿巨大枕脑膨出1例

Surgery Case Reports

Pub Date : 2025-04-23 DOI: 10.1016/j.sycrs.2025.100120

Afaq Ahmad , Lal Rehman , Uswa Hasana , Humaira Bashir , Muhammad Uzair , Maria Amin

A giant occipital encephalocele involves the herniation of brain tissue through a skull defect—a condition that poses significant surgical challenges and demands detailed planning. A 20-day-old neonate, born to non-consanguineous parents, presented with an occipital swelling measuring 21 × 18 cm. CT imaging confirmed the diagnosis of encephalocele. Guided by thorough preoperative imaging and planning, the surgical team carefully excised the dysplastic brain tissue. The operation proceeded without any complications. This case highlights the critical importance of precise anesthesia management and surgical planning, particularly in positioning the neonate in a way that safeguards the airway. It also reinforces the preventive value of folic acid supplementation during the pre-conception and early pregnancy periods to help lessen the risk of neural tube defects.

巨大的枕部脑膨出是由颅骨缺损引起的脑组织突出，这种情况给手术带来了巨大的挑战，需要详细的计划。非近亲新生儿，20天大，枕骨肿胀21 × 18 cm。CT影像证实为脑膨出。在全面的术前成像和计划指导下，手术小组仔细切除了发育不良的脑组织。手术顺利进行，没有出现任何并发症。本病例强调了精确麻醉管理和手术计划的关键重要性，特别是在新生儿定位的方式，以保护气道。它还加强了在孕前和怀孕早期补充叶酸的预防价值，以帮助减少神经管缺陷的风险。

引用次数: 0

Fibrosarcomatous dermatofibrosarcoma protuberans of the scalp, extending to the brain – A rare case report 头皮隆突性皮肤纤维肉瘤，延伸至脑部-罕见病例报告

Surgery Case Reports

Pub Date : 2025-04-22 DOI: 10.1016/j.sycrs.2025.100113

Kavya Varshney , Naveen Kumar , Charanjeet Ahluwalia , Sunil Ranga

This case report highlights a rare instance of fibrosarcomatous dermatofibrosarcoma protuberans of the scalp with extension to the brain. Dermatofibrosarcoma protuberans is a slow-growing, locally aggressive soft tissue tumor. Fibrosarcomatous dermatofibrosarcoma protuberans is a rare and more aggressive variant of dermatofibrosarcoma protuberans. Fibrosarcomatous transformation in dermatofibrosarcoma protuberans is observed in only 5 % of cases. Although the recurrence rate is higher, metastasis and local extension are rarely seen, and intracranial extension is also uncommon. Clinically, fibrosarcomatous dermatofibrosarcoma protuberans is indistinguishable from classical dermatofibrosarcoma protuberans; hence, histopathological examination remains the cornerstone for definitive diagnosis. Histopathological examination reveals that areas of classical dermatofibrosarcoma protuberans show tumor cells arranged in a monotonous storiform pattern with a lack of circumscription, while areas with fibrosarcomatous transformation exhibit spindle cells arranged in a herringbone pattern, which are negative for CD34 on immunohistochemistry.

这个病例报告强调了一个罕见的头皮纤维肉瘤性皮肤纤维肉瘤，并延伸到大脑。隆突性皮肤纤维肉瘤是一种生长缓慢、局部侵袭性的软组织肿瘤。摘要纤维肉瘤性皮肤纤维肉瘤是一种罕见且侵袭性较强的皮肤纤维肉瘤。隆突性皮肤纤维肉瘤的纤维肉瘤转化仅占5 %。虽然复发率较高，但转移和局部扩展很少见，颅内扩展也不常见。临床上，纤维肉瘤性隆突性皮肤纤维肉瘤与典型的隆突性皮肤纤维肉瘤难以区分；因此，组织病理学检查仍然是明确诊断的基石。组织病理学检查显示经典皮肤纤维肉瘤结节区肿瘤细胞呈单调的故事状排列，缺乏边界，而纤维肉瘤转化区梭形细胞呈人字形排列，免疫组织化学CD34阴性。

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引用次数: 0

Splenic artery aneurysm rupture during pregnancy: A report of two cases 妊娠期脾动脉瘤破裂2例报告

Surgery Case Reports

Pub Date : 2025-04-17 DOI: 10.1016/j.sycrs.2025.100112

Kerim Deniz Batun , Ahmet Akmercan , Tayfun Akmercan , Muhammer Ergenç , Tevfik Kıvılcım Uprak

One of the most common aneurysms in the abdomen is the splenic artery aneurysm (SAA). Ruptured SAAs have a significant morbidity and mortality risk, especially for pregnant women and, consequently, for fetuses. The first patient was a twenty-eight-year-old female who, during the 30th week of pregnancy, underwent an urgent cesarean section. Postoperatively, on the 7th day, she developed severe abdominal pain. After the rapid deterioration, imaging revealed SAA rupture, and she underwent an explorative laparotomy and splenectomy. The second patient is thirty-two years old and has had non-cirrhotic portal vein hypertension since the age of 10. During her 28th week of pregnancy, she was admitted to the emergency department with complaints of severe abdominal pain and vomiting, consequently hemorrhagic shock. The imaging revealed massive intraperitoneal fluid and the SAA rupture. She underwent an emergency laparotomy, splenectomy, and cesarean section. Uncommon but has a significant mortality rate for both mother and fetus, and rupture must be considered for any pregnant woman with sudden abdominal pain and hemodynamic instability. Prompt evaluation and intervention are critical for both fetal and maternal morbidity and mortality.

腹腔最常见的动脉瘤之一是脾动脉瘤（SAA）。SAAs破裂具有显著的发病率和死亡率风险，特别是对孕妇，因此对胎儿。第一位患者是一名28岁的女性，她在怀孕第30周时接受了紧急剖宫产手术。术后第7天，患者出现严重腹痛。在快速恶化后，影像学显示SAA破裂，她接受了探查性剖腹手术和脾切除术。第二例患者32岁，自10岁起患有非肝硬化门静脉高压。在她怀孕28周时，她因严重腹痛和呕吐而被送进急诊室，随后出现失血性休克。影像显示大量腹膜内积液及SAA破裂。她接受了紧急剖腹手术、脾切除术和剖宫产手术。不常见，但对母亲和胎儿都有显著的死亡率，对于任何突然腹痛和血流动力学不稳定的孕妇都必须考虑破裂。及时评估和干预对胎儿和产妇的发病率和死亡率都至关重要。

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引用次数: 0