International Journal of Surgery Case Reports最新文献_第10页

A case of glenohumeral joint impingement caused by a giant secondary synovial osteochondromatosis 一例由巨大继发性滑膜骨软骨瘤病引起的盂肱关节撞击症病例

IF 0.6 Q4 SURGERY

International Journal of Surgery Case Reports

Pub Date : 2024-10-26 DOI: 10.1016/j.ijscr.2024.110527

Introduction and importance

Synovial osteochondromatosis of the shoulder joint is predominantly primary, characterized by multiple osteochondral fragments, with reports of secondary synovial osteochondromatosis being rare.

Case presentation

The patient, a 48-year-old male, presented to our hospital with right shoulder pain persisting for several months. While there was no significant restriction in the range of motion, pain was noted during horizontal adduction and external rotation in the dependent position. Radiographs and CT scans revealed an osteochondral loose body in the glenohumeral joint and an osteophyte on the anterior margin of the glenoid cavity. A lidocaine test in the glenohumeral joint was positive, suggesting impingement by the loose body, leading to its surgical removal. Arthroscopically, the loose body was grasped and removed from the anterior aspect of the glenohumeral joint. The osteochondral fragment measured approximately 15 mm, with the total length including soft tissue being about 40 mm. Pathological findings indicated a layered arrangement of synovial cells, consistent with secondary synovial osteochondromatosis. Postoperatively, the shoulder pain improved rapidly, and follow-up was concluded six months after surgery.

Clinical discussion

In this case, arthroscopy revealed a Hill-Sachs-like lesion and labral deficiency on the glenoid, suggesting past trauma. However, no bone defect matching the size of the loose body was observed. In secondary synovial osteochondromatosis, small osteochondral fragments can grow with nourishment from the synovium, suggesting the loose body in this case might have similarly enlarged post-trauma.

Conclusion

The shoulder pain caused by a giant secondary synovial osteochondromatosis improved by removing the loose body arthroscopically.

导言和重要性肩关节滑膜骨软骨瘤病主要是原发性的，以多发性骨软骨碎片为特征，继发性滑膜骨软骨瘤病的报道很少见。病例介绍患者是一名 48 岁的男性，因右肩疼痛持续数月而到我院就诊。虽然活动范围没有明显受限，但在水平内收和外旋时出现疼痛。X光片和CT扫描显示盂肱关节内有一个骨软骨松动体，盂腔前缘有一个骨质增生。盂肱关节内的利多卡因试验呈阳性，表明松动体造成了撞击，因此需要进行手术切除。在关节镜下，松动体从盂肱关节前侧被抓取并移除。骨软骨碎片长约15毫米，包括软组织在内的总长度约为40毫米。病理结果显示滑膜细胞分层排列，与继发性滑膜骨软骨瘤病一致。术后，肩部疼痛迅速改善，术后 6 个月随访结束。临床讨论在该病例中，关节镜检查发现盂唇上有希尔-萨克斯样病变和唇缺损，提示曾有外伤。然而，并未观察到与松动体大小相匹配的骨缺损。在继发性滑膜骨软骨瘤病中，小的骨软骨碎片可以在滑膜的滋养下生长，这表明本病例中的松动体可能同样是在创伤后增大的。结论通过关节镜切除松动体，巨大的继发性滑膜骨软骨瘤病引起的肩部疼痛得到了改善。

{"title":"A case of glenohumeral joint impingement caused by a giant secondary synovial osteochondromatosis","authors":"","doi":"10.1016/j.ijscr.2024.110527","DOIUrl":"10.1016/j.ijscr.2024.110527","url":null,"abstract":"<div><h3>Introduction and importance</h3><div>Synovial osteochondromatosis of the shoulder joint is predominantly primary, characterized by multiple osteochondral fragments, with reports of secondary synovial osteochondromatosis being rare.</div></div><div><h3>Case presentation</h3><div>The patient, a 48-year-old male, presented to our hospital with right shoulder pain persisting for several months. While there was no significant restriction in the range of motion, pain was noted during horizontal adduction and external rotation in the dependent position. Radiographs and CT scans revealed an osteochondral loose body in the glenohumeral joint and an osteophyte on the anterior margin of the glenoid cavity. A lidocaine test in the glenohumeral joint was positive, suggesting impingement by the loose body, leading to its surgical removal. Arthroscopically, the loose body was grasped and removed from the anterior aspect of the glenohumeral joint. The osteochondral fragment measured approximately 15 mm, with the total length including soft tissue being about 40 mm. Pathological findings indicated a layered arrangement of synovial cells, consistent with secondary synovial osteochondromatosis. Postoperatively, the shoulder pain improved rapidly, and follow-up was concluded six months after surgery.</div></div><div><h3>Clinical discussion</h3><div>In this case, arthroscopy revealed a Hill-Sachs-like lesion and labral deficiency on the glenoid, suggesting past trauma. However, no bone defect matching the size of the loose body was observed. In secondary synovial osteochondromatosis, small osteochondral fragments can grow with nourishment from the synovium, suggesting the loose body in this case might have similarly enlarged post-trauma.</div></div><div><h3>Conclusion</h3><div>The shoulder pain caused by a giant secondary synovial osteochondromatosis improved by removing the loose body arthroscopically.</div></div>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142561474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Hemorrhagic pericardial effusion superimposed on total anomalous pulmonary venous connection: First-reported case 出血性心包积液叠加全肺静脉连接异常：首例报告病例。

IF 0.6 Q4 SURGERY

International Journal of Surgery Case Reports

Pub Date : 2024-10-24 DOI: 10.1016/j.ijscr.2024.110520

Introduction

Among congenital heart diseases (CHD), total anomalous pulmonary venous connection (TAPVC), constitutes approximately 0.5–2 % of all detected cardiac anomalies in newborns. Hemorrhagic pericardial effusions are frequently caused by malignancy and iatrogenic cause; however, they can be idiopathic.

Presentation of case

We introduce an exceptional case of a previously healthy young adult male who sought medical attention at our institution due to chest discomfort. Investigation revealed a large hemorrhagic pericardial effusion, which recurred three times despite treatment with pericardiocentesis. Further investigation revealed a TAPVC, which subsequently resolved following surgical repair.

Discussion

TAPVC carries a mortality rate of up to 80 % if unrepaired by one year of age. The supracardiac type of TAPVC and presence of atrial septal defect (ASD) are factors that contribute to survival. The simultaneous occurrence of hemorrhagic pericardial effusions in the setting of unrepaired TAPVC in adults is uncommon. The resolution of the hemorrhagic pericardial effusion suggests a possible association between the two disease entities.

Conclusion

Our case draws attention due to the scarcity of available medical literature reporting such a unique occurrence. Providers should remain vigilant regarding a possible superimposed hemorrhagic pericardial effusion, which could develop in the setting of unrepaired TAPVC in adults.

导言：在先天性心脏病（CHD）中，全肺静脉连接异常（TAPVC）约占新生儿心脏畸形的 0.5-2%。出血性心包积液通常由恶性肿瘤和先天性原因引起，但也可能是特发性的：我们介绍一例特殊病例：一名原本健康的年轻男性因胸部不适到我院就诊。检查发现他有大面积出血性心包积液，尽管进行了心包穿刺治疗，但积液仍反复发作了三次。进一步检查发现该患者患有 TAPVC，经手术修补后症状缓解：讨论：TAPVC 如果在一岁前得不到修复，死亡率高达 80%。TAPVC的心上型和存在房间隔缺损（ASD）是影响存活率的因素。成人 TAPVC 未修复时同时出现出血性心包积液的情况并不常见。出血性心包积液的消退表明这两种疾病可能存在关联：我们的病例引起了人们的注意，因为现有的医学文献很少报道这种独特的病例。医护人员应该对成人 TAPVC 未修复时可能出现的叠加性出血性心包积液保持警惕。

{"title":"Hemorrhagic pericardial effusion superimposed on total anomalous pulmonary venous connection: First-reported case","authors":"","doi":"10.1016/j.ijscr.2024.110520","DOIUrl":"10.1016/j.ijscr.2024.110520","url":null,"abstract":"<div><h3>Introduction</h3><div>Among congenital heart diseases (CHD), total anomalous pulmonary venous connection (TAPVC), constitutes approximately 0.5–2 % of all detected cardiac anomalies in newborns. Hemorrhagic pericardial effusions are frequently caused by malignancy and iatrogenic cause; however, they can be idiopathic.</div></div><div><h3>Presentation of case</h3><div>We introduce an exceptional case of a previously healthy young adult male who sought medical attention at our institution due to chest discomfort. Investigation revealed a large hemorrhagic pericardial effusion, which recurred three times despite treatment with pericardiocentesis. Further investigation revealed a TAPVC, which subsequently resolved following surgical repair.</div></div><div><h3>Discussion</h3><div>TAPVC carries a mortality rate of up to 80 % if unrepaired by one year of age. The supracardiac type of TAPVC and presence of atrial septal defect (ASD) are factors that contribute to survival. The simultaneous occurrence of hemorrhagic pericardial effusions in the setting of unrepaired TAPVC in adults is uncommon. The resolution of the hemorrhagic pericardial effusion suggests a possible association between the two disease entities.</div></div><div><h3>Conclusion</h3><div>Our case draws attention due to the scarcity of available medical literature reporting such a unique occurrence. Providers should remain vigilant regarding a possible superimposed hemorrhagic pericardial effusion, which could develop in the setting of unrepaired TAPVC in adults.</div></div>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Pediatric traumatic spiegelian hernia, not always a handlebar hernia: A case report 小儿外伤性椎弓根疝，不一定是车把疝：病例报告。

IF 0.6 Q4 SURGERY

International Journal of Surgery Case Reports

Pub Date : 2024-10-24 DOI: 10.1016/j.ijscr.2024.110507

Introduction and importance

Traumatic abdominal wall hernia is rare in children, and traumatic Spiegelian hernia is exceptional. Most of them occur due to a handlebar accident in older children. This report concerns a case of a toddler with a rare mechanism and location.

Case presentation

We report a case of a 28-month-old girl who was hit by a car and immediately presented at our institution with a right upper quadrant 5-cm defect traumatic Spiegelian hernia associated with a congenital umbilical hernia and no other associated lesions, as confirmed by a computed tomography scan. Three weeks later, the defect along the semilunar line was still palpable (3 cm), so open tissue repair was performed for both hernias, with good outcomes four months postoperatively.

Clinical discussion

When traumatic Spiegelian hernia occurs mainly due to handlebar accidents, it is rare in children under 5-year-olds, with a different mechanism. The lesion seems more frequent in the right upper quadrant in this population.

Conclusion

Traumatic Spiegelian hernia can occur in toddlers, with a different mechanism and location compared to older children. Computed tomography is essential to explore associated intraabdominal injuries. Despite the tendency for the defect size reduction, repair must be performed for palpable defects.

导言和重要性：外伤性腹壁疝在儿童中很少见，而外伤性斯皮格尔疝则是例外。大多数外伤性腹壁疝发生在年龄较大的儿童身上，是由于车把事故造成的。本报告涉及一例机制和位置罕见的幼儿病例：我们报告了一例 28 个月大的女孩，她被车撞伤后立即到我院就诊，经计算机断层扫描证实，她右上腹 5 厘米缺损的外伤性斯皮格尔疝伴有先天性脐疝，且无其他相关病变。三周后，仍可扪及沿半月线的缺损（3 厘米），因此对两个疝进行了开放性组织修补，术后四个月效果良好：临床讨论：外伤性斯皮格尔疝气主要是由于车把事故引起的，在 5 岁以下儿童中很少见，其发病机制也不尽相同。临床讨论：外伤性斯皮格尔疝气主要是由于车把事故引起的，在 5 岁以下儿童中较为罕见，其发病机制也不尽相同，病变部位多位于右上腹：结论：外伤性斯皮格尔疝可能发生在幼儿身上，其发病机制和部位与年长儿童不同。计算机断层扫描对于探查相关的腹内损伤至关重要。尽管缺损有缩小的趋势，但必须对可触及的缺损进行修补。

{"title":"Pediatric traumatic spiegelian hernia, not always a handlebar hernia: A case report","authors":"","doi":"10.1016/j.ijscr.2024.110507","DOIUrl":"10.1016/j.ijscr.2024.110507","url":null,"abstract":"<div><h3>Introduction and importance</h3><div>Traumatic abdominal wall hernia is rare in children, and traumatic Spiegelian hernia is exceptional. Most of them occur due to a handlebar accident in older children. This report concerns a case of a toddler with a rare mechanism and location.</div></div><div><h3>Case presentation</h3><div>We report a case of a 28-month-old girl who was hit by a car and immediately presented at our institution with a right upper quadrant 5-cm defect traumatic Spiegelian hernia associated with a congenital umbilical hernia and no other associated lesions, as confirmed by a computed tomography scan. Three weeks later, the defect along the semilunar line was still palpable (3 cm), so open tissue repair was performed for both hernias, with good outcomes four months postoperatively.</div></div><div><h3>Clinical discussion</h3><div>When traumatic Spiegelian hernia occurs mainly due to handlebar accidents, it is rare in children under 5-year-olds, with a different mechanism. The lesion seems more frequent in the right upper quadrant in this population.</div></div><div><h3>Conclusion</h3><div>Traumatic Spiegelian hernia can occur in toddlers, with a different mechanism and location compared to older children. Computed tomography is essential to explore associated intraabdominal injuries. Despite the tendency for the defect size reduction, repair must be performed for palpable defects.</div></div>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142510535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Isolated posterior malleolus fracture: A case report and review of the literature 孤立性后踝骨折：病例报告和文献综述

IF 0.6 Q4 SURGERY

International Journal of Surgery Case Reports

Pub Date : 2024-10-24 DOI: 10.1016/j.ijscr.2024.110519

Introduction

Fractures involving the ankle joint typically manifest as bimalleolar or trimalleolar fractures, with isolated posterior malleolus fractures (IPMF) representing a rare subset, comprising 0.5–4 % of cases. Due to its rarity and subtle clinical presentation, IPMF poses unique diagnostic and management challenges. This case report presents the diagnosis and treatment of a 50-year-old woman with an IPMF following a fall, alongside a review of relevant literature.

Case presentation

A 50-year-old woman presented with severe right ankle pain and inability to bear weight after a backward fall. Physical examination showed swelling, tenderness in the medial retromalleolar region, and pain with passive dorsiflexion. Imaging through X-rays and CT scans revealed an isolated posterior malleolus fracture involving 40 % of the tibiotalar articular surface. The patient underwent surgical fixation using two posteroanterior cannulated screws via a posterolateral approach. Post-operative X-rays confirmed adequate reduction and fixation. She remained non-weight-bearing for six weeks, followed by physical therapy.

Discussion

IPMFs are challenging to diagnose due to subtle signs and limitations of standard radiographs. Advanced imaging, particularly CT with 3D reconstruction, is crucial for accurate diagnosis. Classification systems, such as Haraguchi and Mason, guide treatment. Surgical fixation is often necessary for fractures involving significant joint surfaces, displacement, or instability. Posteroanterior cannulated screws offer a minimally invasive and effective stabilization method, as demonstrated in this case.

Conclusion

Early recognition and proper surgical management of IPMF are essential to prevent complications. Increased awareness and further research are needed to improve outcomes for this rare ankle injury.

导言涉及踝关节的骨折通常表现为双侧踝骨骨折或三侧踝骨骨折，孤立的后踝骨骨折（IPMF）是一个罕见的子集，占病例的 0.5-4%。由于其罕见性和微妙的临床表现，IPMF 给诊断和治疗带来了独特的挑战。本病例报告介绍了一名 50 岁女性摔倒后罹患 IPMF 的诊断和治疗情况，并对相关文献进行了回顾。体格检查显示内侧后踝区肿胀、触痛，被动外展时疼痛。X光和CT扫描显示踝骨后方有一处孤立的骨折，涉及胫骨关节面的40%。患者通过后外侧入路，使用两枚后外侧插管螺钉进行了手术固定。术后的 X 光片证实了适当的复位和固定。由于体征微妙且标准X光片存在局限性，IPMF的诊断具有挑战性。先进的成像技术，尤其是三维重建 CT，对于准确诊断至关重要。Haraguchi 和 Mason 等分类系统可指导治疗。对于涉及明显关节面、移位或不稳定的骨折，通常需要进行手术固定。正如本病例所示，后前方套管螺钉提供了一种微创、有效的稳定方法。结论早期识别和正确手术治疗 IPMF 对预防并发症至关重要。为了改善这种罕见的踝关节损伤的治疗效果，需要加强认识和进一步研究。

{"title":"Isolated posterior malleolus fracture: A case report and review of the literature","authors":"","doi":"10.1016/j.ijscr.2024.110519","DOIUrl":"10.1016/j.ijscr.2024.110519","url":null,"abstract":"<div><h3>Introduction</h3><div>Fractures involving the ankle joint typically manifest as bimalleolar or trimalleolar fractures, with isolated posterior malleolus fractures (IPMF) representing a rare subset, comprising 0.5–4 % of cases. Due to its rarity and subtle clinical presentation, IPMF poses unique diagnostic and management challenges. This case report presents the diagnosis and treatment of a 50-year-old woman with an IPMF following a fall, alongside a review of relevant literature.</div></div><div><h3>Case presentation</h3><div>A 50-year-old woman presented with severe right ankle pain and inability to bear weight after a backward fall. Physical examination showed swelling, tenderness in the medial retromalleolar region, and pain with passive dorsiflexion. Imaging through X-rays and CT scans revealed an isolated posterior malleolus fracture involving 40 % of the tibiotalar articular surface. The patient underwent surgical fixation using two posteroanterior cannulated screws via a posterolateral approach. Post-operative X-rays confirmed adequate reduction and fixation. She remained non-weight-bearing for six weeks, followed by physical therapy.</div></div><div><h3>Discussion</h3><div>IPMFs are challenging to diagnose due to subtle signs and limitations of standard radiographs. Advanced imaging, particularly CT with 3D reconstruction, is crucial for accurate diagnosis. Classification systems, such as Haraguchi and Mason, guide treatment. Surgical fixation is often necessary for fractures involving significant joint surfaces, displacement, or instability. Posteroanterior cannulated screws offer a minimally invasive and effective stabilization method, as demonstrated in this case.</div></div><div><h3>Conclusion</h3><div>Early recognition and proper surgical management of IPMF are essential to prevent complications. Increased awareness and further research are needed to improve outcomes for this rare ankle injury.</div></div>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142537400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A rare case of strangulated femoral hernia in a male child: Case report 一例罕见的男童绞窄性股疝：病例报告

IF 0.6 Q4 SURGERY

International Journal of Surgery Case Reports

Pub Date : 2024-10-24 DOI: 10.1016/j.ijscr.2024.110518

Background and importance

Strangulated femoral hernias are rare in pediatric patients. This case highlights the importance of early suspicion and diagnosis to prevent complications.

Case presentation

A 14-years old male presented to our emergency department with a two-days history of worsening left groin pain. Clinical examination confirmed the diagnosis of a strangulated femoral hernia. A hernia sac was identified and the content was necrotic adipose tissue. Resection and hernia repair was performed successfully.

Clinical dissection

Femoral hernia is an uncommon surgical entity in the pediatric population, and its diagnosis remains a challenge, with an incidence ranging from 0.3 % to 1 %. Unlike in adults, the incidence rates are similar by sex, though, like adults, right-side hernias are more common. However, our case presents with a left-side hernia.

Conclusion

Strangulated femoral hernias should be considered in pediatric patients with acute groin pain and a history of reducible hernias. Early diagnosis and prompt surgical intervention are crucial to preventing complications.

背景和重要性股骨绞窄性疝气在儿童患者中非常罕见。本病例强调了早期怀疑和诊断对预防并发症的重要性。病例介绍一名 14 岁的男性因左腹股沟疼痛加重两天后到我院急诊科就诊。临床检查确诊为股骨绞窄性疝。检查发现了一个疝囊，内容物为坏死的脂肪组织。临床解剖股疝在小儿中并不常见，其诊断仍是一个难题，发病率在 0.3 % 到 1 % 之间。与成人不同，不同性别的发病率相似，但与成人一样，右侧疝气更为常见。结论对于腹股沟急性疼痛且有可复性疝气病史的儿童患者，应考虑股骨绞窄性疝气。早期诊断和及时手术治疗对预防并发症至关重要。

{"title":"A rare case of strangulated femoral hernia in a male child: Case report","authors":"","doi":"10.1016/j.ijscr.2024.110518","DOIUrl":"10.1016/j.ijscr.2024.110518","url":null,"abstract":"<div><h3>Background and importance</h3><div>Strangulated femoral hernias are rare in pediatric patients. This case highlights the importance of early suspicion and diagnosis to prevent complications.</div></div><div><h3>Case presentation</h3><div>A 14-years old male presented to our emergency department with a two-days history of worsening left groin pain. Clinical examination confirmed the diagnosis of a strangulated femoral hernia. A hernia sac was identified and the content was necrotic adipose tissue. Resection and hernia repair was performed successfully.</div></div><div><h3>Clinical dissection</h3><div>Femoral hernia is an uncommon surgical entity in the pediatric population, and its diagnosis remains a challenge, with an incidence ranging from 0.3 % to 1 %. Unlike in adults, the incidence rates are similar by sex, though, like adults, right-side hernias are more common. However, our case presents with a left-side hernia.</div></div><div><h3>Conclusion</h3><div>Strangulated femoral hernias should be considered in pediatric patients with acute groin pain and a history of reducible hernias. Early diagnosis and prompt surgical intervention are crucial to preventing complications.</div></div>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142537403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A rare case of posterior reversible encephalopathy syndrome following posterior fossa ependymoma resection a surgical case report 一例罕见的后窝脑膜瘤切除术后可逆性脑病综合征手术病例报告。

IF 0.6 Q4 SURGERY

International Journal of Surgery Case Reports

Pub Date : 2024-10-24 DOI: 10.1016/j.ijscr.2024.110514

Introduction

Posterior reversible encephalopathy syndrome (PRES) is a rare complication following surgical intervention, with varied neurological manifestations. The inherent pathophysiology is diverse and risk factors include certain medical co-morbidities.

Presentation of case

A previously well 24-year-old female, presented with signs of elevated intracranial pressure, with further investigations highlighting a posterior fossa tumor. She was scheduled for resection of this intracranial lesion and the surgical procedure was uneventful. However, moderate but significant labile increases in blood pressures were noted intra- and post- operatively. Following surgery, a clinical presentation of limb weakness and gaze deviation was observed, leading to investigative imaging demonstrating PRES. She was treated expeditiously by a multi-disciplinary team. There was complete resolution of her symptomology once the underlying cause was identified.

Discussion

PRES is not a typical complication of a neurosurgical patient. Moreso, in a young patient without any medical comorbidities. Deviation of her blood pressures from the normal lead to the formation of vasogenic edema along the cerebral hemispheres. The manifestation of this clinically made it arduous to pinpoint a definitive diagnosis. With the aid of different specialists, a diagnosis was clenched, and treatment was successfully implemented.

Conclusion

The major learning point of this case history is the recognition of alterations from a patient's baseline vital signs (blood pressure) during and following surgical procedures. Additionally, the resultant consequences of these deviations, which may manifest as rare neurological conditions, such as PRES. The importance of a multi-disciplinary team in the management of this case was paramount.

简介后可逆性脑病综合征（PRES）是外科手术后的一种罕见并发症，具有多种神经系统表现。其内在病理生理学多种多样，风险因素包括某些并发症：病例简介：一名 24 岁的女性患者，因颅内压升高而就诊，进一步检查发现她患有后窝肿瘤。她被安排切除这个颅内病变，手术过程很顺利。然而，术中和术后血压出现了中度但明显的不稳定升高。手术后，她出现了四肢无力和目光偏离的临床表现，影像学检查显示她患有 PRES。多学科团队迅速对她进行了治疗。在找到病因后，她的症状完全消失：PRES并非神经外科患者的典型并发症。讨论：PRES 并不是神经外科患者的典型并发症，对于一名没有任何并发症的年轻患者来说更是如此。她的血压偏离正常值导致大脑半球形成血管源性水肿。这种临床表现给明确诊断带来了困难。在不同专家的协助下，最终确诊并成功实施了治疗：本病例的主要学习要点是认识到手术过程中和手术后病人生命体征（血压）基线的变化。此外，这些偏差导致的后果可能表现为罕见的神经系统疾病，如 PRES。在这个病例的治疗过程中，多学科团队的重要性至关重要。

{"title":"A rare case of posterior reversible encephalopathy syndrome following posterior fossa ependymoma resection a surgical case report","authors":"","doi":"10.1016/j.ijscr.2024.110514","DOIUrl":"10.1016/j.ijscr.2024.110514","url":null,"abstract":"<div><h3>Introduction</h3><div>Posterior reversible encephalopathy syndrome (PRES) is a rare complication following surgical intervention, with varied neurological manifestations. The inherent pathophysiology is diverse and risk factors include certain medical co-morbidities.</div></div><div><h3>Presentation of case</h3><div>A previously well 24-year-old female, presented with signs of elevated intracranial pressure, with further investigations highlighting a posterior fossa tumor. She was scheduled for resection of this intracranial lesion and the surgical procedure was uneventful. However, moderate but significant labile increases in blood pressures were noted intra- and post- operatively. Following surgery, a clinical presentation of limb weakness and gaze deviation was observed, leading to investigative imaging demonstrating PRES. She was treated expeditiously by a multi-disciplinary team. There was complete resolution of her symptomology once the underlying cause was identified.</div></div><div><h3>Discussion</h3><div>PRES is not a typical complication of a neurosurgical patient. Moreso, in a young patient without any medical comorbidities. Deviation of her blood pressures from the normal lead to the formation of vasogenic edema along the cerebral hemispheres. The manifestation of this clinically made it arduous to pinpoint a definitive diagnosis. With the aid of different specialists, a diagnosis was clenched, and treatment was successfully implemented.</div></div><div><h3>Conclusion</h3><div>The major learning point of this case history is the recognition of alterations from a patient's baseline vital signs (blood pressure) during and following surgical procedures. Additionally, the resultant consequences of these deviations, which may manifest as rare neurological conditions, such as PRES. The importance of a multi-disciplinary team in the management of this case was paramount.</div></div>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142510530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Operative management of cholecystogastric fistula as a rare complication of gallbladder empyema: A case report 胆囊水肿罕见并发症之胆囊胃瘘的手术治疗：病例报告

IF 0.6 Q4 SURGERY

International Journal of Surgery Case Reports

Pub Date : 2024-10-24 DOI: 10.1016/j.ijscr.2024.110515

Introduction

Cholecysto-gastric fistula is a rare, life-threatening complication of cholelithiasis that presents significant challenge to surgeons. Early diagnosis can be obtained and surgical intervention can be planned as elective case. Dilemma comes when patient presenting with acute acute abdominal symptoms necessitating immediate surgery, decision-making becomes more complex increasing morbidity and mortality.

Presentation of case

A 59-year-old gentleman, was admitted for acute epigastric and right hyochondrium pain along with fever persisting for one week. The diagnosis of gallbladder empyema was retained. Emergency laparotomy revealed a cholecysto-gastric fistula, an inter hepatico-diaphragmatic abscess, and acute gangrenous cholecystitis. Surgical intervention included drainage of the abscess, cholecystectomy with placement of a trans-cystic drain, closure of the cholecysto-gastric fistula, and contact drainage.

Discussion

Cholecystogastric fistula a rare, life-threatening complication of cholelithiasis, The pathogenesis underlying is complicated. Despite improvements in imaging techniques, diagnosing remains challenging is associated with considerable morbidity and mortality, necessitating prompt diagnosis and early intervention. The surgical management of cholecysto-enteric fistulas remains a contentious issue, with many surgeons favoring conversion to an open approach over laparoscopic surgery.

Conclusion

Cholecystogastric fistula, although rare, is associated with considerable morbidity and mortality, necessitating prompt diagnosis and early intervention. Advances in radiological and endoscopic techniques facilitate accurate and timely diagnosis, enabling the planning of appropriate surgical management. This brief report sheds light on the importance of a multidisciplinary team preventing a potentially fatal outcome.

导言胆囊胃瘘是胆石症的一种罕见并发症，危及生命，给外科医生带来了巨大挑战。胆囊胃瘘是一种罕见的危及生命的并发症，给外科医生带来了极大的挑战。当患者出现急性急腹症症状，需要立即手术时，决策就会变得更加复杂，从而增加发病率和死亡率。诊断为胆囊水肿。急诊开腹手术发现胆囊胃瘘、肝膈间脓肿和急性坏疽性胆囊炎。手术治疗包括脓肿引流、胆囊切除术并放置经胆囊引流管、胆囊胃瘘闭合和接触性引流。尽管影像学技术有所改进，但胆囊胃瘘的诊断仍具有挑战性，其发病率和死亡率相当高，因此需要及时诊断和早期干预。结论胆囊胃管瘘虽然罕见，但发病率和死亡率相当高，需要及时诊断和早期干预。放射学和内窥镜技术的进步有助于准确及时地诊断，从而制定适当的手术治疗计划。这份简短的报告揭示了多学科团队预防潜在致命后果的重要性。

{"title":"Operative management of cholecystogastric fistula as a rare complication of gallbladder empyema: A case report","authors":"","doi":"10.1016/j.ijscr.2024.110515","DOIUrl":"10.1016/j.ijscr.2024.110515","url":null,"abstract":"<div><h3>Introduction</h3><div>Cholecysto-gastric fistula is a rare, life-threatening complication of cholelithiasis that presents significant challenge to surgeons. Early diagnosis can be obtained and surgical intervention can be planned as elective case. Dilemma comes when patient presenting with acute acute abdominal symptoms necessitating immediate surgery, decision-making becomes more complex increasing morbidity and mortality.</div></div><div><h3>Presentation of case</h3><div>A 59-year-old gentleman, was admitted for acute epigastric and right hyochondrium pain along with fever persisting for one week. The diagnosis of gallbladder empyema was retained. Emergency laparotomy revealed a cholecysto-gastric fistula, an inter hepatico-diaphragmatic abscess, and acute gangrenous cholecystitis. Surgical intervention included drainage of the abscess, cholecystectomy with placement of a trans-cystic drain, closure of the cholecysto-gastric fistula, and contact drainage.</div></div><div><h3>Discussion</h3><div>Cholecystogastric fistula a rare, life-threatening complication of cholelithiasis, The pathogenesis underlying is complicated. Despite improvements in imaging techniques, diagnosing remains challenging is associated with considerable morbidity and mortality, necessitating prompt diagnosis and early intervention. The surgical management of cholecysto-enteric fistulas remains a contentious issue, with many surgeons favoring conversion to an open approach over laparoscopic surgery.</div></div><div><h3>Conclusion</h3><div>Cholecystogastric fistula, although rare, is associated with considerable morbidity and mortality, necessitating prompt diagnosis and early intervention. Advances in radiological and endoscopic techniques facilitate accurate and timely diagnosis, enabling the planning of appropriate surgical management. This brief report sheds light on the importance of a multidisciplinary team preventing a potentially fatal outcome.</div></div>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Pilonidal granuloma formation after an incision and drainage procedure is associated with retained hair within the sinus – A case series 切口引流术后形成的乳头肉芽肿与窦内毛发滞留有关--病例系列。

IF 0.6 Q4 SURGERY

International Journal of Surgery Case Reports

Pub Date : 2024-10-23 DOI: 10.1016/j.ijscr.2024.110500

Introduction and importance

Pilonidal disease may present with a draining secondary sinus or granuloma, but the development of these findings is not well-characterized.

Case presentation

Two adolescent males presented with pilonidal disease. The first patient had a gluteal cleft abscess, and an incision and drainage procedure was performed. Although the abscess resolved, the incision site formed a granuloma with intermittent draining wound with granulation tissue. He underwent a pit-picking procedure along with excision of the granuloma. A large amount of hair was also removed from within the pilonidal sinus. The second patient underwent an incision and drainage procedure to treat the pilonidal abscess. The incision site evolved into a granuloma with recurring drainage. A pit-picking procedure was performed, and the granuloma was excised. During the excision, a moderate amount of hair was evacuated from the pilonidal sinus.

Clinical discussion

Many pilonidal patients present with a granuloma or secondary sinus at the gluteal cleft, but there has been no documentation of the natural history of this development. The role of hair is central to pilonidal disease pathophysiology and is a known factor in foreign body granuloma formation – a cutaneous inflammatory response to endogenous or exogenous material in the dermis that is not broken down readily by macrophages.

Conclusion

Even though the pilonidal abscess was drained with an incision, a granuloma was able to form with recurrent drainage when hair was retained within the pilonidal sinus.

导言和重要性：乳头状瘤病可能伴有引流性继发性窦或肉芽肿，但这些病变的发展特征并不明确：病例介绍：两名青少年男性患有乳头状瘤病。第一例患者臀部裂隙脓肿，进行了切开引流术。虽然脓肿消退了，但切口部位形成了肉芽肿，伤口间歇性引流，并伴有肉芽组织。在切除肉芽肿的同时，他还接受了挖坑手术。此外，还从朝天鼻窦内切除了大量毛发。第二名患者接受了切开引流术治疗朝天鼻脓肿。切口部位演变成肉芽肿，并反复引流。患者接受了取坑手术，肉芽肿被切除。在切除过程中，从朝天鼻窦排出了适量的毛发：临床讨论：许多朝天鼻患者都会在臀裂处出现肉芽肿或继发性窦道，但目前还没有关于这种发展的自然史的文献。毛发的作用是念珠菌病病理生理学的核心，也是异物肉芽肿形成的一个已知因素，异物肉芽肿是对真皮层中不易被巨噬细胞分解的内源性或外源性物质的一种皮肤炎症反应：结论：尽管朝天鼻脓肿是通过切口引流的，但如果头发留在朝天鼻窦内，肉芽肿就会随着反复引流而形成。

{"title":"Pilonidal granuloma formation after an incision and drainage procedure is associated with retained hair within the sinus – A case series","authors":"","doi":"10.1016/j.ijscr.2024.110500","DOIUrl":"10.1016/j.ijscr.2024.110500","url":null,"abstract":"<div><h3>Introduction and importance</h3><div>Pilonidal disease may present with a draining secondary sinus or granuloma, but the development of these findings is not well-characterized.</div></div><div><h3>Case presentation</h3><div>Two adolescent males presented with pilonidal disease. The first patient had a gluteal cleft abscess, and an incision and drainage procedure was performed. Although the abscess resolved, the incision site formed a granuloma with intermittent draining wound with granulation tissue. He underwent a pit-picking procedure along with excision of the granuloma. A large amount of hair was also removed from within the pilonidal sinus. The second patient underwent an incision and drainage procedure to treat the pilonidal abscess. The incision site evolved into a granuloma with recurring drainage. A pit-picking procedure was performed, and the granuloma was excised. During the excision, a moderate amount of hair was evacuated from the pilonidal sinus.</div></div><div><h3>Clinical discussion</h3><div>Many pilonidal patients present with a granuloma or secondary sinus at the gluteal cleft, but there has been no documentation of the natural history of this development. The role of hair is central to pilonidal disease pathophysiology and is a known factor in foreign body granuloma formation – a cutaneous inflammatory response to endogenous or exogenous material in the dermis that is not broken down readily by macrophages.</div></div><div><h3>Conclusion</h3><div>Even though the pilonidal abscess was drained with an incision, a granuloma was able to form with recurrent drainage when hair was retained within the pilonidal sinus.</div></div>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142510537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Successful management of a pancreatic mature cystic teratoma with Whipple procedure: A case report 用 Whipple 手术成功治疗胰腺成熟囊性畸胎瘤：病例报告

IF 0.6 Q4 SURGERY

International Journal of Surgery Case Reports

Pub Date : 2024-10-23 DOI: 10.1016/j.ijscr.2024.110504

Background

Mature cystic teratomas of the pancreas, also known as dermoid cysts, are exceptionally rare tumors characterized by well-differentiated parenchymal tissues. Typically containing diverse tissues from all three germ layers, these teratomas are most commonly found in the ovaries and testes, with infrequent occurrences in the pancreas.

Case presentation

A 30-year-old male with type 2 diabetes mellitus presented with elevated liver enzymes and serum CEA levels. A CT scan detected an 8.8 × 7.2 cm retroperitoneal mass with calcifications. Due to the tumor's involvement with critical structures, a Whipple procedure was performed. Post-surgery, the tumor was confirmed to be a mature cystic teratoma, and the patient experienced a smooth recovery.

Discussion

Pancreatic teratomas are rare, typically affecting younger patients and predominantly occurring in the body or head of the pancreas. These tumors, often categorized into mature and immature types. Diagnosis relies on imaging techniques such as ultrasound, CT, and MRI, which reveal key features like fat, calcifications, and fat-fluid levels. Differential diagnoses include various pancreatic cystic lesions. Surgical resection is the primary treatment, and this case highlights the diagnostic challenges and the critical role of imaging in guiding surgical decisions.

Conclusion

This report describes a rare case of a pancreatic mature cystic teratoma, one of only 52 documented cases. Despite the absence of significant symptoms, imaging revealed a large mass, and Whipple procedure was performed due to its complex relationship with vital structures. This case illustrates the diagnostic and therapeutic challenges associated with such rare tumors.

背景：胰腺成熟囊性畸胎瘤又称皮样囊肿，是一种异常罕见的肿瘤，其特点是实质组织分化良好。这些畸胎瘤通常包含来自所有三个胚层的不同组织，最常见于卵巢和睾丸，在胰腺中很少见：一名患有 2 型糖尿病的 30 岁男性患者出现肝酶和血清 CEA 水平升高。CT 扫描发现一个 8.8 × 7.2 厘米的腹膜后肿块，伴有钙化。由于肿瘤累及重要结构，患者接受了Whipple手术。术后证实肿瘤为成熟性囊性畸胎瘤，患者恢复顺利：胰腺畸胎瘤非常罕见，通常影响年轻患者，主要发生在胰体或胰头。这些肿瘤通常分为成熟型和未成熟型。诊断依赖于超声波、CT 和核磁共振成像等成像技术，这些技术可显示脂肪、钙化和脂肪液水平等关键特征。鉴别诊断包括各种胰腺囊性病变。手术切除是主要的治疗方法，本病例强调了诊断方面的挑战以及影像学在指导手术决策中的关键作用：本报告描述了一例罕见的胰腺成熟囊性畸胎瘤病例，是仅有的 52 例记录病例之一。尽管没有明显症状，但影像学检查发现了一个巨大肿块，由于肿块与重要结构的复杂关系，医生对其实施了Whipple手术。该病例说明了此类罕见肿瘤在诊断和治疗方面的挑战。

{"title":"Successful management of a pancreatic mature cystic teratoma with Whipple procedure: A case report","authors":"","doi":"10.1016/j.ijscr.2024.110504","DOIUrl":"10.1016/j.ijscr.2024.110504","url":null,"abstract":"<div><h3>Background</h3><div>Mature cystic teratomas of the pancreas, also known as dermoid cysts, are exceptionally rare tumors characterized by well-differentiated parenchymal tissues. Typically containing diverse tissues from all three germ layers, these teratomas are most commonly found in the ovaries and testes, with infrequent occurrences in the pancreas.</div></div><div><h3>Case presentation</h3><div>A 30-year-old male with type 2 diabetes mellitus presented with elevated liver enzymes and serum CEA levels. A CT scan detected an 8.8 × 7.2 cm retroperitoneal mass with calcifications. Due to the tumor's involvement with critical structures, a Whipple procedure was performed. Post-surgery, the tumor was confirmed to be a mature cystic teratoma, and the patient experienced a smooth recovery.</div></div><div><h3>Discussion</h3><div>Pancreatic teratomas are rare, typically affecting younger patients and predominantly occurring in the body or head of the pancreas. These tumors, often categorized into mature and immature types. Diagnosis relies on imaging techniques such as ultrasound, CT, and MRI, which reveal key features like fat, calcifications, and fat-fluid levels. Differential diagnoses include various pancreatic cystic lesions. Surgical resection is the primary treatment, and this case highlights the diagnostic challenges and the critical role of imaging in guiding surgical decisions.</div></div><div><h3>Conclusion</h3><div>This report describes a rare case of a pancreatic mature cystic teratoma, one of only 52 documented cases. Despite the absence of significant symptoms, imaging revealed a large mass, and Whipple procedure was performed due to its complex relationship with vital structures. This case illustrates the diagnostic and therapeutic challenges associated with such rare tumors.</div></div>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142510540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Periductal stromal tumor of the breast; Can we expect the diagnosis? A case report and literature review 乳腺导管周围间质瘤；我们能期待确诊吗？病例报告和文献综述。

IF 0.6 Q4 SURGERY

International Journal of Surgery Case Reports

Pub Date : 2024-10-23 DOI: 10.1016/j.ijscr.2024.110505

Introduction and importance

Periductal stromal tumors are rare breast neoplasms characterized by a unique combination of epithelial and mesenchymal tissue. Due to their infrequent occurrence, these tumors are often misdiagnosed as other breast lesions.

Case presentation

A 47-year-old female presented with a right breast swelling. She has a sister treated for breast cancer. Imaging revealed a central lesion of mixed density measuring 38 × 20 mm. The provisional diagnosis was a hamartoma BIRADS 3. The patient underwent wide local excision. Microscopic examination demonstrated biphasic fibroepithelial proliferation. The nodules comprised breast ducts lined by both epithelial and myoepithelial layers; some ducts were patent, while others were compressed into a slit-like configuration. However, the specimen lacked the leaf-like architecture. Immunohistochemical analysis revealed CD34 positivity in stromal cells, while Ki67 was positive in approximately 5 % of cells. The tumor cells were negative for Pan-CK and S-100. These findings led to the diagnosis of a right breast periductal stromal tumor.

Clinical discussion

The clinical presentation of PDST is often misleading. According to the recent pathological classification system, periductal stromal tumors are similar to phyllodes tumors but lack characteristic leaf-like structures. Immunohistochemical studies play a role in supporting the diagnosis. Complete surgical excision of the mass with negative margins is the standard of care.

Conclusion

Periductal stromal tumor is a rare breast neoplasm with potentially benign behavior. Complete excision is the standard management approach, which not only reveals the final diagnosis but may also help reduce the rates of local recurrence and malignant transformation.

导言和重要性：导管周围间质瘤是一种罕见的乳腺肿瘤，其特点是上皮组织和间质组织的独特组合。由于这种肿瘤很少发生，因此常常被误诊为其他乳腺病变：一名 47 岁女性因右侧乳房肿胀就诊。她的姐姐曾接受过乳腺癌治疗。影像学检查发现中央有一个 38 × 20 毫米的混合密度病灶。患者接受了广泛的局部切除术。显微镜检查显示双相纤维上皮增生。结节由上皮层和肌上皮层衬里的乳腺导管组成；一些导管通畅，而另一些则被压成缝隙状。不过，标本缺乏叶状结构。免疫组化分析显示，基质细胞中 CD34 呈阳性，约 5% 的细胞 Ki67 呈阳性。肿瘤细胞的 Pan-CK 和 S-100 阴性。这些结果导致了右侧乳腺导管周围间质瘤的诊断：乳腺导管间质瘤的临床表现常常会引起误解。根据最新的病理分类系统，导管周围间质瘤与蝶形花瘤相似，但缺乏特征性的叶状结构。免疫组化研究在支持诊断方面发挥了作用。彻底手术切除肿块并保留阴性边缘是标准的治疗方法：导管周围间质瘤是一种罕见的乳腺肿瘤，可能是良性的。结论：乳腺导管周围间质瘤是一种罕见的乳腺肿瘤，具有潜在的良性行为，完全切除是标准的治疗方法，这不仅能揭示最终诊断，还有助于降低局部复发率和恶性转化率。

{"title":"Periductal stromal tumor of the breast; Can we expect the diagnosis? A case report and literature review","authors":"","doi":"10.1016/j.ijscr.2024.110505","DOIUrl":"10.1016/j.ijscr.2024.110505","url":null,"abstract":"<div><h3>Introduction and importance</h3><div>Periductal stromal tumors are rare breast neoplasms characterized by a unique combination of epithelial and mesenchymal tissue. Due to their infrequent occurrence, these tumors are often misdiagnosed as other breast lesions.</div></div><div><h3>Case presentation</h3><div>A 47-year-old female presented with a right breast swelling. She has a sister treated for breast cancer. Imaging revealed a central lesion of mixed density measuring 38 × 20 mm. The provisional diagnosis was a hamartoma BIRADS 3. The patient underwent wide local excision. Microscopic examination demonstrated biphasic fibroepithelial proliferation. The nodules comprised breast ducts lined by both epithelial and myoepithelial layers; some ducts were patent, while others were compressed into a slit-like configuration. However, the specimen lacked the leaf-like architecture. Immunohistochemical analysis revealed CD34 positivity in stromal cells, while Ki67 was positive in approximately 5 % of cells. The tumor cells were negative for Pan-CK and S-100. These findings led to the diagnosis of a right breast periductal stromal tumor.</div></div><div><h3>Clinical discussion</h3><div>The clinical presentation of PDST is often misleading. According to the recent pathological classification system, periductal stromal tumors are similar to phyllodes tumors but lack characteristic leaf-like structures. Immunohistochemical studies play a role in supporting the diagnosis. Complete surgical excision of the mass with negative margins is the standard of care.</div></div><div><h3>Conclusion</h3><div>Periductal stromal tumor is a rare breast neoplasm with potentially benign behavior. Complete excision is the standard management approach, which not only reveals the final diagnosis but may also help reduce the rates of local recurrence and malignant transformation.</div></div>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142510536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0