Peri anal region is an overlooked location for pilonidal recurrence after surgical excision and closure - A case series.

INTRODUCTION AND IMPORTANCE: Patients with pilonidal disease (PD) often undergo wide excision of pilonidal sinuses and flap-based closures. Patients who failed these procedures can have recurrent perianal wounds obscured by hair and unrecognized even by the treating physicians. In this report, we describe a series of pilonidal patients with recurrent disease and perianal wounds. CASE PRESENTATION: Five pilonidal patients with recurrent disease after surgical excision and flap closure were referred to our Pilonidal Care Clinic. All five were found to have perianal wounds. Each patient was treated with regular manual and laser epilation and only one patient required a Gips procedure. All wounds were successfully healed. CLINICAL DISCUSSION: After removal of hair at the perianal region, patients with recurrent pilonidal disease can expose a pilonidal sinus that was previously unrecognized. Peri-anal wounds can have poor wound healing due to the close proximity of the wound to the anal verge, risk of contamination, difficulty of consistent observation of the wound, and moist environment of the anus that retains bacteria. Careful consideration of proper wound care post-excision of perianal pilonidal sinuses should be prioritized. CONCLUSIONS: Pilonidal perianal wounds after previous surgical excision and flap closure can be obscured by hair, resulting in recurrent pain and drainage. The perianal wounds can be successfully healed with regular manual and laser epilation and selectively excised using Gips procedure.

Decoding a Rare Case of Pleomorphic Adenoma: A Case Report and Review of the Literature.

Diagnosing palatal swellings is crucial for various reasons, mainly because these swellings can signal a range of health problems, from benign conditions to more serious diseases. Here, we have reported an interesting case of long-standing palatal swelling. Accurate diagnosis typically involves a combination of clinical examination, patient history, imaging studies, and possibly biopsy or other laboratory tests. Since each condition has unique characteristics and treatment approaches, differential diagnosis is essential for ensuring effective management. This case highlights the importance of considering pleomorphic adenoma in the differential diagnosis of palatal tumors and demonstrates the effectiveness of surgical management. A literature review is also presented, discussing the clinical, radiological, and histopathological features of this rare entity. Accurate diagnosis and timely intervention are crucial for effective treatment and maintaining overall oral health.

Managing malignant sublingual gland tumors: a single institution experience with 23 patients.

BACKGROUND: Due to the relative rarity of malignant sublingual gland tumors, diagnosing and treating them clinically pose challenges. Hence, there's a need to explore the pathological types, characteristics, treatment methods, and prognosis of primary malignant tumors of the sublingual gland to improve our understanding and management of these rare yet highly malignant conditions. METHODS: This study reviewed cases of primary malignant sublingual gland tumors, analyzing their characteristics. The treatment methods included surgical excision, with additional radiotherapy, or brachytherapy for advanced stages or positive surgical margins. The study also summarized different treatment approaches, including lymph node dissection and soft tissue reconstruction using free flaps such as the anterolateral thigh flap and forearm flap. RESULTS: We have gathered 23 cases of sublingual gland malignancies treated at the Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, from January 2013 to May 2024. The most common pathological types were adenoid cystic carcinoma and mucoepidermoid carcinoma, with rare cases of mucosa-associated lymphoid tissue (MALT) lymphoma and nonspecific salivary gland clear cell carcinoma. Early diagnosis and surgical intervention were crucial for a favorable prognosis. Marginal mandibulectomy was necessary for cases involving the mandible. Patients with positive preoperative lymph node detection required cervical lymph node dissection. Extensive tissue defects in the floor of the mouth were effectively reconstructed with free flaps to prevent oral-mandibular fistula. CONCLUSION: Surgical excision remains the preferred treatment for malignant sublingual gland tumors. Early diagnosis and comprehensive surgical management are essential for improving prognosis. The study's limitations include a small sample size and short follow-up duration, necessitating further research with larger clinical samples to confirm these findings.

Clinical Characteristics of Local Recurrent Basal Cell Carcinoma After Surgical Excision: A Retrospective Study of the Patients From a Tertiary Clinical Center.

BACKGROUND: Basal cell carcinoma (BCC) is the most frequent form of skin cancer. The etiology of recurrent BCC is multifactorial, and the recurrence rate is variable. OBJECTIVE: The aim of the study was to identify the risk factors of local recurrence after surgical excision in primary BCC. MATERIALS AND METHODS:  In our study, 934 patients histopathological diagnosed with BCCs between January 2017 and June 2022 were evaluated retrospectively. Among these, patients who were regularly followed up for at least three years were included in the study. Patients who underwent non-excision treatment were excluded. All the patients who had pathologically confirmed, surgically excised BCCs with safety margins and those with a clinicopathological diagnosis of recurrent BCCs. Demographic and clinical features of 78 patients with non-recurrent primary BCC and 55 patients with local recurrent BCC were compared. RESULTS: The mean age was 69.7±11.7 years. The gender distribution was M/F:1.3. The time from diagnosis to total surgical excision was 2.3±1.4 months, and the time of recurrence was 27.5±23.3 months. The age of the patients, the time from diagnosis to total excision, the lesion size > 2 cm, and the presence of risk factors (such as radiotherapy, malignancy, and immunosuppression) were higher in the recurrent group than in the non-recurrent group (p < 0.05). Location (high/medium/low-risk area) and the presence of multiple lesions did not differ significantly between the recurrent and non-recurrent groups. CONCLUSION: In patients with BCC, recurrence is often detected in the first three years after diagnosis. Our study determined age, lesion size, accompanying risk factors, and the length of time until total excision as risk factors for recurrence in BCC patients. The histological subtype and lesion localization did not differ between the group with and without recurrence.

Primary angiosarcoma of the breast: a literature review.

BACKGROUND AND OBJECTIVE: Primary angiosarcoma of the breast (PBA) is an extremely rare and heterogeneous disease. PBA is difficult to diagnose and has a poor prognosis. In order to better understand the disease and provide evidence-based treatment for PBA patients, a review of the published literature in the English language was conducted. METHODS: A literature review in agreement with the PRISMA protocol was conducted. Medline and Cochrane databases were searched for English articles on PBA patients in September 2023 with a predetermined strategy. The articles were categorized and assessed based on hierarchical levels of scientific evidence. KEY CONTENT AND FINDINGS: A total of 255 articles were identified, among these 137 publications which included 1,888 patients met the criteria for inclusion in the final analysis. No prospective, randomized trials exclusive to PBA have been recognized. This article provides an overview of the most current and comprehensive evidence concerning the epidemiology, etiology, genomic features, clinical presentations, diagnosis, treatment, and prognosis of PBA. CONCLUSIONS: Despite the fact that current evidence is largely derived from retrospective studies, database analyses, and case reports, we utilized this information to tackle important clinical questions concerning optimal patient management practices for PBA. Complete surgical excision continues to be the mainstay treatment for PBA. However, the effectiveness of adjuvant therapies is still unclear. This narrative review highlights the urgent need for more rigorously designed research to enhance the management and treatment strategies for PBA.

Recurrence in Oral Leukoplakia: A Systematic Review and Meta-analysis.

The management of oral leukoplakia (OL) is challenging because of a high risk for recurrence and malignant transformation (MT), and recurrent OL is associated with a higher risk of MT than nonrecurrent OL. The present meta-analysis aimed to examine the association between OL recurrence and surgical techniques used for their management as well as their clinicopathological factors. Electronic searches were conducted in EMBASE, PubMed, Scopus, and Web of Science to retrieve studies reporting OL recurrence after surgery. The pooled proportion of OL recurrence after surgical excision was estimated. Subgroup analyses were conducted based on the surgical technique, data type, grades of epithelial dysplasia, anatomical subsites, clinical type and size of the lesion, surgical margin, and risk habits. Meta-regression analyses were conducted to identify the association between age, sex, and follow-up duration and OL recurrence. The risk of MT based on the recurrence status was also estimated. A network meta-analysis was performed to determine the surgical modality associated with the least OL recurrence. Eighty studies with a total of 7,614 samples and various surgical modalities (laser-based techniques, conventional scalpel surgery, cryosurgery, and photodynamic therapy) were included in the meta-analysis. A pooled proportion of recurrence of 22% was observed. Laser-based surgeries resulted in fewer OL recurrences than other surgical modalities, and the combination of laser excision and vaporization was identified to be the best treatment approach. OL in the retromolar area and multiple sites, nonhomogeneous OL, advanced age, female sex, inadequate surgical margin, retrospective data, and betel quid chewing habit were significantly associated with higher OL recurrence. Recurrent OL showed a 7.39 times higher risk of MT than nonrecurrent OL. These results suggest that the combination of laser excision and vaporization might reduce OL recurrence. Furthermore, OL in older patients, females, and nonhomogeneous OL need close monitoring after any surgical therapy.

Lipoma in the Oral Cavity: A Rare Entity.

Lipoma is a painless soft tissue tumor of mesenchymal origin, which is a well-defined and slow-growing tissue. The occurrence of lipoma is rare in the oral cavity (1-4%); however, the frequency is much higher in the head and neck region. The lipoma is commonly present in the buccal mucosa, lips, tongue, palate, buccal sulcus, and floor of the mouth. Sometimes, the lipoma becomes large enough to cause difficulty in speech and mastication. The main treatment for lipoma is surgical excision.

Cardiac Paraganglioma in a Young Patient Presents with Angina-like Symptoms: A Case Report and Literature Review.

Paragangliomas are rare extra-adrenal neuroendocrine tumors originating from chromaffin tissue that present a diagnostic and therapeutic challenge due to their diverse clinical manifestations and low incidence. While these tumors often manifest as catecholamine-secreting functional tumors, their clinical presentation can vary, leading to delayed diagnosis and challenging management. This study presents the case of a 22-year-old patient with cardiac paraganglioma who initially presented with angina-like symptoms, highlighting the importance of considering this rare condition in young individuals with nonspecific complaints. Diagnostic imaging, including transthoracic echocardiography, CT angiography, and MRI, played a crucial role in identifying the tumor's location and vascularization. Surgical excision, including pulmonary artery graft and CABG, was the primary management approach, which was accompanied by intraoperative complications that later led to CCU admission, followed by postoperative complications, ultimately leading to the patient's death. This case highlights the significance of early recognition and management of complications following a surgical approach to treat paragangliomas.

Oral Focal Mucinosis of the Tongue: Case Report and Review of the Literature.

Oral focal mucinosis (OFM) is an oral mucosal lesion characterized by focal mucosal accumulation that rarely occurs on the tongue. This report describes a rare case of OFM on the right side of the tongue in a 71-year-old female patient. The clinical features of OFM have not been well defined, making it difficult to differentiate it from other lesions based solely on clinical manifestations; therefore, histopathological examinations are necessary. Although OFM on the tongue is rare and has a good prognosis with resection, it should be considered as differential for painless mass lesions in the oral cavity.

First vacuum-assisted excision of a breast intraductal papilloma in the pediatric age group: Case report.

Intraductal papillomas (IP) are benign breast tumors that can occur in adolescents and young women, but they are extremely rare in pediatric age group and their occurrence in pediatric patients is not well documented in the medical literature [1,2]. The standard approach for IPs in teenagers involves conservative management with careful monitoring and follow-up imaging. However, in select cases, surgical intervention may be warranted to confirm the diagnosis and prevent complications such as bleeding or infection [3,4]. A novel, less invasive alternative to surgical excision is ultrasound-guided vacuum-assisted excision (VAE), which uses ultrasound to accurately target and extract the lesion using a vacuum-assisted device [4,5]. Compared to surgical excision, VAE offers the advantage of being a less invasive procedure, which leads to a decrease in the number of complications. Over the past 10 years, this method has become increasingly popular due to its ability to specifically and efficiently remove intraductal papilloma while minimizing risks and preserving the structure of the breast [5,6]. To our knowledge, this is the first documented use of VAE in a pediatric patient, as demonstrated in our case of a 9-year-old with nipple discharge successfully managed with VAE, highlighting its potential as a viable treatment option for pediatric breast lesions. This case highlights the potential use and success of VAE as a management option for breast lesions in pediatric patients. Further research and additional case reports are needed to further establish the efficacy and safety of this technique in this specific age group.

Evaluating Treatment Modalities for Reducing Recurrence in Central Giant Cell Granuloma: A Narrative Review.

Treating central giant cell granuloma (CGCG) is challenging due to high recurrence rates and variable therapy responses. This study examines the efficacy of various treatments in reducing CGCG recurrence. A literature review explored outcomes of surgical excision, curettage, intralesional corticosteroid injection, and adjuvant therapy, considering factors like lesion location, size, and histological features. Aggressive surgical techniques such as en bloc resection were found to potentially lower recurrence rates compared to conservative approaches. However, treatment should be tailored to individual patient needs. Further research is needed to confirm these findings and improve treatment strategies. A concise literature review was conducted using PubMed, MEDLINE, and Google Scholar, focusing on papers published from 1986 to 2024. Search terms included "central giant cell granuloma", "recurrence", "treatment modalities", and "surgical excision". Studies reporting recurrence rates and treatment outcomes for CGCG were analyzed. Twenty-nine studies were reviewed, including six studies on surgical excision and curettage, eight studies on intralesional corticosteroid injections, six studies on calcitonin therapy, five studies on interferon-alpha therapy, and four studies on the therapy with denosumab. Analysis indicated that aggressive surgical treatments like en bloc resection were associated with lower recurrence rates compared to conservative methods. Predictors of recurrence included lesion size (>3 cm), location (mandible), and aggressive histopathological features. Aggressive surgical excision combined with nonsurgical methods may lower recurrence rates, while conservative techniques remain viable in some cases. Further prospective research is needed to validate these findings and enhance CGCG treatment options.

Complex odontoma: A single center case series.

Odontoma is a benign mixed odontogenic tumor. Odontoma is classified into two variants: compound odontoma, which has resemblance to the tooth structure, and complex odontoma, which consists of haphazardly arranged enamel and dentin bearing no resemblance to the tooth structure. The most common site of occurrence of complex odontoma is the posterior aspect of mandible. Surgical excision of the complex odontoma remains the mainstay of treatment, which seldom recurs. Here, we report a series of complex odontoma cases reported to our institute that were managed by surgical excision with no signs of recurrence in subsequent follow-up appointments.

Prophylactic antibiotics for excision of premalignant vulvar lesions: A pilot randomized controlled trial.

No prospective data have been described to inform guidelines on antibiotic prophylaxis for partial vulvectomies. Thus, we conducted a single-center, pilot, double-blind randomized controlled trial to assess the effectiveness of prophylactic antibiotics to prevent wound complications after partial vulvectomies. Patients were randomly assigned 1:1 to preoperative antibiotics or no preoperative antibiotics. The primary outcome of 30-day postoperative wound complications occurred in 31 (62 %) of all patients, with no differences between groups. The most common wound complications were superficial separation (54.2 % antibiotic prophylaxis vs. 65.3 % no prophylaxis, p = 0.37) and surgical site infection (0 % antibiotic prophylaxis vs 7.7 % no prophylaxis, p = 0.49). However, this study was limited by differences in patient characteristics between the groups. This study provides data to perform power calculations for a trial examining the effect of preoperative antibiotics on surgical site infection.

An Unexpected Giant: A Case of Massive Paratesticular Extra-mammary Myofibroblastoma.

Mammary-type myofibroblastomas (MFBs) are benign spindle cell tumors, typically presenting in common locations such as the breast, abdomen, and inguinal region. We present a case of a 66-year-old male with a four-year history of painless scrotal swelling. The preoperative diagnosis was challenging, with an initial suspicion of soft tissue sarcoma. A complete surgical excision was performed, revealing a well-circumscribed, encapsulated mass. The tumor measured 30 x 20 x 14 cm, weighing 5.28 kg. Histopathology confirmed an MFB. This exceptionally large paratesticular MFB emphasizes the diagnostic difficulty of such tumors. Surgical resection remains the treatment of choice, with an excellent prognosis. This case highlights the importance of considering MFB in the differential diagnosis of scrotal masses, even with atypical presentations.

Retroperitoneal cystic lymphangioma coexisting with a uterine fibroid in a 42-year-old woman: A case report.

Lymphangiomas are rare benign neoplasms traditionally thought to result from congenital lymphatic channel malformations, though they may also be associated with other conditions. Retroperitoneal lymphangiomas account for 1% of all lymphangiomas, and fewer than 200 cases have been reported. A 42-year-old woman was admitted with symptoms of abdominal pain and distension. A computerized tomography (CT) scan showed an abdomino-pelvic mass and a giant uterine myoma. The patient underwent explorative laparotomy and the whole cyst mass was removed along with the uterine myoma. Cystic lymphangiomas are often misdiagnosed because of the vague symptoms and the absence of obvious etiology. A provisional diagnosis can be made with CT but histological examination confirms the diagnosis. Cystic lymphangioma should be included in the differential diagnosis of an ovarian cystic mass. Complete resection can be curative.

Atypical Presentation of an Osteoid Osteoma With a Multicentric Nidus.

An osteoid osteoma is typically a benign bone tumor affecting young adult males, often presenting with nocturnal pain alleviated by nonsteroidal anti-inflammatory medications (NSAIDS). It usually manifests as a solitary nidus with surrounding sclerosis. An osteoid osteoma with a multicentric nidus, characterized by multiple nidi, is a rare variant. A 12-year-old girl presented with a one-year history of worsening, nighttime pain in her upper left leg. Plain radiographs revealed two lytic lesions with sclerosis. A computed tomography (CT) scan confirmed two well-defined sclerotic lesions with central lytic lesions. Magnetic resonance imaging (MRI) demonstrated two hypointense lesions with peripheral hyperintensity on short tau inversion recovery (STIR) sequences, suggestive of osteoid osteoma with a multicentric nidus. Differential diagnoses included osteomyelitis with Brodie's abscess, osteoblastoma, chondroblastoma, and malignant lesions. Due to the atypical presentation and lack of experience with radiofrequency ablation (RFA) for multicentric cases, surgical excision was performed. Histopathology confirmed osteoid osteoma. After rehabilitation, the patient was asymptomatic at six months with no recurrence on radiographs. This case highlights the unusual presentation of osteoid osteoma with a multicentric nidus in a young female. Radiological workup with plain films, CT, and MRI was crucial for diagnosis. While RFA is gaining popularity, surgical excision remains a valid option, especially for atypical cases.

A case series of preoperative endovascular embolization of nasopharyngeal angiofibroma.

Nasopharyngeal angiofibroma (NA) is a relatively rare, noncancerous, extremely vascular tumor, and it is only found in males. NA receives blood supply from various sources and can lead to major blood loss after surgical excision. Nowadays, endovascular embolization has the potential to reduce intraoperative bleeding and lower the recurrence rate. This case series aimed to describe the preoperative endovascular embolization of nasopharyngeal angiofibroma. In this study, we reported 3 cases of adolescents with NA diagnosed using CT angiography. All subjects had a successful embolization, which led to minimal postoperative bleeding and good outcome.

Using colorimetric in situ hybridisation method for FcaPV-2 to estimate postsurgical prognosis in feline Bowenoid in situ carcinoma.

BACKGROUND: Feline Bowenoid in situ carcinoma (BISC) is frequently associated with Felis catus papillomavirus-2 (FcaPV-2). Although surgical excision of BISC is expected to be curative, recurrent lesions are reported and it is not known whether it is a consequence of incomplete surgery or residual viral load. OBJECTIVES: To combine colorimetric in situ hybridisation (CISH) and quantitative (q)PCR for the detection of viral DNA, and to correlate the clinical outcome of cats with BISC in which FcaPV-2 DNA is detected at surgical margins. ANIMALS: Twenty-seven cats with a histopathological diagnosis of BISC. MATERIALS AND METHODS: Sections including core and margins of the lesions were used for histopathological evaluation, qPCR and CISH. After surgical removal of the lesion, clinical follow-up data were recorded for 6 months. RESULTS: Six of 12 cases in which all four histological margins were evaluable were used to correlate the infection status at the margins with the follow-up data. Four showed margin positivity, of which half relapsed as expected and half cured; two cases were negative, of which one cured as expected while the other relapsed. Fifteen cases where only three, two or one of the histological margins were evaluable, were considered to adequately correlate the status of infection with the follow-up data if CISH was positive. Follow-up data were available for three with positive margins: one relapsed while the other two were cured. CONCLUSIONS AND CLINICAL RELEVANCE: Wide clinical surgical margins are always recommended for neoplastic conditions, yet there was no evidence that CISH margin examination would be beneficial in predicting recurrence in this viral-induced lesion.

Mature Cystic Teratoma of Anterior Mediastinum in a Child: A Case Report and Literature Review.

Mediastinal mature cystic teratomas are rare benign germ cell tumors that predominantly affect children. Despite their low incidence, they present unique diagnostic and management challenges. Early recognition and appropriate surgical intervention are crucial for optimal outcomes. This case report aims to highlight the importance of prompt diagnosis and management of mediastinal mature cystic teratomas in pediatric patients. We present the case of a 10-year-old female patient who presented with persistent chest pain and dyspnea. Imaging studies, including a chest X-ray and contrast-enhanced chest CT scan, revealed a large, well-circumscribed anterior mediastinal mass with calcifications. The patient underwent a right thoracotomy, resulting in the excision of a 6 × 5 × 5 cm mature cystic teratoma. Histopathological examination confirmed the diagnosis. The patient had an uneventful recovery and was discharged in stable condition. Mediastinal mature cystic teratomas pose diagnostic challenges due to their nonspecific symptoms and heterogeneous imaging characteristics. Differential diagnosis includes other mediastinal masses containing fat and calcifications. Surgical excision is the preferred treatment, although complete removal can be challenging due to adhesions to neighboring structures. Close follow-up is necessary to monitor for recurrence and complications. Mediastinal mature cystic teratomas are rare tumors with variable clinical presentations. Early detection and surgical intervention are crucial for optimal outcomes. These tumors should be included in the list of differential diagnoses for mediastinal masses in pediatric patients.

Margin status of basal cell carcinoma: What can be done better?

PURPOSE: Guidelines on clinical margins for basal cell carcinoma (BCC) excisions were recently published, yet the ambiguity regarding the margin continues for surgeons and pathologists. The purpose of this study was to determine the incomplete excision rate of BCC, determine the factors associated with incomplete excision, and evaluate the completeness of reporting between surgeon and pathologist. METHODS: A single-center retrospective analysis was conducted on pathology reports from single excisions of BCC specimens between January 1, 2019 to December 31, 2020. The primary outcome was the incomplete excision rate (positive margins) as reported by pathologist. Logistic regression was used to determine the relationship between incomplete excision rate and anatomical location, pathologist, and surgeon. The completeness of surgeon pathology requisition forms was evaluated qualitatively. RESULTS: Seven hundred and fifty-six pathology reports were included. The incomplete excision rate was 12% (n = 94). The most common site of incomplete excision was head and neck (n = 87, 15%), followed by trunk (n = 5, 7%), and extremities (n = 2, 2%). Five hundred and seventy-nine specimens from 6 surgeons and 9 pathologists were included in the logistic regression analysis. The Wald test showed that the location was significantly associated with incomplete excision (p < 0.05), whereas surgeon and pathologist reports were not (p > 0.05). Regarding missing information, only 47 (6%) pathology reports included "excision" in the requisition form. Four hundred and three (53%) specimens had no clinical history. CONCLUSIONS: The incomplete excision rate found in this study falls within the report range in the literature. Neither surgeon nor pathologist had significant association with incomplete excision. Incomplete excision rate of BCC may be inflated owing to the lack of standardization in requisition form and pathology reporting.