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INTRODUCTION: Copeptin is known to be associated with heart damage, while melatonin is a regulatory hormone related to circadian rhythm and represents the levels of inflammation in the body. METHODS AND PATIENTS: The aim of the study was to measure in different surgeries the levels of copeptin and melatonin at different times before and after surgery in 56 patients aged from 5 days to 13.6 years. We measured copeptin in 50-microL serum and plasma samples from patients before surgery, immediately after surgery, and 24 hours after surgery. The measured levels are aligned with the published GC / MS data, and the sensitivity of the analysis is such that serum and plasma levels can only be measured by rapid extraction. The measurement was made before surgery, immediately after surgery, and 24 hours after surgery. RESULTS: The multifactorial statistical analysis revealed a statistically significant difference between the 24-hour postoperative copeptin values in group 1 (mild-moderate gravity surgery) and group 2 (severe surgery) of the severity of the surgery. Post-hoc tests with Tukey correction for age groups in multiple comparisons of the multifactorial analysis revealed a statistically significant difference (p <0.05) between 24-hour postoperative melatonin values in age groups 3 (3-6 years) and 5 (6-12 years old). The age group 3 showed significantly (p <0.05) lower 24 hours postoperative melatonin values compared to the age group 5 (6-12 years). Again, these 3-6-year-olds were more likely to have inflammation due to the severity of the surgery and the presence of inflammation after the surgery. DISCUSSION: In summary, copeptin is a reliable biomarker for assessing a patient's health both preoperatively and postoperatively. Copeptin and melatonin are two independent agents and are not related to each other, and more studies will be needed with more patients of the same age and with the same underlying disease to assess their diagnostic value. Finally, melatonin could be considered an indicator of inflammation on its own and based on pre-and post-surgery values to determine a patient's health status and take appropriate actions.
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Melatonina , Biomarcadores , Criança , Glicopeptídeos , Humanos , Recém-Nascido , SoroRESUMO
Dermatofibrosarcoma protuberans (DFSP) of the breast is exceptionally obscure and late local recurrence of this entity on this site is even more uncommon. We describe such a case in a 48-year-old woman, who at the age of 35 had a DFSP excised from her right breast. Thirteen years later, she developed an ovoid mass in her right breast over the postsurgical scar area. Wide local excision of the tumor with generous tissue margin was performed and microscopic and immunohistochemical findings established the diagnosis of recurrent DFSP. No further treatment was administered and she remains well 18 months later, without tumor recurrence. We report an exceptionally rare case of local recurrence of DFSP in the female breast and discuss in detail the diagnostic and therapeutic implications of this pathology.
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Neoplasias da Mama/patologia , Dermatofibrossarcoma/patologia , Recidiva Local de Neoplasia/patologia , Neoplasias Cutâneas/patologia , Biomarcadores Tumorais/metabolismo , Neoplasias da Mama/cirurgia , Dermatofibrossarcoma/cirurgia , Feminino , Humanos , Técnicas Imunoenzimáticas , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/cirurgia , Neoplasias Cutâneas/cirurgia , Resultado do TratamentoRESUMO
We report a case of a patient who presented with an acute abdomen 2 days after the insertion of an intragastric balloon system and discuss in detail the advantages and drawbacks of these devices in the therapy of morbid obesity. A 43-year-old morbidly obese man was admitted to the department of surgery in shock with a 2-h history of severe diffuse abdominal pain and the initial diagnosis of visceral perforation. The patient had been subjected to intragastric placement of an inflatable balloon 48 h prior to his presentation. Abdominal exploration revealed the presence of a large linear perforation in the fundus of the stomach.
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Abdome Agudo/etiologia , Balão Gástrico/efeitos adversos , Fundo Gástrico/lesões , Obesidade Mórbida/cirurgia , Ruptura Gástrica/etiologia , Abdome Agudo/patologia , Abdome Agudo/terapia , Adulto , Evolução Fatal , Humanos , Masculino , Obesidade Mórbida/complicações , Obesidade Mórbida/patologia , Ruptura Gástrica/patologia , Ruptura Gástrica/cirurgiaRESUMO
Patients without evidence of breast disease, who present with axillary lymph node metastases, consistent with breast origin, comprise a diagnostic and therapeutic dilemma. We describe such a case of a 47-year-old female, who complained of swelling and pain of the left axilla, but no breast mass was palpable. Although histology identified a metastatic adenocarcinoma in the lymph nodes, numerous tests failed to detect the primary tumor. Immunohistochemistry showed that the resected lymph nodes were positive for both estrogen and progesterone receptors, CEA and Gross Cystic Disease Fluid Protein 15 (GCDFP-15), suggesting the breast as the site of the primary tumor. Left modified radical mastectomy was performed. Pathology revealed an invasive ductal carcinoma, 12 mm in size. The patient received adjuvant chemotherapy and radiation therapy. She is currently being treated with tamoxifen and is well without evidence of disease 2 years after surgery.
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Neoplasias da Mama/patologia , Linfonodos/patologia , Antineoplásicos Hormonais , Axila/patologia , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/radioterapia , Neoplasias da Mama/cirurgia , Feminino , Humanos , Metástase Linfática/patologia , Mastectomia Radical , Pessoa de Meia-Idade , Tamoxifeno/uso terapêuticoAssuntos
Carcinoma Ductal de Mama/patologia , Hamartoma/patologia , Neoplasias Inflamatórias Mamárias/patologia , Pneumopatias/patologia , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/secundário , Adulto , Carcinoma Ductal de Mama/tratamento farmacológico , Carcinoma Ductal de Mama/cirurgia , Feminino , Humanos , Neoplasias Inflamatórias Mamárias/tratamento farmacológico , Neoplasias Inflamatórias Mamárias/cirurgia , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/patologiaRESUMO
INTRODUCTION: Hemangiopericytoma (HPC)/solitary fibrous tumor (SFT) is a very uncommon tumor of uncertain malignant behavior. In 1942, Stout and Murray first characterized these neoplasms as "vascular tumors arising from Zimmerman's pericytes" and till now hemangiopericytomas and solitary fibrous tumors of the soft tissues are regarded as features of the same entity in the soft tissue fascicle. PRESENTATION OF CASE: We present a case of hemangiopericytoma/solitary fibrous tumor of the pectoralis major muscle in a 33-year-old female. She first noticed a painless mass in her right breast. Ultrasound of the breast revealed a large heterogeneously hypoechoic lesion within the pectoralis major muscle. Fine needle aspiration of the tumor did not produce any meaningful result. The lesion was completely removed by surgical resection. Histologically, the tumor had staghorn-like vasculature and immunohistochemistry for CD34 was positive, whereas desmin, smooth-muscle actin, S-100 protein, cytokeratins (AE1/AE3) and epithelial membrane antigen (EMA) were all negative. A diagnosis of hemangiopericytoma/solitary fibrous tumor was rendered. DISCUSSION: Tumors comprising the HPC/SFT spectrum represent a small subset of soft tissue sarcomas and are found virtually at any site in the body. Wide surgical resection can achieve favorable long-term survival. CONCLUSION: Due to the rarity and unpredictable biological potential of these tumors, long-term follow-up is mandatory even after radical resection, because recurrence or development of metastasis may be delayed many years.
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Pure mucinous carcinoma of the male breast is an extremely uncommon malignant breast neoplasm and usually occurs at advanced age. It is characterized by a higher degree of mucus production, a more benign behavior, a lower incidence of metastatic nodal involvement, and a subsequent higher survival rate. We describe such a case of a 59-year-old male, who displayed a gradually growing retroareolar tumor of the right breast. The tumor was well demarcated and had a soft consistency with a gelatinous appearance. Based on the preoperative clinical identification of right axillary lymphadenopathy, the patient eventually underwent right modified radical mastectomy and right axillary nodal dissection. Regarding histological findings, the neoplasm corresponded to a pure mucinous carcinoma with axillary lymph node metastasis. Although lymph node metastasis of pure mucinous carcinoma of the breast is rare, it is essential to perform careful clinical examination when the primary breast mass is suspicious for mucinous carcinoma, because the presence of axillary lymphadenopathy will subsequently define the proper choice of therapeutic strategy.
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Adenocarcinoma Mucinoso/patologia , Neoplasias da Mama Masculina/patologia , Metástase Linfática/patologia , Adenocarcinoma Mucinoso/cirurgia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Axila/patologia , Neoplasias da Mama Masculina/cirurgia , Humanos , Excisão de Linfonodo , Linfonodos/patologia , Linfonodos/cirurgia , Masculino , Mastectomia Radical Modificada , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
Extramedullary relapses of acute lymphoblastic leukemia (ALL) are rare and usually localized in the central nervous system. We describe such an uncommon case of extramedullary relapse of ALL in the breast of a 44 year old female. The patient, who had been diagnosed with precursor B cell, Philadelphia positive (Ph+) acute lymphoblastic leukemia (ALL) 5 years before and had been in complete molecular remission for the last 19 months, was admitted to the hospital for investigation of a hard, non-tender lump in her right breast. Mammography detected a dense, ill-defined mass, whereas on grey-scale and power Doppler sonography, the appearance of the lesion was consistent with malignancy. Histopathologic and immunohistochemical examination of the specimen demonstrated a similar immunophenotype (CD20+, CD10+, Tdt+, CD3-) as this of the onset ALL cell population in the bone marrow.
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Neoplasias da Mama/etiologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicações , Adulto , Mama/patologia , Feminino , Humanos , Imuno-Histoquímica , Leucemia-Linfoma Linfoblástico de Células Precursoras/genética , Leucemia-Linfoma Linfoblástico de Células Precursoras/metabolismo , Leucemia-Linfoma Linfoblástico de Células Precursoras/patologia , RecidivaRESUMO
Femoral hernias are more common in women and lead to a substantial higher rate for an emergency operation, due to strangulation. Incarcerated femoral hernia with fallopian tube as a content is an extremely rare condition. A 20-year-old woman presented to the emergency department complaining of a 6-day right groin swelling, which became painful and tender to palpation during the last 48 hours. Preoperative ultrasonography detected an oedematous hernia sac, above the femoral vessels, suggesting the presence of an incarcerated femoral hernia. The patient eventually underwent emergency surgery and the diagnosis of a strangulated femoral hernia sac, containing fallopian tube, was established. No resection of the uterine tube was performed and the hernia was repaired with polypropylene plug. The postoperative period was uneventful and the woman was discharged on the second postoperative day.
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Breast spindle cell tumors (BSCTs), although uncommon, constitute a heterogeneous group of benign and malignant lesions, often necessitating different therapeutic approaches. This study describes the case of a 62-year-old man who displayed a gradually growing retroareolar tumor of the left breast. The mass was well circumscribed, unilateral, and grossly nodular. The patient eventually underwent wide local excision of the mass. The lesion was made up of spindle cells arranged in fascicular clusters, separated by bands of collagen. No mitotic figures were observed. Immunohistochemically, the mass expressed strong and diffuse cytoplasmic staining for vimentin, CD34, CD10, and bcl-2, whereas it was negative for cytokeratins, smooth muscle actin, desmin, S-100 protein, p53, Ki-67, estrogen and progesterone receptors. Diverse histological results and immunohistochemical features established the diagnosis of benign BSCT, not otherwise specified. The patient remains disease-free 12 months after lumpectomy. This case report adds to the spectrum of the benign BSCTs and delineates the nature of different types of these lesions, in order to carefully select optimal therapeutic regimes.
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Neoplasias da Mama Masculina/patologia , Tumores Fibrosos Solitários/patologia , Biomarcadores Tumorais/análise , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-IdadeRESUMO
Spontaneous ruptures of the colon and rectum are extremely uncommon clinical entities and always require laparotomy. A 44-year-old female was admitted with a 12-hour history of severe abdominal pain periumbilically and at the right hypochondrium. The patient was immediately transferred to the department of surgery for close surgical observation. Computed tomography (CT) of the entire abdomen performed just before the operation demonstrated thickening of the wall of the ascending colon with pericolic fat stranding. Surgery revealed a perforation at the antimesenteric wall of the transverse colon and segmental colectomy of the transverse colon was performed. The histological evaluation demonstrated a perforated solitary ulcer of the transverse colon. There are only few known etiologic factors concerning spontaneous ruptures of the colon and rectum and usually none of these causative factors can easily be recognised. Their clinical appearance is most of the times acute abdomen and, despite the use of all appropriate diagnostic methods, the diagnosis is usually set postoperatively.
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Colo Transverso/patologia , Perfuração Intestinal/diagnóstico , Perfuração Intestinal/patologia , Úlcera/complicações , Úlcera/diagnóstico , Adulto , Colectomia , Feminino , Histocitoquímica , Humanos , Perfuração Intestinal/cirurgia , Laparotomia , Radiografia Abdominal , Tomografia , Úlcera/patologia , Úlcera/cirurgiaRESUMO
We report a case involving a 45-year-old woman, who presented with an axillary mass 10 years after bilateral cosmetic augmentation mammaplasty. A lump was detected in the left axilla, and subsequent mammography and magnetic resonance imaging demonstrated intracapsular rupture of the left breast prosthesis. An excisional biopsy of the left axillary lesion and replacement of the ruptured implant was performed. Histological analysis showed that the axillary lump was lymph nodes containing large amounts of silicone. Silicone lymphadenopathy is an obscure complication of procedures involving the use of silicone. It is thought to occur following the transit of silicone droplets from breast implants to lymph nodes by macrophages and should always be considered as a differential diagnosis in patients in whom silicone prostheses are present.
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Fibroepithelial polyps or hypertrophied anal papillae are essentially skin tags that project up from the dentate line and the junction between the skin and the epithelial lining of the anus. They are usually small in size, but sometimes they become enlarged, causing unexpected medical conditions. An extremely rare case of a giant hypertrophied anal papilla complicated by obstructive ileus is reported. Fibroepithelial anal polyp, despite its size, should be included in the differential diagnosis of a smooth mass located near the anal verge, especially in a patient with a history of chronic anal irritation or infection.
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Neoplasias do Ânus/complicações , Íleus/etiologia , Pólipos Intestinais/complicações , Neoplasias Fibroepiteliais/complicações , Idoso , Canal Anal/patologia , Neoplasias do Ânus/patologia , Feminino , Humanos , Pólipos Intestinais/patologia , Neoplasias Fibroepiteliais/patologiaRESUMO
The clinical appearance and imaging findings of sarcoidosis and breast carcinoma may sometimes mimic one another, making the differential diagnosis between these two diseases difficult in some cases. A 69-year-old woman displayed an irregular shaped lesion in her left breast. Preoperative localization modalities detected a breast mass with malignant characters. The patient also was found to have pulmonary findings for metastatic disease on chest computed tomography. These features were proven upon biopsy to be consistent with sarcoidosis. The patient underwent breast surgery, adjuvant chemoradiotherapy and hormonal therapy, while corticosteroids were administered for pulmonary sarcoidosis. The patient is well 12 months later, without recurrence. An unfortunate consequence of the presence of both entities in the same patient is the risk of misguided differential diagnosis and incorrect therapeutic strategy. This patient shows the importance of confirming a clinical diagnosis of sarcoidosis with appropriate biopsies and histological examination, prior to initiation of breast cancer therapy.