Surgical excision of complex lipoma from the foot: A case report

Malignant soft tissue tumors of the foot and ankle are rare but diagnostic imaging and/or interventional biopsy are vital to establish the nature and grading of a suspicious tumor prior to definitive surgical intervention. The purpose of the study is to provide an account on how a symptomatic mass of the plantar aspect of the foot warranted a referral to a sarcoma center, highlighting the importance of having access to diagnostic imaging and a pathway to refer suspected cases to specialist centers. A single patient with a symptomatic soft tissue tumor of the plantar foot was referred from our service to the regional sarcoma center who considered to be benign, and therefore, open surgical resection was performed by our team. Histopathological analysis identified the excised mass as a lipoma. At 2 years, postoperatively there was no recurrence, and the patient presented with an asymptomatic foot. United Kingdom (UK) guidelines suggest that all soft tissue masses of suspicious nature, greater than 50 mm, deep seated irrespective of size, or fast growing lesions should be referred to a sarcoma unit prior to surgical management. European guidance identifies a threshold of 15 mm for a mass in the foot. Patients presenting with red flag symptoms irrespective of size of mass should be referred to a sarcoma center. Advanced imaging and multidisciplinary input to enable appropriate surgical planning is recommended for suspicious soft tissue tumors that present to the foot and ankle surgeon.     

The postoperative brain tumour stem cell (BTSC) niche and cancer recurrence

Currently, surgical resection is one of only a few options for treating brain cancer. Unfortunately, postoperative tumour recurrence remains almost inevitable despite additional radiation or chemotherapy treatment following resection. Clinical observations and a growing body of experimental evidence have led to speculation that there is a population of persistent brain tumour stem cells (BTSCs) — or brain tumour initiating cells — that are difficult to completely remove surgically. Furthermore, residual BTSCs following surgery may actually be more resistant to subsequent radiation and/or chemotherapies. It remains to be determined if brain surgeries render the postoperative tissue microenvironment more favourable for the survival and growth of BTSCs, and therefore the recurrence of brain tumours. We hypothesise that BTSC-based tumour recurrence may develop within a specific niche of the aberrant tumour microenvironment. Even when the gross appearance of the primary tumour seems confined, BTSCs (albeit accounting only for a small population of tumour cells) may microscopically enter the stroma, hampering curative surgeries. This article discusses the theory that surgical resection of brain tumours generates niches recruiting BTSCs to the surgical wounds, stimulating the proliferation and invasiveness of BTSCs, and leading to tumour recurrence. Postoperative brains are marked with active wound repair in peritumoural margins, which is likely to be accompanied by increased inflammatory paracrine production, angiogenesis and reactive astrogliosis. The postoperative BTSC niche concept is consistent with the observation that brain tumour recurrence usually occurs in tissues that are proximal to the resection margin. In this article, we intend to reflect recent advances that may lead to novel strategies to eliminate postoperative brain tumour recurrence.     

Unusual morphologic features of low‐grade endometrial stromal sarcoma: A case report

BackgroundEndometrial stromal tumours are uncommon tumours of the uterus. They mainly occur in perimenopausal women. Tumours with typical clinicopathological features do not usually pose diagnostic problems. However, rare clinicopathological features can occur, and clinicians without significant experience may have difficulty diagnosing these tumours and managing these patients.MethodsHerein, we report a case of endometrial stromal sarcoma that occurred in a 25‐year‐old woman. The pathological features, immunophenotype, treatment and prognosis were discussed.ResultsThe tumour revealed morphological heterogeneity, and there were similar proliferative‐type endometrial stromal cells, an extensive amount of mature adipose tissue, and prominent rhabdomyoblastic and smooth muscle cells. Histopathological and immunohistochemical studies confirmed low‐grade endometrial stromal sarcoma with smooth muscle, adipocytic and rhabdomyoblastic differentiation (approximately 60% were differentiated tissues). The final treatment of the tumour was total abdominal hysterectomy with bilateral salpingo‐oophorectomy. There was no evidence of recurrence for 109 months postoperatively.ConclusionsWe found that low‐grade endometrial stromal tumours with extensive adipocytic and prominent rhabdomyoblastic differentiation are misdiagnosed because they are infrequent. They must be differentiated from rhabdomyosarcoma with accurate identification of adipocytes, and long‐term follow‐up is needed.     

Primary leiomyosarcoma of the middle ureter: A rare case report with literature review

Leiomyosarcoma is a rarely seen neoplasm of the ureter. Malignant tumors of smooth muscle of the ureter are extremely rare, and about 22 cases of leiomyosarcoma of ureter have been reported to date. A 57‐year‐old diabetic Pakistani man presented with a dull ache pain in the right flank. Past surgical history was three ureteroscopic surgeries for a ureteric stricture. Computed tomography showed a stricture with a peri‐ureteral soft tissue mass of 11 mm x 5 mm at the middle third of the ureter at the level of common iliac vessels. laparoscopic excision with safety margin and right ureterovesical reimplantation is performed. Diagnosis of leiomyosarcoma of the right ureter was made, and one iliac lymph node was excised and was positive for tumor by pathologic examination. Although leiomyosarcoma is rarely seen in urinary tract, it should be considered in the differential diagnosis of ureteral stricture disease and retroperitoneal tumors.     

Minimally invasive management of large duodenal lipoma: endoscopic submucosal dissection

ObjectiveThis study was performed to compare the clinical outcomes of large duodenal lipomas (DLs) of ≥2 cm between endoscopic submucosal dissection (ESD) and endoscopic full-thickness resection (EFTR).MethodsThis retrospective study included patients who underwent endoscopic resection of large DLs from June 2017 to March 2021 at our hospital. Clinicopathologic features, clinical outcomes, and follow-up endoscopy findings were retrospectively reviewed.ResultsTwenty-three patients (12 men) with a mean age of 57.4 years were included. The median tumor size was 28.4 ± 13.3 mm. ESD was performed in 19 patients, and EFTR was performed in 4. Complete resection was achieved in 21 patients. The operative time and postoperative hospital stay were significantly shorter in the ESD than EFTR group. Four patients in the EFTR group developed a fever; no other adverse events occurred. No patients required surgical intervention. During the average follow-up of 21.1 months, no residual tumor, recurrence, or metastasis was observed.ConclusionBoth ESD and EFTR provide minimally invasive, localized treatment of selected DLs. ESD might have some advantages in resecting large DLs in terms of procedure time and hospitalization.     

Thoracoscopic and laparoscopic resection of a huge oesophageal liposarcoma: a case report

Oesophageal liposarcomas are particularly rare, accounting for 1.2–1.5% of all gastrointestinal liposarcomas. Surgical resection is the usual treatment. Endoscopic resection is minimally invasive but still controversial. This current case report describes a rare case of a large oesophageal liposarcoma in a 52-year-old male that presented with 10-year history of dysphagia for dry and solid food that was exacerbated by a recent common cold. Thoracoscopic and laparoscopic oesophagectomy was performed. He did not have any dysphagia or dyspnoea 1 week postoperatively. The excised specimen consisted of a polypoid mass measuring 21.0 cm × 5.1 cm. Histological examination confirmed that it was an oesophageal liposarcoma. At 1-year postoperatively, there was no sign of recurrence. Thoracoscopy and laparoscopy can be used to treat large oesophageal masses. Long-term follow-up is required as oesophageal liposarcomas tend to recur.     

1470 nm/980 nm dual-wavelength laser is safe and efficient for the en-bloc resection of non-muscle invasive bladder cancer: A propensity score-matched analysis

ObjectiveTo evaluate the efficacy and safety of a 1470 nm/980 nm dual-wavelength laser system used for the en-bloc resection of non-muscle invasive bladder cancer (NMIBC) compared with transurethral resection of bladder tumour (TURBT).MethodsThis retrospective study analysed the demographic and clinical data from patients diagnosed with NMIBC that were treated by either dual laser or TURBT. Intraoperative characteristics, postoperative characteristics and outcomes between the two groups were compared.ResultsThis study analysed 64 patients, 32 in each group. No severe complications were identified in either group. After propensity score-matching, there were no significant differences between the two groups in terms of the demographics, clinical and tumour characteristics. There was no significant difference between the two groups in terms of specimen quality. In the laser group, intraoperative blood loss was significantly lower and significantly fewer patients required continuous bladder irrigation after surgery, compared with the TURBT group. No significant differences were observed in the catheterization time, gross haematuria time and hospitalization time. Operation time in the laser group was significantly longer compared with the TURBT group. No significant difference was found in the recurrence and progression rates between the two groups.ConclusionsThe 1470 nm/980 nm dual-wavelength laser provides a safe and effective surgical treatment option for patients with NMIBC.     

超声诊断肢体上皮样肉瘤的临床价值

目的 探讨超声在肢体上皮样肉瘤诊断中的临床价值。方法 收集我院经手术病理证实为肢体上皮样肉瘤患者43例资料,分析其术前超声图像特征,并随访其短期复发情况。结果 43例肢体上皮样肉瘤超声均明确提示病变位置,定位准确率100%;声像图表现均呈团块状低回声,均无包膜,平均最大径（5.73±4.99）cm,为以实性为主（81.4%）,边界不清晰（55.8%）,形态不规则（88.4%）,内部回声不均匀（95.3%）,多为单发（72.1%）,血流分级Ⅲ级（53.5%）。超声明确提示软组织肿物42例,另有1例患者肿物感不明显,超声提示为神经病变,瘢痕粘连。术后随访3个月至8年,出现复发并再次手术者22例,超声均直接提示复发,声像图均表现为回声不均匀的实性低回声,边界不清晰（15/22）,形态不规则（16/22）,Alder血流分级均为Ⅰ级。结论 肢体上皮样肉瘤声像图表现多为单发不规则团块状实性低回声肿物,无包膜,边界不清晰,内部回声不均匀,血流较丰富。超声不仅可在术前明确病变范围及其周围组织受累情况,术后亦可动态随访,具有重要的临床价值。     

Resection of small acoustic neuroma using the transcanal transvestibular endoscopic approach

We evaluated the outcomes of resection of small acoustic neuromas using the transcanal transvestibular endoscopic approach. Two patients with a small acoustic neuroma were treated using this approach. The sizes of the tumors were 11 × 6 mm and 12 × 10 mm. Both tumors were removed completely without residual tumor tissue, and damage to the facial nerve and cochlear nerve was avoided. No patients developed postoperative vertigo, aggravation of postoperative facial paralysis, severe pain, or permanent postoperative complications. The patients were followed up for 6 months, and none developed recurrence. Resection of small acoustic neuromas by the transcanal transvestibular endoscopic approach is a simple and safe technique that achieves excellent functional results.     

Retiform hemangioendothelioma: a rare lesion of the vulva

Retiform hemangioendothelioma (RH) is a rare borderline-malignant vascular tumor with specific histological characteristics, usually occurring in the limbs and trunk. We report the case of a 63-year-old woman who presented with a painless, oval nodule that had been growing slowly on her left vulva for 3 years. Magnetic resonance imaging of the pelvic cavity revealed a 4.4- × 2.7- × 1.8-cm cystic lesion in the subcutaneous fat of the left vulva. Resection beyond the macroscopic border was performed. Pathology revealed vascular structures with elongated and narrow arborizing vascular channels that were arranged in a retiform pattern resembling rete testis tissue. Immunohistochemical endothelial staining was positive for CD31, CD34, and Friend leukemia integration-1 (FLI-1). The above features confirmed a diagnosis of RH. There was no local recurrence or metastasis during the 26-month follow-up. RH of the vulva is rare, and its diagnosis is supported by specific histological characteristics and immunohistochemical staining for CD31, CD34, and FLI-1. Wide surgical resection with tumor-free margins is important for a favorable prognosis.     

软组织上皮样肉瘤的临床及超声特征分析

目的分析软组织上皮样肉瘤临床及超声声像图特征。方法回顾性分析17例经手术病理证实的软组织上皮样肉瘤的临床、灰阶和彩色多普勒超声图像特征。结果 17例软组织上皮样肉瘤患者,女10例(58.8%),男7例(41.2%),年龄28~63岁,平均(44.29±11.40)岁,复发9例(52.9%),原发8例(47.1%),均为扪及质硬肿块就诊,2例(11.8%)伴溃疡。灰阶超声:8例为单发(47.1%),9例为多发(52.9%),远端型12例(70.6%),近端型5例(29.4%),多发者包块均位于同一部位,呈融合状,且超声表现相同。同时累及皮肤皮下层2例(11.8%),仅累及皮下层5例(29.4%),仅累及肌层5例(29.4%),同时累及皮肤、皮下层及肌层5例(29.4%),均表现为弱回声团块,团块最大径线0.8~15 cm,平均(6.36±4.02)cm,边界不清楚12例(70.6%),形态不规则15例(88.2%),内部回声不均匀16例(94.1%),伴液化13例(76.5%),伴钙化4例(23.5%)。CDFI示0级3例(17.6%),Ⅰ级4例(23.5%),Ⅱ级3例(17.6%),Ⅲ级7例(41.2%)。结论软组织上皮样肉瘤多发生于中青年,易复发,临床表现为软组织质硬包块,部分皮肤伴溃疡,好发于四肢,超声表现为软组织内弱回声团块,边界多不清楚,形态多不规则,内部回声多不均匀,常伴液化,偶伴钙化,血流信号较丰富。掌握其临床及超声特征有助于提高诊断准确率。     

胃平滑肌肿瘤的诊断与治疗

目的探讨胃平滑肌肿瘤(GSMT)的临床表现、诊断与合理的手术治疗.方法回顾分析32例胃平滑肌肿瘤(GSMT)的临床治疗及随访资料.结果胃平滑肌瘤17例均手术局部切除;平滑肌肉瘤14例,其中8例行胃大部切除,2例行全胃切除,2例姑息切除.2例探查造瘘,1例上皮样平滑肌瘤行胃大部切除.首发症状表现为上消化道出血.术前内镜GI、CT等联合检查,阳性诊断率为84.61%,手术切除率为93.8%.胃平滑肌恶性肿瘤为非淋巴途径转移,5年生存率64.3%.结论胃平滑肌肿瘤直径＞5 cm多为恶性,且对放化疗均不敏感,术前胃镜、CT检查具有较强特异性.手术切除为唯一有效治疗手段,对转移和复发灶也应积极手术并定期长期随访.     

Giant cervical goiter in Hashimoto’s thyroiditis: A case report

A giant cervical goiter, defined as a thyroid mass larger than 8 cm in diameter, is usually a nodular or adenomatous goiter. A giant cervical goiter can also be caused by hyperthyroidism (i.e., Hashimoto’s thyroiditis). The surgical indications for patients with Hashimoto’s disease include suspected malignant tumors, persistent symptoms related to the disease, or persistent enlargement of the goiter. We herein describe a woman who developed symptoms of compression from a thyroid tumor, the volume of which was almost the largest reported in the relevant literature to date. The bilateral lobes of the giant thyroid tumor were removed by total en bloc excision. We protected the bilateral recurrent laryngeal nerve and preserved the bilateral upper and lower parathyroid glands in situ. The excised left lobe tumor was 16 × 9 × 5.5 cm, whereas the right lobe tumor was 12 × 8 × 4 cm. The pathological diagnosis was Hashimoto’s thyroiditis. Although surgical excision is difficult, it is still the main treatment modality for giant goiters in patients with Hashimoto’s thyroiditis and can help to reduce the occurrence of complications.     

Papillary squamous cell carcinoma successfully treated with bronchoscopic intratumoral injections of cisplatin and Endostar: a case report

Squamous cell carcinoma (SCC) is a malignant epithelial tumor originating from the bronchial epithelium that shows keratosis and/or intercellular bridges. Papillary squamous cell carcinoma (PSCC) is an extremely rare subtype of SCC that manifests with a unique intrabronchial papillary growth pattern. Surgical resection is still the first recommendation for localized noninvasive SCC. However, some patients are not candidates for surgical resection. With the development of interventional pulmonology, bronchoscopic interventional therapy has played a key role in the treatment of central airway tumors. Here, we report a case of noninvasive PSCC in the airway treated with an electric snare, argon plasma coagulation (APC), and cryotherapy. After removing the tumor by electrotomy, cryotherapy, and APC, the tumor was injected with Endostar 15 mg (3 ml) and cisplatin 20 mg (diluted to 3 ml with 0.9% normal saline) in six separate sites, once every 21 days. The tumor was eliminated, and the treatment was stopped after four treatment cycles. During the 1-year follow-up, there was no recurrence of PSCC in the airway. In this case, submucosal injections of Endostar combined with cisplatin was a feasible and effective endoscopic method for treating a low-grade intratracheal malignant tumor.     

Revision endoscopic frontal sinus surgery for refractory chronic rhinosinusitis via modified agger nasi approach

ObjectiveTo examine the clinical effects of revision endoscopic frontal sinus surgery (RESS) through modified agger nasi (MAN)–middle turbinate resection on refractory chronic rhinosinusitis (CRS).MethodsWe reviewed 156 patients who were treated for refractory CRS from February 2012 to August 2014. These patients had been diagnosed with refractory CRS by computed tomography and endoscopy and had received several surgical and medical treatments in the past, but their condition had not been cured. They were divided into the observation group (RESS through MAN–middle turbinate resection, n = 78) and the control group (endoscopic sinus surgery, n = 78). Complete or partial control of the patient’s symptoms and signs suggested that the treatment was effective, and no improvement in the symptoms and signs indicated that the treatment was ineffective.ResultsThe 6-month treatment efficacy rate was significantly higher in the observation group (91.03%) than in the control group (71.79%). The observation group had a significantly lower complication rate (7.69%) and recurrence rate (3.85%) than the control group (17.95% and 12.82%, respectively).ConclusionRESS through MAN–middle turbinate resection together with adequate perioperative preparation has a significant effect on the outcome of refractory CRS and is worthy of clinical promotion.     

Primary cardiac angiosarcoma: a case report

Primary cardiac angiosarcoma is relatively rare, and most cases involve metastasis at the time of diagnosis. The median survival time is 14 months for patients who can be treated surgically, versus 3.8 ± 2.5 months for patients with metastasis who could not undergo surgery. Radical surgical resection, radiotherapy, chemotherapy, and targeted therapy are the main treatments, but prognosis remains poor because of rapid progression and high recurrence and metastasis rates. At present, there is no unified standard treatment, and selecting the correct treatment plan and improving patient survival and quality of life remain challenging. We have reported the case of a 45-year-old woman with a primary heart tumor that infiltrated the right atrial wall and pericardium. Angiosarcoma was verified histologically. After palliative resection of the primary tumor followed by concurrent chemoradiotherapy and targeted therapy, the patient exhibited overall survival of 23 months, highlighting the potential utility of this treatment strategy.     

Anatomical relationship between the common carotid artery and the internal jugular vein during head rotation

This study investigated the anatomical relationship between the common carotid artery and internal jugular vein during head rotation for the effective performance of percutaneous transjugular procedures. The subjects included 30 volunteers who had never undergone internal jugular vein cannulation. In the supine position, two-dimensional ultrasonographic images of the right internal jugular vein and common carotid artery were obtained, 2 and 4 cm above the clavicle, along the lateral border of the sternal head of the sternocleidomastoid muscle. Ultrasonographic images were examined for head rotation at 0°, 15°, 30°, 45°, 60°, and 75° from the midline to the left. The percentage of overlap of the common carotid artery by the internal jugular vein and the flattening of the internal jugular vein at each head rotation position were measured and evaluated. The overlap of the common carotid artery by the internal jugular vein significantly increased at ≥45° of head rotation 2 cm above the clavicle (P < 0.01) and at ≥30° of head rotation 4 cm above the clavicle (P < 0.01), compared with that observed in the neutral position. The flattening of the internal jugular vein significantly decreased at ≥45° of head rotation 2 cm above the clavicle (P < 0.01) and at ≥30° of head rotation 4 cm above the clavicle (P < 0.01). Head rotation should be kept to <45° at 2 cm above the clavicle and <30° at 4 cm above the clavicle to decrease the risk of accidental puncture of the common carotid artery during internal jugular vein puncture. Moreover, flattening of the internal jugular vein gradually decreases during head rotation to the side.     

Optimising intervals for abdominal aortic aneurysm surveillance: A pilot study analysing patient opinion

IntroductionOptimising abdominal aortic aneurysm surveillance intervals will improve current surveillance programmes. To the author’s knowledge, no known study has exclusively asked patient opinion with regards to their surveillance interval. The aim of this study was to therefore determine a patient’s perspective of their optimal intervals, encouraging shared decision-making and creating a patient-focused service.MethodsFifty patients, currently under abdominal aortic aneurysm surveillance, were interviewed. Patients were asked their opinions before and after seeing a patient decision aid. A patient decision aid presents information of risk in an easy-to-understand format. This specific patient decision aid, designed and created for this study, informed patients of the ‘risk of exceeding the 5.5 cm surgical threshold’ with regards to various surveillance intervals. The chosen optimal surveillance interval was recorded for each patient, and a median interval was calculated for each abdominal aortic aneurysm group. Groups were categorised based upon maximum aortic diameter (3.0–3.4 cm, 3.5–3.9 cm, 4.0–4.4 cm and 4.5–4.9 cm).ResultsAfter assessing the patient decision aid, the median surveillance interval calculated for each abdominal aortic aneurysm group was 24 months (3.0–3.4 cm), 12 months (3.5–3.9 cm), 12 months (4.0–4.4 cm) and 6 months (4.5–4.9 cm), respectively. The majority of patients (78%, n = 39) agreed that the patient decision aid was a useful tool to help make an informed choice.ConclusionOverall, patients in abdominal aortic aneurysm groups 3.0–3.4 cm and 4.5–4.9 cm would choose to lengthen abdominal aortic aneurysm surveillance intervals. Lengthening the current surveillance intervals to 24 months (currently 12 months) for abdominal aortic aneurysm group 3.0–3.4 cm and to 6 months (currently 3 months) for abdominal aortic aneurysm group 4.5–4.9 cm would not only increase capacity but also reflect the needs and wishes of those using the National Health Service. The use of a patient decision aid is an effective way of communicating, to the patient, the risk of the proposed changes and thus alleviating potential anxiety.