Aggressive angiomyxoma mimicking inguinal hernia in a man

We report the case of a 37-year-old Japanese man who presented with a left lower abdominal mass that was initially interpreted clinically as an inguinal hernia. The patient reported a swelling in his left lower abdomen over the past 6 months. Magnetic resonance imaging revealed a left inguinal mass extending from the left spermatic cord to the left inguinal subcutaneous layer. Local excision was performed, with a preoperative diagnosis of benign soft tissue tumor. Histopathological diagnosis revealed aggressive angiomyxoma (AAM), and no recurrence was observed 6 months after surgery. AAM is a rare tumor which most commonly occurs in the pelvis or perineum of premenopausal women, with extremely rare cases in men. The findings from previously reported cases and our case suggest that AAM should be considered in patients with an inguinal or scrotal swelling with a suspicious soft tissue tumor.     

An Unusual Case Of Inferior Turbinate Osteoma Removed Endoscopically: A Case Report

Inferior turbinate osteoma is exceptionally rare. Here we are reporting a case of inferior turbinate osteoma presented with history of left nasal obstruction. CT unveiled osseous hypertrophy of left inferior turbinate. Osteoma was removed endoscopically using hammer and gouge. This is the fourth case to be reported in the world literature and second in India.     

Epithelial ovarian tumor in a phenotypic male

Laparotomy in a 41-year-old married man with non-treated left cryptorchidism revealed female internal genitals on the left side, and an epithelial ovarian tumor of intermediate malignancy. Germinal malignancies are frequent in intersexes, but non-germinal gonadal neoplasms are rare. This is the second reported case of epithelial ovarian tumor in intersexes, and the first case of epithelial ovarian tumor in an intersex registered as male.     

Reconstruction of mandible with free fibular vascular graft

This is a case report of ameloblastoma of left mandible. It was treated with left extended hemimandibulectomy with free fibular vascular graft.     

Solitary adrenal metastasis from hepatocellular carcinoma: a case report of simultaneous successful resections

The case is presented of a 64-year-old male with a left adrenal mass and multiple liver lesions. Preoperative image work-ups included ultrasonography, computed tomography, selective liver and adrenal angiographies, and magnetic resonance imaging. Serial serum alpha-fetoprotein monitoring and the adrenal hormone profile were within the normal ranges. A left adrenalectomy and a right lobectomy of the liver were performed, and the pathology revealed hepatocellular carcinoma with left adrenal metastasis. The clinical significance of the present case, together with the diagnosis and management of the disease is discussed.     

Clinical Features and Mid-Term and Long-Term Outcomes of Surgical Treatment of 8 Patients with Primary Ventricular Tumors

OBJECTIVE To summarize the clinical features and surgical treatment of primary ventricular tumors. METHODS Eight patients with primary ventricular tumor, aged 3 to 52 years, underwent surgical treatment. There were 6 males and 2 females. The pathological diagnoses were as follows: multiple left ventricular myxomas in 2 cases; left ventricular rhabclomyoma, fibroma and malignant neurolemmoma in 1 case for each; right ventricular myxoma and malignant neurolemmoma in 1 case for each; intraseptal fibroma in 1 case. The operations were performed through median sternotomy with moderate hypothermic cardiopulmonary bypass in 7 cases; via left anterolateral thoracotomy without extracorporeal circulation in 1 case. Tumors were totally removed in 7 cases and subtotally resectecl in 1 case. RESULTS Cardiac arrest after anaesthetization occurred in 1 case with postoperative coma for 10 days. One case died of massive gastro-intestinal hemorrhage postoperatively. Seven cases survived, During a follow-up period of 1 to 21 years, there was no recurrence or metastasis in the 6 cases who received complete tumor resection including 2 cases with malignant tumor. One case of partial tumor removal had a mild heart murmur without tumor progression. All patients were asymptomatic with cardiac functiongrade I. CONCLUSION Primary ventricular tumors showed diversity in their histological characteristics. The mid- and long-term outcomes of surgical treatment for primary ventricular tumors appear to be satisfactory.     

Onychogryphosis

A case of onychogryphosis of the left index nail is presented. This classical toenail dystrophy in our case involves a fingernail and is associated with onychomycosis.     

Intrathyroid parathyroid carcinoma with intrathyroidal metastasis to the contralateral lobe: source of diagnostic and treatment pitfalls

Intrathyroidal parathyroid carcinoma is extremely rare clinical entity with potentially multiple diagnostic pitfalls. We report a case of 40-year-old man presented with classical manifestations of primary hyperparathyroidism, severe hypercalcemia and profoundly increased serum parathyroid hormone level. Neck ultrasonography demonstrated multinodular goiter with predominant 34 mm nodule in left thyroid lobe. Additional 16 mm nodule was found beneath the left lobe. Routine percutaneous fine-needle aspiration of predominant nodule indicated follicular thyroid carcinoma, while left inferior nodule was confirmed to be of parathyroid origin. The patient underwent surgery, during which frozen sections identified medullary thyroid carcinoma with metastasis to upper mediastinal lymph node. Permanent sections of the predominant left lobe nodule revealed intrathyroidal parathyroid carcinoma surrounded with multiple microscopic metastases. Left inferior nodule was metastatic lymph node. Additional 10 mm intrathyroidal metastasis of primary parathyroid carcinoma was found within right thyroid lobe. This case indicates that fine-needle-aspiration and intraoperative biopsy are of limited value in diagnosing parathyroid carcinoma, especially if localized intrathyroidally. Oncological en-block resection is treatment of choice, implying ipsilateral lobectomy in case of thyroid invasion. This firstly described case of intrathyroidal parathyroid carcinoma causing intrathyroidal dissemination may influence future treatment strategies.     

Bilateral chylothorax following left supraclavicular lymph node dissection for breast cancer:one case report and literature review

Chylothorax is a rare complication of neck dissection, and bilateral chylothorax is even rarer. However, both are potentially serious and sometimes life-threatening, especially those that are associated with left neck dissection for head and neck neoplasms. We report one case of bilateral chylothorax following left supraclavicular dissection for breast cancer. This case was treated successful y with a new conservative management approach.     

A case against elective nephron sparing surgery for renal cell carcinoma

A 62-year old man who incidentally was discovered to have a mass lesion in the lower pole of the left kidney underwent left radical nephrectomy. The mass was 32 millimetres in its largest diameter. Although the left adrenal gland was radiologically and macroscopically normal, histopathological examination revealed microscopic foci of metastasis. The present case urges us to be more cautious in offering partial nephrectomy for left sided tumours even though it is incidentally detected and small.     

Generalised recurrent Rhinosporidiosis

Rhinosporidiosis, a chronic granulomatous lesion by Rhinosporidium seeberi is endemic in India. The disease has a varied clinical picture. A very rare case (in a follow-up of four years) has presented with involvements of mucous membrane (nose, nasoparynx), viscera (trachea, main bronchus), bone (left ring finger) and skin (over left cheek upper arm, seventh rib, left ring finger).     

扩大性手术切除侵犯心房、降主动脉和隆凸的非小细胞肺癌

目的：探讨寸外科手术切除侵犯心脏、大血管和气管隆凸的局限性晚期非小细胞肺癌的临床疗效和手术适应证。方法：对侵犯心房3例、降主动脉1例、气管隆凸3例的非小细胞肺癌实施外科切除。术前排除远处和对侧肺转移，骨扫描排除全身骨转移、侵犯心房3倒中，2例为左全肺切除．1例为右全肺切除；侵犯降主动脉1例为左上叶肺癌术后复发井侵犯降主动脉，在建立左心房一降主动脉转流辅助下完成降主动脉切除及人工血管置换；侵犯隆凸的3例．术前气管镜发现肿瘤距隆凸的距离分别为1.8，1．0和0．3厘米，均行右全肺袖形切除和隆凸成形。术后病理均为鳞癌，分期T4LN0M0 6例，T4N2M0 1例，结果：无1例并发症；7倒中6例随访超过1年，1例(降主动脉切除)已超过9月；4例随访超过3年；肺静脉内血栓形成中的1例于术后2年半即术后30月困脑转移死亡．隆凸切除中的1例固余肺感染致呼吸衰竭于术后15月死亡。结论：对于侵犯心脏、大血管和隆凸的局限性晚期非小细胞肺癌，病例选择正确和良好的手术技术确保局部肿瘤的完整性切除．也能取得较满意的临床疗效。     

Bilateral breast metastases from ewing sarcoma of the femur

We report a case of bilateral breast metastases from Ewing sarcoma of the femur. A 40-year-old woman presented with Ewing sarcoma of the left thigh, treated by complete surgical exeresis and chemotherapy. Secondary, a large tumor appeared in the left breast. Bone scintigraphy, chest, and abdominal computed tomographic scan were normal. A breast biopsy found a malignant tumor composed of small round cells consistent with the initial diagnosis. After the first cycle of chemotherapy, a tumor was discovered in the controlateral breast. After 5 cycles, residual tumors persisted in the 2 breasts. Tumor exeresis was performed and found bilateral breast metastases of Ewing sarcoma. Because of the early recurrence of the left breast tumor, segmentectomy of the right breast and left mastectomy were performed. The histopathological analysis confirmed Ewing sarcoma metastases in the left breast. Despite local radiotherapy, the clinical course was marked by lumbar bone metastasis, local chest evolution, and progression of the disease. Metastases to the breast by extramammary malignant neoplasms are unusual. Sarcoma is an extremely rare cause of breast metastases and our case is the first report of breast metastases from Ewing sarcoma.     

Adenoid cystic carcinoma of nasal cavity - a case report

A 38 year old male patient presented with pain and swelling on left side of nose with mass in left nostril. The other symptoms were nasal obstruction, epistaxisc from left nostril and epiphora from left eye. CT scan showed a mass arising from lateral wall of nose on left side eroding anterior part of medial wall of maxillary sinus. The tumor was excised with wide margin through a lateral rhinotomy approach under general anaesthesia. In histopathologieal examination it was found to be cribriform type of Adenoid Cystic Carcinoma. This case is reported here for its rarit.     

Bilateral endoprosthetic replacements of the proximal femur

Patient. We report the case of a 20-year-old caucasian male with an Ewing's sarcoma in the left upper femur. After induction chemotherapy, he underwent resection of the left upper femur and insertion of a cemented proximal femoral replacement. Four years later, he presented with a solitary bone metastasis in the right upper femur. He underwent further chemotherapy followed by resection and endoprosthetic replacement of the other proximal femur. He remains disease free with excellent function almost a year after the second operation.Discussion. We believe this is the first reported case of bilateral proximal femoral endoprostheses.     

Clinicopathological report: bilateral choroidal metastases from papillary thyroid cancer

Bilateral uveal metastases from papillary thyroid carcinoma are extremely rare. A 36-year-old woman with a 12-month history of papillary thyroid carcinoma presented with sudden loss of visual acuity and fields in the left eye. An examination and B-scan revealed a large, solid choroidal lesion in the left eye causing exudative retinal detachment. A small solid mass was also observed in the right eye fundus. Following left eye enucleation, immunohistopathology confirmed metastatic papillary thyroid carcinoma. The authors report the third known case of bilateral choroidal metastases.     

Primary liposarcoma of the lung: Report of a case

We reported one case of a primary liposarcoma of the lung which has been reported only in six cases to date worldwide, and we added some documented study. A 49-year-old female complained of exertional dyspnea with about 100 ml of hemoptysis. The chest X ray showed a coin lesion at the left upper field. After left pneumonectomy, the histological examination revealed liposarcoma of the lung. Six months after the operation, she died from severe dyspnea; the autopsy revealed the relapse of liposarcoma in the right lung, and no liposarcomas in other organs. This is the seventh case according to a worldwide review of the literature.     

Diffuse intramuscular lipomatosis of a lower limb

Patient. A 40-year-old man presented with a swelling of the left thigh which had been increasing in size over 10 months. Surgery confirmed a diagnosis of lipoma. After 6 months, another swelling appeared, this time in the left calf. Ultrasound-guided biopsies revealed that the tissue showed appearances consistent with intramuscular lipoma. No further surgery was performed and the man is to be reviewed regularly, with possible debulking if necessary.Discussion. This case presents an atypical case of lipomatosis. Magnetic resonance imaging is useful for assessing the extent of the lesion.     

Erlotinib response of EGFR-mutant gefitinib-resistant non-small-cell lung cancer

PURPOSE: Failure to gefitinib is generally believed to be associated with cross-resistance to other epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKI). Here we report a case whose active EGFR-mutant NSCLC responded to erlotinib treatment. PATIENT AND METHODS: Lung specimen was obtained during diagnostic procedures from a 41-year-old Taiwanese male smoker with adenocarcinoma. He received cisplatin-based chemotherapy following craniotomy to remove his brain metastasis. Tumor progressed in both lung and left adrenal gland. He underwent second-line docetaxel chemotherapy. Tumor progressed again 7 months later. He was subsequently treated with gefitinib 250mg QD. Complete regression of the lung tumor and partial response of the left adrenal gland mass was achieved. Nine months later, the left lower lobe lung tumor and left adrenal gland tumor progressed. A lung biopsy from the left lower lobe disclosed an adenocarcinoma which harbored an in-frame deletion in exon 19 (heterozygous delE746-A750) of EGFR without a second mutation such as T790M in exon 20. Subsequent erlotinib 150mg QD was administered. He experienced grade 1 skin rash, diarrhea and paronychia following erlotinib. RESULTS: This patient achieved a partial response to erlotinib treatment. He remained on erlotinib for a total of 18 months until the left adrenal gland tumor progressed. CONCLUSIONS: This case demonstrated that NSCLC bearing in-frame deletion in exon 19 of EGFR may respond to erlotinib treatment following gefitinib failure.     

Haemorrhagic cystic sino-nasal fibrous dysplasia

A 9 years old boy reported with left nasal blockage, occasional left nasal bleeding, protruding left eye ball and widening of the nasal bridge for the last nine months. Clinical examination and radiological evaluation were suggeitive of fibrous dysplasia. Mass was excised by transfacial and transcranial approach. Histopathology of the excised muns proved to be a case of haemorrhagic cystic sino-nasal fibrous dysplasia.