A Giant Cell Tumor of the Tendon Sheath of the Foot: A Rare Presentation.

A giant cell tumor of the tendon sheath (GCTTS) is a benign tumor that can occur in the joint synovium, bursae, or tendon sheath. It generally emerges in the tendons/synovium of the bones of the hand. It has unique characteristics, as noted in histopathological, clinical, and published literature. GCTTS has been reported across different age groups, with higher incidence observed in middle-aged adults. We present an unusual occurrence of GCTTS arising from the foot in a 54-year-old female who visited our medical facility with a history of swelling in her right foot for one year. Ultrasonography suggested a well-defined 5 x 4 cm lesion deep to the flexor tendon with possible intertarsal extension, which was managed surgically. This article represents a detailed understanding of GCTTS, emphasizing its benign yet locally aggressive nature and the complexities involved in its diagnosis and management.

Uterine Leiomyosarcoma in a Young Woman: A Report of a Rare Case.

Uterine leiomyosarcoma (LMS) is an uncommon disease that arises from the smooth muscles present in the uterus. It usually occurs in post-menopausal women. Due to its aggressive nature, it has a very poor prognosis. We present a case of uterine LMS, which presented at a young age of 35 years for infertility, which is rare at this age. She had a fundal fibroid for which myomectomy was done. On histopathology, she was diagnosed with LMS. It is very difficult and nearly impossible to diagnose LMS preoperatively by available imaging modalities. There is an urgent need for a reliable preoperative risk scoring system that can help in diagnosing malignancy so that a correct surgical pathway and treatment can be offered to patients. A total abdominal hysterectomy (TAH) with bilateral salpingo-oophorectomy (BSO) was done and was advised adjuvant chemotherapy. The patient remained disease-free and was put on chemotherapy.

Surgical Perspectives of Open vs. Laparoscopic Approaches to Lateral Pancreaticojejunostomy: A Comprehensive Review.

Pancreaticojejunostomy, a critical step in pancreatic surgery, has significantly evolved surgical approaches, including open, laparoscopic, and robotic techniques. This comprehensive review explores open surgery's historical success, advantages, and disadvantages, emphasizing surgeons' accrued experience and familiarity with this approach. However, heightened morbidity and prolonged recovery associated with open pancreaticojejunostomy underscore the need for a nuanced evaluation of alternatives. The advent of robotic-assisted surgery introduces a paradigm shift in pancreatic procedures. Enhanced dexterity, facilitated by wristed instruments, allows intricate suturing and precise tissue manipulation crucial in pancreatic surgery. Three-dimensional visualization augments surgeon perception, improving spatial orientation and anastomotic alignment. Moreover, the potential for a reduced learning curve may enhance accessibility, especially for surgeons transitioning from open techniques. Emerging technologies, including advanced imaging modalities and artificial intelligence, present promising avenues for refining both open and minimally invasive approaches. The ongoing pursuit of optimal outcomes mandates a judicious consideration of surgical techniques, incorporating technological advancements to navigate challenges and enhance patient care in pancreaticojejunostomy.

Significance of Serum Lactate Dehydrogenase as a Prognostic Marker and Outcome Predictor in Patients With Breast Cancer.

Background Breast carcinoma has been the most prevalent cancer in women, with research-based evidence showing a significant rise in the incidence of cancer and related morbidity and mortality in the Indian subcontinent. The predictive value of plasmatic lactate dehydrogenase (LDH) levels has been studied in breast cancer. Numerous studies have connected high LDH values to a poor prognosis, increased risk of incidence, recurrence, and associated mortality in patients with breast carcinoma. This study aimed to assess the clinical profile of breast carcinoma and determine the correlation of serum lactate dehydrogenase levels with the stage of the disease and assessment of high-risk features using histopathology and immunohistochemistry. Methods A total of 75 patients with carcinoma breast were enrolled for this study and classified into two groups: upfront surgery and post-adjuvant therapy. Serum LDH levels were estimated a day before the surgery (baseline) and on postoperative days 1, 7, 14, and 30. The clinical tumor, node, metastasis (cTNM) staging was correlated with pathological tumor, node, metastasis TNM (pTNM) staging and immunohistochemistry findings. Results The clinical characteristics of breast cancer, serum LDH levels, and stage of the disease were collected and analyzed. A significant decreasing trend was noted in LDH values post-op days, and statistically significant higher LDH values were noted in the triple-negative group, positive lymph nodes, and positive lymphovascular invasion patients. Conclusion Regularly elevated levels or an unanticipated rise in serum LDH might indicate poor outcomes. Hence, this non-specific enzyme marker can be suggested to be used routinely to assess disease outcomes.

Carney Complex and Its Association With Thyroid Cancer, Molecular Pathway, and Treatment.

Thyroid cancer, being the prevailing form of endocrine malignancy, exhibits a notable surge in its incidence rates. Follicular thyroid carcinoma (FTC) and papillary thyroid carcinoma (PTC) represent the predominant well-differentiated subtypes and are recognized as the most prevalent forms of thyroid carcinomas. Over the course of several years, numerous molecular, genetic, and epigenetic modifications have been discerned in diverse forms of thyroid neoplasms. Common occurrences comprise point mutations in the BRAF and RAS genes, along with chromosomal rearrangements involving the RET/PTC and PAX8/PPARγ genes. Thyroid carcinoma, encompassing both FTC and PTC, has been documented in individuals diagnosed with Carney complex (CNC), a hereditary syndrome passed down in an autosomal dominant manner causing increased susceptibility to diverse neoplasms. CNC manifests as a result of inactivating mutations occurring within the tumor-suppressor gene known as PRKAR1A, which is responsible for encoding the regulatory subunit of protein kinase A (PKA) type 1α. Studies have shown that this mutation leads to activation of PKA, which, in turn, can induce FTC. In this comprehensive review, we aim to elucidate the intricate molecular mechanisms underlying thyroid tumorigenesis, specifically focusing on the deleterious consequences resulting from the deactivation of the PRKAR1A gene.

Early Diagnosis and Surgical Management of Tropical Chronic Pancreatitis in a Tertiary Care Rural Hospital: A Case Report.

Tropical chronic pancreatitis represents a variant of chronic calcific non-alcoholic pancreatitis, typically found in adolescents and young adults, predominantly in developing nations. This condition usually presents as a classic triad of recurrent and severe abdominal pain, diabetes, and steatorrhea. As the disease progresses and diabetes develops, it is called fibrocalculous pancreatic diabetes. A defining characteristic of this ailment is the presence of pancreatic calculi, leading to duct dilation. Key features of this condition include an early onset in youth, intraductal calculi, an aggressive disease course, and a heightened susceptibility to pancreatic cancer. Diagnostic tools such as ultrasound, CT, magnetic resonance cholangiopancreatography, and endoscopic retrograde cholangiopancreatography aid in identifying the disease. Timely diagnosis and treatment significantly reduce mortality and morbidity. Our patient, a young female, presented solely with recurrent episodes of abdominal pain resembling pancreatitis, along with a normal biological profile and an absence of readily apparent symptoms. She received a diagnosis of tropical chronic pancreatitis and underwent the Partington-Rochelle procedure for surgical decompression of the main pancreatic duct.

A Rare Case Presentation on Total Colonic Aganglionosis in a Female Infant of Indian Origin.

Total colonic aganglionosis, also called total colonic Hirschsprung's disease, is a known congenital disorder caused by the migration of abnormal embryonic neuroblasts. RET, NRG1, and L1CAM genes are reported as pathological gene variants associated with the incidence of different variants of Hirschsprung's disease. Major clinical presentations are well documented as inefficiency to pass stools, vomiting, fever, persistent crying, and other features of intestinal obstruction. We present here the case of a two-day-old female infant of Indian origin and its diagnostic, clinical, and case management data.

Huge Renal Angiomyolipoma Mimicking a Renal Cell Carcinoma: A Case Report.

Renal angiomyolipoma is a benign mesenchymal tumor composing adipose tissue, smooth muscle, and blood vessels. Despite being benign, the tumor sometimes can be aggressive with a locoregional and venous extension. Here, we present a case of a 48-year-old female who presented with a lump in the abdomen for two months, which was initially small and gradually increased in size associated with pain. Ultrasound of abdomen-pelvis showed ill-defined heterogeneous lesion arising from left kidney showing few hypoechoic and calcific focus within it. Contrast-enhanced computed tomography suggested an exophytic mass lesion with a central scar and calcification measuring 13 x 11 cm indicating renal cell carcinoma. Based on the benign nature and being well encapsulated, the patient was taken up for a left radical nephrectomy. However, the final histologic assessment concurred with renal angiomyolipoma.

Endometrial Cyst Presenting as a Vague Abdominal Lump in a Postmenopausal Woman.

A postmenopausal woman presented with a predominantly right-sided abdominal lump, insidious in onset and not associated with any aggravating or relieving factors. Physical examination revealed a soft cystic mass extending from the right hypochondrium to the right iliac fossa region crossing the midline. Ultrasonography of the abdomen and pelvis showed a large cystic anechoic area noted in the abdomen extending from the epigastric region to the pelvis. Contrast-enhanced CT of the abdomen and pelvis showed a large non-enhancing cystic lesion in the pelvis suggesting the possibility of a right ovarian cyst or mesenteric cyst. Laparotomy was performed and the excised specimen was sent for histopathological analysis, which confirmed it to be an endometrial cyst.