Thoracic composite hemangioendothelioma with neuroendocrine marker expression.

BACKGROUND: Composite hemangioendothelioma is an extraordinarily rare form of vascular neoplasm which develops predominantly in the skins and soft tissues of the adults. Neuroendocrine marker expression in composite hemangioendothelioma is considered as specifically relevant to the more aggressive behavior. CASE PRESENTATION: The patient was a 71-year-old man complaining continuous back pain. Computed tomography (CT) showed that 10 cm of contrast-enhanced soft tissue mass was occurring on the right posterior chest wall and developing adjacent to the spinal canal. Via the laminectomy, the tumor end was identified and separated from the dura mater. Then, via the posterolateral thoracotomy, the en bloc resection was achieved by separating the tumor from the diaphragm and vertebras. Histologic examination showed a complex combination of epithelioid and retiform hemangioendothelioma areas which were positive for anti-synaptophysin staining. At 12-month follow-up, there were no signs of tumor recurrence on CT, and the patient had no symptom. CONCLUSIONS: We achieved the complete resection of a huge thoracic neuroendocrine composite hemangioendothelioma developing adjacent to the spinal canal. The combination of the posterior lumbar laminectomy and the following posterior thoracotomy is a viable approach to radically resect a thoracic neuroendocrine composite hemangioendothelioma involving chest wall.

A Ventral Hernia-repair-related Mycobacterium mageritense Mesh Infection Treated with NPWT without Mesh Removal.

Abdominal hernias are often repaired using prosthetic mesh, which is susceptible to infections. Normally, it is necessary to remove the mesh. However, successful mesh salvation with negative-pressure wound therapy (NPWT) has recently been reported. We encountered Mycobacterium(M) mageritense infection after hernia repair using the mesh. M. mageritense is classified as a fast-growing nontuberculous mycobacterium, but few cases have been reported. Nontuberculous mycobacterium can cause rare chronic infections. Skin and soft-tissue infections by nontuberculous mycobacterium involving localized abscess formation and chronic abscesses under various situations have been reported. We report an 85-year-old woman in whom a ventral hernia repair-related M. mageritense mesh infection was treated with NPWT without mesh removal. The hernia was repaired using Bard Ventralex mesh. Pus discharge was seen on the seventh postoperative day, and there was a small area of necrosis under the mesh. From the 13th postoperative day, NPWT was performed for 4 weeks. On the 29th postoperative day, a M. mageritense infection was diagnosed, which was resistant to multiple drugs. After the NPWT, most of the wound showed good granulation tissue formation. In conclusion, the mesh used to repair a hernia became infected with M. mageritense, but NPWT was able to salvage it. In cases of mesh infection involving small necrotic areas, performing NPWT under the guidance of an infectious disease expert may make it possible to preserve the mesh.

[Allergy of calcium phosphate cement material following skull reconstruction: a case report].

The paste form of calcium phosphate cement is often used in skull reconstruction because of the biocompatibility and early handling of these cements. Although it had rarely been shown to produce a foreign body reaction, we encountered a patient who experienced an allergic reaction to calcium phosphate cements(Biopex®. A patch test was performed and a positive reaction to magnesium phosphate was obtained. Biopex® contains magnesium phosphate, so we diagnosed this case as allergic reaction. Pathological analysis revealed infiltration of plasmacytes in the bone flap around the calcium phosphate cement. The postoperative course was uneventful 3 years after surgery. Allergy to calcium phosphate cements is rare, but must be considered in differential diagnosis of its side effects.

Infection-induced urethral defect treated by urethral reconstruction with a radial forearm flap.

Abstract A 47-year-old man was admitted with the chief complaint of a urethral defect. An approximately 17-cm defect of the urethra seemed to have been occurred by the infection of implanted foreign bodies in the penile skin. Reconstruction of the urethra and the ventral skin was performed with a free radial forearm flap. A fistula formed at the proximal anastomosis after the operation, but was controlled conservatively. Urethral stricture at the proximal anastomosis subsequently developed. A urethral stent made of shape memory alloy was placed with the preservation of voiding function.