Intra-abdominal Tumor Research Articles

Giant benign mesenteric cysts (mesothelioma and lymphangioma): A report of two cases

Introduction and importanceMesenteric cysts are a rare group of intra-abdominal tumors located in the mesentery or omentum, most of this lesion are asymptomatically but occasionally presents with non-specific symptoms, which makes diagnosis difficult. Case presentationWe present two cases of giant mesenteric cyst in our Institution, the first case is a women of 23 years with previous gynecologic surgery with chronic abdominal pain and large abdominal mass CT showed a giant intraabdominal 30 × 25 × 15 cm, the patient went to laparotomy and a large mesenteric tumor found. The Histopathology reported a Benign cyst mesothelioma (BCM). The second case is a 47 year male with intermittent abdominal pain and abdominal CT shows a 20x21x15 cm tumor. Laparotomy was performed. Histopathology reported a large lymphangioma. Clinical discussionBCM tumors are rare intrabdominal lesions often diagnosed in premenopausal women. Its etiopathogenesis is still unclear, associated risk factors are endometriosis, pelvic inflammatory disease and previous pelvic surgery. Lymphangiomas are an infrequent cyst tumors. It results from a failure in the evolutionary development of the lymphatic system, often localized in the head and neck and its localization in the abdomen is even rare. The definitive diagnosis is made by histopathology. ConclusionMesenteric cysts diagnosis if often challenge due to nonspecific symptoms and significant overlap in imaging appearance between the different entities, its diagnosis should be in mind when encounter a cystic abdominal tumor, surgical complete removal of this tumors is the optimal treatment to prevent recurrence and complications.

The Predictive Value of the Fibrinogen-Albumin-Ratio Index on Surgical Outcomes in Patients with Advanced High-Grade Serous Ovarian Cancer.

The present study evaluates predictive implications of the pretherapeutic Fibrinogen-Albumin-Ratio Index (FARI) in high-grade serous ovarian cancer (HGSOC) patients undergoing primary cytoreductive surgery. This retrospective study included 161 patients with HGSOC International Federation of Gynecology and Obstetrics (FIGO) stage ≥ IIb, who underwent primary cytoreductive surgery followed by platinum-based chemotherapy. Associations between the FARI and complete tumor resection status were described by receiver operating characteristics, and binary logistic regression models were fitted. Higher preoperative FARI values correlated with higher ascites volumes (r = 0.371, p < 0.001), and higher CA125 levels (r = 0.271, p = 0.001). A high FARI cut at its median (≥11.06) was associated with lower rates of complete tumor resection (OR 3.13, 95% CI [1.63-6.05], p = 0.001), and retrained its predictive value in a multivariable model independent of ascites volumes, CA125 levels, FIGO stage, and Charlson Comorbidity Index (CCI). The FARI appears to act as a surrogate for higher intra-abdominal tumor load. After clinical validation, FARI could serve as a readily available serologic biomarker to complement preoperative patient assessment, helping to identify patients who are likely to achieve complete tumor resection during primary cytoreductive surgery.

Intra-Abdominal Metastasis After Pelvic Primary Synovial Sarcoma Resection: Case Report

Introduction: Synovial sarcoma is a malignant soft tissue sarcoma. It occurs predominantly in young adults. 90% of synovial sarcomas occur in the extremities, they have been reported in other sites, including the abdomen and pelvis. Up to 40% of all patients with soft tissue sarcomas develop distant metastasis, despite adequate local disease control. Aim of the article: To provide an update on one of the rarest and most aggressive tumors, to affirm the importance of early management and especially surveillance, and to encourage the codification and the management of these tumors. Presentation of cases: Here, we discuss a case of a 78-year-old female patient, operated 10 years earlier for a pelvic Synovial sarcoma, who presented with intra-abdominal mass to our hospital that eventually turned out to be a metastatic intra-abdominal synovial sarcoma following biopsy. Conclusion: It is important to be aware that primary intraabdominal tumors can occur and delayed metastasis is more typical of synovial sarcoma than of many other sarcomas and should be considered in determining the appropriate frequency and duration of follow-up imaging.

Challenges in the diagnosis and treatment of pure non-gestational uterine choriocarcinoma in a child: a case report

BackgroundDiagnosing non-gestational uterine choriocarcinoma in children is challenging because of its rarity and nonspecific imaging findings. Herein, we report a case of non-gestational uterine choriocarcinoma in a child, which was unexpectedly found during exploratory laparotomy and confirmed by histopathological findings. However, the tumor did not respond to chemotherapy.Case presentationA 4-year-old Indonesian female patient was brought into the emergency unit with chief complaint of vaginal bleeding. She had suffered from vaginal spotting 4 months before being admitted to the hospital. Physical examination revealed a distended abdomen in the left lumbar region and a palpable fixed mass with a smooth surface. Abdominal computed tomography scans revealed a large mass (10 × 6 × 12 cm) with fluid density and calcification. Thus, we suspected left ovarian teratoma. The patient’s luteinizing hormone, follicle-stimulating hormone, and lactate dehydrogenase levels were 25.2 mIU/ml, 0.1 mIU/ml, and 406 U/l, respectively. According to the clinical and radiological findings, we decided to perform an exploratory laparotomy and found a tumor originating from the uterus, not the ovarium. We did not observe liver nodules and any enlargement of abdominal lymph nodes. Subsequently, we performed hysterectomy. The histopathological findings supported the diagnosis of choriocarcinoma. The patient was discharged uneventfully on postoperative day 5. Thereafter, the patient underwent nine cycles of chemotherapy, including carboplatin (600 mg/m2 IV), etoposide (120 mg/m2 IV), and bleomycin (15 mg/m2 IV). However, on the basis of the clinical findings of a palpable mass and partial intestinal obstruction, the tumor relapsed soon after the ninth cycle of chemotherapy. Currently, the patient is undergoing chemotherapy again.ConclusionsAlthough pure non-gestational uterine choriocarcinoma is rare, it should be considered as one of the differential diagnoses for intraabdominal tumors in a child, so as to better guide and counsel families regarding the surgical plan and prognosis, respectively. In the present case, the patient’s response to chemotherapy was poor, implying that the treatment of non-gestational choriocarcinoma is still challenging, particularly in the pediatric population.

Incarcerated Intestine by Testicular Mass in Huge Scrotum: A Case Report

Large testicular tumor is not a commonly seen entity in the modern era. While treatment of large testicular tumors is via inguinal radical orchiectomy, large testicular tumors carry the dilemma of delivering these large masses via the inguinal or scrotal approach. Our case was a 90 years old man with obstruction signs and huge scrotum that shows incarcerated large bowel with huge testicular mass, that in his surgery we did Radical Orchiectomy and we replace incarcerated Large Bowel in scrotum and discharge him successfully. Giant testicular cancer is considered one of the largest testicular masses in the world. Delayed seeking medical advice and appropriate management is the major cause behind this rare presentation. Increasing the awareness regarding self-examination and eliminating the stigma is the cornerstone to markedly reduce this type of unusual presentation since any testicular size change and mass can be easily noted by the patient. Surgical exploration and adjuvant chemotherapy seems as a reasonable treatment option in the setting of bilateral intra-abdominal testis tumor in an adult patient. The study underscores the effectiveness of the intervention in promoting preventive behaviours against testicular cancer among university students, laying the groundwork for future educational initiatives. Although testicular cancer (TC) is the most common malignancy in males between the ages of 18 and 50 years, little effort has been made to increase public awareness about TC and testicular self-examinations (TSEs). Intestinal obstruction without a past surgical history of abdominal surgeries or trauma is a rare and challenging clinical situation. This case report describes the presentation, diagnosis, and management of intestinal obstruction in a patient with an uncommon aetiology of small bowel obstruction. Chronic hernia incarceration can lead to weakening and ischemia of the bowel, and minimal trauma can lead to perforation of the weakened segment. In such presentations, bowel resection and repair of the defect with a biological material is safe and feasible.

Identifying intra-abdominal desmoid type fibromatosis mimicking recurrence/metastasis of GISTs using FAPI PET/CT.

e23516 Background: Intra-abdominal desmoid tumor (IADT) can mimic the recurrence/metastases of gastrointestinal stromal tumors (GISTs). However, it is difficult to radiologically differentiate IADT and recurrence/metastases of GISTs. This study aims to investigate the value of 18F fibroblast activation protein inhibitor ( [18F]FAPI-42) PET/CT in identifying intra-abdominal desmoid type fibromatosis mimicking recurrence/metastases of GISTs by comparing it to [18F]FDG PET/CT. Methods: This study retrospectively included a total of 24 patients (12 patients with IADT and 12 patients with recurrent/metastatic GISTs). The differences in [18F]FAPI-42 PET/CT parameters (SUVmax-FAPI and SUVTLR-FAPI ), [18F]FDG PET/CT parameters (SUVmax-FDG and SUVTLR-FDG), SUVfapi/SUVfdg ratio of IADT and GISTs were compared. The difference in PET/CT parameters (SUVmax, SUVTLR) of IADT between FDG PET/CT and FAPI PET/CT were compared. Immunohistochemical verification was performed on IADT lesions of all 12 patients and expression profiles of GEO datasets were analyzed to validate the FAP expression of IADT. Results: Both [18F]FAPI-42 PET/CT parameters, SUVmax-FAPI [8.8 (2.0, 16.0) vs 1.9 (1.0, 6.0), P&lt; 0.001]and SUVTLR-FAPI [7.3 (2.0, 15.8) vs 1.7 (0.5, 6.9), P&lt; 0.001], of IADT was significantly higher than that of GISTs, while there was no statistically significant difference in [18F]FDG PET/CT parameters, SUVmax-FDG and SUVTLR-FDG, between this two group. The ratio (SUVfapi/SUVfdg) of IADT was significantly higher than that of GISTs [3.3 (1.5, 8.0) vs 0.5 (0.1, 3.9), P= 0.001]. The SUVmax and SUVTLR of FAPI PET/CT of IADT were significantly higher than that of FDG PET/CT [8.8 (2.0, 16.0) vs 2.5 (1.1, 6.2), P&lt; 0.001; 7.3 (2.0, 15.8) vs 0.9 (0.4, 2.7), P&lt; 0.001; respectively]. FAP expression was found to be expressed in all the examined tissues and highly expressed in most of them. GEO database analysis shows that the FAP gene expression in DT is significantly higher than that in GISTs. Conclusions: FAPI PET/CT is a promising method in differentiating IADT from recurrence/metastases of GISTs compared with FDG PET/CT since FAP expression in DT is significantly higher than that in GISTs.

Investigation of clinicopathological characteristics and prognosis of abdominal Desmoid tumors

BackgroundAbdominal desmoid tumors (DTs) are rare soft-tissue neoplasms known for their relatively high local recurrence rate. This study aims to elucidate the clinicopathological features and investigate prognostic factors related to abdominal DTs across various tumor locations.MethodsFrom January 2000 to January 2021, patients diagnosed with abdominal DTs who underwent complete resection at the Cancer Hospital, Chinese Academy of Medical Sciences, were included in this study. Thorough collection and review of clinicopathologic characteristics and follow-up data were performed. Prognostic factors, including age at presentation, sex, tumor location, size, and proximity to nerves or vasculature, were meticulously analyzed to assess their impact on recurrence-free survival.ResultsA cohort of 226 patients diagnosed with abdominal DTs was categorized into two groups based on tumor site: the abdominal wall group (n = 132) and the intra-abdominal cavity group (n = 94). Distinct clinicopathological features and prognoses were observed between abdominal wall DTs and intra-abdominal DTs. During a median follow-up of 60 months, 24 patients (10.2%) experienced local recurrence. Univariate and multivariate analyses identified intra-abdominal tumors, tumor size >10cm, and positive margins as independent risk factors associated with poor prognosis.ConclusionAbdominal wall DTs demonstrate different clinicopathological characteristics and better prognoses compared to intra-abdominal DTs. By achieving negative margins, patients with abdominal wall DTs can achieve favorable therapeutic outcomes and prognosis through curative resection.

Embryonal sarcoma of the liver in pediatric and young adult patients: A report from Children's Oncology Group study ARST0332.

Embryonal sarcoma of the liver (ESL) is a rare mesenchymal tumor most common in childhood; the optimal treatment approach is uncertain. The clinical features and outcomes of patients with ESL enrolled in a Children's Oncology Group (COG) clinical trial that evaluated a risk-based strategy for treating soft tissue sarcomas in patients aged <30 years were evaluated. This subset analysis included patients with ESL enrolled in COG study ARST0332. Central review of records, pathology, and imaging confirmed the diagnosis, presenting features, and surgery extent and complications. All patients received dose-intensive ifosfamide/doxorubicin chemotherapy, with cycle timing dependent on surgery and radiotherapy. Tumor resection occurred before study entry or after four cycles of chemotherapy; radiotherapy for residual tumor was optional. Thirty-nine eligible/evaluable patients with ESL were analyzed. All tumors were >10 cm in diameter; four were metastatic. Tumor resection was performed upfront in 23 and delayed in 16. Positive surgical margins (n=6) and intraoperative tumor rupture (n=6) occurred only in upfront resections. Eight patients received radiotherapy. Estimated 5-year event-free and overall survival were 79% (95% confidence interval [CI], 65%-93%) and 95% (95% CI, 87%-100%), respectively. Positive margins increased the local recurrence risk. One of 13 patients with documented hemorrhagic ascites and/or tumor rupture developed extrahepatic intra-abdominal tumor recurrence. The treatment strategy used in ARST0332 achieved favorable outcomes for patients with ESL despite a substantial proportion having high-risk disease features. Deferring tumor resection until after neoadjuvant chemotherapy may decrease the risk of intraoperative tumor rupture and improve the likelihood of adequate surgical margins.

Intra-tumoral immunomodulatory therapy for advanced abdominal cancers using lipopolysaccharide: The Regional Immuno-Oncology Trial-1 (RIOT-1) protocol (NCT05751837)

BackgroundIntra-tumoral immunotherapy has shown potential in treating advanced cancers. Delivery challenges have limited exploration of these modalities in intra-abdominal tumors. In this study, we explore the safety of injecting intra-abdominal tumors with lipopolysaccharide (LPS) from Escherichia coli 0113. This agonist of toll-like receptor 4 (TLR4) holds promise as an agent to enhance the anti-tumor immune response within the tumor microenvironment. MethodsThis Phase I study will recruit adult patients with peritoneal metastases from gastrointestinal primary malignancies who have at least two suitable intra-abdominal soft tissue tumors for injection. LPS will be administered as a single 1 μg dose during diagnostic laparoscopy in patients in whom a subsequent interval laparotomy is planned. A control injection of saline will be injected into a second lesion. Primary outcome is safety, with secondary outcomes being biomarkers of the tumor immune microenvironment in pre- and post-treatment biopsies. ResultsThe primary endpoint is to determine the safety (frequency and nature of adverse events) following intra-tumoral LPS injection. Adverse events will be classified using Common Terminology Criteria for Adverse Events. Secondary endpoints include cellular and molecular biomarkers of immune response. The study will proceed until twelve patients have completed the protocol. DiscussionPatients undergoing standard-of-care laparoscopy in preparation for interval cytoreductive surgery may be ideal candidates for intra-tumoral immunotherapy. This study seeks to establish the safety of using E. coli LPS for injection into intra-abdominal tumors and to establish precedent for interval tumor immune microenvironment assessment as a window-of-opportunity concept in the context of abdominal metastatic disease. Trial RegistrationThe trial is registered at Clinical Trials.gov; NCT05751837 (registered February 28th, 2023).

Abdominal Compartment Syndrome: Definitions, Epidemiology, and Management

Abdominal compartment syndrome (ACS) is a multifaceted and potentially life-threatening medical condition characterized by elevated intra-abdominal pressure. While ACS was initially associated with trauma, it has become evident that this syndrome can manifest in various clinical scenarios.&#x0D; The prevalence of ACS varies across diverse patient populations and clinical settings. Risk factors such as obesity, intra-abdominal tumors, ascites, and major surgery heighten the vulnerability to developing ACS. The pathophysiology of ACS involves a cascade of events compromising organ perfusion. This includes the compression of the inferior vena cava and renal veins, leading to reduced venous return and impaired renal blood flow, which can result in renal failure.&#x0D; Accurate diagnosis of ACS relies on the measurement of intra-abdominal pressure, often performed through bladder pressure measurement. Management encompasses a range of supportive measures, careful patient positioning, ventilatory support, and strategies to reduce intra-abdominal volume. Surgical decompression becomes necessary when conservative approaches fail, although this decision must consider individual patient factors.&#x0D; This review underscores the evolving landscape of ACS and emphasizes the imperative for continued research to address uncertainties in pathophysiology, diagnostic criteria, and management strategies. Enhanced understanding and refined approaches hold the potential to significantly improve outcomes for at-risk or affected patients.

Anaesthesia Management for Giant Intraabdominal Tumours: A Case Series Study.

Due to a lack of randomised controlled trials and guidelines, and only case reports being available in the literature, there is no consensus on how to approach anaesthetic management in patients with giant intraabdominal tumours. This study aimed to evaluate the literature and explore the current status of evidence, by undertaking an observational research design with a descriptive account of characteristics observed in a case series referring to patients with giant intraabdominal tumours who underwent anaesthesia. Twenty patients diagnosed with giant intraabdominal tumours were included in the study, most of them women, with the overall pathology being ovarian-related and sarcomas. Most of the patients were unable to lie supine and assumed a lateral decubitus position. Pulmonary function tests, chest X-rays, and thoracoabdominal CT were the most often performed preoperative evaluation methods, with the overall findings that there was no atelectasis or pleural effusion present, but there was bilateral diaphragm elevation. The removal of the intraabdominal tumour was performed under general anaesthesia in all cases. Awake fiberoptic intubation or awake videolaryngoscopy was performed in five cases, while the rest were performed with general anaesthesia with rapid sequence induction. Only one patient was ventilated with pressure support ventilation while maintaining spontaneous ventilation, while the rest were ventilated with controlled ventilation. Hypoxemia was the most reported respiratory complication during surgery. In more than 50% of cases, there was hypotension present during surgery, especially after the induction of anaesthesia and after tumour removal, which required vasopressor support. Most cases involved blood loss with subsequent transfusion requirements. The removal of the tumor requires prolonged surgical and anaesthesia times. Fluid drainage from cystic tumour ranged from 15.7 L to 107 L, with a fluid extraction rate of 0.5-2.5 L/min, and there was no re-expansion pulmonary oedema reported. Following surgery, all the patients required intensive care unit admission. One patient died during hospitalization. This study contributes to the creation of a certain standard of care when dealing with patients presenting with giant intraabdominal tumour. More research is needed to define the proper way to administer anaesthesia and create practice guidelines.

Congenital mesenteric cysts: rare but important entities in abdominal surgery

Mesenteric cysts are rare, benign, intra-abdominal tumors with an incidence of 1 case per 2,50,000 hospital admission. They present with non-specific clinical symptoms and signs which mostly lead to misdiagnosis. In many conditions mesenteric cysts are discovered either accidentally during radiological examination or during laparotomy for management of complications. Mesenteric cysts are usually non-cancerous and can be lined by different kinds of tissues. The exact cause of mesenteric cysts is not known, but there are various theories regarding it. In children they are considered as congenital i.e., due to abnormalities in development of embryonic mesentery and in adults it might be due to lymphatic malformation, occult trauma or infection. Treatment of mesenteric cyst includes enucleation or surgical excision depending on type of cyst. Since the case is very rare, pre-operative diagnosis and treatment is a challenge. We report a case of five-year-old female child with enterogenous mesenteric cyst in the small intestine. The differentials of ultrasound showed para ovarian cyst or mesenteric cyst. Abdominal computed tomography (CT) revealed an attached cystic mass at mesentery measuring 96×28×17 mm (CC×AP×AR). The child underwent exploratory laparotomy with cyst excision and intestinal resection with end-to-end anastomosis of small intestine. The knowledge about these cysts is important because many times they go undiagnosed and cause serious complications like rupture, torsion or intestinal obstruction.

Volume-based 18F-FDG PET/CT predicts prognosis and outcome of active surveillance for intra-abdominal desmoid tumor.

Desmoid tumor (DT) is a rare monoclonal, fibroblastic proliferation characterized by a variable and often unpredictable clinical course. Initial active surveillance is recommended by current guideline, and surgery is one of the main therapies for DT. Predicting the prognosis and outcome of active surveillance for intra-abdominal DT is pressing issue. The study included eighteen patients with intra-abdominal DT. Metabolic tumor volume (MTV), total lesion glycolysis (TLG), and maximum standardized uptake value (SUVmax) were measured. We analyzed their relationship with the outcome of active surveillance, as well as clinical, prognostic, and pathological data. The MTV and TLG of recurrent DT were significantly higher than those of non-recurrent DT (P < 0.001 and P = 0.00, respectively). The ROC curve suggested that the appropriate cutoff values for distinguishing recurrent DT from non-recurrent DT were 760.8 for MTV (sensitivity = 1, specificity = 0.857 and AUC = 0.929), and 1318.4 for TLG (sensitivity = 1, specificity = 0.786, and AUC = 0.911). The cutoff values of MTV and TLG significantly correlated with PFS using the Kaplan-Meier method (P = 0.002 and P = 0.007, respectively). MTV and TLG could distinguish DTs with subsequent progression from stable ones (P = 0.004 and P = 0.004, respectively). The ROC curve suggested that the appropriate cutoff values for distinguishing DTs with subsequent progression from stable ones were 197.1 for MTV (sensitivity = 0.9, specificity = 1, and AUC = 0.900), and 445.45 for TLG (sensitivity = 0.9, specificity = 1, and AUC = 0.900). Volume-based 18F-FDG-PET can predict prognosis of intra-abdominal DT. MTV and TLG can predict the outcome of active surveillance for intra-abdominal DT. MTV and TLG can potentially be predictors of surgical risk and difficulty.

Intra-abdominal fibromatosis following laparoscopic surgery for sigmoid colon cancer: A case report

Introduction: Desmoid tumors, also known as aggressive fibromatosis, are rare, benign, non-inflammatory, and fibroblastic tumors. Characterized by their locally aggressive behavior and the potential for recurrence, these tumors do not metastasize. Intra-abdominal desmoid tumors comprise 8% of all desmoid tumors. Case Report: This paper presents a case of a 50-year-old male, highlighting the diagnostic challenge posed by the incidental discovery of an intra-abdominal mesenteric mass in a patient previously treated for stage I sigmoid colon cancer by laparoscopic proctocolectomy. Multidisciplinary consensus favored surgical intervention, successfully revealing and removing a benign desmoid-type fibromatosis. The occurrence of intra-abdominal desmoid tumors after laparoscopic surgery for colorectal cancer is exceptionally rare, underscoring the unique nature of this case. Conclusion: During post-operative follow-up for colon cancer, the discovery of an intra-abdominal mass is often initially regarded as a sign of cancer recurrence and metastasis. Radiologists and oncologists may not immediately consider alternative causes. The incidentally discovered desmoid-type fibromatosis emphasizes the necessity for vigilant monitoring and consideration of diverse pathologies during follow-up, especially in low-risk scenarios.

A giant liposarcoma originating from peripancreatic fat tissue with identification using 3D-CT angiography: a case report

BackgroundLiposarcoma originating from peripancreatic fat tissue is extremely rare. This case report presents a surgical case of a giant liposarcoma originating from peripancreatic fat tissue with origin identification using 3-Dimensional Computed Tomography Angiography (3D-CTA).Case presentationA 59-year-old female was referred to our hospital with a giant abdominal tumor. Computed tomography revealed a 34 cm tumor composed of fatty tissue, exerting pressure on the posterior aspect of the pancreas. Suspecting liposarcoma, we planned for surgery. At first, the tumor appeared to be intra-abdominal tumor, based on the identification of the tumor’s feeding artery as a branch of the dorsal pancreatic artery using 3D-CTA, we concluded that the liposarcoma originated from the peripancreatic fat tissue and situated in the retroperitoneum. During surgery, we observed a well-capsulated, elastic, yellowish mass without infiltration into surrounding tissues. We carefully dissected the tumor from the greater omentum and transverse mesocolon while preserving the tumor capsule. We ligated the feeding artery at the border with the pancreatic parenchyma and successfully completed the excision of the tumor. The resected specimen weighted 2620 g and was pathologically diagnosed as a well-differentiated liposarcoma. There was no injury to the tumor’s capsule, and the surgical margins were negative.ConclusionsIn this report, we present an extremely rare case of a liposarcoma originating in the peripancreatic fat tissue. The use of 3D-CTA was instrumental in identifying the primary site of this giant tumor, enabling us to guide the surgery and achieve complete resection successfully.

The Role of Colon in Isolated Intestinal Transplantation: Description of 4 Cases.

Intra-abdominal desmoid tumors are a rare and complex clinical problem. These tumors are locally invasive, and surgical ablation represents the mainstay of treatment. When localized at the root of the mesentery, their resection may require extensive excision of the intestine resulting in intestinal failure and life-long total parenteral nutrition. Intestinal transplantation, either autotransplantation or allotransplantation, has been used as a viable option to treat this group of patients. Herein, we describe a series of 4 patients with unresectable intra-abdominal desmoid tumor who underwent cadaveric isolated intestinal and ascending colon transplantation.

Desmoplastic small round cell tumor a case report of a rare intra-abdominal tumor of the young adult

Desmoplastic small round cell tumor is a rare and highly aggressive mesenchymal tumor described as a distinct clinico-pathological entity in 1989 by Gerald . These tumors occur mainly in the peritoneal cavity,although other primary sites, such as testicular, ovarian, thoracic, pulmonary, intracranial and head and neck regions have been reported. Clinical symptoms are non-specific. Diagnosis is based on histological analysis combined with immunohistochemical study. Histological study typically shows small round blue cells in nests separated by abundant desmoplastic stroma associated with a single chromosomal translocation t(11:22) (p 13; q 12) involving the EWSR1 and WT1 genes. The prognosis is particularly poor, with median survival ranging from 17 to 25 months. Management of this tumor remains difficult, and current regimens do not achieve a significant cure rate despite the use of aggressive treatments such as polychemotherapy.

Anaesthesia for Laparoscopic Abdominal Surgery in a Morbidly Obese Female with Hypothyroidism and Hypertension: A Case Report

Obesity is characterised by a body weight that surpasses the expected or ideal weight by over 10%, considering factors such as height, age, body build, and sex. Another way to define obesity is based on body fat content: a male is considered obese if body fat exceeds 25% of his total weight, while a female is considered obese if body fat exceeds 30%. Abdominal obesity, prevalent in 40% of women in India, poses significant challenges in the realm of anaesthesia, particularly during laparoscopic abdominal surgeries. The co-existence of morbid obesity, hypothyroidism, and hypertension present intricate medical conditions that demand precise management. During the surgical procedure, issues related to large intraabdominal tumours and airway maintenance impact respiratory and circulatory dynamics. Notably, intraoperative challenges, including bronchospasm, hypotension, and respiratory acidosis, were addressed to ensure the patient's well-being and a successful surgical outcome. The present case report provides insights into the comprehensive management of high-risk patients undergoing laparoscopic abdominal surgery. It underscores the significance of tailored anaesthesia strategies to mitigate complications and ensure a favourable postoperative recovery. This report presents the case of a 59-year-old female with obesity (BMI: 39.6 kg/m2 ), hypothyroidism, and hypertension who underwent laparoscopic abdominal surgery and discusses managing intraoperative challenges, such as bronchospasm, hypotension, and respiratory acidosis, and the postoperative care for successful patient recovery

Long-Term Outcomes After Abdominal Radiation for Wilms Tumor: A 20-Year Experience.

As radiation therapy (RT) for Wilms tumor (WT) evolves with more conformal techniques, it is necessary to evaluate patterns of failure and toxicity. We sought to determine the rate of local failure (LF) after abdominal RT in WT, specifically focusing on those with contained rupture treated with whole abdominal and pelvic RT (WAPRT) vs flank RT. Secondary objectives were to determine overall survival (OS), distant failure (DF), and late toxicities. A single institution retrospective study of 54 pediatric patients with WT treated with abdominal RT between May 2000 and October 2022. LF and DF were calculated through cumulative incidence function and OS by Kaplan-Meier method. The median age was 4.5 years and the median follow-up was 6 years. Most patients (91%) had favorable histology. Only 1 patient experienced LF, 15 months from completion of RT (cumulative incidence 2% at 5y). All patients who received unilateral flank radiation for contained rupture/spillage (n=13) experienced long-lasting intra-abdominal tumor control. A total of 5 patients experienced a DF at a median of 7 months, all in the lung. No patient relapsed in the lungs after upfront whole lung irradiation (n=16). OS was 96% at 5 years. Among 28 patients who followed through puberty, 4 female patients with prior WAPRT experienced hormonal irregularities/infertility. Unilateral flank radiation may be a viable alternative to WAPRT for contained rupture/spillage and should be further explored prospectively. Our results may also be utilized in the future for outcome and toxicity comparison as conformal radiation techniques evolve.

Abdominal wall mass resections: single-center closure practices and outcomes following oncologic resections of abdominal wall fascia.

Radical resections for abdominal wall tumors are rare, thus yielding limited data on reconstruction of defects. We describe surgical management and long-term outcomes following radical tumor resection. This was a single-center retrospective review of patients between January 2010 and December 2022. Variables included operative characteristics, wound complications, hernia development, tumor recurrence, and reoperation. A multivariable analysis compared wound morbidity for suture and mesh repairs while adjusting for defect width, fascial closure, and CDC wound class. 120 patients were identified. Mean follow-up was 3.9 ± 3.4years. Seventy-five (62.5%) of the masses were primary; most commonly desmoid (n = 25) and endometrioma (n = 27). Forty-five masses were metastases. Mean tumor width was 6.2 ± 3.4cm; mean defect width was 8.1 ± 4.1cm. Sixty-one patients (50.8%) had mesh placed, with variation in technique. Postoperative CT scans were available for 88 (73.3%) patients. Forty SSOs (33.3%), 11 SSIs (9.2%), and 18 (15%) SSOPIs occurred within 30 days. On multivariable analysis, increased defect width was associated with SSOPI (OR 1.17, p = 0.041) and CDC wound class II-III was associated with SSI (OR 8.38 and 49.1, p < 0.05) and SSOPI (OR 5.77 and 17.4, p < 0.05); mesh was not associated with these outcomes. Seven patients (5.8%) underwent 30-day reoperations and 35 (20.8%) required additional operations after 30 days. Thirteen percent developed abdominal wall (n = 8) or intra-abdominal tumor recurrence (n = 8) requiring reoperation. Twenty-seven (22.5%) patients developed hernias with a mean fascial defect width of 9.8 ± 7.2cm. Abdominal wall mass resections are morbid, often contaminated cases with high postoperative complication rates. Risks and benefits of mesh implantation should be tailored on an individual basis.