A Case Giving Proof of Pathogenesis of Abdominoscrotal Hydrocele: A Case Report

An abdominoscrotal hydrocele (ASH) is an uncommon condition characterized by cystic mass that occupies the scrotum and abdomen. The characteristic aspect is the presence of two hydrocele sacs in the abdominal cavity and the scrotum, and compression of one side causes enlargement of the other side, thereby connecting the two sacs. There are several hypotheses regarding the occurrence of ASH. However, the evidence of the hypotheses is lacking. The patient was a 52-year-old male. During observation of the right inguinoscrotal hydrocele, the patient complained of a palpable mass lesion on the right lower quadrant of the abdomen. Physical examination revealed ASH that occurred with the growth of the inguinoscrotal hydrocele. This was further confirmed by sequential imaging test thereby proposing the verification of cephalad extension of hydrocele. The surgical excision was recommended and inguinal exploration was performed under general anesthesia. No evidence of relapse was observed during the 2-year follow-up period after surgery. The present case proves the cephalad extension of hydrocele among other hypotheses on the etiology of ASH.

Post-operative Intussusception, a rare case in pediatric, National Center for Paediatric Surgery, Gezira State, Sudan; 2021

Intussusception is defined by Treves in 1899 as invagination of segment of bowel into adjacent segment usually proximal into distal. It’s a common cause of abdominal emergencies especially in children two years of age and younger. It accounts for 1 in 2000 infants and children and results in intestinal obstruction. Post-operative intussusception is one of the rare etiologies of intestinal obstruction that represents 0.01 to 0.25% after laparotomies and 5 -10% of all early postoperative intestinal obstructions. Our case is a ten years old female presented to the National Center for Pediatric Surgery; Gezira state; Sudan; February 2021 complaining of abdominal distention and constipation for 6 days. She had past history of acute appendicitis due to which she underwent emergency opened appendectomy. Her condition started one day after appendectomy. O/E : patient looks ill, febrile, not pale or jaundice; PR:140b/m; RR:25c/m; abdominal examination show: distended abdomen with full flanks, unhealed lanz incision with small amount of pus discharge; no dilated veins or visible peristalsis; hernia orifice were intact; lower abdomen was tense & tender; no palpable mass; DRE: rectum contains impacted hard stool. Emergency explorative laparotomy was done. Findings: Ileocecal intussusception, bowel was healthy and viable. Simple reduction was done. Conclusion and Recommendations: Post-operative intussusception usually associated with bowel ischemia and necrosis which is not consistent with our case. We highly recommended abdominal ultrasonography, CT scan; when there is a high index of suspicion.

Pneumonitis associated with Trastuzumab emtansine in a patient with metastatic breast cancer

Introduction Trastuzumab emtansine (TDM-1) is an antibody–drug conjugate effective in human epidermal growth factor receptor-2 - expressing advanced breast cancer. Pulmonary complications of TDM-1 are rarely reported. TDM-1-associated interstitial lung disease is referred to as pneumonitis. Case report A 47-year-old female patient who underwent modified radical mastectomy and axillary lymph node dissection operations due to a palpable mass in the right breast and axillary region. The patient who had received multiple chemotherapy was last receiving TDM-1 treatment. Fatigue, dyspnea, and tachypnea were detected for the first time on 20 days after the 6th treatment. Menagement and outcome In our case, we first considered metastasis, pneumonia and fungal infection based on radiological findings, but the lack of response to the treatments and the results of the investigations suggested drug-induced pneumonia and steroid treatment was started. Our case had a complete radiological recovery and complete response to sterod therapy. In such cases, it is important to first exclude infections and metastasis. In cases of drug-induced pneumonia, the first treatment option is systemic corticosteroids and generally responded well. Discussion Unlike other cases of interstitial pneumonia, lung imaging of our case was resembling a metastasis, pneumonia and fungal infection. With increasing use of TDM-1, we will have more experience in both efficacy and complications of TDM-1. Although TDM-1 is a well-tolerated drug, clinicians should be aware of rare pulmonary complications and prepared to respond appropriately.

Pediatric cystic nephroma: clinical and molecular genetic characteristics

Cystic nephroma (CN) is a rare renal tumor occurring in children which belongs to a group of neoplasms linked with the inherited DICER1 syndrome. Given the rarity of CNs, it is important to describe clinical, radiological, and molecular genetic characteristics of these tumors in children and adolescents as well as to analyze treatment outcomes. We present our experience in managing 8 patients with histologically verified CN who received treatment and consultations at the D. Rogachev NMRCPHOI over a period of 9 years (2012–2020). The study was approved by the Independent Ethics Committee and the Scientific Council of the D. Rogachev NMRCPHOI. The patients’ parents gave their consent to the use of their child’s data, including photographs, for research purposes and in publications. We performed a retrospective analysis of clinical presentation, radiological findings, the extent of treatment given to patients, treatment outcomes, and the results of molecular genetic testing. The study included patients aged between 8.6 and 197 months at diagnosis (the median age was 14.2 months). The analysis of initial complaints revealed that six patients (75%) had an increased abdominal girth and a palpable mass in the abdomen, one patient (12.5%) presented with arterial hypertension, and another patient (12.5%) had a mass detected by a routine abdominal ultrasound examination. On contrast-enhanced computed tomography scans, CNs appeared as multicystic masses with thin, contrast-enhancing septa; the CN volume ranged from 59.7 to 1293.1 cm3 (the median volume was 626.3 cm3 ). In all cases, the diagnosis of CN was verified histologically. Surgical treatment included nephrectomy (n = 6) or partial resection of the affected kidney (n = 2) with the removal of the tumor. Some patients (n = 5) included in our analysis received pre-operative chemotherapy at the discretion of their treating physicians. Molecular genetic testing was carried out for 7 children: 4 out of 7 patients (57.1%) were found to have somatic and germline mutations in the DICER1 gene. Carriers of pathogenic DICER1 variant were identified in the family of 1 patient. The median duration of follow-up was 17.6 months (range: 1.7 to 58.9 months). Currently, all patients are alive, no relapses have occurred. Cystic renal neoplasms detected by radiological investigations should be reviewed at the reference centers for pediatric oncological diseases and included CN in the differential diagnosis. Initial surgery is the first line of treatment for cystic nephroma. The final diagnosis is made on the basis of a histological examination of tumor tissue. All patients with confirmed CN should be referred for genetic counseling and molecular genetic testing for germline mutations in the DICER1 gene and should receive surveillance recommendations for the early detection of other metachronous DICER1-associated tumors.

The management of appendicular abscesses in a Tunisian Tertiary Care Hospital

Background This study aims to describe the epidemiological, clinical, and radiological features of appendicular abscesses, compare the different approaches, and assess the safety and utility of laparoscopy in its management. Methods This descriptive retrospective study was carried out over 3 years extending from January 2017 to December 2019, reporting 150 appendicular abscesses cases. Data were collected from the register of the general surgery department B of the Rabta hospital. Cases with appendicular abscess were included. Files concerning patients with early appendicitis, non-appendicular abscesses or generalized appendicular peritonitis were excluded. Data were analysed with Statistical Package for the Social Sciences (SPSS) software. In univariate analysis, we used the chi2 test, the Fischer test, the Student t test. The factors retained by the univariate analysis were introduced into a logistic regression model. The significance level was set to 0.05. Results The mean age was 40.51 years. The gender ratio in patients with appendicular abscesses was M:F 1.94:1. Pain in the right iliac fossa associated with fever was the most common symptom (78% of cases). Clinical examination showed tenderness in the right iliac fossa in 38% of cases, rebound and guarding were found in 77 patients (51.3%), and a palpable mass was noted in 4 cases (4.2%). Imaging was done to confirm diagnosis; 46 patients underwent ultrasonogram and this confirmed the diagnosis in 26 patients (56%), while among the 71 patients who underwent CT abdomen confirmatory diagnosis was made in 65 patients (91.55%). An appendectomy was performed in 148 patients (98.6%) via laparoscopic approach in 94 patients, open Mac burney procedure in 32 cases (21.3%) and midline incision in 24 cases (16%). Two patients had an ileocecal resection. The appendix was most commonly located retrocecally (55.3%) in our cohort. The laparoscopic approach was performed in 94 patients (62.6%), and we had to convert in 44 patients due to dissection difficulties (46.8%). Among patients who underwent laparascopic approach 7 had developed peritonitis.. There were only 2 deaths. The mortality rate was 0,013%. The median duration of outpatient followup was 6 months (4–24 weeks) and was uneventful. Conclusion Appendicular abscess is a disease of young adults more common in men. Location of the appendix in our case series was mostly retroceacal. Laparoscopy was associated with good outcomes; peritonitis was uncommon and mortality was rare. The laparoscopic approach is a safe surgical technique for treating appendicular abscess and it can be considered as the routine approach for this condition In developing countries with limited technical resources, laparoscopy guarantees the absence of recurrence, reduces healthcare costs and decreases the risk of treating a severe disease conservatively.

A Case of Functional Testicular Torsion Caused by Incarcerated Inguinal Hernia in a Newborn

Testicular torsion in neonates is a urologic emergency with an incidence of 6.1 per 100,000 live births. Incarcerated inguinal hernia is also an emergency with an incidence of approximately 6% to 31% in children with inguinal hernia. Functional testicular torsion from an incarcerated inguinal hernia is a rare event in children, often not considered in the initial evaluation. A 19-day-old newborn boy was admitted to our neonatal intensive care unit after visiting a primary clinic. He presented with inconsolable crying and right scrotal swelling. Upon initial physical examination, a hard palpable mass and swelling was found in the inguinoscrotal region, accompanied with redness and warmth of the scrotum. Scrotal ultrasound with color Doppler showed inguinal hernia with strangulation and scanty blood flow to the testis. The patient underwent a right orchiectomy and partial resection of the affected small bowel. Surgical findings confirmed a testicular torsion and incarcerated inguinal hernia with testis with small bowel necrosis. Here, we report a rare case of a newborn with functional testicular torsion as a result of prolonged spermatic cord compression due to incarcerated inguinal hernia.

Mesenteric cystic lymphangioma – A rare case report; National Center for Pediatric Surgery, Gezira State, Sudan; 2021

Cystic lymphangioma is a benign congenital malformation of the lymphatic vessels. At the National Center for Pediatric Surgery, Gezira State, Sudan; 2021; a female baby of 15 months old age presented complaining of abdominal distention of 10 days duration. Patient Looks unwell, not febrile, and not pale or jaundice; abdomen was distended with full flanks, there was a palpable mass in the epigastric region, no area of tenderness and no palpable organs. Abdomino-pelvic U/S showed very huge abdomino –pelvic cystic mass with multiple thick septa. CT abdomen showed huge abdomino-pelvic mass with multiple cysts that having variable sizes measuring up to 6*7 cm. An elective explorative laparotomy was done. Intra operative findings: Multiple cystic masses arise from the root of the small bowel mesentery matted together with multiple enlarged mesenteric lymph nodes involving segment of distal jejunum with multiple adhesions. Release of adhesion, resection of the masses along with 57 cm of the involving jejunum, anastomosis was done, and homeostasis was secured. Histopathology result showed dilated cystic spaces; lined by flat endothelial cells and multiple reactive lymph nodes, no evidence of malignancy. Features are in line with lymphangioma and associated mesenteric lymphadenitis. Discussion and Conclusion: Our case was 15 months old which is the age of presentation as mentioned internationally. Mesenteric cystic Lymphangiomas are more common among male unlike our case. Ultrasonography and CT abdomen were highly recommended to achieve early diagnosis and treatment of such cases.

Triple-negative apocrine carcinoma as a rare cause of a breast lump in a Syrian female: a case report and review of the literature

Background Apocrine carcinoma is a rare tumor that constitutes < 4% of all breast malignancies, characterized by the proliferation of large atypical cells with strictly defined borders, abundant eosinophilic cytoplasm, large nuclei, and prominent nucleoli in more than 90% of tumor cells. Triple-negative apocrine carcinoma is a rare molecular subtype that constitutes less than 1% of triple-negative breast cancers and is characterized by negative expression of estrogen receptor, progesterone receptor, and human epidermal growth factor receptor, with positive expression of androgen receptor. Case presentation We report a case of a 45-year-old Syrian female who presented to our hospital due to a painless palpable mass in her left breast. Following physical and radiological examinations, an excisional biopsy was performed. Microscopic examination of the specimen followed by immunohistochemical staining revealed the diagnosis of a triple-negative apocrine carcinoma. Conclusion Triple-negative apocrine carcinoma is an extremely rare neoplasm that must be considered in the differential diagnoses of breast lesions through detailed clinical, histological, and immunohistochemical correlations. In our manuscript, we aimed to present the first case report of a Syrian female who was diagnosed with a triple-negative apocrine carcinoma, aiming to highlight the importance of detailed clinical, histological and immunohistochemical correlations with a detailed review of diagnostic criteria, molecular characteristics, and treatment recommendations.

Appendiceal Mucocele - A Review of Literature with a Case Report

Background: Appendiceal mucoceles represent neoplastic and non-neoplastic, dilatated, mucus filled appendix vermiformix. Appendectomy is obligatory due to a possible malignancy. It is crucially important to avoid rupturing of the mucocele because it can result in pseudomyxoma peritonei, with high morbidity and mortality. Case Report: We presented a 52-year-old man with pain and palpable mass in the lower right quadrant of the abdomen. The mucocele was removed without a rupture, and the patient was discharged from the surgical department one day after the surgery without a complication. Discussion: The resection must be done very carefully, because the rupture of a mucocele can cause pseudomyxoma peritonei, a very dangerous and often lethal condition. Due to the concern of rupture, we performed the classical resection through laparotomy. Conclusion: It is very important, especially for young, inexperienced surgeons to be aware of this rare diagnosis and perform a surgical intervention according to the guidelines of good clinical practice.

Intrasalivary Thymic Carcinoma: A Case Report and Literature Review

Ectopic thymic carcinomas are rarely diagnosed in the thyroid gland, let alone in extrathyroid tissues. In the currently available literature, only five cases of extrathyroidal malignancies with thymic differentiation have been reported as arising in the major salivary glands. A 69-year-old female presented with a slow-growing palpable mass in the left parotid gland. Fine needle aspiration biopsy suggested metastatic cancer, whereas core needle biopsy revealed high-grade squamous cell carcinoma. The patient underwent left radical parotidectomy with selective ipsilateral lymph node dissection and subsequent radiation therapy. The surgical specimen was taken for histopathological examination. Microscopically, the tumor resembled thymic carcinoma. It was composed of large nests of squamoid cells with smooth contours, focally with a syncytial growth pattern, and accompanied by abundant lymphocytes with reactive lymphoid follicles. This appearance resembled a micronodular thymic carcinoma with lymphoid hyperplasia. Moreover, the tumor displayed expression of squamous markers (p40 and p63) and markers of thymic carcinoma (CD5 and CD117). Therefore, the final diagnosis of intrasalivary thymic carcinoma was rendered. The molecular analysis including next-generation sequencing demonstrated no variants of the strong, potential, or unknown clinical significance. The patient remains disease-free at 1-year follow-up. In the current case, we comprehensively present a clinical, microscopic, molecular, and radiological picture of CD5-positive squamous cell carcinoma of the parotid. We postulate that similar cases should be designated as intrasalivary thymic carcinoma analogically to similar thyroid tumors. Our case and the limited literature data indicate they should be distinguished from conventional squamous cell carcinoma of major salivary glands due to their rather favorable prognosis.