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1.
Anticancer Res ; 40(10): 5853-5860, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32988915

RESUMO

BACKGROUND/AIM: The optimal treatment sequencing for asymptomatic de novo metastatic rectal cancer is unclear. The aim of this study was to investigate the role of upfront radiotherapy, with or without chemotherapy on risk for local complications, in patients with asymptomatic advanced metastatic rectal cancer treated with palliative intention. PATIENTS AND METHODS: All patients with de novo metastatic rectal cancer diagnosed between January 2008 and December 2017 in two healthcare regions in Sweden (Örebro län, Sörmland) were identified and data were extracted from electronic medical records. Patients were divided into 3 groups based on treatment sequence: upfront radiotherapy, upfront chemotherapy, and only palliative surgery. RESULTS: In total, 102 patients were included in the study cohort, 30 patients in upfront radiotherapy group, 54 in upfront chemotherapy, and 18 in only palliative surgery group. Patients with only upfront CT [odds ratio (OR)= 5.10; 95% confidence interval (CI)=1.24-20.91, p=0.024] had a higher risk to suffer from a local complication compared to those who received upfront radiotherapy. Cause-specific Cox regression analysis among patients who received oncological therapy revealed that female patients [cause-specific hazard ratio (csHR)=3.61; 95% confidence interval (CI)=1.67-7.81] and upfront chemotherapy [csHR=1.85; 95% CI=1.11-3.77] were associated with increased cumulative incidence of local complication over time, whereas primary surgery with ostomy or stent with lower risk [csHR=0.45; 95% CI=0.21-0.99]. CONCLUSION: Patients who received upfront radiotherapy, with or without chemotherapy, had fewer local complications due to primary tumor compared to patients who only received chemotherapy. This could indicate that radiotherapy to the primary tumor could be discussed with the patients as a first treatment option for asymptomatic metastatic rectal cancer to prevent local complications later during the disease.


Assuntos
Doenças Assintomáticas/terapia , Doenças Raras/radioterapia , Neoplasias Retais/radioterapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Assintomáticas/epidemiologia , Estudos de Coortes , Terapia Combinada , Feminino , Humanos , Masculino , Oncologia/tendências , Pessoa de Meia-Idade , Cuidados Paliativos , Modelos de Riscos Proporcionais , Doenças Raras/tratamento farmacológico , Doenças Raras/patologia , Doenças Raras/cirurgia , Neoplasias Retais/tratamento farmacológico , Neoplasias Retais/patologia , Neoplasias Retais/cirurgia , Suécia/epidemiologia
2.
J Cancer Res Ther ; 16(3): 630-633, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32719279

RESUMO

Malignant peripheral nerve sheath tumors (MPNSTs) of parapharyngeal space are rare and if present are most often in association with neurofibromatosis type 1 (NF-1). Only a few cases of MPNST have been reported in the literature without coexisting NF. We report one such case of an MPNST of parapharyngeal space tumor in a 35-year-old female with no associated features of NF-1. She presented with right-sided neck swelling and ptosis. Magnetic resonance imaging showed a 7 cm × 8 cm × 11 cm irregular swelling in the right parapharyngeal space with invasion of surrounding muscles. The mass was excised using a transcervical approach. Postoperative histopathological examination of the specimen revealed MPNST possibly arising from the cervical sympathetic chain.


Assuntos
Neurofibrossarcoma/patologia , Neoplasias Faríngeas/patologia , Sistema Nervoso Simpático/patologia , Adulto , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Pescoço/diagnóstico por imagem , Pescoço/patologia , Neurofibrossarcoma/diagnóstico por imagem , Neurofibrossarcoma/cirurgia , Espaço Parafaríngeo/diagnóstico por imagem , Espaço Parafaríngeo/patologia , Neoplasias Faríngeas/diagnóstico por imagem , Neoplasias Faríngeas/cirurgia , Doenças Raras/diagnóstico por imagem , Doenças Raras/patologia , Doenças Raras/cirurgia , Sistema Nervoso Simpático/diagnóstico por imagem , Sistema Nervoso Simpático/cirurgia
3.
J Cancer Res Ther ; 16(3): 647-652, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32719283

RESUMO

The leiomyoma is a benign smooth-muscle neoplasm commonly found in the female genital tract, gastrointestinal tract, or skin. Leiomyomas of the oral cavity are unusual. Oral leiomyomas are uncommon due to the paucity of the smooth muscle in the mouth (except in blood vessels) and thus the involvement of jaw bones is extremely rare. Leiomyomas have been classified as solid angiomyoma, angioleiomyoma (vascular leiomyoma), and epithelioid variants. Angioleiomyomas are benign mesenchymal tumors derived from smooth muscle, which rarely occur in the oral cavity. Malignant transformation probably does not occur but careful histopathologic examination is still necessary to differentiate these benign lesions from their malignant counterparts due to different prognosis. Although uncommon in the maxilla and mandible, they should be included in the differential diagnosis of radiolucent lesions of jaw bones. An extensive search of literature was carried out on the Medline-PubMed and Google Scholar database using the keywords such as leiomyoma, angioleiomyoma, jaw bones, maxilla, mandible, intra-osseous to thoroughly search and collect all the reported cases of intraosseous leiomyoma (but our search was not limited to these terms only). To the best of our knowledge, only 23 cases of intraosseous leiomyomas have been reported so far in the jaw bones, among which only 8 belonged to angioleiomyomas. Herein, we report the 9th case of intraosseous angioleiomyoma, one of the variants of leiomyoma and overall 24th intraosseous leiomyoma in a 6-year-old female child, together with conventional histopathologic and immunohistochemical findings.


Assuntos
Angiomioma/patologia , Neoplasias Mandibulares/patologia , Doenças Raras/patologia , Actinas/metabolismo , Angiomioma/metabolismo , Angiomioma/cirurgia , Antígenos CD34/metabolismo , Biomarcadores Tumorais/metabolismo , Criança , Feminino , Humanos , Neoplasias Mandibulares/metabolismo , Neoplasias Mandibulares/cirurgia , Músculo Liso/metabolismo , Músculo Liso/patologia , Doenças Raras/metabolismo , Doenças Raras/cirurgia
4.
J Cancer Res Ther ; 16(3): 661-664, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32719286

RESUMO

The present case report is a case of peripheral dentinogenic ghost cell tumor (PDGCT), an extremely rare solid benign neoplastic variant of calcifying cystic odontogenic tumor of the gingiva mimicking clinically as pyogenic granuloma, fibroma, peripheral ossifying fibroma, and peripheral giant-cell granuloma. A 24-year-old male reported with painless, firm, solitary, sessile, smooth-surfaced, nonulcerative, nonpulsatile, well-defined swelling measuring ≈12 mm × 9 mm in the interdental gingiva of the teeth #13 and #14 extending to the mucogingival junction. Intraoral periapical radiographic showed a normal trabecular pattern with mild radiolucency without bony expansion, periapical lesion, and resorption of the adjacent teeth. The diagnosis was established by histopathologic examination. Very few cases of this entity have been documented in the literature. The present case report aims to document this rare entity and emphasizes on the fact that histopathological examination of every localized gingival growth should be included in the treatment planning to differentiate with other commonly found lesions.


Assuntos
Dente Canino/patologia , Neoplasias Gengivais/patologia , Granuloma de Células Gigantes/patologia , Neoplasias Maxilares/patologia , Doenças Raras/patologia , Adulto , Dente Canino/cirurgia , Neoplasias Gengivais/cirurgia , Granuloma de Células Gigantes/cirurgia , Humanos , Masculino , Neoplasias Maxilares/cirurgia , Prognóstico , Doenças Raras/cirurgia , Adulto Jovem
5.
J Cancer Res Ther ; 16(3): 675-679, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32719290

RESUMO

Acinic cell carcinoma (ACC) is a low-grade malignant salivary gland neoplasm that comprises approximately 17% of primary salivary gland malignancies or about 6% of all salivary gland neoplasms. The most common intraoral sites are the buccal mucosa, lips, and palate. The diagnosis of ACC frequently presents difficulties, owing to its great radiological and cytological similarity with benign tumors and with normal acinar component of the salivary gland, respectively. The management of ACC consists of complete surgical excision. Here, we report a case of ACC on the left retromolar trigone, a rare location in a 44-year-old female.


Assuntos
Carcinoma de Células Acinares/patologia , Mucosa Bucal/patologia , Doenças Raras/patologia , Neoplasias das Glândulas Salivares/patologia , Adulto , Carcinoma de Células Acinares/cirurgia , Feminino , Humanos , Mucosa Bucal/cirurgia , Prognóstico , Doenças Raras/cirurgia , Neoplasias das Glândulas Salivares/cirurgia
6.
Folia Med Cracov ; 60(1): 55-60, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32658212

RESUMO

An incarcerated epigastric hernia (localized in linea alba) is a very rare observation. Here, we present a case of a 66-year-old white male who was admitted to the emergency department due to vomiting and epigastric pain. On physical examination, the only observed abnormality was a painless soft epigastric tumor located in the upper midline, measuring about 12 cm in diameter. The patient claimed that he had the tumor for more than 30 years and it never changed in diameter nor caused him any discomfort. A lipoma was initially suspected. However, an ultrasound of the abdomen revealed an incarcerated stomach, trapped due to the defect in the epigastric abdominal wall. The patient was sent for surgery and the presence of an incarcerated epigastric hernia of the linea alba, which contained the anterior wall of the stomach was confirmed. The presented case confirms that the use of ultrasonography may be an effective method to recognize unusual types of hernias, and that ultrasonography should be routinely used in emergency departments.


Assuntos
Artérias Epigástricas/cirurgia , Hérnia Abdominal/diagnóstico , Hérnia Abdominal/cirurgia , Herniorrafia/métodos , Doenças Raras/diagnóstico , Doenças Raras/cirurgia , Ultrassonografia/métodos , Idoso , Humanos , Masculino , Período Pré-Operatório , Resultado do Tratamento
7.
Gynecol Oncol ; 157(1): 29-35, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32241341

RESUMO

OBJECTIVES: Description of fertility and prognosis of patients with borderline ovarian tumor (BOT) treated by fertility-sparing surgery through a longitudinal study from the French national cancer network. METHODS: All consecutive patients diagnosed with BOT from the French National Network dedicated to Ovarian Malignant Rare Tumors from 2010 and 2017 were selected. In 2018, an update was made by sending a questionnaire regarding recurrence and fertility to patients aged under 43 years at diagnosis and treated conservatively. We compared the characteristics of the patients with/without recurrence and with/without live birth. RESULTS: Fifty-two patients aged 18 to 42 years presented a desire of pregnancy. Thirty patients (58%) presented a FIGO IA tumor, and 20 patients were treated by bilateral cystectomies (38%). We observed at least one live birth for 33 patients (63%) and local recurrences in 20 patients (38%). Both recurrence and live birth in 17 patients (33%) were reported, with recurrence occurring before pregnancy, after a second fertility-sparing treatment, in half of the cases. No factors associated with recurrence or live birth in this study were identified. Moreover, in this population, both recurrence and live birth were independent of age, with a linear risk along time. Disease-free survival was worse for patients treated with bilateral cystectomy (n = 20, 38%), with no difference in terms of fertility. CONCLUSION: Two third of the patients experienced life birth after conservation surgery. We did not highlight an age/time from surgery for which the risk of recurrence outweighs the chance of pregnancy and to radicalize surgery. Moreover, almost a quarter of the live birth occurred after recurrence, with no more further event to date in these patients. The results encourage to consider a second fertility-sparing surgery after local borderline recurrence in the case of pregnancy desire. All these decisions must be discussed in specialized multidisciplinary boards.


Assuntos
Preservação da Fertilidade , Neoplasias Ovarianas/cirurgia , Adolescente , Adulto , Estudos de Coortes , Feminino , Humanos , Estudos Longitudinais , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias , Neoplasias Ovarianas/patologia , Gravidez , Taxa de Gravidez , Prognóstico , Doenças Raras/cirurgia , Inquéritos e Questionários , Adulto Jovem
8.
Gynecol Oncol ; 157(1): 78-84, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32131977

RESUMO

OBJECTIVE: The French national rare gynecological tumor network has been established to improve the quality of care through offering expertise in double reading histological diagnosis, reviewing cases and guiding management of these tumors through specialized multidisciplinary tumor boards and online clinical guidelines (www.ovaire-rare.com). The aim of this study is to evaluate the impact of the development and implementation of this network by assessing the conformity of medical practice with the guidelines concerning the granulosa cell tumors (GCTs). METHODS: This is a French nationwide study, including 463 patients (out of the 639 identified patients) with a definitive diagnosis of GCT between 2011 and 2016. Surgical practices were analyzed for conformity with the current guidelines (www.ovaire-rare.org). Medical records, surgical and pathological reports were systematically analyzed. Total conformity was defined by a conservative (unilateral salpingo-oophorectomy) or radical surgery (hysterectomy and bilateral salpingo-oophorectomy) including surgical staging (omentectomy, peritoneal biopsies and peritoneal cytology) according to the FIGO stage. Partial conformity referred to a conservative or radical surgery without surgical staging and non-conformity was defined as a non-optimal surgery as recommended by the guidelines. RESULTS: Median age at diagnosis was 49 years old (range 10-89). The median size of tumor was 94 mm (range 5-400). Radical surgery was performed in 240 patients (52%); while a fertility-sparing surgery was performed in 98 cases (21%). A surgical staging was performed in 76 cases (16%) and an evaluation of the endometrium in 289 cases (62%). Surgery was fully compliant with the guidelines in 65 patients (14%), partially compliant in 213 patients (46%), non-compliant in 137 patients (30%) and not assessable in 48 cases (10%). A statistically significant difference for compliance was observed in restaging surgery (p < 0,001), radical surgery (p = 0,017) and the period (before or after) of the implementation of the network (p < 0,001). Survival analyses did not allow us to demonstrate a significant difference in overall survival nor in PFS although there was a trend in favor of optimal surgery compared to incomplete/non optimal surgery. CONCLUSION: Surgical management's conformity to the guidelines increases over time from 2011 to 2016. According to this study, the implementation of a national network dedicated to rare gynecologic tumors seems to significantly improve the surgical management of the patients with ovarian granulosa cell tumors.


Assuntos
Tumor de Células da Granulosa/diagnóstico , Tumor de Células da Granulosa/cirurgia , Procedimentos Cirúrgicos em Ginecologia/normas , Neoplasias Ovarianas/diagnóstico , Neoplasias Ovarianas/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Estudos de Coortes , Feminino , França/epidemiologia , Tumor de Células da Granulosa/mortalidade , Fidelidade a Diretrizes , Procedimentos Cirúrgicos em Ginecologia/métodos , Procedimentos Cirúrgicos em Ginecologia/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias Ovarianas/mortalidade , Doenças Raras/diagnóstico , Doenças Raras/cirurgia , Estudos Retrospectivos , Adulto Jovem
9.
G Chir ; 41(1): 18-33, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32038009

RESUMO

BACKGROUND: Retroperitoneal sarcoma is a rare malignancy arising from mesenchymal cells, most commonly presented as an abdominal mass and is associated with poor prognosis. The most effective treatment modality for retroperitoneal sarcomas is complete surgical resection, including sometimes adjacent organs infiltrated by the tumor. Radiotherapy is frequently applied and has shown some benefit, while the role of chemotherapy and molecular-targeted agents is still not clear. Local recurrence is common for retroperitoneal sarcomas and still remains the main cause of death. The major factors associated with the overall survival are tumor grade, histological subtype, complete macroscopic excision and multifocality. AIM: To report our experience via the presentation of patients with retroperitoneal sarcomas managed in our department during the period 2014-18; and to review the current literature. PATIENTS AND METHODS: Eight patients appeared with chronic non-specific complaints including abdominal distension and changes in bowel or bladder habit, while one patient presented with acute abdominal pain due to mass rupture. All of the patients underwent surgical resection of the tumor. RESULTS: Among the patients, seven were operated for primary disease and one only for recurrent. The most common histologic type was liposarcoma (well-differentiated, dedifferentiated), found in five patients; followed by leiomyosarcoma found in two cases. Fibrous histiocytoma was found in only one case. The masses were removed with macroscopically clear margins (R0 and R1 resections) in four cases. In five patient cases adjuvant therapy was required. Three patients are still alive and free of disease. CONCLUSIONS: Retroperitoneal sarcomas present to be a therapeutic challenge based on their location, their extent at the time of diagnosis and the high risk of local recurrence or distant metastasis. Their management requires a multidisciplinary approach, with the surgical resection remaining the mainstay of curative treatment, combined with surveillance for early detection of recurrence or metastases.


Assuntos
Neoplasias Retroperitoneais/diagnóstico , Neoplasias Retroperitoneais/cirurgia , Sarcoma/diagnóstico , Sarcoma/cirurgia , Dor Abdominal/etiologia , Dor Aguda/etiologia , Histiocitoma Fibroso Benigno/complicações , Histiocitoma Fibroso Benigno/diagnóstico , Histiocitoma Fibroso Benigno/cirurgia , Humanos , Leiomiossarcoma/complicações , Leiomiossarcoma/diagnóstico , Leiomiossarcoma/cirurgia , Lipossarcoma/complicações , Lipossarcoma/diagnóstico , Lipossarcoma/cirurgia , Recidiva Local de Neoplasia/diagnóstico , Recidiva Local de Neoplasia/cirurgia , Doenças Raras/complicações , Doenças Raras/diagnóstico , Doenças Raras/cirurgia , Neoplasias Retroperitoneais/complicações , Sarcoma/complicações
10.
Am J Case Rep ; 21: e920821, 2020 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-32071285

RESUMO

BACKGROUND A left-sided gallbladder without situs inversus is a rare congenital anomaly of the gallbladder with a prevalence ranging from 0.04-0.3%. CASE REPORT We present a case of a female patient, referred to our clinic with clinical features of an acute cholecystitis. After performing the standard preoperative investigations, which confirmed the diagnosis, the patient underwent a laparoscopic cholecystectomy. We found a left-sided gallbladder, attached to the lower surface of the left lobe of the liver. During the dissection in the Callot triangle an aplastic cystic duct was also identified. The extirpation of the gallbladder was performed anterograde, allowing a better exposition of the critical structures. CONCLUSIONS A left sided gallbladder is almost an incidental finding, which can be accompanied with further anomalies of the biliary tree. A combination of these 2 variations is very rare without any other reported cases in the literature.


Assuntos
Colecistite Aguda/cirurgia , Ducto Cístico/cirurgia , Doenças da Vesícula Biliar/cirurgia , Vesícula Biliar/anormalidades , Colecistectomia Laparoscópica , Feminino , Vesícula Biliar/cirurgia , Humanos , Pessoa de Meia-Idade , Doenças Raras/cirurgia
11.
Cir Cir ; 88(1): 95-99, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31967610

RESUMO

Bouveret´s syndrome refers to the condition of gastric outlet obstruction caused by the impaction of a large gallstone into the duodenum after passage through a cholecystoduodenal fistula. Many endoscopic and surgical techniques have been described in the management of this syndrome, however the morbidity and mortality are still very high. We present the case of a 67-year-old female patient with Bouveret´s syndrome, with successful resolution with surgical treatment after two failed endoscopic treatments.


Assuntos
Obstrução Duodenal/complicações , Cálculos Biliares/complicações , Obstrução da Saída Gástrica/etiologia , Doenças Raras/etiologia , Idoso , Fístula Biliar/complicações , Obstrução Duodenal/cirurgia , Feminino , Cálculos Biliares/cirurgia , Obstrução da Saída Gástrica/cirurgia , Humanos , Fístula Intestinal/complicações , Doenças Raras/cirurgia , Síndrome
12.
Urology ; 135: 71-75, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31195014

RESUMO

OBJECTIVE: To summarize the clinical characteristics and surgical management of adrenal teratoma in adults. PATIENTS AND METHODS: We retrospectively reviewed 14 patients with adrenal teratoma from January 2002 to June 2017, at 2 large centers in China and performed a systematic review of 39 patients from our series and published literatures. The clinicopathological characteristics, imaging features, surgical management and outcomes of this rare disease were analyzed. RESULTS: Our series includes 12 females and 2 males with the median age of 35. Seven patients were treated by open adrenalectomy (OA) and 7 by laparoscopic adrenalectomy (LA) without perioperative complications. All patients were alive without recurrence or canceration over a mean follow-up of 77.1 months. In the systemic review, the male-female ratio was nearly 1:3, with a median age of 29 years. Mean tumor size was 9.4 cm and the distribution was almost the same between left and right side (53.8% vs 46.2%). The most common symptoms were flank or abdominal pain (46.2%), whereas 53.8% patients were asymptomatic. Tumors were often cystic (63.9%) with intratumoral fat (91.7%) and calcifications (80.6%). All patients underwent surgery including 17 (43.6%) OA and 22 (56.4%) minimally invasive surgery. All tumors were pathologically confirmed mature teratoma except for one. CONCLUSION: Adrenal teratoma is an extremely rare entity, frequently found to be large, benign and cystic. The patient's prognosis is generally good. As for its large volume, OA is the first choice for teratoma in most cases, while the LA can be an option in the small one.


Assuntos
Neoplasias das Glândulas Suprarrenais/cirurgia , Glândulas Suprarrenais/patologia , Doenças Assintomáticas/terapia , Doenças Raras/cirurgia , Teratoma/cirurgia , Neoplasias das Glândulas Suprarrenais/diagnóstico , Neoplasias das Glândulas Suprarrenais/patologia , Glândulas Suprarrenais/cirurgia , Adrenalectomia , Adulto , China , Feminino , Seguimentos , Humanos , Laparoscopia , Masculino , Prognóstico , Doenças Raras/diagnóstico , Doenças Raras/patologia , Estudos Retrospectivos , Teratoma/diagnóstico , Teratoma/patologia , Resultado do Tratamento
13.
Int J Dermatol ; 59(3): 321-325, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31777957

RESUMO

BACKGROUND: The use of Mohs micrographic surgery (MMS) for rare cutaneous tumors is poorly defined. We aim to describe the demographics, tumor presentation and topography, surgery characteristics and complications of MMS for rare cutaneous tumors in a national registry. METHODS: Prospective cohort study of patients treated with MMS in Spain between July 2013 and June 2018. The inclusion criteria were patients with cutaneous tumors with final diagnosis different from basal cell carcinoma, squamous cell carcinoma, dermatofibrosarcoma protuberans, or any kind of melanoma. RESULTS: Five thousand and ninety patients were recorded in the registry, from which only 73 tumors (1.4%) fulfilled the inclusion criteria: atypical fibroxanthoma (18), microcystic adnexal carcinoma (10), extramammary Paget's disease (7), Merkel cell carcinoma (5), dermatofibroma (4), trichilemmal carcinoma (4), desmoplastic trichoepithelioma (4), sebaceous carcinoma (3), leiomyosarcoma (2), porocarcinoma (2), angiosarcoma (2), trichoblastoma (1), superficial acral fibromyxoma (1), and others (10). No intra-surgery morbidity was registered. Postsurgery complications appeared in six patients (9%) and were considered mild. Median follow-up time was 0.9 years during which three Merkel cell carcinomas, one angiosarcoma, one microcystic adnexal carcinoma, and four others recurred (12.3%). CONCLUSION: This national registry shows that rare cutaneous tumors represent a negligible part of the total MMS performed in our country with a low complication rate.


Assuntos
Cirurgia de Mohs/estatística & dados numéricos , Cirurgia de Mohs/normas , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/cirurgia , Humanos , Doenças Raras/diagnóstico , Doenças Raras/epidemiologia , Doenças Raras/cirurgia , Sistema de Registros/estatística & dados numéricos , Neoplasias Cutâneas/diagnóstico , Espanha/epidemiologia
16.
BMC Infect Dis ; 19(1): 953, 2019 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-31703558

RESUMO

BACKGROUND: Localized `and disseminated Nocardia farcinica infection is frequently reported in immunocompromised patients. However, orbital nocardiosis is rare, and, to our knowledge, traumatic orbital nocardiosis that affects the brain has never been described. Here, we report a case of traumatic orbital and intracranial N. farcinica infection in an immunocompetent patient. CASE PRESENTATION: A 35-year-old man, who was immunocompetent, to the best of our knowledge and as per the absence of immunodeficiency symptoms, with orbital trauma caused by the penetration of a rotten bamboo branch developed lesions in the orbit and brain. Subsequently, he underwent debridement and received broad-spectrum antibiotic therapy, but orbital infection occurred, with drainage of pus through the sinus tract. The patient then underwent endoscope-assisted local debridement. Bacterial culture of the sinusal pus was positive for N. farcinica, and a combined intracranial infection had developed. The disease was treated effectively by trimethoprim-sulfamethoxazole and ceftriaxone sodium therapy. The patient remained infection free and without complications at the 14-month follow-up. CONCLUSIONS: Traumatic orbital and intracranial infection caused by N. farcinica is a rare infectious disease, and atypical presentations easily lead to misdiagnosis. When a patient presents with an atypical orbital infection that is unresponsive to empirical broad-spectrum antibiotics, along with suspicious neurologic symptoms, Nocardia infection should be considered. Identification by bacterial culture is the gold standard. Complete local debridement and appropriate antibiotic treatment are keys to the treatment of the disease.


Assuntos
Ferimentos Oculares Penetrantes/microbiologia , Nocardiose/diagnóstico , Nocardiose/microbiologia , Nocardia/isolamento & purificação , Órbita/lesões , Adulto , Antibacterianos/uso terapêutico , Ceftriaxona/uso terapêutico , Desbridamento , Drenagem , Seguimentos , Humanos , Hospedeiro Imunocomprometido , Masculino , Nocardiose/tratamento farmacológico , Nocardiose/cirurgia , Doenças Raras/diagnóstico , Doenças Raras/tratamento farmacológico , Doenças Raras/microbiologia , Doenças Raras/cirurgia , Sasa/microbiologia , Resultado do Tratamento , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico
18.
BMC Cancer ; 19(1): 888, 2019 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-31488091

RESUMO

BACKGROUND: Glomus tumors in the digital nerve are extremely rare. Multiple intraneural glomus tumors in different digital nerve fascicles have not been previously reported. CASE PRESENTATION: We report the case of a 54-year-old male with a 1-year history of progressive numbness of the middle finger with point tenderness at the level of the middle phalanx. Surgical incision revealed the presence of two glomus tumors within different fascicles of the ulnar digital nerve of the middle finger. One tumor was excised along with surrounding fascicle, the other was removed leaving the fascicle intact. Subsequently, the patient regained function of the finger and no tumors have recurred. CONCLUSIONS: Patients and physicians should be aware of the properties of intraneural glomus tumors so that early diagnosis and treatment can be sought.


Assuntos
Dedos/patologia , Tumor Glômico/cirurgia , Paraganglioma Extrassuprarrenal/cirurgia , Neoplasias do Sistema Nervoso Periférico/cirurgia , Doenças Raras/cirurgia , Neuropatias Ulnares/cirurgia , Competência Clínica , Tumor Glômico/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Paraganglioma Extrassuprarrenal/diagnóstico por imagem , Neoplasias do Sistema Nervoso Periférico/diagnóstico por imagem , Doenças Raras/diagnóstico por imagem , Resultado do Tratamento , Nervo Ulnar/patologia , Neuropatias Ulnares/diagnóstico por imagem
19.
G Chir ; 40(3): 188-192, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31484007

RESUMO

INTRODUCTION: Although inguinal hernia repair is a routine procedure and frequently performed as one-day surgery, we should be particularly aware of the possible complications, which could be life-threatening if not recognized in due course. CASE REPORT: We report a case of life-threatening extra-peritoneal bleeding after open inguinal hernia repair requiring damage control surgery. DISCUSSION: Several vessels can be responsible for massive extraperitoneal bleeding - external iliac vessels, lower epigastric artery, crema steric vessels and corona mortis. Although damage control surgery was developed to treat the severe trauma, it can also be a life-saving maneuver in cases as the presented one. Hemodynamic instability with distended abdomen is a primary indication for laparotomy, but in some cases the contrast CT provides valuable information about the location and the size of hematoma and can guide the operative approach - midline laparotomy or revision of the wound as in our case. To the best of our knowledge, this is the first reported case of life-threatening retroperitoneal bleeding after open inguinal hernia repair. The present case is a good example for the application of damage control in pathology considered as one-day surgery. CONCLUSIONS: Although casuistic, the life-threatening bleeding after open hernia repair should be suspected. The prompt surgical response with damage control can be life-saving maneuver even in the routine hernia surgery. Detailed knowledge of the anatomy and carefull dissection are required to avoid this kind of complications.


Assuntos
Artérias Epigástricas/lesões , Hematoma/cirurgia , Hérnia Inguinal/cirurgia , Herniorrafia/efeitos adversos , Hemorragia Pós-Operatória/cirurgia , Doenças Raras/cirurgia , Terapia de Salvação/métodos , Idoso de 80 Anos ou mais , Feminino , Hematoma/diagnóstico por imagem , Humanos , Intestino Delgado , Hemorragia Pós-Operatória/diagnóstico por imagem , Doenças Raras/diagnóstico por imagem , Reoperação , Espaço Retroperitoneal , Tomografia Computadorizada por Raios X
20.
G Chir ; 40(3): 225-229, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31484013

RESUMO

INTRODUCTION: Jejunal adenocarcinoma is a very rare disease but the frequency of this rare carcinoma is higher in celiac patients. We report the first case report of a second jejunal loop adenocarcinoma associated with celiac disease. PRESENTATION OF CASE: A 47-year-old woman, with a history of celiac disease. Computerized tomographic scans of the abdomen and pelvis demonstrated a severe retroperitoneal lymphoadenopathy, para-aortic, inter-aorto-caval, porto-caval, posterior pancreaticoduodenal space, celiac trunk, lesser gastric curvature, lymph node grouping. The patient underwent digiunal resection and regional lymphadenectomy. Diagnosis was poorly differentiated jejunal adenocarcinoma, infiltrating subserosal adipose tissue, metastasing in five out of eight regional lymph nodes. U.I.C.C. 2017 grading = pT3 pN2 G3 R0; Stage IIIB. DISCUSSION: The jejunum accounts for 11-25% of small bowel adenocarcinoma, that accounts for less than 5% of gastrointestinal cancer, notwithstanding that 90% of the mucosa surface area of the digestive tract is made by small intestine. To the best of our knowledge, this is the first report on a second loop jejunal adenocarcinoma complicating celiac disease. In our study, the diagnosis of cancer was made by computed tomography (CT) of abdomen and the patient was operated. For the diagnosis of small bowel tumour, CT enteroclysis has a sensitivity of 85-95% and a specificity of 90-96%. Complete resection (RO) of the jejunal adenocarcinoma, with regional lymph nodes resection and jejuno-jejunal anastomosis should be performed. CONCLUSION: After curative surgical resections of small bowel adenocarcinoma, adjuvant chemo-therapy has not shown a clear benefit in retrospective studies. Preoperative Chemo-Radio-therapy and careful Imaging Staging are the first steps to planning surgery.


Assuntos
Adenocarcinoma/complicações , Doença Celíaca/complicações , Neoplasias do Jejuno/complicações , Doenças Raras/complicações , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/cirurgia , Feminino , Humanos , Neoplasias do Jejuno/diagnóstico por imagem , Neoplasias do Jejuno/cirurgia , Jejuno/diagnóstico por imagem , Jejuno/cirurgia , Excisão de Linfonodo , Pessoa de Meia-Idade , Doenças Raras/diagnóstico por imagem , Doenças Raras/cirurgia , Tomografia Computadorizada por Raios X
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