Abdominal wall reconstruction for desmoid tumors following radical resection from the abdominoplasty incision: Case report

Desmoid tumours are rare and locally invasive neoplasms that originate from the muscles and their aponeurosis. Incomplete excision causes recurrences; therefore, patients require aggressive resection that essentially entails tumour excision with a clear surgical margin. After radical resection, the resultant wide defect may lead to difficulty in closure of the anterior abdominal wall. Here, we report a case having surgery for large desmoid tumour of the anterior abdominal wall through an abdominoplasty incision followed by an abdominal wall reconstruction with a dual-sided composite mesh.

Non-invasive ductal carcinoma within malignant phyllodes tumor of the breast

Phyllodes tumors are uncommon breast neoplasms that constitute of 1-2% of breast malignancies. The tumor can mimic fibroadenoma clinically, radiologically and histologically. Ductal carcinoma in-situ in the epithelial component of phyllodes tumor is very rare. When ductal carcinoma in-situ is detected within the specimen, the management of treatment changes completely. We report a rare case of low grade ductal carcinoma in-situ arising in a malignant phyllodes tumor in a 55-year-old female patient.

Comparison of predictive factors for the diagnosis and clinical course of phyllodes tumours of the breast

BACKGROUND

To compare predicting factors for the diagnosis and clinical course of benign and malign/ borderline phyllodes tumours (PT) of the breast, and to discuss treatment modalities.

METHODS

Clinical and demographic characteristics of the patients with histopathological diagnosis of phyllodes tumour were examined. Patients were divided into group 1 (benign PT) and group 2 (borderline/malignant PT). Groups were compared in terms of demographic and clinical characteristics.

RESULTS

Of the patients studied, 37 (68.5%) had benign, 7 (12.9%) had borderline and 10 (18.5) had malignant histopathology. A statistically significant relationship was detected between the incidence of malignancy and mass diameter (p = 0.001) and age (p = 0.030) when the two groups were compared. Wide surgical excision was performed on 46 (82.5%) patients, simple mastectomy on 7 (13%) patients and modified radical mastectomy on one (1.9%) patient. Ten (18.5%) patients were re-operated for surgical margin positivity. Local recurrence was determined only in one (1.9%) patient. Distant metastasis due to malignant PT developed in two (3.7%) patients.

CONCLUSIONS

Among the patients who were considered to have PT, malignancy was likely to be present, especially if the patient's age was over 40 and the diameter of the mass was above 33.5 mm. Therefore, in patients with similar characteristics, surgical margins should be kept slightly wider or wider excisions should be preferred with or without simultaneous reconstructive surgery in appropriate cases.

Comparison of Predictive Factors For the Diagnosis and Clinical Course of Phyllodes Tumours of the Breast

BACKGROUND

To compare predicting factors for the diagnosis and clinical course of benign and malign/borderline phyllodes tumours (PT) of the breast, and to discuss treatment modalities.

METHODS

Clinical and demographic characteristics of the patients with histopathological diagnosis of phyllodes tumour were examined. Patients were divided into group 1 (benign PT) and group 2 (borderline/malignant PT). Groups were compared in terms of demographic and clinical characteristics.

RESULTS

Of the patients studied, 37 (68.5%) had benign, 7 (12.9%) had borderline and 10 (18.5) had malignant histopa-thology. A statistically significant relationship was detected between the incidence of malignancy and mass diameter (p = 0.001) and age (p = 0.030) when the two groups were compared. Wide surgical excision was performed on 46 (82.5%) patients, simple mastectomy on 7 (13%) patients and modified radical mastectomy on one (1.9%) patient. Ten (18.5%) patients were re-operated for surgical margin positivity. Local recurrence was determined only in one (1.9%) patient. Distant metastasis due to malignant PT developed in two (3.7%) patients.

CONCLUSION

Among the patients who were considered to have PT, malignancy was likely to be present, especially if the patient's age was over 40 and the diameter of the mass was above 33.5 mm. Therefore, in patients with similar characteristics, surgical margins should be kept slightly wider or wider excisions should be preferred with or without simultaneous reconstructive surgery in appropriate cases.

A different technique for the closure of trocar sites

This study aims to present a different technique for the closure of trocar sites in laparoscopic surgeries.

MATERIALS AND METHODS

Retrospective records of cases who received the new closure technique were collected. Multifilament synthetic absorbable suture was used in this technique, with no additional tools.

RESULTS

This technique was applied in a total of ten cases, which included myomectomy, hysterectomy, sacrocolpopexy, and ectopic pregnancy. No intraoperative and postoperative complications were seen in any of the cases.

CONCLUSION

This new and relatively easy-to-use technique can be used as an alternative technique for the closure of trocar sites in laparoscopy.

Emergent surgical treatment of radiation-induced enteropathies for patients with urogynecological and colorectal carcinomas

AIM

The aim of this study is to describe our 10-year experience in patients with urogynecological and colorectal carcinomas with radiation enteropathy treated surgically as an emergency, and to reassess symptoms and mortality.

PATIENTS AND METHODS

The study included 17 patients receiving emergency surgery for complications of radiotherapy. Data about the patients and outcomes of the treatment alternatives used were retrospectively analyzed.

RESULTS

Of 17 patients, nine had colorectal cancer, six had gynecological cancer, and two had cancer of the urinary system. As an emergency, 12 patients had ileus only, one patient had intestinal fistulae and ileus, two patients had bleeding and ileus and two patients had perforation on admission. Seven patients underwent resection and anastomosis, two patients intestinal by-pass, four patients resection and ostomy and four patients bridectomy. Morbidity (75% for early complications and 100% for late complications) and mortality in the early postoperative period (25%) were higher in the patients undergoing bridectomy than in the patients undergoing other surgical methods. The rate of early and late complications (71.4% and 66.6%, respectively) was lower in the patients undergoing resection-anastomosis with a higher of quality life. Only 11 patients survived during a long follow-up period (64.7%).

CONCLUSION

As the postoperative complication rate, overall and operative mortality of patients treated for radiation enteropaties as emergent surgery are high, specialists following this group of patients may favor removal of the pathologic tissue to avoid complications in the early and late postoperative period.

Infected tuboovarian hydatid cyst: a rare cause of tuboovarian abcess

Pelvic hydatid cysts, although rare, must be considered when evaluating a pelvic mass in women living in an endemic area. The pelvis may become secondarily involved as a result of a rupture of the cyst in another location or be the only localization of the disease. If the cyst becomes secondarily infected, it may mimic a tuboovarian abscess. A 49-year-old multipara was admitted to the emergency department with the complaint of fever, generalized abdominal pain and distension. Abdominal ultrasound revealed a 4 cm cystic structure in the liver and the gynecological examination was normal. The patient's abdominal pain receded spontaneously, so she was prescribed albendazole and discharged from the hospital. Ten days later, she complained of pelvic pain, pressure and vaginal discharge. The uterus and adnexa were tender on pelvic examination. Ultrasound revealed an 8 cm uniloculated cyst with free floating internal echogenities located between the bladder and the uterus. At surgery a 10 cm right-sided tuboovarian mass was present. A germinative membrane was present inside the abscess and pericystectomy with unilateral salphingo-oophorectomy was performed.

Diagnosis and treatment of mesenteric tumours

PURPOSE

To reveal clinical and diagnostic findings in patients with mesenteric tumours and to give an insight into the follow-up of these patients.

BACKGROUND

Primary tumours of the mesentery are very infrequent. These tumours are cystic or solid and show benign or malignant clinical behaviour. In this article, we report clinical and radiological findings from eight cases of mesenteric tumours.

PATIENTS AND METHODS

This study included eight patients with mesenteric tumours who underwent computed tomography in the Department of General Surgery, Baskent University, between December 2003 and April 2007.

RESULTS

Three mesenteric tumours were solid and five had cystic patterns. Seven were excised totally on laparotomy and one was excised on laparoscopy. None of the patients showed malignant progression. CT showed mesenteric cysts in only two cases, but failed to show solid tumours: the pre-operative diagnosis was made accurately in just (2/8) 25% of the patients.

CONCLUSIONS

It can be concluded that pre-operative CT is generally helpful, but inconclusive in an accurate diagnosis of mesenteric tumours. Surgery is required to make a definitive diagnosis of mesenteric tumours and to avoid complications.

Nine years' experience of needle localized breast biopsy in a university hospital: results and evaluation of the role of the surgeon in decision making

BACKGROUND

Needle localized breast biopsy is an effective means of detecting breast cancer in its early stages. We analysed the indications for needle localized biopsies, evaluated the results, and determined the surgeon's role in the decision-making process.

METHODS

The needle localized open biopsy results of 350 patients were assessed.

RESULTS

Malignancy was encountered in 7 of 56 patients in whom the radiologist suggested follow-up due to mammographical images, although a surgeon performed a biopsy with the assessment of the patient's historical and clinical findings (12.5%). Biopsy failure rates were higher for office-based ambulatory patients (9.1%) than for those patients who underwent biopsies in an operating theatre (1.9%; P < .05). Patients undergoing operating theatre biopsies under local anaesthesia showed statistically significant failure rates compared with those under general anaesthesia (p = .04). The rate of malignancy of micro-calcification was highest in patients younger than 40 years of age (64.3%), while spicular lesions were commonly malignant in patients over 50 years of age.

CONCLUSIONS

From our experience, we suggest that needle localized biopsies should be performed in the operating theatre with the patient under general anaesthesia. Although both micro-calcifications and spicular lesions have a high rate of malignancy in all decades, micro-calcifications are more prevalent in younger patients while spicular lesions prevail in older patients. The final decision, to follow-up or biopsy, should be based on a patient's clinical and historical perspective and not only on the guidance of the mammography report.

An unusual cause of chemical peritonitis

We report a case of chemical peritonitis associated with a bispyridine derivate used for abdominal lavage.