Local recurrence of the atypical fibrous histiocytoma - a case report.

Atypical fibrous histiocytoma (AFH) is an uncommon variant of benign skin neoplasm, fibrous histiocytoma. Despite having pseudosarcomatous histological features, atypical fibrous histiocytoma is characterized by a benign clinical course. AIM: The aim of the study was to present the case of local recurrence of atypical fibrous histiocytoma in scar after the primary excision. A CASE REPORT: A 28-year-old woman was admitted due to a slowgrowing 10 mm skin tumor of the left elbow, which has been observed for 18 months. Physical examination revealed that the tumor was covered by normal skin, firm, painless and movable. Tumor was excised and the wound was healed properly. Histopathological examination revealed AFH with normal tissue margins below 1 mm. It was decided to increase the excision. After 4 months patient was admitted for an extended resection. Physical examination showed no abnormalities within the scar. Despite this the primary procedure was radicalized and the scar with margins was excised. Histopathological examination reveals a subcuticular, single-site, 2 mm recurrent atypical fibrous histiocytoma with a surrounding of 2-10 mm normal tissue margin. The patient remains in follow-up the scar reveals no irregularities. The excisional biopsy followed by an extended resection makes a complete recovery. CONCLUSIONS: The probability of a too small surgical margin (<1 mm) could contribute to the local recurrence of atypical fibrous histiocytoma.

Totally extraperitoneal inguinal hernia repair with or without fixation leads to similar results. Outcome of randomized prospective trial.

INTRODUCTION: The use of implants in inguinal hernia repair has reduced its recurrence rate. However, postoperative groin pain still remains an unresolved problem. There are suggestions that in totally extraperitoneal inguinal hernia repair (TEP-IHR) two of the likely factors responsible for pain are use of fixation and the type of fixation used. AIM: To evaluate the impact of mesh fixation on the incidence of postoperative pain, restriction of physical activities, hernia recurrence risk, return to normal activities and demand for analgesics in patients after unilateral TEP-IHR. MATERIAL AND METHODS: Unilateral TEP-IHR was performed in 139 male patients randomized to three groups: self-gripping mesh (SG), lightweight mesh (L) and lightweight mesh with fixation (LF). Full study-inclusion criteria were met by 110 patients; 43, 18 and 49 in groups SG, L and LF respectively. Follow-up occurred on the 1st, 2nd, and 7th day and 3, 6, 12 months postoperatively. The numeric rating scale (NRS) was used to assess pain and the EuraHS-QoL (European Registry for Abdominal Wall Hernias Quality of Life Score) questionnaire to compare quality of life (QoL) prior to surgery and one year later. RESULTS: No statistically significant differences were observed between study groups with regard to the incidence rate and intensity of acute post-operative pain, chronic pain, analgesic demand, return to normal activity, hernia recurrence rate and post-operative QoL. CONCLUSIONS: Lack of fixation in TEP-IHR does not increase the risk of hernia recurrence, and its presence does not significantly worsen the treatment results; especially it does not increase the incidence of chronic pain.