Evaluation of the coexistence of pilonidal sinus disease and hirsutism in female patients: a retrospective cross-sectional study.

This study aimed to investigate the coexistence of pilonidal sinus disease (PSD) and hirsutism in female patients. Materials and methods: The demographic and clinical data of 164 female patients who underwent surgery for PSD between January 2007 and May 2014 were evaluated for this retrospective cross-sectional study. Data collected for this study were age, BMI, the modified Ferriman and Gallwey scale (mFGS) for hirsutism, main symptoms, type of surgery, early postoperative complications (wound infection, wound dehiscence), recurrence, and follow-up. The independent variables are hirsutism (mFGS scores) and BMI. Dependent variables are early postoperative complications and recurrence. Results: The median age was 20 years (95% CI for median: 19-21 years). According to the BMI, 45.7, 50.6, and 3.7% of patients were considered normal, overweight, and obese, respectively. According to the mFGS, 11, 9.8, 52.4, and 26.8% of patients were considered to have none, mild, moderate, or severe hirsutism, respectively. Fourteen (8.5%) patients had developed recurrence. Recurrence developed in six patients with primary closure, five patients with Limberg flaps, two patients with Karydakis, and one with marsupialization. There was no statistical difference between recurrent and nonrecurrent patients in terms of BMI (P=0.054) and mFGS (P=0.921). On the other hand, BMI was statistically significantly higher in those who developed early postoperative complications than in those who did not (P<0.001). Conclusion: PSD is no longer a 'men's only disease'. BMI increases the risk of early postoperative complications, but this association was not found between BMI and recurrence. Prospective multicenter studies are needed on the relationship between PSD and hirsutism.

Coexistence of tuberculosis and extranodal marginal zone lymphoma of the thyroid gland: Case report and literature review.

Introduction: Primary thyroid tuberculosis (TB) is rare even in countries where TB disease is endemic, with the prevalence ranging from 0.1 to 1.15%. Primary thyroid lymphoma is uncommon, and the majority of lymphomas arising in the thyroid gland are non-Hodgkin's lymphomas of B-cell origin, of which about 25% is extranodal marginal zone B cell lymphoma (MALToma). Case presentation: An 86-year- old Turkish female patient with thyroid nodules and cervical lymphadenopathies presented with large multinodular goiter and compressive symptoms. Total thyroidectomy and central lymph node dissection were performed. The revised histological and immunohistochemical revealed the coexistence of thyroid TB and MALToma. The patient received an anti-TB treatment for six months before a revised histopathological examination. About seven months after anti-TB treatment, the patient died due to an unknown cause. Clinical discussion: Although six cases of thyroid TB and papillary thyroid cancer have been documented in the medical literature, no cases of TB and MALToma coexistence have been published so far, to our knowledge. Another essential feature of this study is that the initial pathological examination was reported as thyroid TB. A subsequent re-examination revealed that the patient had both TB and MALT lymphoma. Conclusion: We discuss this rare association and the dilemma encountered in the diagnosis and management of this patient with a review of the literature.

Assessment of demographic, clinical and histopathological features of patients who underwent appendectomy due to a presumed diagnosis of acute appendicitis.

BACKGROUND: To compare the clinical, biochemical, and histopathological features of patients who underwent appendectomy due to a presumed diagnosis of acute appendicitis (AAp). METHODS: The demographic, biochemical and histopathological data of 8206 patients who underwent appendectomy for AAp between January 2006 and March 2014 were retrospectively analyzed in this study. Patients were compared regarding the following characteristics: disruption by season (autumn vs. winter vs. spring vs. summer), working days (weekdays vs. weekends), histopathological findings (AAp vs. normal appendix [NAp]) and histopathological subgroup (non-perforated AAp vs. perforated AAp vs. NAp). RESULTS: Of the 8206 patients aged between 16 and 89 years, 4763 (58.0%) were male. Appendectomy distribution by season was as follows: autumn (n=1959; 23.9%), winter (n=2062; 25.1%), spring (n=2061; 25.1%) and summer (n=2124, 25.9%). NAp rates were higher in summer than those in other seasons. White blood cell (WBC) and neutrophil levels were significantly higher in autumn and winter compared with those in other seasons. In total, 6120 (74.6%) appendectomies occurred on weekdays and 2086 (25.4%) on weekends. WBC and neutrophil levels were significantly higher on weekends than those on weekdays. Appendectomy distribution by histopathological groups as follows: AAp (n=7414; 90.3%) and NAp (n=792; 9.7%). Appendectomy distribution by histopathological subgroups was as follows: non-perforated AAp (n=6966; 84.9%), perforated AAp (n=448; 5.5%), and NAp (n=792; 9.7%). WBC, neutrophil, and TBil levels in the non-perforated and perforated AAp groups were significantly higher than in the NAp group. While most of the patients with perforated AAp (62.1%) and non-perforated AAp (59.6%) were males, most of the patients with NAp (58.1%) were females. CONCLUSION: This study suggests that a relationship exists between demographic features, histopathological findings of appendectomy specimens, seasons, days of the week, and working days in patients undergoing appendectomy.

Metastatic melanoma causing recurrent intussusception and perforation of small bowel: case reports and literature review.

AIM: To present cases of recurred jejuno-jejunal intussusception and jejunal perforation due to melanoma. MATERIALS & METHODS: Case 1: A 43-year-old male under treatment for malignant melanoma was presented with abdominal pain and distention. Ten centimeter intussuscepted jejunum was resected. Second exploration was done due to failure to pass gas and stool. The reintussusception was detected and resection of reintussuscepted jejunum was performed. Case 2: A 63-year-old male was presented with abdominal pain. Abdomen computed tomography showed free air in the abdomen suggesting intestinal perforations. Perforated area at 80 cm in the jejunum sutured. CONCLUSION: We present the seemingly first report of reintussusception of resected segment in a very short time. Surgeons should be aware of both intussusception and perforation in metastatic melanoma.

Recent classifications systems for gastroenteropancreatic neuroendocrine tumors A single-center experience.

AIM: In this study, we aimed to review the demographic histopathological and clinical findings and long-term results of our GEP-NET cases, as well as to re-evaluate our cases according to the new classification systems. MATERIAL AND METHOD: 46 patients diagnosed as GEPNETs were presented. Immunohistochemical studies were performed in all cases. The cases were divided into 3 groups according to their embryogenic origin (Foregut, Midgut and Hindgut). All cases re-evaluated according to recent WHO (2019) and AJCC (2017) TNM calcification. Investigation was made to find differences between the embryonic origins and to find correlation between stage and grading systems with each other. RESULTS: The most common localization was appendix (52.3%) The distribution of cases according to embryologic origin were as follows: foregut tumors 13 cases (27.7%), midgut tumors 27 cases (57.4%) and hindgut tumors in 6 cases (12.8%). The Ki-67 ratio was evaluated in all patients, with a mean of 6.34%±2.51 (range: 1-80). The Ki-67 ratio was less than 3% in 82.6% of patients. Mitotic count was less than 2 per/10 HPF in 76% of patients. According to WHO 2019 most of patients were Grade 1 Neuroendocrine Tumor (65.2%) and there were only 2 Neuroendocrine Carcinoma (NEC) cases. According to AJCC 2017 most cases were Stage 1 (52.1%) and only 4 cases were Stage 4. The grades and stages of our cases were statistically significantly correlated. Overall survival did not differ significantly with regard to embryologic origin (log-rank test, p=0.062). The median overall survival was 106±7.4 months. The 5-year cumulative survival rate was 84.1±5.6 years. Seven patients died during this time with a median time of 5 months (range: 1-31 months). In the Cox regression analysis, the percentage of Ki- 67 was found to have a statistically significant effect on overall survival (p=0.000) CONCLUSION: Correlation was noticed between WHO 2019 and AJCC 2017 classification for grade and stage and controlled trials must be undertaken to develop a single diagnostic algorithm and to change the future management of such patients. KEY WORDS: Neuroendocrine Tumors, Gastroenteropancreatic neuroendocrine tumor.

Relationship between clinical and histopathological features of patients undergoing cholecystectomy.

INTRODUCTION: Cholelithiasis is most common disease of the gallbladder and cholecystectomy is the one of the most performed surgical procedure worldwide. AIM: To assess the relationship between the demographic, biochemical, and histopathological variables of patients who underwent cholecystectomy. MATERIAL AND METHODS: Demographic, biochemical, and histopathological data of 5077 patients undergoing cholecystectomy were compared in terms of two different aspects: open cholecystectomy (OC group; n = 2090) versus laparoscopic cholecystectomy (LC group; n = 2987), and an elective group (n = 4814) versus an emergency group (n = 263). RESULTS: A total of 5077 patients aged between 13 and 97 years were included in the study. Aspartate aminotransferase (AST) levels, alanine aminotransferase (ALT) levels, mean platelet volume, and prevalence of acute/chronic cholecystitis were significantly higher in the LC group than in the OC group. On the other hand, age, direct bilirubin level, thrombocyte count, and prevalence of gallbladder cancer/gangrenous cholecystitis were significantly higher in the OC group than in the LC group. Levels of AST, ALT, white blood cells, neutrophils, and some prevalence of acute/chronic active cholecystitis were higher in the emergency group than in the elective group. On the other hand, the lymphocyte count and prevalence of chronic cholecystitis/hyperplastic polyps were higher in the elective group than in the emergency group. Histopathological analysis identified 32 patients with malignant gallbladder cancer as follows: adenocarcinoma (n = 21), mucinous adenocarcinoma (n = 3), papillary adenocarcinoma (n = 3), adenosquamous carcinoma (n = 1), clear cell adenocarcinoma (n = 2), squamous carcinoma (n = 1), and hepatocellular carcinoma metastasis (n = 1). CONCLUSIONS: Even when the appearance of gallbladder specimens is normal, histopathological assessment allows for early diagnosis of many unusual findings such as gallbladder cancer.

Retained gallbladder stones in trocar site hernia.

AIM: Retained stones after laparoscopic cholecystectomy occur after perforated gallbladder during surgery. A trocar site hernia with 8 retained gallstones is presented. PATIENT-METHOD: A 54-year-old female presented to our clinics with a paraumbilical hernia in trocar site. The patient had laparoscopic cholecystectomy in another hospital one year ago. Retained stones were noticed in the trocar site while preparing patients for hernia surgery. The patient had laparoscopic hernia repair with the removal of retained stones. 8 stones sized up to 2 cm were taken out of the abdomen. It seems to be the first case of retained stones in trocar site hernia. CONCLUSION: Gallbladder perforations are common during laparoscopic cholecystectomy due to traction with forceps or inflammation. Careful inspection for spillage stone should be done. KEY WORDS: Laparoscopic cholecystectomy, Retained Stones, hernia, Trocar Site.

Primary diffuse large B cell lymphoma of the lactating left breast. A case report and review of the literature.

The aim of this study is to present a case of Primary Diffuse Large B Cell Lymphoma of lactating left breast and after 10 years treatment in the right breast again during lactating period in a 31 years old female. Mammography showed a 4 cm lobule contoured mass in the outer quadrant of the left breast. Thorax CT showed a 42.6 mm and a few smaller nodular lesions in the middle and lower outer quadrants of the left breast and 27.3 mm diameter lymphadenopathy and smaller lymph nodes. In the past history of patient a mobile mass of 4 cm was found in the upper outer quadrant of the right breast during breastfeeding period after the 2nd birth at the 8th month in July 2010. Breast ultrasonography showed 37x22 mm solid lesion. Segmental mastectomy was performed for the mass (7x5x2.5 cm) at the state hospital in September 2010. The patient was diagnosed with Primary Diffuse Large B Cell Lymphoma (DLBCL), stage III. Six cycles of CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) and 2 cycles of monoclonal antibody rituximab were applied to the patient. In March 2011, the right chest wall was irradiated. Patient was under follow since that time. Almost 10 year later patient applied to our clinic with left breast mass again during lactating period. Mastectomy and axillary dissection were performed for local control and patient request. In pathological specimen examination, 5x4x4 cm gray a white hard mass was observed and gray-yellow lesion-like areas were observed in other areas. Two of 8 lymph nodes of axilla, the largest 3 cm, were found metastatic. In immunohistochemical staining, CD20, CD79a and PAX5 positive, Ki 67 70%, CD3, CD5, CyclinD1, CD10, CD30, CD99, TDT, CD38, CD1A, BCL- 2, CD34, EMA were negative. Pathological diagnosis was found primary DLBCL. The patient is currently good and receiving chemotherapy. CONCLUSION: Although bilateral primary DLBCL during breast feeding is very rare, mothers should be examined for breast mass during pregnancy and breastfeeding term. Surgery may be choice for local control of disease and supplementary radiotherapy, chemotherapy, and immunotherapy should be administered promptly following surgery. KEY WORDS: Bilateral, Lactating, Primary Breast Diffuse Large B Cell Lymphoma.

Assessment of the relationship between clinical and histopathological features in cases of thyroidectomy.

AIM: The aim of this study is to evaluate the relationship between clinical parameters and ultimate histopathologic features of patients underwent thyroid surgery. METHOD: Demographic and clinicopathologic parameters of patients who underwent thyroid surgery for benign or malignant disease in our clinic between June 2006 and March 2014 were retrospectively reviewed. Pearson's Chi-Square, Independent Sample T test, ROC Curve and Youden J Index were used to investigate whether there was any relationship between the clinical parameters and permanent histopathologic features of patients. RESULTS: A total of 3059 patients (Benign: 2727; Malign: 332) aged between 15 and 90 years were reviewed. The patients age was higher in malign group (mean ± SD: 46.8 ± 4.2) than benign group (mean ± SD: 43.7 ± 12.9 yr) and this difference was statistically significant (p <0.001). The nodule diameter (mean ± SD: 30.8 ± 13.5 mm) was greater in malign group than the benign group (mean ± SD: 28.3 ± 13.4 mm) and this difference was statistically significant (p = 0.002). The sensitivity and specificity rates of the most appropriate cut-off point (> 26 mm) for the nodule size were 60% and 49.05%, respectively. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of FNAB were calculated as 4.17 %, 100 %, 100 %, 89.96% and 90 %, respectively. CONCLUSION: This study showed that higher age and greater nodule diameter (> 26 mm) are associated with malignancy. KEY WORDS: Age, Large Nodule Diameter, Risk factors, Thyroid disease,Thyroid Cancer.

Bochdalek hernia: A rare case report of adult age.

INTRODUCTION: Bochdalek hernia is the most common type of congenital diaphragmatic hernia and constitutes 85% of cases. Bochdalek hernia (BH) in adults is extremely rare. We present a BH case in an adult patient and discuss the literature. PRESENTATION: 22-year-old female patient with abdominal pain, occasional cramps, dysphagic problems, constipation, shortness of breath and choking for about 2 years applied to our clinic. DIAGNOSIS: A defect about 5 cm in the left hemidiaphragm posterior area and herniation of intra-abdominal fat plan in the left hemithorax was seen in intravenous and oral whole abdominal CT. TREATMENT: Patient was operated laparoscopically. Transverse colon and a large portion of the omentum entering into hemidiaphragm were pulled in to intraperitoneal area carefully. Approximately 10 × 8 cm intraabdominal mesh was fixed to the defect area with the help of laparoscopic tacker. CONCLUSION: Adult BH is very rare and when confronted laparoscopic treatment with mesh fixation can be performed safely.

Case Report of Four Different Primary Mesenteric Neoplasms and Review of Literature.

INTRODUCTION: It is rare for primary tumors to arise from the mesentery. Lymphangiomas appear as congenital malformations of the lymphatic system or benign neoplasms as a large, thin-walled, often multilocular cyst. Mesenteric infiltration is common and during surgical treatment, adjustment of structures such as the bowel and resection of the spleen may be required. Cystic mesotheliomas are rare, benign tumors that originate from the peritoneal mesothelium and are more common in women. Mesenteric cysts are mostly benign and rare intra-abdominal tumors, and can be seen as occupying a large cyst. Malignant fibrous histiocytoma is a rare pleomorphic sarcoma that is more commonly encountered in men. After the extremities, the second most common areas to be affected are the retroperitoneum and peritoneal cavity. CASE PRESENTATION: We encountered four cases of different primary mesenteric neoplasms that were operated at the Gazi Yasargil teaching and research hospital, department of general surgery, Diyarbakir, Turkey, between 2013 and 2014. We reviewed these primary mesenteric neoplasms and compared them with previous literature. CONCLUSIONS: Primary mesenteric tumors are rare and mostly benign tumors. Complete surgical excision is necessary for all tumors and follow-up is necessary after surgery for malignant fibrous histiocytoma due to recurrence.

Giant Splenic Artery Pseudoaneurysm: A Case Report and Literature Review.

Splenic artery aneurysms (SAAs) are the third most frequent intra-abdominal aneurysm, following abdominal aorta and iliac artery aneurysms. SAAs are classified according to their involvement of arterial wall layers: true aneurysms involve all 3 layers (intima, media, and adventitia), and pseudoaneurysms involve only one or two. Herein we present a new case of giant pseudo SAA. A 65-year-old female patient with a pancreatic mass and iron deficiency was referred to our clinic for further investigation. Abdominal ultrasonography, contrast-enhanced CT and magnetic resonance imaging showed a lesion resembling a subcapsular hemangioma in the spleen, and aneurysmatic dilation of the splenic artery with a diameter of >5 cm. The large size of the aneurysm and the clinical findings were indications for surgical treatment. The patient underwent en bloc resection of the spleen, distal pancreas, and aneurysmatic segment of the splenic artery. The patient remains complication-free 2 months after the operation. Spontaneous rupture is the most important life-threatening complications of giant SAAs. Therefore, all symptomatic patients with SAA should be treated, as well as asymptomatic patients with lesions ≥2 cm, who are pregnant or fertile, have portal hypertension, or are candidates for liver transplantation. Despite advances in endovascular techniques, conventional abdominal surgery remains the gold standard for treatment.

Solid cystic pseudopapillary tumor of pancreas with splenic metastasis: Case report and review of literature.

INTRODUCTION: Solid-cystic pseudopapillary tumor of the pancreas is rare and most commonly seen in young women. We present a young women with solid-cystic pseudopapillary tumor of the pancreas and discuss the literature. PRESENTATION OF CASE: Thirty nine years old female patient with a mass about 12cm in the pancreas with splenic invasion seen in our clinic. After having CT and PET-CT view, patient underwent surgery. Distal pancreatectomy with mass excision and splenectomy was performed. Microscopic examination result was solid cystic pseudopapillary tumor with spleen invasion. DISCUSSION: Solid-cystic pseudopapillary tumor of the pancreas has cystic solid pseudopapillary structures. Prognosis of tumor is better than other pancreatic tumor. Complete resection of tumor with splenic inclusion is surgical treatment. CONCLUSION: In case of large slow growing pancreatic tumor with splenic metastasis, solid-cystic pseudopapillary tumor of the pancreas should be considered in the diagnosis. Complete surgical resection is associated with long-term survival even in the presence of metastatic disease. Close follow-up is necessary after surgery.

The effect of laser epilation on recurrence and satisfaction in patients with sacrococcygeal pilonidal disease: a prospective randomized controlled trial.

BACKGROUND: The primary aim of this prospective study was to investigate the effects of laser epilation on patient satisfaction and recurrence in patients who underwent pilonidal sinus surgery. METHOD: Sixty patients scheduled for pilonidal sinus surgery in our clinic between 2011 and 2012 were enrolled in this prospective randomized controlled study. Patients were divided in two groups of 30 patients each. Only the Karydakis flap reconstruction technique was performed in the first group. Two sessions of laser epilation were applied in the second group in addition to Karydakis flap reconstruction. The patients in the second group underwent laser epilation 2 weeks before and 3 weeks after the surgery for a total of 2 times in a private office. RESULTS: There were no statistically significant differences between the groups in terms of age, gender, smoking usage, ASA Score, duration of patient's complaints, BMI and hospital stay. There were no statistically significant differences between the groups in terms of surgical site infection, wound separation, abscess formation at the any time postoperatively. There were statistically significant differences between the two groups in the first week post operation considering the VAS pain score (P<0.03) and VAS satisfaction score (P<0.01). While there were statistically significant differences between the two groups in the first month post operation considering the VAS pain score (P<0.0001), there were no statistically significant differences between the groups in terms of VAS satisfaction score in the first and three month postoperatively. In the telephone interviews done 1 year after the surgery, recurrence were detected in 4% of first group and in 20% of second group. Recurrence rates were significantly higher in the second group (P=0.045). CONCLUSION: Our results show that laser epilation does not reduce the relapse rates in pilonidal sinus surgery, as expected. It is obvious that prospective randomized studies need to be held on this subject.

Post cholecystectomy gossypiboma mimicking a liver hydatid cyst: comprehensive literature review.

BACKGROUND: Gossypiboma is the term for forgotten textile products such as a surgical sponge and compress in the body cavity after a surgical procedure. OBJECTIVES: The aim of this study was to evaluate previously published articles related to post cholecystectomy gossypiboma. MATERIALS AND METHODS: We conducted a systematic search using PubMed, Medline, Google and Google Scholar on post cholecystectomy gossypiboma. The keywords used were: gossypiboma and cholecystectomy, textiloma and cholecystectomy and post cholecystectomy gossypiboma. Furthermore, we also present a new case of post cholecystectomy gossypiboma. RESULTS: A total of 32 articles concerning 38 patients with post cholecystectomy gossypiboma that met the aforementioned criteria were included. Detailed intraoperative findings and surgical management were provided. The patients were aged from 26 to 79 years (Mean ± SD: 47 ± 13.6 years); 32 were female and six were male. The time from the causative operation to presentation with a retained surgical sponge ranged from one to 480 months (Mean ± SD: 56.5 ± 93.5 months). CONCLUSIONS: Gossypiboma may not be symptomatic for many years or could be symptomatic for a short duration of time. Besides being a rare surgical complication, gossypiboma can lead to serious morbidity and mortality that may cause medico-legal problems. Diagnosis with imaging methods is difficult.

Actinomyces-induced inflammatory myofibroblastic tumor of the colon: A rare cause of an abdominal mass: Akbulut et al. inflammatory myofibroblastictumor due to actinomyces spp.

INTRODUCTION: Inflammatory myofibroblastic tumors (IMFTs) are neoplastic lesions that are either benign or have low-grade malignancy potential. Although the etiopathogenesis is not entirely clear, many factors play a role in their development, including trauma, autoimmune disorders, and infectious and inflammatory processes. However, IMFTs caused by Actinomyces spp. infection are rare, with a limited number of cases reported in the literature. PRESENTATION OF CASE: A 30-year-old woman was admitted to our clinic with abdominal pain and a palpable abdominal mass. Contrast-enhanced computed tomography revealed a tumoral lesion (11×10×7cm) in the right colon. A right hemicolectomy and ileocolic anastomosis were performed, during which almost complete obstruction of the lumen by the 7.5×7.0×5.0cm tumor was observed. Histopathology and immunohistochemical findings revealed that the tumor was consistent with an IMFT that developed from an Actinomyces infection. The patient was then placed on amoxicillin and doxycycline therapy. CONCLUSION: This case demonstrates that the development of IMFT secondary to actinomycosis is difficult to predict in the preoperative period. Once an exact diagnosis is confirmed by histopathologic examination, affected patients should receive prolonged antibiotherapy.

Mesenteric inflammatory pseudotumor: a case report and comprehensive literature review.

PURPOSE: This study aims to provide an overview of the literature on mesenteric/omental inflammatory pseudotumors (IPTs). METHODOLOGY: We present a new case of mesenteric IPT. We also conducted a systematic search of the English-language medical literature using PubMed, Medline, Google, and Google Scholar related to mesenteric or omental IPTs. The following search terms were used in various combinations: inflammatory myofibroblastic tumor, IPT, mesentery, and omentum. The search included articles published in the English language between January, 1978 and April, 2014. Studies were excluded if the full text was unavailable or missing information prohibited comparisons. RESULTS: A total of 30 reports concerning 36 patients with inflammatory pseudotumors meeting the aforementioned criteria were included. The patients were aged from 10 months to 68 years (mean, 19.98 ± 20.5 years); 12 were female (16.75 ± 16.97 years; range, 10 months to 68 years) and 24 were male (21.6 ± 21.9 years; range, 18 months to 63 years). Detailed clinical and pathologic characteristics of 36 patients with IPTs are provided in Table 1. CONCLUSION: IPTs may be definitively diagnosed only by histopathological examination and are most effectively treated by resection with negative surgical borders. No consensus has yet been reached regarding when nonsurgical treatment options are most appropriate in management of these lesions. IPTs often recur locally, while distant metastases are very rare. Postoperative close surveillance is essential to detect recurrences early.

Alternative medicine for management of breast masses: more harm than good.

UNLABELLED: CASE SERIES. PATIENT: -. FINAL DIAGNOSIS: Breast cancer. SYMPTOMS: -. MEDICATION: -. CLINICAL PROCEDURE: - SPECIALTY: -. OBJECTIVE: Diagnostic/therapeutic accidents. BACKGROUND: Several well-established, evidence-based treatment modalities are currently available and widely applied to breast cancer patients, but it is known that some of the cancer patients use traditional/alternative medicine other than their treatments. CASE REPORT: Herein, we report the cases of 2 middle-aged women (45 and 50 years old) with malignant breast masses who experienced serious complications in response to self-prescribed use of alternative medicine practices to treat their condition in lieu of evidence-based medical treatment. Specifically, the use and/or inappropriate application of alternative medical approaches promoted the progression of malignant fungating lesions in the breast for these 2 patients. The first patient sought medical assistance upon development of a fungating lesion 7∼8 cm in diameter and involving 1/3 of the breast, with a palpable mass of 5×6 cm immediately beneath the wound. The second patient sought medical assistance upon development of a wide, bleeding, ulcerous area with patchy necrotic tissue that comprised 2/3 of the breast and had a 10×6 cm palpable mass under the affected area. Use of some non-evidence-based medical treatments as complementary to evidence-based medical treatments may benefit the patient on an emotional level; however, this strategy should be used with caution, as the non-evidence-based therapies may cause physical harm or even counteract the evidence-based treatment. CONCLUSIONS: A malignant, fungating wound is a serious complication of advanced breast cancer. It is critical that the public is informed about the potential problems of self-treating wounds such as breast ulcers and masses. Additionally, campaigns are needed to increase awareness of the risks and life-threatening potential of using non-evidence-based medical therapies exclusively.

Gastrointestinal perforation due to incarcerated Meckel's diverticulum in right femoral canal.

Meckel's diverticulum is a very common congenital anomaly of the gastrointestinal tract but many cases remain asymptomatic and are diagnosed incidentally during laparoscopic or other surgical procedures. Cases of femoral hernia involving Meckel's diverticulum are rare, with less than 50 cases reported in the literature since Littre published the first description of this coincident condition over 300 years ago. While all true "Littre's hernias" contain a Meckel's diverticulum, the involved anatomical sites are various, the most common being the inner groin (inguinal), the outer groin (femoral), and the belly button (umbilical). Complications of Littre's hernias include incarceration, strangulation, necrosis, and perforation. Herein, we describe a case of Littre's hernia that involved an incarcerated Meckel's diverticulum in a femoral hernia that was diagnosed upon investigation of symptomology manifesting from perforation and was successfully managed by surgical resection with stapler devices.

Giant Meckel's diverticulum: An exceptional cause of intestinal obstruction.

Meckel's diverticulum (MD) results from incomplete involution of the proximal portion of the vitelline (also known as the omphalomesenteric) duct during weeks 5-7 of foetal development. Although MD is the most commonly diagnosed congenital gastrointestinal anomaly, it is estimated to affect only 2% of the population worldwide. Most cases are asymptomatic, and diagnosis is often made following investigation of unexplained gastrointestinal bleeding, perforation, inflammation or obstruction that prompt clinic presentation. While MD range in size from 1-10 cm, cases of giant MD (≥ 5 cm) are relatively rare and associated with more severe forms of the complications, especially for obstruction. Herein, we report a case of giant MD with secondary small bowel obstruction in an adult male that was successfully managed by surgical resection and anastomosis created with endoscopic stapler device (80 mm, endo-GIA stapler). Patient was discharged on post-operative day 6 without any complications. Histopathologic examination indicated Meckel's diverticulitis without gastric or pancreatic metaplasia.