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International Journal of Surgery Case... Jul 2024The most common cancer among females worldwide and in Saudi Arabia is breast cancer. Lobular breast carcinoma is the second most common subtype of breast cancer. There...
INTRODUCTION AND IMPORTANCE
The most common cancer among females worldwide and in Saudi Arabia is breast cancer. Lobular breast carcinoma is the second most common subtype of breast cancer. There are different patterns of metastasis as ductal breast cancer spreads to the liver, lung, brain, and bone while the lobular subtype metastasizes to the gastrointestinal tract.
CASE PRESENTATION
A 69-year-old Indian pilgrim presented to the ER complaining of abdominal pain, vomiting, and abdominal distention admitted as a case of intestinal obstruction. CT scan demonstrated intestinal obstruction with transition zone at the terminal ileum. The patient underwent exploratory laparotomy where she was found to have a mass at the terminal ileum. Resection of around 8 cm of small bowel and primary anastomosis were done, histopathology revealed metastatic lobular breast carcinoma.
CLINICAL DISCUSSION
Patients with metastatic breast cancer to the gastrointestinal tract often present with nonspecific symptoms, while acute cases present with complications such as perforation. In a retrospective review of metastatic breast cancer, the majority metastasizes to the colon and rectum, while 19 % to the small bowel. Palliative surgery is considered the first-line treatment of complicated patients, while stable cases are referred to medical oncology.
CONCLUSION
Breast cancer is the second most common cancer leading to death and lobular subtype has more propensity to metastasize to the gastrointestinal tract compared to ductal breast cancer. Regarding patients presenting to the emergency bay, treating the emergency complaints is the standard management. For immigrant patients, we highly recommend creating a data system for sending histopathology reports to facilitate follow-up in their countries.
CASE PRESENTATION
A 69-year-old Indian pilgrim patient presented to the ER complaining of abdominal pain for 3 days associated with nausea and vomiting, not passing stool nor flatus was admitted as a case of intestinal obstruction. On examination patient was in pain with tachycardia, abdominal distended with generalized tenderness. Labs revealed metabolic alkalosis with hypokalemia. Abdomen X-ray showed signs of intestinal obstruction with multiple air-fluid levels and dilated small bowel loops. CT scan abdomen and pelvis with IV contrast reported (Figs. 1,2) distended ileum around 5 cm proximal to the transition zone at the terminal ileum with mild free fluid in the abdomen and pelvis. The patient underwent exploratory laparotomy where she was found to have a mass at the terminal ileum with the proximal loop dilated and distal loops collapsed, and further exploration showed enlarged mesenteric lymph nodes. Small bowel resection of around 8 cm and side to side anastomosis was done to relive the intestinal obstruction. Gross pathology showed a solid lesion protruding into the lumen measuring 1.5*1.5*1.5 cm, while the microscopic description consists of small cells with round ovoid nuclei which lack cohesion and appear individually dispersed through a fibrous connective tissue and arranged in single file linear cords that invade the stroma (Fig. 4) concluded as metastatic lobular carcinoma of the breast. Immunohistochemistry reported CK7 + ve, ER + ve, EMA + ve and CKAE1/AE3 + ve. The patient had an uneventful recovery, then she was discharged against medical advice and traveled to her country after two days before the histopathology result and she lost follow-up with us.
PubMed: 38865947
DOI: 10.1016/j.ijscr.2024.109855 -
Heliyon Jan 2024Ischaemic stroke often leaves serious sequelae affecting patients' daily activities and quality of life, especially shoulder pain. Shoulder pain after stroke often...
INTRODUCTION
Ischaemic stroke often leaves serious sequelae affecting patients' daily activities and quality of life, especially shoulder pain. Shoulder pain after stroke often occurs in the first 3 months with an occurrence rate of 25-72% due to the strong natural neurological mechanism during the time, interferes with the recovery of motor function, increases hospital stay, is associated with depression, and limits mobility as well as inhibits treatment results. In Vietnam, Traditional Medicine (TM) has played an essential role in treating and rehabilitating shoulder pain after stroke for quite a long time. Studies on the pathology of shoulder pain (Jian Tong) after stroke in TM in Vietnam are still inadequate. Therefore, this study evaluated the severity and characteristics of post-stroke Jian Tong in patients with ischaemic stroke.
METHODS
The study was conducted from January 1, 2023-May 1, 2023. The study consisted of two phases: Phase 1: Searching TM documents and selecting the characteristics that appear in the documents as components for the questionnaire of phase 2. Phase 2: Conduct a cross-sectional study to investigate the characteristics of Jian Tong in 65 patients after ischaemic stroke in the early rehabilitation phase.
RESULTS
In phase 1, the study encoded 17 features of Jian Tong from 10 literary documents. In phase 2, we surveyed over 65 patients, and the result was that shoulder pain aggravated by exertion had the highest rate, whereas shoulder pain alleviated by cold and distended shoulder had the fewest. Pain level measured by Number Rating Scale (NRS) points and gender was significantly related to the characteristics of TM shoulder pain - Jian Tong (p < 0.05).
CONCLUSION
The study demonstrated the pain level and the characteristics of Jian Tong in patients with ischaemic stroke in the early rehabilitation phase to contribute to the process of personalized diagnosing and treating Jian Tong after stroke for each patient, especially based on the theoretical basis and reasoning methods of Traditional Medicine.
PubMed: 38298670
DOI: 10.1016/j.heliyon.2024.e24626 -
Journal of Comparative Pathology Jan 2024An adult sulphur-crested cockatoo (Cacatua galerita) was unexpectedly found dead and was presented for post-mortem examination. Macroscopically, the proventricular wall...
An adult sulphur-crested cockatoo (Cacatua galerita) was unexpectedly found dead and was presented for post-mortem examination. Macroscopically, the proventricular wall was expanded by an infiltrative off-white mass, 10 mm in diameter, with secondary mucosal ulceration. Cytological examination of impression smears revealed a neoplastic epithelial cell population forming occasional well-defined acini with secretory product. Histologically, the neoplastic cells were predominantly arranged in acini and tubules, with fewer in small clusters, supported by a desmoplastic stroma. Neoplastic cells were polygonal, with mostly well-demarcated cell boundaries and a moderate amount of eosinophilic cytoplasm that was multifocally markedly distended by more intensely eosinophilic material. There was an increased nuclear-to-cytoplasmic ratio with moderately sized to large nuclei (approximately 15 μm diameter) with lightly to densely stippled chromatin and single or paired prominent basophilic nucleoli. The mitotic count was 19 in 10 high-power fields (2.37 mm), with scattered bizarre mitotic figures and atypia including moderate anisocytosis and anisokaryosis and moderate cellular and nuclear pleomorphism. There was frequent intratubular brightly eosinophilic proteinaceous material, which was Alcian blue and periodic acid‒Schiff positive. Proventricular lymphovascular invasion was detected, with metastases within the ventriculus and lungs. The macroscopic, cytological and histological appearance of the neoplasm was consistent with a proventricular adenocarcinoma.
Topics: Animals; Cockatoos; Adenocarcinoma
PubMed: 38101282
DOI: 10.1016/j.jcpa.2023.11.004 -
Veterinary Medicine and Science Jan 2024A 6-year-old female neutered Persian cat presented with hyporexia and gradual weight loss over 6 months. Physical examination revealed cranial abdominal pain....
A 6-year-old female neutered Persian cat presented with hyporexia and gradual weight loss over 6 months. Physical examination revealed cranial abdominal pain. Haematology and serum biochemistry were within normal limits. Abdominal ultrasonography and a computed tomography scan suggested a non-neoplastic mass compressing the gallbladder. During an exploratory laparotomy, a duplex gallbladder with two separate cystic ducts was diagnosed intraoperatively. The mass identified using the imaging techniques was an abnormal right gallbladder which was distended with immobile mucoid bile and a thickened wall. The left gallbladder and cystic duct were grossly normal. A cholecystectomy of both gallbladders was performed. Histopathology of the right gallbladder identified chronic cholecystitis. The cat made a good recovery from surgery and reported complete resolution of its hyporexia and a return to normal body weight. This is the first report of a successful cholecystectomy of a duplex gallbladder with chronic cholecystitis of a single gallbladder.
Topics: Female; Cats; Animals; Cholecystitis; Cholecystectomy; Tomography, X-Ray Computed; Ultrasonography; Cat Diseases
PubMed: 38124456
DOI: 10.1002/vms3.1337 -
Frontiers in Physiology 2023Gut smooth muscle dysfunctions contribute to symptoms such as abdominal cramping, diarrhea, and constipation in inflammatory bowel disease (IBD). The mechanisms for...
Gut smooth muscle dysfunctions contribute to symptoms such as abdominal cramping, diarrhea, and constipation in inflammatory bowel disease (IBD). The mechanisms for muscle dysfunctions are incompletely understood. We tested the hypothesis that mechanical stress plays a role in muscle dysfunction in a rat model of Crohn's-like colitis where inflammatory stenosis leads to mechanical distention in the pre-inflammation site. Crohn's-like colitis was induced by intracolonic instillation of TNBS (65 mg/kg) in Sprague-Dawley rats. Control rats were instilled with saline. The rats were fed with either regular solid food or exclusively liquid diet. Rats were euthanized by day 7. When rats were fed with solid food, TNBS treatment induced localized transmural inflammation with stenosis in the instillation site and marked distention with no inflammation in the pre-inflammation site of the colon. Smooth muscle contractility was suppressed, and expression of cyclo-oxygenase-2 (COX-2) and production of prostaglandin E (PGE) were increased not only in the inflammation site but also in the pre-inflammation site. Liquid diet treatment, mimicking exclusive enteral nutrition, completely released mechanical distention, eliminated COX-2 expression and PGE production, and improved smooth muscle contractility especially in the pre-inflammation site. When rats were administered with COX-2 inhibitor NS-398 (5 mg/kg, i. p. daily), smooth muscle contractility was restored in the pre-inflammation site and significantly improved in the inflammation site. Colonic smooth muscle contractility is significantly impaired in stenotic Crohn's-like colitis rats not only in the inflammation site, but in the distended pre-inflammation site. Mechanical stress-induced expression of COX-2 plays a critical role in smooth muscle dysfunction in the pre-inflammation site in Crohn's-like colitis rats.
PubMed: 37520831
DOI: 10.3389/fphys.2023.1215900 -
International Journal of Surgery Case... Mar 2024Gastric volvulus is an uncommon potentially life-threatening medical condition characterized by rotation of the stomach or part of the stomach around its longitudinal or...
INTRODUCTION AND IMPORTANCE
Gastric volvulus is an uncommon potentially life-threatening medical condition characterized by rotation of the stomach or part of the stomach around its longitudinal or transverse axis. Acute gastric volvulus usually presents with the triads of epigastric pain, nonproductive retching, and inability to pass the nasogastric tube. Diagnosis is assisted with abdominal and chest x-ray and contrast studies.
CASE PRESENTATION
A 53-year-old female presented with abdominal pain of two days duration which started at the epigastric region and later on became diffuse all over the abdomen. She had associated frequent episodes of vomiting which were initially bilious followed by nonproductive retching and low-grade intermittent fever. Abdominal examination showed a distended, diffusely tender abdomen with an ill-defined epigastric mass. Abdominal X-ray showed central abdominal circular opacity continuous with stomach outline. Intraoperative findings revealed perforated gangrenous mesenteroaxial gastric volvulus and splenopancreatic torsion with wandering spleen. Proximal subtotal gastrectomy with esophagogastric anastomosis and splenopexy was performed. The patient was discharged on the 10th postoperative day and had an uneventful post-operative recovery.
CLINICAL DISCUSSION
Primary gastric volvulus is usually mesenteroaxial with the pylorus commonly rotating anteriorly. Primary gastric volvulus can be associated with congenital asplenia and wandering spleen as both conditions are characterized by absent or loose ligamentous attachments. This case was a mesenteroaxial volvulus with splenopancreatic torsion with a wandering spleen caused by abnormal ligamentous attachments.
CONCLUSION
A high index of suspicion for early diagnosis of gastric volvulus and timely intervention is required to improve treatment outcome.
PubMed: 38308980
DOI: 10.1016/j.ijscr.2024.109338 -
Life (Basel, Switzerland) Sep 2023Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract with a 1-3% prevalence in the general population. The surgical management...
Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract with a 1-3% prevalence in the general population. The surgical management of symptomatic MD is well described in the literature, but there is still no consensus on the indication for prophylactic resection of incidental asymptomatic MD. To address this issue, we extensively reviewed the current literature and report our experience with laparoscopic management of an unusual case of MD causing ileal volvulus and acute peritonitis two weeks after a laparoscopic appendectomy for acute gangrenous appendicitis performed in another hospital. A 50-year-old man presented to the emergency department with acute and severe abdominal pain, vomiting, and constipation. He had undergone a laparoscopic appendectomy for acute appendicitis two weeks before in another hospital. The patient was apyretic, distressed, and seeking an antalgic position. The abdomen was mildly distended and tender, and the Blumberg sign was mildly positive in the central quadrants. The clinical picture deteriorated with fever, peritonismus, and leukocytosis. A CT scan showed an ileo-ileal adhesion near the ileocolic junction and dilatation of the upstream loops with the air-fluid levels. Through an urgent laparoscopy, a necrotic mass, the MD, was wedge-resected, and the surrounding ileal volvulus derotated. The postoperative course was uneventful. There is no definitive consensus on the appropriate management of incidental asymptomatic MD, although several studies have attempted to identify guiding criteria. Features of the MD, the patient's risk factors, clinical presentation, and surgical approach need to be considered to establish definitive guidelines for the management of incidental asymptomatic MD. In the absence of definitive guidelines, personal expertise and judgement are the main resources for the surgeon approaching an incidental asymptomatic MD.
PubMed: 37895380
DOI: 10.3390/life13101996 -
Radiology Case Reports Jun 2024Endometrioid carcinoma is the second most common ovarian tumor, classified as an epithelial-stromal ovarian tumor, and is usually characterized by a cystic tumor with...
Endometrioid carcinoma is the second most common ovarian tumor, classified as an epithelial-stromal ovarian tumor, and is usually characterized by a cystic tumor with partial solid components on magnetic resonance (MR) images. In this case report, we discuss an 81-year-old female who presented with atypical genital bleeding and distended abdomen, for which she underwent abdominal computed tomography and MR imaging. Solid endometrioid carcinoma of the ovary is very rare but was confirmed in our patient during the histological examination after surgery.
PubMed: 38523718
DOI: 10.1016/j.radcr.2024.02.074 -
Journal of Surgical Case Reports Oct 2023High-grade appendiceal mucinous neoplasms (HAMN) are rare mucinous appendiceal tumors that are mostly incidentally discovered and histologically show marked cytoplasmic...
High-grade appendiceal mucinous neoplasms (HAMN) are rare mucinous appendiceal tumors that are mostly incidentally discovered and histologically show marked cytoplasmic atypia. We report a 62-year-old female patient who was diagnosed with acute right flank pain mimicking renal colic. Abdominal and pelvis CT scans showed no calculi or hydronephrosis. Incidentally, a markedly distended retrocecal appendix was identified and an appendectomy was performed. Histopathology revealed an HAMN of size 5.8 cm. HAMN are one of the rare and somewhat recently described epithelial appendiceal tumors. The latest 2019 classification is based on histologic appearance and on the consensus for classification and pathologic reporting of and associated appendiceal neoplasia (Peritoneal Surface Pathology Group International, modified Delphi process). Histologically, appendiceal mucinous lesions are classified as nonneoplastic/mucocele and neoplastic lesions with separate subcategorization. Despite its rarity, it is crucial for clinicians to be aware of HAMN to distinguish it from other clinical differentials.
PubMed: 37854517
DOI: 10.1093/jscr/rjad567 -
Medicine Nov 2023Phacolytic glaucoma (PLG), a secondary open-angle glaucoma caused by high molecular weight proteins leaking through the capsule of a hypermature cataract. Leakage of...
RATIONALE
Phacolytic glaucoma (PLG), a secondary open-angle glaucoma caused by high molecular weight proteins leaking through the capsule of a hypermature cataract. Leakage of liquefied lens cortex behind the posterior capsule is rare. In this paper, we review a case of phacolytic glaucoma in the lens cortex behind posterior capsule.
PATIENT CONCERNS
This case report describes a 79-year-old male patient with a 7-year history of progressive blurred vision and a 1-day history of distended in his left eye. He underwent phacoemulsification combined with intraocular lens implantation at our facility 7 years ago.
DIAGNOSES
The patient had lower vision (light perception vision) and increased intraocular pressure (IOP) (60 mmHg) in the left eye. Auxiliary inspection found that the left eye had deep anterior chamber depth (around 1 corneal thickness of the peripheral AC angle) as well as vitreous and aqueous humor opacity in the left eye. Combining the clinical symptoms and examinations, we made the diagnosis of PLG in the left eye.
INTERVENTIONS
The patient underwent trabeculectomy and extracapsular cataract extraction of the left after a stable ocular condition, during the operation to see that white chyous cortex was visible under the posterior capsule and posterior capsule membrane of the lens was avulsed circularly.
OUTCOMES
The postoperative condition was stable. During the follow up of 3 months, the IOP of the left eye was stable without ocular discomfort.
LESSONS
This case reported a patient with phacolytic glaucoma in the lens cortex behind posterior capsule who underwent successful surgery, indicating spontaneous capsule rupture can occur in the posterior capsules in PLG and when this situation is detected during the operation, the posterior capsule tearing method can be applied to absorb the lens cortex sticking at the posterior surface of the posterior capsule.
Topics: Aged; Humans; Male; Cataract; Cataract Extraction; Glaucoma; Glaucoma, Open-Angle; Intraocular Pressure
PubMed: 37933005
DOI: 10.1097/MD.0000000000035784