Abdominal wall endometriosis misdiagnosed as a desmoid tumor: A case report.

INTRODUCTION: Abdominal wall masses have different aetiologies. Diagnosis includes desmoid tumors (DTs) and other benign and malignant lesions, among which abdominal wall endometriosis (AWE). Diagnosis is challenging if symptoms are aspecific, and the contribution of imaging may be weak. We present a case of AWE that according to clinical history and imaging was misdiagnosed as DT. PRESENTATION OF CASE: A healthy 35-year-old female presented, 4 years after a cesarean delivery, a rapidly growing painless subumbilical mass within the right rectus abdominis muscle. Ultrasound and magnetic resonance imaging suspected a DT. The patient underwent complete resection of the mass and pathological examination revealed foci of endometriosis in the muscle. Patient's post-operative course was uneventful and at 18-month follow-up, no recurrence has been detected. DISCUSSION: The current case highlights differences in clinical presentation and imaging in case of AWE and DTs, underlining possible pitfalls in diagnosis. In young women with previous gynaecological abdominal surgery, AWE is the most likely disease when a mass in the region of the scar appears. Differential diagnosis is complex and rare entities like DTs should nevertheless be taken into consideration. A complete surgical resection with negative margins is considered the primary treatment for AWE and for selected DTs. Final pathology of the tumor can state the precise diagnosis. CONCLUSION: Since AWE and DTs share similar clinical signs and aspecific imaging exams, both diseases should be considered in case of abdominal wall mass in female patients of childbearing age and history of uterine-related surgery.

Laparoscopic management of non-midline incisional hernia: A multicentric study.

BACKGROUND: The laparoscopic repair of non-midline ventral hernia (LNM) has been debated. The aim of this study is to analyze our experience performing the laparoscopic approach to non-midline ventral hernias (NMVHs) in Northwest Italy for 6 years. METHODS: A total of 78 patients who underwent LNM between March 2008 and March 2014 in the selected institutions were analyzed. We retrospectively analyzed the peri- and postoperative data and the recurrence rate of four subgroups of NMVHs: subcostal, suprapubic, lumbar, and epigastric. We also conducted a literature review. RESULTS: No difference was found between the four subgroups in terms of demographic data, defect characteristics, admission data, and complications. Subcostal defects required a shorter operating time. Obesity was found to be a risk factor for recurrence. CONCLUSIONS: In our experience, subcostal defects were easier to perform, with a lower recurrence rate, lesser chronic pain, and faster surgical performance. A more specific prospective randomized trial with a larger sample is awaited. Based on our experience, however, the laparoscopic approach is a safe treatment for NMVHs in specialized centers.

[Hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (IHCC): a double cancer in the non-cirrhotic liver]. / Carcinoma epatocellulare (HCC) e colangiocarcinoma intraepatico (IHCC): doppio tumore su fegato non cirrotico. Presentazione di un caso.

The authors report a case of a large tumour, located in the right hepatic lateral segments, (size: 15 cm), consisting of a hepatocellular carcinoma (size: 10 cm) and an intrahepatic cholangiocarcinoma (size: 5 cm). The mass was detected by ultrasonography during an examination for abdominal pain in an 80-year-old female. After tumour biopsy and histological examination, hepatic resection was performed. The postoperative course was uneventful and the patient was discharged 6 days after surgery. The rarity of this double cancer is stressed.