Periareolar Incision for Endoscopic Cardiac Surgery: How to Do It?

Minimally invasive cardiac surgery (MICS) has demonstrated its efficacy in diminishing postoperative pain, accelerating early recovery, and facilitating a prompt return to daily activities. Notably, the periareolar incision has gained prominence owing to its superior cosmesis. This article elucidates the procedural details for implementing periareolar incision access in MICS and providing insights into its technique and applications.

Surgical resection of primary intracardiac sarcomas and outcomes: A review of case reports over 20 years.

Objective: A quarter of all cardiac tumors are malignant, and most (~ 95%) are sarcomas. It is the most aggressive malignant cardiac tumor carrying the worst prognosis. Tumor involvement with the vital intracardiac structures makes it difficult for complete surgical resection. We aimed to study the role of complete surgical resection and its importance in long-term outcomes. Methods: We analyzed published literature from 2002 to 2022 using PubMed. Cases reported adult, intracardiac sarcomas, and received surgical resections were included. We reviewed 132 published case reports, including and analyzed the following variables: demographics, clinical presentations, diagnostic imaging modality, the extent of surgical resection, pathological diagnosis, tumor location, postoperative chemo-radiation therapy, and follow-up (including re-operation, local and distant recurrence). Results: A total of 135 patients are included from 132 articles. The mean age was 46.69 (18-86) and 76 patients were females. The main complaints were dyspnea (70%) and chest pain (32%). Performed investigations were transthoracic echocardiography (TTE) in 114/135 (84%), computer tomography (CT) scan 89/135 (66%), trans-esophageal echocardiography (TOE) 22%, and cardiac magnetic resonance imaging (MRI) 29%. The most common location was the atrium (left 46%, right 30%). Complete surgical resection was performed in 91 cases (67%), and frozen section was performed in 62 patients (43 positives). Incomplete resections were in 42 cases. Patients who underwent complete surgical resection had mean survival of 14.58 months and median of 10.5 months, compared to incomplete resection patients with 9.12 months and 6.5 months respectively. Conclusion: Our review shows complete surgical resection results in better short- and long-term outcomes in intracardiac sarcoma patients. Furthermore, combining chemo-radiotherapy has additional benefits towards long-term survival.

Primary undifferentiated high-grade pleomorphic cardiac sarcoma in the left atrium with atypical presentation.

A woman in her 60s had 4 months of malaise, fatigue, dyspnoea, night sweats and grade 3 clubbing. She had a pansystolic murmur and signs of congestive heart failure. Multimodal imaging with a transthoracic echocardiogram, transoesophageal echocardiogram and CT was carried out to diagnose and reconstruct the mass for surgical planning. A 2×2.8 cm circular dense mass was found in the left atrium with vegetations on the mitral valve. Positron emission tomography and cardiac MRI confirmed the mass's hypermetabolic activity and malignant features. Mitral valve replacement and surgical resection were performed. She was diagnosed with grade 3 undifferentiated cardiac sarcoma and referred to the sarcoma multidisciplinary team for further management given sarcoma's rarity and complexity. The poor prognosis of sarcoma was evident as her symptoms recurred 2 months postoperatively.

Infiltrating angiolipoma of the chest wall: a rare clinical entity.

Angiolipoma is a rare variant of lipoma. Infiltrating chest wall angiolipoma usually presents as painful subcutaneous lesions. There are only a handful of cases reported in the literature. Malignancy is suspected in the differential diagnosis, and hence a tissue diagnosis is needed to rule out an underlying malignancy. Symptomatic infiltrating angiolipoma warrants surgical excision. We report a case of an infiltrating angiolipoma of the chest wall, which was successfully treated with surgical excision.

FNAC and frozen section correlations with definitive histology in thyroid diseases.

The ability to diagnose thyroid cancers pre-op or intra-operatively by fine needle aspiration cytology (FNAC) or frozen section (FS) leads to the delivery of appropriate one-stage surgical management. We aim to study the concordance and discordance of FNAC and FS with final histology in thyroid pathologies. All thyroid procedures from 2007 to 2011(n = 423), involving FNAC and or frozen section in their management pathway were included. FNAC (n = 159) were classified in a five-tier system (Nondiagnostic, Benign, Atypical, Suspicious or Malignant). FS (n = 128) were classified as inconclusive, benign, suspicious or malignant. FNAC and FS were correlated with final histopathology. 159 out of 423 patients had FNAC (PPV 85.1 %), 26 inadequate specimens noted, benign cytology 57, atypical (n = 23), follicular neoplasm (n = 27), suspicious for malignancy (n = 16) and malignant 11. 13 out of 27 follicular neoplasm and 6 of atypical FNAC cases showed malignancy in their final histopathology. Frozen sections; total of 126 patients had intra-operative frozen section biopsies performed. Overall 105 out of 126 FS biopsies were benign; 21 malignancies detected intraoperatively. Three FS were inconclusive and reported benign in final histopathology. Overall, FNAC demonstrated a PPV of 66.6 % and NPV of 84.6 %. FS demonstrated PPV and NPV of 76.1 and 85.7%, respectively. In conclusion, FNAC is considered as the best modality to triage the thyroid nodule pre-operatively. Atypical and follicular neoplasm cytology categories warrant further clinical assessment and close follow-ups when appear benign. The intra-operative frozen sections are helpful to perform a one-stage operation for suspicious thyroid lesion. This study also highlights the recognised limitation of intra-operative frozen section analysis of thyroid neoplasia.

Kikuchi-Fujimoto disease: an unusual cause of neck swelling in pregnancy.

Kikuchi-Fujimoto disease (KFD) is an unusual cause of lymphadenopathy and fever. Pregnancy associated with KFD presents as a diagnostic dilemma for clinicians. The diagnosis can be confirmed with invasive biopsies or non-invasive gene analysis. We report a case of a 24-year-old woman at 18 weeks' gestation with a neck lump and histologically confirmed KFD.

Thoracic vertebral osteomyelitis: an unusual complication of Crohn's disease.

Vertebral osteomyelitis complicating Crohn's disease is a rare occurrence and mostly occurred in patients with Crohn's disease complicated by an abscess or fistulising disease. We report a case of thoracic vertebral osteomyelitis, occurring in a refractory Crohn's disease without contiguous abscess or fistula with the bowel.