Huge Tumor Research Articles

Huge fibromyoma of the left large lip; operation; recovery

The author describes a case of removal of a huge tumor from a 45-year-old woman from the left large lip.

A giant malignant phyllodes tumor of breast post mastectomy with metastasis to stomach manifesting as anemia: a case report and review of literature

BackgroundPhyllodes tumors (PTs) are well known for local recurrence and progression. Less than 10% of these tumors grow larger than 10 cm. Distant metastases have been reported in up to 22% of malignant PTs, with most metastases being discovered in the lungs. PTs of the breast rarely metastasize to the gastrointestinal tract, and reported cases are scarce. To date, a review of the English literature revealed only 3 cases, including our case, of PTs metastasis to stomach.Case presentationAn 82-year-old female patient had 10-year-duration of palpable huge tumor on left breast which was in rapid growth in recent months. Total mastectomy of left breast was performed thereafter, and pathology diagnosis was malignant phyllodes tumor. Adjuvant radiotherapy was suggested while she declined out of personal reasons initially. For PTs recurred locally on left chest wall 2 months later, and excision of the recurrent PTs was performed. She, at length, completed adjuvant radiation therapy since then. Six months later, she was diagnosed of metastasis to stomach due to severe anemia with symptom of melena. Gastrostomy with tumor excision was performed for uncontrollable tumor bleeding.ConclusionFor PTs presenting as anemia without known etiologies, further studies are suggested to rule out possible gastrointestinal tract metastasis though such cases are extremely rare. Management of metastatic gastric tumor from PTs should be done on a case-to-case basis, surgical intervention may be needed if there is persistent active bleeding despite medical treatment. Adjuvant radiotherapy is recommended in borderline and malignant PTs with tumor-free margin < 1 cm and high-risk malignant tumors. Adjuvant chemotherapy or target therapy may be helpful for metastatic PTs. Molecular and genomic techniques may predict clinical outcomes of benign and borderline PTs more precisely.

A Huge Para-pharyngeal Mass: Excision through Trans-cervical Approach

Para-Pharyngeal Space (PPS) is an inverted cone-shaped potential space that extends from the hyoid bone to the base of the skull. It is filled with fat and areolar tissue lie laterally on either sides of pharynx; and is bounded and subdivided by various condensations of fascia. Tumors, although rare less than1% of head neck neoplasm can arise from any structures of this space. Mostly they are benign 70-80% and 20-30% are malignant. Salivary gland tumor, particularly deep lobe parotid constitutes more than 80%. Imaging studies are invaluable to define the site of origin, extension, relationship to the great vessels of the neck and other neurovascular structures. Surgery is the mainstay of treatment. Several approaches have been discussed in the text books. We present a case of a huge para-pharyngeal space tumor that was excised completely through trans-cervical approach without any morbidly.

TFAP2B, AP-1 and JAZF1 Expression in Tissues of Papillary Thyroid Carcinoma Patients; Clinical, Pathological and Prognostic Values

Objective:Transcription factor activating protein 2 B (TFAP2 B) is a transcription factor that regulates many steps of embryogenesis, cell growth, apoptosis and recently oncogenesis and cancer progression. AP-1 is a transcription factor that is a downstream molecule of the MAPK signaling pathway. Juxtaposed with zinc finger gene 1 (JAZF1) is a recently detected transforming growth factor which has a role in carcinogenesis. Hence the present study aimed to assess those markers expression in tissues from patients with such cancer correlation their expression with clinic-pathological findings of the tumor and prognostic and follow-up findings of patients. Methods:We have collected tissue samples from papillary thyroid cancer patients and adjacent non-neoplastic tissues from 80 patients. We assessed the expression of TFAP2B, AP-1 and JAZF1 using immunohistochemistry. Results:Expression of TFAP2B was positively associated with lymph nodes metastases (p=0.003), distant metastases (p=0.002), recurrence of the tumor (p=0.002), unfavourable disease-free survival rate (p=0.003). AP-1 expression is positively associated with advanced stage (p=0.002), presence of extra-thyroid invasion (p=0.005), recurrence of the tumor (p=0.005), unfavorable disease-free survival rate (p=0.01). JAZF1 expression is negatively associated with huge tumor size (0.023), vascular invasion (p=0.007) and unfavorable overall survival rate (p=.030). Conclusion:High expression levels of TFAP2B and AP-1 and low expression levels of JAZF1 were associated with unfavourable pathological, prognostic parameters and dismal patient’s outcome.

Huge typical pulmonary carcinoid presented with gigantism syndrome

A 27-year-old male patient presented with cough and right-sided, light thoracic pain. His physical appearance showed typical features of gigantism. Subsequently, further diagnostic work-up showed elevated level of growth hormone and a huge tumor of the right lung, identifying a typical pulmonary carcinoid tumor (TPCT). Curative surgery was performed leading to normalization of the elevated growth hormone levels few days after surgery. Two- and five-year follow-up showed no signs of recurrence. Respected to tumor size, we determined the largest TPCT to be reported in medical literature history.

A CASE OF EXTRASKELETAL EWING'S SARCOMA IN THE RETROPERITONEUM

A 23-year-old man was admitted to our hospital with a huge pelvic tumor. MRI showed a tumor mixed with a solid component and polycystic cyst with maximum diameter of about 20 cm. Percutaneous tumor needle biopsy was performed and diagnosis was Ewing sarcoma. At that time, operation is extremely difficult, so the neoadjuvant chemotherapy with ifosfamide, etoposide, Adriamycin, and vincristine were administered. After 6 courses, MRI showed tumor reduction to maximum diameter of 10 cm. We planned tumor resection with total cystectomy for radical resection, but we also tried to preserve bladder considering the young age and quality of life. Although the bladder was partially resected, tumor resection was succeeded without removing surrounding organs. Histopathological examination revealed viable cells remained, but more than 95% was disappeared and the surgical margins were negative. Here we report a case of extra skeletal Ewing sarcoma in the retroperitoneum that was treated with chemotherapy and surgery without scarifying surrounding organs.

Stemness regulation of the adrenal mixed corticomedullary tumorigenesis-a case-control study

Mixed corticomedullary tumor is an adrenal tumor intermixed with cortical and medullary cells. It is extremely rare with unclear tumorigenesis. We reported a 32-year-old female, manifested with typical Cushing’s syndrome and hypertension, to be diagnosed with right huge adrenal mixed corticomedullary tumor (8.8 cm). Right adrenalectomy was done to document the tumor intimately admixed with adrenal cortical adenoma and pheochromocytoma by biochemistry and immunohistochemistry. A case-control study was designed to explore the tumorigenesis of mixed corticomedullary tumor by whole exome sequencing. Expression of the stemness markers was controlled by a tissue array of 80 adrenal tumors. Overall, 1559 identical variants coexisted in parts of adrenal cortical adenoma and pheochromocytoma, which mainly (85.8%) originated from germline mutations. These enriched mutations were engaged in stemness control, coherent with substantial expression of the stemness markers (SOX2, CD44 and OCT4) in both parts. The differential stemness expressions were demonstrated in other adrenal tumors as well. The germline mutations were also enriched in signaling involving cancer proliferation, hypoxia inducible factor-1, focal adhesion and extracellular matrix receptor interaction. Somatic mutations affecting mitogen-activated protein kinase signaling, glycolysis and the citrate cycle were found in some tumor elements. This is the first study to verify the rare mixed corticomedullary tumor by molecular and genetic evidence to link with its phenotype. Germline mutations involving the stemness regulation and cancer proliferative signaling may drive intermixed tumor formation. Somatic mutations related to glycolysis and the citrate cycle may contribute to greater tumor outgrowth.

A Newborn Girl with a Huge Abdominal Multicystic Tumor

Question: A newborn girl was delivered via cesarean section at gestational ages of 33 weeks owing to a prenatally diagnosed huge abdominal multicystic tumor. After delivery, abdominal distention with respiratory compromise were noted. Abdominal ultrasound examination confirmed a huge multicystic tumor in the abdomen (13.5 × 12.1 × 7.7 cm) (Figure A). The cyst content was homogeneous, without solid component or a blood flow signal. The liver and spleen were normal. Diagnostic and therapeutic fine needle aspiration after birth revealed sterile and clear cystic fluid with low nucleated cell count (8/μL) and low triglyceride level (<10 mg/dL) (Figure B).

Rarity does not rule out the diagnosis-huge sex-cord stromal cell tumor of the ovary

Huge borderline ovarian tumors are rare in modern medicine because of the awareness, earlier medical consultation and available ultrasound facility even in rural area. Huge ovarian tumor with rapid growth in reproductive age group will lead the clinician towards a diagnosis of ovarian carcinoma. Ovarian sex cord-stromal tumours are a rare group of tumors and accounts for approximately for 7% of all ovarian tumors. A 44-year-old female presented with abdominal distension and pain. Her examination findings and investigation gave a probable diagnosis of ovarian carcinoma. Staging laparotomy and enucleation of tumor was performed en bloc. Histopathology revealed the tumor as mixed sex cord stromal tumor.

Fiberoptic intubation of a child with huge maxillofacial tumor under spontaneous respiration

Fiberoptic intubation of a child with huge maxillofacial tumor under spontaneous respiration

Successful removal of a giant esophageal lipoma by thoracoscopic enucleation: a case report

BackgroundWe report a rare case of giant esophageal lipoma treated with thoracoscopic enucleation successfully.Case presentationA 69-year-old woman was referred to our department with dysphagia. Computed tomography examination revealed a large hypoattenuating submucosal mass with dense fat in the middle and lower esophagus. Upper gastrointestinal endoscopy revealed a submucosal mass with normal mucosa on the middle and lower esophageal wall. On a diagnosis of esophageal lipoma, we performed a video-assisted thoracoscopic operation and the 14.0 × 6.5 × 3.0 cm in size submucosal tumor was completely enucleated. We could successfully avoid a subtotal esophagectomy with high invasiveness. The patient was discharged on the 36th day after operation, and no symptoms had been noted.ConclusionsVideo-assisted thoracoscopic enucleation with minimal invasiveness may be an appropriate treatment option even for such a huge benign esophageal submucosal tumor.

Atraumatic bleeding of the subclavian artery 20 years after surgical treatment of pneumothorax

BackgroundBleeding of the subclavian artery is a fatal condition. Adhesion between the pleura and staple line may develop after surgical treatment of pneumothorax, and collateral arteries often develop from the subclavian artery toward the adhesion at the lung apex; however, atraumatic tearing and bleeding of these collateral arteries into the extrapleural and intrathoracic cavities is rare.Case presentationA 70-year-old man visited the hospital for evaluation of left chest pain. Contrast-enhanced chest computed tomography showed a huge tumor in the left apex of the lung. It was suspected to be an extrapleural huge hematoma, and it ruptured into the thoracic cavity. Bleeding from the left subclavian artery was suspected; therefore, emergency angiography was performed. Angiography showed some collateral circulation from the left subclavian artery to the apex of the left lung. Distal and proximal bleeding points were identified. The distal bleeding point was embolized using coils. The proximal bleeding point was blown out, and stents were placed in the left subclavian artery. He had undergone pneumothorax surgery 20 years previously, and the present bleeding episode was strongly suspected to be associated with that surgery. The collateral circulation from the subclavian artery could have developed because of post-pneumothorax inflammation, eventually rupturing and bleeding into the extrapleural space.ConclusionsThis report described an important case of atraumatic subclavian artery bleeding considered to have been caused by surgical treatment of pneumothorax 20 years previously. Emergency angiography and percutaneous stent placement or coil embolization should be considered first in such cases.

Rektumun Benign Tümörünün Malign Görüntüsü

Rectal schwannomas are rare mesenchymal tumour of the gastrointestinal tract. They are scarcely identified in the low rectum as compared to the proximal tract. If present, huge tumour tends to be symptomatic leading to obstruction, bleeding, and tenesmus. We highlight a 74-year-old man with malignant presentations mimicking low rectal cancer. Colonoscopy revealed a huge pedunculated polyp measuring 10 x 8 cm with a diagnosis of benign tumour of schwannoma upon punch biopsy. Transanal excision was made after failure of endoscopic resection. Microscopic evaluation of the tumour showed a benign nerve sheath tumour of schwannoma supported by positive S100 protein expression. His recovery was excellent, hence he was discharged on the following day. There are no similar symptoms and tumour recurrence on follow up. A huge rectal tumour is not always malignant. Despite their rarity, schwannomas can manifest as malignant features. In case of tumour that mimics rectal carcinoma, preoperative diagnosis is very important for a management plan. The definitive histological diagnosis is based on the morphological features with diffuse positivity of S100 from immunohistochemical study. Surgical resection either endoscopic or transanal approach is the mainstay of treatment, especially when dealing with local complication caused by the huge bulk of tumour.

Fibrous hamartoma of infancy (FHI) of the parotid region in a 3-year-old female presenting as a huge parapharyngeal tumor: A very rare case presentation

Introduction: Fibrous hamartoma of infancy (FHI) is a rare, benign tumor arising from the lower dermis and subcutaneous tissue. It usually occurs in children below two years of age and is often misdiagnosed as being of malignant nature. It most commonly effects the lower extremities, very rarely involves the head and neck region, and is commonly found in males. Microscopically, it is a poorly circumscribed and non-capsulated tumor comprising of interlacing fascicles of pale eosinophilic myofibroblasts and stellate shaped fibroblasts with island of mature adipocytes. Case Report: We report a very rare case of FHI of parotid gland in a 3-year-old female child, posing a diagnostic difficulty for management. The site, size, and age of presentation of the tumor were unique. This tumor is common in males but our case was a female child. Our patient presented with involvement of the parotid, submandibular and upper neck area with a huge size of around 7 × 8 cm which was causing mild swallowing difficulty due to intraoral swelling in the child. Cytopathology from the lesion demonstrated spindle cell lesion, the differential diagnosis of which is often malignant in pediatric age group. We took a biopsy for confirmatory diagnosis and after histopathological diagnosis of FHI proceeded with complete surgical excision. Conclusion: Treatment of choice for these benign tumors is complete surgical excision, with excellent prognosis.

Endotracheal intubation in a case of huge parotid tumor–A Challenge

Endotracheal intubation in a case of huge parotid tumor–A Challenge

Giant Malignant Phyllodes Tumor of the Breast

Phyllodes tumor is a rare fibroepithelial tumor of the breast that account for less than 1% of all breast neoplasms [1]. Clinically, it is typically a large, smooth and fast-growing mass that forms from the periductal stroma of the breast [2]. Phyllodes tumor can be considered benign, borderline, or malignant and the percentage of malignant tumors ranges from 23 to 50%. This classification depends on histologic features, as the degree of stromal cellularity and atypia, mitotic count and stromal overgrowth [3]. We report a case of a huge malignant phyllodes tumor in a 62-year old woman who presented with a large breast mass with 10-month disease evolution time. The patient underwent total mastectomy and the pathology analysis revealed a malignant tumor.

LOWER LIP SQUAMOUS CELL CARCINOMA WITH EXUBERANT PRESENTATION IN THE FACE: A CASE REPORT

Oral squamous cell carcinoma (OSCC) is the most common malignant neoplasm that affects the lower lip more because of chronic UV radiation exposure. The objective of this work is to describe a case of OSCC with exuberant clinical presentation on the face. We report a case of a 63-year-old woman with complaints of the appearance of a painless ulceration with slow growth in the lower lip for 3 years. In the extraoral examination, a huge tumor was observed with ulcerated and necrotic surface. Histologic sections revealed fragments of OSCC. She was referred for cancer treatment. This case reinforces the importance of the stomatologist for the correct diagnosis and treatment orientation. The case reported shows the importance of the diagnosis of oral malignant lesions performed by the stomatologist. Oral squamous cell carcinoma (OSCC) is the most common malignant neoplasm that affects the lower lip more because of chronic UV radiation exposure. The objective of this work is to describe a case of OSCC with exuberant clinical presentation on the face. We report a case of a 63-year-old woman with complaints of the appearance of a painless ulceration with slow growth in the lower lip for 3 years. In the extraoral examination, a huge tumor was observed with ulcerated and necrotic surface. Histologic sections revealed fragments of OSCC. She was referred for cancer treatment. This case reinforces the importance of the stomatologist for the correct diagnosis and treatment orientation. The case reported shows the importance of the diagnosis of oral malignant lesions performed by the stomatologist.

Endoscopic resection of giant gastrointestinal stromal tumor at the esophagogastric junction: a case report

BackgroundGastrointestinal stromal tumors (GISTs) at the esophagogastric junction are rare and its treatment is complicated and challenging. Endoscopic resection has advantages with less complications compared to open and laparoscopic surgery.Case presentationWe report a 33-year-old male patient who was admitted to our department complaining of abdominal fullness for 20 days. A huge submucosal tumor at the esophagogastric junction was found by upper gastrointestinal endoscopy. We successfully resected the lesion through endoscopic submucosal excavation without complications, which was pathologically confirmed to be a GIST. The patient was discharged 5 days after operation and has been doing well, and there was no recurrence 8 months after the operation.ConclusionESE is possibly an effective and minimally invasive method of giant esophagogastric junction stromal tumor.

Clinical Significance of Improved Intraoperative Neurophysiological Monitoring Signal during Spine Surgery: A Retrospective Study of a Single-Institution Prospective Cohort.

Study DesignRetrospective case series.PurposeWe reviewed the cases that showed significant improvement of intraoperative neurophysiological monitoring (IONM) signals during spine surgery to assess whether there is a correlation with signal improvement and postoperative clinical status and its clinical significance.Overview of LiteratureTo reduce the risk of neural injury, many spine surgeons are using multimodality IONM. Although many studies attempted to identify valid alarm criteria for predicting postoperative neurologic deterioration, studies concerning the improvement of IONM signals are rare.MethodsWe reviewed all spine surgery cases with IONM data treated at our department between January 2013 and May 2017. We found cases showing significant IONM signal improvements. We prospectively analyzed the neurological and clinical outcomes of these patients and compared outcomes pre- and postoperatively.ResultsAmong 317 cases with the IONM data, we found 29 cases that showed IONM signal improvement compared with baseline. There were 27 cases of compressive myelopathy: 22 had a degenerative cause at the cervical spine, and five, at the thoracic spine. There were two cases of huge neurogenic tumor each at the craniovertebral junction and at the lumbar spine. Both motor-evoked potentials (MEPs) and somatosensory-evoked potentials (SSEPs) signals were improved in six cases, only the MEPs signal improved in 10, and only SSEP signal improved in 13 cases. All cases showed the IONM signal improvement consistently after the decompression procedure during surgery. All patients had a significant improvement in neurological function and subjective symptoms, and none had neurologic deterioration postoperatively.ConclusionsImprovement of IONM signals during surgery may indicate that no unrecognized neural injury occurred during surgery and a favorable postoperative neurological outcome can be expected.

Progress in adrenal surgery: future widening of indications for the gold standard treatment

Laparoscopic adrenalectomy is regarded as a golden standard for surgical treatment of patients with adrenal pathology. Its advantages over the traditional surgery were shown by the experience and it explain commitment of surgeons to this method. However, implementation of this surgery is still discussible in some groups of the patients. Most relevant questions arouse about using laparoscopic technologies in patients with huge and malignant adrenal tumors. Objectively worse outcomes in these groups of patients and concerns about oncological results dictate need for future researches in this sphere. The article is devoted to the last achievements in adrenal surgery, connected with the implementation and wide spreading of laparoscopic operations. It covers most discussible in medical literature indications for such kind of surgery. Major attention is given to the modern concepts of indications and contraindications for laparoscopic procedures. A review of complications is done and we discuss ways of preventing them. Also, the article addresses to the role of endovascular embolization, in particular to the preoperative embolization, in complex treatment of patients with adrenal tumors.