A Pelvic Hernia Through Two Defects in the Pouch of Douglas in a Patient With Peritoneal Xanogranuloma: A Report of a Very Rare Case

Pelvic internal hernias, including pouch of Douglas hernias, are a very rare cause of small bowel obstruction. They pose a challenge in diagnosis due to their rarity and lack of specific radiological features. The definitive diagnosis is usually reached intraoperatively. The treatment consists of reduction with or without resection of the herniated bowel and primary repair of the defect. Mesh placement has been reported but is still arguable, as no musculofacial defect is involved. Here, we present a case of a 28-year-old female patient, a nulliparous with multiple medical conditions including familial Mediterranean fever (FMF) and an extremely rare tumor, peritoneal xanthogranuloma. She had a history of laparoscopic left ovarian cystectomy, and complained of abdominal pain and distention for three days prior to admission. Her symptoms were associated with constipation and recurrent vomiting and she was admitted as a suspected case of small bowel obstruction. CT scan suggested the possible diagnosis of a pelvic hernia, yet the definitive diagnosis was reached intraoperatively after noticing the presence of two defects on the left side of the pouch of Douglas. A primary repair of the defects was performed after reduction of the viable herniated bowel. The patient was discharged on the third postoperative day with uneventful course of recovery.

Pilomatrixoma of the Arm: A Case Report and Review of Literature

Pilomatrixoma (PMX), also known as calcifying epithelioma of Malherbe, is a rare benign neoplasm that arises from the hair matrix cells, commonly in the head, neck, and upper trunk regions, infrequently affecting upper and lower extremities. It has to two peaks of presentation: under 20 years of age or between 50 and 65 years of age, slightly more common in females. The neoplasm exhibits diverse clinical manifestations and is frequently subject to misdiagnosis with alternative dermatological diseases. We present an atypical case of PMX affecting the upper extremity of a 62-year-old female patient. Surgical removal of the affected tissue under local anesthesia was performed, and subsequent histopathological analysis confirmed the presence of PMX. Based on the literature search we performed, we found out that this pathology is underreported in Jordan, with only one study published describing this tumor in the maxillofacial region. Physicians should be aware of this condition and its different presentations to include it in the differential diagnosis of suspected cases to provide the appropriate management and follow-up.

A Sporadic Giant Mesenteric Desmoid-Type Fibromatosis in a Teenage Female: A Report of a Rare Case

Mesenteric desmoid-type fibromatosis (DTF) is a rare benign yet aggressive neoplasm that has an unpredictable biological behavior ranging from spontaneous regression to extensive local infiltration and has a high tendency for recurrence. The presenting symptoms are usually nonspecific and mostly related to the large size of the tumor compressing adjacent organs. Imaging studies can be suggestive of the diagnosis, but confirmation is based on histopathological and immunohistochemical examination. The lack of knowledge on the etiology and pathogenetic behavior of this tumor leads to therapeutic and prognostic challenges. Future genetic studies may help in advancing our understanding of this neoplasm and in formulating the proper management and follow-up plan. Here we present a case of a 14-year-old female who presented to the emergency room complaining of diffuse abdominal pain and distention. A computed tomography (CT) scan showed a large mass occupying most of the abdominal cavity and compressing adjacent organs. Exploratory laparotomy with resection and anastomosis was performed, and the histopathological and immunohistochemical examination of the resected mass was consistent with mesenteric DTF.

Pediatric Ileosigmoid Knotting: A Rare Culprit of Acute Abdominal Pain

The present study focuses on ileosigmoid knotting (ISK), an infrequent but potentially lethal surgical emergency. ISK is more frequently observed in males and is prevalent in regions with high rates of sigmoid volvulus. The current medical scenario revolves around the intricate intertwining of the ileum and sigmoid colon, leading to a complicated volvulus. This condition often results in acute intestinal obstruction, which can subsequently cause bowel necrosis. The clinical presentation of the condition is characterized by symptoms such as abdominal distention, pain, vomiting, and obstipation, which can be misleading as they are similar to other common abdominal conditions. A delay in definitive diagnosis and intervention is likely, which can lead to severe consequences such as peritonitis, bowel necrosis, sepsis, and even septic shock. Our case report discusses an instance of ISK presenting as an acute abdomen requiring an emergency laparotomy and detorsion of the volvulus-knotted segment, followed by an elective sigmoidectomy. The significance of a heightened level of suspicion, prompt decision-making, and timely surgical intervention in achieving better patient outcomes cannot be overstated. The objective is to enhance the medical community's understanding of ISK, focusing on early diagnosis and effective treatment of this rare but life-threatening disease.

Mullerian Cyst Presenting as an Inguinal Mass: A Rare Case Report

Mullerian cysts are rare cystic lesions that represent remnants of Mullerian ducts. The clinical presentation usually involves swelling or symptoms of large cyst-size compression of adjacent structures. The preoperative diagnosis is very challenging due to the lack of specific features, and the precise diagnosis is reached with histopathological examination. In this report, we discuss a case involving a 26-year-old woman who visited our clinic with complaints of swelling in her left inguinal region. The patient was operated on as a case of a suspected left inguinal hernia, but the histopathological examination of the excised mass was consistent with the diagnosis of a Mullerian cyst.

Nipple-Sparing Mastectomy: Initial Experience Evaluating Patients Satisfaction and Oncological Safety in a Tertiary Care Centre in Jordan

Introduction

Nipple-sparing mastectomy (NSM), a procedure involving careful dissection of the breast tissue whilst keeping the nipple-areola complex (NAC) intact, is now increasingly practiced amongst surgeons in the treatment of certain situations of breast cancer. Given the importance of breasts to the female body image, this type of conservative breast surgery takes into account patient satisfaction and overall cosmesis, whilst ensuring appropriate oncological safety.

Methods and results

Four nipple-sparing mastectomy procedures were performed in our tertiary care centre, Princess Basma Teaching Hospital, in Jordan between June and September 2019. Indications for these procedures included invasive ductal carcinoma, malignant phyllodes, and high-grade ductal carcinoma in-situ. Patients were carefully assessed prior to surgical intervention using radiological imaging, ensuring a distance from NAC of >2 cm in all cases. Procedures were performed successfully with minimal intraoperative and no post-operative complications. Follow-up was carried out at 24 months, with no cases of local or distant post-operative recurrence, and patient satisfaction was qualitatively measured with the use of a BREAST-Q questionnaire. The questionnaire demonstrated improved overall physical well-being and satisfaction with an average overall post-operative physical well-being of 97%.

Conclusion

Following nipple-sparing mastectomy and immediate submuscular reconstruction with silicone implants,patients demonstrated high levels of satisfaction and quality of life (QoL) as measured by BREAST-Q survey. Two years of follow-up confirmed high patient satisfaction with increased scores from the preoperative baseline level.

Spindle Cell Carcinoma of the Breast: A Case Report Representing Diagnostics, Therapeutics, Intervention, and Outcome

Background: Spindle cell carcinoma (SpCC) is an unusual form of squamous cell carcinoma (SCC) and can sometimes present in the breast. Owing to the rarity of breast SpCC, few case studies are available nowadays and proper evidence is scarce.  Case presentation: We herein report a 60-year-old female patient, who was referred to the surgery services after presenting with a right breast ulcerated mass. On physical examination, a 7x7 cm mass was found along with a 3 cm ulcer on the top of it. Both mammography and ultrasound showed a dense mass, and tru-cut and skin punch biopsies confirmed neoplastic spindle cells within the lesion. The patient underwent a right total mastectomy with sentinel lymph node biopsies with no further chemotherapy or radiotherapy. Conclusion: Owing to the heterogeneity of SpCC, there is no exact treatment protocol for this type of cancer, and mastectomy or conservative surgery can be performed in certain groups of patients depending on tumor size, stage, and lymph node involvement. Fortunately, promising medical and biological therapies might be of use in the near future.

Multifocal intra-parenchymal and sub-pectoral malignant phyllodes tumor in young female, rare and unusual presentation: A case report

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To the best of our knowledge, the current report is the first to mention Sub-pectoral breast primary phyllodes tumor.

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Phyllodes tumors usually present in 35–55 years old female patients but should be suspected in any fast-growing breast mass, even in young age groups.

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In this case the patient preferred adjuvant radiotherapy to the nipple-areola complex and surrounding skin instead of surgical excision although results are oncologically inferior.

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Early diagnosis and initiation of appropriate treatment of Phyllodes tumors may lead to prevent metastasis and improve outcomes.

Introduction

Phyllodes tumors are rare fibroepithelial breast tumors, accounting for less than 1% of all breast tumors. Most Phyllodes tumors are benign. However, about 10% are malignant. The Mean age of presentation for the Malignant Phyllodes tumors is 40 years. This case report describes an unusual presentation of Phyllodes tumor in a young female with an unusual site and presentation of the tumor.

Presentation of case

A 23-year-old female presented with multiple left breast rapidly growing masses. Imaging showed two intra-parenchymal left breast masses and one mass lying posterior to the left pectoralis major muscle, anterior to the chest wall. Diagnosed as phyllodes tumor. Nipple areola sparing mastectomy was performed with excision of the tumor and immediate reconstruction using a silicone implant, followed by radiotherapy.

Conclusion

Phyllodes tumor usually presents in patients between 35–55 years old as a single breast mass. Yet, in rare cases, multifocal disease can happen, and disease can present in younger ages. The sub-pectoral presentation of phyllodes tumor is not mentioned in the literature before this case.