Local Resection Research Articles

New Perspectives in the Medical Treatment of Non-Muscle-Invasive Bladder Cancer: Immune Checkpoint Inhibitors and Beyond.

Non-muscle-invasive bladder cancer (NMIBC) is characterized by a high rate of cure, but also by a non-negligible probability of recurrence and risk progression to muscle-invasive disease. NMIBC management requires a proper local resection and staging, followed by a risk-based treatment with intravesical agents. For many years, the current gold standard treatment for patients with intermediate or high-risk disease is transurethral resection of the bladder (TURB) followed by intravesical bacillus Calmette–Guérin (BCG) instillations. Unfortunately, in about half of high-risk patients, intravesical BCG treatment fails and NMIBC persists or recurs early. While radical cystectomy remains the gold standard for these patients, new therapeutic targets are being individuated and studied. Radical cystectomy in fact can provide an excellent long-term disease control, but can deeply interfere with quality of life. In particular, the enhanced immune checkpoints expression shown in BCG-unresponsive patients and the activity of immune checkpoints inhibitors (ICIs) in advanced bladder cancer provided the rationale for testing ICIs in NMIBC. Recently, pembrolizumab has shown promising activity in BCG-unresponsive NMIBC patients, obtaining FDA approval. Meanwhile multiple novel drugs with alternative mechanisms of action have proven to be safe and effective in NMIBC treatment and others are under investigation. The aim of this review is to analyse and describe the clinical activity of new emerging drugs in BCG-unresponsive NMIBC focusing on immunotherapy results.

Surgical margins in the resection of oral squamous cell carcinoma under local versus general anesthesia

ObjectivesThis study analyzes the influence of the surgical setting, i.e. resection under local anesthesia versus resection under general anesthesia, on surgical margins in tumor resection of stage I and II oral squamous cell carcinoma (OSCC). Materials and MethodsRetrospective study on tumor resections of stage I or II OSCC performed between 2014 and 2020. Potential predictors associated with surgical margins were identified. Multinomial logistic regression was used to analyze the effect of type of anesthesia on surgical margins, adjusted for potential predictors. ResultsIn total, 109 cases were included: 54 tumor resections were performed under local anesthesia and 55 under general anesthesia. Histopathological examination showed 19 clear surgical margins, 54 close surgical margins, and 36 positive surgical margins. Compared to resection under general anesthesia, resection under local anesthesia increased the risk of close margins (adjusted OR = 6.26; 95 %CI 1.66–23.58; p = .01) and positive margins (adjusted OR = 6.81; 95 %Cl 1.70–27.27; p = .01). Tumor resection of the floor of mouth, buccal mucosa, gingiva, retromolar trigone, hard palate, and soft palate had a higher risk of close and positive margins than tumor resection of the tongue. Tumor resection of the tongue under local anesthesia was associated with an increased risk of positive margins compared to resection under general anesthesia. ConclusionTumor resection under local anesthesia of stage I and II OSCC increases the risk of close and positive surgical margins compared to tumor resection under general anesthesia.

Application of free peroneal artery chimeric perforator flap in repairing the defect after advanced local lesions resection in parotid gland carcinoma

To investigate the effectiveness of free peroneal artery chimeric perforator flap in repairing the defect after advanced local lesions resection in parotid gland carcinoma (PGC). Between June 2010 and June 2020, 32 patients with advanced local lesions of PGC were treated with extended radical resection. After that, 17 patients were repaired with the free peroneal artery chimeric perforator flaps (trial group) and another 15 patients were repaired with the pedicled pectoralis major myocutaneous flaps (control group). There was no significant difference in gender, age, disease type, histopathological classification, clinical stage, and pathological stage between groups ( P>0.05). The size of skin flap in trial group ranged from 7 cm×6 cm to 12 cm×8 cm and the size of soleus muscle flap ranged from 5 cm×3 cm to 6 cm×4 cm. The donor sites were repaired with skin grafting. The size of the pedicled pectoralis major myocutaneous flaps in control group ranged from 9 cm×6 cm to 14 cm×7 cm. The donor sites were sutured directly. The operation time, survival rate of flap, and postoperative survival of patients were recorded and compared between groups. At 1 year after operation, the University of Washington quality of life (UW-QOL) questionnaire was used to evaluate the quality of life of patients in the two groups, including appearance, shoulder movement, sociability, masticatory function, speech function, and mood. The operations completed successfully. The operation time was (6.19±0.72) hours in trial group and (6.41±0.71) hours in control group, showing no significant difference between groups ( t=-0.863, P=0.395). The survival rate of flap in trial group was 94.1% (16/17); and 1 patient suffered from vascular crisis after operation and was replaced with the pedicled pectoralis major myocutaneous flap. The survival rate of flap in control group was 100%. All grafts survived and the incisions healed by first intention in the two groups. All patients were followed up. The follow-up time was 6-60 months (median, 60 months) in trial group and 7-60 months (median, 60 months) in control group. Cumulative survival rates of patients at 1, 3, and 5 years after operation were 94.1%, 64.7%, and 58.8% in trial group, respectively; 86.7%, 66.7%, and 53.3% in control group, respectively. There was no significant difference in the cumulative survival rate between groups ( χ 2=0.090, P=0.762). According to the UW-QOL questionnaire at 1 year after operation, the scores of appearance, shoulder movement, sociability, and mood in trial group were significantly higher than those in control group ( P<0.05); and there was no significant difference in masticatory function and speech function scores between groups ( P>0.05). The peroneal artery perforator has an invariable anatomical relationship. Each perforator emits the muscular branch that nourishes the soleus muscle. Therefore, personalized free peroneal artery chimeric perforator flap can be designed according to the tissue defect, and used to repair the defect after advanced local lesions resection in PGC.

Paratesticular liposarcoma: the clinicopathological features of nineteen cases

Objective: To investigate the clinicopathological features and differential diagnoses of paratesticular liposarcoma. Methods: The cases were collected from 2012-2020, from the archives of the Department of Pathology, Peking University Third Hospital, with diagnosis confirmed by histology, immunostaining and FISH tests. Results: Totally 19 patients were enrolled (including 11 in-hospital patients and 8 consultant cases). The patients aged 37-84 years (mean 57 years). The preoperative clinical diagnoses were spermatic cord/inguinal masses (nine patients), scrotal masses (seven patients), and inguinal hernia (three patients). Six lesions recurred after local resection, including one case extending from pelvic liposarcoma. Histologically, there were 10 cases of well-differentiated liposarcoma (WDLPS) and nine cases of dedifferentiated liposarcoma (DDLPS). WDLPSs mostly showed the combined features of lipoma-like, inflammatory and sclerosing subtypes (six patients); the other four WDLPSs had pure lipoma-like subtype features. DDLPSs were low-grade (three patients) or high-grade (six patients), with the morphology resembling myxofibrosarcoma, inflammatory myofibroblastoma, spindle cell sarcoma, pleomorphic undifferentiated sarcoma and pleomorphic liposarcoma. Intense inflammatory cells infiltration was commonly observed in five WDLPSs and two DDLPSs. Ossification was observed in three tumors. Immunohistochemically, the tumors were positive for MDM2 (8/10) and CDK4 (10/10), which were expressed in lipo-differentiating cells, spindle cells in WDLPS, and in dediffferentiated components. S-100 was only expressed by lipocytes (10/10). CD34 expression was positive and diffuse in the stromal cells of WDLPSs and focal or diffuse in dedifferentiated areas (10/10). FISH tests with an MDM2 gene probe were positive (12/12). Conclusions: Paratesticular liposarcoma may be overlooked by both clinicians and pathologists. WDLPS and DDLPS predominate, showing various histologic divergences. The presence of amplification of the 12q14-q15 region (containing the MDM2 and CDK4 genes) is helpful for making the correct diagnosis.

Organ Sparing Duodenal Resections

Introduction: Duodenum has the highest incidence of tumours per square metre of its area, with most tumours being managed by pancreaticoduodenectomy. Though local resections are feasible, technical difficulty, fear of complications and doubt of oncological adequacy have discouraged their usage. However, these concerns are ill-founded and an understanding of the surgical anatomy of duodenum may allow a surgeon to preserve the pancreas and resect only the required segments of duodenum with equivalent long term survival outcomes. In this study, we reviewed our experience with duodenal tumours over 3 years and describe the surgical procedures and their outcomes. Methods: All patients undergoing pancreas sparing, local duodenal resections in a single surgical unit of a tertiary care centre from October2017 to September2020 were reviewed. Data was extracted from a prospectively maintained database regarding demographics, clinical presentation, imaging and endoscopic parameters, surgical procedures, and outcomes. Patients were contacted telephonically for their follow up. Results: A total of 8patients were operated for duodenal tumours over the study period. Of these, 5patients underwent local duodenal resections and 3 underwent pancreaticoduodenectomy. 2patients underwent D1 resections, one D3-D4 resection, one D4 and proximal jejunal resection and one DJ resection. The tumour was away from the ampulla in all patients. There was no mortality or major perioperative morbidity. After a median follow up of 20(12-34) months, there was no recurrence or death. Conclusion: Local duodenal resections offer a safe, feasible organ sparing surgical strategy for management of both benign and malignant, localized duodenal tumours.

Management of Tumors of the 3rd-4th Duodenal Portion and Treitz Angle

Introduction: Tumors located in the 3rd-4th duodenal portion and Treitz angle are rare entities. GIST, neuroendocrine, and carcinomas are the most frequent subtypes, however, due to the extremely low incidence, there is no strong evidence regarding which surgical approach is best. Local resection and Whipple procedure are the surgical approaches most used but the evidence is still lacking. Our purpose is to analyze the oncological and surgical outcomes of each technique. Methods: From 2010 to 2020, 6 patients with tumors in these locations were operated. Histology showed 3 adenocarcinomas, 1 GIST, 1 leiomyosarcoma, and 1 neuroendocrine. Medium age was 67,5 years, sex distribution included 4 males and 2 females. Results: Local resection and anastomosis were performed in 4 patients while Whipple procedure was performed in 2 patients. Tumour resection patients presented one IIIA, two II, and one 0 Clavien-Dindo complications while Whipple patients presented one IIIA and one V (exitus) Clavien-Dindo complications. Among patients with duodenal adenocarcinoma, one was T4 and a Whipple procedure was performed, the other 2 patients were T3 and T2, N0 and local resection was performed. All the local resection patients are still alive and disease-free. Both Whipple patients died, one due to surgical complications and the other one died because of brain metastases. Conclusion: Duodenal resection seems to be a suitable approach for local tumors (T1-T3, N0) independently of the pathologic type while advanced (T4) or lymph nodes positive (N1) should be submitted to a Whipple procedure.

Potential Applicability of Local Resection With Prophylactic Left Gastric Artery Basin Dissection for Early-Stage Gastric Cancer in the Upper Third of the Stomach.

PurposeTotal or proximal gastrectomy of the upper-third early gastric cancer (u-EGC) often causes severe post-gastrectomy syndrome, suggesting that these procedures are extremely invasive for patients without pathologically positive lymph node (LN) metastasis. This study aimed to evaluate the clinical applicability of a stomach function-preserving surgery, local resection (LR), with prophylactic left gastric artery (LGA)-basin dissection (LGA-BD).Materials and MethodsThe data of patients with u-EGC (pathologically diagnosed as T1) were retrospectively analyzed. Total gastrectomy was performed in 30 patients, proximal gastrectomy in 45, and subtotal gastrectomy in 6; the LN status was evaluated assuming that the patients had already underwent LR + LGA-BD. This procedure was considered feasible in patients without LN metastases or in patients with cancer in the LGA basin. The reproducibility of the results was also evaluated using an external validation dataset.ResultsOf the 82 eligible patients, 79 (96.3%) were cured after undergoing LR + LGA-BD, 74 (90.2%) were pathologically negative for LN metastases, and 5 (6.1%) had LN metastases, but these findings were only observed in the LGA basin. Similarly, of the 406 eligible tumors in the validation dataset, 396 (97.5%) were potentially curative. Tumors in the lesser curvature, post-endoscopic resection status, and small tumors (<20 mm) were considered to be stronger indicators of LR + LGA-BD as all subpopulation cases met our feasibility criteria.ConclusionsMore than 95% of the patients with u-EGC might be eligible for LR + LGA-BD. This function-preserving procedure may contribute to the development of u-EGC without pathological LN metastases, especially for tumors located at the lesser curvature.

Ligand-modified Nanomaterials for Specific Targeting of Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) is the leading cause of death globally. Patients with HCC are generally diagnosed at advanced stages, which leads to their dismal survival status. Current treatment strategies for HCC mainly include liver transplantation, local ablative treatment, surgical resection, and systematic therapy with chemotherapeutic reagents. However, the low efficacy and side effects essentially limit the prognosis of HCC patients. In recent years, significant success has been achieved in the nanomedicine area. Nanomaterials could achieve selective and effective targeting of cancer cells by functionalization and surface modification, enhancing their ability to encapsulate drugs and diagnostic agents and bind to specific molecules on the cancer cell surface. This review introduces the representative ligands, such as monoclonal antibodies, peptides, and glycoproteins, extensively used to decorate nanomaterials that target the HCC cell surface.

Posterior-prefrontal and medial orbitofrontal regions play crucial roles in happiness and sadness recognition

The core brain regions responsible for basic human emotions are not yet fully understood. We investigated the key areas responsible for emotion recognition of facial expressions of happiness and sadness using data obtained from patients who underwent local brain resection. A total of 44 patients with right cerebral hemispheric brain tumors and 33 healthy volunteers were enrolled and subjected to a facial expression recognition test. Voxel-based lesion-symptom mapping was performed to investigate the relationship between the accuracy of emotion recognition and the resected regions. Consequently, trade-off relationships were discovered: the posterior-prefrontal region was related to a low score of happiness recognition and a high score of sadness recognition (disorder-of-happiness group), whereas the medial orbitofrontal region was related to a low score of sadness recognition and a high score of happiness recognition (disorder-of-sadness group). The emotion recognition score in both the happiness and sadness disorder groups was significantly lower than that in the control group (p = 0.0009 and p = 0.021, respectively). Interestingly, the deficit in happiness recognition was temporary, whereas the deficit in sadness recognition persisted during the chronic phase. Using graph theoretical analysis, we identified structural connectivity between the posterior-prefrontal and medial orbitofrontal regions. When either of these regions was damaged, the tract volume connecting them was significantly reduced (p = 0.013). These results indicate that the posterior-prefrontal and medial orbitofrontal regions may be crucial for maintaining a balance between happiness and sadness recognition in humans. Investigating the clinical impact of certain area resections using lesion studies combined with connectivity analysis is a useful neuroimaging method for understanding neural networks.

Comparison of the prognostic value of prognostic nutritional index in colorectal cancer deaths:a retrospective cohort study

Evidences showed that Prognostic Nutritional Index (PNI) is one important predictive factor for some cancers. However, the association between PNI and colorectal cancer is still unclear. In this study, we aim to explore the association between PNI and death in patients with locally advanced colorectal cancer. We enrolled 400 patients with colorectal cancer. The pathological results was used to confirm it. The patients received radical resection. The PNI at baseline was set as the exposure variable, death was the outcome variable, and other potential confounders were also analyzed. There was no association between PNI and the deaths of local advanced colorectal cancer and radical resection of colorectal cancer (HR=0.88; 95% CI, 0.78-1.00).Applying the cubic spline function, we found that it is not linear between PNI and death. Two-piecewise cox model showed that there was 68% decrease of risk of deaths when PNI change per 1 (HR=0.32; 95% CI, 0.13-0.79) on the left side of the inflection point (41.35). On the right of the inflection point, there was no association between PNI and death. PNI and deaths are linear correlation. Within a certain range (PNI=26-41), PNI is an independent protective factor for death risk.

Pediatric Malignant Sacrococcygeal Germ Cell Tumor with Intraspinal Extension.

Aims:The study aimed to evaluate the presentation, management, and outcome of patients of sacrococcygeal malignant germ cell tumors (SC-MGCTs) with intraspinal extension.Materials and Methods:Case records of all cases of SC-MGCT were reviewed to identify cases with intraspinal extension. They were evaluated in terms of their presentation, response to therapy, extent of surgical resection, recovery of neurological symptoms if any, and outcome.Results:Of the three cases of SC-MGT, two had intraspinal extension. One had Altman Type 3 disease and another had Altman Type 4 disease; both had Stage 4 disease. The intraspinal extension in both patients was detected on contrast computed tomography scan and magnetic resonance imaging. One patient had bladder and bowel incontinence. All the tumors responded to preoperative chemotherapy. Gross complete local resection could be achieved in all patients. Neurological recovery was complete. All were alive with no recurrence on follow-up.Conclusions:Malignant sacrococcygeal GCTs with intraspinal extension are rare and can be managed with neoadjuvant chemotherapy which obviates the need for extensive exploration for excision and has got good neurological and oncological prognosis.

Rare but Real Presentation of Pancreatic Cystic Tumor

Cystic tumors of the pancreas are rare neoplasms. These tumors are frequently detected incidentally and a definitive preoperative diagnosis remains challenging. Because of widespread use of high quality cross-sectional imaging, pancreatic cystic neoplasms are being diagnosed with increasing frequency. This heterogeneous group of tumors is important because of their high cure rate as well as frequent confusion with the commoner pancreatic pseudocyst. We present a 69-year-old man with vague abdominal pain and loose motion for 3 months. Firstly, this case was misdiagnosed radiologically as pancreatitis with infected pseudocyst. From endoscopic diagnosis, pancreatico-gastrostomy fistula was found and biopsy taken from cyst wall. Histology report showed mucinous adenocarcinoma of pancreas. This was managed by excision of tumor and partial gastrectomy and local resection of transverse colon. It is rare but real presentation of pancreatic cystic tumor.

The pocket-creation method of endoscopic submucosal dissection

Endoscopic submucosal dissection (ESD) is rapidly becoming the standard treatment for superficial gastrointestinal tumors because ESD can achieve complete local resection facilitating thorough pathological examination of the resected specimen. The pocket-creation method (PCM) has been established to perform safe and reliable ESD obtaining a high-quality pathological specimen. A minimal mucosal incision using PCM minimizes leakage of submucosally injected solution, which results in prolonged mucosal elevation. A limited-space submucosal pocket created using PCM makes the endoscope tip stable. A conical cap, small-caliber-tip transparent (ST) hood is used when performing PCM. The submucosa can be cut along the ideal dissection line just above the muscularis with minimal thermal damage because the tip of the ST hood produces both traction and countertraction to stretch the submucosal tissue in the pocket. PCM is recommended as the standard strategy not only for colorectal ESD but also for upper-gastrointestinal ESD. It is expected that the use of traction techniques will make PCM easier to perform.

Full-Thickness Scar Resection After R1/Rx Excised T1 Colorectal Cancers as an Alternative to Completion Surgery.

Local full-thickness resections of the scar (FTRS) after local excision of a T1 colorectal cancer (CRC) with uncertain resection margins is proposed as an alternative strategy to completion surgery (CS), provided that no local intramural residual cancer (LIRC) is found. However, a comparison on long-term oncological outcome between both strategies is missing. A large cohort of patients with consecutive T1 CRC between 2000 and 2017 was used. Patients were selected if they underwent a macroscopically complete local excision of a T1 CRC but positive or unassessable (R1/Rx) resection margins at histology and without lymphovascular invasion or poor differentiation. Patients treated with CS or FTRS were compared on the presence of CRC recurrence, a 5-year overall survival, disease-free survival, and metastasis-free survival. Of 3,697 patients with a T1 CRC, 434 met the inclusion criteria (mean age 66 years, 61% men). Three hundred thirty-four patients underwent CS, and 100 patients underwent FTRS. The median follow-up period was 64 months. CRC recurrence was seen in 7 patients who underwent CS (2.2%, 95% CI 0.9%-4.6%) and in 8 patients who underwent FTRS (9.0%, 95% CI 3.9%-17.7%). Disease-free survival was lower in FTRS strategy (96.8% vs 89.9%, P = 0.019), but 5 of the 8 FTRS recurrences could be treated with salvage surgery. The metastasis-free survival (CS 96.8% vs FTRS 92.1%, P = 0.10) and overall survival (CS 95.6% vs FTRS 94.4%, P = 0.55) did not differ significantly between both strategies. FTRS after local excision of a T1 CRC with R1/Rx resection margins as a sole risk factor, followed by surveillance and salvage surgery in case of CRC recurrence, could be a valid alternative strategy to CS.

Peronea Magna Artery Challenging Proximal Fibula Resection of Ewing’s Sarcoma, Report of a Case

Surgical resection of the fibula is commonly done for either to obtain structural bone graft or to respect the fibula if involved by bone tumor. The vascular anatomy around the popliteal fossa is complex and has to be studied prior to any attempt of surgical resection. We present a case of 11 years old female patient who was diagnosed as a Ewing’s sarcoma of the fibula and her pre-operative CT angiography showed a vascular anomaly of Peronea magna artery. Following adjuvant chemotherapy, the patient was treated by wide local resection and the surgical procedure has to be modified in order to save the dominant peroneal artery the vascularity of the limb.

The Pedicled Flap of Adductor Longus, a New Technique for Inguinal Reconstruction.

Introduction: Reconstruction surgeries of the inguinal area pose a challenge for oncological and orthopedic surgeons, especially after radical local resection (RLR), radical inguinal lymph node dissection (RILND), or both. Although numerous surgical procedures have been reported, there is no report about a pedicle adductor longus flap method. The aim of this work is to show our experience about inguinal reconstruction with pedicled adductor longus flap and associated outcomes.Patients and Methods: A retrospective study of 16 patients with localized inguinal region interventions and reconstructed by adductor longus flap from March 2016 to July 2020. Patients' average age was 60.0 years (range = 38–79 years) and had postoperative follow-up of 10 months (ranging 2–19 months). All patients had unilateral inguinal region involvement—seven cases on the left and nine cases on the right. The patients' clinical course, operative course, and postoperative follow-up data were evaluated.Results: All 16 patients recovered well post-operatively and did not require any re-intervention. Four patients experienced negligible discomfort around the groin area. Five patients experienced a minor strength deficit in thigh adduction compared with that of preoperative strength in the same or contralateral leg. The aforementioned complications resolved during the postoperative course and had no functional impact on their activity of daily living. All adductor longus flaps survived, completely filled the inguinal dead space, and wounds healed uneventfully within 3 weeks except for three patients who suffered delayed wound healing for more than 4 weeks. Other common complications such as infection, seroma, or wound dehiscence were not encountered in this series.Conclusion: The adductor longus flap is a reliable alternative method for inguinal region reconstruction following radical local resection (RLR), radical inguinal lymph node dissection (RILND), or both.

Complete wedge resection for duodenal gastrointestinal stromal tumour: A case series of three patients.

IntroductionDuodenal gastrointestinal stromal tumours (GIST) are rare. Therefore, difficulties are experienced when selecting the appropriate surgical procedure in patients with duodenal GISTs. This report presents the cases of three patients with duodenal GISTs who underwent wedge resection. This report would help surgeons identify clinical features and surgical procedures in patients with duodenal GISTs.Presentation of caseThree patients were diagnosed with duodenal submucosal tumours. The first patient presented with melena, the second with postoperative anaemia, and the third with an incidental finding of a large abdominal tumour after presenting with ischaemic colitis. All tumours arose in the 2nd portion of the duodenum and measured 3.5, 3, and 9.2 cm, respectively. Wedge resection of the duodenum was performed in all patients. In patients one and two, simple closure of duodenal wall was performed after wedge resection. In patient three, side-to-side anastomosis with the jejunum was performed because a large area of the wall was removed using the wedge resection technique. Pancreatoduodenectomy was avoided in all patients. Recurrence was not noted in any patient.DiscussionSince GISTs are not generally associated with lymph node metastasis, local resection with negative margins is sufficient to surgically manage patients with GISTs.ConclusionOur results indicated the effectiveness of performing wedge resection for duodenal GISTs not in close proximity to the ampulla of Vater. Moreover, less invasive procedures should be adopted in patients with duodenal GISTs.

Chondrocutaneous compund graft to repair cicatrizal ectropion

Lower eyelid ectropion is a complication that occasionally occurs as a consequence of local trauma or surgical resections when there is a skin deficit. This type of ectropion is called scarring and the eyelid behaves differently in relation to other areas of the body. The lower eyelid has a thin musculocutaneous anterior lamella and a posterior lamella composed of the tarsus and conjunctiva. Skin grafts placed in this area may have retraction and the lamella often do not have enough strength to prevent ectropion. That is why, for special cases, the use of the chondrocutaneous composite graft is very useful as it avoids skin retraction as much as possible and provides greater support by having cartilage at its base.The present work suggests that the chondrocutaneous composite graft obtained from the auricular area is a very useful material for complex cases of scar ectropion of the lower eyelid

A Case Report of a Bleeding Duodenal Gastro-Intestinal Stromal Tumor and its Emergent Management

A gastrointestinal stromal tumor (GIST) arising in the duodenum is a rare subtype of mesenchymal tumor. GISTs have a reported incidence of 11.9–19.6 per million population and duodenal GISTs make up just 5% of these tumors. Common presentation of duodenal GISTs is through an upper gastrointestinal bleed, of which, they are responsible for less than 1% of all gastrointestinal bleeding. In an elective setting, surgical management remains the mainstay of treatment. In this Case Report, the emergent management of a localized duodenal resection was performed by an acute care surgeon, in an unstable patient. The risk factors for malignancy include tumor size and a high mitotic cell index. Tumor recurrence is determined by tumor size, tumor rupture, high mitotic cell index, a non-gastric location and gastrointestinal bleeding.

Development of metastatic inguinal squamous cell carcinoma in a patient with Netherton syndrome: A case report

Introduction: Netherton syndrome (NS) is a rare multisystem disorder with both cutaneous and extra-cutaneous manifestations. The syndrome includes the presence of congenital ichthyosis, exhibited by hyperkeratosis and abnormal skin scaling over the entire body. In rare instances, NS has been associated with the development of squamous cell carcinoma (SCC). Case Report: A 54-year-old male with a history of NS and recurrent squamous cell carcinoma presented with an enlarging left inguinal mass. Biopsy of the mass was positive for a new invasive squamous cell carcinoma with regional lymph node involvement and invasion of the left femoral vein. The patient underwent wide local resection, superficial and deep regional lymph node dissection, and resection of the left femoral vein. His hospital course was further complicated by multiple infections and progression of his cancer. He eventually transitioned to hospice care before receiving any additional treatment for his malignancy. Conclusion: This case highlights a patient with NS and a history of recurrent inguinal squamous cell carcinoma. Further investigation is needed to better highlight the complexity of factors associated with the development of squamous cell carcinoma in patients with NS and other forms of ichthyoses.