Surgical management of a benign multicystic peritoneal mesothelioma: A case report.

INTRODUCTION AND IMPORTANCE: Benign multicystic peritoneal mesothelioma is rare, with around 200 cases reported in the literature. We report the case of a patient operated on for the diagnosis of cystic lymphangioma but the pathology examination retained the diagnosis of benign cystic peritoneal mesothelioma. CASE PRESENTATION: A 47-year-old patient, who consulted for abdominal distension evolving for a year. Examination revealed a 30-centimeter abdominal mass. The CT scan showed an intraperitoneal cystic mass measuring 24 × 13 × 32 cm. The diagnosis of cystic lymphangioma was suspected and we decided to surgically remove the mass. We performed a laparotomy. There was a large multi-cystic formation that seemed to develop at the expense of the parietal peritoneum and the greater omentum. A monobloc resection was performed. The postoperative was eventless. Pathology concluded to a benign cystic peritoneal mesothelioma. DISCUSSION: The BMPM is a rare peritoneal neoplasm that develops mainly in women, during sexual activity. Its etiopathogenesis is unknown. It is often mesenteric or omental. Generally, resection is considered the sole treatment for benign mesotheliomas. However, this surgery needs to be R0 or it will expose to a certain recurrence. Some authors recommend a more aggressive approach associating cytoreductive surgery with heated intraperitoneal chemotherapy. CONCLUSION: Benign multicystic peritoneal mesothelioma is a rare pathology of the peritoneum which develops mainly in women during periods of reproductive activity. Despite its benignity, it presents a high risk of recurrence, up to 50 % of cases.

Case report of a recurrent resected glucagonoma.

Introduction and importance: Glucagonoma is a rare neuroendocrine tumor (NET). Most glucagonomas are in the tail or body of the pancreas and are diagnosed at a metastatic stage. We report a case of an early recurrence after surgical resection of a glucagonoma and its management. Case report: We present a case of a 44-year-old female patient with no medical and surgical history, operated on in May 2018 for pancreatic glucagonoma revealed by skin necrolytic migratory erythema. The patient was regularly monitored by clinical exams and CT scans. In December 2020 (31 months postoperatively), we noticed the recurrence of the cutaneous lesions.Admission laboratory measurements demonstrated hyperglycemia as well as elevated blood Glucagon levels. Explorations showed 3 retro-pancreatic lesions. Based on these findings, we concluded that it was a recurrence of her glucagonoma. The patient was operated on by median laparotomy We performed a warshow's procedure.Pathology confirmed the endocrine nature of the 3 nodules. We are currently 6 months behind the surgery. The examination is strictly normal with no recurrence of the skin lesions so far. Clinical discussion: Surgical resection on a recurrent glucagonoma is what is unique in our case as we haven't found any case in the literature to our knowledge.What is also unique about our case is both the local aspect of the recurrence and the multiplicity of the tumors observed as multiple nodules around the tail of the pancreas. These lesions were not metastatic lymph nodes as confirmed by pathology. Probably it was an effraction of the big tumor at enucleation. Conclusion: Due to its rareness, there is no clear consensus on the management of glucagonomas therefore we chose to write our case in order to further enrich the literature to achieve one-day guidelines for glucagonomas treatment.

Surgical treatment of a presacral schwannoma: A case report.

Introduction and importance: Schwannomas are rare benign tumors that develop from Schwann cells that represent 0.3 to 0.4 cases per 100,000 persons per year. We report a case of pre-sacral schwannoma, a rare tumor, especially in the pelvic area. This case comes to help further teams in their management as its scarcity made any attempt to make proper recommendations obsolete. Case presentation: a 53-year-old otherwise healthy woman who presented with a 2-year history of right-sided sciatica. The radiologic characteristics of the mass suggested presacral schwannoma type III of the Klimo classification as the most possible diagnosis.Therefore, surgical resection was decided, and an anterior approach was chosen. By laparotomy a 6cm retroperitoneal encapsulated mass with no invasion of the adjacent organs. We performed a digital enucleation of the tumor through a capsulotomy.Pathology confirmed the diagnosis of schwannoma. There were no features of malignancy. The post-operative period was uneventful. A follow-up examination at 6 months showed no signs of numbness or weakness in the right leg. The previously described pain totally regressed. Discussion: Although schwannoma is a benign lesion, it may become malignant, especially when associated with neurofibromatosis making its surgical removal primordial. Its pelvic location may make its diagnosis delayed due to non-specific symptoms mainly through compression of local organs. Its surgical management can be challenging due to large size tumors with adherence to peritoneal and retroperitoneal organs. Quality of the resection is important in the recurrence and necessity for reoperation. A multidisciplinary approach is therefore recommended to ensure optimal treatment. Conclusion: Due to its rareness, there is no clear consensus in on the management of schwannomas therefore we chose to write our case in order to further enrich the literature to achieve one-day guidelines for schwannoma treatment.

Primary duodenal tuberculosis complicated with perforation: A review of literature and case report.

Tuberculous (TB) disease remains an endemic pathology in Tunisia. the ileocecal region is the predominant site of involvement while gastroduodenal tuberculosis is very rare, this form is often presenting as one of the complications, mainly upper gastrointestinal stenosis or exceptionally as a perforation. We describe a case of female patient aged 33 years-old presented with a 2-day history of acute abdominal pain, with a tenderness of the right hypochondrium and the epigastrium, ultrasound of the abdomen revealed gallbladder distension with a wall thickening. The diagnosis of acute cholecystitis was suspected and the patient had an exploratory laparoscopy that revealed the presence of a perforated duodenal ulcer which was blocked by the gallbladder and several peri-duodenal lymph nodes. Cholecystectomy was performed and the edges of the ulcer were resected and the ulcer was sutured. Histological examination revealed duodenal tuberculosis and the patient was referred to the TB eradication program.