Historical changes in surgical strategy and complication management for hepatic cystic echinococcosis

Echinococcosis is a zoonotic parasitic disease caused by Escherichia larvae.It frequently involves the liver(70%-75%),followed by the lungs(15%-20%),and occasionally the brain,heart,spleen,bone,and other organs.The main pathogenic forms of human echinococcosis currently include cystic echinococcosis(CE)and alveolar echinococcosis(AE).CE is globally distributed,while the distribution of AE is generally restricted to the northern hemisphere.In China,CE accounts for 75%of all echinococcosis cases.With rapid advances in surgical techniques in recent decades,the surgical strategy for CE has changed,especially with the continuous improvement of surgical methods and the expansion of surgical contraindications.To further understand the changes in surgical treatment strategies for hepatic CE,we interpreted and analyzed the existing literature addressing the surgical treatment of hepatic CE both domestically and abroad and briefly summarized them in chronological order.This review aims to provide a deeper understanding of the progress in the surgical treatment of hepatic CE to provide clearer avenues for its clinical diagnosis and treatment.

Rupture of a giant jejunal mesenteric cystic lymphangioma misdiagnosed as ovarian torsion: A case report

BACKGROUND Cystic lymphangioma is a rare benign tumor that affects the lymphatic system.Mesenteric lymphangiomas in the small bowel are extremely uncommon.CASE SUMMARY We present a 21-year-old female patient who complained of abdominal pain.The diagnosis of ovarian torsion was suspected after abdominopelvic unenhanced computed tomography and ultrasound revealed a large cyst in contact with the bladder,ovary,and uterus.The patient underwent emergency laparotomy per-formed by gynecologists,but it was discovered that the cystic tumor originated from the jejunum.Gastrointestinal surgeons were then called in to perform a cystectomy.Pathological examination confirmed the diagnosis of cystic lymphangioma of the mesentery.The patient had an uneventful postoperative recovery.CONCLUSION Mesenteric lymphangiomas can cause abdominal pain,and imaging techniques can help determine their characteristics,location,and size.Complete surgical excision and pathological examination are considered the standard treatment and diagnostic method.

Giant retroperitoneal hemolymphangioma:A case report and review of literature

BACKGROUND Hemolymphangioma is a very rare benign tumor in clinical practice caused by abnormalities of the vasculature.Its clinical features are often atypical,and it is easy to miss and misdiagnose.When the time of nuclear magnetic T1 is significantly reduced,the diagnosis of hemangioma should be considered.Therefore,we report this case in the hope of raising clinicians'awareness of the disease.CASE SUMMARY A 37-year-old man presented with a giant retroperitoneal hemolymphangioma.Computed tomography and magnetic resonance imaging indicated the possibility of a large perirenal lymphatic cyst.The postoperative pathological diagnosis is retroperitoneal hemolymphangioma.The patient underwent surgical excision after adequate drainage.The postoperative recovery was smooth and there were no complications.There was no recurrence during half a year of follow-up.CONCLUSION This case reiterates that large retroperitoneal cystic masses with significantly shortened nuclear T1 time should be considered hemolymphangioma.Specific clinical basis and experience for the diagnosis and treatment of these diseases is necessary.

Malignant triton tumor in the abdominal wall:A case report

BACKGROUND Malignant triton tumors(MTTs)comprise a subgroup of malignant peripheral nerve sheath tumors(MPNSTs)that exhibits rhabdomyosarcomatous differen-tiation and follow an aggressive course.MTTs are primarily located along peripheral nerves.Cases of MTTs in the abdominal wall have not been reported.MTT has a poorer prognosis than classic MPNSTs,and accurate diagnosis necessitates a keen understanding of the clinical history and knowledge of its differential diagnosis intricacies.Treatment for MTTs mirrors that for MPNSTs and is predominantly surgical.CASE SUMMARY A 49-year-old woman presented with a subcutaneous mass in her lower abdo-minal wall and a pre-existing surgical scar that had grown slowly over 3-4 months before the consultation.She had previously undergone radical hysterectomy and concurrent chemo-radiotherapy for cervical cancer approximately 5 years prior to the consultation.Abdominal computed tomography(CT)showed a 1.3 cm midline mass in the lower abdomen with infiltration into the rectus abdominis muscle.There was no sign of metastasis(T1N0M0).An incisional biopsy identified sporadic MTT of the lower abdomen.A comprehensive surgical excision with a 3 cm margin inclusive of the peritoneum was executed.Subse-quently,the general surgeon utilized an approach akin to the open peritoneal onlay mesh technique.The patient underwent additional treatment with an excision shaped as a mini-abdominoplasty for the skin defect.No complications arose,and annual follow-up CTs did not show signs of recurrence or metastasis.CONCLUSION An abdominal MTT was efficaciously treated with extensive excision and abdominal wall reconstruction,eliminating the need for postoperative radiotherapy.

Treatment of oral lichen planus by surgical excision and acellular dermal matrix grafting:Eleven case reports and review of literature

BACKGROUND Oral lichen planus(OLP)is a chronic inflammatory disorder,and it can affect normal oral function.The conventional treatments for OLP are not always effective,and relapse easily occurs.Therefore,treatment of OLP is difficult and challenging.In this study,we evaluated over a long period the clinical efficacy of surgical excision and acellular dermal matrix(ADM)grafting in patients with refractory OLP.CASE SUMMARY Eleven patients with refractory OLP underwent a standardized protocol of surgical excision and ADM grafting.The condition of the area of the grafted wound,the intraoperative maximum mouth opening,pain,and clinical healing were assessed at postoperative follow-up visits.All patients had a flat surgical area with similar mucosal tissue coverage and local scar formation.Patients had no irritation and pain in their mucous membranes when eating acidic and spicy food.All patients’mouth openings returned to normal within 2-6 mo after surgery.During follow-up,none of the patients had recurrence of OLP after surgery.The longest follow-up was 11 yr and the shortest was 6 mo,and none of the patients relapsed during follow-up.CONCLUSION Surgical excision and ADM grafting could be an effective method to treat refractory OLP.

Persistent Congenital Paraurethral Cyst, a Rare Cause of Dysuria in a Girl

Congenital paraurethral cyst rarely occurs. Its natural history is spontaneous regression, leading to conservative management adoption. We report an exceptional case of a 13-year-old female with a persistent congenital paraurethral cyst, leading to dysuria. We surgically excised the cyst, and the outcomes were unremarkable 20 months postoperatively.

A New Technique to Remove Accurately Osteoid Osteomas Using Gamma Probe

Study design: Description of a technique through a case-series. Objective: To promote a technique by using a gamma probe that asses intraoperatively the adequacy of the lesion curettage through a minimal invasive procedure. Methods: Reviewing the technique steps through 4 cases of osteoid osteoma surgical removal. Results: Four patients diagnosed with osteoid osteoma and moved to surgical removal. During the operation, excision of the tumour was assessed by a gamma probe, avoiding leaving residual lesion in the field. Operating time was not prolonged, so as the cost of the operation was not increased. Conclusions: Surgical excision of osteoid osteoma in spine region is still the gold standard method. Avoiding recurrence of the lesion is important. The use of gamma probe is an effective and economic solution.

Advances and challenges in laparoscopic surgery in the management of hepatocellular carcinoma

Hepatocellular carcinoma is the fifth most common malignancy and the third most common cause of cancer-related mortality worldwide. From the wide variety of treatment options, surgical resection and liver transplantation are the only therapeutic ones. However, due to shortage of liver grafts, surgical resection is the most common therapeutic modality implemented. Owing to rapid technological development, minimally invasive approaches have been incorporated in liver surgery. Liver laparoscopic resection has been evaluated in comparison to the open technique and has been shown to be superior because of the reported decrease in surgical incision length and trauma, blood loss, operating theatre time, postsurgical pain and complications, R0 resection, length of stay, time to recovery and oral intake. It has been reported that laparoscopic excision is a safe and feasible approach with near zero mortality and oncologic outcomes similar to open resection. Nevertheless, current indications include solid tumors in the periphery < 5 cm, especially in segments Ⅱ through Ⅵ, while according to the consensus laparoscopic major hepatectomy should only be performed by surgeons with high expertise in laparoscopic and hepatobiliary surgery in tertiary centers. It is necessary for a surgeon to surpass the 60-cases learning curve observed in order to accomplish the desirable outcomes and preserve patient safety. In this review, our aim is to thoroughly describe the general principles and current status of laparoscopic liver resection for hepatocellular carcinoma, as well as future prospects.

Similar therapeutic effects of ^(125I) seed radiotherapy andγ-ray radiotherapy on lacrimal gland adenoid cystic carcinoma

AIM:To evaluate the survival outcomes of patients with lacrimal gland adenoid cystic carcinoma who underwent eye-sparing surgery combined with ^(125I)seed implantation radiotherapy or local externalγ-ray radiotherapy.METHODS:In this retrospective comparative case series,the clinical records of 27 primary and 8 recurrent patients were reviewed.Univariate and multivariate analyses were used to identify risk factors associated with distant metastasis(DM),and the overall survival(OS)after the initial surgery was analyzed.RESULTS:The median follow-up after radiotherapy was 36 mo(range 6-120 mo).At the last follow-up after radiotherapy,26(74.3%)patients had no evidence of disease,7(20%)patients had DM,2(5.9%)patients died of DM,and 1 patient with DM was lost to follow-up.Univariate analyses showed that duration of symptoms,bone destruction,T stage classification,and wide excision surgery were risk factors influencing DM(P<0.05).The 5-year and 10-year OS rates after the initial surgery were 95.8%and 79.9%,respectively.The 5-year DM-free survival and disease-free survival rates after radiotherapy were 66.4%and 52.7%,respectively.CONCLUSION:^(125I)seed radiotherapy and local externalγ-ray radiotherapy may have similar therapeutic effects in preventing DM.Patients with T1/T2 stage disease have a better prognosis than those with T3/T4 stage disease.

Abdominal neurenteric cyst

Neurenteric cysts are extremely rare congenital anomalies, often presenting in the first 5 years of life, and are caused by an incomplete separation of the notochord from the foregut during the third week of embryogenesis. They are frequently accompanied with spinal or gastrointestinal abnormalities, but the latter may be absent in adults. Although usually located in the thorax, neurenteric cysts may be found along the entire spine. We present a 24-year-old woman admitted for epigastric pain, nausea, vomiting, low grade fever and leucocytosis. She underwent cystgastrostomy for a Ioculated cyst of the distal pancreas at the age of 4 years, which recurred when she was at the age of 11 years. Ultrasound and computer tomograghy （CT） scan revealed a 16 cmx 15 cm cystic mass in the body and tail of pancreas, with a 6-7 mm thickened wall. Laboratory data and chest X-ray were normal and spinal radiographs did not show any structural abnormalities. The patient underwent a complete cyst excision, and after an uneventful recovery, remained symptom-free without recurrence during the 5-year follow-up. The cyst was found to contain 1200 mL of pale viscous fluid. It was covered by a primitive singlelayered cuboidal epithelium, along with specialized antral glandular parenchyma and hypoplastic primitive gastric mucosa. Focal glandular groups resembling those of the body of the stomach were also seen. In addition, ciliary respiratory epithelium, foci of squamous metaplasia and mucinous glands were present. The wall of the cyst contained a muscular layer, neuroglial tissue with plexogenic nerve fascicles, Paccini corpuscle-like structures, hyperplastic neuroganglionar elements and occasional psammomatous bodies, as well as fibroblast-like areas of surrounding stroma. Cartilagenous tissue was not found in any part of the cyst. Immunohistochemistry confirmed the presence of neurogenic elements marked by S-100, GFAP, NF and NSE. The gastric epithelium showed mostly CK7 and EMA immunoexpression, and the respiratory epithelium revealed a CK8 and CK18 immunoprofile without CK 10/13 positive elements, though neither CEA or AFP positive cells were found. To our knowledge, this is the first reported case of an abdominally located neurenteric cyst with no associated spinal anomalies.

Tuberculous lymphadenitis as a cause of obstructive jaundice:A case report and literature review

Obstructive jaundice secondary to tuberculosis (TB) is extremely rare. It can be caused by TB enlargement of the head of the pancreas, TB lymphadenitis, TB stricture of the biliary tree, or a TB mass of the retroperitoneum. A 29-year-old man with no previous history of TB presented with abdominal pain, obstructive jaundice, malaise and weight loss. Ultrasonography (US), computer tomography (CT) scan and endoscopic retrograde cholangiopancreatography (ERCP) were suggestive of a stenosis of the distal common bile duct (CBD) caused by a mass in the posterior head of the pancreas. Tumor markers, CEA and CA19-9 were within normal limits. At operation, an enlarged, centrally caseous lymph node of the posterior head of the pancreas was found, causing inflammatory stenosis and a fistula with the distal CBD. The lymph node was removed and the bile duct resected and anastomosed with the Roux-en Y jejunal limb. Histology and PCR based-assay confirmed tuberculous lymphadenitis. After an uneventful postoperative recovery, the patient was treated with anti-tuberculous medication and remained well 2.5 years later. Though obstructive jaundice secondary to tuberculous lymphadenitis is rare, abdominal TB should be considered as a differential diagnosis in immunocompromised patients and in TB endemic areas. Any stenosis or fistulation into the CBD should also be taken into consideration, and biliary bypass surgery be performed to both relieve jaundice and prevent further stricture.

Recurrence of intratendinous ganglion due to incomplete excision of satellite lesion in the extensor digitorum brevis tendon: A case report

BACKGROUND Intratendious ganglions are rare lesions, especially on the foot and ankle. Although several studies have presented the intratendinous ganglion of the foot and ankle, there are only few reported cases, and no cases of recurrence or secondary surgery have been reported.CASE SUMMARY We present the case of a 32-year-old man with an intratendinous ganglion of the second extensor digitorum brevis(EDB) tendon that recurred after ganglion excision. Magnetic resonance imaging(MRI) performed before the first surgery was reviewed to analyze the causes of the recurrence. We confirmed that there was a lack of satellite detection. After recurrence, MRI revealed an extratendinous lesion, tenosynovitis, and intratendinous ganglion of the second EDB tendon. Since the second EDB tendon can compensate for the extrinsic muscle, en bloc resection was performed alone. In addition, meticulous excision and synovectomy were performed for extra-tendinous lesions and tenosynovitis, respectively. The patient returned to daily life without any functional problems or recurrence.CONCLUSION If removal of the affected tendon is not fatal, en bloc resection should first be considered to prevent incomplete excision and intraoperative leakage. When planning surgical excision, it is necessary to evaluate the presence of satellite lesions along the course of the affected tendon.

Giant Lactant Adenoma: About a Case

Affecting young women, lactating adenoma is a rare benign tumor of the breast. It is seen mainly in the third trimester of pregnancy and in the postpartum period. Clinically, it is a solid mass, mobile typically benign but its character of rapid evolution is reminiscent of phyllodes tumors, sarcomas and galactoceles. The definitive diagnosis is histological. We report a case of lactating adenoma in a 26-year-old lactating woman, third procedure, second pare, with a history of tumor resection of the outer quadrants of the left breast, 9 months ago, whose histology evoked a fibrotic disease, cystic breast associating non-specific subacute mastitis with suppuration. Received for recurrence of a tumor in the left breast which was the site of a polylobed mass of about 10/5 cm occupying 3/4 of the breast with mobile ipsilateral axillary adenopathies. A micro tru-cut biopsy was performed and the histology was in favor of a lactating breast adenoma with no signs of malignancy. She underwent surgical excision, the consequences of which were simple.

Surgical treatment of usual type vulvar intraepithelial neoplasia： a study at three academic hospitals

Vulvar intraepithelial neoplasia （VIN） is a relatively uncommon disease that includes all of the precancerous lesions of vulvar malignancies with an incidence of approximately 2.5 per 100 000 women.In 2004,the International Society for the Study of Vulvovaginal Diseases （ISSVD） abolished the old VIN grading system and introduced a two-tier classification for squamous VIN：the usual type and the differentiated type;the term VIN applied only to histologically ＆quot;high-grade＆quot; squamous lesions （old terms VIN 2 and VIN 3）.1 The two types of VIN differ in etiology,morphology,biology,clinical features and malignant potential.The usual type VIN （uVIN）,which is associated with HPV infection,is the most comrnon subtype,accounting for more than 80% of all VIN cases.Currently,the old 3-grade system of the VIN terminology is still used in most of the hospitals in China.In this presentation,we categorized the patients with the ISSVD 2004 classification standard and attempted to describe the clinical features and the outcome of surgical treatment of uVIN using the retrospective data from three academic hospitals in China.

Hyperbaric oxygen therapy improves the effect of keloid surgery and radiotherapy by reducing the recurrence rate

Objective： Keloids are exuberant cutaneous scars that form due to abnormal growth of fibrous tissue fol- lowing an injury. The primary aim of this study was to assess the efficacy and mechanism of hyperbaric oxygen therapy （HBOT） to reduce the keloid recurrence rate after surgical excision and radiotherapy. Methods： （1） A total of 240 patients were randomly divided into two groups. Patients in the HBOT group （O group） received HBOT after surgical excision and radiotherapy. Patients in the other group were treated with only surgical excision and radiotherapy （K group）. （2） Scar tissue from recurrent patients was collected after a second operation. Hematoxylin and eosin （H＆E） staining was used to observe keloid morphology. Certain inflammatory factors （interleukin-6 （IL-6）, hypoxia-inducible factor-1α （HIF-1α）, tumor necrosis factor-α （TNF-α）, nuclear factor KB （NF-κB）, and vascular endothelial growth factor （VEGF）） were measured using immunohistochemical staining. Results： （1） The recurrence rate of the O group （5.97%） was significantly lower than that of the K group （14.15%）, P〈0.05. Moreover, patients in the O group reported greater satisfaction than those in the K group （P〈0.05）. （2） Compared with the recurrent scar tissue of the K group, the expression levels of the inflammatory factors were lower in the recurrent scar tissue of the O group. Conclusions： Adjunctive HBOT effectively reduces the keloid recurrence rate after surgical excision and radiotherapy by improving the oxygen level of the tissue and alleviating the inflammatory process.

Toe Absence Related to Verrucous Carcinoma

Introduction:Verrucous carcinoma is a rare variant of squamous cell carcinoma.It generally grows exogenously and bone erosion is rare.Here we present a case of verrucous carcinoma on the foot with toe absence.Case presentation:A 64-year-old man presented with a 6-year history of a slowly growing exogenous hyperkeratotic verrucous lesion on the right fifth toe,which had been absent for 1year.Before the lesion appeared,he had undergone nail extraction on this toe.The culture of fungi and mycobacteria were negative.Three-dimensional computed tomography showed that the fifth toe of the right foot was absent.Histopathological examination showed that the lesion was exogenous and verrucous and exhibited moderate keratinocyte hyperplasia.Combined with clinical manifestation and histopathological examination,verrucous carcinoma is suggested.The lesion was surgically excised,and the patient was followed up for more than 6months without recurrence.Discussion:Verrucous carcinoma is an exophytic tumor with verrucous growth at the beginning,which can invade deep tissues and even cause limb mutilation.When encountering a patient with a wart-like plaque on the foot that responds poorly to conventional treatments,clinicians should maintain a high degree of clinical vigilance and a low threshold for biopsy.Conclusion:We observed a rare outcome of toe absence associated with verrucous carcinoma.Therefore,early diagnosis of verrucous carcinoma is very important.Surgical excision is an effective treatment at present.Extensive resection is usually required to avoid recurrence.

Erosive Pustular Dermatosis of the Scalp After Excision and Skin Grafting of Scalp Squamous Cell Carcinoma

Introduction:Erosive pustular dermatosis of the scalp(EPDS)is an uncommon condition with unknown etiology.The clinical exclusive diagnosis needs to be differentiated from similar diseases.Case presentation:A 68-year-old woman presented with an eight-month history of a chronic scalp eruption.She had been diagnosed as squamous cell carcinoma by biopsy nine months ago,and had been treated by surgical excision and skin grafting.One month later,she was referred for evaluation of the newly enlarged lesion which was observed at the skin grafting site.She was diagnosed of EPDS based on characteristics of lesions,clinicopathological findings and laboratory data.The condition had clinically improved with systemic steroid therapy and topical tacrolimus for two weeks.Relapses occurred after complete withdrawal of both treatments.After repeating the above therapy and applying topical tacrolimus as maintenance therapy,the condition was well controlled at the one-year follow-up.Discussion:EPDS is an uncommon inflammatory dermatosis with main incidence rate of elderly patients and female predominance.The diagnosis of EPDS cant be made only by histopathological examination,which is helpful for differential diagnosis.Microbiological investigations commonly remain negative.For the high risk of relapse,it is important for clinicians to be aware of maintenance treatment and a long-term management.Conclusion:It should be recognized by clinicians that EPDS is an uncommon and relapse disease,leading to serious cosmetic problems.The treatment lacks evidence-based medicine data,clinician should choose the appropriate therapy according to the condition of patients.