Pub Date : 2020-02-18DOI: 10.31487/j.crss.2020.01.05
Andrew M. Nouri, Poya Pourghaderi, Sara E. Chapin, Z. Nemeth, Zubin M. Bamboat
Phyllodes tumors are uncommon fibroepithelial tumors of the breast. These tumors are graded based on the World Health Organization criteria into benign, borderline, and malignant subtypes. While benign phyllodes tumors are by far the most common presentation, borderline and malignant tumors have important clinical implications, as they are more likely to locally recur and metastasize. The most common sites of distant metastasis include the lung, bone, heart, and liver. Rare spread to the small intestines, kidney and pelvis have also been reported. We report a case of a 71-year-old woman with a history of locally recurrent phyllodes tumor of the breasts found to have retroperitoneal and intraperitoneal metastases. The retroperitoneal mass was just below the left kidney, extending into the pelvis, and overlying the psoas and iliacus muscle. The second mass involved the second portion of the duodenum, the proximal transverse colon, and the overlying mesentery. This is a rare case of delayed metastatic spread of phyllodes tumor to two sites, seventeen years after first presentation.
{"title":"A Rare Case of Recurrent Phyllodes Tumor of Bilateral Breasts with Metastasis to the Retroperitoneum and Duodenum","authors":"Andrew M. Nouri, Poya Pourghaderi, Sara E. Chapin, Z. Nemeth, Zubin M. Bamboat","doi":"10.31487/j.crss.2020.01.05","DOIUrl":"https://doi.org/10.31487/j.crss.2020.01.05","url":null,"abstract":"Phyllodes tumors are uncommon fibroepithelial tumors of the breast. These tumors are graded based on the\u0000World Health Organization criteria into benign, borderline, and malignant subtypes. While benign phyllodes\u0000tumors are by far the most common presentation, borderline and malignant tumors have important clinical\u0000implications, as they are more likely to locally recur and metastasize. The most common sites of distant\u0000metastasis include the lung, bone, heart, and liver. Rare spread to the small intestines, kidney and pelvis\u0000have also been reported. We report a case of a 71-year-old woman with a history of locally recurrent\u0000phyllodes tumor of the breasts found to have retroperitoneal and intraperitoneal metastases. The\u0000retroperitoneal mass was just below the left kidney, extending into the pelvis, and overlying the psoas and\u0000iliacus muscle. The second mass involved the second portion of the duodenum, the proximal transverse\u0000colon, and the overlying mesentery. This is a rare case of delayed metastatic spread of phyllodes tumor to\u0000two sites, seventeen years after first presentation.","PeriodicalId":137602,"journal":{"name":"Case Reports and Series in Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130617099","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 : 2020-02-07DOI: 10.31487/j.crss.2020.01.02
A. Iyer, J. Elliott
Patients undergoing Left Upper Lobectomy (LUL) appear to be at risk of a unique post-operative complication that is not well-documented: Pulmonary Vein (PV) stump thrombosis +/- systemic arterial embolisation [1-3]. We describe the details of a rare case from our institution, present a review of this subject from the limited literature available, and suggest potential strategies to anticipate, detect and manage this entity. A 70 year old female patient underwent left upper lobectomy and mediastinal lymph node sampling via repeat left thoracotomy. The procedure was unremarkable apart from some adhesions. She progressed well post-operatively on the ward. On post-operative day 2 the patient developed sudden-onset left leg pain and paraesthesia and CT-Angiography confirmed the diagnosis of left common femoral artery embolus and left superior PV stump thrombosis. The patient returned to theatre for femoral embolectomy, continued systemic anticoagulation, and made an excellent recovery thereafter. The aetiology of this complication has been documented in some case reports, but it is not explored further in trials or thoracic surgery texts [2-3]. One cohort study involving CT-angiography after lobectomy surgeries found that left upper lobectomy was unique as a risk factor for PV stump thrombosis1. It may be related to the relatively longer LSPV stump and stasis of blood in the stump [4].
{"title":"Acute Limb Ischaemia Following Elective Left Upper Lobectomy for Early NSCLC: A Rare but Serious Complication Arising from the Pulmonary Vein Stump","authors":"A. Iyer, J. Elliott","doi":"10.31487/j.crss.2020.01.02","DOIUrl":"https://doi.org/10.31487/j.crss.2020.01.02","url":null,"abstract":"Patients undergoing Left Upper Lobectomy (LUL) appear to be at risk of a unique post-operative\u0000complication that is not well-documented: Pulmonary Vein (PV) stump thrombosis +/- systemic arterial\u0000embolisation [1-3]. We describe the details of a rare case from our institution, present a review of this subject\u0000from the limited literature available, and suggest potential strategies to anticipate, detect and manage this\u0000entity.\u0000A 70 year old female patient underwent left upper lobectomy and mediastinal lymph node sampling via\u0000repeat left thoracotomy. The procedure was unremarkable apart from some adhesions. She progressed well\u0000post-operatively on the ward. On post-operative day 2 the patient developed sudden-onset left leg pain and\u0000paraesthesia and CT-Angiography confirmed the diagnosis of left common femoral artery embolus and left\u0000superior PV stump thrombosis. The patient returned to theatre for femoral embolectomy, continued systemic\u0000anticoagulation, and made an excellent recovery thereafter.\u0000The aetiology of this complication has been documented in some case reports, but it is not explored further\u0000in trials or thoracic surgery texts [2-3]. One cohort study involving CT-angiography after lobectomy\u0000surgeries found that left upper lobectomy was unique as a risk factor for PV stump thrombosis1. It may be\u0000related to the relatively longer LSPV stump and stasis of blood in the stump [4].","PeriodicalId":137602,"journal":{"name":"Case Reports and Series in Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114255983","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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