Journal of Surgical Case Reports最新文献

Human papillomavirus (HPV)-mediated rectal adenocarcinoma is a rare variant of colorectal adenocarcinoma that has only been described in a few case reports and series, with most originating from South America and the Middle East. This report, from North America, details the presentation, workup, and management of a 59-year-old Caucasian female who initially presented to her primary care with rectal bleeding who underwent interval colonoscopy and was found to have a T2 or early T3 rectal adenocarcinoma 1.2 cm from her anal verge. The tumor's unique pathologic feature demonstrated adenocarcinoma strongly positive for p16 protein, suggesting mediation by HPV. She is currently undergoing total neoadjuvant chemotherapy and radiation for this pathology-proven, HPV-mediated low rectal adenocarcinoma. Based on a thorough literature review, she is likely one of the first patients with HPV-mediated adenocarcinoma to be managed with total neoadjuvant chemotherapy and radiation with hopes for a complete clinical response.

A man in his sixties with locally advanced prostate cancer underwent ultra-low pressure robotic-assisted radical prostatectomy (RARP) with pelvic lymph node dissection (PLND) and was safely discharged the same day. This is the first reported UK case of day-case RARP with PLND performed at 6 mmHg. The patient experienced no complications and reported minimal discomfort postoperatively. We highlight that, with appropriate patient selection, patient's counselling, perioperative optimization, and ultra-low pressure techniques, same-day discharge after RARP with PLND is feasible, safe, and potentially scalable within NHS pathways.

We report the case of a 70-year-old man with a gastric gastrointestinal stromal tumour who subsequently developed two rare metastatic recurrences to the subcutaneous tissue and skeletal muscle following initial curative resection and adjuvant imatinib therapy. This case illustrates the potential for atypical metastatic patterns in gastrointestinal stromal tumour and emphasizes the importance of long-term surveillance, even after extended disease-free intervals.

Breast sarcomas are rare malignancies, accounting for <1% of all breast malignancies and <5% of all soft tissue sarcomas. Malignant peripheral nerve sheath tumors (MPNSTs) are aggressive soft tissue sarcomas that arise from peripheral nerves. Their occurrence in the breast is exceedingly rare. This is the fourth published case of mammary MPNST in a male patient. We present a case of a 93-year-old male with a three-year history of a progressively enlarging and painful right breast mass. Examination revealed a 20 × 30 cm immobile, fungating, and ulcerating mass with purulent discharge. Histopathological assessment confirmed a high-grade spindle cell sarcoma, and immunohistochemistry revealed positivity for vimentin, S100 protein, and p63 in a focal pattern, confirming the diagnosis of MPNST. The patient underwent a right mastectomy, achieving a surgical clearance. After 3 months, he passed away with malignant pleural effusion due to lung metastasis.

Rapunzel syndrome is a rare form of trichobezoar, typically associated with an underlying and often untreated psychiatric disorder such as trichotillomania. This case report describes a 24-year-old female patient previously diagnosed with trichotillomania and trichophagia, who presented with abdominal distension and vomiting due to a large gastric bezoar extending into the duodenum. Diagnostic evaluation included upper endoscopy and computed tomography, confirming complete upper gastrointestinal obstruction. Emergency laparoscopic management was successfully performed, allowing complete extraction of the trichobezoar, followed by gastric repair. Postoperative recovery was favorable, and psychiatric follow-up was initiated to address the underlying condition and reduce the risk of recurrence. Timely diagnosis enables successful minimally invasive surgical treatment and underscores the need for coordinated multidisciplinary management.

Bloody nipple discharge in children is rare and often alarms families because of its malignant associations in adults. We describe two prepubertal boys (3 and 5 years) with unilateral, spontaneous, painless bloody nipple discharge without trauma, infection, systemic symptoms, or exogenous hormone exposure. Examinations showed only mild unilateral breast change, with no masses, skin or nipple abnormalities, or lymphadenopathy. Breast ultrasonography was the primary investigation: one child had retroareolar ductal dilatation with cystic change consistent with mammary duct ectasia; the other had normal breast architecture. When obtained, laboratory, microbiologic, and cytologic studies were unremarkable. Both patients were managed conservatively with caregiver counseling and structured clinical/sonographic follow-up. Discharge resolved spontaneously within 14 and 8 months, respectively, with complete clinical and imaging resolution and no recurrence. These cases support ultrasound-based assessment and expectant management when no concerning features are present.

Neurofibromatosis type 1 is an autosomal dominant disorder associated with an increased risk of tumours, including gastrointestinal stromal tumours. These are usually asymptomatic and discovered incidentally. Small bowel obstruction due to gastrointestinal stromal tumour in neurofibromatosis 1 is rare, especially in young adults. We report a 24-year-old man with neurofibromatosis type 1 who presented with right upper quadrant pain and biochemical features of acute cholecystitis. During laparoscopic cholecystectomy, unexpected small bowel dilatation prompted conversion to laparotomy, revealing obstruction from a large multifocal jejunal gastrointestinal stromal tumour. This case highlights the rarity of such a presentation and the importance of surgical adaptability intraoperatively.

Meckel's diverticulum (MD) is a common developmental abnormality of the gastrointestinal tract that, in adults, is usually asymptomatic but can present with complications including malignancy. Although malignancy in MD is rare overall, MD is recognized a high-risk site for tumorigenesis compared to the surrounding ileum. Neuroendocrine neoplasms are the most common malignancy arising in MD and are often associated with nodal metastases, even if the primary tumor is small. We report the case of a 66-year-old male who underwent exploratory laparotomy for small bowel obstruction and was intraoperatively found to have MD causing an internal hernia. Pathologic examination of the diverticulectomy specimen revealed a well-differentiated neuroendocrine tumor, grade 1, pathologic stage pT2. The case highlights the role of resection for incidentally found and symptomatic MD due to the elevated risk of malignancy at this site.

We present a novel local groin flap approach for phalloplasty with minimal visible scarring. The presented patient is a 32-year-old transgender male with a prior metoidioplasty. He desired phalloplasty to optimized standing micturition and sexual function but was unwilling to undergo standard radial forearm or anterolateral thigh due to high visible scar burden. A staged approach to phalloplasty was employed, using a lower abdominal random pattern flap to construct the phallus. Once healed, future stages will create a urethral channel with full thickness skin graft from the thigh to maintain a low scar burden. Although this technique does not provide an option for direct neurotization of the construct, burial of the clitoral structures is expected to provide adequate sexual function. This technique can be considered for patients who do not desire the typical visible scarring with traditional phalloplasty methods.

Solitary fibrous tumours can cause non-islet cell tumour-induced hypoglycaemia, a paraneoplastic syndrome resulting from extrapancreatic tumours secreting insulin-like growth factor -II. This is also known as Doege-Potter syndrome. A male patient in his 70s presented to our hospital with loss of consciousness because of a second relapse of the solitary fibrous tumour with Doege-Potter syndrome. A third surgery was performed after transcatheter arterial embolization. After surgery, blood glucose levels stabilized. Repeated relapses can occur in solitary fibrous tumours even after the complete resection. Embolization of the feeding arteries before resection may be effective in avoiding massive haemorrhage and reducing complications.