Leiomyoma of round ligament mimicking an incarcerated inguinal hernia-report of a rare case.

Inguinal hernia is a common condition and may contain small or large bowel, omentum or other tissues. Leiomyomas of a round ligament are a rare condition occurring predominantly in premenopausal women. Abdominal, inguinal and vulvar locations have been described. Rare situations have been reported in which leiomyomas resemble to an incarcerated inguinal hernia. We describe a rare case of a leiomyoma of a round ligament in a young Caucasian female mimicking an incarcerated inguinal hernia. The treatment was surgical and we were able to remove the leiomyoma of the round ligament successfully. Leiomyoma of the round ligament is a benign tumor. Surgeons should take into consideration this condition in terms of differential diagnosis of masses that mimic an inguinal hernia.

Kaposi Sarcoma in an Human Immunodeficiency Virus (HIV)-Seronegative Mediterranean Female: Report of a Rare Case.

BACKGROUND Kaposi sarcoma is a malignancy commonly linked to HIV infection or immunosuppression. An association with human herpes virus 8 (HHV-8) infection has also been reported. We present a case of classic Kaposi sarcoma in a female Mediterranean patient. CASE REPORT A 57-year-old white female of Greek ethnicity, with no history of HIV infection or immunosuppression, presented to the Surgical Out-patient Department of our Center, with complaints of extensive discolored skin lesion on both legs, initially considered as chronic vein insufficiency. Histopathological findings from skin biopsies revealed Kaposi sarcoma. CONCLUSIONS Non-HIV-related Kaposi sarcoma is an HHV-8-related, angioproliferating skin cancer that can cause pain, disfigurement, and limb dysfunction. High suspicion of this condition can lead to early treatment and delay progression.

Robotic right segmental hepatectomy for the treatment of a giant hepatic hemangioma-a case report.

Hemangioma is the most common benign hepatic tumor. We present the case of a patient with a giant symptomatic hemangioma, treated with segmental liver resection using the Da Vinci Robotic System. A 38-year-old woman presented to our surgical out-patient Department complaining about abdominal discomfort and recurrent episodes of acute abdominal pain. CT-scan and MRI imaging of the abdomen revealed the presence of a giant hepatic hemangioma (>5 cm) involving segments VI and VII. Robotic right segmental hepatectomy was performed. The procedure was successfully completed in 120 min and with intraoperative blood loss of only 450 ml. Postoperative period was uneventful and the patient was discharged on the second postoperative day. In case of giant hemangiomas, a minimally invasive robotic major hepatic resection is a viable option that can be performed with minimal complications. A careful preoperative and intraoperative strategy is required, while significant experience in liver and robotic surgery is mandatory.

Primary solitary peritoneal tumor of the abdominal wall-report of a rare case and review of the literature.

Abdominal wall tumors are sometimes diagnosed as metastases of ovarian cancer, however, primary peritoneal tumors should be taken into consideration in the final diagnosis. A 49-year-old female patient was admitted in our Department for the excision of a pulpable abdominal wall lump, with no other abnormalities shown on imaging investigation. On histology examination, the excised specimen revealed characteristics of metastatic high-grade serous ovarian carcinoma. Total hysterectomy, bilateral oophorectomy, omentectomy and appendectomy were performed. No signs of malignancy were proved on histology, leading to the final diagnosis of a primary serous peritoneal tumor. This is the third described case of solitary primary serous peritoneal tumor located in the abdominal wall. This condition should be included in the differential diagnosis of a probable metastatic ovarian carcinoma, as both present similar histologic characteristics.

Successful multiple-step management of intravenous leiomyomatosis diagnosed after episode of acute abdominal pain: Case report and review of literature.

INTRODUCTION: We present the case of a 37-year old woman diagnosed with intravenous leiomyomatosis (IVL) that was managed uneventfully with multiple-step management. PRESENTATION OF CASE: A 37-year-old woman was admitted because of acute abdominal pain. Emergency Computed Tomography demonstrated a big pelvic mass 5×15cm of heterogenous composition intaking the contrast agent. Total hysterectomy with salpingoophorectomy was proposed to patient, however, patient expressed her will for fertility preservation and gave consent only for the resection of a single ovary. Laparotomy revealed the presence of myoma, multiple lesions of potential adenomyosis and cordon-shaped formations arising from uterus and extending mainly to left ovary. Final histological diagnosis was intravenous leiomyomatosis (IVL). MRI angiography revealed the presence of residual lesions in inferior vena cava. Laparoscopic resection was performed one month after laparotomy and left ovary was resected without complications. Venovenous bypass was finally performed three months later from initial surgery. The process was significantly labored, resulted in the successful resection of intravenous lesions but was complicated intraoperatively by right kidney rupture. After a follow-up of 33 months, case remains uncomplicated without signs or symptoms of potential recurrence. DISCUSSION: Intravenous leiomyomatosis represents a rare clinical entity histologically bening but clinically aggressive. No consensus exists regarding the optimal management, especially in cases with initial will for fertility preservation. CONCLUSION: IVL represents a rare clinical entity often presenting difficulties in diagnosis and optimal treatment. Large case-series studies should be encouraged to assess the optimal management.

Acral lentiginous melanoma: a case control study and guidelines update.

Background. Malignant melanoma incidence is increasing dramatically. We report herein a case of the rarest acral lentiginous type. Case Report. A 58-year-old man presented with a melanoma resembling lesion over the sole of his right foot, measuring 15-20 mm in diameter. An excisional biopsy with a narrow (2 mm) margin of surrounding skin was obtained. Histological findings were consistent with a diagnosis of acral lentiginous melanoma. Sentinel lymph node biopsy was also performed and micrometastases were not identified in frozen-section examination. According to the AJCC system, the tumor stage was IB (T2aN0M0). A wide local excision of the biopsy scar with a margin of 2 cm was performed. A split-thickness thick skin graft was used to reconstruct the excisional defect. During an 18-month followup, no local or distant recurrence has been observed. This paper aims to extract an updated rational approach to the management of this disease out of an enormous body of knowledge.

Total laparoscopic distal pancreatectomy for a benign appearing tumor: a case report.

INTRODUCTION: Therapeutic laparoscopy of the pancreas is still described as experimental surgery by many surgeons. Many issues remain to be clarified in determining the future of this new method. CASE PRESENTATION: The objective of the present study was to present a case of a patient who underwent totally laparoscopic distal pancreatectomy for a benign appearing tumor in the tail of the pancreas and to critically discuss the treatment of the pancreatic remnant and the need to perform splenectomy with or without ligation of the splenic vessels. CONCLUSION: Laparoscopic distal pancreatectomy is usually performed en-bloc along with resection of the spleen, for technical reasons, making the operation short and easy. However, it should only be performed in centers with expertise in both pancreatic surgery and advanced laparoscopy. Furthermore, the use of linear stapler to cut the pancreas (4.5-mm staples) seems to prevent fistula formation and ischemia of the pancreatic stump.

Synchronous colorectal adenocarcinoma and gastrointestinal stromal tumor in Meckel's diverticulum; an unusual association.

BACKGROUND: Coexistence of gastrointestinal stromal tumor with synchronous or metachronous colorectal cancer represents a phenomenon with increasing number of relative reports in the last 5 years. Synchronous occurence of GISTs with other gastrointestinal tumors of different histogenesis presents a special interest. We herein report a case of GIST in Meckel's diverticulum synchronous with colorectal adenocarcinoma. CASE PRESENTATION: A 69 year old man, presented with abdominal distension and anal bleeding on defecation. Colonoscopy revealed colorectal cancer and a low anterior resection was performed, during which a tumor in Meckel's diverticulum was discovered. Histologic examination revealed GIST in Meckel's diverticulum and a rectosigmoid adenocarcinoma. CONCLUSION: Whenever GIST is encountered, the surgeon should be alert to recognize a possible coexistent tumor with different histological origin. Correct diagnosis of synchronous tumors of different origin is the cornerstone of treatment.

Elective laparoscopic splenectomy for giant hemangioma: a case report.

Although unusual, hemangioma is the most common primary splenic neoplasm. Splenectomy is indicated when the tumor is large, with increased risk of hemorrhage. The laparoscopic approach is preferred for most elective splenectomies. Although technically feasible, laparoscopic splenectomy can be a challenge in the patient with splenomegaly. We present herein a case of an 18-year-old male asymptomatic patient who underwent laparoscopic splenectomy for the incidental finding of splenomegaly caused by a large splenic hemangioma. Laparoscopic splenectomy appears to be a safe and effective procedure, in appropriately experienced hands, for patients with splenomegaly, given the spleen's fragile anatomy and its relationship to other abdominal viscera.

Transperitoneal laparoscopic right radical nephrectomy for renal cell carcinoma and end-stage renal disease: a case report.

Nephron-sparing surgery (partial nephrectomy) results are similar to those of radical nephrectomy for small (<4 cm) renal tumors. However, in patients with end-stage renal disease, radical nephrectomy emerges as a more efficient treatment for localized renal cell cancer. Laparoscopic radical nephrectomy (LRN) increasingly is being performed. The objective of the present study was to present a case of a patient under hemodialysis who was submitted to LRN for a small renal mass and discuss the current issues concerning this approach. It appears that radical nephrectomy should be the standard treatment in dialysis patients even for small tumors. The laparoscopic technique is associated with acceptable cancer-specific survival and recurrence rate along with shorter hospital stay, less postoperative pain and earlier return to normal activities.

Barber's hair sinus in a female hairdresser: uncommon manifestation of an occupational disease: a case report.

BACKGROUND: Barber's disease is an acquired occupational disease produced by short customers' hairs that penetrate the interdigital spaces of the hands. The lesion has been reported to occur mostly on the hands of male hairdressers. The purpose of this article is to report a rare case of a female hairdresser who developed a pilonidal sinus in the interdigital web of her non-dominant hand and review the relevant literature. CASE PRESENTATION: A 29 year-old Greek female hairdresser underwent surgical excision of the pilonidal sinus and curettage. She was not hospitalised, while prompt resolution of the condition and prevention of recurrence was achieved. CONCLUSION: Pilonidal sinus of the interdigital spaces of the hand is a rare and preventable acquired occupational disease. The personal hygiene with thorough removal of any hairs that have penetrated the epidermis during the working day could prevent the formation of the disease. Surgical excision, curettage and primary healing seem to be a safe method of treatment.

Kaposi's sarcoma of the hand mimicking squamous cell carcinoma in a woman with no evidence of HIV infection: a case report.

INTRODUCTION: Kaposi's sarcoma is a vascular neoplasm mainly affecting the skin of the lower extremities. Although it is the most common neoplasm affecting patients with AIDS, sporadic cases in HIV-negative people have been reported. It is a lesion mainly affecting men and its clinical presentation presents a challenge, as it can resemble other benign or malignant skin lesions. CASE PRESENTATION: We report a rare case of Kaposi's sarcoma presenting in a 68-year-old Mediterranean woman with no evidence of HIV infection. The patient had a 6-month history of a slowly progressing pigmented lesion on the dorsum of her left hand. The lesion clinically resembled a squamous cell carcinoma. The patient was treated with a wide excision of the lesion and primary reconstruction with a full thickness skin graft. Histopathological and immunohistochemical analysis of the excised lesion revealed the presence of Kaposi's sarcoma. Serologic investigation for HIV was negative but polymerase chain reaction for human herpes virus type 8 infection was positive. Thorough clinical and imaging investigation of the abdomen and chest were both negative for loci of disease. CONCLUSION: Kaposi's sarcoma, although rare in its sporadic form, should be considered in the differential diagnosis of indeterminate skin lesions, especially those affecting the extremities.

A rare form of isolated mesenteric Castleman's disease presenting as an abdominal mass (isolated mesenteric Castleman's disease).

Castleman's disease is a rare disorder characterized by proliferation of the lymphoid tissue. The most frequent location of the disease is the mediastinum. The location of the disease in the mesentery is rare and it is usually associated with the generalized form of the disease. We report a case of a 22-year old woman with isolated mesenteric Castleman's disease of the lymphoid variant, which presented as a palpable abdominal mass. The final diagnosis was reached after exploratory laparotomy and resection of the tumor. The described case is the first reported case of Castleman's disease of the lymphoid subtype, located in the mesentery.

A variant of the double gallbladder. A possible cause of cholelithiasis?

Congenital duplication of the gallbladder is a rare anatomical malformation, which is usually discovered as an incidental finding during cholecystectomy. We report a case of a double gallbladder in a 45-year-old woman, which was discovered during laparoscopic cholecystectomy for symptomatic cholelithiasis. As it was not possible to identify the anatomical structures safely, the procedure was converted to open cholecystectomy. Inspection of the resected gallbladder showed that it consisted of 2 chambers with separate cystic ducts, which communicated through an ostium. Both chambers contained multiple gallstones. The inadequate drainage of the second chamber could be considered as a predisposing factor for the development of cholelithiasis in this case.