RESUMO
Introduction: Electromechanical power morcellation is a widely used technique to extract uterine fibroids during laparoscopic hysterectomy. Although the complication rate of morcellators is low, ectopic leiomyoma can appear several years after their use.Patients and methods: We present a case of an ectopic leiomyoma and a literature review of power morcellation-induced complications and ectopic leiomyoma.Results: A 49-year-old female presented with epigastric pain 12 years after laparoscopic subtotal hysterectomy with morcellation of the specimen. Radiological examinations revealed an epigastric mass of 45 mm that was laparoscopically removed. Histological examination confirmed the diagnosis of an ectopic leiomyoma. Complications of power morcellation are rarely reported and include perioperative injuries to bowel, vascular and urinary tract, spreading of ectopic leiomyoma and occult malignancy.Conclusions: Ectopic leiomyoma are a late and rare complication of a laparoscopic hysterectomy with power morcellation of the uterus.
Assuntos
Histerectomia/efeitos adversos , Laparoscopia/efeitos adversos , Leiomioma/etiologia , Morcelação/efeitos adversos , Neoplasias Ovarianas/etiologia , Complicações Pós-Operatórias/etiologia , Feminino , Humanos , Leiomioma/diagnóstico , Leiomioma/cirurgia , Pessoa de Meia-Idade , Neoplasias Ovarianas/diagnóstico , Neoplasias Ovarianas/cirurgia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/cirurgiaRESUMO
BACKGROUND: Cellular fibrous histiocytoma was first described in 1994 as a distinct variant of fibrous histiocytoma. Since then, at least 21 cases of cellular fibrous histiocytomas metastasizing to regional lymph nodes and/or lungs have been described, though not all fatal. CASE: We report the case of a 68-year-old male patient who presented with a large ulcerated skin tumor on the left thigh. The lesion was urgently excised. Histopathological examination led to the diagnosis of cellular fibrous histiocytoma. Nine months later, the patient presented with progressive dyspnea. A thoracoabdominal computed tomography revealed diffusely spread nodular lung lesions. A lung biopsy confirmed them to be metastases of the cellular fibrous histiocytoma. The condition of the patient quickly deteriorated, and he deceased 2 months later. CONCLUSIONS: Given the possible aggressive nature of cellular type of fibrous histiocytoma, we advice complete excision and clinical follow-up. Chest x-rays and ultrasound examination of regional lymph nodes should be performed in atypical lesions.
Assuntos
Histiocitoma Fibroso Maligno/patologia , Idoso , Evolução Fatal , Humanos , Neoplasias Pulmonares/secundário , MasculinoRESUMO
Solitary fibrous tumor (SFT) of the breast is a rare mesenchymal tumor composed of spindle-shaped tumor cells with collagen and large blood vessels in the shape of a "staghorn". It is discovered anywhere in the human body, usually incidentally or through nonspecific symptoms. A combination of clinical, histological, and immunohistochemical features is required to establish a diagnosis. There are no proper guidelines for the treatment of SFTs because of their rarity; however, wide surgical excision remains the "gold standard". A multidisciplinary team approach is recommended. They are mostly benign with a 5-year survival rate of 89%. Following a PubMed-indexed English literature review, only six publications presenting nine cases of breast SFT in a male patient were found. The following is the case of a 73-year-old man who presented with dry cough. A SFT in the right breast was discovered incidentally during the investigative work up, and the patient was referred to our Breast Clinic at the Jules Bordet Institute, Brussels, Belgium, for appropriate treatment. The patient's presentation, imaging, and histological sample all supported the diagnosis, and he underwent uneventful surgical resection. Here, we present the first case of an incidental finding of a SFT of the male breast, with its diagnosis and therapeutic challenges.
Assuntos
Achados Incidentais , Tumores Fibrosos Solitários , Humanos , Masculino , Idoso , Tumores Fibrosos Solitários/diagnóstico , Tumores Fibrosos Solitários/patologia , Tumores Fibrosos Solitários/cirurgiaRESUMO
Although portal venous supply is considered essential to preserve hepatic integrity, in this study, effects of portal arterialization on liver regeneration were evaluated in a rat model of partial hepatectomy (PH). Ninety-six Lewis rats were randomly assigned to four groups of 24 rats each: PH only (group 1), PH with either venous or arterialized portal supply (groups 2 and 3, respectively), and PH without portal supply (group 4). Liver regeneration rate (LRR), 5-bromo-2-deoxyuridine (BrdU) labeling index, and liver biological characteristics were assessed on days 1, 2, 3, and 7. Compared with group 1, all tested rats had a marked body weight loss after surgery, and only rats in group 4 showed no signs of recovery on day 7. With maintained portal inflow (groups 1, 2, and 3), LRRs increased steadily to day-7 values of 89.2% +/- 11.8%, 81.4% +/- 8%, and 77.4% +/- 9.4%, respectively (P = not significant), and 24-hour peak values of BrdU labeling index were 159 +/- 26, 157 +/- 42, and 149 +/- 48, respectively (P = not significant). Conversely, rats deprived of portal supply (group 4) showed profound inhibition of these two parameters (14 +/- 13; P <.01;32.1% +/- 7.7%; P <.001, respectively). These results indicate that proper portal blood supply is essential to initiate and maintain liver regeneration after PH. With an equivalent portal inflow rate of either venous or arterial source, the hepatic regeneration response can be sustained.