Lymphoepithelial cyst mimicking pancreatic cancer: a case report and literature review

Background Pancreatic lymphoepithelial cyst (LEC) is a rare nonmalignant cyst consisting of a benign collection of keratinizing squamous epithelial cells with lymphoid tissue. Diagnosing LEC preoperatively is considered difficult because of its non-specific clinical features; therefore, LEC is generally treated the same as a malignant tumor. Case presentation Our case was a 65-year-old man who underwent pancreatoduodenectomy 3 years previously for carcinoma arising from the ampulla of Vater. A pancreatic mass in the remnant pancreatic tail was detected through follow-up abdominal contrast-enhanced computed tomography (CT). This revealed two adjacent ring-enhanced masses that had been in tight contact with the left diaphragm and were enlarged. The tumors had high signal intensity in diffusion-weighted images of magnetic resonance imaging, and fluorodeoxyglucose-positron emission tomography (FDG-PET) showed abnormal uptake (standardized uptake value maximum: 17.4). Therefore, we conducted a partial resection of the remnant pancreas with concomitant resection of the left diaphragm. Microscopically, one of the tumors revealed rare fragments of apparently benign squamous epithelium on a background of keratinous debris, cyst contents, and scattered lymphocytes, and the adjacent mass revealed infiltrated neutrophils. The histopathological diagnosis was an LEC with chronic abscess. The patient recovered uneventfully and was discharged on postoperative day 10. Conclusions We reported a rare case of LEC with chronic abscess that was positively visualized on FDG-PET. When a pancreatic malignancy cannot be excluded, surgical resection is considered inevitable.

Study of spectrum and clinical profile of benign breast disease in the rural area: is there any change

Background: Recent understanding of pathophysiology and health awareness may have impact on spectrum of benign breast disease (BBD) in rural area. We have analyzed clinical data of 88 cases of BBD for spectrum and clinical profile to compare with present studies.Methods: Clinical records of 88 cases of BBD were reviewed for demographic details, clinical presentation, management and outcome. Recent literature related to BBD in rural area was searched using various search engines. Results of our study were compared with recent studies.Results: Fibroadenoma (FA) was most common condition followed by fibrocystic disease. BBD were common in third decade 46 (52.3%). Lump was present in 87 cases. Lump was painful in 45 (52.3%), and associated with fever in 15 (17.1%) cases. Fine needle aspiration cytology and ultrasound was done in 70 and 32 patients in which diagnostic accuracy with histopathology was seen in 69.7% and 56.2% respectively. Surgical treatment included lumpectomy, lump excision, mastectomy, drainage with debridement and axillary clearance. Three patients of breast tuberculosis were treated with 9 months AKT. When compared with recent studies, over all spectrum was same expect chronic abscess presenting as lump was more in our series.Conclusions: Our study revealed benign neoplasms, inflammatory condition and tumor like lesions in 43.1%, 14.6% and 13.8% cases respectively. FA was the most common lesion. BBD were common in third decade. Except the chronic mastitis, incidence of various types of benign lesions was comparable with those found in other studies. There is not much change in overall spectrum of benign breast disease.

ENDOBRONCHIAL SURGICAL METHODS IN THE TREATMENT OF CHRONIC LUNG ABSCESS

Summary. Treatment of chronic lung abscesses remains a relevant problem of thoracic surgery. A key condition for clinical recovery of the patient or for optimal preoperative preparation is adequate drainage of the chronic abscess cavity. Endobronchial drainage methods are the most physiological and the least invasive. Materials and methods of research. On the basis of the clinic of the State Institution «V. T. Zaytsev Institute of General and Urgent Surgery of the National Academy of Sciences of Ukraine» 98 patients with chronic lung abscesses were examined and treated. The patients were divided into 2 groups. Patients of the main group together with anti-inflammatory drugs were systemically and locally prescribed liposomal drug «Lipin». The patients of the comparison group used traditional methods. Results and discussion. Efficiency of endobronchial drainage of a cavity of chronic abscesses is proved by positive ultrasound dynamics: acceleration of cleaning of an abscess cavity — earlier on 2,3 days, acceleration of positive ultrasound dynamics — earlier on 2,9 days. In the analysis of laboratory efficacy indicators — a significant positive effect of the specified methodology on reducing the level of endogenous intoxication is observed. Conclusions. The data obtained demonstrate the effectiveness of the proposed method of endobronchial drainage of a chronic abscess cavity together with combination anti-inflammatory therapy using Lipin and its advantage over traditional treatment regimens.

Recovering of Dizziness of a Patient with Sinusitis after Root Canal Therapy for Upper Second Molar

This case report illustrates the recovery of dizziness of a young healthy patient after root canal therapy of upper second molar. The patient developed dizziness and unbalanced walking four months ago. After cardiac, ENT, neurological, physiotherapy and medical investigations, his entire checkup showed no abnormalities. The patient visited a dental clinic for a routine checkup; after dental clinical and radiographical examination, a chronic abscess infection in an upper second molar region close to the sinus was diagnosed. Root canal therapy was performed that resulted in a disappearance of the dizziness and full recovery was achieved. Conclusion. Infected upper teeth with periapical lesion are associated with dizziness as a complication of odontogenic-related sinusitis. Dental and medical cooperation contributes to a better management diagnosis of the dizziness.

Gossypiboma: case report and review of literature

Gossypiboma or retained surgical sponge is an entirely preventable surgical complication; it is associated with significant morbidity to patient and medico legal issues to the surgeon. Clinical presentation depends upon location of the foreign body and tissue reaction to the foreign body. Pre-operative diagnosis is the most difficult part and treatment of choice is surgery. A 30 year female presented with 16 months history of gradually increasing lump on left side of lower abdomen following a caeserian section. Ultrasonography was suggestive of infected mesenteric cyst and contrast enhanced computed tomography scan of abdomen was suggestive of either chronic abscess or gossypiboma. She was treated surgically; intra-operatively there was a 10×10 cm well circumscribed lesion in sigmoid mesentery which was adherent to sigmoid colon. It was a single surgical sponge with about 1000 ml of pus. Gossypiboma is an entirely avoidable surgical complication which is associated with significant morbidity and medico-legal implications. Meticulous counts with thorough exploration of site before closure can lessen the undue morbidity or mortality. Radio frequency identification verification by barcode scanner can reduce the error rate.

Outcomes of Unroofing with Limited Excision and Structured Postoperative Care for Pilonidal Disease

Despite a wide variety of surgical techniques to treat chronic pilonidal disease, high rates of recurrence are common. The current study analyzes the outcome of unroofing with limited excision combined with structured postoperative wound care for pilonidal disease. We performed a retrospective review of all patients who were treated with this technique over a seven year period. Ninety-four patients aged 11 to 63 (mean age 26) received this treatment for pilonidal disease. Eighty-nine patients were treated for primary pilonidal disease and five were treated for recurrent disease after procedures such as flaps. There were 66 males (70%) and 28 females (30%). The operation was performed by unroofing the entire pilonidal sinus along with its pits and area of chronic abscess cavity. All granulation tissue was removed and the base of the sinus was completely cauterized. No wide local excisions were performed. The cavity was packed with dry gauze and the dressing was changed twice daily. Patients were seen postoperatively on a weekly basis in clinic. The area was shaved; the cavity was cleaned and often treated with silver nitrate. In the event of premature skin closure starting to form, unroofing was easily performed in the office. The median time to achieve complete healing was 53 days requiring, on average, seven visits. With a mean follow-up of 40 months, there were two recurrences (2.1%) and reoperation for two (2.1%) inappropriately healing wounds. This study demonstrates that unroofing with limited excision and structured postoperative care for pilonidal disease is a safe and effective treatment approach with a very low recurrence and complication rate.

Study of various benign breast diseases

Background:Benign breast disorders can be defined as any non-malignant breast condition and encompasses a wide range of clinical and pathological disorders. BBD are very common and 1/3rd of women are suffering from this disorder in one time of their life. The aim of this study is to look at the patterns of benign breast diseases, the mode of presentation, management and to identify risk factors.Methods: This descriptive study was done in 168 patients presented to the surgery OPD department with benign breast disorders. All the patients with breast related disease were included in this study. Both male and female patients were included in this study. Patients with obvious or biopsy proven malignant diseases were excluded in this study.Results:The study comprised of 168 patients with BBD; the commonest being Fibroadenoma which formed 55.9% followed by fibroadenosis 20.8%. The other benign lesions observed were cystosarcoma phylloids, acute abscess, chronic abscess, tuberculous mastitis, antibioma, cysts, galactocele, gynaecomastia, traumatic fat necrosis, duct papilloma and mastalgia.Conclusions:Benign breast disease is a neglected entity despite the fact that it constitutes the majority of breast complaints. Benign breast disease can no longer be ignored. Much more work needs to be done to collect data about the incidence and prevalence of benign breast diseases. Breast self-examination and education to the females is required for early diagnosis and prompt treatment as majority of anxiety and worry of having breast cancer can be alleviated.