Primary splenic angiosarcoma - the same diagnosis yielding two different clinical pictures. Case report.

Splenic angiosarcoma has been presented as an extremely rare malignant tumour. Amongst the rarest of all neoplasms, primary splenic angiosarcoma comprises 0.14-0.25 of all annually reported cases per one million persons Splenic angiosarcoma was first described in 1879 by T. Langerhans. The clinical symptoms and diagnostic values associated with splenic angiosarcoma are extremely variable. Nonetheless, majority of the patients (75%) complain of abdominal pain, and a quarter to one-third present with rupture of the involved organ. We hereby report our experience with two splenic angiosarcoma cases, which despite being similar in their diagnosis, nonetheless present with an entirely different clinical picture. Our first case, whereby the patient presented with a liver that was also affected by the angiosarcoma of the spleen. In the second case however, although the patient did show evidence of metastasis to the abdominal cavity as well as the liver, she also suffered from primary adenocarcinoma of the colon. To our knowledge, no previous article has made mention of primary splenic angiosarcoma existing independently of another primary neoplasm. Both may be found in common practice, and ought to be highlighted for their significance as such.

Laparoscopic organ-sparing surgery for cystic lesions of the spleen - own observations.

<b>Introduction:</b> Splenic cysts are quite rare. In this publication, authors focus on presenting their own observations related to the management of patients with such lesions. </br></br> <b> Aim:</b> To evaluate the effectiveness of laparoscopic procedures in the case of patients with splenic cysts. </br></br> <b>Material and methods:</b> The study included patients treated surgically for cystic lesions located in the spleen at the 2^nd Department of General, Gastroenterological and Oncological Surgery of the Medical University of Bialystok over the years 2017-01.2020. </br></br> <b>Results:</b> All patients were referred for elective excision of the spleen lesion (the size of the lesions ranged from 7 to 15 cm - based on CT examination). In all cases, excision of the anterior wall of the cyst was performed with the help of advanced surgical tools. The duration of the procedure ranged between 65 and 100 minutes. No significant blood loss was observed. No postoperative complications were found. </br></br> <b>Conclusions:</b> In conclusion, sparing laparoscopic surgery for cystic lesions of the spleen seem to be safe and rarely associated with complications or relapses. Extending the scope of the procedure to total splenectomy should also not pose a major problem.

Gas gangrene as a surgical emergency - own experience.

In this paper the authors would like to present a correct procedure in both surgical and hyperbaric treatment of patients with gas gangrene admitted to a surgical department during ER. Gas gangrene is not very common these days, but when it comes to dealing with gangrenous infection in the emergency it is quite likely to make errors in both diagnostic and therapeutic manners. When there is a gas gangrene in a patient at the emergency time plays crucial role and the proper application of procedures is vital for the patient's survival. 10 cases made the study group here, all of them were patients diagnosed and treated surgically due to gas gangrene. As shown here, It is important to perform a revision of surgical wounds after few hours since primary surgery and to begin hyperbaric treatment as quickly as possible. The findings and suggestions included in this study are supported by own experience of The 2nd Department of General and Gastrointestinal Surgery of Medical University in Bialystok, Poland.

Significance of selected morphological and histopathological parameters of colon tumors as prognostic factors of cancer spread.

BACKGROUND/AIMS: The identification of prognostic factors of metastatic development is one of the most important issues in colorectal cancer (CRC) research. The aim of this study was to determine the usefulness of colon tumor characteristics, including location, circumferential location, histological type, and histological grade, as predictors of metastases. MATERIALS AND METHODS: To identify potential predictors of CRC spread, we analyzed data of 191 patients who had undergone surgery for colon tumors. We searched for potential associations between the location in the right or left colon, circumferential location, histological type, and histological grade (G-parameter) of colon tumors and the incidence of lymph node and distal metastases. The analysis was based on Pearson's chi-square (χ2) test with a statistical significance of p<0.05. RESULTS: Lymph node metastases were found in 100 patients, including 44 patients with synchronous liver metastases. Lymph node involvement was detected in 43 (52.4%) patients with right-sided and in 57 (52.3%) patients with left-sided tumors (p=0.984). Liver metastases were detected in 19 (23.17%) patients with right-sided colon tumors and in 25 (22.9%) patients with left-sided tumors (p=0.969). Lymph node and liver metastases were found in 60 (47.6%) and 24 (19.0%) patients with annular tumors, respectively (p=NS), and these were found on the mesenteric side in 75.0% (n=30) and 20.0% (n=8) patients (p=0.004) and on the antimesenteric side in 47.6% (n=10) and 48.0% (n=12) patients (p=0.044), respectively. CONCLUSION: The circumferential location of primary colon tumors is a significant predictor of their metastatic potential. The mesenteric location of the tumor is predisposed to lymphatic spread, whereas the antimesenteric location predicts hematogenous spread.

Assessment of the accuracy of preoperative imaging methods in the diagnosis of hepatic single-chamber echinococcosis.

UNLABELLED: Echinococcosis is an infectious disease, caused by larval stages of cestode species of the genus Echinococcus. The course of the disease is determined on the basis of the location and larval size. In 80-95% of cases echinococcosis is located in the liver and lungs, rarely in the brain. Symptoms are usually uncharacteristic for an uncomplicated disease. The diagnosis of echinococcosis is based on imaging and immunodiagnostic tests. The aim of the study was to assess the accuracy of preoperative imaging methods in the diagnosis of hepatic single- chamber echinococcosis. MATERIAL AND METHODS: Amongst the 110 patients with hepatic cysts diagnosed during the period between 2000 and 2009, a group of 30 subjects with suspicion of single-chamber echinococcosis (ultrasound and CT) was isolated. The imaging methods visualized structures typical for hydatid cysts: the mother cyst with satellite cysts called " honeycomb appearance", cysts with calcified walls and compartments, and endocyst separation called "water lily-sign". The study group comprised 22 female and 8 male patients with an average age of 52±16.2 years. The histopathological examination of the excised cyst verified the diagnosis. RESULTS: Single-chamber echinococcosis was finally recognized in 19 cases, while in the 11 remaining cases the parasitic disease was excluded. The sensitivity of imaging methods was estimated at 73.7%, specificity - 88.9%, negative predictive value - 61.5%, positive predictive value - 93.3%, Youden`s factor - 0.626, and Φ index - 0.586. CONCLUSIONS: In conclusion, the presence of an unilocular cyst with an uniform anechoic content can be a simple cyst or single-chamber echinococcus cyst. The typical, characteristic image of a hydatid cyst, such as the "water lily-sign" is rarely observed during imaging examinations. It has also been shown that cystic calcification, observed during ultrasonography and computed tomography was evidence of the parasitic character of the lesion.