Surgical Case Reports最新文献

{"title":"Successful Emergency Stenting of a Visceral Branch Prior to Central Aortic Repair in Type A Aortic Dissection with Mesenteric Malperfusion: A Case Report.","authors":"Sho Akita, Akinori Tamenishi, Yasumoto Matsumura, Kunihiro Maruyama, Jun Ito","doi":"10.70352/scrj.cr.25-0136","DOIUrl":"10.70352/scrj.cr.25-0136","url":null,"abstract":"<p><strong>Introduction: </strong>Stanford Type A acute aortic dissection (AAD) complicated by mesenteric malperfusion has a mortality rate exceeding 60%. Conventional immediate central aortic repair may be inadequate in such complex cases. Emerging evidence suggests that a staged approach may improve outcomes.</p><p><strong>Case presentation: </strong>A 71-year-old male presented with acute chest pain and was diagnosed with Stanford Type A AAD extending to the abdominal aorta, with superior mesenteric artery (SMA) dissection leading to intestinal ischemia. To restore intestinal perfusion, emergency endovascular SMA stenting was performed as the initial intervention, followed by ascending aorta and total arch replacement using the frozen elephant trunk technique 12 hours later. The patient recovered without complications and was discharged ambulatory on postoperative day 20.</p><p><strong>Conclusions: </strong>This case highlights the efficacy of a staged approach prioritizing mesenteric revascularization before central aortic repair in AAD complicated by visceral malperfusion. By first addressing end-organ ischemia, we potentially mitigated the risk of irreversible bowel necrosis while enabling subsequent central aortic repair. Our experience adds to the growing body of evidence supporting individualized, pathophysiology-guided treatment strategies for this challenging clinical scenario.</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/PMC12179782/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144476768","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":"Surgical Management of Destructive Thyroiditis Triggered by Neoadjuvant Immune Checkpoint Inhibitor Therapy in Locally Advanced Non-Small Cell Lung Cancer: A Case Report.","authors":"Sachi Kawagishi, Toru Kimura, Kenji Kimura, Eriko Fukui, Takashi Kanou, Naoko Ose, Yasushi Shintani","doi":"10.70352/scrj.cr.25-0104","DOIUrl":"10.70352/scrj.cr.25-0104","url":null,"abstract":"<p><strong>Introduction: </strong>The use of immune checkpoint inhibitors (ICIs) as neoadjuvant therapies for locally advanced and resectable non-small cell lung cancer is increasing. As a result, immune-related adverse events (irAEs) may be observed before surgery and may require preoperative intervention. We report the case of a patient with destructive thyroiditis induced by neoadjuvant ICI treatment, in which surgical resection was performed after steroid treatment.</p><p><strong>Case presentation: </strong>A 74-year-old woman was diagnosed with slow-growing squamous cell carcinoma of the right upper lobe during treatment for another disease. Imaging studies revealed a small nodule suggestive of pulmonary metastasis in the right upper lobe and hilar lymph node metastasis. The patient was initially diagnosed with primary lung cancer of the right upper lobe (cT3N1M0, Stage IIIA, TNM Classification, 8th edition), and neoadjuvant nivolumab combined with chemotherapy was planned every 3 weeks for three cycles. After the first cycle, the patient experienced drug-induced kidney injury. Nivolumab and chemotherapy were discontinued, and surgical resection was planned. However, a laboratory analysis on the day before surgery revealed elevated free triiodothyronine and free thyroxine, and decreased thyroid-stimulating hormone. Subsequent examination led to a diagnosis of destructive thyroiditis due to irAEs, and surgery was postponed. Dexamethasone was administered orally for 1 week, and once the thyroid function showed consistent improvement, a thoracoscopic right upper lobectomy was performed. The patient progressed without any other complications after surgery.</p><p><strong>Conclusions: </strong>This report highlights a case of preoperative destructive thyroiditis secondary to irAEs. In patients receiving preoperative ICIs therapy, routine blood tests, including thyroid function tests, are recommended as part of preoperative assessment. In this case, the patient underwent lobectomy safely following steroid administration. The optimal timing of surgery in patients with preoperative ICI-induced destructive thyroiditis requires further investigation.</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/PMC12127077/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200015","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":"Thymoma with Intravascular Tumor Thrombus in the Left Brachiocephalic Vein: A Case Report.","authors":"Taimei Tachibana, Yosuke Matsuura, Hironori Ninomiya, Yoshinao Sato, Ayumi Suzuki, Junji Ichinose, Masayuki Nakao, Sakae Okumura, Norihiko Ikeda, Mingyon Mun","doi":"10.70352/scrj.cr.25-0118","DOIUrl":"10.70352/scrj.cr.25-0118","url":null,"abstract":"<p><strong>Introduction: </strong>Thymomas have the potential to locally invade and metastasize, occasionally infiltrating adjacent structures, such as the great vessels and the heart. Although direct extension is the primary mechanism of vascular invasion, rare cases of intravascular growth have also been reported.</p><p><strong>Case presentation: </strong>We present the case of a 50-year-old woman diagnosed with a thymoma that extended intraluminally into the left brachiocephalic vein (LBCV), forming a tumor thrombus. The patient was referred to our hospital after chest computed tomography (CT), which revealed an anterior mediastinal tumor with a filling defect adjacent to the superior aspect of the tumor. Initially, the defect was thought to be a blood clot because of the preserved vascular wall structure. However, follow-up CT scans conducted 2 weeks later revealed persistence of the defect and a slight increase in size, leading to the diagnosis of a tumor thrombus. Further imaging, including contrast-enhanced CT and magnetic resonance imaging, confirmed thymoma invasion of the LBCV, necessitating surgical intervention. The patient underwent a median sternotomy and tumor resection with combined partial resection of the LBCV and right upper lobe. Intraoperatively, a dilated thymic vein continuous with the tumor was identified. The tumor thrombus was visible through the LBCV wall, aiding in the determination of its extent. The LBCV was clamped proximally and distally, and the dilated thymic vein was ligated and divided. Subsequently, thymectomy encompassing the tumor and partial resection of the LBCV wall were performed to remove the thrombus. Microscopically, the tumor was classified as a type B2 thymoma. No evidence of continuity between the tumor thrombus and the thymic vein was observed. No postoperative complication was observed. Nine months after surgery, the patient experienced recurrence with pleural dissemination and underwent resection.</p><p><strong>Conclusions: </strong>Thymomas can invade vessels through intravascular growth, and contrast-enhanced CT is important for accurately diagnosing such cases. In this instance, preoperative identification of the tumor thrombus enabled a comprehensive surgical approach, resulting in complete resection of the tumor and thrombus, without the need for embolization. This case underscores the significance of meticulous imaging and surgical planning in the management of complex thymomas to ensure optimal patient outcomes.</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/PMC12229713/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144576279","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 Curative Surgery after Effective Chemotherapy for Gastric Adenocarcinoma with Enteroblastic Differentiation Accompanied by Synchronous Multiple Liver Metastases.","authors":"Shuhei Yamada, Toshiki Wakabayashi, Isao Kikuchi, Michinobu Umakoshi, Masato Sageshima, Tsutomu Sato, Junichi Arita","doi":"10.70352/scrj.cr.25-0205","DOIUrl":"10.70352/scrj.cr.25-0205","url":null,"abstract":"<p><strong>Introduction: </strong>Gastric adenocarcinoma with enteroblastic differentiation (GAED) is associated with a poor prognosis because of high rates of liver and lymph node metastases. While systemic chemotherapy is the standard treatment for gastric cancer (GC) with liver metastases, several studies suggest that hepatectomy, when combined with multimodal treatment, may provide a survival benefit. However, the role of surgical resection for GAED with liver metastases remains controversial.</p><p><strong>Case presentation: </strong>A 71-year-old man presented with abdominal pain and nausea. Endoscopy revealed a type 2 tumor at the greater curvature of the gastric body. Contrast-enhanced computed tomography showed thickening and enhancement of the gastric wall, bulky lymph node metastases, and bilobar hepatic lesions, with the largest tumor measuring 60 mm in diameter. Histological examination of the stomach and liver tumors revealed adenocarcinoma composed of cuboidal or columnar cells resembling a primitive intestine-like structure with clear cells. Immunostaining showed heterogeneous cytoplasmic positivity for alpha-fetoprotein and spalt-like protein 4, leading to a diagnosis of GAED with liver metastases. Because the tumor was positive for human epidermal growth factor receptor 2 (HER2), chemotherapy with capecitabine, cisplatin, and trastuzumab was administered. After six cycles, the tumors had significantly decreased in size, and curative-intent surgery was performed, including distal gastrectomy, left lateral sectionectomy, and partial hepatectomy, successfully eradicating all five liver metastases. Histological examination of the liver metastases revealed extensive necrosis and fibrosis with no viable tumor cells. Adjuvant chemotherapy with the same regimen was continued for 1 year. At the time of this writing, the patient had remained recurrence-free for more than 2 years postoperatively.</p><p><strong>Conclusions: </strong>We report a rare case of GAED with multiple liver metastases successfully treated with aggressive surgical resection following systemic chemotherapy. Trastuzumab-based chemotherapy may be a viable treatment option for HER2-overexpressing GAED. In addition, radical surgery for GAED with liver metastases might prolong the survival if the chemotherapeutic regimen was effective.</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/PMC12245621/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144627121","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":"Combined Arterial Reconstruction and Surgical Distal Venous Arterialization for Limb Salvage in Thromboangiitis Obliterans: A Case Report.","authors":"Yuri Yoshida, Shinsuke Kikuchi, Daichi Mizushima, Hirofumi Jinno, Hiroya Moriyama, Takayuki Uramoto, Kazuki Takahashi, Tsutomu Doita, Keisuke Kamada, Seima Ohira, Daiki Uchida, Naoya Kuriyama, Nobuyoshi Azuma","doi":"10.70352/scrj.cr.25-0342","DOIUrl":"10.70352/scrj.cr.25-0342","url":null,"abstract":"<p><strong>Introduction: </strong>Thromboangiitis obliterans (TAO) has become increasingly uncommon in Japan due to declining smoking prevalence. However, in advanced cases with severely compromised distal vasculature, achieving durable limb salvage remains a formidable surgical challenge.</p><p><strong>Case presentation: </strong>A 51-year-old man with a 12-year history of TAO presented with rest pain and a necrotic ulcer on the 2nd toe. He had recently ceased smoking after a 31-year history. Imaging demonstrated complete occlusion of the popliteal and tibial arteries, with foot perfusion reliant on corkscrew collaterals. The ankle-brachial index was 0.43, and skin perfusion pressure (SPP) was critically low. A severely diseased plantar artery was identified as a potential distal target. Given the high risk of graft failure, a hybrid strategy combining <i>in situ</i> bypass and surgical distal venous arterialization (DVA) was preoperatively planned. To mitigate perioperative vasospasm, a lumbar sympathetic block was administered 1 week prior to surgery. An <i>in situ</i> bypass using the ipsilateral great saphenous vein was constructed from the superficial femoral artery to the plantar artery. DVA was established via retrograde puncture of the plantar vein, balloon angioplasty for valve sites, and end-to-side anastomosis to the bypass graft. Early duplex ultrasonography revealed anastomotic stenosis at the DVA site as well as stenosis at valve sites, both of which were successfully managed with a single endovascular procedure. The toe stump healed completely within 3 months. The graft remained patent for 2 years, and SPP was preserved even after graft occlusion. Notably, graft failure coincided with DVA occlusion, suggesting its critical role in maintaining flow. At 42 months postoperatively, the patient remained ulcer-free with favorable perfusion, pain-free ambulation, and full return to work.</p><p><strong>Conclusions: </strong>Preoperatively planned surgical DVA, in conjunction with sympathetic modulation and timely postoperative intervention, may offer a durable limb salvage strategy in advanced TAO with limited distal targets.</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/PMC12313424/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144776186","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":"Aortic Valve Replacement with Annular Patch Reconstruction for Prosthetic Valve Endocarditis after the Bentall Procedure: A Case Series.","authors":"Taiki Matsuoka, Ikuko Shibasaki, Shunsuke Saito, Yusuke Takei, Hirotsugu Fukuda","doi":"10.70352/scrj.cr.25-0316","DOIUrl":"10.70352/scrj.cr.25-0316","url":null,"abstract":"<p><strong>Introduction: </strong>Prosthetic valve endocarditis following aortic root replacement (ARR) typically necessitates redo-ARR, which involves complete graft removal, extensive aortic root dissection, and coronary reimplantation. This highly invasive procedure carries substantial surgical risk, including high operative mortality. In select high-risk patients without evidence of prosthetic graft infection, alternative surgical strategies may reduce procedural complexity and improve outcomes.</p><p><strong>Case presentation: </strong>Here, we report 3 cases of prosthetic valve endocarditis following the Bentall procedure, a common ARR technique, in older patients (mean age: 73.7 ± 3.5 years). All preoperative blood cultures were negative, and no signs of prosthetic graft infection were noted on CT. Due to advanced frailty (Clinical Frailty Scale scores of 7 or 8), conventional redo-ARR was deemed prohibitively high-risk. Risk assessment using the JapanSCORE showed a mean predicted mortality of 32.5% ± 21.0%, with combined mortality and morbidity of 63.7% ± 22.9%. Instead of redo-ARR, annular reconstruction using a bovine pericardial patch was performed, followed by redo aortic valve replacement. All patients underwent successful surgery with no postoperative reinfection. One patient required prolonged intensive care and was transferred to another facility for rehabilitation, while the other 2 recovered uneventfully and were discharged. During a mean follow-up of 26.3 ± 17.6 months, 2 patients died due to non-cardiac causes: one from pneumonia and the other from gastric cancer.</p><p><strong>Conclusions: </strong>In high-risk patients without clear evidence of prosthetic graft infection, aortic valve replacement with annular patch reconstruction may represent a viable alternative to redo-ARR, particularly in settings where homografts are not readily available. This approach reduces operative complexity while maintaining structural integrity. Further studies are warranted to validate infection control criteria and assess long-term outcomes.</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/PMC12408195/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016173","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 Gastric Neuroendocrine Carcinoma with Disseminated Recurrence 14 Years after Initial Surgery.","authors":"Takara Kinjo, Keishi Okubo, Masahiro Hamanoue, Miki Murakami, Takao Ohtsuka, Sonshin Takao","doi":"10.70352/scrj.cr.25-0285","DOIUrl":"10.70352/scrj.cr.25-0285","url":null,"abstract":"<p><strong>Introduction: </strong>Gastric neuroendocrine carcinoma (NEC) is a rare disease among gastric cancers, accounting for only 0.1%-0.6% of all cases. This disease is known to have a poor prognosis and a higher risk of recurrence compared to conventional gastric adenocarcinoma.</p><p><strong>Case presentation: </strong>At the age of 44, a 60-year-old female underwent a laparoscopic-assisted proximal gastrectomy for gastric cancer at a previous hospital. Neuroendocrine carcinoma was diagnosed following a postoperative pathological examination based on histological findings and immunostaining results. The patient was followed up without any recurrences. After 14 years, a follow-up contrast-enhanced CT revealed a 9-mm mass on the greater curvature side of the gastric antrum, which was suspected to be lymph node swelling at the previous hospital. After 8 months, she came to our hospital with abdominal discomfort and distention. The CT scan revealed a 55-mm mass, indicating an increase in the previously mentioned mass. At our hospital, the patient underwent open tumor resection. The pathological findings revealed a recurrence of gastric NEC. The patient has been recurrence-free for 6 months following surgery.</p><p><strong>Conclusions: </strong>We present a case of gastric NEC with disseminated recurrence. To our knowledge, this is the first report of a disseminated case in which a recurrent lesion caused by omental dissemination grew in size and infiltrated a portion of the gastric serosa approximately 14 years after the initial surgery.</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/PMC12370320/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144969828","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":"Pancreatic Hemangioblastoma in a Patient with von Hippel-Lindau Disease: A Case Report.","authors":"Naoto Nakamura, Yosuke Kasai, Kazuyuki Nagai, Asahi Sato, Kentaro Kadono, Norimitsu Uza, Tsuyoshi Ohno, Sho Koyasu, Yuji Nakamoto, Noritaka Sano, Ayako Takahashi, Shinya Otsuki, Hiroaki Ito, Kei Yamane, Takayuki Anazawa, Satoshi Ogiso, Yoichiro Uchida, Takashi Ito, Takamichi Ishii, Etsuro Hatano","doi":"10.70352/scrj.cr.25-0247","DOIUrl":"10.70352/scrj.cr.25-0247","url":null,"abstract":"<p><strong>Introduction: </strong>von Hippel-Lindau (VHL) disease is an autosomal dominant hereditary disorder characterized by the development of tumor-like lesions in multiple organs. While central nervous system hemangioblastomas, pancreatic neuroendocrine tumors, and pancreatic cysts are commonly associated with VHL disease, there have been few reported cases of pancreatic hemangioblastoma in patients with VHL disease.</p><p><strong>Case presentation: </strong>A male patient in his 30s had been diagnosed with VHL disease and had been followed for cerebellar and spinal hemangioblastomas, and renal cell carcinoma, for which he had undergone several tumor resections, radiation therapy, and a ventriculoperitoneal shunt. A pancreatic head tumor deemed to be a neuroendocrine tumor on imaging findings exhibited a gradual increase in size from 12 to 33 mm for the past 2 years, but it had been monitored due to his comorbidities and declining daily living activities. Severe anemia was detected during his regular outpatient visit, and an emergency esophagogastroduodenoscopy revealed a submucosal tumor near the duodenal papilla with ulceration and active bleeding, making endoscopic hemostasis challenging. Dynamic contrast-enhanced CT showed active bleeding from the pancreatic tumor. Subsequently, emergency angiography was performed via the superior mesenteric artery, successfully embolizing vessels supplied by the inferior pancreaticoduodenal artery to achieve hemostasis. Due to concerns about rebleeding, we performed pancreaticoduodenectomy 1 month after the emergency angiography, during which we awaited the improvement of the patient's overall condition. Microscopic findings of the tumor showed multinodular proliferation with hematoxylin-eosin staining, revealing cells with clear cytoplasm and abundant capillaries and dilated branching vessels within the nests. Immunohistochemical analysis demonstrated positivity for alpha-inhibin and S100, with partial positivity for carbonic anhydrase IX, leading to a diagnosis of pancreatic hemangioblastoma.</p><p><strong>Conclusions: </strong>This paper reports a rare case of pancreatic hemangioblastoma arising in a patient with VHL disease. It is crucial to consider the possibility of pancreatic hemangioblastoma when treating pancreatic tumors in VHL disease patients.</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/PMC12415619/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145030371","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":"Pelvic Malignant Tumor with Liver Metastasis is Actually Conventional Leiomyoma with Abdominal Metastasis.","authors":"Jingjun Yang, Jianming Lu","doi":"10.70352/scrj.cr.25-0157","DOIUrl":"10.70352/scrj.cr.25-0157","url":null,"abstract":"<p><strong>Introduction: </strong>For this case, when the preoperative diagnosis indicated malignant tumor with metastasis, intraoperative frozen section examination was performed to adjust the surgical plan accordingly. This approach helped avoid overtreatment, minimizing the patient's pain and surgical trauma. This case holds educational significance.</p><p><strong>Case presentation: </strong>A 45-year-old female patient underwent open myomectomy 12 years ago for uterine fibroids and laparoscopic subtotal hysterectomy 10 years ago for the same condition. During this check-up, her CA125 was found to be elevated. Further examinations, including ultrasound, enhanced CT, and enhanced MRI, all suggested a pelvic malignant tumor with liver metastasis. The patient underwent tumor resection, and both intraoperative frozen section and routine histopathologic examination confirmed that the pelvic and subphrenic tumors (which had been considered as liver metastases preoperatively) were both conventional leiomyomas.</p><p><strong>Conclusions: </strong>This case highlights that leiomyomas, when metastatic, are easily misdiagnosed as malignant tumors with metastasis, presenting a significant challenge for preoperative diagnosis. Clinicians should maintain a high level of suspicion in such cases to avoid overtreatment. In this case, the intraoperative frozen section played a crucial role in preventing unnecessary pelvic lymph node dissection.</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/PMC12375418/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144969783","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":"Bronchogenic Cyst with Degeneration of the Adjacent Membranous Portion of the Trachea: A Case Report.","authors":"Takamitsu Hayakawa, Mikako Mitake, Hirohisa Inaba, Mayumi Kobayashi, Yasuhiro Watanabe, Asako Okabe, Kazuhito Funai","doi":"10.70352/scrj.cr.25-0287","DOIUrl":"10.70352/scrj.cr.25-0287","url":null,"abstract":"<p><strong>Introduction: </strong>Bronchogenic cysts are congenital, benign cystic lesions that develop in the mediastinum. Many patients are asymptomatic, and conservative observation is often chosen in clinical practice. However, delayed surgical resection following cyst enlargement and compression of the adjacent membranous portion of the trachea can result in perioperative challenges.</p><p><strong>Case presentation: </strong>We report the case of a 53-year-old woman who had been under observation for 10 years for an asymptomatic mediastinal mass. The mass enlarged gradually and caused persistent cough along with obstructive ventilatory impairment. Chest CT revealed a 5.5 cm mass compressing the membranous trachea, resulting in tracheal stenosis. MRI revealed a homogeneously high T2 signal within the mass, suggesting a simple cystic nature. PET showed no accumulation of fluorodeoxyglucose in the mass, indicating no malignancy. Based on preoperative diagnosis of a bronchogenic cyst, the patient underwent video-assisted thoracoscopic surgery. Tracheal intubation using a double-lumen tube was challenging due to the tracheal stenosis. Moreover, the membranous trachea compressed by the cyst exhibited white degeneration, suggesting thinning and fragility. Intraoperatively, due to firm adhesion to the membranous trachea, a part of the cyst wall was intentionally left in place to avoid tracheal injury. The inner lining of the residual cyst was cauterized to prevent recurrence. Bronchoscopic findings on POD 7 showed that white degeneration of the membranous trachea remained. Histopathological examination revealed ciliated columnar epithelium and cartilage on the cyst wall, confirming the diagnosis of a bronchogenic cyst.</p><p><strong>Conclusions: </strong>Long-term observation of mediastinal bronchogenic cysts can lead to degeneration and thinning of the membranous trachea, increasing the risk of tracheal injury and incomplete resection during surgery. Therefore, the absence of symptoms should not justify delaying surgical intervention. Preoperative assessment for coexisting malignancy and tracheal abnormalities can support surgical decision-making to ensure a safe procedure.</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/PMC12377854/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144969785","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}