A Case of a Metastatic Pancreatic Neuroendocrine Tumor: A Surgical Conundrum Wrapped in Functionality's Embrace.

This case study reports a rare case of a non-functioning metastatic pancreatic neuroendocrine tumor (pNET) transforming into a functioning pNET. A 59-year-old male, previously treated with distal pancreatectomy, splenectomy, lymph node dissection, liver metastasectomy, and pharmacotherapy, presented with weakness, hypoglycemia, and daily episodes of watery diarrhea. A functioning neuroendocrine liver metastasis expressing insulin and gastrin was identified. Surgical intervention, including left lateral hepatectomy and microwave ablation of multiple intrahepatic lesions, resulted in symptom resolution and uneventful recovery. However, metastatic liver disease re-emerged seven months post-surgery, necessitating chemotherapy. This case highlights the importance of vigilance for symptom development in non-functioning pNETs, signaling potential disease relapse and phenotype transformation, and suggests surgical treatment as a viable option in select cases.

Hepatic Small Vessel Neoplasm: A Case Report and Review of the Literature.

Hepatic small vessel neoplasm (HSVN) is a recently described vascular neoplasm of the liver. It demonstrates an infiltrative growth pattern and lacks cytologic atypia and mitotic activity. So far, no cases of metastasis or disease recurrence after excision have been reported in the literature. In this report, we present the case of a 31-year-old woman with a lesion in segments VII-VIII of the liver who was referred to our surgical department due to right lumbar pain. She underwent an atypical wedge hepatectomy (segments VII, VIII) and cholecystectomy. The histopathology of the resected specimen confirmed a 40mm HSVN. The patient did not receive any adjuvant therapy and is scheduled for follow-up with serial magnetic resonance imaging (MRI) scans over the next five years due to the unknown malignant potential of the tumor.

Bacterial Translocation as a Source of Postoperative Fever After Revision of a Previous Duodenal Switch for Super-morbid Obesity: A Case Report.

Bacterial translocation is defined as the invasion of gut bacteria or bacterial products to the systemic circulation via permeation through the gastrointestinal mucosal wall. In this article, we present the case of a patient with postoperative fever of unknown origin which was attributed to bacterial translocation after revisional surgery due to malabsorptive complications after an initial duodenal switch for super-morbid obesity.

Role and Efficacy of Robotic-assisted Radical Antegrade Modular Pancreatosplenectomy (RAMPS) in Left-sided Pancreatic Cancer.

Distal pancreatectomy with splenectomy is the gold-standard surgery for the treatment of left-sided pancreatic cancer. Margin negative resection accompanied by effective lymphadenectomy are the deciding factors affecting the outcome of tail-body pancreatic adenocarcinoma. Radical antegrade modular pancreatosplenectomy (RAMPS) is considered as a reasonable approach for margin-negative and systemic lymph node clearance. Herein, we aim to present all existing data regarding this novel approach including surgical technique and comparison with standardized procedures. RAMPS has shown oncological superiority comparing to distal pancreatectomy with splenectomy due to radical lymphadenectomy and improved dissection of the posterior pancreatic aspects. Robotic-assisted RAMPS has recently been described as a valuable alternative to open RAMPS. With this novel technique, anterior, posterior or modified approaches can be achieved; favorable clinical and oncological outcomes have been reported in the current literature, with reduced conversion rates compared to other minimally invasive approaches, as well as vastly improved maneuverability, accuracy and vision. Robotic-assisted RAMPS is not only technically feasible but also oncologically safe in cases of well-selected, left-sided pancreatic cancer.

Minimally Invasive Transcervical Esophagectomy With Mediastinal Lymphadenectomy for Cancer. A Comparison With Standardized Techniques.

Pulmonary complications remain the most common problem following transthoracic esophagectomy. Minimally invasive approach has significantly improved clinical outcomes; however, respiratory distress is still significant. Minimally invasive transcervical esophagectomy with mediastinal lymphadenectomy avoids thoracic access, which may decrease pulmonary complications. Transcervical esophagectomy refers to transcervical esophageal mobilization and mediastinal lymphadenectomy followed by a transhiatal gastric and distal-esophageal mobilization, abdominal and lower mediastinal lymphadenectomy. Adoption of innovative minimally invasive techniques for the transcervical or transhiatal approach, such as laparoscopy or robotic-assisted mediastinoscopy have made possible transmediastinal approach for radical esophagectomy. This novel approach with avoidance of thoracotomy or thoracoscopy can omit one lung ventilation as in transthoracic esophagectomy. Patients with previous thoracic surgery, impaired respiratory system, and major comorbidities, who are unable to undergo transthoracic esophagectomy, become candidates for radical esophagectomy with promising results. Minimally invasive transcervical esophagectomy for esophageal cancer is a safe and feasible approach and may be a valuable alternative with promising clinical and oncological outcomes.

An extraordinary rare presentation of liver hydatidosis with hydatid cyst scolices.

The extraordinary finding of scolices with the characteristic hooklets may be found during the microscopic analysis in patients with cystic echinococcosis.

Treatment of Fournier's Gangrene With Vacuum-assisted Closure Therapy as Enhanced Recovery Treatment Modality.

BACKGROUND/AIM: Fournier's gangrene is an uncommon, but extremely serious condition of necrotizing, soft tissue infection. There is a great debate regarding the management of larger defects and wound closure, with various techniques being described in the current literature. We aimed to present the surgical management of extensive Fournier's gangrene treated successfully with Vacuum-assisted closure (VAC) therapy, a novel approach to treatment algorithm that can lead to a paradigm shift. CASE: A 66-year-old male patient with Fournier's gangrene was treated with extensive surgical debridement, protective colostomy and VAC therapy. RESULTS: After initial extensive surgical debridement, VAC therapy significantly improved the clinical and aesthetic condition of the patient. CONCLUSION: VAC therapy in Fournier's gangrene patients may be a safe and effective technique with favorable clinical outcomes, by improving and enhancing wound healing and recovery.

Lymphoepithelial pancreatic cyst: A rare entity among pancreatic cystic lesions. Report of two cases.

Lymphoepithelial pancreatic cysts are extremely rare benign pancreatic cystic lesions. High suspicion and an individual approach are imperative for the best management of those extremely rare entities.

Laparoscopic repair of Amyand's hernia complicated with acute appendicitis. Report of a case.

The presence of vermiform appendix in an inguinal hernia sac is known as Amyand's hernia. Amyand's hernia complicated with acute appendicitis is an extremely rare entity with challenging diagnosis and large debate about the optimal treatment option. We report a case of a 58-year-old man presenting to the Emergency Department with an incarcerated right inguinal hernia. At laparoscopy, an inflamed appendix was identified within the inguinal canal, representing an indirect Amyand's hernia. A laparoscopic appendicectomy was performed followed by a trans-abdominal pre-peritoneal mesh repair of the aforementioned hernia. We report this rare clinical entity raising physicians' awareness to include acute appendicitis within an Amyand's hernia in the differential diagnosis of incarcerated inguinal hernias, along with a successful minimally invasive surgical approach.

Breast reconstruction with autologous fat combined with platelet rich plasma: fighting between medical novelty and cancer biology.

The use of autologous fat transplantation for reconstruction purposes after mastectomy or Breast Conserving Treatment (BCT) for Breast Cancer (BC) has increased significantly the past twenty years. Adipose-derived stemm cells hold great tissue regenerative potential due to their established ability to improve the healing process through in situ differentiation and secretion of paracrine factors. Platelet-rich Plasma (PRP), contains high levels of diverse human growth factors for stem cells proliferation and differentiation in the course of tissue regeneration, and it has recently been accepted by many as a highly promising method for tissue regeneration. The molecular mechanisms mediating this effect are unclear and still remain under investigation. Major disadvantages on the use of PRP are not reported. Promising results in enhancing the survival of grafted fat has been shown with PRP with the potential of affecting patient's oncological outcome when applied on tumor excision sites.