Liver hemangioma is the most common benign liver tumor, often discovered incidentally. Symptom development and complications underscore the need for surgical intervention. Managing hemangiomas larger than 20 cm is challe...Liver hemangioma is the most common benign liver tumor, often discovered incidentally. Symptom development and complications underscore the need for surgical intervention. Managing hemangiomas larger than 20 cm is challenging because of the risk of perioperative complications. We report a case of a patient with compressive symptoms caused by a 20 cm liver hemangioma in the right hepatic lobe. An extended right hepatectomy was performed, yielding a favorable postoperative outcome. This case demonstrates that surgical treatment can be a safe and effective option for selected patients when performed at highly specialized centers, with outcomes comparable to those reported in the literature. It provides evidence that intraoperative surgical decision-making is essential for an appropriate outcome in cases of giant symptomatic hemangioma.
BACKGROUND: Xanthogranulomatous cholecystitis (XGC) is a rare form of chronic cholecystitis characterized by progressive fibrosis of the gallbladder wall. Its clinical, laboratory, and radiological features often mimic g...BACKGROUND: Xanthogranulomatous cholecystitis (XGC) is a rare form of chronic cholecystitis characterized by progressive fibrosis of the gallbladder wall. Its clinical, laboratory, and radiological features often mimic gallbladder carcinoma (GC), making preoperative diagnosis challenging. A definitive diagnosis is usually established by histopathological examination. As XGC may occasionally coexist with malignancy, surgical resection is generally recommended. CASE PRESENTATION: A 66-year-old woman presented with weight loss, epigastric discomfort, and a palpable mass in the right upper quadrant. Imaging revealed diffuse gallbladder wall thickening and a 33-mm vascularized mass in the gallbladder fundus, with suspected extension to the liver, transverse colon, and abdominal wall, strongly suggesting GC. Multiple hepatic cysts were also identified. Following multidisciplinary evaluation, laparoscopic exploration was performed. Hepatic and colonic infiltration, distortion of Calot's triangle, regional lymphadenopathy, and diffuse millimetric liver lesions initially suggested GC with intrahepatic metastases. However, histological examination of biopsied lesions excluded malignancy. After a 4-month recovery from COVID-19, the patient experienced clinical improvement and weight gain. Follow-up computed tomography (CT) showed regression of both the gallbladder mass and hepatic involvement, supporting a benign inflammatory process. During subsequent laparotomy, frozen-section analysis of the colonic infiltration confirmed inflammatory tissue. Radical cholecystectomy with en bloc resection of the adjacent liver parenchyma was performed. Final histopathology revealed diffuse XGC associated with diffuse biliary hamartomatosis. CONCLUSION: This case highlights the diagnostic challenge of distinguishing XGC from GC, particularly in the presence of biliary hamartomatosis. A stepwise diagnostic approach and multidisciplinary decision-making were essential to ensure accurate diagnosis and appropriate management.
Caecal bascule is the rarest form of caecal volvulus, representing 5%-20% of caecal volvulus cases and accounting for 0.2% of intestinal obstructions. Diagnosis can be delayed due to non-specific clinical and radiologica...Caecal bascule is the rarest form of caecal volvulus, representing 5%-20% of caecal volvulus cases and accounting for 0.2% of intestinal obstructions. Diagnosis can be delayed due to non-specific clinical and radiological features, increasing the risk of ischaemia or perforation. Herein, we report the case of a 70-year-old woman who presented with vague right iliac fossa (RIF) pain, nausea and bilious vomiting. Computed tomography (CT) of the abdomen and pelvis demonstrated a mesenteric 'whirl sign' concerning for a volvulus. Emergency laparoscopy demonstrated a distended caecum (C) folded anteriorly without torsion, consistent with caecal bascule. A right hemicolectomy with primary anastomosis was performed. The postoperative course was complicated by a small non-drainable collection, managed conservatively with antibiotics. Histopathology showed mild vascular congestion with normal architecture and no ischaemia, malignancy or inflammatory bowel disease. This case highlights the diagnostic challenge of caecal bascule and the importance of timely surgical intervention.
BACKGROUND: Mirizzi Syndrome (MS) is a rare cause of biliary obstruction. While laparoscopic cholecystectomy is the standard treatment, severe inflammation often necessitates subtotal cholecystectomy to prevent bile duct...BACKGROUND: Mirizzi Syndrome (MS) is a rare cause of biliary obstruction. While laparoscopic cholecystectomy is the standard treatment, severe inflammation often necessitates subtotal cholecystectomy to prevent bile duct injury (BDI). However, retained stones in the gallbladder remnant or cystic duct can cause recurrent obstruction, termed post-cholecystectomy Mirizzi Syndrome (PCMS). CASE REPORT: A 34-year-old female presented with PCMS 6 years after undergoing a subtotal cholecystectomy for MS. Despite initial conservative management, definitive resolution required secondary surgical intervention. CONCLUSION: As subtotal cholecystectomy becomes more frequent to avoid BDI, the incidence of PCMS is expected to rise. Clinicians must maintain a high index of suspicion. Management should be multidisciplinary; however, surgery remains the definitive treatment when conservative approaches fail.
Microscopic thymoma (MT) is defined as solitary or multifocal small thymic epithelial nests <1 mm in diameter, occurring in approximately 15% of patients with myasthenia gravis (MG) and sometimes associated with thymic c...Microscopic thymoma (MT) is defined as solitary or multifocal small thymic epithelial nests <1 mm in diameter, occurring in approximately 15% of patients with myasthenia gravis (MG) and sometimes associated with thymic cysts. Its preoperative diagnosis is challenging due to its small size, and computed tomography (CT) scans are unable to detect it. MTs are considered incipient or precursor lesions of thymoma, detectable only via microscopic examination. We report a case of MT identified pathologically in the thymic tissue surrounding a thymic cyst in a 52-year-old female hospitalized for drooping eyelids and muscle weakness. A mediastinal CT scan revealed an enlarged thymic gland with an associated cyst in the anterior mediastinum. Due to symptomatic disease, we performed a right video-assisted thoracoscopic thymectomy. No macroscopic tumor was observed, but histopathological analysis revealed an acquired multilocular thymic cyst with multiple thymic epithelial islands (MTs) in the surrounding thymic tissue. All previous cases reported, except one, were symptomatic for MG and none were diagnosed before surgery. The morphological pattern of MT differs from conventional thymoma, and the latest WHO classification categorizes it as thymic nodular hyperplasia. To maximize the detection of MT nests, complete resection and thorough histopathological examination of the thymic gland and surrounding tissue are essential, even in the absence of macroscopic lesions. Here, we propose key points for the evaluation and management of MT.
We report a rare case of a 62-year-old man with a right giant inguinoscrotal hernia and a concurrent retroperitoneal mass. Preoperative imaging was inconclusive regarding the hernia sac contents and the nature of the pel...We report a rare case of a 62-year-old man with a right giant inguinoscrotal hernia and a concurrent retroperitoneal mass. Preoperative imaging was inconclusive regarding the hernia sac contents and the nature of the pelvic mass. Intraoperatively, the hernia sac contained the caecum, appendix, Meckel's diverticulum (MD) and terminal ileum-confirming the simultaneous presence of Amyand and Littre hernias. Additionally, a left-sided retroperitoneal solid-cystic mass was identified and excised. This case underscores the diagnostic difficulties posed by complex hernias and highlighted the surgical challenges involved in managing coexisting intra-abdominal pathologies. Histopathological examination revealed a mesenteric cyst with infarcted tissue and an incidental diagnosis of mixed cellularity classical Hodgkin lymphoma (MCCHL) from the lymph node, adding a haematological dimension to this already rare surgical case.
Hepatic abscess secondary to foreign body ingestion is a rare but potentially life-threatening condition. Although most ingested foreign bodies pass harmlessly through the gastrointestinal tract, sharp objects may perfor...Hepatic abscess secondary to foreign body ingestion is a rare but potentially life-threatening condition. Although most ingested foreign bodies pass harmlessly through the gastrointestinal tract, sharp objects may perforate the gastric or intestinal walls, migrate into adjacent organs, and lead to abscess formation. This report describes a 22-year-old female with a 10-year history of systemic lupus erythematosus (SLE) who presented with persistent epigastric discomfort, nausea, and vomiting for 2 weeks. Initial evaluations, including laboratory tests and abdominal ultrasonography, were unremarkable. Subsequent endoscopy revealed a foreign body lodged in the distal stomach that could not be removed endoscopically. A contrast-enhanced computed tomography (CT) scan demonstrated a 7 cm × 5.6 cm abscess in the left hepatic lobe. The patient underwent laparotomy, which confirmed a toothpick penetrating the gastric wall and lodging in the liver. The abscess was drained, and gastrorrhaphy was performed. The patient recovered uneventfully following antibiotic therapy and was discharged in stable condition, with no recurrence during follow-up. Foreign body-induced hepatic abscesses are uncommon, and diagnosis can be challenging because classical signs of infection may be absent or attenuated. Endoscopy remains the first-line diagnostic and therapeutic approach; however, surgical intervention is required when the foreign body is embedded or complications occur. Clinicians should maintain a high index of suspicion in patients with persistent or unexplained abdominal symptoms, particularly in immunocompromised individuals.
We present a 23-year-old at 35 weeks' gestation with Marfan syndrome (MFS) and sickle cell trait (SCT) with acute Type A aortic dissection (TAAD) requiring concurrent cesarean delivery and aortic repair. Delivery, hemi-a...We present a 23-year-old at 35 weeks' gestation with Marfan syndrome (MFS) and sickle cell trait (SCT) with acute Type A aortic dissection (TAAD) requiring concurrent cesarean delivery and aortic repair. Delivery, hemi-arch aortic replacement, and coronary reconstruction were successfully performed. Despite intraoperative complexity and postoperative complications, the patient was managed with fewer ischemic complications compared to previous cases of coincident SCT and aortic repair. This case demonstrates critical principles for managing cardiothoracic emergencies in pregnancy with high-risk conditions. It emphasizes multidisciplinary care and cardiopulmonary bypass (CPB) techniques for optimization of SCT and maternal-fetal outcomes in aortopathies.
Penetrating scrotal trauma from gunshot injuries is rare but can severely impact fertility and endocrine function. We report a 32-year-old male with bilateral testicular injury managed with left partial orchiectomy and r...Penetrating scrotal trauma from gunshot injuries is rare but can severely impact fertility and endocrine function. We report a 32-year-old male with bilateral testicular injury managed with left partial orchiectomy and right testicular repair. Viable tissue was preserved without grafts, and perfusion was confirmed intraoperatively. Postoperative recovery was uneventful, with Doppler ultrasonography showing bilateral viability. Initial severe asthenozoospermia improved markedly over 2 years. This case underscores the potential for testicular salvage and fertility preservation in severe bilateral injuries, highlighting the value of prompt, tailored surgical intervention.
Teratomas are germ cell tumors, with ovarian teratomas being the most common type. However, extragonadal teratomas are extremely rare. Omental teratomas are the most common type of extragonadal teratomas. Most patients w...Teratomas are germ cell tumors, with ovarian teratomas being the most common type. However, extragonadal teratomas are extremely rare. Omental teratomas are the most common type of extragonadal teratomas. Most patients with omental teratomas are asymptomatic, making preoperative diagnosis challenging. Imaging studies, such as CT scans, can provide valuable information, but a definitive diagnosis requires histopathological examination. In this case, a 65-year-old Iranian woman presented with mild abdominal pain and a normal physical examination. A preoperative abdominopelvic CT scan revealed a calcified pelvic mass with fat components, suggesting a connection to the right fallopian tube. However, during surgery, the mass was found to be in the greater omentum, with no adnexal involvement. Histopathological examination confirmed a mature teratoma. Treatment for mature teratomas typically involves surgical excision, which was successfully performed in this case, resulting in a smooth postoperative recovery.
We report a case of leiomyosarcoma of the inferior vena cava (IVC) treated with liver resection, autotransplantation, and IVC reconstruction using a Dacron graft. A 47-year-old female presented with mild to moderate lowe...We report a case of leiomyosarcoma of the inferior vena cava (IVC) treated with liver resection, autotransplantation, and IVC reconstruction using a Dacron graft. A 47-year-old female presented with mild to moderate lower extremity edema and weakness. Physical examination revealed no abdominal or pelvic abnormalities. However, further evaluation confirmed a tumor in the suprarenal IVC, extending to the hepatic veins, with thrombus formation in the suprahepatic IVC. During surgery, the tumor was confirmed to originate from the IVC. Given its proximity to the hepatic veins, an ex vivo liver resection and autotransplantation (ELRA) were performed, followed by IVC reconstruction using a Dacron graft via the piggyback technique. The patient experienced no postoperative complications. Although liver resection and autotransplantation are considered extremely aggressive procedures, they can be viable options in cases where complete surgical resection is not feasible using standard techniques.
DICER1-related tumor predisposition (DRTP) results from loss-of-function germline variants that predispose patients to numerous benign and malignant tumors. Cystic nephromas are among the most common neoplasms in patient...DICER1-related tumor predisposition (DRTP) results from loss-of-function germline variants that predispose patients to numerous benign and malignant tumors. Cystic nephromas are among the most common neoplasms in patients with DRTP; however, there are no reports of rhabdomyosarcoma from adrenal tissue in children with DRTP. We present a case of a 30-month-old child with simultaneous cystic nephroma and rhabdomyosarcoma from ectopic adrenal tissue. He initially presented with chronic abdominal pain and poor weight gain. CT imaging demonstrated a large mass extending from the left kidney as well as an adjacent smaller mass in the retroperitoneum. Routine laboratory tests and tumor markers were unremarkable. He underwent an open left radical nephroureterectomy with excision of the midline retroperitoneal mass and lymph node dissection of the retrocaval and paraaortic basins. Pathologic examination revealed the larger mass to be a cystic nephroma, while the smaller mass was found to be embryonal rhabdomyosarcoma arising from ectopic adrenal tissue. Genetic testing of the rhabdomyosarcoma revealed a pathogenic c.4102dup (p.R1368fs) germline frameshift variant and a second c.5425G > A (p.G1809R) somatic missense variant in , as well as a somatic variant in BCOR. With this report, we advocate for further investigation of DICER1-associated rhabdomyosarcoma to improve management of this rare presentation.
OBJECTIVES: We present a case of a ruptured side-branch intraductal papillary mucinous neoplasm (IPMN) who was found to have pseudomyxoma peritonei (PMP) with a deposit of acellular mucin in the pelvis. CASE PRESENTATION...OBJECTIVES: We present a case of a ruptured side-branch intraductal papillary mucinous neoplasm (IPMN) who was found to have pseudomyxoma peritonei (PMP) with a deposit of acellular mucin in the pelvis. CASE PRESENTATION: The patient is a 65-year-old female who initially presented to care with intermittent right upper quadrant pain and fullness. Preoperative imaging demonstrated a large cystic mass in the pancreatic tail, and, therefore, she was taken to the operating room for a distal pancreatectomy and splenectomy. Intraoperatively, she was found to have two distinct deposits of acellular mucin. Both deposits were nonadherent to the surrounding tissue and removed. RESULTS: The patient recovered postoperatively without incident. She will be surveilled postoperatively with serial computed tomography. CONCLUSION: PMP arising from an IPMN of the pancreas is a rare and potentially devastating complication of the disease. Given the complexity of these cases, a multidisciplinary discussion for ongoing management is essential, and these cases are best managed at centers with significant experience in the management of PMP from other sources.
Anterior horseshoe anal fistula is a challenging variant of complex anorectal infections. Classical surgeries, including ksharasutra therapy in these cases may result in extensive postsurgical scarring and anal incontine...Anterior horseshoe anal fistula is a challenging variant of complex anorectal infections. Classical surgeries, including ksharasutra therapy in these cases may result in extensive postsurgical scarring and anal incontinence. On the other hand, interception of fistulous track with application of ksharasutra (IFTAK) technique has emerged as a novel way of managing anal fistulas because of its nature of minimal invasiveness, ability to cut and heal tissues with controlled fibrosis, and continence preservation. Here, we explain a detailed case study of a 40-year-old gentleman who presented with a recurrent anterior horseshoe fistula effectively managed with IFTAK. The digital rectal examination (DRE), proctoscopy, methylene blue test, and probing were done to delineate tracts and confirm the diagnosis. Fistula healed completely and showed no recurrence at 8 months of follow-up. Compared to traditional methods, the technique results in a shorter hospital stay and a shorter treatment duration.
Concealment of illicit drug ampoules is an unusual clinical scenario, posing diagnostic and management challenges due to delayed disclosure, drug leakage risk, and retrieval difficulties. We present the case of a 28-year...Concealment of illicit drug ampoules is an unusual clinical scenario, posing diagnostic and management challenges due to delayed disclosure, drug leakage risk, and retrieval difficulties. We present the case of a 28-year-old male, an intravenous drug user, brought from police custody with complaints of per rectal pain. After initial denial, he admitted to rectal insertion of six tramadol ampoules. Clinical examination and imaging confirmed the presence of foreign bodies in the rectum. While surgical removal was planned, spontaneous expulsion occurred without complications, as verified by postoperative imaging. This case underscores the importance of early suspicion, detailed history-taking, and prompt imaging in suspected rectal foreign bodies. In stable patients, conservative management with laxatives may allow safe natural expulsion, reducing the need for invasive intervention, as in this case; however, this should be seen as a positive outcome rather than a recommended management approach, especially in cases involving fragile drug-containing ampoules.
Gastrointestinal stromal tumors (GISTs) are known to arise from any of the five layers of the gastric wall, most commonly from the muscularis propria. Extraluminal gastric GISTs account for approximately 8% of cases and...Gastrointestinal stromal tumors (GISTs) are known to arise from any of the five layers of the gastric wall, most commonly from the muscularis propria. Extraluminal gastric GISTs account for approximately 8% of cases and are relatively rare, with pedunculated forms being scarcely reported in South Korea. A 25-year-old man presented to our hospital with an incidental left upper quadrant (LUQ) mass adjacent to the stomach on a screening computed tomography (CT) scan. He had no symptoms and no suspicious findings on gastrointestinal endoscopy. Laparoscopic excision was performed, revealing an 8 cm × 7 cm mass connected to the posterior gastric serosa. Immunohistochemical staining confirmed the diagnosis of GIST. We report this case as an extremely rare presentation of a gastric GIST presenting as a pedunculated mass connected to the outer serosal surface, underscoring the diagnostic challenges associated with such atypical presentations.
Firearm injuries (FAIs) are a significant public health concern, often resulting in retained bullets (RBs) that pose management challenges. We present a 24-year-old male with a retained subcutaneous chest wall bullet ~2 ...Firearm injuries (FAIs) are a significant public health concern, often resulting in retained bullets (RBs) that pose management challenges. We present a 24-year-old male with a retained subcutaneous chest wall bullet ~2 cm lateral to the midclavicular line, causing persistent psychological distress and functional impairment. Initial attempts at bullet removal under local anesthesia failed, leading to nonoperative management. However, the patient's ongoing anxiety, fear of death, and inability to work necessitated reconsideration of treatment. Fluoroscopy-guided extraction under local anesthesia enabled precise localization of the RB and facilitated targeted dissection, avoiding blind exploration, minimizing tissue trauma, and eliminating the need for general anesthesia. The procedure was completed successfully with resolution of symptoms. The case underscores the importance of integrating psychological considerations into RB management and highlights fluoroscopy-guided extraction as a safe, minimally invasive, and effective technique for bullet removal, particularly in anatomically challenging cases or after failed blind exploration.
Spinal cord infarction (SCI) is an uncommon condition with a generally poor prognosis for neurologic recovery. There are numerous possible causes for SCI, yet frequently the etiology is not fully elucidated. Literature r...Spinal cord infarction (SCI) is an uncommon condition with a generally poor prognosis for neurologic recovery. There are numerous possible causes for SCI, yet frequently the etiology is not fully elucidated. Literature regarding SCI is sparse, with no conclusive algorithmic strategies for diagnosis and treatment. This case report describes the hospital course of a male in his seventh decade of life who presented to our emergency department with acute onset of bilateral lower extremity paralysis and intense lower back pain due to an SCI at the T4 spinal level.
We report the case of a 42-year-old woman with a history of uterine fibroids treated with robotic myomectomy 12 years prior who presented with extensive uterine fibroids, perihepatic lesions, and an umbilical mass. Preop...We report the case of a 42-year-old woman with a history of uterine fibroids treated with robotic myomectomy 12 years prior who presented with extensive uterine fibroids, perihepatic lesions, and an umbilical mass. Preoperative imaging and biopsy of perihepatic lesions confirmed benign leiomyomas with estrogen and progesterone receptor (PR) positivity. Multidisciplinary surgical management included total hysterectomy, partial hepatectomy, and abdominal wall resection with reconstruction. Histopathologic analysis confirmed the presence of uterine fibroids, hepatic benign metastasizing leiomyoma (BML), and abdominal wall endometriosis (AWE). This case highlights the rare phenomenon of concurrent BML and endometriosis and their potential association with prior uterine surgery involving morcellation.
Synovial sarcoma is a high-grade soft-tissue sarcoma that commonly affects adolescents and young adults. Involvement of the head and neck region is rare, and tumors arising from the sinonasal tract are particularly uncom...Synovial sarcoma is a high-grade soft-tissue sarcoma that commonly affects adolescents and young adults. Involvement of the head and neck region is rare, and tumors arising from the sinonasal tract are particularly uncommon and diagnostically challenging. We report the case of a 38-year-old male who presented with head trauma and decreased consciousness following a transient neurological episode while driving. Brain computed tomography revealed a lesion involving the left anterior ethmoidal air cells with associated old cerebral infarctions. Further magnetic resonance imaging demonstrated an aggressive enhancing sinonasal mass with limited intracranial extension, associated with radiologic findings suggestive of vasculitis and acute-on-chronic ischemic insults. Histopathological evaluation showed a spindle-cell neoplasm considered most consistent with synovial sarcoma based on morphology and available immunohistochemical findings. The patient was started on neoadjuvant chemotherapy, after which the vasculitic findings showed regression, suggesting a probable paraneoplastic vasculitic association. Due to the complex anatomical location and local extension of the tumor, complete surgical resection was not initially feasible. Planned management included combined chemoradiotherapy with consideration of future surgical intervention. This case highlights the diagnostic and therapeutic challenges of sinonasal synovial sarcoma and emphasizes the importance of multidisciplinary evaluation, particularly in cases associated with unusual vasculitic and ischemic manifestations.