Concomitant treatment of ureteral calculi and ipsilateral pelvic sciatic nerve schwannoma with transperitoneal laparoscopic approach: A case report

BACKGROUND Schwannomas are rare peripheral neural myelin sheath tumors that originate from Schwann cells.Of the different types of schwannomas,pelvic sciatic nerve schwannoma is extremely rare.Definite preoperative diagnosis of pelvic schwannomas is difficult,and surgical resection is the gold standard for its definite diagnosis and treatment.CASE SUMMARY We present a case of pelvic schwannoma arising from the sciatic nerve that was detected in a 40-year-old man who underwent computed tomography for intermittent right lower back pain caused exclusively by a right ureteral calculus.Subsequently,successful transperitoneal laparoscopic surgery was performed for the intact removal of the stone and en bloc resection of the schwannoma.The total operative time was 125 min,and the estimated blood loss was inconspicuous.The surgical procedure was uneventful.The patient was discharged on postoperative day 5 with the simultaneous removal of the urinary catheter.However,the patient presented with motor and sensory disorders of the right lower limb,caused by partial damage to the right sciatic nerve.No tumor recurrence was observed at the postoperative appointment.CONCLUSION Histopathological examination of the specimen confirmed the diagnosis of a schwannoma.Thus,laparoscopic surgery is safe and feasible for concomitant extirpation of pelvic schwannomas and other pelvic and abdominal diseases that require surgical treatment.

Practical approaches to effective management of intestinal radiation injury:Benefit of resectional surgery

AIM:To study the outcome of patients undergoing surgical resection of the bowel for sustained radiation-induced damage intractable to conservative management.METHODS:During a 7-year period we operated on 17 cases (5 male,12 female) admitted to our surgical department with intestinal radiation injury (IRI).They were originally treated for a pelvic malignancy by surgical resection followed by postoperative radiotherapy.During follow-up,they developed radiation enteritis requiring surgical treatment due to failure of conservative management.RESULTS:IRI was located in the terminal ileum in 12 patients,in the rectum in 2 patients,in the descending colon in 2 patients,and in the cecum in one patient.All patients had resection of the affected region(s).There were no postoperative deaths,while 3 cases presented with postoperative complications (17.7%).All patients remained free of symptoms without evidence of recurrence of IRI for a median follow-up period of 42 mo (range,6-96 mo).CONCLUSION:We report a favorable outcome without IRI recurrence of 17 patients treated by resection of the diseased bowel segment.

Prostatic sarcoma of the Ewing family in a 33-year-old male e A case report and review of the literature

Ewing sarcoma is the second most common primary bone tumor seen in children and adolescents,typically presenting between 10 and 20 years of age.Extraosseous sarcomas of the Ewing family in adults are rare.We report a manifestation of this tumor entity in the periprostatic tissue of a 33-year-old male and discuss our treatment approach.Transrectal biopsy is a feasible and simple diagnostic tool for unclear pelvic masses.Multi-modal therapy and central registries are needed to gain knowledge of rare pelvic tumors like Ewing sarcoma.

Unusual presentation of bladder neuroblastoma in a child: A case report

BACKGROUND Neuroblastoma is an extracranial malignant tumor in children that is most often located in the adrenal gland and sympathetic ganglion.Here,we present a rare case of neuroblastoma originating from the urinary bladder.CASE SUMMARY A 3-year-old girl presented with lower abdominal pain with micturition.Ultrasound revealed a lower abdominal mass.Abdominal computed tomography scan displayed a solitary mass at the top of the urinary bladder.Blood levels of neuron-specific enolase and lactate dehydrogenase were elevated.We treated the child with partial cystectomy and six courses of chemotherapy,and the outcome at 4-year follow-up was unremarkable.CONCLUSION Neuroblastoma should be considered when tumors are located in the urinary bladder,especially in the dome;although this presentation is rare,the prognosis is very good.

Low-grade mucinous appendiceal neoplasm mimicking an ovarian lesion: A case report and review of literature

BACKGROUND Appendiceal tumors are rare lesions that may not be easily differentiated from primary ovarian lesions preoperatively,despite the use of advanced diagnostic methods by experienced clinicians.CASE SUMMARY A 59-year-old G2P2 woman,with chronic pelvic pain,underwent a pelvic ultrasound that revealed an adnexal mass measuring 58 mm×34 mm×36 mm,with irregular borders,heterogeneous echogenicity,no color Doppler vascularization and without acoustic shadowing.Normal ovarian tissue was visualized in contact with the lesion,and it was impossible to separate the lesion from the ovary by applying pressure with the ultrasound probe.Ascites,peritoneal metastases or other alterations were not observed.With the international ovarian tumor analysis ADNEX model,the lesion was classified as a malignant tumor(the risk of malignancy was 27.1%,corresponding to Ovarian-Adnexal Reporting Data System category 4).Magnetic resonance imaging confirmed the presence of a right adnexal mass,apparently an ovarian tumor measuring 65 mm×35 mm,without signs of invasive or metastatic disease.During explorative laparotomy,normal morphology of the internal reproductive organs was noted.A solid mobile lesion involved the entire appendix.Appendectomy was performed.Inspection of the abdominal cavity revealed no signs of malignant dissemination.Histopathologically,the appendiceal lesion corresponded to a completely resected low-grade mucinous appendiceal neoplasm(LAMN).CONCLUSION The appropriate treatment and team of specialists who should provide health care to patients with seemingly adnexal lesions depend on the nature(benign vs malignant)and origin(gynecological vs nongynecological)of the lesion.Radiologists,gynecologists and other pelvic surgeons should be familiar with the imaging signs of LAMN whose clinical presentation is silent or nonspecific.The assistance of a consultant specializing in intestinal tumors is important support that gynecological surgeons can receive during the operation to offer the patient with intestinal pathology an optimal intervention.

Efficacy and safety of Yunxiangjing derived from Chinese herbal medicine administered as an enema in the management of acute radiation-induced proctitis in patients with pelvic malignancy

OBJECTIVE： To assess the efficacy and safety of Yunxiangjing （YXJ）, derived from Chinese herbal medicine, in the management of acute radiation-induced proctitis （ARIP） in patients with pelvic malignancy. METHODS： Forty-eight patients with grade 2 ARIP were administered YXJ as an enema （I ： 30 dilution） for 2 weeks and followed up for 2 years. All were a sessed for response and ARIP grade. Quality of life （QOL） was assessed with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30. RESULTS： Of the 48 patients, six （12.5%） achieved complete remission of ARIP and 28 （58.3%） showed a decrease from grade 2 to grade 1 ARIR No patient experienced a grade 〉3 toxicity. At the end of radio- therapy, patients showed significant improvements in QOL （P 〈 0.05）. Two years after treatment, 46 patients showed no late toxicity, with only two experiencing grade 1 late toxicity. CONCLUSION; YXJ can be used as an enema to manage acute radiation-induced proctitis in cancer patients undergoing radiotherapy. These findings suggest that YXJ enema may be an alternative treatment of ARIP.