International Journal of Surgery Case Reports最新文献

Introduction: While acute and chronic subdural hematomas (SDH) are relatively common, co-occurrence is rare. Here, we report a case of unilateral simultaneous acute and chronic SDH.

Case presentation: A 74-year-old man with comorbid diabetes mellitus and hypertension presented with decreased consciousness (Glasgow Coma Scale (GCS) 4; E1M2V1) with stable hemodynamics. Isochoric pupils and right motoric lateralization were found upon neurological examination. CT scan of the brain without contrast showed acute and chronic SDH in the left frontotemporoparietal area with a midline shift 2 cm to the right. An evacuation craniectomy of the SDH was performed. Postoperative care included mechanical ventilation, monitoring, fluid balance maintenance, and medication. The patient showed improvement during follow-up and was weaned off mechanical ventilation on the 5th day after surgery.

Clinical discussion: SDH with a thickness of 10 mm or more and mass effect requires surgical management. Various techniques can be used for surgical evacuation. The prognosis of chronic SDH patients depends on their clinical condition when admitted, with early diagnosis and intervention resulting in improved prognosis.

Conclusion: This rare case highlights the significance of promptly recognizing and addressing symptoms such as headache and decreased consciousness, especially in older patients with underlying health conditions. Good prognosis is dependent on prompt evaluation, including a head CT scan for recurrent headaches, and immediate treatment when necessary.

Introduction and significance: Peripheral giant cell granuloma (PGCG) is a benign reactive lesion commonly found in the mandible but rarely in the maxillary sinus and extending to the infratemporal fossa, which poses a major challenge in excision in this case. It can occasionally lead to bone erosion. Complete surgical excision is the primary treatment.

Case presentation: We present a rare case of PGCG in the maxillary sinus of a male patient following the extraction of the maxillary second molar, resulting in destruction of the bony margins. The patient underwent complete endoscopic resection with a flap to repair the bone loss in the maxilla.

Clinical discussion: Clinicians should be aware of this uncommon location of PGCG to ensure accurate diagnosis and appropriate treatment with minimal patient trauma and excellent outcomes.

Conclusion: Endoscopy is a highly effective method for removing PGCG located in the maxillary sinus and extending to the infratemporal fossa, even in cases of large size. It offers excellent results and provides good visualization of the maxillary sinus.

Introduction and importance: Partial anomalous pulmonary venous connection (PAPVC) is a relatively rare congenital vascular anomaly that complicates the surgical management of lung cancer and other lung lesions.

Case presentation: A 74-year-old woman underwent computed tomography (CT) during an episode of chest trauma. Chest CT showed a 24-mm ground glass opacity in the right lower lobe and a PAPVC in the right upper lobe. She was diagnosed with suspected stage IA1 lung cancer with clinical T1miN0M0 and was scheduled for surgery. Preoperative catheterization revealed a pulmonary to systemic flow ratio (Qp/Qs) of 0.98. Surgical repair of PAPVC is indicated when the patient is symptomatic and has a Qp/Qs of 1.5 to 2.0 or more. The patient was scheduled for right lower lobectomy. Although worsening of postoperative right heart strain was considered, the Qp/Qs results indicated that surgical repair of the PAPVC was unnecessary. The intraoperative circulatory dynamics remained stable, and a right lower lobectomy was performed. Her postoperative course was uneventful. There was no evidence of right heart failure or recurrence of lung cancer at the last follow-up examination 6 and 12 months after surgery.

Clinical discussion: If the PAPVC is in the non-resected lobe, preoperative assessment is really important, as major lung resection can increase shunt flow and cause right heart failure.

Conclusion: We believe that careful interpretation of CT images of all pulmonary veins before major lung resection while considering PAPVC is important for safe perioperative management and adequate evaluation of cardiac dynamics when PAPVC is present.

Introduction and importance: Inflammatory myofibroblastic tumor IMT¹ is a rare neoplasm with diverse clinical presentations, needing histological confirmation for diagnosis. The tumor often mimics malignant conditions, making accurate diagnosis challenging.

Case presentation: We report a case of a 29-year-old male presenting with long standing recurrent abdominal pain, with more recent increasing frequency and associated weight loss. Imaging revealed a heterogenous soft tissue lesions causing mechanical small bowel obstruction, prompting surgical intervention. Histology analysis confirmed the diagnosis of IMT.

Clinical discussion: This case highlights the importance of considering IMT in the differential diagnosis of neoplastic mechanical small bowel obstruction, particularly in patients presenting with atypical symptoms and image findings. Despite its rarity, IMT should be considered, as it can present similarly to more common malignancies. Further research is warranted to unravel the pathogenesis and refine management strategies for this intriguing neoplasm.

Conclusion: IMT is a rare and intriguing neoplasm that presents significant diagnostic challenge. This case emphasize the need for thorough histological evaluation to confirm rhe diagnosis and guide appropriate management strategies.

Introduction and importance: Endometrial polyps are rare sites of metastatic breast carcinoma. Such cases have mainly been reported in tamoxifen-related polyps.

Case presentation: We describe the case of a 56-year-old woman with invasive lobular carcinoma who was experiencing vaginal bleeding. She underwent hysteroscopy with biopsy. Microscopic examination revealed an endometrial polyp with foci of adenocarcinoma. The morphological features of the tumor matched those of the original breast carcinoma.

Clinical discussion: Neoplasms originating from extra-genital sites frequently spread to the female genital organs. However, these metastases are mainly concentrated in the ovaries and vagina, while those affecting the uterus are rare. Among non-genital malignant tumors, mammary carcinoma - particularly the lobular type - is the most common to affect the uterus, followed by digestive and pulmonary tumors. Metastases within an endometrial polyp are particularly unusual.

Conclusions: It is crucial to consider metastatic tumors when assessing vaginal bleeding in patients with breast carcinoma. Because of the possibility of endometrial polyps being affected by metastasis, pathologists must examine them rigorously and thoroughly.

Introduction and importance: Mucinous tubular and spindle cell carcinoma (MTSCC) is a rare and usually slow-growing subtype of renal cell carcinoma (RCC), with low malignant potential. There is scant knowledge in the literature of this rare subtype of renal cell carcinoma.

Case presentation: We present the case of a 56 year old with an aggressive recurrent metastatic MTSCC para-aortic lymph node treated with surgical excision.

Clinical discussion: This case is unusual due to its recurrent and aggressive metastatic nature and not typical for this rare subtype of renal cell carcinoma.

Conclusion: Metastatic and recurrent renal mucinous tubular and spindle cell carcinoma is a very rare entity. Our case report aims to add to the limited knowledge in the literature on this rare malignancy.

Introduction: Tall cell carcinoma of the breast with reverse polarity (TCCRP) is a recently described rare entity with low potential for malignancy which exhibits morphological features with tall cell variant of papillary thyroid carcinoma. Immunohistochemical and molecular studies help establish the diagnosis.

Case report: We report the case of a 45-year-old woman with no significant medical or surgical history who presented with mastodynia. Physical examination was negative. Screening by bilateral mammography revealed a mass of the right breast which was classified as 4B. The mass was surgically excised. The pathological report concluded to a TCCRP of the breast with free margins. The tumor cells were negative for hormone receptors as well as for the Human Epidermal Growth Factor Receptor-2 (HER2neu). The patient underwent a sentinel lymph node dissection that was negative followed by loco-regional radiotherapy. Chemotherapy and endocrine therapy were not indicated for the patient. After 24 months of follow-up, no signs of loco-regional or distant recurrences have been identified.

Clinical discussion: TCCRP is a rare entity that has been recently introduced in the WHO classification of breast cancer. It is usually a triple negative tumor, negative to TTF1 and thyroglobulin with low proliferation index, and a low potential for malignancy. Wide excision is the keystone of the treatment; however, chemotherapy and radiotherapy are still controversial due to lack of evidence.

Conclusion: TCCRP is a rare entity, which carries an excellent prognosis. A proper diagnosis is essential to conduct the best treatment next to a careful follow-up due to the ambiguous natural history of this rare entity.

Papers that have been previously published as meeting abstracts: None.

Introduction: Colpocephaly, a midline anomaly, may be associated with agenesis of the corpus callosum. While prenatal diagnosis is possible, this malformation is rarely detected in adults and may be asymptomatic.

Case presentation: We present a case of a 54-year-old male with Colpocephaly and dysgenesis of the corpus callosum, incidentally diagnosed during an emergency department visit. Computed tomography imaging revealed bilateral dilation of the posterior horns of the lateral ventricles and the absence of the corpus callosum.

Clinical discussion: Although some adults with Colpocephaly may show clinical symptoms, this anomaly can often be an incidental finding in asymptomatic individuals. Medical imaging plays a crucial role in the early diagnosis of this anomaly. Prenatal ultrasound can also detect midline anomalies, including Colpocephaly.

Conclusion: Awareness of this anomaly can prevent unnecessary diagnostic and therapeutic interventions.

Introduction: Teratomas are neoplasms originating from embryonic tissues, characterized by a diverse composition of cells from all three germ layers in varying ratios. Rarely reported in the heart, we present here a rare case of a teratoma in the right atrium of a newborn.

Case presentation: A 20-h-old newborn was referred for a mild heart murmur. An echocardiogram revealed a 6 × 9 mm mass in the right atrium, attached to the interatrial septum. The mass caused mild tricuspid regurgitation without any significant pressure gradient. Surgery to remove the mass was successful. Pathological examination confirmed the mass as a teratoma. The child was discharged in excellent health and has had normal follow-up exams.

Discussion: Mature teratomas, a common type of germ cell tumor, are rare in the mediastinum, accounting for 10-15 % of mediastinal masses. These tumors arise from displaced primordial germ cells, which may become malignant. They can metastasize to the heart via various routes, causing symptoms like cough, dyspnea, and chest pain due to compression of mediastinal structures. Severe cases may lead to superior vena cava syndrome or hemoptysis. Tumor location influences clinical presentation, with some posing life-threatening risks.

Conclusion: Early diagnosis and intervention were crucial in preventing severe complications. This case emphasizes the importance of vigilant clinical evaluation and timely surgical management for infants presenting with cardiac symptoms.

Introduction and importance: Bladder exstrophy (BE) is a rare congenital anomaly in which the anterior wall of the bladder is absent. In females, sexuality and fertility may be negatively affected with the association with pubic diastasis, dysplasia of the pelvic floor muscles, clitoris bifurcated, short vagina or narrow introitus.

Presentation of case: We present a case of 26-year-old woman with treated BE, vaginoplasty, and bicornuate uterus that came at week 36 of gestation. An elective cesarean section was made by paramedian section. Five years later, she came back with placental abruption at week 30 of gestation, and a successful vaginal delivery was made.

Discussion: Bladder exstrophy is a challenging disease that is accompanied with other morbidities. Impaired fertility is common due to previous surgeries and concomitant diseases, and pregnancy is high risk for both mother and baby. Delivery should be at a tertiary referral obstetric hospital.

Conclusion: Balancing the pros and cones of medical decision in order to achieve the best outcomes for both the mother and child is crucial, as choosing the right decision depends on the presentation and past history of the patient not only the existence of the bladder exstrophy.