A case of malignancy in a thyroglossal duct cyst--recommendations for management.

Thyroglossal duct cyst carcinomas are rare tumors with just more than 200 cases published to date. This is a case report of a thyroglossal duct cyst harboring an occult carcinoma for which a Sistrunk operation was performed. Histopathological examination revealed a papillary carcinoma arising from a thyroglossal duct cyst after which the patient underwent a total thyroidectomy. With current evidence-based guidelines lacking, we discussed some of the issues relevant to the surgical planning and postoperative management of such a patient.

Early hospital discharge following breast cancer surgery in the West Indies: a Trinidad study.

PURPOSE: To examine the outcome of a policy of early hospital discharge (<24 hours) after breast cancer surgery in a Third World setting, where health care resources and support services are very limited. DESIGN: Prospective enrollment into a plan of early hospital discharge within 24 hours following breast surgery. Followup was conducted for wound infections; seroma formation; flap dehiscence; and readmission, if any. SUBJECTS: All patients over a 15-year period who underwent wide local excision or mastectomy and axillary clearance were enrolled. RESULTS: A total of 331 patients were entered into the study. Of these, 148 had modified radical mastectomy and 183 had wide local excision plus axillary dissection. Each patient had a drain placed and output was recorded. Follow-up revealed that there was no increase in the complication rates. CONCLUSION: Early hospital discharge following breast cancer surgery is a feasible option for most patients and can be safely implemented even in a resource-limited setting where cost containment is essential.

A rare case of massive lower gastrointestinal bleeding from a ruptured splenic artery aneurysm.

Splenic artery aneurysms (SAAs) are an extremely rare cause of asymptomatic massive lower gastrointestinal bleeding with less than a handful of patients surviving such a presentation. A 24-year-old female presented in shock after multiple episodes of massive rectal bleeding. Imaging revealed a heterogeneous mass arising from the tail of the pancreas eroding into the splenic flexure of the colon. Further episodes of bleeding led to an exploratory laparotomy. Intraoperatively, a suspected neoplastic process arising from the tail of the pancreas with contiguous involvement of the splenic flexure of the colon and the greater curvature of the stomach was noted. Distal pancreaticosplenectomy, gastric wedge resection with segmental colectomy and primary anastomosis were performed. Histology revealed a SAA with rupture into the colon. This case report shows that en-bloc resection of a ruptured SAA can be performed with success in the emergency setting.

Solid pseudopapillary neoplasms of the pancreas: a report of two cases.

Solid pseudopapillary neoplasms of the pancreas are uncommon, accounting for only 1-2% of all pancreatic neoplasms. These tumors are being detected at an increased rate, probably due to the increased awareness and the liberal use of imaging. We report two cases of patients with solid pseudopapillary pancreatic tumors and review the existing literature.