Excision Of Mass Research Articles

Soft Tissue Sarcomas at Atypical Locations in Gynecologic Oncology: A Series of 3 Cases

PurposeThe most frequent primary site of sarcomas in gynecologic oncology is uterus (83%) followed by ovary (8%), vulva and vagina (5%). We present three cases of sarcomas at atypical locations.MethodRecords of cases were retrieved from electronic medical records, and telephonic follow-up was done to know their current status.ResultCase 1: A 26-year-old parous lady presented with complaint of recurrent vulvar mass. Biopsy at our institute revealed myxoid liposarcoma. Metastatic workup was negative. She underwent radical local excision with VY-plasty and bilateral ovarian transposition (BOT) followed by concurrent chemo-radiotherapy. She is disease free at 12 months. Case 2: A 29-year-old lady presented with large bleeding mass arising from right wall of vagina. Histopathology report of vaginal biopsy was high-grade leiomyosarcoma. MRI pelvis with thorax and abdomen scan, examination under anesthesia and cystoscopy revealed non-metastatic operable disease. She underwent radical hysterectomy with vaginectomy with BOT followed by pelvic radiotherapy. At 4-month follow-up, she presented with scalp lesion. Further workup revealed disseminated metastatic disease. She is on palliative chemotherapy at the time of submission or article. Case 3: A 54-year-old lady underwent evaluation for pain abdomen with contrast-enhanced computed tomography which revealed a large omental mass. She had past history of carcinoma cervix 6 years back treated outside with surgery and chemo-radiotherapy. Image-guided biopsy was reported as leiomyosarcoma. Metastatic workup showed no disease elsewhere. She underwent omental mass excision followed by chemotherapy. She is disease free at 13 months.ConclusionSurgery remains the mainstay of treatment in non-metastatic sarcomas. Long-term follow-up of patients is needed in view of their atypical presentation.

A case report on Madelung’s disease and comprehensive review of the literature

BackgroundMadelung’s disease (MD), alternatively referred to as benign symmetric lipomatosis, multiple symmetric lipomatosis, or Launois–Bensaude syndrome, is an uncommon benign disorder marked by symmetric proliferation of adipose tissue in the head, neck, and torso regions.Case descriptionIn this case, the patient was a female with the late middle-aged demographic, diagnosed with Type I MD. Notably, she exhibited no prior history of alcohol consumption, and there was no family history of MD. Subsequent to the clinical diagnosis, the patient underwent medical imaging assessments to delineate the surgical parameters. Post-surgery, she demonstrated a favorable recovery trajectory, marked by the absence of any surgical complications.ResultThe patient underwent successful surgical excision of the lipomatous mass. Postoperatively, she had an uneventful recovery with no complications and no recurrence observed during the follow-up period of seven months.ConclusionTimely diagnosis and early surgical intervention play a pivotal role in enhancing the quality of life for individuals with MD. Preoperative medical imaging examinations function as highly effective tools, contributing to heightened surgical safety and a decreased probability of encountering complications during the surgical procedure.

Surgical resection of a bilateral temporomandibular joint ankylosis and interposition gap arthroplasty using bilateral temporo-parietal fascial flap in a 5 years old child: treatment challenges and literature review

Temporomandibular joint (TMJ) ankylosis is a debilitating state that involves fusion of glenoid fossa and condyle of mandible. This can lead to restriction in mouth opening and mandibular movements. Subsequently, patient develops difficulty in chewing, speech, breathing as well as poor dental hygiene. All of these have detrimental effects on patient’s wellbeing and their quality of life. TMJ ankylosis can also have secondary effects on facial growth like asymmetry of face, retro or micrognathia, malocclusion, anterior or posterior open bite and overcrowding of teeth specially if it presents at early age. Main event that leads to TMJ ankylosis is trauma but this can occur as a secondary insult to surgery, local and systemic infections or diseases like chronic otitis media, tuberculosis, juvenile rheumatoid arthritis and septic arthritis. The management of TMJ ankylosis poses a significant challenge because of technical difficulties and a high incidence of recurrence. It is mainly managed by surgery with different options like gap and interpositional arthroplasty, reconstruction arthroplasty or distraction osteogenesis and aggressive post op physiotherapy. Here, we present a case five years old girl child with post traumatic TMJ ankylosis who was managed with excision of ankylotic mass and interpositional arthroplasty by using bilateral temporo-parietal fascial flap. She was followed for a 1 year and had adequate mouth opening and no recurrence.

Sweat gland tumor: A rare diagnosis of eyelid mass- A case report

Eccrine acrospiroma or Nodular hidradenomas are extremely rare sweat gland tumors of eyelid that arise as intradermal nodules from eccrine sweat glands. This case reports documents evaluation of a nodular mass of upper eyelid and its adequate management. Clinical examination followed by wide local excision and histopathologic evaluation of mass was done. Clinically, the mass was diagnosed as sebaceous cell carcinoma of eyelid. Post-operative histopathologic evaluation of the mass was suggestive of benign acrospiroma. Sweat gland tumors constitute of a very small proportion of eyelid tumors which often mimic other malignant tumors of eyelid.

Isolated Omental Panniculitis

Isolated Omental Panniculitis is a very uncommon intra-abdominal disease, causing non-specific inflammatory symptoms, which only involves omentum without involving other organs like bowel, fat necrosis and pancreatitis. It is mostly seen in adults. The exact etiology of IAP is still obscure. Also, Modern diagnostic tools like CT & MRI were also ineffective to make the diagnosis. Different treatment modalities including conservative medical management with Anti-inflammatory drugs like low dose steroid along with NSAIDS and surgical excision of mass both were tried in past. In this article we are reporting an isolated omental panniculitis patient who presented to emergency with acute abdominal pain & was treated with laparoscopic omental segment resection.

Solitary fibrous tumor of nasal cavity: A case report

Solitary fibrous tumor is fibroblastic tumor, located mostly in deep soft tissue as well as extrapulmonary sites. In the present case, a 27-year female presented with complain of bilateral nasal blockage (right >left) with history of nasal bleed. The CT scan report revealed p/o hypervascular nasal polyp and sinusitis. Patient underwent excision of granulomatous mass arising from lateral nasal wall in right nasal cavity. The pathological report stated nasal tumor with hemangiopericytoma like pattern with differential diagnosis of 1) Solitary fibrous tumor – right nasal cavity 2) Glomangiopericytoma; further Immunohistochemistry was positive for CD34 (membranous) and STAT6 (nuclear) which leads to final diagnosis of Solitary fibrous tumor – right nasal cavity. Histopathological characteristics serve as the primary criteria for differentiating this condition from other entities.

Isolated spermatic cord metastasis of prostate cancer after radiotherapy detected with 18F-PSMA PET/CT: a case report and literature review.

We report the case of a 65year-old male with prostate cancer previously treated with external beam radiotherapy and 2years of androgen deprivation therapy. His nadir PSA reached undetectable level but gradually increased to 0.89ng/dL. 18F-PSMA PET/CT demonstrated a PSMA-avid lesion at left spermatic cord. Left groin exploration revealed an 8mm left vas deferens mass. Mass excision was performed and pathology result showed prostatic adenocarcinoma. The metastatic route is unknown but the possible routes are intraluminal route via ejaculatory duct, hematogenous route and lymphatic route. This case also highlights the role of 18F-PSMA PET/CT to detect a recurrent lesion at an atypical site in biochemical failure patients even at the low PSA level.

Recurrent sinonasal chondrosarcoma with intracranial extension- A case report

Chondrosarcoma (CS) is the rare, slowly growing, malignant neoplasm. CS of the sino nasal cavity is extremely rare. It is usually present with common symptoms like nasal obstruction and epistaxis. It rarely present with ocular symptoms. Histopathological examination is useful for confirmation of diagnosis. Surgical excision is the treatment of choice. Radiotherapy is indicated if the tumor involves the vital structures. Here we are reporting a case of recurrent chondrosarcoma. Patient is presented to our department with proptosis of left eye and nasal obstruction since two months. Combined with neurosurgeon bi frontal craniotomy with endoscopic excision of mass done. Post operatively patient received adjuvant radiotherapy. Patient is on regular follow up. Keywords: chondrosarcoma; combined excision; radio therapy

Large cell neuroendocrine carcinoma of oral cavity: A rare case report with review of literature

Abstract Neuroendocrine tumours (NETs) primarily affect the lungs and larynx. Primary neuroendocrine carcinomas (NECs) rarely occur in the oral cavity. The classification of these tumours is ambiguous; however, the literature acknowledges their aggressiveness. Merkel cell carcinoma (MCC) is rare and more common in the skin but could occur intraorally. MCC and NECs are aggressive neoplasms and recommend intensive treatment. In this case report, a 22-year-old female presented with an ulceroinfiltrative lesion in the left buccal mucosa of the cheek, which was diagnosed as primary NEC in the oral cavity. This patient underwent wide local lesion excision of oral cavity mass, ipsilateral selective neck node dissection of levels 1–4 and postoperative chemotherapy. This aggressive tumour type requires large local excisions with margins like Merkel cell skin carcinomas. To our knowledge, this is the youngest oral cavity primary neuroendocrine cancer patient to date in the literature.

Systemic Complications of an Exceptional Case of Ruptured Left Intra-Ventricular Hydatid Cyst in a Child

Cardiac involvement in hydatid disease is exceptional but has a formidable prognosis. Cardiac localization of hydatidosis exposes to the dissemination of vesicles in the systemic circulation, especially when it is located on the left side. Its treatment is essentially surgical, which helps to avoid complications and the spread of the disease. We report the case of a 13-year-old patient with no particular pathological history, hospitalized for an ischemic stroke and limb ischemia, who was found to have a mass at the apex of the left ventricle on transthoracic cardiac ultrasound. The diagnosis of hydatid cyst was strongly suggested by the discovery of hydatid cyst membranes during the anatomopathological examination of the operative samples from the surgical thrombectomy of the left lower limb. Cardiac magnetic resonance imaging showed a mycotic aneurysm, while serology for hydatid disease was negative. A medical treatment based on albendazole was initiated, but the patient died in a context of multi-visceral failure postoperatively after the cardiac mass excision performed under extracorporeal circulation.

Optimizing Morbidity in Unplanned Soft Tissue Sarcoma Excisions: Should We Skip the Reconstructive Ladder?

Soft tissue sarcomas (STSs) are rare and diverse primary malignant tumors that comprise approximately 1% of all malignancies. Misdiagnoses and unplanned excisions of STSs are common due to the tumor's rarity, leading to secondary tumor bed excisions (TBEs). Reconstructive outcomes for TBEs remain poorly understood, prompting this study to address the knowledge gap and inform preoperative discussions. This was a retrospective cohort study of patients who underwent STS excisions at a quaternary cancer center. Patients were categorized into mass excision (ME) and TBE groups. Reconstructive approaches were divided into simple (primary closure, complex repair, skin grafts, local flaps) and advanced (pedicled or free flaps). The groups were compared for postoperative outcomes, including complications, recurrence, and death. When simple reconstructive techniques were used, TBEs exhibited higher rates of overall and major complications, whereas MEs had higher rates of overall and minor complications. Intergroup analysis revealed that with simple reconstruction, rates of overall and major complications were higher in TBEs than in MEs, and rates of minor complications were higher in MEs than in TBEs. Regression analyses revealed that simple reconstruction of TBEs had 90% and 180% higher odds of major complications and reoperation compared to simple reconstruction of MEs (P < 0.05). TBEs, despite their smaller size, exhibited a heightened susceptibility to overall and major complications, challenging the notion that simpler techniques suffice in these cases. Our findings encourage the consideration of advanced reconstructive techniques for TBEs that may seem amenable to simple reconstructive techniques.

Anterior mediastinal masses: A single centre-based retrospective study

Anterior mediastinal masses pose a serious challenge to anaesthetists and surgeons alike. It is sometimes associated with a severe cardiorespiratory compromise during surgery. The aim of this study was to evaluate the incidence of difficulty in airway management, intraoperative cardiorespiratory and postoperative complications in patients undergoing surgery for anterior mediastinal mass excision. We conducted a single centre-based retrospective observational study of the data of patients with anterior mediastinal mass who were treated surgically between February 2016 to January 2021. All the data of the patients were kept confidential. Data were collected from electronic medical records, operation theatre records, anaesthesia charts, intensive care unit (ICU) records, and discharge sheets. Demographic data, medical history, and preoperative imaging investigations were noted. The difficulty in airway management, amount of blood loss, blood transfusion, and other significant events during the intraoperative period were noted. In the postoperative period, the duration of mechanical ventilation, re-exploration, duration of ICU stay, hospital stay, and other complications were recorded. In our study, no patient suffered difficulty in intraoperative airway management(N=29). The intraoperative complication was seen in 13% of cases in the form of significant hemodynamic compromise. No patient underwent re-exploration. The mean blood loss during surgery was 455 ml. The mean duration of postoperative mechanical ventilation was 17 hours, and the ICU stay was 2.3 days. Postoperative complications were seen in 6% of cases (2 patients). Despite best management, some complications may happen in this subset of patients. A comprehensive multidisciplinary approach can minimize the risk of catastrophic hemodynamic and airway compromise during surgical excision.

A Case of Transmural Lipoma of the Right Atrium

Primary cardiac tumors are a relatively rare disease. About 75% of primary cardiac tumors are benign. The most common histological type is myxoma, followed by cardiac fibroma, lipoma, etc. We report a case of a 53-year-old female patient admitted to the hospital due to &amp;quot;repeated palpitations and tightness of breath for 5 years, worsened for 2 days.&amp;quot; Preoperative transthoracic echocardiography revealed a hypoechoic mass approximately 3.1 cm x 3.0 cm in size within the right atrium, suggesting an intracardiac mass: nature? Chest computed tomography (CT) indicated a fat-density nodule within the right atrium, with a larger cross-sectional size of about 3.0 cm x 2.5 cm, suggesting a lipoma. The patient underwent excision of the right atrial mass under cardiopulmonary bypass. Intraoperative transesophageal echocardiography (TEE) revealed a mass within the right atrium, closely connected to the atrial wall, with no signs of tricuspid valve obstruction. Exploration during surgery revealed a yellow, smooth-surfaced mass approximately 3.0 cm x 3.0 cm in size, penetrating the right atrial wall, from which the mass and an additional 2mm margin of the right atrial wall were completely excised. A suitable-sized bovine pericardial patch was used to repair the defect in the right atrial wall. Postoperative TEE showed the disappearance of the right atrial mass. The postoperative pathological result indicated a lipoma. Cardiac lipoma is a rare benign primary cardiac tumor. The common sites of occurrence of this tumor are the right atrium, left ventricle, and pericardium. Based on their location, cardiac lipomas can be divided into three types: subepicardial, intramyocardial, and subendocardial lipomas, with subendocardial lipomas being the most common, accounting for over 50% of primary cardiac lipomas. Clinical symptoms largely depend on the size and growth location of the tumor, and it is generally believed that most cardiac lipomas are asymptomatic. Symptomatic lipomas can be treated with curative surgical excision. Transmural lipomas of the right atrium are relatively rare, and such lipomas may affect adjacent structures both inside and outside the atrial wall. Although the lipoma in this case did not significantly affect valve function or blood flow, the patient experienced repeated symptoms of palpitations and tightness of breath. Despite being a benign tumor, the lipoma in this case exhibited transmural growth within the right atrium, showing a certain degree of invasiveness, making surgical excision an effective treatment method.

CO2 LASER versus Blade Scalpel Surgery in the Management of Nasopharyngeal Masses in Dogs.

We aimed to compare surgical time, bleeding level, patient pain level, healing period, scar tissue, relapse of the initial process and complications in patients with nasopharyngeal oncological masses undergoing surgery using a scalpel blade versus a CO2 surgical laser. This is a clinical prospective study comprising surgical work in the nasopharynx area. A sample of 12 inpatients dogs (N = 12) of both genders underwent a surgical excision of nasopharyngeal masses with a scalpel blade (GS n = 6) and CO2 surgical laser (GL n = 6). An Aesculigth CO2 surgical laser-Vetscalpel® model with a superpulse mode, 12 W of power, and a multi-focus pen was used. Statistically significant differences were registered for a p-value of < 0.05. Variations were noted between both groups (GS and GL) concerning surgery time (p = 0.038), first meal time (p = 0.013), pain level (p = 0.003), and healing time (p = 0.014), with the GL group presenting lower values. GL exhibited only one relapse case, with the elapsed time being more than double that of the GS group. Surgical and healing times were shorter in the GL group, and pain levels were lower, with the GL group also demonstrating less scar tissue than the GS group, along with a lower relapse rate. Nasopharynx surgical exposure with precision via the soft palate using the CO2 laser has facilitated successful treatment of regional masses without discomfort and complications, compared to conventional blade scalpel procedures.

Concomitant Left Atrial Mass Excision and Bi-Atrial Cox-Maze Procedure

Concomitant Left Atrial Mass Excision and Bi-Atrial Cox-Maze Procedure

Robotic surgeries in pediatric patients: an early experience in a single center.

Robotic surgery (RS) has the advantages of 3-dimensional view, optical magnification, motional scaling, and improved ergonomics and degree of freedom. Although RS has widely been performed on pediatric patients lately, there are still numerous restrictions and ambiguous indications. The purpose of this study was to report our early experience with RS on pediatric patients at a single center. Electronic medical records of patients who underwent RS with the da Vinci Xi surgical platform (Intuitive Surgical, Inc.) in Seoul National University Children Hospital from November 2019 to August 2021 were reviewed retrospectively. The median follow-up was 21.0 months (range, 12.3-31.8 months). An online survey was conducted to investigate satisfaction with robotic surgical scars. Fifty-four patients underwent robotic surgeries (median age at operation, 11.1 years [range, 0.1-17.8 years]). In our hospital, patients had 20 different kinds of robotic surgeries, including choledochal cyst excision with hepaticojejunostomy, ovarian mass excision, and others. Median operation time and console time were 157.5 minutes (range, 45-505 minutes) and 40 minutes (range, 11-360 minutes), respectively. All cases were done without conversion into open or laparoscopic methods. Postoperative complications were found in 5 patients. According to an online survey, over half of patients (60.9%) answered that they felt satisfied with scars. Our early experience demonstrated the safety and feasibility of RS in children with a range of diagnoses and complicated procedures. With more experience, RS could be an alternative to traditional open or laparoscopic operations in pediatric patients. Further studies are needed to clarify indications of pediatric RS.

Inguinal hernia coexisting with spermatic cord leiomyoma

Leiomyomas primarily occur in the uterus, small bowel, and esophagus, with occasional instances found in the genitourinary system-bladder, epididymis, prostate, testis, and penis. Among these, scrotal leiomyomas, belonging to genital leiomyomas, present as solitary growths within scrotal structures, displaying gradual growth. Specifically, spermatic cord leiomyoma is exceptionally rare, with limited cases since the 1950s. A 63-year-old male exhibited persistent left groin pain and swelling, initially suggesting a hernia. Examination revealed an inguinal hernia and a palpable, mobile 3 cm solid mass. Ultrasonography identified a well-defined solid hypoechoic lesion. Magnetic resonance imaging (MRI) displayed a 37x24 mm ovoid lesion, hinting at its origin from the spermatic cord. Surgical intervention involved hernia repair and mass excision, confirming leiomyoma via histopathology. Spermatic cord leiomyomas, rare and hernia-mimicking, highlight the crucial role of MRI in accurate preoperative diagnosis, emphasizing the need to consider leiomyoma in inguinal mass differentials.

The effect of 11th rib excision on perioperative outcomes in patients undergoing partial nephrectomy for upper pole renal tumors

IntroductionWe aimed to evaluate the effect of eleven11th rib resection.on the perioperative period TRIFECTA criteria in patients who underwent retroperitoneal partial nephrectomy (PN) with the diagnosis of upper pole kidney tumors.Materials and methodsWe conducted a retrospective analysis of the data of the patients who underwent Open PN for upper pole renal masses between 2018 and 2023. The patients were divided into two groups: PN with rib resection and PN without rib resection. The demographic characteristics, tumor sizes, PADUA scores, warm–cold renal ischemia times, mass excision and tumor bed suturing times, histopathological tumor type and surgical margin positivity of the patients were examined. Both groups were evaluated comparatively based on this data.ResultsThe renal nephrometry scores of the two groups were similar. The total renal ischemia time was significantly shorter in the patients who underwent a rib resection than in those who did not (p < 0.001). Both the tumor excision and tumor bed suturing times were significantly shorter in the group that underwent a rib resection than in the group that did not (p < 0.001). The Clavien–Dindo complication grades were statistically similar between the two groups.ConclusionComplex in nature and high–risk renal masses located in the upper pole of the kidney, partial nephrectomy performed with an 11th rib resection can be considered a reliable surgical option with a shorter ischemia time, supporting the preservation of long-term renal function.

Madelung’s Disease in a Middle-Aged Nigerian Man: A Case Report

Abstract Madelung’s disease is a rare metabolic disease of surgical importance seldom reported among Africans. This case reports the condition in a middle-aged Nigerian man with Type 1 variety of the condition. In addition, he was overweight and had diastolic hypertension (90 mmHg) with a 30-year history of local alcohol consumption of 30-60 units/day. Diagnosis of Madelung’s disease was made by fine-needle aspiration cytology, ultrasound scan, and x-ray of the fatty deposits on the body. The patient also had an aspartate transaminase-to-alanine transaminase (AST/ALT) ratio of 2.0, indicative of alcoholic fatty liver disease. Management was through counseling to stop alcohol and excision of the neck mass. The case introduces this rare condition, demonstrates the need for evaluation of patients with Madelung’s disease for metabolic complications, and highlights the role of interdisciplinary collaboration in the management of this disease.

Cat Scratch Disease: A Diagnostic Challenge in Cervical Lymphadenopathy

Introduction: Cat scratch disease typically manifests as long standing regional lymphadenopathy, though clinical features may cover a wide spectrum. Lack of definite history of cat scratch, atypical presentation, non-availability of serological tests and misleading needle cytology may often lead to delay in diagnosis. Case report: A 44 years old diabetic female, presented with persistent fever for 15 days followed by 4x4cm, tender tense swelling in left parotid region extending into upper neck. Her blood sugar was deranged. Polymorphonuclear leucocytosis was noted. Radiological investigation showed lymph nodal conglomeration involving level II, III and IV with non-enhancing necrotic areas within it. Mass was abutting Internal Jugular Vein, which was attenuated cranially. Aggressive antibiotics treatment and optimal glycemic control failed to resolve fever and lymphadenopathy, hence excision of neck mass was done which was reported histopathologically as Cat Scratch Disease. Conclusion: While ruling out tuberculosis, Epstein Barr-Virus infection, acute bacterial lymphadenitis or malignant disease, Cat Scratch Disease should be included in the differential diagnosis of lymphadenopathies in head-neck region so that possibility of antibiotic abuse, an unnecessary biopsy, long term antitubercular drug therapy or even surgical treatment may be avoided. Keywords: Cat Scratch Disease; Bartonella henselae; lymphadenopathy; serological test