Metastasis of carcinoid tumor to the transplanted liver graft: a rare case report.

In this study, we present a rare case of gastrointestinal carcinoid tumor that metastasized to a transplanted liver graft. A 14-year-old female patient suffering from cryptogenic cirrhosis had undergone liver transplantation. The liver was received from a deceased donor. She presented to our clinic with complaints of abdominal pain, diarrhea, flushing, fatigue, and syncope four years after transplantation. On multislice computed tomography, multiple masses ranging from 1 cm to 4 cm in size were detected in both lobes of the transplanted liver. Biopsy from both lobes revealed carcinoid tumor. The primary tumor could not be localized, and a colonoscopy was scheduled. As the patient refused an invasive investigation, octreotide therapy was begun. Her symptoms related to the carcinoid tumor diminished following initiation of the octreotide therapy. During the fifth year of octreotide therapy, a whole-body positron emission tomography (PET CT) with 10 mCi F-18 fludeoxyglucose (FDG) showed an increase in the metabolic activity with a SUVmax value of 8 at the localization site, consistent with the ileocecal region. The findings were considered secondary, as the carcinoid tumor originated from the appendix or distal ileum. Again, the patient again refused endoscopic investigations and continued the follow-up visits. To our knowledge, this is the only reported case in the scientific literature of a carcinoid tumor that metastasized to a transplanted liver.

Unusual histopathological findings in appendectomy specimens from patients with suspected acute appendicitis.

AIM: To investigate the prevalence and implications of unusual histopathological findings in appendectomy specimens from patients with suspected acute appendicitis. METHODS: The demographic and histopathological data of 1621 patients (≥ 16 years-old) who underwent appendectomy to treat an initial diagnosis of acute appendicitis between January 1999 and November 2011 were retrospectively assessed. Microscopic findings were used to classify the patients under six categories: appendix vermiformis, phlegmonous appendicitis, gangrenous appendicitis, perforated appendicitis, supurative appendicitis, and unusual histopathologic findings. The demographic and clinicopathologic characteristics of patients with unusual histopathologic findings were evaluated in detail, and re-analysis of archived resected appendix specimens was carried out. RESULTS: A total of 912 males and 709 females, from 16 to 94 years old, were included in the study and comprised 789 cases of suppurative appendicitis, 370 cases of appendix vermiformis, 243 cases of perforated gangrenous appendicitis, 53 cases of flegmaneous appendicitis, 32 cases of gangrenous appendicitis, and 134 (8.3%) cases of unusual histopathological findings. The unusual histopathological findings included fibrous obliteration (n = 62), enterobius vermicularis (n = 31), eosinophilic infiltration (n = 10), mucinous cystadenoma (n = 8), carcinoid tumor (n = 6), granulomatous inflammation (n = 5), adenocarcinoma (n = 4; one of them mucinous), and mucocele (n = 3), adenomatous polyp (n = 1), taenia sup (n = 1), ascaris lumbricoides (n = 1), appendiceal diverticula (n = 1), and B cell non-hodgkin lymphoma (n = 1). None of the 11 patients with subsequent diagnosis of tumor were suspected of cancer prior to the appendectomy. CONCLUSION: Even when the macroscopic appearance of appendectomy specimens is normal, histopathological assessment will allow early diagnosis of many unusual diseases.

Hydatid cyst of the thyroid gland: report of three cases.

Cystic Echinococcosis is a parasitic infestation that is distributed world-wide. It may be found in nearly any part of the body, most often in the liver and the lungs, but occasionally in other structures such as the thyroid gland. The present study reports three cases of hydatid cysts of the thyroid gland, in patient ranging from 18 to 25 years of age. Two patients had concomitant hydatid disease involving organs other than the thyroid gland (secondary disease), and one had, sole, involvement of the thyroid gland itself (primary disease). Moreover, an occult papillary thyroid carcinoma was detected incidentally in one case, involving the unilateral thyroid lobe as the hydatid cyst. While several surgical procedures including left lobectomy and isthmectomy were undertaken in one patient, two patients underwent total thyroidectomy. No disease recurrence was observed in any of the three patients during the postoperative follow-up period. No study reporting the concomitance of hydatid cyst and neoplasia of the thyroid gland has been previously published. This concomitance indicates the importance of the differential diagnosis of lesions characterized by calcifications in the thyroid gland, especially in endemic regions.

Effects of two different meshes used in hernia repair on nerve transport.

BACKGROUND: We aimed to investigate the effects of two different types of mesh used in hernia repair on nerve transport and neural injury. STUDY DESIGN: Forty-five Wistar-albino rats were randomly allocated to three groups. Basal neural transport on the index of the left sciatic nerve was performed in all groups before surgery. In the control group, only sciatic nerve manipulation was performed. Other groups received a cuff around the index sciatic nerve. The second group received a monofilament polypropylene and the third group received a polytetrafluoroethylene mesh. Effects of entrapment on neural transport were evaluated by electromyography on the 28th day. Tissue samples from sciatic nerves were taken for evaluation of nerve injury. RESULTS: There was no significant difference between basal latency and amplitudes (p=0.609 and p=0.152, respectively). But latency was significantly different 4 weeks after the operation (p < 0.0001). At post hoc evaluation, entrapment groups had longer latency times compared with those in the control group (p=0.006 and p < 0.0001, respectively). But the increase in latency between entrapment arms was similar on the 28th day (p=0.601). Both initial and late term amplitudes were similar (p=0.364 and 0.913, respectively). Histologic evaluation by Masson's trichrome staining revealed high fibrosis scores and increased collagen deposits, especially in the polypropylene group (p < 0.0001), and increased inflammation in the polytetrafluoroethylene group (p < 0.001). CONCLUSIONS: Our results showed that the two most commonly used meshes in tension-free hernia surgery have different effects on nerve physiology and morphology. We concluded that alterations in nerve physiomorphology are from the properties of the mesh and may be the source of postoperative pain in hernia surgery.