Granulomatous mastitis − treatment options and our experience

2021 ◽  
Vol 100 (4) ◽  
Keyword(s):  
Recurrence Rate ◽  
Surgical Approach ◽  
Case Reports ◽  
Treatment Options ◽  
Breast Conservation ◽  
Fistula Formation ◽  
High Recurrence Rate ◽  
Granulomatous Mastitis ◽  
Oral Steroids ◽  
Irregular Mass

Granulomatous mastitis (GM) is a rare benign inflammatory disease of the breast, first described by Kessler and Wolloch in 1972. Clinically, it can present as unilateral, sometimes painful, increasing breast resistance, or as a hard, irregular mass. Sonography is the most useful diagnostic method for GM evaluation. The only method for definitive diagnosis is the use of biopsy. In histological findings, GM is characterized by non-caseifying granulomas, often associated with microabscess and fistula formation. There is considerable heterogeneity in treatment options; this may explain the high recurrence rate which is close to 50%. Such a high recurrence rate is alarming and proves that current treatments are suboptimal. Two treatment options are discussed worldwide: conservative strategies involving drug therapy with corticosteroids versus a surgical approach involving partial or total mastectomy. All conservative treatment options are associated with a high risk of recurrence, and most patients require surgery in the end. Thorough excision of inflammatory tissue is crucial for successful treatment while negative surgical margins are associated with a low recurrence rate. The surgical approach to GM requires sufficient radicality and presumes knowledge in the field of reconstructive breast surgery, similarly to oncosurgical breast conservation operations. However, alternatives to GM treatment with oral steroids may be acceptable for patients concerned about surgery. This article presents six case reports of patients treated at our department.

scholarly journals Decompression: a first-intention treatment for “large” non-syndromic odontogenic keratocysts

2021 ◽  
Vol 27 (2) ◽  
pp. 29
Author(s):  
Marjorie Muret ◽  
Eve Malthiéry ◽  
Théo Casenave ◽  
Valérie Costes-Martineau ◽  
Jacques-Henri Torres
Keyword(s):  
Recurrence Rate ◽  
Dentigerous Cyst ◽  
Treatment Options ◽  
Inferior Alveolar Nerve ◽  
Final Diagnosis ◽  
High Recurrence Rate ◽  
Odontogenic Cysts ◽  
Complete Regression ◽  
Odontogenic Keratocysts ◽  
Long Term Follow Up

Though odontogenic keratocysts (OKCs) are benign lesions, they have a high recurrence rate. Because of their aggressive behavior, they have been classified as tumors by the WHO until 2017. Main differential diagnoses are amelobastoma and dentigerous cyst. Anatomopathological examination can reach a final diagnosis. Several treatments have been proposed: curettage, resection, enucleation (alone or together with peripheral ostectomy) and decompression. Decompression aims to decrease the volume of the lesion of “large” OKCs, in order to prevent surgery-related fractures and to preserve the surrounding important anatomical structures such as the inferior alveolar nerve. It could lead to a complete regression. If not, secondary enucleation can be performed in better conditions: a reduced volume to remove, a thicker epithelium to detach, a lower risk to damage neighboring anatomic structures and a lower recurrence rate. Long-term follow-up however remains necessary. Nowadays, minimally invasive surgery prevails. And since OKC was returned into the odontogenic cysts group in the WHO classification, decompression should be considered as the first intention treatment. The purpose of this paper is to provide an update about OKC features and biological mechanisms, to review the different treatment options and to provide a step-by-step protocol for decompression.

scholarly journals Complete Surgical Excision with Keeping Drain Tube in Situ for 2 to 3 Weeks in the Treatment of Cystic Hygroma: A study of 5 years

2016 ◽  
Vol 10 (1) ◽  
pp. 26-28 ◽  
Author(s):  
Swapan Kumar Paul ◽  
Suprotim Howlader ◽  
Diponker Kumar Saha ◽  
Abdur Rahed Khan
Keyword(s):  
Recurrence Rate ◽  
Surgical Resection ◽  
Treatment Options ◽  
Surgical Excision ◽  
Cystic Hygroma ◽  
The Body ◽  
High Recurrence Rate ◽  
Drain Tube ◽  
Complete Surgical Excision

Lymphangiomas are benign hamartomatous lymphatic tumours characterized by multiple communicating lymphatic channels and cystic spaces. Cystic lyphangiomas may be seen anywhere in the body but are common in neck, axilla, mediastinum and groin. Treatment options are surgical resection, radiation, sclerotherapy etc but have got high recurrence rate and complications. In the present study we hypothesized that complete surgical resection along with keeping a drain for 2-3 wks, may reduce recurrence rate. This prospective study was performed from July 2008 to June 2013. Total 21 children treated during this period by the technique of complete surgical excision with keeping drain tube in situ for 2 to 3 weeks. Ultrasound performed in all patients, CT scan and Duplex study performed in some patients, histopathology done in all patients. Patients with intra-abdominal lymphangioma not included in this study. Twenty one patients were operated during the study period and average duration of keeping drain tube was 18.57 days. Among the 21 cases 2 (9.52%) patients developed mild infection, 1 (4.76%) patient developed infection with pus formation and 1 (4.76%) patient developed recurrence. Our success in the treatment warrants further verification of potential benefits of keeping drain tube in situ for 2-3 weeks after surgical excision of lymphangiomas.Faridpur Med. Coll. J. Jan 2015;10(1): 26-28

scholarly journals A clinicopathological study and management of odontogenic keratocyst

2019 ◽  
Vol 9 (1) ◽  
pp. 8-15
Author(s):  
Mohammad Asifur Rahman ◽  
Tarin Rahman ◽  
Ismat Ara Haider
Keyword(s):  
Conservative Treatment ◽  
Recurrence Rate ◽  
Surgical Resection ◽  
Treatment Options ◽  
Anatomical Structure ◽  
Odontogenic Keratocyst ◽  
High Recurrence Rate ◽  
Odontogenic Cysts ◽  
Odontogenic Keratocysts ◽  
Surgical Methods

Odontogenic Keratocyst is an aggressive odontogenic cyst with a high recurrence rate. After radicular and follicular cysts, odontogenic keratocysts are the third most common cyst of the jaws and approximately 12-14% of all odontogenic cysts. It has been retermed to Keratocystic odontogenic tumour (KCOT) as it better reflects its neoplastic nature but recently it has been re classified and retermed into the cystic category. Various surgical methods have been proposed but comparatively, conservative treatment options such as Dredging methods might be the treatment of choice due to preservation of anatomical structure. Objective: The aim of this study was to analyse the clinical, radiological and histopathological characteristics of Odontogenic Keratocyst and provide a proper management system affected by this type of lesions. Materials and methods: The prospective study was performed in Dhaka Dental College and Hospital from a period of January 2014 to January 2018. A total number of 75 patients were selected for this study based on clinical, radiological and histopathological confirmation of odontogenic keratocysts. The treatment options were enucleation, enucleation with curettage, enucleation with peripheral ostectomy, Dredging method and surgical resection. After treatment patients were followed up 1months, 3 months and 6 months in every year at least for 5 years. Results: Among 75 patient of odontogenic keratocyst; the mean age was 27.69±13.35 and age range was 11 to 66 years. Male were 53(71%) and 22 (29%) were female patients. 53 (70.67%) cases were found in the mandible, 15(20%) cases in the maxilla and in 7(9.33%) cases were involved in both maxilla and mandible; mandibular posterior region was the most specific region involved 37(69.81%).The most common clinical features revealed pain and swelling. Radiologically, 70.66% unilocular, 96% well defined and 94.66% radiolucent area were prominent. Bone expansion 37.38%, root resorption 30.00% and 36% were associated with an impacted tooth. Regarding treatment options enucleation with curatage 12%, enucleation, curettage & peripheral ostectomy 29.33%, Dredging 52% and surgical resection 6.6% was done. Recurrence occurred in 18 patients with recurrence rate of 24%. Conclusion: Odontogenic keratocyst is an aggressive cyst, male predominant, posterior mandible is the commonest site and well defined unilocular radiolucency are commonest radiological feature. Radical treatment options such as resection reduced the recurrences of the tumour but higher morbidity and jaw deformity. Comparatively, conservative treatment options such as Dredging methods might be the treatment of choice due to preservation of anatomical structure. A long term follow up is paramount importance for the research and understanding the clinical pattern, behavior, treatment and recurrence of the lesion. Update Dent. Coll. j: 2019; 9 (1): 8-15

Intraoperative, postoperative and long-term oncosurgical safety of therapeutic mammaplasty

2013 ◽  
Vol 154 (33) ◽  
pp. 1291-1296 ◽  
Author(s):  
László Romics Jr. ◽  
Sophie Barrett ◽  
Sheila Stallard ◽  
Eva Weiler-Mithoff
Keyword(s):  
Recurrence Rate ◽  
Tumour Size ◽  
Breast Conservation ◽  
Malignant Lesion ◽  
Surgical Techniques ◽  
Incomplete Resection ◽  
Immediate Reconstruction ◽  
Oncological Safety

Introduction: (Pre)malignant lesion in the breast requiring mastectomy conventionally may be treated with breast conservation by using oncoplastic breast surgical techniques, which is called therapeutic mammaplasty. However, no reliable data has been published so far as regards the oncological safety of this method. Aim: The aim of the authors was to analyse the oncological safety of therapeutic mammaplasty in a series of patients. Method: 99 patients were treated with therapeutic mammaplasty and data were collected in a breast surgical database prospectively. Results were analysed with respect to intraoperative, postoperative and long-term oncological safety. Results: Incomplete resection rate was 14.1%, which correlated with tumour size (p = 0.023), and multifocality (p = 0.012). Time between surgery (therapeutic mammaplasty) and chemotherapy was similar to time between conventional breast surgeries (wide excision, mastectomy, mastectomy with immediate reconstruction) and chemotherapy (mean 29–31 days; p<0.05). Overall recurrence rate was 6.1%, locoregional recurrence rate was 2% during 27 month (1–88) mean follow-up. Conclusions: Since literature data are based on relatively short follow-up and low patient number, it is highly important that all data on therapeutic mammaplasty is collected in a prospectively maintained breast surgical database in order to determine true recurrence after long-follow-up. Orv. Hetil., 2013, 154, 1291–1296.

Modern molecular and biological aspects of endometriosis-associated infertility

GYNECOLOGY ◽  
2019 ◽  
Vol 21 (5) ◽  
pp. 12-15
Author(s):  
Anastasiia S Safronova ◽  
Mikhail Yu Vysokikh ◽  
Vladimir D Chuprynin ◽  
Natalia A Buralkina
Keyword(s):  
Signaling Pathways ◽  
Recurrence Rate ◽  
High Recurrence Rate ◽  
Modern Drug ◽  
Surgical Methods ◽  
Prevention And Treatment ◽  
Biological Aspects ◽  
Methods Of Treatment ◽  
New Strategies

There is currently no consensus on the etiopathogenetic nature of endometriosis. The causes of aggressive, progressive, infiltrative growth of endometrioid tissue also remain unclear. An important problem remains the high recurrence rate of endometriosis, despite the availability of modern drug and surgical methods of treatment. The study of the central signaling pathways and the search for new key molecules is of paramount importance for a better understanding of the pathogenesis of the disease, and is also an important step in the development of new strategies for the diagnosis, prevention and treatment of endometriosis.

scholarly journals Characteristics and Treatment Challenges of Non-Clear Cell Renal Cell Carcinoma

Cancers ◽  
2021 ◽  
Vol 13 (15) ◽  
pp. 3807
Author(s):  
Pierangela Sepe ◽  
Arianna Ottini ◽  
Chiara Carlotta Pircher ◽  
Andrea Franza ◽  
Melanie Claps ◽  
...  
Keyword(s):  
Renal Cell ◽  
Kinase Inhibitors ◽  
Clear Cell ◽  
Case Reports ◽  
Treatment Options ◽  
Single Agent ◽  
Growth Factor Receptor ◽  
Mtor Inhibitors ◽  
Cell Renal Cell Carcinoma ◽  
Clear Cell Rcc

Non-clear cell renal cell carcinomas (RCC) comprise several rare and poorly described diseases, often characterized by bad prognosis and with no standard treatments available. The gap in their clinical management is linked to the poor molecular characterization in handling the treatment of non clear-cell RCC with untailored therapies. Due to their rarity, non-clear RCC are in fact under-represented in prospective randomized trials. Thus, treatment choices are based on extrapolating results from clear cell RCC trials, retrospective data, or case reports. Over the last two decades, various options have been considered as the mainstay for the treatment of metastatic RCC (mRCC), including angiogenesis inhibitors, vascular endothelial growth factor receptor inhibitors, other tyrosine kinase inhibitors (TKIs), as well as MET inhibitors and mammalian targeting of rapamycin (mTOR) inhibitors. More recently, the therapeutic armamentarium has been enriched with immunotherapy, alone or in combination with targeted agents that have been shown to significantly improve outcomes of mRCC patients, if compared to TKI single-agent. It has been widely proven that non-clear cell RCC is a morphologically and clinically distinct entity from its clear cell counterpart but more knowledge about its biology is certainly needed. Histology-specific collaborative trials are in fact now emerging to investigate different treatments for non-clear cell RCC. This review summarizes pathogenetic mechanisms of non-clear cell RCC, the evolution of treatment paradigms over the last few decades, with a focus on immunotherapy-based trials, and future potential treatment options.

scholarly journals Out Come of Wide Local Excision with and without Corticosteroid Therapy in Management of Idiopathic Granulomatous Mastitis

2021 ◽  
Vol 107 (1_suppl) ◽  
pp. 13-13
Author(s):  
R Amira Maher ◽  
Ahmed Gamal Eldin Osman ◽  
K Fahmy ◽  
Shinamwi M ◽  
Osama Al Atarash
Keyword(s):  
Recurrence Rate ◽  
Corticosteroid Therapy ◽  
Surgical Excision ◽  
Cosmetic Outcome ◽  
Systemic Steroid ◽  
Granulomatous Mastitis ◽  
Idiopathic Granulomatous Mastitis ◽  
Palpable Mass ◽  
Group A ◽  
Group B

Introduction: Idiopathic granulomatous mastitis is a rare benign breast disease. Initial reports from hospitals in Egypt from Departments of Pathology at Cancer Institutes of Cairo, Tanta and Mansoura Universities; indicate that the disease is not as rare as that in the developed countries. It often mimics breast carcinoma both clinically and radiologically. Histological examination is the gold standard for diagnosis. Management of Idiopathic granulomatous mastitis is still debatable. In our study, we aimed to evaluate the addition of corticosteroid therapy to surgical excision in management of idiopathic granulomatous mastitis. Patients and Methods: This is a comparative study was conducted at Ain-Shams University Hospital’s breast clinic on patients with idiopathic granulomatous mastitis from to August 2015 till September 2018. Thirty patients were divided into 2 groups. Group (A) includes patients who underwent surgical management only. Group (B) includes patients who received corticosteroid therapy according to the severity of the cases then surgical Excision was done for the residual lesion. Follow up of all cases up to 1-2 years was done to document the recurrence rate and compare the cosmetic outcome of both groups. Informed consent was obtained from all patients included in the study. Results: The mean age of the affected women was 38.80 and 33.13 in group (A) and group (B), respectively and it wasn’t statistically different (p value = 0.099). The most common presenting symptom was a palpable mass in the breast (66.7% and 93.3%) in group (A) and group (B) respectively. Recurrence rate was higher in group (A) (40%) with no recurrence documented in group (B) however 2 cases were omitted from the study due to steroid noncompliance and complications. Cosmetic outcome was excellent in 76.9% of group (B) and good in 53.3% of group (A). Conclusion: Systemic steroid therapy with surgical resection is the recommended as first-line treatment strategy for IGM as it shows less recurrence rate and surgical scarring. Increased awareness of IGM will increase their understanding and improve their management.

scholarly journals Squamous cell carcinoma of the scrotum in HIV: two case reports

2021 ◽  
Vol 27 (1) ◽  
Author(s):  
Jeff John ◽  
Ken Kesner ◽  
John Lazarus
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Case Reports ◽  
Treatment Options ◽  
Punch Biopsy ◽  
Delayed Treatment ◽  
Clinical Presentations ◽  
T1 N0 M0

Abstract Background Squamous cell carcinoma (SCC) of the scrotum was the first malignancy known to be associated with exposure to an occupational carcinogen—in this case, soot trapped in the breeches of chimney sweeps. Better civil rules and regulations and the replacement of hearths with other forms of heating have rendered SCC of the scrotum a rarity. We report two cases of scrotal SCC with vastly differing clinical presentations and management. Case presentation Case 1 had T1 N0 M0 disease and presented with a small (< 2 cm), innocuous-looking, non-healing ulcer of eight years duration. A punch biopsy revealed a superficially invasive SCC confirmed on immunohistochemical profiling. A wide local excision of the lesion was subsequently performed. Follow-up at three years showed no signs of recurrence. Case 2 presented with T4 N1 M1 disease and rapidly progressing locally destructive mass. A punch biopsy of the scrotal lesion confirmed invasive moderately differentiated focally keratinising SCC. The metastatic evaluation confirmed the presence of metastatic, extensive para-aortic lymphadenopathy. He was managed with cisplatin-based chemoradiotherapy. Conclusion Early detection and management of patients with SCC of the scrotum are essential. If the diagnosis is delayed, treatment options become limited, and the prognosis is poor. Notwithstanding the rarity of this disease, multicentre trials are needed to provide more precise guidelines as to the optimal management of these patients.

scholarly journals Management of Amelogenesis Imperfecta in Childhood: Two Case Reports

2021 ◽  
Vol 18 (13) ◽  
pp. 7204
Author(s):  
Mirja Möhn ◽  
Julia Camilla Bulski ◽  
Norbert Krämer ◽  
Alexander Rahman ◽  
Nelly Schulz-Weidner
Keyword(s):  
Case Reports ◽  
Treatment Options ◽  
Permanent Dentition ◽  
Amelogenesis Imperfecta ◽  
Structural Defects ◽  
Type I ◽  
Oral Rehabilitation ◽  
Self Confidence ◽  
Health Quality ◽  
Masticatory System

Amelogenesis imperfecta (AI) is defined as an interruption of enamel formation due to genetic inheritance. To prevent malfunction of the masticatory system and an unaesthetic appearance, various treatment options are described. While restoration with a compomer in the anterior region and stainless steel crowns in the posterior region is recommended for deciduous dentition, the challenges when treating such structural defects in mixed or permanent dentition are changing teeth and growing jaw, allowing only temporary restoration. The purpose of this case report is to demonstrate oral rehabilitation from mixed to permanent dentition. The dentition of a 7-year-old patient with AI type I and a 12-year-old patient with AI type II was restored under general anesthesia to improve their poor aesthetics and increase vertical dimension, which are related to problems with self-confidence and reduced oral health quality of life. These two cases show the complexity of dental care for structural anomalies of genetic origin and the challenges in rehabilitating the different phases of dentition.

scholarly journals Successful endovascular stenting of a bleeding external iliac vein mycotic aneurysm in an oncologic patient: a case report

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Rupal S. Parikh ◽  
Shiyi Li ◽  
Christopher Shackles ◽  
Tamim Khaddash
Keyword(s):  
Mycotic Aneurysm ◽  
Case Reports ◽  
Treatment Options ◽  
Iliac Vein ◽  
Pelvic Abscess ◽  
Vascular Lesions ◽  
Endovascular Stenting ◽  
Oncologic Patient ◽  
External Iliac Vein ◽  
Effective Option

Abstract Background Mycotic aneurysms are rare vascular lesions, occurring in 0.6–2% of arterial aneurysms but with no reported venous cases. Venous aneurysms unrelated to an underlying infectious process have been previously described and are typically surgically repaired due to risk of thromboembolic events. Case presentation This case reports a bleeding external iliac vein mycotic aneurysm secondary to erosion of a chronic pelvic abscess, successfully treated with endovascular stenting, in an oncologic patient without alternative therapeutic options. Conclusion Venous aneurysms are uncommon vascular lesions which have historically been treated with open surgical repair. Given the lower degree of procedural morbidity, endovascular management of these lesions may be an effective option in the appropriate setting, particularly as a last resort in patients without surgical treatment options.

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