Predicting incomplete basal cell carcinoma excisions - a large multidisciplinary retrospective analysis in a tertiary center

Introduction: Surgical treatment of basal cell carcinomas is often performed by physicians with different surgical backgrounds. Collecting data from different surgical departments would better reflect their real-life surgical management.Objectives: To identify the rate, recurrence risk, and predictive factors accordingly to their relative contribution for an incomplete basal cell carcinoma excision in a large multidisciplinary real-life settingMethods: Retrospective cohort study of 2305 surgically treated lesions in different departments of a tertiary center.Results: There was a rate of incomplete excisions (15%) and a recurrence rate (35.5% vs. 6.8% in incomplete vs. complete excisions (p < .001)). A third of incompletely excised basal cell carcinoma (BCC) will recur over time. Stratified by relevancy, high-risk histological subtypes (micronodular (OR 5.10 - p < .001) and morpheaform (OR 5.42 - p < .001), smaller specimen sizes ( <0.5 cm or 0.5-1 cm, OR 3.99 and 2.49, respectively, p < .001) high-risk locations (OR 3.06 on the nose, OR 2.77 on the eyelids, p < .001), and recurrent BCCs (OR 1.72, p < .001). are the best predictors of an incomplete excision.Conclusions: Acknowledging the rate, recurrence risk and predictive factors for incomplete excisions may be beneficial for optimal preoperative planning and to prevent unwarranted re-interventions, morbidity, and healthcare costs.

Trichophagia and trichobezoar: case report

Objective:

Trichobezoar consists of a compact mass of hair occupying the gastric cavity to a various extent. When the trichobezoar extends past the duodenum it is better referred to as Rapunzel Syndrome. Although trichobezoars are well described in terms of surgical diagnostic and procedure, there are only but very scarce reports on psychiatric literature, usually associated with trichotillomania. The authors present a clinical case of trichobezoar and discuss the most relevant aspects concerning this entity.

Methods:

Presentation of psychiatric and surgical data concerning the case report. Previously reported cases are also mentioned.

Results:

Report of a 27-year-old female patient with a trichobezoar submitted to surgical removal, with a prior intervention 4 years before also due to trichobezoar, and with unknown psychiatric antecedents or follow-up.

Conclusions:

A trichobezoar represents a serious surgical condition. It is important to consider such diagnosis in face of suggestive symptoms, even if signs of trichotillomania are not present. The discrepancies between the prevalence of trichotillomania and trichobezoars due to trichophagia may be due to issues related to self-selection of patients and symptom severity. Such issues may also be important in the study of impulsive-compulsive spectrum models and to their relevance to impulse control disorders.

[Pre-natal retroperitoneal mass: teratoma or fetus in fetu?]

BACKGROUND

Several case reports in the literature brought to discussion the distinction criteria between fetus in fetu and teratoma.

CASE REPORT

The authors present a case report of a premature newborn boy, evaluated for a capsulated abdominal mass with prenatal diagnosis pointing to possible malignant lesion. A CT scan showed an expansive, retroperitoneal lesion, from kidneys to pelvis, sacrum and coccyx, with solid, cystic and fatty areas; the fine needle aspiration was inconclusive, and he underwent surgery on day 9 with partial resection of the lesion. A new procedure to complete the excision was performed 8 months later. The histopathologic examination of the two fragments showed mature and organized components of nervous system, respiratory and digestive apparatus (liver and pancreas included), thymus, nervous ganglia, skin and adnexa, musculoskeletal and brown adipose tissues; cartilage and several focus of calcification. These components showed a craniocaudal orientation, but no evidence of organoid formation.

DISCUSSION

This case presents features of both teratoma and fetus in fetu. The assumption of either one of the diagnosis has prognostic implications, with resulting differences in clinical follow up and expectations about the child's health.

Canine Leishmaniasis Chemotherapy: Dog's Clinical Condition and Risk of Leishmania Transmission

The aim of this study was to investigate whether treatment against canine leishmaniasis reduced the presence of Leishmania in the healthy skin of dogs, affecting the capacity of parasite transmission. A total of 37 dogs from an endemic region of leishmaniasis were studied. Thirteen symptomatic animals revealed parasites in the bone marrow and eight had also in the skin. Five of the 22 dogs that had been treated with meglumine antimoniate alone, meglumine antimoniate or trifluralin followed by allopurinol or just with allopurinol had the parasite in bone marrow but none showed Leishmania in the skin. One dog that was treated only with aminosidine was polisymptomatic and had parasites in bone marrow and skin. The different treatments used in this study did not completely eliminate the parasite allowing relapses to occur when the treatment is discontinued, but the use of meglumine antimoniate or allopurinol, alone or combined may improve dogs clinical condition and reduce or eliminate the parasite from the skin decreasing the probability of Leishmania transmission.

Equine infection withLeishmaniain Portugal

The present report describes the first case of equine leishmaniasis in Portugal. Leishmania infection was detected in one animal, which presented an ulcerated skin lesion. Diagnosis was based on serology by CIE, and parasite DNA detection by real-time PCR using a probe specific for L. infantum. This finding requests further leishmaniasis equine surveys in order to clarify the role of the horse as reservoir host in european endemic areas.