Surgical Anatomy of Large Retroperitoneal Teratomas in Infants: Report of Two Cases

We report on two infants of 11 and 12 months of age, respectively, with large solid-cystic retroperitoneal tumors. Complete resection was achieved, and both children are doing well over a follow-up of more than 17 months. The presented paper focuses on surgical anatomy of this very rare type of tumor. Teratomas were located mainly within the upper abdominal cavity, and both tumors displaced the pancreas in an anterior position. The following anatomical features were observed (1) displacement of surrounding organs, (2) deformation and elongation of large retroperitoneal vessels, (3) fibrous incorporation of large vessels by the tumor pseudocapsule, (4) wrapping of anterior aortic branches by lobes and fingers of the tumor.

Download Full-text

Intrahepatic Pregnancy - A Rare Form Of Abdominal Pregnancy At Lira Regional Referral Hospital, Northern Uganda; A Case Report And Literature Review

International Journal Of Medical Science And Clinical Invention ◽

10.18535/ijmsci/v7i08.01 ◽

2020 ◽

Vol 7 (08) ◽

pp. 4895-4899

Author(s):

Andrew Odur ◽

Tom Richard Okello ◽

Richard Okii ◽

John Stephen Obbo Olwenyi ◽

Irene Pecorella

Keyword(s):

Abdominal Cavity ◽

Rare Condition ◽

Rare Form ◽

Regional Referral Hospital ◽

Female Baby ◽

Upper Abdominal ◽

The Right ◽

Hepatic Pregnancy

Primary intra-hepatic pregnancy is an extremely rare condition. The purpose of this study was to report a case of 24-year-old Gravida 2 para 1+0 who presented at 35 weeks of amenorrhea, vaginal bleeding and mild right upper abdominal tenderness. Ultrasonography revealed a non-viable extra-uterine fetus located around the right upper part of the abdomen with a bulky uterus. At laparotomy was preferred and on finding a fetus free abdominal cavity and uterus, a macerated female baby was delivered from inside the liver with birth weight of 2.7kilogram. Placenta was left in situ and methotrexate given to hasten its resorption. Maternal outcome during the 18 days of intense follow up was uneventful. This case is a rare occurrence in our setting and it has diagnostic challenges in low resource settings like ours, however intra-hepatic pregnancy can grow to considerable size and weight.

Download Full-text

Complete Remission of Recurrent Retroperitoneal Liposarcoma after the Administration of Gemcitabine and Docetaxel as First-Line Adjuvant Chemotherapy: A Case Report

Case Reports in Oncology ◽

10.1159/000489393 ◽

2018 ◽

Vol 11 (2) ◽

pp. 341-346 ◽

Cited By ~ 5

Author(s):

Filipe Rocha Da Silva ◽

Alan Vitor Jerônimo Lima ◽

Erick Willian Rocha Pereira Albuquerque ◽

Carlos Augusto Moreira-Silva ◽

Nicole Maués Flexa De Oliveira ◽

...

Keyword(s):

Tumor Resection ◽

Complete Resection ◽

First Line ◽

Complete Tumor Resection ◽

Rare Type ◽

Retroperitoneal Liposarcoma ◽

New Surgery ◽

Tumor Remission ◽

Complete Tumor

Retroperitoneal liposarcoma is a rare type of cancer. Relapse after surgery is frequent, and relapsing tumors tend to be more aggressive and less differentiated each episode, worsening the prognosis. This report describes the case of a 42-year-old female diagnosed with retroperitoneal liposarcoma after complete tumor resection. At the 3-month follow-up, another expansive lipomatous mass in the retroperitoneal area almost the same size as the previous one was detected. The patient underwent a new surgery, followed by first-line treatment with a gemcitabine- and docetaxel-based regimen for 8 cycles. Finally, the patient achieved complete tumor remission confirmed by CT after the end of the treatment proposed. Although recurrence is a well-known characteristic of this neoplasia, no other case with such a vast expansion of a new tumor shortly after complete resection was found in the literature.

Download Full-text

Microsurgical resection of foramen magnum meningioma through a transcondylar approach: three-dimensional operative video

Neurosurgical Focus: Video ◽

10.3171/2019.10.focusvid.19465 ◽

2019 ◽

Vol 1 (2) ◽

pp. V3

Author(s):

Guilherme H. W. Ceccato ◽

Rodolfo F. M. da Rocha ◽

Duarte N. C. Cândido ◽

Wladimir O. Melo ◽

Marcio S. Rassi ◽

...

Keyword(s):

Nerve Palsy ◽

Three Dimensional ◽

Foramen Magnum ◽

Complete Resection ◽

Neurophysiological Monitoring ◽

Cervical Instability ◽

Transcondylar Approach ◽

Postoperative Mri ◽

Microsurgical Resection

Foramen magnum (FM) meningiomas are challenging lesions. We present the case of a 38-year-old female with neck pain, dysphonia, and slight twelfth nerve palsy. Imaging workup was highly suggestive of an FM meningioma, and microsurgical resection with the aid of intraoperative neurophysiological monitoring was indicated. A transcondylar approach was employed, the vertebral artery was mobilized, and the tumor was completely removed. Postoperative MRI demonstrated complete resection. There were no signs of cervical instability. The patient presented with improvement of her symptoms and no new neurological deficit on follow-up. FM meningiomas can be successfully resected using a transcondylar approach, since it increases the exposure of the ventral FM, allowing the surgeon to work parallel to the skull base and flush with the tumor’s attachment. Informed consent was obtained from the patient for publication of this operative video.The video can be found here: https://youtu.be/itfUOB-6zM0.

Download Full-text

Surgical Anatomy of the Ocular Adnexa

10.1093/oso/9780199744268.001.0001 ◽

2012 ◽

Author(s):

David Jordan ◽

Louise Mawn ◽

Richard L. Anderson

Keyword(s):

Head And Neck ◽

Plastic Surgery ◽

Surgical Approach ◽

Neck Surgery ◽

Surgical Anatomy ◽

Head And Neck Surgery ◽

Anatomical Features ◽

Ocular Adnexa ◽

Periocular Region ◽

Orbital Region

Surgical Anatomy of the Ocular Adnexa is a beautifully and thoughtfully illustrated anatomical text that provides the ophthalmic surgeon or any surgeon working in the eyelid/orbital region with detailed yet concise, easy to read and understand descriptions of the anatomy in any particular region of the eyelid, orbit or nasolacrimal system. Throughout the text are clinical pearls and vignettes to help the reader appreciate why certain anatomical features are important to understand. Key anatomical concepts are highlighted and easy to visualize with real cadaver photos as well as the artists rendition of the same region. This book: - Develops a thorough understanding of the anatomy in the eyelid, orbit, nasolacriaml and periocular regions. - Fosters an appreciation of how knowledge of the anatomy leads to a better understanding of the pathophysiology of various disease processes involving the eyelid, orbit, nasolacrimal and periocular region. - Conveys the importance of anatomy in the surgical approach to various disease processes in the eyelid, orbit, nasolacrimal and periocular regions. This second edition will be an invaluable guidel to all those working in the eyelid, orbital, and nasolacrimal areas including residents, fellows and staff in ophthalmology, otolaryngology/head and neck surgery, plastic surgery and neurosurgeons working in and around the orbit.

Download Full-text

Hybrid treatment of fibroadipose vascular anomaly: A case report

Open Medicine ◽

10.1515/med-2020-0228 ◽

2020 ◽

Vol 15 (1) ◽

pp. 890-897

Author(s):

Francesco Stillo ◽

Federica Ruggiero ◽

Antonio De Fiores ◽

Rita Compagna ◽

Bruno Amato

Keyword(s):

Patient Satisfaction ◽

Vascular Anomaly ◽

Rare Type ◽

Complete Excision ◽

Hybrid Treatment ◽

Constant Pain ◽

Additional Surgery ◽

Ethanol Embolization

AbstractBackgroundFirst identified in 2014, fibroadipose vascular anomaly (FAVA) is a very rare type of venous and lymphatic malformation. Marked by tough fibrofatty tissue in the extremities overtaking portions of the muscles, it is associated with constant pain and contracture of the affected extremity. There is a paucity of literature, and no guidelines on treatment procedure are available. This case highlights the role of hybrid treatment with primary ethanol percutaneous ethanol embolization and additional surgery for radicality in excision of FAVA lesions.Case summaryA 9-year-old girl with FAVA underwent the hybrid treatment. The achievements of complete excision, clinical response, and patient satisfaction in long-term follow-up were assessed. Following the hybrid treatment, the patient experienced significant improvement in pain. Concurrent symptoms of physical limitation, leg swelling, and skin hyperesthesia also improved. The clinical benefit, supported by postoperative physiotherapy, was well stabilized at 6-month follow-up, resulting in complete patient satisfaction at 12- and 36-month follow-ups. No major complications were encountered.ConclusionEthanol embolization plus surgery is a safe, effective, and long-term hybrid treatment of symptomatic FAVA lesions.

Download Full-text

Stereotactic radiosurgery for treating meningiomas eligible for complete resection

Radiation Oncology ◽

10.1186/s13014-021-01748-y ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Maximilian I. Ruge ◽

Juman Tutunji ◽

Daniel Rueß ◽

Eren Celik ◽

Christian Baues ◽

...

Keyword(s):

Adverse Events ◽

Stereotactic Radiosurgery ◽

Medical Condition ◽

Local Tumor Control ◽

Complete Resection ◽

Neurological Deficits ◽

Tumor Control ◽

Recurrence Rates ◽

Treatment Volume

Abstract Background For meningiomas, complete resection is recommended as first-line treatment while stereotactic radiosurgery (SRS) is established for meningiomas of smaller size considered inoperable. If the patient´s medical condition or preference excludes surgery, SRS remains a treatment option. We evaluated the efficacy and safety of SRS in a cohort comprising these cases. Methods In this retrospective single-centre analysis we included patients receiving single fraction SRS either by modified LINAC or robotic guidance by Cyberknife for potentially resectable intracranial meningiomas. Treatment-related adverse events as well as local and regional control rates were determined from follow-up imaging and estimated by the Kaplan–Meier method. Results We analyzed 188 patients with 218 meningiomas. The median radiological, and clinical follow-up periods were 51.4 (6.2–289.6) and 55.8 (6.2–300.9) months. The median tumor volume was 4.2 ml (0.1–22), and the mean marginal radiation dose was 13.0 ± 3.1 Gy, with reference to the 80.0 ± 11.2% isodose level. Local recurrence was observed in one case (0.5%) after 239 months. The estimated 2-, 5-, 10- and 15-year regional recurrence rates were 1.5%, 3.0%, 6.6% and 6.6%, respectively. Early adverse events (≤ 6 months after SRS) occurred in 11.2% (CTCEA grade 1–2) and resolved during follow-up in 7.4% of patients, while late adverse events were documented in 14.4% (grade 1–2; one case grade 3). Adverse effects (early and late) were associated with the presence of symptoms or neurological deficits prior to SRS (p < 0.03) and correlated with the treatment volume (p < 0.02). Conclusion In this analysis SRS appears to be an effective treatment for patients with meningiomas eligible for complete resection and provides reliable long-term local tumor control with low rates of mild morbidity.

Download Full-text

Carcinosarcomas of the larynx: systematic review of the literature of a rare nosologic entity

European Archives of Oto-Rhino-Laryngology ◽

10.1007/s00405-021-07027-6 ◽

2021 ◽

Author(s):

Andrea Colizza ◽

Antonio Gilardi ◽

Antonio Greco ◽

Fabrizio Cialente ◽

Federica Zoccali ◽

...

Keyword(s):

Overall Survival ◽

Data Extraction ◽

Treatment Guideline ◽

Cancer Staging ◽

Spindle Cell Carcinoma ◽

Nodal Metastasis ◽

Partial Laryngectomy ◽

Rare Type ◽

Rare Malignancy

Abstract Purpose Carcinosarcoma, also known as Spindle Cell Carcinoma (SpCC), is a rare type of malignant tumor. Generally, this type of pathology occurs in the urogenital tract, the gastrointestinal tract, respiratory tract and mammary gland; in the larynx, SpCC represents only 2–3% of all malignancies. Due to its rarity, there is currently no generally acceptable treatment guideline for this disease. The aim of this study was to systematically review the literature of SpCC of larynx and report epidemiologic, clinicopathologic and main therapeutic approaches for this entity. Methods A systematic literature review was performed using MEDLINE, EMBASE, PubMed and Scopus databases. For this review, the results were extrapolated in the period between January 1990 to September 2020. Data extraction was performed using a standard registry database. The clinical and pathological staging were recalculated according to the Eight Edition of AJCC Cancer Staging Manual and statistical analyses were performed using SPSS Version 25.0. Results A total of 111 patients affected by laryngeal carcinosarcoma were included. From our review arises that surgery is the main treatment for primary laryngeal carcinosarcoma. In this way, various techniques such as minimally invasive laryngoscopy excision, laser CO2 cordectomy, partial laryngectomy (vertical and horizontal) and total laryngectomy. The role of radiotherapy is still controversial. The overall survival (OS) for T1 stage tumor at 5 years of follow-up is 82.9%, the OS for T2 and T3 tumor is 74% and 73.4%. The OS at 5 years of follow-up is 91.7% for supraglottic tumor, 69.3% for glottic tumor and 50% for transglottic site. Subglottic site is described in only 2 cases [12–13], so the OS at 5 years is not statistically significant. The 5-year overall survival in patients without lymph nodes involvement (N0) is 90.2%, 66.7% and 50%, respectively, for N1 and N2 lesions. Conclusion Primary laryngeal carcinosarcoma is a very rare malignancy. There are no clear guidelines in the management but in the literature, surgery is described as the best modality of therapy; radiation only can be a reasonable alternative with controversial efficacy. The most important prognostic factor is the nodal metastasis.

Download Full-text

“Push–Pull Technique” for the Management of a Selected Superomedial Intraorbital Lesion

The Surgery Journal ◽

10.1055/s-0038-1661417 ◽

2018 ◽

Vol 04 (03) ◽

pp. e105-e109 ◽

Cited By ~ 1

Author(s):

Paolo Castelnuovo ◽

Giacomo Fiacchini ◽

Francesca Fiorini ◽

Iacopo Dallan

Keyword(s):

Venous Malformation ◽

Complete Resection ◽

Safe Procedure ◽

Combined Approach ◽

Main Approach ◽

Transnasal Approach ◽

Superior Eyelid Approach ◽

Push Down ◽

Orbital Lesions

Orbital lesions are traditionally managed through external approaches when laterally located, and through a transnasal approach or other external approaches when medially located. However, when the lesion is superomedially located, it may determine a technical challenge.In this study, we present the case of a patient with a superomedial intraconal venous malformation of the left eye. We addressed the mass through a combined approach, using the transnasal route as the main approach, and the superior eyelid approach to push down the lesion to facilitate the excision. We have called this approach “push–pull technique.”We achieved a complete resection of the lesion and did not observe any intraoperative or postoperative complications. The last follow-up at 6 months postoperatively showed no recurrence, and the patient was satisfied and completely recovered.According to our experience, the “push–pull” technique seems to be a safe procedure and might be considered a valid alternative to address selected superomedial intraconal lesions.

Download Full-text

Spontaneous pneumoperitoneum with duodenal diverticulosis in an elderly patient: a case report

Surgical Case Reports ◽

10.1186/s40792-019-0769-4 ◽

2020 ◽

Vol 6 (1) ◽

Cited By ~ 2

Author(s):

Takeshi Ueda ◽

Tetsuya Tanaka ◽

Takashi Yokoyama ◽

Tomomi Sadamitsu ◽

Suzuka Harada ◽

...

Keyword(s):

Conservative Treatment ◽

Abdominal Cavity ◽

Vital Signs ◽

Rare Condition ◽

Exploratory Laparotomy ◽

Case Presentation ◽

Free Air ◽

Spontaneous Pneumoperitoneum ◽

Upper Abdominal ◽

Emergent Laparotomy

Abstract Background Pneumoperitoneum commonly occurs as a result of a viscus perforation and usually presents with peritoneal signs requiring emergent laparotomy. Spontaneous pneumoperitoneum is a rare condition characterized by intraperitoneal gas with no clear etiology. Case presentation We herein report a case in which conservative treatment was achieved for an 83-year-old male patient with spontaneous pneumoperitoneum that probably occurred due to duodenal diverticulosis. He had stable vital signs and slight epigastric discomfort without any other signs of peritonitis. A chest radiograph and computed tomography showed that a large amount of free gas extended into the upper abdominal cavity. Esophagogastroduodenoscopy showed duodenal diverticulosis but no perforation of the upper gastrointestinal tract. He was diagnosed with spontaneous pneumoperitoneum, and conservative treatment was selected. His medical course was uneventful, and pneumoperitoneum disappeared after 6 months. Conclusion In the management of spontaneous pneumoperitoneum, recognition of this rare condition and an accurate diagnosis based on symptoms and clinical imaging might contribute to reducing the performance of unnecessary laparotomy. However, in uncertain cases with peritoneal signs, spontaneous pneumoperitoneum is difficult to differentiate from free air resulting from gastrointestinal perforation and emergency exploratory laparotomy should be considered for these patients.

Download Full-text

Incarcerated Femoral Hernia Repair with Ventralex™ Hernia Patch through Same Skin Incision and Suprainguinal Laparotomy

Case Reports in Surgery ◽

10.1155/2018/9719310 ◽

2018 ◽

Vol 2018 ◽

pp. 1-3

Author(s):

David Aranovich ◽

Veacheslav Zilbermints ◽

Oleg Kaminsky

Keyword(s):

Hernia Repair ◽

Femoral Hernia ◽

Bowel Resection ◽

Abdominal Cavity ◽

Skin Incision ◽

Operative Approach ◽

Easy Access ◽

Midline Laparotomy ◽

Femoral Ring

Purpose. To report our experience with incarcerated femoral hernia procedure, which allows laparotomy through same inguinal skin incision, inspection and resection of compromised bowel, and preperitoneal tension-free transabdominal repair with Ventralex™ Hernia Patch.Materials and Methods. The suprainguinal laparotomy was performed via same groin incision without compromising iliopubic tract. The femoral ring was sealed with Ventralex™ Hernia Patch pulled through the abdominal cavity and secured outside. Five consecutive patients diagnosed with incarcerated femoral hernias were operated. All of them required laparotomy, either for bowel resection (n=3) or for inspection of viability (n=2).Results. All patients tolerated the procedure well. There were no wound or mesh infections, incisional hernias, or recurrences during follow-up.Conclusions. Our easy-to-master operative approach to incarcerated femoral hernia allows easy access to abdominal cavity through same groin incision without compromising iliopubic tract or midline laparotomy. Reduction of incarcerated bowel and its inspection and resection can be safely performed. The femoral ring defect can be effectively obliterated with Ventralex™ Hernia Patch.

Download Full-text