International Journal of Surgery Case Reports最新文献

Introduction and importance: Brunner's gland hamartoma is a rare benign duodenal tumor. Resection is recommended for large or symptomatic lesions, but conventional pancreaticoduodenectomy and other procedures can be overly invasive for the lesion. We report a case of Brunner's gland hamartoma resected using laparoscopic and endoscopic cooperative surgery (LECS).

Case presentation: A 51-year-old woman was referred to our hospital with an asymptomatic duodenal tumor that had increased in size. A submucosal tumor was found on the anterior wall of the duodenal bulb during a detailed examination, and surgery was performed because the tumor was large (2 cm). In order to optimally resect the tumor, duodenal LECS (D-LECS) was selected. The resection line was determined while checking the base of the lesion with an intraoperative endoscope, and after the lesion was resected, the mucosal defect was closed using laparoscopic manipulation. Histopathological evaluation revealed Brunner's gland hyperplasia and mixed smooth muscle bundles, and the lesion was diagnosed as a Brunner's gland hamartoma. The surgery was completed without any problems, and the patient made a full recovery after the surgery with no complications such as stenosis, and no recurrence was observed.

Clinical discussion: With D-LECS, the lesion can be resected without excess or deficiency, and the incision can be sutured with minimal invasiveness. D-LECS is an effective method as a treatment option for Brunner's gland hamartoma.

Conclusion: We herein report a case of Brunner's gland hamartoma treated safely with a minimally invasive surgical technique: D-LECS.

Introduction and importance: Chondroid syringoma also referred to as a mixed tumor, is a benign and rare tumor originating from apocrine or eccrine sweat glands; it predominantly affects middle-aged men. While fine-needle aspiration cytology can aid in diagnosis, histological confirmation remains essential due to the potential for misdiagnosis.

Case presentation: A-22-year-old male who presented with a solitary, slow-growing, painless, erythematous nodule on the right nasal wing that had been present for 1 year, which was misdiagnosed as an epidermal cyst. an excisional biopsy was performed and showed in histological examination foci of myxoid to cartilaginous lakes associated with glandular structures.

Clinical discussion: Chondroid syringoma characterized by mesenchymal and epithelial components. Typically presenting as a painless nodule on the head and neck, CS can be misdiagnosed due to overlapping features with other lesions. Diagnosis involves fine-needle aspiration cytology and histological confirmation. The primary treatment is surgical excision.

Conclusion: Chondroid syringoma has distinctive histological characteristics, which include myxoid to cartilaginous components alongside glandular structures, these features are essential for accurate differentiation from other neoplasms. Surgical excision with an adequate margin of normal tissue is the recommended treatment approach to ensure complete removal and minimize recurrence.

Introduction and importance: Synovial sarcoma is a high-grade soft tissue sarcoma primarily affecting teenagers and young adults. Inguinal region involvement is rare, making diagnosis and treatment challenging.

Case presentation: A 35-year-old Tunisian man presented with a progressively enlarging right inguinal swelling. Imaging revealed a mass behind the inguinal ligament, confirmed as biphasic synovial sarcoma through biopsy. The patient underwent successful surgery with clear resection margins. Histopathological examination revealed a biphasic sarcoma with spindle cell and glandular components, supporting the diagnosis of synovial sarcoma. Following surgery, the patient received adjuvant radiotherapy. Regular outpatient follow-up is being conducted to monitor progress.

Clinical discussion: Synovial sarcoma is characterized by slow growth and local invasiveness, with potential for metastasis. It typically presents as a solid mass that can compress nearby structures such as blood vessels. Imaging studies offer valuable insights into tumor location, size, invasiveness, and potential metastases. Local tumor staging relies on MRI, while distant metastases are detected using chest CT or bone scans. Diagnosis is confirmed through histopathological examination and immunohistochemical analysis.

Conclusions: This case report highlights a rare presentation of inguinal synovial sarcoma and emphasizes the importance of individualized multimodal therapy in its management.

Introduction and importance: Atypical lipomatous tumor/well differentiated liposarcoma (ATL/WDL) is an intermediate, locally aggressive malignant mesenchymal neoplasm composed either entirely or in part of a mature adipocytic proliferation showing significant variation in cell size and at least focal nuclear atypia in both adipocytes and stromal cells. Symptoms related to these tumors depend on the anatomic site.

Case presentation: A 61-year-old female presented with a long-standing worsening abdominal distension. Her vital signs and blood workup tests were within normal ranges. CT scans revealed a gigantic soft tissue mass occupying the entire abdominal cavity, displacing visceral organs. An en block surgical resection was attempted. Histopathology report confirmed the diagnosis of ALT/WDL, incompletely excised. Postoperative period was uneventful. To date, a year of close follow-up has passed; she remains disease-free.

Clinical discussion: The most important prognostic factor includes anatomic location and tumor size. These tumors do not metastasize unless they dedifferentiate, which is associated with significantly shorter overall survival. Subcutaneous or intramuscular tumors may recur but typically do not dedifferentiate or metastasize. The risk of dedifferentiation is directly related to location and duration of growth. Wide local excision with negative margins is curative. The efficacy and safety of further therapeutic choices, such as chemotherapy and radiotherapy, are still controversial.

Conclusion: As clinicians, it is important that we have a thorough understanding of the clinico-pathology, diagnosis, treatment, and prognosis of this tumor. Regular follow-up is important after treatment due to the risk of recurrence.

Introduction: Reports of rectal neuroendocrine tumor (R-NET) are relatively rare. There is a lack of experience in how to accurately locate and resect metastatic lateral lymph nodes.

Case presentation: We present a challenging case. The patient was diagnosed with rectal neuroendocrine tumor. After endoscopic submucosal dissection (ESD), this patient came to hospital for reexamination. The imaging results indicated the presence of left lateral lymph node metastasis, so total mesorectal excision (TME) plus lateral lymph node dissection(LLND) was performed. One year later, PET-CT was reexamined again, using a contrast agent targeted at somatostatin receptor. The result showed residual metastatic lymph nodes. We used nanocarbon combined with coil to accurately locate the metastatic lymph nodes and finally successfully resected the lymph node. The patient recovered and was discharged 5 days after the operation.

Discussion: Surgery is the most effective method for treating rectal neuroendocrine tumors. However, it is still challenging to accurately detect and locate metastatic lymph nodes after surgery. 68Ga-DOTA-NOC is a special contrast agent that targets somatostatin receptors, and somatostatin receptors are highly expressed in NETs. Using it can clearly trace whether the lateral lymph nodes are metastasized. Nanocarbon localization has been used for the localization of various tumors. We combined it with coils and effectively located the metastatic lymph nodes. This localization method has great potential.

Conclusion: Surgical resection is the most effective way to treat rectal neuroendocrine tumors. Nanocarbon combined with coils can effectively locate metastatic lymph nodes, which is helpful for accurate resection later. And 68Ga-DOTA-NOC can assist in detection of metastatic lymph nodes.

Introduction and importance: Solitary Fibrous Tumors (SFTs) of the chest wall are rare and present unique challenges, particularly when they recur and extend into the thoracic cavity. This case contributes to the limited surgical literature on the management of chest wall SFTs with significant intrathoracic involvement. Understanding the complexities and potential for recurrence in such cases is crucial for improving surgical outcomes and patient care.

Case presentation: A 63-year-old woman presented with a recurrent mass in the upper left breast, initially treated surgically in 2018. The mass reappeared in 2021, causing pain and shortness of breath. Clinical examination revealed diminished breath sounds on the left side, and imaging studies identified a large, complex chest wall tumor with intrathoracic extension.

Clinical discussion: The patient was diagnosed with a recurrent, extended intrathoracic chest wall SFT. She underwent thoracotomy for tumor resection, which was challenging due to dense vascular adhesions. The tumor was successfully removed with an estimated blood loss of 1100 mL. Postoperative recovery was uneventful, and histopathological analysis confirmed the diagnosis of SFT, with low proliferative activity on immunohistochemistry. The patient was discharged in good condition on postoperative day 7.

Conclusion: This case highlights the importance of comprehensive imaging, meticulous surgical planning, and long-term follow-up in managing recurrent chest wall SFTs. The successful outcome reinforces the value of a multidisciplinary approach in treating rare and complex tumors. Vigilance in monitoring for recurrence and ensuring clear resection margins are essential take-away lessons from this case.

Background: Duplication of the gallbladder is a rare occurrence and seldom detected before surgery but can complicate the procedure, potentially leading to a higher likelihood of converting to open surgery and encountering complications. Symptoms, when present, typically relate to gallstone disease and cholecystitis. We report a unique case of a diabetic patient with duplicate gallbladder complicated by acute cholecystitis, which was effectively treated through laparoscopic cholecystectomy.

Presentation of case: A 51-year-old man with well-managed diabetes presented with right upper quadrant pain worsened by fatty meals. Initially diagnosed with acute acalculous cholecystitis, he was treated conservatively with antibiotics and pain relief. Recurrent symptoms led to cholecystostomy tube insertion, offering temporary relief. Subsequent imaging identified a double gallbladder with inflammatory changes, confirmed by magnetic resonance cholangiopancreatography. Elective laparoscopic cholecystectomy was performed, revealing an inflamed double gallbladder with a unique arterial supply. Histopathology showed inflammation without malignancy, and the procedure was complication-free.

Discussion: Reporting this case of gallbladder duplication in a diabetic patient suffering from acute cholecystitis is important due to its rarity and surgical management challenges it presents. This case offers valuable insights into handling complex biliary anatomies, highlights the necessity for customized surgical techniques and thorough perioperative care, and enriches the medical literature by adding knowledge about uncommon surgical situations.

Conclusion: The case presented highlights the successful surgical management of acute cholecystitis in a diabetic patient with gallbladder duplication. Despite the anatomical complexity, laparoscopic techniques proved effective in achieving successful surgical outcomes with minimal invasiveness and reduced postoperative complications.

Introduction and importance: Neurofibromatosis type 1 (NF1) affects the musculoskeletal system as well as the cervical spine. It is associated with severe, progressive cervical kyphosis. Surgical intervention is the treatment of choice to avoid neurological impairment and malalignment.

Case presentation: We herein report an 11-year-old NF-1 patient with severe cervical kyphosis and intact neurological status. We applied five days of cervical traction followed by surgery utilizing the combined cervical approach (posterior release, anterior corpectomy and reconstruction, and posterior cervicothoracic instrumentation). In one-year follow-up, atlantoaxial dislocation (AAD) and basilar invagination (BI) were detected in neuroimagings. The complication was corrected by adding C1 to the previous construct via unilateral C1 lateral mass screw, contralateral C1 sublaminar hook, unilateral C3 and contralateral C4 sublaminar hook insertion, fixed with contoured rods medial to previous rods. This led to the correction of the AAD and the BI and the patients remained neurologically intact.

Clinical discussion: Severe cervical kyphosis in the setting of NF-1 is progressive and carries a considerable risk of neurologic compromise. Surgical intervention is thus necessary.

Conclusion: The combined approach with complete spinal column reconstruction is the surgical approach of choice. However, complete curve correction to near-normal lordosis carries the risk of proximal junctional failure (PJF).

Introduction: Gastroduodenal perforations are relatively common surgical emergencies with mortality rates as high as 40%. The Graham patch repair is one surgical approach but may need to be modified when the patient lacks viable omentum. The gastrocolic ligament can be utilized to repair these perforations for coverage.

Presentation of cases: Case 1: A 77-year-old female with a complex history presented with severe abdominal pain and was found to have pneumoperitoneum on CT scan. She was found to have a first segment duodenal perforation. We employed a modified Graham patch omentopexy utilizing the gastrocolic ligament to repair the defect. She recovered well with no complications. Case 2: A 65-year-old male with multiple myeloma presented with chemotherapy intolerance and diffuse abdominal pain. CT scan demonstrated pneumoperitoneum. Upon surgical exploration, he was noted to have a 1 cm anterior duodenal perforation. He had almost no viable omentum and therefore underwent a modified Graham patch repair using the gastrocolic ligament. He recovered well with no complications.

Discussion: There have been reports of patients with gastroduodenal perforation with suboptimal omentum who underwent modified repair with the falciform ligament or a jejunal serosal patch repair. The gastrocolic ligament was found to be an effective alternative for our cases. This approach is an attractive one due to its relative ease and effectiveness.

Conclusion: We described the use of the gastrocolic ligament as an alternative approach for gastroduodenal perforation in patients with suboptimal omentum. Further studies are needed to assess long term postoperative outcomes and establish best practices.

Introduction and importance: Low-grade appendicular mucinous neoplasms are rare. In contrast to other malignant tumors, they lack the ability for infiltrative growth or lymph node metastasis, but intraperitoneal mucin spread may lead to a life-threatening condition, known as a pseudomyxoma peritonei.

Case presentation: Patient, a 47-year-old female, with complaints of a palpable mass in her right inguinal area, presented to our clinic. After a clinical workup, which included computer tomography, magnetic resonance imaging, and colonoscopy, a preliminary diagnosis of LAMN was established. Laparoscopic cecal pole resection was performed. A pathological examination confirmed the diagnosis of LAMN. Patient was followed up for six months after the surgery, at which point a contrast-enhanced CT scan was obtained with no pathological findings.

Clinical discussion: Mucinous neoplasms of the appendix are a group of tumors in which mucin accumulates within the lumen of the appendix and while this type of neoplasia cannot spread hematologically, extramural mucin may lead to pseudomyxoma peritonei. Not long ago, a right hemicolectomy was accepted as a radical treatment method. Nowadays various studies have shown that laparoscopic appendectomy may be a safe option in patients with mucin, confined to the lumen of the appendix. This case holds educational value due to the detailed course of the disease presented and justified clinical decisions.

Conclusion: LAMN is a rare type of neoplasm. When confined to the lumen of the appendix, it lacks the ability for infiltrative growth and lymph node metastasis. Appropriate treatment in case of a contained disease is surgical removal.