scholarly journals Primary Appendiceal Adenocarcinoma Presenting with Hematochezia due to the Invading Tumor in the Sigmoid Colon

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Tatsuya Suzuki ◽  
Yasuhiro Yamamoto ◽  
Toshihiko Torigoe ◽  
Shoichiro Mizukami ◽  
Kengo Shigehara
Keyword(s):  
Sigmoid Colon ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Pathological Examination ◽  
Ileocecal Resection ◽  
Tubular Adenocarcinoma ◽  
En Bloc ◽  
Appendiceal Tumor ◽  
Appendiceal Adenocarcinoma ◽  
Well Differentiated

Primary appendiceal tumors are rare malignancies; some cases have been described to invade other organs, and this represents a very rare clinical condition. We report a case of appendiceal adenocarcinoma invading the sigmoid colon and a review of similar cases. A 69-year-old woman with complaints of hematochezia was admitted to the hospital. Colonoscopy revealed a tumor in the sigmoid colon, which was a well-differentiated tubular adenocarcinoma. A computed tomography scan showed an appendiceal mass that involved the sigmoid colon, suggesting an appendiceal cancer invading the sigmoid colon. Ileocecal resection with extended lymphadenectomy and en bloc resection of the sigmoid colon was performed. The appendiceal tumor involved the sigmoid colon and the terminal ileum. The ileocecal part which included the tumor and the involved sigmoid colon was resected in total. Macroscopic findings showed that the appendiceal tumor made a fistula with the sigmoid colon. Pathological examination revealed that the tumor was a well-differentiated tubular adenocarcinoma that invaded the sigmoid colon. The final pathological stage was T4bN0M0, stage IIC. The patient was discharged from the hospital uneventfully. She was alive without relapse after a 20-month follow-up. Although an appendiceal tumor invading the rectosigmoid region is rare, a preoperative diagnosis can be obtained that facilitates the planning of a suitable surgical procedure: en bloc resection of the ileocecal part and the rectosigmoid part.

scholarly journals Mandibular periosteal (juxtacortical) chondrosarcoma

2009 ◽  
Vol 20 (5) ◽  
pp. 428-433 ◽  
Author(s):  
Elisângela Maria Cunha Costa ◽  
Bárbara Lima Lucas ◽  
Mariana Reis Silva ◽  
Renata Hinhug Vilarinho ◽  
Paulo Rogério de Faria ◽  
...  
Keyword(s):  
Final Diagnosis ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Bone Surface ◽  
En Bloc ◽  
Grade Ii ◽  
Well Differentiated ◽  
Slow Growing ◽  
Tomography Scan

Periosteal (juxtacortical) chondrosarcoma (PC) is a well-differentiated malignant cartilage-forming tumor arising from the external bone surface, especially in long bones. The therapy of choice is en-bloc resection and, in general, its prognosis is good. This paper reports a rare case of PC affecting the mandible of a 41-year-old man. The lesion presented as a slow-growing-painless swelling that lasted 2 months. Computed tomography scan showed a tumoral mass arising from the external bone surface, extending into the adjacent soft tissue presenting patchy regions of popcorn-like calcifications. A final diagnosis of PC (grade II) was rendered after biopsy. Hemimandibulectomy was undertaken followed by complementary radiotherapy with 70 Gy. Although no episodes of recurrence or metastasis had been noticed after 18 months of follow-up, the patient died and causa mortis could not be established.

scholarly journals Appendiceal Adenocarcinoma Presenting as a Rectal Polyp

2016 ◽  
Vol 10 (1) ◽  
pp. 24-29 ◽  
Author(s):  
Erin Fitzgerald ◽  
Lilian Chen ◽  
Moises Guelrud ◽  
Harmony Allison ◽  
Tao Zuo ◽  
...  
Keyword(s):  
Rectal Wall ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Rectal Polyp ◽  
Preoperative Imaging ◽  
En Bloc ◽  
Lower Quadrant ◽  
Operative Strategy ◽  
Radiographic Findings ◽  
Appendiceal Adenocarcinoma

Appendiceal adenocarcinoma typically presents as an incidentally noted appendiceal mass, or with symptoms of right lower quadrant pain that can mimic appendicitis, but local involvement of adjacent organs is uncommon, particularly as the presenting sign. We report on a case of a primary appendiceal cancer initially diagnosed as a rectal polyp based on its appearance in the rectal lumen. The management of the patient was in keeping with standard practice for a rectal polyp, and the diagnosis of appendiceal adenocarcinoma was made intraoperatively. The operative strategy had to be adjusted due to this unexpected finding. Although there are published cases of appendiceal adenocarcinoma inducing intussusception and thus mimicking a cecal polyp, there are no reports in the literature describing invasion of the appendix through the rectal wall and thus mimicking a rectal polyp. The patient is a 75-year-old female who presented with spontaneous hematochezia and, on colonoscopy, was noted to have a rectal polyp that appeared to be located within a diverticulum. When endoscopic mucosal resection was not successful, she was referred to colorectal surgery for a low anterior resection. Preoperative imaging was notable for an enlarged appendix adjacent to the rectum. Intraoperatively, the appendix was found to be densely adherent to the right lateral rectal wall. An en bloc resection of the distal sigmoid colon, proximal rectum and appendix was performed, with pathology demonstrating appendiceal adenocarcinoma that invaded through the rectal wall. The prognosis in this type of malignancy weighs heavily on whether or not perforation and spread throughout the peritoneal cavity have occurred. In this unusual presentation, an en bloc resection is required for a complete resection and to minimize the risk of peritoneal spread. Unusual appearing polyps do not always originate from the bowel wall. Abnormal radiographic findings adjacent to an area of gastrointestinal pathology may signify locally advanced disease from a surrounding organ that secondarily involves the gastrointestinal tract. These findings warrant further investigation prior to any intervention to ensure appropriate treatment.

Upper facet joint en bloc resection for the treatment of thoracic myelopathy caused by ossification of the ligamentum flavum

2013 ◽  
Vol 19 (1) ◽  
pp. 81-89 ◽  
Author(s):  
Zhong Yang ◽  
Yuan Xue ◽  
Qin Dai ◽  
Chao Zhang ◽  
H. Fang Zhou ◽  
...  
Keyword(s):  
Thoracic Spine ◽  
Ligamentum Flavum ◽  
Facet Joint ◽  
Neurological Status ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Pathological Examination ◽  
Thoracic Myelopathy ◽  
En Bloc ◽  
The Mean

Object The authors introduce a novel technique to treat thoracic myelopathy caused by ossification of the ligamentum flavum (OLF): upper facet joint en bloc resection. This surgical procedure avoids surgery to the most heavily compressed cord surface, contact with the cord, and cord injury. The epidural venous plexus bleeding point can be directly seen and easily controlled during the decompression. Methods Between January 2007 and January 2009, thoracic myelopathy caused by OLF was diagnosed in 38 patients using plain radiography, CT, and MRI, and diagnoses were confirmed by postoperative pathological examination. All upper facet joint en bloc resection procedures were performed in 2 steps. First, the bony structures above the upper facet joint surfaces were resected and the upper facet joints were isolated. Second, en bloc resection of the upper facet joint was performed by dissection of the junction between the pedicle and upper facet joint. Intraoperative neurological monitoring was performed in all cases. The modified Japanese Orthopaedic Association (mJOA) scoring system was used to assess neurological status. The degree of postoperative expansion of the spinal cord was calculated on axial MR images. The pre- and postdecompression Cobb angle was applied to assess the magnitude of local kyphosis. Results Of the 38 cases of OLF, 6 were single level, 12 were double level, and 20 were multilevel. Of the 92 ossified segments in this study, 23 (25.0%) were located in the upper thoracic spine (T1–4), 13 (14.1%) were located in the midthoracic spine (T5–8), and 56 (60.9%) were located in the lower thoracic spine (T9–L1). The mean intraoperative blood loss was 340 ± 54 ml. The neurological status improved during follow-up (mean 46.1 months) from a preoperative mean mJOA score of 5.39 ± 1.52 to 8.97 ± 1.22 points (t = 18.39, p < 0.05). The neurological function recovery rate ranged from 28.6% to 100%. The mean increase in pre- and postoperative kyphosis of the involved vertebrae was only 1.3° ± 1.6°. The increase in the cross-sectional area of the dural sac at the level of maximum compression suggested that decompression was complete. Conclusions Upper facet joint en bloc resection is effective and may be a reasonable alternative treatment choice for thoracic myelopathy caused by OLF.

scholarly journals Clinicopathological examination of ESD as salvage therapy for esophageal cancer after definitive chemo-radiation therapy

2018 ◽  
Vol 06 (04) ◽  
pp. E450-E461 ◽  
Author(s):  
Tomo Kagawa ◽  
Shigenao Ishikawa ◽  
Tomoki Inaba ◽  
Mariko Colvin ◽  
Junki Toyosawa ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Radiation Therapy ◽  
Salvage Therapy ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Maximum Diameter ◽  
Pathological Examination ◽  
Muscularis Mucosa ◽  
Resection Rate ◽  
En Bloc

Abstract Background and study aims Salvage therapy for esophageal cancer following chemo-radiation therapy (CRT) has not been established. We aimed to evaluate endoscopic submucosal dissection (ESD) as a salvage therapy based on histopathological features of lesions. Patients and methods We compared 10 lesions in eight patients with local residual, recurrent, or metachronous esophageal squamous cell carcinoma treated by ESD after CRT (CRT group) and 59 lesions treated by ESD without CRT (non-CRT group) during the same period. Results The en bloc resection rate was 100 % while the complete resection rate was 80.0 % in the lesions after CRT, indicating no difference between the CRT and non-CRT groups. Pathological examination showed that fibrosis was more intense in the lamina propria mucosa, muscularis mucosa, and submucosa. The muscularis mucosa was thicker in both non-tumor and tumor sites in the CRT group compared to the non-CRT group. However, severe submucosal fibrosis was observed only in one lesion in the CRT group. The maximum diameter of the submucosal artery was significantly larger in the CRT group (P < 0.001). Conclusions Compared to the non-CRT group, the lesions in the CRT group were accompanied by fibrosis while the muscularis mucosa were thicker; however, severe fibrosis of the submucosa was rare. It is important to dissect the muscularis mucosa appropriately during ESD, which makes successful dissection of the submucosa possible. Attention should be paid to bleeding from large arteries.

scholarly journals Pancreatic malignancy in the backdrop of chronic pancreatitis: How much to push the boundaries to achieve R0 resection

2021 ◽  
Vol 12 (1) ◽  
pp. 47-51
Author(s):  
Kunal Sadanand Joshi ◽  
Sisir Bodepudi ◽  
Santhosh Kumar Ganapathi ◽  
Chandrasekar Murugesan ◽  
Jagan Balu ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
Distal Pancreatectomy ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
The Body ◽  
Metastatic Spread ◽  
Pathological Examination ◽  
Jejunal Loop ◽  
En Bloc ◽  
Lateral Pancreaticojejunostomy

Abstract Tumors of the body and tail of the pancreas are often more aggressive than tumors of the head and would have often undergone metastatic spread to other organs at the time of diagnosis. Most patients with carcinoma of the body and tail of the pancreas present at a late stage. Surgery is only indicated in those patients in whom there is no evidence of metastatic spread. Surgery is often not possible in cancers of the body and tail of the pancreas if the tumor invades celiac artery. Controversy exists regarding the margin status impact of microscopic resection margin involvement (R1) after pancreaticoduodenectomy (PD) for PDAC. There are reports indicating the rate of R1 resections increases significantly after PD if pathological examination is standardized. In this report, we present the case of a 56-year-old female who had undergone lateral pancreaticojejunostomy for chronic pancreatitis 8 years ago, but has now developed malignancy of the body and tail of the pancreas involving multiple organs. This patient underwent en bloc resection involving: 1. distal pancreatectomy with jejunal loop (lateral pancreaticojejunostomy) resection; 2. splenectomy; 3. left nephrectomy; 4. total gastrectomy; and 5. segmental colectomy with reconstruction by esophagojejunostomy, jejunojejunostomy, and colocolic anastomosis. The infrequent occurrence of tumor in the distal gland and advanced tumor stage at the time of diagnosis have both combined to produce therapeutic nihilism/dilemma in the minds of many surgeons. This report highlights the decision on how much to the push limits for multi-organ resection (en bloc resection with distal pancreatectomy, gastrectomy, splenectomy, colectomy, nephrectomy) with the intent of achieving R0 status in spite of the complexity of surgery in selected patients.

scholarly journals Parathyromatosis: a very rare cause of recurrent primary hyperparathyroidism – case report and review of the literature

2019 ◽  
Vol 101 (8) ◽  
pp. e178-e183 ◽  
Author(s):  
M Haciyanli ◽  
S Karaisli ◽  
S Gucek Haciyanli ◽  
A Atasever ◽  
D Arikan Etit ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Subcutaneous Tissue ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Pathological Examination ◽  
Rare Entity ◽  
Review Of The Literature ◽  
En Bloc ◽  
First Case ◽  
History Of

Parathyromatosis is a rare entity and usually appears as a consequence of the seeding on previous parathyroid surgery which was applied for the secondary hyperparathyroidism. A 63-year-old woman presented with a history of subtotal thyroidectomy 20 years ago and parathyroidectomy due to primary hyperparathyroidism (PHPT) four years ago. Imaging methods revealed multiple parathyromatosis foci on subcutaneous tissue of the neck. En-bloc resection was performed and pathological examination confirmed the diagnosis of parathyromatosis. After an uneventful 10 months, biochemical and radiological tests revealed recurrence on bilateral thyroid lodges. En-bloc resection was performed. The patient has remained well for 24 months after the second operation and has been followed-up with normal parathormone and serum calcium values. To the best of our knowledge, this report describes the twenty-first case of parathyromatosis in PHPT setting in the literature. It should be kept in mind that parathyromatosis may recur at different sites in the neck even in patients with PHPT.

scholarly journals Solitary fibrous tumour of the sigmoid colon mesentery

2019 ◽  
Vol 12 (5) ◽  
pp. e228774
Author(s):  
Gabriel Mekel ◽  
Eli Balshan ◽  
Frank Traupman
Keyword(s):  
Sigmoid Colon ◽  
Surgical Excision ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Solitary Fibrous Tumour ◽  
The Body ◽  
En Bloc ◽  
Solitary Fibrous Tumours ◽  
Rare Tumours ◽  
Benign Nature

Solitary fibrous tumours (SFTs) are rare tumours arising from mesenchymal tissues. Despite of their more frequent occurrence in the pleura, SFT can present anywhere in the body. Only a few cases have been described arising from the mesentery. Most tumours have a benign nature; however, up to 20% of them can spread, most commonly to liver, lung and bone. Surgical excision including all surrounding tissues remains the treatment of choice; however, there is no consensus regarding the need for adjuvant therapies. We present a 79-year-old man with abdominal pain who was found to have a SFT in the mesentery of the sigmoid colon, treated with en bloc resection. A multidisciplinary team including surgeons, medical and radiation oncologists is recommended in the care of these patients.

En Bloc Total Sacrectomy Performed in a Single Stage through a Posterior Approach

2008 ◽  
Vol 63 (suppl_1) ◽  
pp. ONS115-ONS120 ◽  
Author(s):  
Gregory S. McLoughlin ◽  
Daniel M. Sciubba ◽  
Ian Suk ◽  
Timothy Witham ◽  
Ali Bydon ◽  
...  
Keyword(s):  
Posterior Approach ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Bladder Function ◽  
Pathological Examination ◽  
Vascular Control ◽  
En Bloc ◽  
Internal Iliac ◽  
Total Sacrectomy ◽  
Gradual Distraction

Abstract Objective: Total sacrectomies are performed for extensive en bloctumor resections. Exposure traditionally combines a posterior approach with a laparotomy to facilitate vascular control. We present a case of a total en bloc sacrectomy performed entirely through the posterior approach, thereby avoiding the need for a laparotomy. Clinical Presentation: A 57-year-old man presented with sacral pain and loss of bowel and bladder function. A large sacral mass was identified and submitted to biopsy. Results were consistent with an osteoblastoma, although osteosarcoma could not be excluded on pathological examination. The patient was taken to the operating room for a total sacrectomy and en bloc resection of the mass. Technique: Lateral iliac osteotomies were performed, followed by an L5–S1 discectomy and resection of the annulus, thus mobilizing the sacrum. Gradual distraction of the interspace coupled with upward traction of the sacrum provided an anterior exposure through which the internal iliac vessels were controlled, dissected, and divided. A combined transperineal approach completed the posterior dissection and the tumor was delivered en bloc. Lumbopelvic reconstruction was performed simultaneously. Conclusion: With the use of interspace distraction and sacral elevation to facilitate vascular control, a total sacrectomy was performed without the need for the anterior exposure of a laparotomy.

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