Perioperative group and save testing are not routinely indicated for emergency laparoscopic appendicectomy and laparoscopic hernia repairs: A North West London retrospective study.

INTRODUCTION: Two valid group and saves are commonly required for patients undergoing laparoscopic appendicectomy and laparoscopic hernia repairs preoperatively; however, perioperative blood transfusions are seldom required. This is financially burdensome and frequently leads to delays in theatre lists. We performed a retrospective analysis to investigate blood transfusions performed perioperatively and within 28 days of these procedures. METHOD: We used our electronic records to collect data of all laparoscopic appendectomies and laparoscopic hernia repairs between March 2017 and March 2021. Patients of any age undergoing these operations were included. Patients requiring concomitant intra-abdominal surgery or who had incomplete medical records were excluded. RESULTS: A total of 1891 patients were included, of which 1462 (77.3%) had a laparoscopic appendicectomy versus 429 (22.7%) who had a laparoscopic hernia repair. In all, 3507 group and saves were taken costing £47,398.50. One patient (0.068%) required emergency blood transfusion (4 units of red cells) secondary to major haemorrhage. CONCLUSION: Our findings demonstrate that the incidence of perioperative blood transfusions for laparoscopic appendicectomy and laparoscopic hernia repairs is low, challenging the indication for routine preoperative group and saves.

Donut Mastopexy Lumpectomy.

Advancements in oncoplastic techniques have enhanced commitment to restore shape and, hence, has improved cosmetic outcomes. Donut mastopexy lumpectomy is one such technique and is best utilized in a setting of a malignancy not extending to the skin or the nipple-areolar complex. As a potential alternative to standard lumpectomy, it has many advantages including restriction of scar to the periareolar region, ease and rapidity of surgery, retention of nipple-areolar sensation, and the possibility of performing augmentation mammoplasty. A mini breast lift is also provided without ugly and visible scars. This report provides an insight into the technical details and utility of donut mastopexy lumpectomy (DML) in breast oncoplasty.

Primary Osteosarcoma of the Breast.

Extraskeletal osteosarcomas are extremely rare and account for < 1% of the soft tissue sarcomas. Most common site is in soft tissues of the lower extremities. Primary osteosarcomas of the breast are extremely rare and only a few cases have been reported in literature. It carries a very dismal prognosis in view of its high rate of local recurrence and distant spread. We report a case of primary osteosarcoma of the breast. A 44-year-old female presented with a 14 × 10 cm solid mass in right breast. She underwent wide excision and frozen section was consistent with metaplastic carcinoma. A possibility of malignant phyllodes tumor was kept therefore right axillary dissection was also done along with. Final histopathology was consistent with high-grade osteogenic sarcoma in view of haphazardly arranged spindle to stellate cells with presence of giant cells and a matrix showing osteoid and cartilaginous differentiation and on IHC tumor cells were positive for Vimentin, EMA, Pankeratin, and P 63 and negative for ER, PR, Her 2 neu, CK 7, CK 8/18, and CK 34. It is imperative to recognize this rare pathologic tumor variant in view of its need of multimodal management and overall poor prognosis. Immunohistochemistry plays an important part in establishing the diagnosis and hence the further management.

Malignant Peripheral Nerve Sheath Tumor of the Parotid Gland.

Malignant peripheral nerve sheath tumor (MPNST) refers to spindle cell sarcomas arising from or separating in the direction of cells of peripheral nerve sheath. The MPNST of the parotid gland is an extremely rare tumor, accounts for < 5% of all soft tissue sarcomas, and carries a poor prognosis. In this article, we report a case of MPNST of parotid gland in a 45-year-old male and review its diagnostic and therapeutic challenges. A 45-year-old male presented with right parotid swelling for 2 years with rapid increase in size over the last 3 months. He underwent right total conservative parotidectomy with selective neck dissection. Reconstruction was done with microvascular anterolateral thigh flap. On immunohistochemistry, the tumor cells expressed CD 56 diffusely and S 100 focally. Tumor was immunonegative for CK, Desmin, SOX - 10, and SMA consistent with MPNST. The MPNSTs arising as parotid mass are very rare and aggressive tumors. The role of IHC is paramount in establishing the diagnosis. Multimodal management including wide surgical resection, neck dissection, and adjuvant chemoradiotherapy is the choice of treatment.

Sarcomatoid Carcinoma of Urinary Bladder: a Case Report.

Sarcomatoid carcinoma is an extremely rare aggressive tumor variant comprising about 0.3% of all primary tumors of the urinary bladder and carries an overall dismal prognosis. Diagnosis is important and is sometimes difficult. Immunohistochemistry plays an important role in establishing diagnosis. We report a case with sarcomatoid variant of bladder urothelial carcinoma and review the pathologic features. A 65-year-old male on evaluation of long standing obstructive voiding symptoms and intermittent hematuria found to have a bladder mass. Magnetic resonance urography revealed a 35 × 45 mm mass at dome of urinary bladder with perivesical fat infiltration. He underwent transurethral resection and histopathology revealed pT1 high-grade malignant spindle cell tumor. He underwent radical cystoprostatectomy with bilateral extended pelvic lymphadenectomy with EPLND with ileal conduit urine diversion. Histopathology revealed high-grade muscle invasive spindle cell tumor. The diagnosis was uncertain and two differential diagnosis were kept, sarcomatoid carcinoma and pleomorphic sarcoma. Finally, IHC confirmed the final diagnosis of sarcomatoid carcinoma as it was positive for cytokeratin, CK - 8/18, GATA 3. All lymph nodes were negative for metastasis (pT2, N0, Mx). Recognition of the rare variants of the urinary bladder urothelial tumors is imperative as it is affects the overall management and hence prognosis. Immunohistochemistry plays a paramount role in establishing the diagnosis.

Brachial Plexus Injury After Right Hepatectomy.

Iatrogenic nerve palsies due to faulty positioning on the operating table are commonly seen over the elbow and popliteal fossa. However, injury to the brachial plexus (BP) is rarely encountered and is a recently reported phenomenon due to the increasing number of complex surgeries including hepatobiliary surgical procedures. Brachial plexus injury (BPI) needs to be recognized as a potential complication of prolonged abdominal surgery. The present case report highlights the potential for BPI and its early recognition, management, and prevention in complex prolonged abdominal surgical procedures. BPI has been described in a 64-year-old patient following a prolonged right hepatectomy.

Bilateral Aldosterone-Producing Adrenocortical Carcinoma: a Rare Entity.

Adrenal cortical carcinomas (ACC) are rare aggressive malignant neoplasms with a reported incidence of 1-2 cases per 1 million population and account for 0.05-0.2 % of all malignancies. About 60 % are functional tumors and majority, 40 % present with Cushing's syndrome. Rarely, 2.5 to 11 % present with hypertension due to increased secretion of aldosterone and are usually unilateral. Bilateral aldosterone-producing adrenocortical carcinoma (APAC) has not been reported yet. We report a case of bilateral APAC in a 22-year-old male.

Adenosquamous Carcinoma of the Duodenum: a Rare Entity.

Adenosquamous carcinomas (ASC) of the duodenum are extremely rare neoplasms. They have been reported throughout gastrointestinal tract, including the gastroesophageal junction and the anal canal. Only a few cases of ASC of the small bowel and duodenum have been reported in the literature. Here in we report a case ASC of the second part of the duodenum in a 78-year-old man.

Vaginal mass with urinary incontinence: a rare presentation.

To our knowledge, there are only few published cases of benign renal AML presenting with tumor thrombus in females. We present a new case of this uncommon complication of a benign renal tumor.Epithelioid angiomyolipoma is a recently described rare variant of renal angiomyolipoma.It can occur in patients with or without tuberous sclerosis, and may potentially bemalignant. Benign renal angiomyolipoma (AML) rarely presents with evidence of extension into the renal vein, inferior vena cava (IVC) or atrium. We report a case of a benign renal AML with a tumor thrombus extending into the IVC in a 46-year-old female who presented with right-sided flank pain associated with a right sided abdominal mass. Right Radical nephrectomy with IVC tumor thrombectomy was done. Patient is totally asymptomatic. At 1 month after surgery, an abdominal ultrasound showed no evidence of thrombus within the IVC. CT scan of the abdomen at 3 months post-operatively showed no evidence of recurrence. Surgical treatment of angiomyolipoma with IVC thrombus is warranted in view of risk of malignancy and to prevent tumor embolus to the heart or lungs.

Benign renal angiomyolipoma with inferior vena cava thrombosis.

OBJECTIVE: To present a new case of an uncommon complication of a benign renal tumor. To our knowledge, there are only few published cases of benign renal angiomyolipoma (AML) presenting with tumor thrombus in females. Epithelioid angiomyolipoma is a recently described rare variant of renal angiomyolipoma. It can occur in patients with or without tuberous sclerosis, and may potentially be malignant. Benign renal angiomyolipoma AML rarely presents with evidence of extension into the renal vein, inferior vena cava (IVC) or atrium. We report a case of a benign renal AML with a tumor thrombus to the IVC in a 46-year-old female who presented with right-sided flank pain associated with a right sided abdominal mass. METHODS: Right Radical nephrectomy with IVC tumor thrombectomy. RESULTS: Patient is totally asymptomatic. At 1 month after surgery, an abdominal ultrasound showed no evidence of thrombus within the IVC. CT scan of the abdomen at 3 months post-operatively showed no evidence of recurrence. CONCLUSION: Surgical treatment of angiomyolipoma with IVC thrombus is warranted in view of risk of malignancy and to prevent tumor embolus to the heart or lungs.

Epithelial cyst of the spleen.

This is a report of a case of epithelial cyst of the spleen in an 8-year-old boy. The cyst showed squamous metaplasia on histology. The risk of malignant transformation is discussed.