Surgical Case Reports最新文献

{"title":"Postoperative Intra-Pouch Mucosal Bridge Formation in a Child with Ulcerative Colitis.","authors":"Yuhki Koike, Koki Higashi, Yuki Sato, Shinji Yamashita, Yuka Nagano, Tadanobu Shimura, Takahito Kitajima, Kohei Matsushita, Yoshinaga Okugawa, Yoshiki Okita, Yuji Toiyama","doi":"10.70352/scrj.cr.25-0045","DOIUrl":"https://doi.org/10.70352/scrj.cr.25-0045","url":null,"abstract":"<p><strong>Introduction: </strong>Restorative proctocolectomy with construction of an ileal J-pouch anal anastomosis is an established gold standard procedure for managing ulcerative colitis. One of the reported complications is a residual mucosal bridge as a result of leaving an apical bridge remnant when constructing the ileal J-pouch. However, now that the surgical procedure is well established, such complications rarely occur.</p><p><strong>Case presentation: </strong>A 12-year-old girl presented to our hospital because of anal pain. She had undergone three-stage surgery for ulcerative colitis refractory to medical therapy, the third stage (stoma closure) having been performed 1 month before the present admission. A computed tomography scan to investigate the possibility of a perianal or pelvic abscess showed no abscess, but revealed what appeared to be a thickening of the wall of the J-pouch, suggestive of pouchitis. Endoscopy revealed a mucosal bridge crossing the anterior and posterior walls of the J-pouch, with a stapler line near the posterior wall's root; however, there was no evidence of pouchitis. While creating the J-pouch (during the second stage of surgery for ulcerative colitis), we had ensured that an apical bridge was eliminated with a linear stapler. Moreover, a contrast enema of the J-pouch during the present admission demonstrated interruption of contrast in the J-pouch. These findings led us to conclude that the mucosal bridge had probably formed postoperatively, after J-pouch creation. The patient underwent endoscopic resection of the mucosal bridge in the J-pouch using an XXS wound retractor transanally. Both ends of the bridge were cut three times with a 5-mm stapler and the bridge was resected. The patient was discharged after surgery, having experienced immediate resolution of anal pain and no complications. Pathological examination of the resected specimen showed that the ileal wall had bent toward the J-pouch lumen with fibrous adherence on the serosal side, indicating that the mucosal bridge had developed unintentionally post-stoma closure. Preoperative computed tomography showed limited pouch expansion, whereas postoperative computed tomography showed sufficient expansion.</p><p><strong>Conclusion: </strong>If anal pain develops following radical ulcerative colitis surgery (after ileal stoma closure), postoperative mucosal bridge formation should be included in the differential diagnosis.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"11 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12055236/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144038865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Worsening Ileal Stenosis Caused by Multiple Ectopic Gastric Mucosa Lesions in an Elderly Patient: A Novel Case with a Long Observation Period.","authors":"Ryozan Naito, Etsuko Hisanaga, Ikuma Shioi, Nobuhiro Hosoi, Takayoshi Watanabe, Yuta Shibasaki, Nobuhiro Nakazawa, Katsuya Osone, Takuhisa Okada, Takuya Shiraishi, Akihiko Sano, Makoto Sakai, Hiroomi Ogawa, Makoto Sohda, Yoshihiro Ohno, Ken Shirabe, Hiroshi Saeki","doi":"10.70352/scrj.cr.24-0120","DOIUrl":"10.70352/scrj.cr.24-0120","url":null,"abstract":"<p><strong>Introduction: </strong>Ectopic gastric mucosa (EGM) is a hyperplastic primitive gut epithelium found in tissues other than the stomach. EGM in the small intestine, distal to the ligament of Treitz (EGMdT), is uncommon. EGMdT without congenital anomalies has rarely been reported. Most reported cases are diagnosed in youth, with a single lesion and urgent symptoms requiring emergency surgery. Herein, we report a unique case of multiple EGMdTs without congenital anomalies that caused progressive ileal stenosis in an elderly patient with an observation period of 11 years.</p><p><strong>Case presentation: </strong>The patient was a 77-year-old man. On a medical exam 11 years before arrival at our hospital, the patient was diagnosed with EGMdT in the terminal ileum without stenosis. Five years after the initial diagnosis of EGMdT, the patient experienced his first episode of bowel obstruction, which was treated conservatively. The patient experienced three episodes of bowel obstruction, all of which were treated conservatively. The patient was then referred to our hospital for further examination and treatment. Colonoscopy at our hospital showed an EGMdT that protruded from the Bauhin's valve. Double-balloon colonoscopy revealed a lymph follicle-like elevation 20 cm from the Bauhin's valve with obvious stenosis. No malignancies were found on lesion biopsy. The fluoroscopic gastrointestinal series showed five lesions on the oral side of the Bauhin's valve. Based on these findings, the patient's symptoms were considered as the outcome of ileal stenosis caused by multiple EGMdTs; therefore, surgical resection was recommended. Laparoscopic resection of the lesion was performed. Intraoperative findings were not suspicious of malignancy. There were five erosions in the resected specimen, and all lesions were diagnosed as EGMdTs without malignancies. The patient was discharged on the 7th postoperative day without any complications. The patient had no recurrent symptoms after discharge.</p><p><strong>Conclusions: </strong>Based on the present case, we recommend that clinicians consider surgical resection for symptomatic EGMdT, even without malignancy, and screen for multiple lesions to avoid residual EGMdT.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"11 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12120499/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144182827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful Conversion Surgery for Locally Advanced Pancreatic Neuroendocrine Carcinoma: A Case Report.","authors":"Yuuko Tohmatsu, Mihoko Yamada, Nobuyuki Ohike, Tomoko Norose, Hidemasa Kubo, Ryo Ashida, Katsuhisa Ohgi, Shimpei Otsuka, Yoshiyasu Kato, Hideyuki Dei, Katsuhiko Uesaka, Takashi Sugino, Teiichi Sugiura","doi":"10.70352/scrj.cr.24-0064","DOIUrl":"10.70352/scrj.cr.24-0064","url":null,"abstract":"<p><strong>Introduction: </strong>Pancreatic neuroendocrine carcinoma (panNEC) is a poorly differentiated, highly malignant neoplasm with an extremely poor prognosis. This tumor often presents as locally advanced or unresectable at the initial diagnosis.</p><p><strong>Case presentation: </strong>A 72-year-old woman presented to our hospital with weight loss. A computed tomography scan showed an enhanced tumor measuring 32 mm in the pancreatic head region, with contact to the common hepatic artery over 180°. The pathological findings from the specimens obtained via endoscopic ultrasonography-guided fine-needle aspiration identified small cell-type NEC with extensive necrosis, leading to a diagnosis of locally advanced unresectable panNEC. Accordingly, she began a course of carboplatin and etoposide therapy. After 7 courses, given the significant shrinkage of the tumor, we performed a pancreatoduodenectomy as a conversion surgery. Pathological examination revealed a localized, residual nodule of NEC, consisting mainly of large neoplastic cells, with carcinoma <i>in situ</i> components scattered within and around the nodule. In addition, the diffuse membrane expression of somatostatin receptor 2 was observed in NEC components. Each component showed the same type of <i>KRAS</i> mutation (p.G12V) and was considered to originate from a single primary tumor in the pancreas. She received 3 courses of the same regimen as adjuvant chemotherapy and has remained recurrence-free for 24 months.</p><p><strong>Conclusion: </strong>This is a rare case of successful conversion surgery for locally advanced, unresectable panNEC after chemotherapy, providing several important histopathological and molecular insights.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"11 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11933743/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143710939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Breast Cancer with a Newly Diagnosed Variant in the <i>PTEN</i> Gene: A Case Report.","authors":"Yuka Maeda, Tatsuhiko Ikeda, Ayana Sato, Akiko Matsumoto, Hiromitsu Jinno","doi":"10.70352/scrj.cr.24-0082","DOIUrl":"10.70352/scrj.cr.24-0082","url":null,"abstract":"<p><strong>Introduction: </strong>The phosphatase and tensin homolog hamartoma tumor syndrome (PHTS) refers to a spectrum of disorders caused by variants of the phosphatase and tensin homolog (<i>PTEN</i>) gene, including Cowden syndrome (CS), Bannayan-Riley-Ruvalcaba syndrome, adult Lhermitte-Duclos disease, and autism spectrum disorders associated with macrocephaly. PHTS is characterized by hamartomas in multiple organs and is associated with an increased risk of developing malignant tumors including, breast, thyroid, endometrial, colorectal, and kidney tumors. Breast cancer is the most common malignancy associated with PHTS.</p><p><strong>Case presentation: </strong>We describe the case of a 44-year-old female patient with invasive ductal carcinoma of the right breast. Cobblestone papillomatosis was present in the gingiva. She had a medical history of bilateral adenomatous goiters for 10 years. Her mother had been diagnosed with breast cancer, thyroid and tongue tumors, gastric polyps, hepatic hemangioma, and collagen disease. Additionally, the patient's maternal grandmother had a history of colon cancer. Based on the patient's family history and physical findings, CS was suspected, and direct DNA sequencing analysis revealed a haplotype c.634del mutation in exon 7 of the <i>PTEN</i> gene. Although there is no clear evidence supporting risk-reducing surgery for PHTS, a right nipple-sparing mastectomy, sentinel lymph node biopsy, and tissue expander reconstruction were performed.</p><p><strong>Conclusions: </strong>We report a case of breast cancer with a newly diagnosed c.634del mutation in the <i>PTEN</i> gene. We also reviewed the current literature on <i>PTEN</i> genetic variants and breast cancer subtypes.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"11 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11835985/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcome of Surgical Intervention for Intrathoracic Lymph Node Metastasis in Uterine and Ovarian Cancer without Lung Metastasis: A Report of Three Cases.","authors":"Ryohei Miyazaki, Masaya Tamura, Marino Yamamoto, Hironobu Okada, Yusuke Ujihara, Takashi Ushiwaka, Nagamasa Maeda","doi":"10.70352/scrj.cr.24-0080","DOIUrl":"10.70352/scrj.cr.24-0080","url":null,"abstract":"<p><strong>Introduction: </strong>Metastasis to the hilar and mediastinal lymph nodes in gynecological cancer is rare, and isolated hilar or mediastinal lymph node metastases are even rarer. In this report, we describe the results of lymph node dissection performed on 3 patients with hilar mediastinal lymph node metastasis but no lung metastasis from uterine or ovarian cancer.</p><p><strong>Case presentation: </strong>Case 1 was a 50-year-old woman diagnosed with ovarian cancer with mediastinal lymph node metastasis. After 4 courses of chemotherapy, a total hysterectomy, omentectomy, and mediastinal lymph node dissection were performed simultaneously. The patient is still alive 58 months after surgery. Case 2 was a 68-year-old woman who underwent a total hysterectomy after chemotherapy for endometrial cancer with multiple lymph node metastases. Forty-two months after surgery, mediastinal lymph node dissection was performed for metastasis of uterine cancer. She is still alive 75 months after surgery. Case 3 was a 69-year-old woman who underwent a hysterectomy for endometrial cancer. One year after surgery, she underwent thoracoscopic hilar and mediastinal lymph node dissection due to metastasis. Thirty-nine months have passed with no recurrence. Aggressive local control, particularly surgical resection of isolated hilar mediastinal lymph nodes in gynecological cancer, may contribute to prolonging patient survival.</p><p><strong>Conclusions: </strong>Aggressive local control, especially surgical resection, for isolated hilar mediastinal lymph nodes due to gynecological cancer is safe and may contribute to prolonging survival.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"11 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11835979/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143459372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delayed Onset Immune-Related Pituitary Adrenal Insufficiency Induced by Neoadjuvant Nivolumab Therapy for Locally Advanced Lung Cancer in the Postoperative Period: A Case Report.","authors":"Takafumi Kabuto, Shizuka Kaneko, Shinnosuke Nomura, Satoshi Terashita, Kaito Kitahori, Masaki Ikeda, Naohisa Chiba, Masashi Ishikawa","doi":"10.70352/scrj.cr.24-0044","DOIUrl":"10.70352/scrj.cr.24-0044","url":null,"abstract":"<p><strong>Introduction: </strong>Neoadjuvant, adjuvant, and perioperative immune checkpoint inhibitor (ICI) regimens for treating locally advanced lung cancer have dramatically evolved in recent years. Despite these immunotherapies being very promising, they can be associated with potential life-threatening immune-related adverse events (irAEs), and there is not much awareness regarding irAEs in surgical regimens.</p><p><strong>Case presentation: </strong>A Japanese man in his 70s was diagnosed with right upper lobe lung adenocarcinoma (cT3N1[#12u]M0, parietal pleural invasion, cStage IIIA), with the programmed death-ligand 1 expression level of <1%. He underwent right upper lobectomy via open thoracotomy followed by 3 cycles of neoadjuvant cisplatin, pemetrexed, and nivolumab. The pathological response rate was 50% and the pathological stage was ypT2bN0M0, ypStage IIA. Seven months after the surgery, he experienced gradually worsening anorexia, fatigue, and hyponatremia. He was diagnosed with pituitary adrenal insufficiency induced by neoadjuvant immunotherapy by the 100 μg corticotropin-releasing hormone stress test. Cardiogenic shock caused by takotsubo cardiomyopathy occurred, and intensive treatment was performed. Steroid therapy was effective, but the physical dysfunction persisted, although no recurrence of lung cancer was observed.</p><p><strong>Conclusions: </strong>Patients receiving neoadjuvant immunotherapies can develop life-threatening irAEs late in the postoperative period. Surgeons who follow up patients after neoadjuvant immunotherapies must be as vigilant regarding the development of irAEs in the postoperative phase as clinical oncologists.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"11 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11842875/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hilar Cholangiocarcinoma with Para-Aortic Lymph Node Metastasis Treated with Chemoimmunotherapy and Conversion Surgery: A Case Report.","authors":"Yuma Yasui, Koichi Kimura, Norifumi Iseda, Yoshinari Nobuto, Hiroko Yano, Yuichiro Kajiwara, Takuro Watanabe, Fang Cao, Michiko Amano, Takaaki Tanaka, Hironori Ochi, Nobuaki Azemoto, Kazuhito Minami, Ryosuke Minagawa, Tomoyuki Yokota, Takashi Nishizaki","doi":"10.70352/scrj.cr.25-0023","DOIUrl":"10.70352/scrj.cr.25-0023","url":null,"abstract":"<p><strong>Introduction: </strong>Cholangiocarcinoma (CC) has a poor prognosis and few treatment options. Conversion surgery for unresectable CC has been frequently reported; however, there are almost no reports of conversion surgery after durvalumab plus gemcitabine and cisplatin therapy. In this study, we report the case of a patient with unresectable hilar CC who received durvalumab plus gemcitabine and cisplatin therapy and achieved a pathological complete response after conversion surgery.</p><p><strong>Case presentation: </strong>A 70-year-old man was diagnosed with hilar CC (cT3N1M0, Stage III C) based on biopsy of the common bile duct stenosis and computed tomography (CT) and magnetic resonance cholangiopancreatography scans. Initially, a right lobe hepatectomy and subtotal stomach-preserving pancreatoduodenectomy were planned. However, there were concerns about an insufficient functional remnant liver volume. Trans-ileocolic portal embolization of the right portal vein branch was performed. On a preoperative CT scan 1 month later for liver volumetry, swelling of the para-aortic lymph nodes was observed, which was judged as distant metastasis, and radical resection could not be performed. After 8 courses of durvalumab plus gemcitabine and cisplatin therapy, vanishing fluorodeoxyglucose accumulation in the para-aortic lymph nodes was observed on positron emission tomography-CT. The possibility of resection was reevaluated, and a right lobe hepatectomy and extrahepatic biliary reconstruction were performed as conversion surgeries. Histological examination confirmed the absence of residual tumors or lymph node metastases. Ten months after surgery, the patient was free of recurrence.</p><p><strong>Conclusions: </strong>Chemoimmunotherapy with durvalumab as a first-line treatment for unresectable CC has shown promising results. Immunotherapy with durvalumab, followed by conversion surgery, may improve the prognosis of patients with unresectable CC.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"11 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11925595/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143671051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Cystic Neutrophilic Granulomatous Mastitis in Which <i>Mycobacteroides abscessus</i> Was Detected.","authors":"Hirokazu Yamazaki, Yasushi Ito, Keigo Goto, Masako Kasami","doi":"10.70352/scrj.cr.24-0115","DOIUrl":"10.70352/scrj.cr.24-0115","url":null,"abstract":"<p><strong>Introduction: </strong>Cystic neutrophilic granulomatous mastitis (CNGM) is characterized by granulomas with cysts that sometimes contain bacteria in the lumen, a surrounding neutrophilic infiltrate, and Langhans giant cells. There are no universally accepted diagnostic criteria for CNGM. <i>Corynebacterium kroppenstedtii</i>, a Gram-positive bacillus, has been reported to cause several infections, but the exact cause remains unclear. We report our experience with a case of CNGM, thought to be due to a rare <i>Mycobacteroides abscessus</i> infection.</p><p><strong>Case presentation: </strong>We report the case of a 36-year-old Japanese woman with granulomatous mastitis due to <i>Mycobacteroides abscessus</i> who had not undergone surgery and was not immunosuppressed. She presented with a chief complaint of pain and swelling in her left breast for 1 month. Mammography showed asymmetrical focal increased density, and ultrasonography showed an irregular hypoechoic area in the left 3 o'clock position. Contrast-enhanced magnetic resonance imaging showed segmental non-mass-enhancement. Ultrasound-guided vacuum-assisted biopsy with pathology revealed granulomatous mastitis. Ziehl-Neelsen staining revealed red-staining bacilli. The patient was followed up for observation because her breast pain had decreased after the examination, and there was no redness or fever. However, the breast pain has not completely disappeared, and intermittent purulent discharge from the biopsy site persisted for 5 months. Hence, two 12-Fr drains were inserted along the ductal dilatation-like hypoechoic area. Imipenem, amikacin, and clarithromycin were administered for 8 days. After 8 days of this therapy, the patient developed a drug-associated rash; therefore, antimicrobial therapy was discontinued, and the drains were removed. Her symptoms improved, and magnetic resonance imaging after 1 month showed that the previous imaging findings in her left breast had disappeared. At the time of writing, 18 months have passed since treatment, and no recurrence has been observed.</p><p><strong>Conclusions: </strong>We experienced a rare case of CNGM associated with <i>Mycobacteroides abscessus</i>. This case suggests that a combination of drainage and antimicrobial therapy may shorten the duration of antimicrobial therapy in CNGM.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"11 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11850989/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143504318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Myoepithelioma-Like Tumor of the Vulvar Region after Removal of an Inguinal Tumor.","authors":"Kei Urakami, Hiroaki Saito, Akimitsu Tanio, Yoichiro Tada, Yoshinori Yamada, Yutaka Yamashiro, Yumi Yamaguchi","doi":"10.70352/scrj.cr.25-0237","DOIUrl":"10.70352/scrj.cr.25-0237","url":null,"abstract":"<p><strong>Introduction: </strong>Myoepithelioma-like tumor of the vulvar region (MELTVR) is a mesenchymal neoplasm first reported in 2015 and typically develops from the inguinal to the vulvar regions of adult women.</p><p><strong>Case presentation: </strong>Here we report the case of a 42-year-old woman who presented with right inguinal tumor. The tumor had recently increased in size continuously. Computed tomography (CT) showed a homogeneous neoplastic lesion along the uterine cord in the right inguinal region and marginal resection was performed. Pathological examination revealed a well-defined tumor. And there were areas of epithelial-like tumor cells arranged in a reticular or cord-like pattern against a background of mucinous stroma, and areas of spindle-shaped cells growing in mucinous substrate with transition from epithelial cells. The nucleus was irregular in size and shape. Necrotic nests were scattered in the tumor. Immunohistological examination showed that the tumor cells were positive for epithelial membrane antigen (EMA), estrogen receptor (ER), and progesterone receptor (PgR). Alpha-smooth muscle actin (α-SMA) was slightly positive. The tumor was negative for cytokeratin AE1/AE3, p63, desmin, CD34, S100, glial fibrillary acidic protein (GFAP), and SOX10. Loss of INI1 protein expression was also confirmed. The patient was suspected of having high-grade myoepithelioma on pathological diagnosis at our hospital. However, immunohistological findings led to the diagnosis of MELTVR. The patient underwent additional wide excision and has been alive 10 months postoperatively without recurrence.</p><p><strong>Conclusions: </strong>Due to its rarity, it is difficult to make preoperative diagnosis of MELTVR. Awareness of this condition can contribute to accurate diagnosis and appropriate management in adult female patients presenting with swelling extending from the inguinal to the vulvar regions.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"11 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12324924/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Solitary Fibrous Tumor of the Stomach: Diagnostic Pitfalls and Clinical Implications.","authors":"Tadakazu Ao, Eiji Shinto, Tenma Ichisawa, Koki Ichio, Takafumi Suzuki, Shohei Mori, Hiroki Abe, Tomomi Koiwai, Makoto Nishikawa, Kiyoshi Nishiyama, Kimi Kato, Hiroaki Takeo","doi":"10.70352/scrj.cr.25-0314","DOIUrl":"10.70352/scrj.cr.25-0314","url":null,"abstract":"<p><strong>Introduction: </strong>Solitary fibrous tumor (SFT) is a rare mesenchymal neoplasm that most commonly originates in the pleura but can also occur at extrapleural sites, including the abdominal cavity. Among these, primary SFT of the stomach is exceptionally rare. Due to overlapping clinical, endoscopic, and radiologic characteristics, distinguishing SFT from gastrointestinal stromal tumor (GIST) can be particularly challenging. Misdiagnosis may result in inappropriate treatment, such as unnecessary administration of imatinib. Therefore, accurate preoperative differentiation is essential for appropriate management.</p><p><strong>Case presentation: </strong>A 74-year-old man was incidentally found to have a submucosal gastric tumor during a routine health checkup and was referred to our hospital for further evaluation and treatment. Upper gastrointestinal endoscopy revealed a 30-mm subepithelial lesion on the greater curvature of the gastric fundus. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) demonstrated isolated and clustered cells with ovoid to spindle-shaped nuclei. Although not definitive, the combined endoscopic and cytological findings led to a preoperative diagnosis of suspected GIST, and laparoscopy and endoscopy cooperative surgery (LECS) was subsequently performed for local resection. Histopathological examination of the resected specimen revealed an irregular proliferation of spindle cells and nuclear immunopositivity for signal transducer and activator of transcription 6 (STAT6), leading to a final diagnosis of SFT of the stomach. According to Demicco's risk stratification model, the tumor was classified as low risk. The patient underwent complete resection via LECS and has remained free of recurrence for more than 2.5 years postoperatively.</p><p><strong>Conclusions: </strong>This case highlights the difficulty in differentiating SFT from GIST preoperatively and underscores the importance of obtaining sufficient tissue samples to allow for immunohistochemical analysis, particularly STAT6 staining. Recognizing gastric SFT as part of the differential diagnosis is critical to avoid misdiagnosis and ensure appropriate therapeutic decision-making.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"11 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12414647/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}