Assuntos
Linfoma de Células T Associado a Enteropatia/complicações , Divertículo Ileal/complicações , Idoso , Linfoma de Células T Associado a Enteropatia/diagnóstico , Humanos , Laparoscopia/métodos , Masculino , Divertículo Ileal/diagnóstico , Divertículo Ileal/cirurgia , Tomografia Computadorizada por Raios XAssuntos
Carcinoma Mucoepidermoide/diagnóstico , Neoplasias Orofaríngeas/diagnóstico , Tonsila Palatina , Adulto , Carcinoma Mucoepidermoide/cirurgia , Humanos , Masculino , Neoplasias Orofaríngeas/cirurgia , Tonsila Palatina/diagnóstico por imagem , Tonsila Palatina/patologia , Tonsila Palatina/cirurgia , LínguaRESUMO
BACKGROUND: Parathyroid carcinoma is a rare neoplasm representing <1% of primary hyperparathyroidism cases. It is often not diagnosed until surgical exploration as a preoperative diagnosis is often not possible. Thus, preoperative staging for most patients is not feasible and this may compromise the treatment strategy. METHODS AND RESULTS: We report a case of a 29-year-old man presenting with avulsion fracture of the right elbow after a trivial fall. Neck exploration revealed an enlarged left lobe focally adherent to the larynx and trachea. Final pathology revealed parathyroid carcinoma with focally positive margin at the site of tracheal invasion. CONCLUSION: Parathyroid carcinoma is a rare cause of primary hyperparathyroidism. The etiology of parathyroid carcinoma is usually obscured, and the initial operation offers the best chance for cure.
Assuntos
Lesões no Cotovelo , Fraturas Espontâneas/etiologia , Neoplasias das Paratireoides/complicações , Neoplasias das Paratireoides/diagnóstico , Acidentes por Quedas , Adulto , Biópsia por Agulha , Diagnóstico Diferencial , Seguimentos , Fraturas Espontâneas/diagnóstico , Fraturas Espontâneas/cirurgia , Humanos , Imuno-Histoquímica , Imageamento por Ressonância Magnética/métodos , Masculino , Neoplasias das Paratireoides/cirurgia , Paratireoidectomia/métodos , Resultado do TratamentoRESUMO
Background. Acral lentiginous melanoma (ALM) is a less-common form of melanoma in US, and it accounts for about 5% of all diagnosed melanomas in US. ALM is often overlooked until it is well advanced because of the lesion's location and its atypical appearance in the early stages. We present a case of ALM initially presented as a diabetic foot ulcer. Case Report. An 81-year-old man initially presented to the primary care clinic with a right foot diabetic ulcer. There was a large plantar, dark-colored ulcer that bled easy. Initial excision biopsy revealed Clark's Level IV ALM. Subsequent definitive wide excision and sentinel node biopsy confirmed ALM with metastasis to inguinal lymph nodes (stage IIIb). The treatment included wide margin excision of the lesion with en bloc amputations of 4th and 5th toes, followed by adjuvant chemotherapy. Discussion. The development of ALM may potentially relate to diabetes as a reported higher prevalence of diabetes with ALM patients. Conclusion. The difficulty in early diagnosing of ALM remains as a formidable challenge particularly in diabetic patients who commonly develop plantar foot ulcers due to the diabetic neuropathy. This case reiterates the importance of a thorough foot exam in such patients.
Assuntos
Neoplasias Ósseas/cirurgia , Lipoma/cirurgia , Doenças do Sistema Nervoso Periférico/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Escápula/cirurgia , Diagnóstico Diferencial , Eletromiografia , Humanos , Inflamação , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso Periférico/reabilitação , Complicações Pós-Operatórias/reabilitação , Tomografia Computadorizada por Raios XAssuntos
Adenocarcinoma/cirurgia , Adenoma/cirurgia , Colectomia/métodos , Neoplasias do Colo/cirurgia , Laparoscopia/métodos , Idoso , Idoso de 80 Anos ou mais , Estudos de Viabilidade , Humanos , Tempo de Internação/estatística & dados numéricos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Resultado do TratamentoAssuntos
Adenocarcinoma Folicular/secundário , Neoplasias Ósseas/secundário , Fraturas do Fêmur/diagnóstico , Fêmur , Fraturas Espontâneas/diagnóstico , Neoplasias da Glândula Tireoide/patologia , Adenocarcinoma Folicular/diagnóstico , Adenocarcinoma Folicular/cirurgia , Idoso de 80 Anos ou mais , Neoplasias Ósseas/complicações , Neoplasias Ósseas/diagnóstico , Diagnóstico Diferencial , Evolução Fatal , Feminino , Fraturas do Fêmur/etiologia , Seguimentos , Fraturas Espontâneas/etiologia , Humanos , Cintilografia , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia , Tomografia Computadorizada por Raios XAssuntos
Adenoma/patologia , Pólipos Adenomatosos/patologia , Neoplasias Colorretais/patologia , Lesões Pré-Cancerosas/patologia , Adenoma/epidemiologia , Adenoma/cirurgia , Pólipos Adenomatosos/epidemiologia , Pólipos Adenomatosos/cirurgia , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha , Estudos de Coortes , Colectomia/métodos , Pólipos do Colo/epidemiologia , Pólipos do Colo/patologia , Pólipos do Colo/cirurgia , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/cirurgia , Feminino , Humanos , Imuno-Histoquímica , Incidência , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Medição de Risco , Distribuição por Sexo , Análise de Sobrevida , Resultado do TratamentoAssuntos
Cálculos Biliares/diagnóstico , Cálculos Biliares/cirurgia , Íleus/cirurgia , Doenças do Jejuno/cirurgia , Laparoscopia , Idoso de 80 Anos ou mais , Feminino , Cálculos Biliares/complicações , Humanos , Íleus/diagnóstico , Íleus/etiologia , Doenças do Jejuno/diagnóstico , Doenças do Jejuno/etiologiaAssuntos
Ceco/lesões , Corpos Estranhos/complicações , Corpos Estranhos/cirurgia , Perfuração Intestinal/etiologia , Perfuração Intestinal/cirurgia , Laparoscopia , Idoso , Corpos Estranhos/diagnóstico por imagem , Humanos , Perfuração Intestinal/diagnóstico por imagem , Masculino , Tomografia Computadorizada por Raios XRESUMO
Acute epiploic appendagitis (EA) is a rare and often misdiagnosed cause of acute abdominal pain. Though a benign and often self-limiting condition, EA's ability to mimic other disease processes makes it an important consideration in patients presenting with acute abdominal symptoms. Careful evaluation of abdominal CT scan findings is crucial in the accurate diagnosis of epiploic appendagitis, thus avoiding unnecessary surgical intervention. We report a case of a 29-year-old male presenting with a two day history of generalized abdominal pain. Physical exam revealed a diffusely tender abdomen with hypoactive bowel sounds. The patient had a leukocytosis of 18,000 and abdominal CT scan revealed right lower quadrant inflammatory changes suggestive of acute appendicitis. Laparoscopic exploration revealed an inflamed gangrenous structure adjacent to the ileocecal junction. Pathologic evaluation revealed tissue consistent with epiploic appendagitis. Retrospective review of the CT scan revealed a normal appearing appendiceal structure supero-lateral to the area of inflammation. The patient recovered uneventfully with resolving leukocytosis. We present a case of cecal epiploic appendagitis mimicking acute appendicitis and review the current literature on radiographic findings, diagnosis, and treatment of this often misdiagnosed condition. General surgeons should be aware of this self-limiting condition and consider this in the differential diagnosis.
Assuntos
Dor Abdominal , Apêndice , Doenças do Ceco , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Dor Abdominal/cirurgia , Adulto , Apendicectomia , Apendicite/diagnóstico , Doenças do Ceco/complicações , Doenças do Ceco/diagnóstico , Doenças do Ceco/cirurgia , Diagnóstico Diferencial , Humanos , Laparoscopia , Contagem de Leucócitos , Masculino , Tomografia Computadorizada por Raios X , Anormalidade Torcional/complicações , Anormalidade Torcional/diagnósticoRESUMO
Adrenal myelolipoma is a rare benign tumor composed of mature lipomatous and hemopoietic tissue. Although it is often discovered as an incidental finding on imaging of the abdomen for some other reason or at autopsy, adrenal myelolipoma has been reported to present with symptoms such as flank pain resulting from tumor bulk, necrosis, or spontaneous retroperitoneal hemorrhage. Myelolipomas are hormonally inactive but have also been reported to coexist with other hormonally active tumors of the adrenal gland. They are usually unilateral but may be bilateral and may also develop in extraadrenal sites like the retroperitoneum, thorax, and pelvis. We report a patient with symptomatic adrenal myelolipoma diagnosed on computed tomography scan and confirmed on computed tomography-guided biopsy. The patient underwent surgical resection for symptomatic relief. We also review the literature to evaluate the presentation and optimal management of this rare adrenal tumor that is not encountered by most general surgeons and therefore not well known to most surgeons.
Assuntos
Neoplasias das Glândulas Suprarrenais/cirurgia , Mielolipoma/cirurgia , Adrenalectomia , Biópsia , Feminino , Humanos , Pessoa de Meia-Idade , Radiografia Intervencionista , Tomografia Computadorizada por Raios XRESUMO
Video capsule endoscopy (VCE) is a novel diagnostic tool for noninvasively visualizing the lumen of the entire small intestine. It is especially useful in identifying the source of obscure small intestinal bleeding. However, VCE is not always optimal for localizing small bowel lesions. Several studies show VCE to be markedly superior to standard diagnostic techniques although the true clinical relevance of many of the capsule endoscopic findings remain unknown. We present two case reports of VCE findings that resulted in surgical intervention but were found to be benign lesions on definitive pathological examination. The actual clinical relevance of many of the lesions found on VCE thus remains to be demonstrated.
Assuntos
Endoscopia Gastrointestinal , Hemorragia Gastrointestinal/patologia , Doenças do Íleo/patologia , Gravação em Vídeo , Idoso , Endoscopia Gastrointestinal/efeitos adversos , Feminino , Hemorragia Gastrointestinal/diagnóstico por imagem , Hemorragia Gastrointestinal/cirurgia , Humanos , Doenças do Íleo/diagnóstico por imagem , Doenças do Íleo/cirurgia , Masculino , Pessoa de Meia-Idade , Radiografia , Sensibilidade e EspecificidadeRESUMO
Subcapsular hematoma of the spleen is a rare complication of pancreatitis despite its close proximity to the pancreas. Pancreatic pseudocyst involving the tail of the pancreas may erode into the splenic hilum causing hilar vessel bleeding with subcapsular dissection and hematoma formation. The management of such complication is still controversial. It has been suggested that most of these complications spontaneously regress and therefore can be managed conservatively. A case of spontaneous splenic subcapsular hematoma resulting from pancreatitis was managed conservatively with a good outcome.
Assuntos
Hemorragia Gastrointestinal/diagnóstico , Hematoma/diagnóstico , Pseudocisto Pancreático/diagnóstico , Pancreatite/diagnóstico , Ruptura Esplênica/diagnóstico , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Adulto , Seguimentos , Hemorragia Gastrointestinal/complicações , Hemorragia Gastrointestinal/terapia , Hematoma/complicações , Hematoma/terapia , Hemodinâmica/fisiologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Pseudocisto Pancreático/complicações , Pseudocisto Pancreático/terapia , Pancreatite/complicações , Pancreatite/terapia , Remissão Espontânea , Medição de Risco , Ruptura Esplênica/complicações , Ruptura Esplênica/terapia , Tomografia Computadorizada por Raios X , Ultrassonografia DopplerRESUMO
Low-grade lymphoma arising in mucosa-associated lymphoid tissue (MALT) of the duodenum represents a very rare neoplasm. We report an unusual presentation of primary duodenal MALT lymphoma in a 78-year-old man. The patient initially presented with a suspected pulmonary embolus and was anticoagulated, which precipitated a major gastrointestinal hemorrhage. A large atypical ulcer with narrowing of the duodenum beyond the bulb was seen on endoscopy. Biopsies revealed atypical lymphoid cells. Abdominal CT scan revealed a mass in either the duodenum or head of the pancreas. An endoscopic retrograde cholangiopancreatography (ERCP) was performed, which revealed a normal pancreatic duct with a large calculus in the common bile duct, which was extracted after sphincterotomy. Elective surgery was planned for suspected lymphoma of the duodenum. The patient developed severe nausea, vomiting, and fullness after meals. The patient underwent pancreaticoduodectomy for a neoplastic mass causing duodenal obstruction. Pathological examination of the resected specimen revealed a low-grade B-cell lymphoma (MALToma) arising in the duodenum and invading the pancreas. Flow cytometry confirmed the phenotype typical of MALT lymphoma. Celiac, peripancreatic, pelvic, and cervical nodes were also involved with tumor. Bone marrow was also positive for metastasis. The patient was postoperatively treated with chemotherapy for stage IV disease.
Assuntos
Neoplasias Duodenais/complicações , Neoplasias Duodenais/cirurgia , Obstrução da Saída Gástrica/cirurgia , Linfoma de Zona Marginal Tipo Células B/complicações , Linfoma de Zona Marginal Tipo Células B/cirurgia , Idoso , Terapia Combinada , Neoplasias Duodenais/diagnóstico , Neoplasias Duodenais/tratamento farmacológico , Obstrução da Saída Gástrica/etiologia , Humanos , Linfoma de Zona Marginal Tipo Células B/diagnóstico , Linfoma de Zona Marginal Tipo Células B/tratamento farmacológico , MasculinoRESUMO
Nasopharyngeal carcinoma is endemic in China, Hong Kong, and the Philippines. However, this disease is rare in North America and the Caribbean. This paper discusses the clinical features, prognosis, treatment outcomes, and survival rates of nasopharyngeal carcinoma in Jamaica. The incidence in Jamaica is 1.4 per 100,000. The National Cancer Registry in Jamaica keeps a record of all cancers. A retrospective cohort study of patients with nasopharyngeal carcinoma between 1988-2000 was reviewed. The presenting features, staging, histological diagnosis, treatment, and patient outcome were assessed. All patients received radiation therapy, and 89% of the patients completed the course of therapy. Seventeen percent received chemotherapy, consisting of cisplatin and 5-fluorouracil. Surgery played a minor role in the definitive management of nasopharyngeal carcinoma in this study. Three-year survival rates were 21%. The study demonstrates findings unique to the Caribbean nation of Jamaica. There is a bimodal pattern to the age distribution typical in non-endemic areas, such as shown in this study. Nasopharyngeal carcinoma evades early diagnosis because of its anatomic location and varied symptomatology. Prognostic indicators include intracranial extension, cervical node, and distant metastasis.
Assuntos
Neoplasias Nasofaríngeas/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Criança , Estudos de Coortes , Feminino , Humanos , Incidência , Jamaica/epidemiologia , Masculino , Pessoa de Meia-Idade , Neoplasias Nasofaríngeas/diagnóstico , Neoplasias Nasofaríngeas/terapia , Estudos Retrospectivos , Taxa de SobrevidaRESUMO
Somatostatinomas are extremely rare periampullary malignant neuroendocrine tumors that may be associated with von Recklinghausen disease or type-I neurofibromatosis. Duodenal somatostatinomas are distinguished from pancreatic somatostatinomas by their frequent association with type-I neurofibromatosis and typically absence of somatostatinoma syndrome. We report a very rare and atypical case of malignant duodenal somatostatinoma presenting with somatostatinoma syndrome in association with type-I neurofibromatosis.