Surgical resection

手术切除
  • 文章类型: Case Reports
    阑尾黏液囊肿是一种罕见的疾病,有时可以模仿急性阑尾炎或在手术中意外发现。阑尾黏液囊肿的临床表现是由于黏液积累引起的管腔扩张。这种情况有良性和恶性的潜在病因,这可以通过组织病理学检查来证实。阑尾黏液囊肿的急性表现很少见,大多类似于急性阑尾炎的症状。由于粘液扩散引起的腹膜假性黏液瘤的风险,阑尾黏液囊肿的治疗至关重要,黏液囊肿穿孔,或粘液癌等恶性肿瘤的存在。手术切除,阑尾切除术,肺切除术,或者有时右半结肠切除术,是推荐的管理方法。这是一例74岁的男性,腹部疼痛是主要的主诉。他有一个明显的右髂窝肿块。阑尾黏液囊肿的诊断是通过对比增强计算机断层扫描,后来被组织病理学证实。患者接受了手术切除,在三个月的随访中表现良好。
    Appendiceal mucocele is a rare disease that can sometimes mimic acute appendicitis or be discovered accidentally during surgeries. The clinical presentation of appendiceal mucocele is observed as lumen distension due to mucin accumulation. This condition has both benign and malignant underlying etiologies, which can be confirmed by histopathological examination. Acute presentation of appendiceal mucocele is rare and mostly resembles the symptoms of acute appendicitis. The treatment of appendiceal mucocele is crucial due to the risk of pseudomyxoma peritonei caused by the spread of mucus, mucocele perforation, or the presence of malignancy such as mucinous carcinoma. Surgical resection, either appendicectomy, typhlectomy, or sometimes right hemicolectomy, is the recommended management approach. This is a case of a 74-year-old male with pain in the abdomen as the major presenting complaint. He had a palpable right iliac fossa mass. The diagnosis of appendiceal mucocele was made by contrast-enhanced computed tomography, which was later confirmed by histopathology. The patient underwent surgical resection and was doing well at the three-month follow-up.
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  • 文章类型: Case Reports
    颅咽管瘤是上皮起源的罕见良性肿瘤。通常位于鞍区和鞍上区域,它们通常表现出质量效应的症状,颅内张力升高,或内分泌异常。没有这些症状的非典型表现通常会延迟诊断并恶化患者的预后结果。而没有这些症状的及时诊断对患者的获益至关重要。下面,我们介绍了一例50岁女性的adamantinoma型颅咽管瘤,症状轻微且无特异性。影像学检查报告鞍区存在囊性病变,鞍上,和手术切除前的鞍旁区域。告知患者,并决定对肿块病变进行手术切除。术后组织病理学研究证实该肿瘤为金刚烷酸颅咽管瘤。
    Craniopharyngiomas are rare benign neoplasms of epithelial origin. Usually located in the sellar and suprasellar regions, they typically present with symptoms of mass effect, raised intracranial tension, or endocrinological aberrations. Atypical presentations without these symptoms often delay diagnosis and worsen patient prognostic outcome, while timely diagnosis without these symptoms is essential for patient beneficence. Below, we present a case of an adamantinomatous craniopharyngioma in a 50-year-old female with minimal and non-specific symptoms. Radiographic imagining reported the presence of a cystic lesion in the sellar, suprasellar, and parasellar regions before the surgical excision. The patient was informed and a decision was made to undergo surgical resection of the mass lesion. The postoperative histopathologic study confirmed the neoplasm to be an adamantinomatous craniopharyngioma.
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  • 文章类型: Case Reports
    特发性腹膜后纤维化(IRF)是一种罕见的疾病,其特征是腹膜后间隙的纤维组织增生,通常影响输尿管和其他腹部结构。本病例报告描述了一名52岁女性以前没有记录的IRF,在六个月内出现反复消化道出血和严重贫血的患者。诊断检查包括内窥镜检查,结肠镜检查,腹部计算机断层扫描(CT),还有活检,显示肠系膜血管的纤维包裹,导致缺血性损伤和胃肠道出血。治疗包括大剂量皮质类固醇和手术切除纤维化组织,导致症状完全缓解。本病例报告的目的是强调IRF的这种独特表现,讨论诊断挑战,并探索有效的治疗策略来管理这种罕见但重要的并发症。
    Idiopathic retroperitoneal fibrosis (IRF) is a rare condition characterized by fibrous tissue proliferation in the retroperitoneal space, commonly affecting the ureters and other abdominal structures. This case report describes a previously undocumented presentation of IRF in a 52-year-old female, who presented with recurrent gastrointestinal bleeding and severe anemia over six months. Diagnostic workup included endoscopy, colonoscopy, abdominal computed tomography (CT), and biopsy, revealing fibrous encasement of the mesenteric vessels leading to ischemic damage and gastrointestinal bleeding. Treatment involved high-dose corticosteroids and surgical resection of the fibrotic tissue, which resulted in complete resolution of symptoms. The aim of this case report is to highlight this unique presentation of IRF, discuss the diagnostic challenges, and explore effective treatment strategies for managing this rare but significant complication.
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  • 文章类型: Case Reports
    脑室内心脏血管瘤是非常罕见的肿瘤,占所有心脏肿瘤的5-10%。我们报告了一例无症状的21岁年轻男性,该男性在超声心动图和磁共振成像中偶然发现了心室质量。进行手术切除以确认并避免潜在的并发症。组织病理学和免疫组织化学研究证实了脑室血管瘤的诊断。随后的定期随访显示没有并发症或复发,强调良好的长期预后。此病例报告强调了即使在无症状个体中诊断评估的重要性,允许早期识别和有效管理这种罕见的心脏实体。
    Intraventricular cardiac hemangiomas are very rare tumors that account for 5-10% of all cardiac tumors. We report a case of an asymptomatic 21-year-old young male who was incidentally detected with ventricular mass on echocardiography followed by magnetic resonance imaging. Surgical resection was done for confirmation and to avoid potential complications. Histopathology and immunohistochemical studies confirmed the diagnosis of a hemangioma of the ventricle. Subsequent regular follow-up has revealed no complications or recurrence, underscoring the favorable long-term prognosis. This case report highlights the importance of diagnostic evaluation even in asymptomatic individuals, allowing for early recognition and effective management of this rare cardiac entity.
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  • 文章类型: Case Reports
    肺动脉动脉瘤被定义为肺动脉的局部扩张>正常上限的1.5倍或测量4cm的肺动脉。肺动脉瘤被认为是一种罕见的疾病,在14,000次验尸中发病率为1。
    方法:下面是一个28岁绅士的案例,表现为劳力性呼吸困难和端坐呼吸,并在计算机断层扫描时被诊断出由主肺动脉引起的76cm×56cm×53cm的肺动脉瘤,根据现有文献,这是罕见的发现。
    肺动脉瘤的临床表现各不相同,很少发生。然而,放射成像的使用有助于诊断。然而,文献中还没有提到具体的治疗指南,医疗管理,手术切除和血管内治疗是多种选择之一.
    结论:肺动脉动脉瘤表现出非特异性症状,这使得医生的诊断非常具有挑战性,在过程中,延迟疾病的准确管理。然而,必须将肺动脉瘤视为鉴别诊断和适当的治疗方案,无论是医疗还是手术,都应该选择记住疾病的大小和并发症。
    UNASSIGNED: Pulmonary Artery Aneurysm is defined as the localized dilation of the pulmonary artery >1.5 times the upper normal limit or pulmonary artery measuring 4 cm. Pulmonary artery aneurysm is considered as a rare disorder having an incidence of 1 in 14,000 post-mortem examinations.
    METHODS: Presented below is a case of a 28 year old gentleman, who presented with exertional dyspnea and orthopnea and was diagnosed with having a pulmonary artery aneurysm of 76 cm × 56 cm × 53 cm arising from the main pulmonary artery upon Computed Tomography Scan which is a rare finding according to the available literature.
    UNASSIGNED: Clinical manifestations of pulmonary artery aneurysm are varying and rarely occur. However the use of radiological imaging has aided in the diagnosis. No specific treatment guidelines have been mentioned yet in the literature however, medical management, surgical resection and endovascular therapy are one of the multiple options available.
    CONCLUSIONS: Pulmonary Artery Aneurysm presents with non-specific symptoms which makes the diagnosis very challenging for the physicians, in process, delaying the accurate management of the disease. However, pulmonary artery aneurysm must be considered as a differential diagnosis and appropriate management options, whether medical or surgical should be opted for keeping in mind the size and the complications of the disease.
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  • 文章类型: Case Reports
    在这里,我们报告了2例原发性病变控制良好的胶质母细胞瘤孤立的鞍上播散病例。一名22岁的女性和一名56岁的女性在初次手术后26和17个月出现了快速生长的鞍上胶质母细胞瘤扩散,分别。两名患者均出现急性视力障碍(视力下降和视野障碍),但缺乏严重的垂体功能障碍。在播散性肿瘤的手术中,由于术中发现提示视路侵犯,因此难以切除整个肿瘤.两名患者在手术后几个月内进一步颅内扩散。孤立鞍和鞍上播散的存在可能表明晚期。
    Herein, we present two cases of isolated suprasellar dissemination of glioblastoma in patients with well-controlled primary lesions. A 22-year-old woman and a 56-year-old woman developed rapid growth of suprasellar glioblastoma dissemination 26 and 17 months after initial surgery, respectively. Both patients presented with acute visual impairment (decreased acuity and visual field disturbances) but lacked severe pituitary dysfunction. During surgery for the disseminated tumors, gross total tumor resection was difficult due to intraoperative findings suggesting optic pathway invasion. Both patients developed further intracranial dissemination within several months post-surgery. The presence of solitary sellar and suprasellar dissemination may indicate a terminal stage.
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  • 文章类型: Case Reports
    肝血管瘤是良性间叶性肝肿瘤中最常见的类型,通常预后良好。然而,巨大肝血管瘤大于10厘米是一个不寻常的事件,内部出血性坏死的症状极为罕见。只有少数病例报告。
    这里,我们报道了一例52岁的巨大肝血管瘤出血性坏死患者。患者就诊于肝胆外科,主诉右腹部疼痛。患者在就诊前2周行肝动脉栓塞治疗巨大肝血管瘤。住院期间,腹部计算机断层扫描显示肝右叶下方有一个高密度肿块(15.8×14.2×14.7cm)。患者随后在三维可视化技术的指导下接受了不规则右肝切除术。手术解剖证实了内出血坏死的诊断。在4个月的随访中没有复发或并发症。回顾了以前的病例,以描述巨大肝血管瘤伴内部出血坏死的临床特征。
    伴有内部出血性坏死的巨大肝血管瘤很少见,通常仅表现为发热或上腹痛。所有患者在回顾病例中最后均行手术切除。在这种情况下,经肝动脉治疗的愈合效果不是很理想。由于腹腔有限,患者被认为是不良的腹腔镜手术候选人。为了规范这些罕见疾病的诊断,现有和未来病例数据的汇总当然是必要的。如果被诊断,应考虑通过三维可视化技术根据患者病情实施手术切除。
    UNASSIGNED: Hepatic hemangioma is the most common type of benign mesenchymal liver tumor and often has a good prognosis. However, giant hepatic hemangioma larger than 10 cm is an unusual event, and accompanying symptoms of internal hemorrhagic necrosis are extremely rare. There are only a few cases reported.
    UNASSIGNED: Herein, we report the case of a 52-year-old man with hemorrhagic necrosis of a giant hepatic hemangioma. The patient presented to the Department of Hepatobiliary Surgery with a complaint of distending pain on the right abdomen. The patient underwent hepatic artery embolization for giant hepatic hemangioma 2 weeks before presentation. During hospitalization, abdominal computed tomography revealed a mass (15.8 × 14.2 × 14.7 cm) with high density below the right lobe of the liver. The patient subsequently underwent irregular right hepatectomy with the guidance of three-dimensional visualization technology. The surgical anatomy confirmed the diagnosis of internal hemorrhagic necrosis. There was no recurrence or complications in a 4-month follow-up. Previous cases were reviewed to characterize the clinical features of giant hepatic hemangioma with internal hemorrhage necrosis.
    UNASSIGNED: Cases of giant hepatic hemangioma with internal hemorrhagic necrosis are rare and usually only exhibit fever or epigastric pain. All patients in reviewed cases finally underwent surgical resection. Under these circumstances, the healing effect of transhepatic arterial treatment is not very satisfactory. Patients are deemed poor laparoscopic surgical candidates due to limited abdominal cavity. In order to standardize the diagnosis of these rare cares, the aggregation of existing and future case data is certainly warranted. If diagnosed, consideration should be given to implementing surgical resection according to patients\' condition by three-dimensional visualized technology.
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  • 文章类型: Case Reports
    纤维瘤很少见,良性,但是局部侵袭性纤维瘤病带来了重大的治疗挑战,特别是当位于头部和颈部区域时。本报告详细介绍了一例广泛的颈椎韧带样肿瘤,该肿瘤依赖于提上肩cap肌,并涉及通过手术切除和术中导航管理的椎动脉。一名45岁的男性表现为宫颈肿块缓慢增长。成像显示右侧椎旁间隙有83x68x40mm肿块,依赖于肩胛骨提上肌并累及椎动脉。活检证实低度融合细胞肌纤维母细胞瘤与硬纤维瘤一致。鉴于与症状性肿块相关的不良预后,使用Brainlab术中导航进行手术切除(Brainlab,慕尼黑,德国)。手术成功了,保留重要结构,没有术后复发的证据。头颈部纤维瘤,虽然罕见,需要精确的诊断和治疗方法,由于其侵略性和接近关键的解剖结构。术中导航的使用,在这种情况下,有助于准确切除肿瘤,减少对周围组织的损害。病理分析显示CTNNB1基因突变,特别是S45P变体,这与复发风险增加有关。这个案例突出了多学科方法的重要性,结合先进的外科技术和基因分析,在复杂的硬纤维瘤的治疗中。术中导航在实现成功的手术结果方面被证明是非常宝贵的,强调其在类似情况下的潜在效用。持续的后续行动至关重要,考虑到与硬纤维瘤相关的复发可能性。
    Desmoid tumors are rare, benign, but locally aggressive fibromatoses that pose significant therapeutic challenges, particularly when located in the head and neck region. This report details the case of an extensive cervical desmoid tumor dependent on the levator scapulae muscle and involving the vertebral artery managed through surgical resection and intraoperative navigation. A 45-year-old male presented with a slowly growing cervical mass. Imaging revealed an 83x68x40 mm mass in the right lateral paravertebral space, dependent on the levator scapulae muscle and involving the vertebral artery. Biopsy confirmed a low-grade fusocellular myofibroblastic neoplasm consistent with a desmoid tumor. Given the poor prognosis associated with the symptomatic mass, surgical resection was performed using Brainlab intraoperative navigation (Brainlab, Munich, Germany). The procedure was successful, with preservation of vital structures and no evidence of recurrence postoperatively. Desmoid tumors in the head and neck region, though rare, require precise diagnostic and therapeutic approaches due to their aggressive nature and proximity to critical anatomical structures. The use of intraoperative navigation, in this case, facilitated accurate tumor resection, minimizing damage to surrounding tissues. Pathological analysis revealed a CTNNB1 gene mutation, specifically the S45P variant, which is associated with an increased risk of recurrence. This case highlights the importance of a multidisciplinary approach, incorporating advanced surgical techniques and genetic analysis, in the management of complex desmoid tumors. Intraoperative navigation proved invaluable in achieving successful surgical outcomes, underscoring its potential utility in similar cases. Continued follow-up is essential, given the potential for recurrence associated with desmoid tumors.
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  • 文章类型: Case Reports
    深部血管粘液瘤(DAM)是一种生长缓慢的良性肿瘤,手术切除后局部复发的风险很高。虽然下肢的DAM极为罕见,临床医生必须意识到它的可能发生。可以根据临床检查和放射影像学进行怀疑,但最终诊断在组织病理学检查和免疫组织化学上得到证实。我们打算介绍一个极其罕见的膝盖DAM病例,边缘切除成功管理。
    一个4岁的男孩被无痛的抱怨,逐步增加,软,非招标,右膝肿胀波动.X线平片显示无钙化的软组织肿胀,MRI显示多部位囊性病变伴多发隔膜。术前诊断为良性囊性病变。通过边缘切除肿瘤进行管理,并进行了DAM的组织学诊断。免疫组化染色显示SMA阳性,CD34和波形蛋白呈局灶性阳性,而desmin和calponin呈阴性。在12个月的随访中,患者的步态正常,无痛,膝盖ROM饱满,没有任何局部复发。
    DAM是一种罕见的肿瘤,常被误诊。在这份报告中,我们介绍了一例罕见的良性囊性病变,结果是切除标本的HPE上的DAM。该病变的边缘切除显示良好的结果,直到最后随访12个月才复发。有了这个,我们得出的结论是,在DAM病例中,手术切除应该是金标准。
    UNASSIGNED: Deep angiomyxoma (DAM) is a slow-growing benign tumor with high risk of local recurrence after surgical resection. Although DAM in a lower extremity is extremely rare, clinicians must be aware of its possible occurrence. Suspicion can be made based on clinical examination and radiological imaging but final diagnosis is confirmed on histopathological examination and immunohistochemistry. We intend to present an extremely rare case of DAM in the knee, managed successfully with marginal excision.
    UNASSIGNED: A 4-year-old male child presented with the complains of a painless, progressively increasing, soft, non-tender, and fluctuant swelling in his right knee. The plain radiograph showed a non-calcified soft-tissue swelling and MRI revealed a multi-loculated cystic lesion with multiple septations. A pre-operative diagnosis of a benign cystic lesion was made. It was managed by marginal excision of the tumor and a histological diagnosis of DAM was made. IHC staining showed positivity for SMA, CD34 and vimentin were focally positive, while desmin and calponin were negative. At 12 months of follow-up, the patient had a normal painless gait and full knee ROM, without any local recurrence.
    UNASSIGNED: DAM is a rare tumor which is often misdiagnosed. In this report, we present a rare case of benign cystic lesion which turned out to be DAM on HPE of resected specimen. Marginal excision of this lesion revealed good outcomes with no recurrence until 12 months of final follow-up. With this, we conclude that surgical excision should be the gold standard in cases of DAM.
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  • 文章类型: Case Reports
    脐带血残存是一种罕见的疾病,其特征是脐带血持续到出生后,经常表现为脐带积液等症状,牙周炎,和腹痛。手术切除是治疗的基石,但是,确保在切除边缘完全切除脐尿管上皮仍然是一个挑战。此病例报告着重于评估脐尿管残留物的切除边缘,并报告了一名25岁妇女的脐带积液和肿块。她被诊断为脐尿残留,并接受了脐尿切除和重建,术后证实良好的结果和没有镜下血尿。术中检查未发现脐尿管切除边缘的任何肉眼清晰的管腔结构。随后使用苏木精和曙红染色对边缘进行组织病理学分析具有挑战性,提示使用角蛋白AE1/AE3抗体进行免疫组织学染色。抗体没有染色脐尿管切除边缘,确认完全去除脐尿管上皮成分。我们的研究结果表明,角蛋白AE1/AE3染色可用于评估脐尿管残留边缘,并强调了彻底评估和完全切除脐尿管残留以预防复发和减轻脐尿管癌风险的重要性。有助于改善手术效果和患者护理。
    A urachal remnant is a rare condition characterized by the persistence of the urachus beyond birth, often presenting with symptoms such as umbilical effusion, periomphalitis, and abdominal pain. Surgical resection is the cornerstone of treatment, but ensuring complete removal of urachal epithelium at the resection margin remains a challenge. This case report focuses on evaluating resection margins of urachal remnants and reports the case of a 25-year-old woman with complaints of umbilical effusion and a mass. She was diagnosed with a urachal remnant and underwent urachal resection and reconstruction, with postoperative confirmation of favorable outcomes and the absence of microscopic hematuria. The intraoperative examination did not reveal any macroscopically clear luminal structure of the urachal resection margin. Subsequent histopathological analysis of the margin using hematoxylin and eosin staining was challenging, prompting the use of immunohistological staining with keratin AE1/AE3 antibody. The antibody did not stain the urachal resection margin, confirming the complete removal of urachal epithelial components. Our study findings suggest the utility of keratin AE1/AE3 staining for assessing urachal remnant margins and underscore the importance of thorough evaluation and complete resection of urachal remnant to prevent recurrence and mitigate the risk of urachal cancer, contributing to improved surgical outcomes and patient care.
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