Primary Gas Gangrene of the Pancreas: Report of a Case

Spontaneous gas gangrene of the pancreas, caused by an infection of Clostridium perfringens, is an extremely rare but severe form of acute pancreatitis. A 67-year-old man complaining of severe epigastric pain with diffuse guarding underwent an emergency laparotomy. During surgery, hemorrhagic pancreatic necrosis was observed with a large amount of peripancreatic gas. Cultures demonstrated C. perfringens. The identification of hemolysis and the accumulation of peripancreatic gas on computed tomography, which were both caused by an infection of C. perfringens, led us to make a diagnosis of clostridial infection of the pancreas.     

Primary Stromal Tumor of the Omentum: Report of a Case

We report the case of a primary extragastrointestinal stromal tumor (EGIST) found in the omentum of a 65-year-old woman. The resected specimen, which measured 6 cm at its largest point, consisted of an outer solid part and inner uniloculated cysts. Microscopically, the tumor was characterized by interlacing bundles of elongated spindle cells, with the nuclei showing a focal palisading pattern; however, skenoid fibers were not observed anywhere and mitoses were absent. Immunohistochemically, the tumor was negative for smooth-muscle actin, desmin, and S-100 protein, but it was positive for CD117 and CD34. The microscopic features were consistent with a gastrointestinal stromal tumor.     

Mucoepidermoid Carcinoma of the Liver Diagnosed as a Liver Abscess: Report of a Case

Mucoepidermoid carcinoma of the liver is a rare variant of cholangiocarcinoma, containing both mucus-secreting glandular cells and squamous cells mixed in nests. We report a case of mucoepidermoid carcinoma of the liver in a 69-year-old woman who presented with a 1-week history of fever, chills, and right flank pain. On admission, she was not jaundiced, and under a provisional diagnosis of liver abscess, a pigtail catheter was inserted into the abscess cavity. We performed right hepatectomy and partial excision of the diaphragm 1 month later. Microscopically, the tumor was composed of solid and invasive nests of epidermoid and mucin-producing cells with desmoplastic stroma. The epidermoid component of the tumor contained intercellular bridges and individual cell keratinization. Alcian blue and Periodic acid-Schiff (PAS) staining confirmed that there was mucin in the cytoplasm of mucus-secreting cells. The tumor cells, intrahepatic bile ducts, and ductules were consistently reactive with cytokeratin (CK) 7 and negative for CK20. The adjacent nonneoplastic liver cells were CK 7–/CK20–, and P63 immunostaining was positive in the epidermoid cells. The tumor was diagnosed as mucoepidermoid carcinoma arising from the intrahepatic bile duct. Despite aggressive surgical treatment, the patient died of multiple liver metastases 4 months after the right hepatectomy.     

Primary Malignant Mesothelioma of the Greater Omentum: Report of a Case

We report a rare case of primary malignant mesothelioma of the greater omentum. To our knowledge, only one other such case has been described in the English literature. The patient was a 61-year-old Taiwanese woman without any history of exposure to asbestos, who presented with lower back pain. Abdominal sonography and computed tomography showed a 12 × 9 × 9-cm³ mass occupying the lower abdomen. Laparotomy revealed a tumor in the greater omentum, invading the posterior wall of the uterus, without diffuse mesenteric thickening or multiple small nodules in the peritoneum. We performed en bloc resection of the mass, which involved omentectomy, hysterectomy, and bilateral salpingo-oophorectomy. Microscopically, the tumor cells were arranged in a tubulopapillary pattern lined by a single layer of uniform, cuboidal cells. A pattern of sclerotic stroma with irregular glandular elements was also recognized. Immunohistochemically, the tumor cells showed strong positivity for calretinin. The final pathologic diagnosis was malignant mesothelioma. The patient did not receive chemotherapy or radiotherapy, and has remained in good health without any evidence of recurrence for almost 3 years since her operation.     

Abcès cérébral à Clostridium perfringens après chirurgie d’exérèse d’un glioblastome : à propos d’un cas et revue de la littérature

Clostridium perfringens is rare in neurosurgery. The source of clostridial brain abscess is usually a penetrating head injury. We report the case of a 57-year-old man who had parietal glioblastoma resection with local carmustine chemotherapy and who presented a clostridial brain abscess three weeks later. Progression was especially brutal, leading to patient's death in few hours. We discuss the etiology and progression of this case compared to the data reported in the literature.     

Primary Peritonitis Associated with Streptococcal Toxic Shock-Like Syndrome: Report of a Case

Several reports over the past 15 years describe severe group A streptococcal infections causing septic shock, soft-tissue necrosis, and multiple organ failure; a phenomenon known as streptococcal toxic shock-like syndrome (TSLS). However, primary peritonitis associated with TSLS is rare. We report the case of a 40-year-old man admitted with pain in both thighs, hypotension, and severe abdominal pain. His daughter had been diagnosed with streptococcal pharyngitis 3 days earlier. We performed an emergency laparotomy for peritonitis, and culture of the ascites was positive for group A -hemolytic streptococcus (GAS). Further serotyping of the isolated GAS strain revealed the T-type 22 and the pyrogenic exotoxin gene, spe-C. The criteria for TSLS were clearly met, including the isolation of GAS from ascites, hypotension, liver failure, renal failure, coagulopathy, myositis, and a generalized erythematous macular rash with desquamation.     

Treatment of Necrotic Infection on the Anterior Chest Wall Secondary to Mastectomy and Postoperative Radiotherapy by the Application of Omentum and Mesh Skin Grafting: Report of a Case

We report herein the case of a patient who initially underwent right radical mastectomy for breast carcinoma in 1988, followed by left breast-conserving surgery in 1997. On both occasions she was given postoperative radiation therapy of 50 Gy. Repeated dressings and the administration of antibiotics failed to heal ulcerative infected lesions that had formed on the anterior chest wall in early 1998. In 1999, the sternum and surrounding tissue were debrided and the anterior chest wall was reconstructed by omentum transposition and mesh skin grafting. The patient is currently well and alive without any evidence of recurrence of either infection or breast cancer. Received: March 7, 2001 / Accepted: September 11, 2001     

Primary omental torsion: Report of two cases

Two patients with omental torsion, who presented with acute abdomen, are reported. The first case, a 14-yearold boy, was admitted for acute appendicitis. During surgery, omental torsion on the long axis was diagnosed and the involved omentum was resected. The patient had not experienced any previous abdominal surgery. The second case, a 49-year-old man, was admitted with symptoms of acute abdomen. Similarly, a laparotomy revealed omental torsion around the long axis. This patient also had no history of previous abdominal surgery. The involved portion of the omentum was also resected. Omental torsion is a rare cause of acute abdomen in children and adults, who may present with various signs and symptoms mimicking other etiologies of acute abdomen. A preoperative diagnosis may therefore be difficult and it usually can only be established during surgery.     

Primary small cell carcinoma of the esophagus: Report of a case

A case of esophageal small cell carcinoma successfully treated with combination therapy consisting of both pre- and postoperative chemotherapy as well as surgical resection is presented. A 74-year-old man presented with a small cell carcinoma measuring 11 cm in diameter in the lower half of his thoracic esophagus. After undergoing preoperative chemotherapy with cisplatin (25 mg, iv, days 1 through 5), the gross tumor completely regressed. However, a microscopic focus of residual cancer showing squamous cell carcinoma was found in the resected esophageal specimen. The patient received an additional two courses of postoperative chemotherapy with cisplatin (75 mg, iv monthly). He has since survived more than 9 years with no evidence of recurrent disease. We herein report a rare case of a patient with esophageal small cell carcinoma who demonstrated a complete cure.     

Hemangiopericytoma Arising in the Greater Omentum: Report of a Case

Although hemangiopericytoma may arise in any anatomic site, it rarely develops in the greater omentum. To our knowledge, only ten cases have been reported to date in the English-language literature. We report herein an additional case of hemangiopericytoma arising in the greater omentum. A review of the reported cases suggests that surgical resection provides the only chance of cure and that a high mitotic index (4/10 high-power fields) and a tumor size of 20cm predict an unfavorable prognosis after resection.     

Klebsiella Pneumoniae pulmonary infection with thyroid abscess: Report of a case

Thyroid abscess is a rare clinical entity, usually associated with a pyriform sinus fistula. A prompt diagnosis is important because it may progress rapidly into a life-threatening condition. We report a very unusual case of thyroid abscess associated with a lung infection, both caused by Klebsiella pneumoniae. The patient was treated successfully with a culture-appropriate antibiotic and an uneventful thyroid lobectomy. A delay in diagnosis of morbidities associated with a thyroid abscess may result in rapid exacerbation of this condition; therefore, prompt and appropriate treatment is mandatory for a successful outcome.     

Liver Abscess Caused by <Emphasis Type="Italic">Stenotrophomonas maltophilia</Emphasis>: Report of a Case

We report the case of a melioidosis-like abscess of the liver caused by Stenotrophomonas (Xanthomonas) maltophilia infection in a Chinese man living in Hungary. Although this appears to be the first documentation of a liver abscess of this origin in a nonimmunocompromised patient, our case report demonstrates that this common facultative pathogen can also cause liver abscess and sepsis. After repeated negative blood cultures, histological examinations of liver biopsies suggested the possibility of chronic melioidosis, but the microbiological examination performed directly on the same specimen identified a Stenotrophomonas maltophilia infection. Surgical drainage was performed and sulphamethoxazole/trimethoprim therapy was commenced, after which the patient recovered fully. The facultative pathogen S. maltophilia, which most often causes nosocomial infections, may cause severe sepsis and liver abscess. We wish to draw attention to the fact that the antibiotic sensitivity of S. maltophilia is not necessarily the same in vivo and in vitro. This can create difficulties in both diagnosis and treatment. Received: January 23, 2001 / Accepted: September 3, 2002 Reprint requests to: A. Petri     

Alveolar Echinococcosis of the Liver in a Tokyo Resident with an Unknown Route of Infection: Report of a Case

We report the case of a 45-year-old Tokyo man who developed alveolar echinococcosis of the liver, which is an extremely rare disorder in Japan, except for Hokkaido, Japan's northernmost island. The findings of multiple clustered cysts on computed tomography were unlike those of any hepatic tumors we had previously encountered. T2-weighted magnetic resonance imaging revealed the characteristic findings of small cysts with a very high signal intensity. The tumors were successfully removed by a hepatic resection. The patient lives in Tokyo, but has visited Hokkaido many times. The exact route of infection in this patient remains unclear. Sliced raw venison, which he reported eating on every visit to Sapporo in Hokkaido, represented the only potential route of infection we could identify. This meat may have somehow become contaminated with embryonated eggs. Nowadays, even city inhabitants are at risk of developing rare diseases due to the rapid development of transportation systems.     

An Amebic Lung Abscess: Report of a Case

Recently the number of amebiasis cases has increased in Japan. Pleuropulmonary amebiasis is a very rare complication of liver amebiasis. We report herein the case of a 54-year-old man presenting with an amebic lung abscess in his right lower lung. The diagnosis of lung amebiasis was established from a direct examination of the pus in which trophozoites of Entamoeba histolytica were detected. After the oral administration of metronidazole, the laboratory findings improved and he thus underwent a right lower lobectomy. He was discharged without any relapse of infection 20 days after a thoracotomy. We conclude that a protozoan infection should thus be suspected in the case of a pleuropulmonary infection in which several types of antibiotics prove to be ineffective. Received: January 29, 2001 / Accepted: May 15, 2001     

Intrahepatic Cholangiocarcinoma with Old Infestation of Schistosoma japonicum: Report of a Case

We report a rare case of intrahepatic cholangiocarcinoma associated with old infestation of Schistosoma japonicum. The patient was a 76-year-old Japanese man who had lived his childhood in an endemic area of this parasite. He presented with jaundice and computed tomography showed a 4-cm, hypodense tumor in segment VIII of the liver. Microscopically, the resected mass was composed of well-differentiated adenocarcinoma cells. Fibrosis and inflammation were seen around the dilated peripheral portal veins embolized with dead S. japonicum eggs. Our search of the literature found only one other case of cholangiocarcinoma coincident with S. japonicum, suggesting that it is not a risk factor for cholangiocarcinoma, although the inflammation and fibrosis caused by the S. japonicum eggshells may predispose to carcinogenesis. However, there is no evidence supporting this hypothesis. More data are necessary to evaluate the differences in clinicopathological findings between cholangiocarcinoma concomitant with S. japonicum and the usual type of cholangiocarcinoma.     

Fistula Formation following Epidural Catheter:A Case Report

A case of fistula formation following epidural catheterisation is presented. The diagnosis and treatment of epidural abscesses are discussed.     

Sterile Pretibial Abscess After Anterior Cruciate Reconstruction From Bioabsorbable Interference Screws: A Report of 2 Cases

We report 2 cases of extra-articular pretibial sterile abscesses with minimal osteolysis after anterior cruciate ligament reconstruction with poly-L-lactic acid bioabsorbable interference screw fixation. No joint involvement was evident in either case. Both patients underwent surgical exploration for incision, drainage, and excision with debridement of the biodegradable screw debris from the tibial bone tunnel. The cystic area in case 1 contained 8 mL of chalky white fluid with fragments of particulate matter. Microscopic evaluation revealed birefringent foreign material in a benign histiocyte-lined cyst. We encountered 20 mL of chalky white material during surgical debridement in case 2. Intraoperative cultures and Gram’s stain were negative. Both patients had an uneventful recovery after surgical debridement and were able to return to their athletic activities. To our knowledge, this is the first case report of a local reaction to poly-L-lactic acid bioabsorbable interference screws after anterior cruciate ligament reconstruction.     

Chylothorax Resulting from a Penetrating Injury of the Neck: a Case Report

Abstract  Chylothorax is characterized by an accumulation of lymphatic fluid in the pleural cavity due to compression or loss of integrity of the thoracic duct for any reason. It is frequently secondary to intrathoracic malignancies and iatrogenic trauma. Thoracic duct injury and resulting chylothorax, due to penetrating injuries of the neck, are very rare. This report presents a patient with chylothorax associated with penetrating neck trauma, who was successfully treated, and provides discussion on this very rare case in the light of the available literature.