Incidental finding of left-sided superior vena cava: A case report and comprehensive literature review

INTRODUCTION AND IMPORTANCE

Persistent left superior vena cava (PLSVC) is a rare vascular anomaly that affects systemic venous circulation. PLSVC typically is asymptomatic as the return of venous blood to the right atrium occurs through the coronary sinus. It is important to possess a comprehensive understanding of drainage as it can present challenges in catheter placement on the right side of the heart, aiming to prevent potential complications.

CASE PRESENTATION

A 59-year-old female patient presented at the medical service with abdominal distention. During the examination, the presence of ascites was observed. Subsequent studies revealed peritoneal carcinomatosis of unknown origin. The patient underwent staging laparoscopy with biopsy sampling. Consequently, the placement of a catheter for chemotherapy was performed. A portable chest X-ray was obtained revealing the catheter extending along the left subclavian vein and progressing through the left paramediastinal regionThe presence of persistent left superior vena cava was confirmed after reviewing prior studies.

CLINICAL DISCUSSION

The most common abnormality in the venous drainage system is PLSVC. Approximately 40 % of PLSVC cases have associated significant cardiovascular anomalies, with septal defects being the most common. Recognizing anomalies and anatomical variants with the involvement of a multidisciplinary team is critical to prevent vascular complications during endovascular procedures and to tailor techniques for patients in need of cardiac endovascular procedures or cardiac devices.

CONCLUSION

PLSVC is often asymptomatic and discovered incidentally, it is essential to have a comprehensive understanding of this anomaly and perform meticulous imaging workup to prevent potential complications.

Extrapulmonary bronchogenic cyst: A case report

INTRODUCTION

Bronchogenic cysts (BCs) are rare congenital lesions that originate from the tracheobronchial bud and can be found in any organ derived from the embryonic foregut. Complete surgical excision is the treatment of choice, and the definitive diagnosis is established by histopathological examination.

PRESENTATION OF THE CASE

41-year-old female with diastolic arterial hypertension and a heterogeneous mass, with multiple calcifications and a solid component with well-defined regular contours. A biochemical study revealed no functionality. Intraoperatively we noticed an adrenal gland-dependent mass with a cystic component and an area of sebaceous content and histological examination confirmed a bronchogenic cyst.

DISCUSSION

The majority of cases of BCs are asymptomatic. They can be intrapulmonary, mediastinal or ectopic, being the left adrenal region the most common retroperitoneal location. Symptomatic cysts should always be surgically resected either by thoracotomy or a minimally invasive technique, which has been shown to improve postoperative discomfort and shorten hospital stay with reliable postoperative outcomes.

CONCLUSION

Despite their low incidence, it is important to consider BCs in the differential diagnosis of retroperitoneal masses, particularly in the left para-adrenal region.

Laparoendoscopic assisted surgery for a gastrointestinal stromal tumor (GIST): A case report

INTRODUCTION

Gastrointestinal stromal tumors (GIST) are infrequent, and clinical presentation varies between asymptomatic and diffuse symptoms such as abdominal pain and dyspepsia. Surgical approach depends on location and size of the tumor. There are some reports of the specific surgical approach for GIST located at the gastroesophageal junction. This is a case report of a patient with a GIST located specifically at the gastroesophageal junction and the surgical approach selected for the treatment.

PRESENTATION OF THE CASE

A 70-year-old patient who developed an episode of upper gastrointestinal bleeding with hemorrhagic shock accompanied by elevated troponins that required transfusion therapy and whose endoscopic evaluation showed a subcardial ulcerated lesion of 16 × 5 mm, located 2 cm below the z-line. The lesion was biopsied and was negative for malignancy. A combined surgical approach for resection by combined laparoscopy and submucosal resection by upper gastrointestinal endoscopy was performed by the interventional gastroenterology service and surgical oncology service.

DISCUSSION

Specific management of GISTs depends on the location of the tumor, even though, complete surgical resection remains the gold standard treatment. Minimally invasive techniques can be used to assess these tumors leading to shorter hospital stays and lesser risk of complications. Laparoendoscopic cooperative surgery is a promising approach for managing lesions near the gastroesophageal junction.

CONCLUSION

GISTs located near the gastroesophageal junction require a complex approach. The laparaendoscopic approach seems to be a feasible approach for GIST in the gastroesophageal junction.

Giant retroperitoneal liposarcoma surgical management

Retroperitoneal liposarcomas are very infrequent retroperitoneal malignant tumours. Most patients complain of palpable abdominal mass and only half present with abdominal pain. With haematogenous spread they can reach, mainly, lungs and liver, but only in 10% of cases. Here we report the presentation and surgical treatment of a giant massive retroperitoneal liposarcoma in a 53-year-old man.

Giant retroperitoneal liposarcoma surgical management

Retroperitoneal liposarcomas are very infrequent retroperitoneal malignant tumours. Most patients complain of palpable abdominal mass and only half present with abdominal pain. With haematogenous spread they can reach, mainly, lungs and liver, but only in 10% of cases. Here we report the presentation and surgical treatment of a giant massive retroperitoneal liposarcoma in a 53-year-old man.

Minimally Invasive Gastric Surgery

The incidence of gastric cancer is increasing in the United States, particularly for various subtypes as well as presenting in earlier states. Such changes have allowed various centers to increasingly offer less invasive approaches to the treatment of gastric cancer, namely laparoscopic and robotic techniques. Minimally invasive gastrectomy has been suggested to have similar oncology outcomes compared to open procedures. In the last two decades, large retrospective and a series of randomized trials evaluated the role of minimally invasive gastrectomy for early gastric cancer, distal gastrectomy, total gastrectomy and advanced gastric cancer. As the experience with emerging technologies such as robotic assisted gastrectomies increases, the indications for minimally invasive surgery will likely expand.

Initial report of near-infrared fluorescence imaging as an intraoperative adjunct for lymph node harvesting during robot-assisted laparoscopic gastrectomy

INTRODUCTION

Adequate lymphadenectomy is a fundamental aspect of oncologically sound gastrectomies. Robot-assisted laparoscopic gastrectomy is a minimally invasive alternative that allows functional imaging to be easily integrated to the surgical field and may aid in intraoperative identification of lymphovascular bundles.

METHODS

Indocyanine green application and near-infrared fluorescence imaging were used during robot-assisted laparoscopic gastrectomy as an adjunct for the identification of relevant lymph node basins in real time.

RESULTS

A total of 31 patients were included. Twenty-nine gastrectomies were performed for adenocarcinoma and two wedge resections for neuroendocrine tumors. The mean lymph node retrieval was twenty-nine (range 17-61) for adenocarcinoma and five for neuroendocrine tumors. In all cases, at least five lymph nodes were seen along the main nodal basins, which provided real time intraoperative feedback regarding lymph node identification. Average time for indocyanine green application and functional imaging was less than 10 min.

CONCLUSIONS

Near-infrared fluorescent imaging may provide an improved method to help visualize lymph nodes intraoperatively during robot-assisted laparoscopic gastrectomy, thus adding a potentially valuable adjunct for lymphadenectomy and overall lymph node retrieval. J. Surg. Oncol. 2016;113:768-770. © 2016 Wiley Periodicals, Inc.