Heterotopic supradiaphragmatic liver combined with intralobar pulmonary sequestration

Heterotopic supradiaphragmatic liver is exceedingly rare. A total of 16 cases of supradiaphragmatic liver have been reported in the literature. Therefore, it is difficult to make a correct diagnosis preoperatively. Herein we report a case of supradiaphragmatic heterotopic liver coincidentally combined with intralobar pulmonary sequestration.     

Ectopic liver: an unexpected finding in a right atrial mass

Ectopic liver is a rare finding, particularly in intrathoracic locations. We report the case of a 42-year-old woman with a mobile right atrial mass that was subsequently identified as ectopic liver by histology. Its point of origin was in a hepatic vein with extension into the right atrium. Although accurate diagnosis of ectopic liver may be possible with advanced imaging techniques, limited familiarity with the clinical entity is a barrier to early diagnosis.     

Resection of a posterior mediastinal metastasis of colon cancer

We report a resection of a posterior mediastinal metastasis of colon cancer. A 29-year-old man who had undergone a right hemicolectomy and liver resection for ascending colon cancer with liver metastasis was referred to our hospital with the diagnosis of a solitary posterior mediastinal metastasis. Tumor extirpation with descending aorta replacement was performed. Five months after the operation, local recurrence developed in the posterior mediastinum, which was also resected. He has been recurrence-free for 5 years since the second procedure. In this case, the metastases were believed to have occurred through the thoracic duct.     

Transdiaphragmatic amyloidoma

The term "amyloidoma" has been used to describe localized pulmonary nodular amyloidosis when it is a solitary lesion. Amyloidoma is an uncommon and infrequently reported cause of benign pulmonary lesions. We report the case of a 45-year-old man with hemoptysis, eosinophilia, and a large mass involving both lobes of the left lung, the chest wall, and, via extension through the diaphragm, the liver. Clinical suspicion of echinococcal cyst led to treatment via en bloc excision rather than attempting tissue biopsy for diagnosis. Complete resection of the isolated pulmonary amyloidoma was achieved with no evidence of recurrence.     

Primary pleural epithelioid hemangioendothelioma

Epithelioid hemangioendothelioma is a rare neoplasm of vascular endothelial origin. It can develop in any tissue, but it occurs primarily in the soft tissue, liver, and rarely in the lung. Pulmonary epithelioid hemangioendothelioma can present in the thorax in various manifestations. In the typical pulmonary forms, epithelioid hemangioendothelioma presents as either a solitary nodule, or more often as multiple, small nodules. Pulmonary epithelioid hemangioendothelioma involving the pleural space occurs in patients with disseminated disease [1, 2]. We present a case of primary pleural epithelioid hemangioendothelioma.     

III Consensus Meeting of the Spanish Society of Liver Transplantation. Hepatitis C, living-donor liver transplantation, quality of liver grafts and of liver transplantation programs

The constant updating in the field of liver transplant led to the holding of the III Consensus Meeting of the Spanish Liver Transplant Association. Three current topics of great clinical interest were debated during this meeting; transplant in patients with liver cirrhosis due to hepatitis C, live donor liver transplant and the evaluation of the quality of liver grafts. A subject of great interest to Liver Transplant Units was also discussed: the assessment of their quality.     

Microorganisms and cancer: scientific evidence and new hypotheses

Microorganism involvement in cancer has been known for over a century, and different types of parasites, bacteria and viruses have been associated with oncogenic processes. Among the bacteria, the first recognised was Helicobacter pylori which causes gastric cancer and might be related to extra-gastric cancer in humans. Helicobacter hepaticus has been associated with liver cancers using animal models. Other bacteria such as, Chlamydia psitacii, Borrelia burgdorferi and Streptococcus bovis have been associated with ocular, skin and colorectal cancers, respectively. Also, a commensal bacterium in the human intestine, Bacteroides fragilis, has been linked, very recently, with colorectal cancer using animal models.     

Oncosurgical strategies for metastatic liver cancer

Patients with liver metastases from colorectal cancer (CRC) present a major public health challenge with approximatelly, 1,2 million cases of CRC occur yearly worldwide. Resection of colorectal liver metastases (CRLM) is the only treatment offering the possibility of cure and has been shown to provide clear survival benefits. However, only 10 to 20% of patients with CRLM are eligible for this procedure upfront. During the last decade, major advances in the management of CRLM have taken place involving three fields: oncology, interventional radiology, and surgery. These advances have increased the resectability rate to 20-30% of cases with a 5-year survival of 35-50%. Neoadjuvant treatment with chemotherapeutic agents such as irinotecan and oxaliplatin, and hepatic artery infusion combined with systemic therapy and biologic agents (bevacizumab, cetuximab) play an important role in increasing the number of patients eligible to secondary resection. However, with the progressive use of neoadjuvant chemotherapy further studies are necessary to answer questions such as the risk: benefit ratio in maximizing response rates versus vascular changes in the liver (current opinion still divided concerning their importance). These questions remain challenging and should not be underestimated.In this review, we have described the current oncosurgical strategies employed in patients with resectable and non resectable CRLM, their benefits, and future treatment strategies.     

Good syndrome coexisting with leukopenia

A 61-year-old man was admitted to our hospital for further examinations of a mediastinal mass. He had underwent an extended thymothymectomy, and had a tumor that was diagnosed as a type B1 thymoma, according to the World Health Organization. One year after surgery he was admitted again for recurrent diarrhea and pneumonia. Laboratory data revealed severe hypogammaglobulinemia with leukopenia. He was diagnosed with Good syndrome with leukopenia. Regular gamma globulin and figrastim injections were successful in keeping the patient symptom free. The prognosis of patients with Good syndrome and leukopenia is very poor; therefore, immediate diagnosis is important. The development of infectious diseases in a patient with thymoma or after the resection of thymoma mandates early and comprehensive immunologic investigation.     

Alternative approach to the surgical management of congenital tracheal stenosis

Congenital tracheal stenosis is a serious disease associated with high operative mortality and morbidity, especially in the newborn period. Its surgical management involves either sliding tracheoplasty, which is associated with extensive dissection and recurrent stenosis, or with pericardial patch tracheoplasty that fails to address recoiling of the stenotic complete ring and collapse of the patch into the tracheal lumen. We report a modification of the latter technique, in which a half ring external stenting device is used to keep the rings from recoiling.     

Rare presentation of subclavian artery isolation in a neonate with a family history of aortic arch anomalies

Isolation of the left subclavian artery is a rare aortic arch anomaly in which the artery originates from the pulmonary artery through a ductus arteriosus rather than the aorta. In neonates it is usually diagnosed incidentally with other aortic or cardiac anomalies and can be associated with chromosomal deletions. We describe an extremely rare presentation whereby subclavian artery isolation was presented with left arm ischemia in a 6-day-old child. There were also a concurrent right aortic arch, ventricular septal defect, persistent left superior vena cava, and both radial and ulnar artery hypoplasia. A family history of aortic arch anomalies with no known chromosomal aberration was also present, whereby all the male family members on the maternal side had undergone aorto-cardiac surgery as neonates. Diagnosis and surgical management are discussed.     

Chondrosarcoma masquerading as cardiomyopathy

A 17-year-old male patient presented to his primary care provider with heart failure symptoms and was transferred to our hospital with the diagnosis of idiopathic cardiomyopathy. His workup identified a large mediastinal mass with right ventricular outflow obstruction, which was resected. The pathology of the mass was a low-grade chondrosarcoma. The patient currently remains disease free at 4 years.     

Giant coronary artery aneurysm in the left main coronary artery: a novel surgical procedure

Giant coronary artery aneurysm is quite rare and the corresponding surgical strategy is difficult to standardize. We present the case of a patient with giant coronary aneurysm involving the left main coronary artery who underwent an aneurysmectomy and coronary artery reconstruction with direct suture of the coronary vessels. Because of compression of the main pulmonary artery, the left main coronary artery was reconstructed using interposition of a short artificial graft.     

Late disruption of a Freestyle stentless bioprosthesis used for repair of sinus of Valsalva aneurysm of noncoronary cusp

We present a case of disruption of the porcine aortic wall of the 27-mm Freestyle stentless bioprosthesis 5 years after the subcoronary implantation to exclude the sinus of Valsalva aneurysm of the noncoronary cusp. At the urgent reoperation, the inflow suture line was found to be intact, and therefore a new stented valve was sutured with the inflow Dacron cuff after removal of ruptured valve. The subcoronary implantation technique creates a cavity between the prosthetic and native aortic walls filled with hematoma. The outflow suture line dehiscence caused blood flow into the cavity, porcine aortic wall rupture, and leaflet destruction.     

Pulmonary thromboembolism with floating thrombus trapped in patent foramen ovale

A 39-year-old man was hospitalized with symptoms of acute deep vein thrombosis, and computed tomography showed that he had pulmonary thromboembolism. Transthoracic echocardiography showed a large, right atrial thrombus and transesophageal echocardiography showed migrating thrombus trapped in a patent foramen ovale and extending all the way up to the ascending aorta. He underwent surgical embolectomy under cardiopulmonary bypass. At the conclusion of the operation, repeat transesophageal echocardiography examination revealed fresh but small thrombus in the right atrium. This continued entry of thrombi into the heart was further managed with fluoroscopy-guided insertion of a retrievable inferior vena cava filter through the internal jugular vein in the operating room itself.     

Obstruction of left ventricular outflow tract after mechanical mitral valve replacement

We successfully operated on a patient with a rare complication of left ventricular outflow tract obstruction after mitral valve replacement. In a 57-year-old woman with previous mitral valve replacement, transthoracic echocardiography showed left ventricular outflow tract obstruction as a result of anterior displacement of the mitral prosthesis and local thickening of the interventricular septum. Cardiac surgery verified this rare lesion. During the operation, the anterior half of the prosthesis ring was cut away from hyperplastic tissue and sutured to the natural mitral annulus. Subaortic hyperplastic tissue was excised to enlarge the left ventricular outflow tract. The patient had an uneventful postoperative recovery, and left ventricular outflow tract obstruction disappeared on postoperative transthoracic echocardiography.     

Stanford type A acute aortic dissection caused by blunt trauma in a patient with situs inversus

Left ventricular posterior wall pseudoaneurysm after native mitral valve infective endocarditis is a very rare occurrence. We report such a case in a patient with HLA-B27-associated spondyloarthritis and normal coronary arteries. Excision of the aneurysm with left ventricular reconstruction and mitral valve replacement resulted in an excellent outcome.     

Aneurysmal bone cyst in the first rib

Aneurysmal bone cyst is a benign tumor of the skeletal system that rarely occurs in ribs. We report two cases of aneurysmal bone cyst in the first rib. The first patient was a 21-year-old woman with an aneurysmal bone cyst in the left first rib that was resected with an L incision. The second patient was a 42-year-old man with an aneurysmal bone cyst in the right first rib that was resected with a posterolateral incision but recurred 1 year later. An en bloc resection was performed, without recurrence to date. We also review this disease with emphasis on the etiology, clinicopathology, and treatment approaches.