[Implantation metastasis of colorectal adenocarcinoma in an anal fistula]. / Colorectalis adenocarcinoma implantációs áttéte végbélsipolyban.

In our case report, we describe a rare form of metastatic colorectal carcinoma, in which tumor cells spread intraluminally and metastasis occurs with implantation mechanism far from the primary tumor. A 43-year-old male patient developed perianal abscess. After surgical intervention a fistula-in-ano appeared at the site of the abscess. Fistulotomy was performed in another hospital. A few months later, we admitted him to our department with an abnormal tissue proliferation appearing in the surgical area. Histology confirmed adenocarcinoma. Colonoscopy detected tissue proliferation in the sigmoid colon, causing a subtotal stenosis. Laparoscopic rectosigmoid resection and per anum tumor excision were performed. Detailed histological examination confirmed the same mucinous adenocarcinoma in the colon and the anorectal malformation. In this case, implantation mechanism is likely in the development of a synchronous tumor at the site of the fistula-in-ano. Implantation metastasis is considered rare, only a few cases have been reported in the international literature so far. We are not aware of any similar case reported from Hungary. Orv Hetil. 2023; 164(3): 110-113.

[The role of radical surgical approach in the treatment of benign multinodular goitre depending on anatomical variations of the recurrent laryngeal nerve]. / A radikalitás helye a benignus pajzsmirigybetegségek sebészi kezelésében a nervus rekurrens anatómiai sajátságainak tükrében.

UNLABELLED: From time to time there is a surprise at the end of surgery - even after subtotal resection - when a vocal cord is observed on indirect laryngoscopy to be non-functional. Surgeons are highly individualistic and develop their own special ways of locating and protecting the nerve. The present study has tried to clarify whether relying on palpation alone during surgery is safe enough in each case. MATERIALS AND METHODS: Between 01.01.2001 and 31.12.2008, 1228 recurrent laryngeal nerve (RLN) were exposed in 702 patients on thyroid surgery. The RLN was found and traced until the laryngeal entry point in all patients. Substernal spreading was noted in 38.6% (271/702), while tracheal compression or dislocation was present in 19.5% (137/702). Recurrent thyroid disease counted for 8.4% (59/702) of all cases. Total thyroid lobectomy was carried out in 82.2% (1009/1228), near-total thyroidectomy in 15.5% (191/1228), and subtotal resection only in 2.3% (28/1228). RESULTS: Palpation was helpful in 80.7% (991/1228), proved false positive in 8.7% (107/1228), while in 10.6% (130/1228) it did not provide any help in the localization. The palpability of the RLN showed marked discrepancy between the two sides. False positivity was noted with palpation in 3.4% (21/625) and 14.3% (86/603) on the right and left side, respectively. On the other hand, palpation helped localization in 4.8% (29/603) on the left side, while the same figure was 16.2% (101/603) on the right side. Definitive RLN palsy was experienced in 0.8% of all cases (10/1228), whilst transient paresis was encountered in 1.4% (17/1228). Occult malignancy was noticed in 5.6% (39/702). CONCLUSIONS: No indication has been left for subtotal resection. Even if benign multinodular goitre is present, since the clinical and pathophysiological evidences suggest that multinodular goitre affects the entire gland, any surgery that leaves potentially abnormal thyroid tissue in situ carries a risk of recurrent disease. RLN palpatory method is a useful part of thyroid surgery but it is suitable for rough orientation only.

[Dilemmas associated with the surgical treatment of cutaneous B cell lymphomas]. / A cutan B-sejtes lymphomák sebészi kezelésének dilemmái.

INTRODUCTION: Cutaneous lymphomas belong to the group of non-Hodgkin lymphomas. However, in case of an in-time diagnose and adequate treatment the prognosis of the disease is fairly good. Nevertheless, a thorny path leads to the correct diagnosis as several dermatological diseases cause problems in differential diagnostics. CASE REPORT: The authors describe the case history of a 53-year-old woman patient, who had a dermatological check-up due to a dermatitis in the shoulder region. A conservative treatment was started because of a suspected mycosis. Following its inefficiency an operative excision was carried out. The postoperative biopsy verified cutaneous B-cell lymphoma. DISCUSSION: The cutaneous B-cell lymphomas are such forms of non-Hodgkin lymphomas, where the malignant proliferation appears primarily in the skin, and in 6 months after the diagnosis extracutaneous manifestation cannot be detected. Several cases can be found in the literature, which show long interval between the manifestation of the symptoms and the setting of the diagnosis. This calls the attention to the significance of difficulties in the differential diagnosis. During the treatment of cutaneous lymphomas the type, the cutaneous extension, and the extracutaneous manifestation of the disease must be defined. The therapeutic plan can be made up by analysing these findings. On the basis of findings in this case and in the literature, a surgical treatment--beyond determining the correct diagnosis--could be a therapeutic alternative in the treatment of cutaneous B-cell lymphomas.