Complete Surgical Excision Research Articles

An unusual localization of an Abrikossoff tumor

Abrikossoff’s tumor, also known as Granular Cell Tumor (GCT), is a rare benign neoplasm commonly found in the cervicofacial region, particularly the oral cavity. Here, we present a case of GCT occurring in an atypical location on the left flank of a 43-year-old patient. The lesion presented as an erythematous ovoid nodule with central ulceration, accompanied by white structures and polymorphic vascularization on dermoscopy. Initially considered as Darrier-Ferrand’s dermatofibrosarcoma, histopathological examination of a cutaneous biopsy revealed granular cells and eosinophils in the dermis, suggestive of GCT. Immunohistochemical analysis confirmed the diagnosis, expressing S100 protein and CD68. Complete surgical excision with safety margins was performed, with no recurrence observed after 1 year of follow-up. This case highlights the importance of considering GCT in the differential diagnosis of flank lesions and emphasizes the need for clinicians to remain vigilant for uncommon presentations of this rare tumor.

Chest wall tuberculosis: Precision surgery with indigo carmine in limited cases for safe and intuitive lesion excision.

In addition to treatment with antituberculosis drugs, complete surgical excision is important for the cure of chest wall tuberculosis. However, surgery is often challenging to perform due to different factors such as the strong adhesion of tuberculous lesions to the surrounding normal tissue, growth of neovascularization, and presence of fragile necrotic tissues. Firm adhesions, bleeding, and fragile tissue make it difficult to determine the boundary with normal tissue and completely excide the lesion. Moreover, ingenuity is required. Herein, we report the identification of the boundary between the lesion and normal tissue by injecting indigo carmine into the abscess to completely excide the lesion, which is considered an intuitive and safe method.

Evaluation of the efficacy of the Z-plasty surgical technique vs. secondary wound healing mechanism in the treatment of the pilonidal sinus: a clinical trial.

The most important step in treating a pilonidal sinus is eradication by surgical excision. Over the years, various surgical techniques have been reported for wound closure, yet their management still poses a challenge. The current study compares the results of two different methods of wound management: secondary wound healing versus the Z-plasty surgical technique. The current clinical trial recruited 84 uncomplicated pilonidal sinus patients who were to undergo complete surgical excision of the pilonidal sinus. For wound healing, the 84 subjects were equally divided into two groups of 42 patients each. One group was selected for Z-plasty surgical wound closure and the other for the secondary healing mechanism. Outcomes measured consisted of demographic data, length of operation, complications, severity of pain, number of dressings, recurrence, and complete healing time. Age or sex distribution and the median BMI (kg/m²) did not significantly differ between the two groups. The length of the operation for Z-plasty subjects was significantly longer (P <0.0001). The median number of dressing changes for secondary wound healing patients was 38.69, which was significantly higher than the 4.95 dressing changes for the Z-plasty group. The total time recorded for complete wound healing was 21.61±4.27 days in the Z-plasty group and 41.23±24.28 days for secondary wound healing subjects, which was statistically significant. Twenty-four hours postoperation, patients in the secondary wound healing group had significantly more pain, and the Visual Analogue Scale scores of the Z-plasty and secondary wound healing groups were 3.42±0.76 and 6.09±1.2, respectively. Concerning the recurrence rate, there were no significant differences between the two groups. SPSS version 22 performed the analyses, and the independent t-test compared the continuous variables. A P value less than 0.05 was considered statistically significant. Z-plasty is a safe and effective procedure in terms of wound complications and recurrence rate. This method is also cost-effective and better received by patients.

Thickness of melanocytes in giant congenital melanocytic nevus for complete surgical excision: clinicopathological evaluation of 117 lesions according to the area and size

BackgroundGiant congenital melanocytic nevi (GCMN) are usually defined as nevi that exceed 20 cm in maximal diameter or 15% of the total body surface area. There have been reports of life-long malignant change risks arising from GCMN, leading to surgical excision of GCMN. This study aims to evaluate the thickness of melanocytes based on clinical factors in order to provide objective information for the complete resection of the lesion.MethodsOverall, 75 patients diagnosed with GCMN between 2000 and 2021 were included, and their clinical records were collected retrospectively. 117 pathologic slides obtained during excision were reviewed to measure nevus thickness. Clinical factors were assessed with a generalized estimated equation model for association with nevus thickness.ResultsThe thickness of nevus was significantly associated with the location and size. Nevus thickness was more superficial in the distal extremity than in the head and trunk (P = 0.003 [head]; P < 0.001 [trunk]; P = 0.091 [Proximal extremity]). Nevi sized 60 cm or more were significantly deeper than those measuring 20–29.9 cm (P = 0.035). An interaction between size and location existed (P < 0.001). Trunk and distal extremity lesions consistently exhibited uniform thickness regardless of lesion size, whereas head and proximal extremity lesions showed variations in thickness based on lesion size.ConclusionGCMNs have differences in thickness according to location and size. Therefore, it is necessary to devise an approach optimized for each patient to treat GCMN.Mini-abstractIn the study, it was emphasized that the thickness of GCMN is correlated with clinical factors, specifically the location and size of the nevus. Consequently, these findings underscore the need for individualized treatment plans for effective surgical intervention.

A Novel Foley Catheter-Based Brain Retraction Method for the Interhemispheric Approach: Technical Considerations and an Illustrative Video

BACKGROUNDManagement of interhemispheric pathologies requires surgical intervention through a restricted anatomical corridor ensconced within critical cerebral structures. The use of retractors to facilitate operative access may cause damage to cerebral tissue. The development of an innovative retraction technique designed to alleviate cerebral damage in such cases is imperative. OBJECTIVEIn this study, we present a novel and gentle retraction method to facilitate the interhemispheric approach. METHODSWe retrospectively examined data of nine right-handed patients who underwent surgical resection of interhemispheric lesions between 2021 and 2022. All patients underwent surgery for the first time because of this pathology. All operative specimens were histologically confirmed. Clinical characteristics, operative details, and follow-up data were retrospectively analyzed. RESULTSThe new retraction technique was successfully applied to eight tumor patients and one patient with an aneurysm. Eight patients had an anterior interhemispheric approach, and one patient had a posterior interhemispheric approach. Complete surgical excision was achieved in all patients with no postoperative complications. Postoperative Gadolinium (Gd)-enhanced magnetic resonance imaging (MRI) showed no signs of ischemia or contusion. All patients exhibited significant improvements in their symptoms. An illustrative video that elucidates the removal of an interhemispheric epidermoid tumor, employing the anterior ipsilateral interhemispheric approach, featuring the novel retraction method. CONCLUSIONSThe ideal retraction technique during the interhemispheric approach is still a challenge. Our novel retraction technique may help minimize brain parenchymal damage during surgical resection of interhemispheric lesions.

Renal cell carcinoma with an “uncoiling” tumor thrombus: intraoperative shift from level III to level IV

BackgroundThe gold standard treatment for renal cell carcinoma (RCC) with tumor thrombus (TT) is complete surgical excision. The surgery is complex and challenging to the surgeon, especially with large tumor thrombus extending into the inferior vena cava (IVC) and right atrium. Traditionally, these difficult cases required the use of cardiopulmonary bypass (CPB) with or without deep hypothermic cardiac arrest, but in recent years, different surgical techniques derived from the field of liver transplantation have been used in efforts to avoid CPB.Case presentationWe present a case of RCC with TT level IIIc (extending above major hepatic veins) that “uncoiled” intraoperatively into the right atrium after division of the IVC ligament, transforming into a level IV TT. Despite the new TT extension, the surgery was successfully completed exclusively through an abdominal approach without CPB and while using intraoperative transesophageal echocardiography (TEE) monitoring and a cardiothoracic team standby.ConclusionsThis case highlights the need for a multidisciplinary approach and the utility of intraoperative continous TEE monitoring which helped to visualize the change of the TT venous extension, allowing the surgical teamto modify their surgical approach as needed avoiding a catastrophic event.

Operative treatment of pulmonary primitive neuroectodermal tumor: a case report and literature review

BackgroundPulmonary primitive neuroectodermal tumor (PNET), a member of the Ewing sarcoma family of tumors, is a rare malignancy that is associated with a grim prognosis. To date, fewer than 30 cases of pulmonary PNET have been reported. In this case report, we present the clinical details of a 12-year-old girl with pulmonary PNET who underwent surgical treatment. We also conducted an analysis and summary of other relevant studies and the surgical outcomes.Case presentationIn May 2018, a 12-year-old girl was admitted with symptoms of cough and blood-tinged phlegm. A computed tomography scan revealed a large mass, measuring 12.9 cm × 8.1 cm, in the right middle and lower lungs. A percutaneous lung biopsy confirmed poorly differentiated tumor cells with a nested growth pattern. Immunohistochemical staining demonstrated positive expression of CD99, CD56, Vimentin, and Synaptophysin. The patient was diagnosed with pulmonary PNET. Following three cycles of neoadjuvant chemotherapy, a substantial reduction in tumor volume was observed. Subsequently, the patient underwent a surgical procedure involving pneumonectomy and partial resection of the left atrium with the assistance of cardiopulmonary bypass. The patient was discharged 37 days after surgery. During a three-year follow-up period, she exhibited no signs of tumor recurrence and has successfully returned to school.ConclusionsThis case highlights the successful management of an advanced PNET with neoadjuvant chemotherapy, pneumonectomy, and partial resection of the left atrium employing cardiopulmonary bypass. The patient remained disease-free after three years. Our analysis of surgically treated cases indicates that neoadjuvant chemotherapy can contribute to improved prognoses for PNET patients. It is crucial to emphasize that complete surgical excision remains the cornerstone of treatment, underscoring the importance of surgeons considering radical surgical approaches whenever feasible for patients with pulmonary PNETs.

Review of recent advances in managing periocular skin malignancies.

Management of cutaneous malignancies can be particularly challenging when they are located in the periocular region. The standard of care for localized disease is complete surgical excision, but this may not be possible without significant disruption to visual structures and facial appearance. Definitive radiation may be an option for some patients who cannot or do not wish to undergo surgery. Advances in systemic treatment options for locally advanced and metastatic skin cancers in the past 10 years have prompted investigation into neoadjuvant treatment of periocular cancers. The use of chemotherapy, immune checkpoint inhibitors, and targeted therapies have all been reported with varying degrees of success. For many patients, targeted therapies or immune checkpoint inhibitors should be considered depending on the cancer type, symptoms, and goals with the input of a multidisciplinary cancer care team. In this article, we systematically review the latest updates in surgical, radiotherapeutic, and medical management of periocular malignancies.

Digital mucous cyst marsupialization: Surgical technique

Digital mucous cysts are benign synovial fluid collections that typically involve the lateral or dorsal surfaces of the distal interphalangeal joints (DIPJs) or beneath the proximal nail fold. They are typically found in the setting of arthritic degeneration of the underlying joint and occur most frequently between the fifth and seventh decades. 1 Many treatment options for digital mucous cysts have been described, ranging from conservative/minimally invasive to complete surgical excision, with no consensus on best technique. Here, a surgical approach is presented which allows access to address the cyst pedicle as well as any underlying osteophyte while preserving the overlying skin with good outcomes even with compromised or involved dermis and epidermis. This is a reproducible, readily adaptable technique. The surgical technique is presented and reviewed in detail.

Inflammatory myofibroblastic tumor of the genitourinary tract: a narrative review.

Inflammatory myofibroblastic tumor (IMT) is a rare entity that is described in several organ systems. This comprehensive review aims to identify IMTs occurring at various genitourinary (GU) organ sites and describe patterns of clinical management in adult and pediatric patients. A comprehensive search of PubMed and Web of Science was conducted according to the Preferred Reporting Items for Systematic Review and meta-analyses statement. Two reviewers performed independent initial screening of abstracts. Eligible articles underwent full review and data extraction. The clinical features, diagnostic tests, treatment, and outcomes at each GU organ site were analyzed individually and summarized into a comprehensive review. Of the 270 articles identified, 112 met inclusion criteria. Articles primarily consisted of case reports or small series describing a total of 167 cases, of which 30 (18%) occurred in children. Most patients (96%) were symptomatic at presentation. The most frequently involved sites included bladder (106 cases) and kidney (n=33) followed by epididymis (n=6), urachus (n=6), ureter (n=5), prostate (n=4), testis (n=4), and spermatic cord (n=3). Complete surgical excision of the mass including partial or total removal of involved organs provided excellent outcomes. Incomplete excision was associated with early local recurrence and progression. Late recurrence or metastatic transformation was rarely noted (<2%). IMTs exhibit locally invasive, symptomatic and progressive phenotypes that affect all urologic organs in adults and children. Clinical features and imaging results are similar to those noted with urologic cancers. These tumors require complete surgical excision since incomplete resection increases the risk of symptomatic recurrence.

MERKEL CELL CARCINOMA: A CASE REPORT

Merkel cell carcinoma is a rare but highly agressive skin tumor. MCC clinically represents as cutaneous or subcutaneous nodule, and in 30% of the cases loco-regional metastasis are already there in primary diagnosis. Pathogenesis is essentially due to excessive exposure to UV light. The confirmation diagnosis is based on histological and immunological features on the lesion. The treatment methods require a complete surgical excision and radiotherapy.

Mediastinal Thymic Cyst in Adults: A Rare Case Report

Thymic cysts are rare, benign lesions located in the cervico-thoracic region, often incidentally discovered. The only curative treatment is complete surgical excision, which eliminates symptoms, prevents complications, and provides a definitive diagnosis through histopathological examination, typically revealing the presence of Hassall's corpuscles. Minimally invasive approaches are preferable. We present the case of a 40-year-old patient with an anterior mediastinal cystic mass that underwent successful complete surgical resection. The histopathological examination confirmed a diagnosis of benign unilocular thymic cyst, resulting in favorable clinical and radiological outcomes.

Calcific Myonecrosis of Tibialis Anterior in a 76-Year-Old Man with Foot Drop

Background: Calcific myonecrosis is a rare entity that is considered a sequela of chronic compartment syndrome. A fusiform mass with central liquefaction and peripheral calcification replaces the affected muscle unit.&#x0D; Case Report: We are presenting a case of calcific myonecrosis of the tibialis anterior in a 76-year-old man. Although the mass was present for several years, the patient recently developed leg pain and foot drop. After radiological and histopathological diagnosis, patient was treated with surgical excision of the mass.&#x0D; Conclusion: Although calcific myonecrosis is a benign condition, due to the pressure effect on surrounding structures, it may be a source of leg pain and foot drop. Cortical erosion and scalloping of underlying major bone may be reasons for extremity pain. To relieve pain, alleviate pressure effect, and prevent pathological fracture of the underlying bone, complete surgical excision of the lesion is essential.

Successful Surgical Management of Giant Mediastinal Teratoma – A Case Report of a Difficult Case without Any Post-Operative Complication

Introduction. Mediastinal teratoma is a rare germ cell tumor, located in anterior mediastinum and is lack of population-based study. It usually occurs in the age of 20-40 years, accounting for 15% of anterior mediastinal masses in adults and 25% of anterior mediastinal masses in children. It is frequently diagnosed accidentally on chest imaging due to its asymptomatic nature. Hereby, we presented a case of giant anterior mediastinum teratoma with complete surgical excision without any post-operative complication. This case is unique due to its uneventful result after excision. From our literature research, we successfully avoid the potential post operative complications of resecting this tumor such as bleeding, wound dehiscence and even death. It is due to early diagnosis, treatment and good intraoperative management of lesion &amp; hemodynamics. Case Report. A 21-year old male was referred from pulmonologist oncologist to our Thoracic Surgical Unit with complains of dyspnea and chest pain. Physical examination showed no lung sounds in (R) hemithorax and was dull to percussion, ictus cordis shifted 2 fingerbreadths towards left-side. Chest X-ray showed a large well-defined lesion in (R) hemithorax and chest CT-scan with contrast showed hypodense mass on (R) hemithorax adhering &amp; compressing the lung, diaphragm, pericardium &amp; chest wall, with estimation size of 60 x 20 x 12 cm, lesion displaced the heart. Patient was then treated with complete surgical excision and found a huge cystic tumor with a size of 60 x 20 x 12 cm adhering to all parts of (R) lung, diaphragm and pericardium. He underwent (R) pneumonectomy due to adhesion. Histologic examination was consistent with mature teratoma. Patient showed no complication after surgery and was discharged uneventfully from our hospital after 5 days. Discussion. Approximately 95% of benign teratomas arise in the anterior mediastinum. The tumor grows progressively, mostly asymptomatic, dyspnea and substernal chest pain are the most common symptoms if present. Productive Cough of hair or sebum is a pathognomonic sign. Chest radiograph typically reveals a well-circumscribed anterior mediastinal mass that often protrudes into one of the lung, they are usually large at the time of diagnosis. Complete surgical excision is a treatment of choice of mediastinal teratoma, which can be performed through median sternotomy or thoracotomy or thoracoscopy. Some patients require additional procedures (eg, lobectomy, pericardiectomy) for complete tumor resection. Conclusion. There is still limited data on mediastinal teratoma. Early referral &amp; treatment show good prognosis. Benign Mediastinal Teratomas was tricky to be diagnosed, when it is diagnosed, it is usually very large in size. Complete Surgical Excision can be performed safely without any complications.

A giant, recurrent, subpectoral breast lipoma: case report

Lipomas are mesenchymal tumors composed of mature fat tissue and are considered one of the most common benign tumors. They are usually small in size, and giant lipomas are rare. The exact etiology of lipoma development is unclear, though several factors have been proposed. Intramuscular or subpectoral lipomas involving the pectoralis major muscle are uncommon. In this report, the author has described the case of a 52-year-old female patient who presented with an uncommon form of subpectoral, giant, recurrent breast lipoma. The patient had undergone a complete surgical excision. The author suggests an individualized assessment and treatment of each case.

Efficacy of Immediate Postoperative Single Fractional 10Gy Radiotherapy for Earlobe Keloids.

The ear is a common site for keloid formation, typically due to ear piercing or trauma. Auricular keloids are always difficult to treat and pose a challenging situation. The purpose of this study is to present our experience treating earlobe keloids through complete surgical excision followed by immediate postoperative single fraction 10Gy radiation therapy either on the same day or the next day. The authors retrospectively evaluated 48 patients with 71 earlobe keloids treated with complete surgical excision followed by single-fractional 10Gy radiotherapy within 24 hours from May 2021 to December 2022. The outcome was reported with a recurrence-free rate and side effects. The mean follow-up period was 20.8 months. All patients tolerated the treatments well. The overall recurrence-free rate was 100%. There were only 2 grade III radiation dermatitis. There were no reports of second malignancies or severe complications. The authors have obtained excellent outcomes from treating earlobe keloids through complete excision followed by postoperative radiotherapy with a single fractional dose of 10Gy on the same day or the next day.

Challenges in Diagnosing and Initial Treatment of Advanced Eyelid Basal Cell Carcinoma in Rural Area: A Case Report

Introduction : Basal cell carcinoma (BCC) is the most common non-melanoma eyelid cancer with a high risk of recurrence. This case report discusses the management of extensive BCC in a rural setting with limited resources.&#x0D; Case Illustration : A 62-year-old Timorese female, presented to the hospital with a mass on the left periocular region. It appeared as a mole in the lower left eyelid and extended to the surrounding tissues over nine years. As a farmer, she was frequently sun-exposed. A blackish mass was found at the left orbit, buccal, and entire nose (8 x 7.5 cm) with an ulcerated surface and attached firmly. The right eye had bedside visual acuity &gt;6/60, with palpebral edema, free eye movement, hyperemia nasal conjunctiva, and transparent cornea. The left eye is difficult to examine. Two submandibular lymphadenopathies were palpated. A Head CT scan showed a suspected malignant soft tissue mass with irregular thickening of soft tissue with ill-defined borders. Histopathology examination revealed a nodulocystic type of basal cell carcinoma.&#x0D; Discussion : Locally advanced BCC cases need a multidisciplinary approach. In a limited resources setting, the treatment highlights are histological diagnosis, complete surgical excision, and exenteration with margin control. From a broader perspective, the role of primary health care in educating and revering for early treatment is paramount.&#x0D; Conclusion : Prevention and early treatment are the most important factors in managing locally advanced BCC.

Nodular Hidradenoma of the Scalp: A Rare Case Report

Nodular hidradenoma is a rare benign tumour originating from eccrine or apocrine sweat glands. While documented cases exist in the medical literature, nodular hidradenoma of the scalp is relatively uncommon. We present a rare case of nodular hidradenoma located on the scalp to contribute to the limited knowledge regarding its clinical presentation, diagnosis, management and outcomes in this specific anatomical site. We present a case of a 45-year-old female with a nodular hidradenoma of the scalp. The patient complained of a slow growing swelling, itchy, slightly tender scalp lump over 9 years period. Clinical examination revealed a well-defined, firm nodule measuring 3.5 x 3 cms in diameter with 2 cms wide stalk. The patient underwent complete surgical excision, resulting in a favourable outcome for regular follow up to one year

Tracheal resection anastomosis for rare tracheal inflammatory lesions mimicking malignancy: report of 2 cases

BackgroundTumor-like lesions of the trachea are rare and challenging in diagnosis and management. Inflammatory myofibroblastoma, also known as Inflammatory pseudo tumors (IPTs), as well as Rosai Dorfman Disease (RDD) are inflammatory lesions that may involve the central airways with variable non-specific clinical features mimicking tumors.Case presentationIn this study 2 cases with tumor-like lesions are presented. One case with an inflammatory pseudotumor and the other one with Rosai–Dorfman disease affecting the upper trachea. Both cases were successfully managed with tracheal resection anastomosis.ConclusionTracheal Inflammatory myofibroblastoma, and Rosai–Dorfman diseases are rare tumor like lesions that present with upper airway obstruction. Despite being benign, these lesions may have features suggestive of malignancy, requiring prompt management. Complete surgical excision by segmental resection and primary anastomosis (if feasible) is the treatment of choice with an optimum outcome.

Replacement of tibialis cranialis tendon with polyester, silicone-coated artificial tendon preserves biomechanical function in rabbits compared to tendon excision only

BackgroundArtificial tendons may be an effective alternative to autologous and allogenic tendon grafts for repairing critically sized tendon defects. The goal of this study was to quantify the in vivo hindlimb biomechanics (ground contact pressure and sagittal-plane motion) during hopping gait of rabbits having a critically sized tendon defect of the tibialis cranialis and either with or without repair using an artificial tendon.MethodsIn five rabbits, the tibialis cranialis tendon of the left hindlimb was surgically replaced with a polyester, silicone-coated artificial tendon (PET-SI); five operated control rabbits underwent complete surgical excision of the biological tibialis cranialis tendon in the left hindlimb with no replacement (TE).ResultsAt 8 weeks post-surgery, peak vertical ground contact force in the left hindlimb was statistically significantly less compared to baseline for the TE group (p = 0.0215). Statistical parametric mapping (SPM) analysis showed that, compared to baseline, the knee was significantly more extended during stance at 2 weeks post-surgery and during the swing phase of stride at 2 and 8 weeks post-surgery for the TE group (p < 0.05). Also, the ankle was significantly more plantarflexed during swing at 2 and 8 weeks postoperative for the TE group (p < 0.05). In contrast, there were no significant differences in the SPM analysis among timepoints in the PET-SI group for the knee or ankle.ConclusionsOur findings suggest that the artificial tibialis cranialis tendon effectively replaced the biomechanical function of the native tendon. Future studies should investigate (1) effects of artificial tendons on other (e.g., neuromuscular) tissues and systems and (2) biomechanical outcomes when there is a delay between tendon injury and artificial tendon implantation.