Surgical Case Reports最新文献

{"title":"Histiocytic Sarcoma Diagnosed on Repeat Biopsy of Multifocal Extranodal Tumors.","authors":"Toshinari Ito, Yuya Iwata, Yoshimasa Akiba, Saki Ishiya, Toshiki Okasaka","doi":"10.70352/scrj.cr.25-0133","DOIUrl":"https://doi.org/10.70352/scrj.cr.25-0133","url":null,"abstract":"<p><strong>Introduction: </strong>Histiocytic sarcoma (HS) is a rare malignant disease with a poor prognosis and unknown pathogenesis. In addition, this disease is difficult to diagnose due to the wide variety of diseases to be differentiated from it.</p><p><strong>Case presentation: </strong>A 37-year-old woman with right-sided chest pain was referred to our hospital. Computed tomography (CT) revealed a 30-mm mass with osteolytic changes in the right eighth rib. Further examination revealed a rib mass, right renal mass, anterior mediastinal nodule, bilateral pulmonary nodules, and suprasellar nodule. A needle biopsy of the rib mass revealed granuloma with histiocytes. A subsequent needle biopsy of the right renal mass revealed similar findings without evidence of malignancy. The imaging findings suggested malignant disease; therefore, wedge resection of the upper lobe of the right lung and biopsy of the mediastinal mass were performed under general anesthesia. HS was diagnosed based on the immunostaining results.</p><p><strong>Conclusions: </strong>For the treatment of HS, early intervention is said to contribute to a prolonged prognosis. In order to provide appropriate therapy, HS should be included in the differential diagnosis for multifocal extranodal tumors.</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/PMC12127659/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144209562","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 Resection of Leiomyosarcoma Originating from the Inferior Vena Cava with Common Iliac Artery and Vein Reconstruction: A Case Report.","authors":"Takashi Miyata, Koki Furuse, Saki Kuwata, Kaori Maruyama, Yuki Shinden, Shota Motoyama, Yuta Sannomiya, Hozumi Tamezawa, Taigo Nagayama, Hisashi Nishiki, Akifumi Hashimoto, Daisuke Kaida, Koichi Okamoto, Hideto Fujita, Nobuhiko Ueda, Daisuke Sakamoto, Yasuhiro Nagayoshi, Hiroyuki Takamura","doi":"10.70352/scrj.cr.25-0008","DOIUrl":"https://doi.org/10.70352/scrj.cr.25-0008","url":null,"abstract":"<p><strong>Introduction: </strong>Leiomyosarcomas originating from the inferior vena cava are extremely rare. Because they have a strong tendency to invade the surrounding vital structures, cure can only be achieved by R0 resection.</p><p><strong>Case presentation: </strong>A 59-year-old Japanese woman was referred to our hospital because an abdominal tumor had been detected on a routine ultrasound examination. Computed tomography revealed a 7.0 × 5.3 cm lesion occluding the inferior vena cava to the confluence of the common iliac vein and creating a mass effect on the adjacent aorta and common iliac artery bifurcation. After an open biopsy had yielded a diagnosis of leiomyosarcoma, radical surgery was planned. The tumor was excised <i>en bloc</i> together with the inferior vena cava and abdominal aorta and reconstruction performed using artificial blood vessels. Histopathological examination of the resected specimen confirmed it was a leiomyosarcoma originating from the inferior vena cava and invading the aorta and that the surgical margins were negative.</p><p><strong>Conclusions: </strong>This report of a rare case of a leiomyosarcoma originating from the inferior vena cava and invading the aorta emphasizes that this combination of pathologies does not preclude curative surgery. However, more data are needed. Further research on leiomyosarcomas is essential for optimizing management and prognosis.</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/PMC12129700/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217000","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":"Omental Torsion Diagnosed and Treated with Single-Incision Laparoscopic Surgery in 2 Pediatric Patients: A Case Report.","authors":"Shohei Maekawa, Masafumi Kamiyama, Chisato Fujita, Daishi Takao, Kiyoaki Sumi, Kimihiko Watanabe, Kazunori Masahata","doi":"10.70352/scrj.cr.24-0021","DOIUrl":"10.70352/scrj.cr.24-0021","url":null,"abstract":"<p><strong>Introduction: </strong>Omental torsion (OT), caused by twisting of the greater omentum around its axis, leading to reduced blood supply to the distal aspect of the omentum and tissue infarction, is a rare disease that manifests clinically as acute abdominal pain. Accurate preoperative diagnosis is difficult. Here, we present 2 pediatric patients diagnosed and treated using computed tomography (CT).</p><p><strong>Case presentation: </strong>Case 1, a 14-year-old boy, had abdominal pain for 3 days. Upon referral to our hospital due to worsening pain, CT revealed an intra-abdominal fatty mass extending into high-density lesions in the fat tissue. Due to severe peritoneal irritation, emergency single-incision laparoscopic surgery was performed. Secondary OT was diagnosed as the greater omentum was twisted by the cord-like tissue, continuing from the greater omental infarction to the lesser omentum. Partial omentectomy, including the ischemic portion, was performed. Case 2, an 11-year-old boy, was referred with suspected appendicitis due to right lower abdominal pain for 2 days. CT revealed a whirling sign in the greater omentum and high-density lesions in the fat tissue. The patient was in good condition, and the peritoneal irritation was unclear; therefore, conservative treatment was initiated. However, symptoms did not improve after 48 h and single-incision laparoscopic surgery was performed, revealing a twisted necrotic omental mass diagnosed as primary idiopathic greater OT. Partial omentectomy, including the ischemic portion, was performed.</p><p><strong>Conclusions: </strong>CT scan aids in preoperative diagnosis of OT, for which single-incision laparoscopic surgery is a less invasive and useful therapy. Early surgical intervention is warranted when conservative treatment fails.</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/PMC11832222/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441970","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":"Multiple Desmoplastic Small Round Cell Tumor in the Intestine: A Case Report.","authors":"Naoto Tsujimura, Mitsuyoshi Tei, Daisuke Umeda, Koki Ishimaru, Shoko Minamiura, Takehiro Yamamoto, Soichiro Mori, Kentaro Nishida, Yukihiro Yoshikawa, Masatoshi Nomura, Koki Tamai, Takuya Hamakawa, Daisuke Takiuchi, Hironao Yasuoka, Masanori Tsujie, Yusuke Akamaru","doi":"10.70352/scrj.cr.24-0135","DOIUrl":"10.70352/scrj.cr.24-0135","url":null,"abstract":"<p><strong>Introduction: </strong>Desmoplastic small round cell tumor (DSRCT) is a highly malignant sarcoma and an extremely rare tumor, predominantly found in the abdominal and pelvic regions. Here, we report the case of a patient who underwent surgical treatment for multiple desmoplastic round cell tumor in the intestine.</p><p><strong>Case presentation: </strong>A 38-year-old male patient visited our hospital after a health check revealed positive occult blood in his stool and a colonoscopy revealed tumors in descending colon and sigmoid colon. Biopsy results revealed poorly differentiated adenocarcinoma. Chest and abdominal enhanced computed tomography revealed 3 tumors from descending colon to sigmoid colon and numerous peritoneal disseminations. Based on these findings, we diagnosed multiple colon cancers and performed a laparoscopic left hemicolectomy. Hematoxylin-Eosin (H&E) staining showed that in all tumors, atypical cells with large and small swollen nuclei formed irregular solid nests of various sizes against a background of extensive desmoplastic or myxomatous stroma. Immunohistochemistry showed that tumor cells were AE1/3 (+), S-100 (-), Desmin (-), WT1 (-). Genetic analysis detected the Ewing's sarcoma and Wilms tumor fusion gene at another inspection agency. Histopathological examination identified desmoplastic small round cell tumor. The patient was discharged on the 19th postoperative day without postoperative complications. He will undergo chemotherapy at another hospital.</p><p><strong>Conclusions: </strong>We experienced a very rare case of DSRCT. DSRCT is a fatal disease that primarily affects adolescent and young adult males. Currently, there is no proven treatment. More case reports are essential to improve management of this disease.</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/PMC11873736/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543584","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":"Salvage Lung Resection of Aspergilloma Mimicking Tumor Regrowth after Immune Checkpoint Inhibitor Therapy for Stage IV Squamous Cell Lung Cancer: A Case Report.","authors":"Takahiro Utsumi, Haruaki Hino, Yuki Takeyasu, Natsumi Maru, Hiroshi Matsui, Yohei Taniguchi, Tomohito Saito, Takayasu Kurata, Koji Tsuta, Tomohiro Murakawa","doi":"10.70352/scrj.cr.24-0096","DOIUrl":"https://doi.org/10.70352/scrj.cr.24-0096","url":null,"abstract":"<p><strong>Introduction: </strong>Recent advancements in chemotherapy, including immune checkpoint inhibitors, sometimes achieve complete remission in cases of stage IV lung cancer. On the other hand, immune-related adverse events may occur despite showing successful oncological effects. Herein, we report a rare case of a patient who underwent salvage lung resection after immune checkpoint inhibitor therapy for stage IVB lung cancer, which led to confirmed not only complete pathological remission but also complications with aspergilloma as a result of powerful effect for chemotherapy with immune checkpoint inhibitors.</p><p><strong>Case presentation: </strong>A 71-year-old woman was diagnosed with stage IVB squamous cell carcinoma of the lung located in the right upper lobe, accompanied by distant organ metastases in the thoracic vertebrae and right adrenal gland. Because the tumor shrank after systemic cytotoxic chemotherapy plus immune checkpoint inhibitor therapy, a partial response was considered to have been achieved clinically, and chemotherapy was discontinued afterward. After 5 months, however, the primary lesion gradually regrew, and tumor regrowth was highly suspected. A bronchoscopic biopsy revealed <i>Aspergillus</i> organism infection other than lung cancer. As local recurrence could not be completely ruled out, salvage thoracoscopic right upper lobectomy with hilar lymph node dissection was performed uneventfully. The pathological diagnosis was pulmonary aspergilloma without residual cancer (pathological complete remission). After the surgery, an antifungal agent was administered for half a year and no obvious cancer recurrence or fungal relapse was detected over 1.5 years.</p><p><strong>Conclusion: </strong>A salvage lung resection via thoracoscopic surgery was considered a feasible procedure. However, preoperative imaging does not always provide clear evidence of residual cancer, especially after chemotherapy with immune checkpoint inhibitors, as seen in the current patient. Therefore, salvage surgery should be considered comprehensively for selected patients with downstaged or relapsed lung cancer based on close image findings.</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/PMC11907164/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143650883","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 Hypoglycemia Diagnosed by Neuropsychiatric Symptoms after Distal Gastrectomy and Total Colectomy.","authors":"Kota Okuno, Masahiro Niihara, Shohei Fujita, Tadashi Higuchi, Hiroki Harada, Marie Washio, Mikiko Sakuraya, Koshi Kumagai, Takeo Sato, Takafumi Sangai, Yusuke Kumamoto, Takeshi Naitoh, Keishi Yamashita, Naoki Hiki","doi":"10.70352/scrj.cr.24-0099","DOIUrl":"https://doi.org/10.70352/scrj.cr.24-0099","url":null,"abstract":"<p><strong>Introduction: </strong>Hypoglycemia can lead to significant adverse effects, including cognitive impairment, fatigue, convulsions, and even loss of consciousness in severe cases. Recent reviews also associate hypoglycemia with severe outcomes, such as mortality, dementia, and cardiovascular events. In gastrointestinal surgery, postoperative hypoglycemia related to dumping syndrome is well documented after gastric procedures. However, hypoglycemia in patients who have undergone both gastrectomy and total colectomy is rare, and the underlying mechanisms and effective management strategies remain unclear.</p><p><strong>Case presentation: </strong>The patient, a 46-year-old woman diagnosed with chronic intestinal pseudo-obstruction (CIPO), had a medical history of distal gastrectomy with Billroth-I reconstruction and colostomy. Recently, she underwent total colectomy, after which she began experiencing symptoms of unexplained malaise, depression, and cognitive decline. She received treatment with medication at a neuropsychiatric department to address these symptoms, but they persisted. Strong anxiety and fatigue led her to engage in frequent drug overdose. She then presented to our hospital. Given her history of gastrointestinal surgery, we considered the possibility of nocturnal hypoglycemia and performed continuous glucose monitoring (CGM), which showed marked hypoglycemia. Nutritional therapy to control hypoglycemia effectively improved her condition, resolving drug overdose behavior completely and reducing the dosage of her psychotropic medications by half.</p><p><strong>Conclusion: </strong>This case highlights the diagnostic utility of CGM and the effectiveness of nutritional management in treating hypoglycemia after total colectomy in addition to gastrectomy and provides new insights into the management of similar postoperative cases.</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/PMC11906528/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143650769","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":"Mesenteric SMARCA2-Deficient Yet SMARCA4-Preserved Aggressive Undifferentiated Tumor: A Case Report.","authors":"Ichiro Tamaki, Koichi Kitagawa, Hidetaka Kozai, Yoshikuni Yonenaga, Takashi Nitta","doi":"10.70352/scrj.cr.24-0070","DOIUrl":"10.70352/scrj.cr.24-0070","url":null,"abstract":"<p><strong>Introduction: </strong>The SWItch Sucrose Non-Fermentable (SWI/SNF) chromatin remodeling complex, which includes components such as SMARCA4 and SMARCA2, regulates gene expression by controlling chromatin compaction and accessibility in an ATP-dependent manner. These components are also implicated in carcinogenesis. Thoracic SMARCA4-deficient undifferentiated tumor is a recently introduced category in the fifth edition of the WHO classification in 2021, typically exhibiting rhabdoid morphology in adults. In contrast, rhabdoid tumors occurring within the abdominal cavity in adults are rare and sporadic, with limited detailed documentation, making them relatively less understood compared to their thoracic counterparts.</p><p><strong>Case presentation: </strong>A man in his 70s was admitted to our hospital with a chief complaint of fever. He was diagnosed with a mesenteric solid tumor measuring 6 cm in maximum diameter. Shortly after the hospitalization, bowel obstruction became evident, accompanied by the rapid tumor progression, and then surgical treatment was attempted. A soft, bulky tumor situated in the mesentery accompanied by extensive tumor dissemination was found intraoperatively. The tumor was resected along with the obstructed terminal ileum, aiming to restore intestinal patency and obtain tissue samples. Histopathologically, the tumor represented morphological features resembling a rhabdoid tumor along with a high Ki67 labeling index (50%). Immunohistochemistry revealed SMARCA2 deficiency with preserved SMARCA4 expression. The absence of Claudin-4 expression further supported the diagnosis of a mesenteric SMARCA2-deficient yet SMARCA4-preserved undifferentiated tumor. The patient succumbed 20 days after surgery due to aggressive peritonitis carcinomatosis.</p><p><strong>Conclusions: </strong>To the best of our knowledge, this is the first case report of a mesenteric undifferentiated tumor with rhabdoid cytomorphology due to SWI/SNF chromatin remodeling complex deficiency caused by isolated SMARCA2 deficiency. The tumor, in our case, arose in the abdominal organs and appears to share a similar oncogenic process with the category of thoracic SMARCA4-deficient undifferentiated tumors in the WHO classification. Further research is required to improve our understanding of its clinical features, underlying mechanisms, and optimal management strategies.</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/PMC11863095/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143516783","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":"Laparoscopic Intra-Mediastinum Omental Filling Repair for Spontaneous Esophageal Rupture: A Case Report.","authors":"Demba Ishimine, Hiroki Sunagawa, Maina Teruya, Keigo Hayashi","doi":"10.70352/scrj.cr.24-0131","DOIUrl":"https://doi.org/10.70352/scrj.cr.24-0131","url":null,"abstract":"<p><strong>Introduction: </strong>Spontaneous esophageal rupture is a rare but life-threatening condition with a high mortality rate. While conservative and endoscopic therapies have been reported, surgical treatment remains essential. The optimal approach involves esophageal defect repair and mediastinal drainage, which is performed via laparotomy, thoracotomy, laparoscopy, or a combination of these techniques. We report a case of laparoscopic intramediastinal omental filling for a spontaneous esophageal rupture that was challenging to close.</p><p><strong>Case presentation: </strong>A 62-year-old man presented with sudden-onset right-sided abdominal pain. Computed tomography and esophagography revealed a spontaneous rupture of the right wall of the lower esophagus. Laparoscopic surgery was performed 4 h following symptom onset. A partially necrotic area was identified in the lower esophagus. Given the difficulty of suturing the necrotic esophageal wall, the mediastinum was filled with the greater omentum to cover the perforation site. The patient had no significant postoperative complications and was discharged on the 24th postoperative day.</p><p><strong>Conclusions: </strong>Laparoscopic omental filling repair is a viable option for esophageal rupture when primary suture closure is not feasible.</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/PMC12066238/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144023732","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":"Ileo-Ileal Knot with Three Closed Loops: A Case Report and Review of Pathophysiology.","authors":"Ryogo Ito, Hideo Matsubara, Masahito Uji, Yasutomo Miura, Yudai Aoki, Ryoichi Shimizu, Mayuko Fujisawa, Yasuji Mokuno","doi":"10.70352/scrj.cr.25-0011","DOIUrl":"https://doi.org/10.70352/scrj.cr.25-0011","url":null,"abstract":"<p><strong>Introduction: </strong>The ileo-ileal knot is a rare condition in which 2 ileal loops form a knot, leading to obstruction, ischemia, and the need for urgent surgical intervention. It is challenging to diagnose preoperatively, with 2 closed loops on CT scan as its characteristic feature. This case revealed 3 nearly situated closed loops, which offers insights into the diagnosis and management of the ileo-ileal knot.</p><p><strong>Case presentation: </strong>A 69-year-old female patient presented with a 3-h history of upper abdominal pain and repeated vomiting. Contrast-enhanced CT scan revealed a poorly enhanced small-bowel obstruction, with 3 nearly situated closed loops. The patient was diagnosed with a strangulated small-bowel obstruction, likely caused by an unusual internal hernia. Emergency laparoscopic surgery was performed. Due to the difficulty in assessing the intestinal condition and the risk of injury, the procedure was converted to open surgery. Direct evaluation during laparotomy confirmed the diagnosis of an ileo-ileal knot. The knot was untied, further improving bowel color and peristalsis and allowing bowel preservation. Based on the retrospective evaluation of the reconstructed CT scan images and intraoperative findings, the 3 closed loops comprised 2 tied loops and 1 knotting loop. The patient initially recovered. However, she was readmitted on postoperative day 24 due to bowel obstruction caused by fibrosis near the terminal ileum. After undergoing ileocolic resection, the patient recovered uneventfully.</p><p><strong>Conclusions: </strong>An ileo-ileal knot should be considered in cases of strangulated bowel obstruction with more than 2 closed loops. Because the intraoperative assessment of the knot is challenging, laparoscopic surgery can be difficult. Therefore, early conversion to laparotomy should be considered.</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/PMC12058428/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144050043","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 Chest Wall Myofibroma in an Adult.","authors":"Yasuaki Kubouchi, Tomohiro Haruki, Toho Wada, Masaya Yamasaki, Kengo Yasuda, Wakako Fujiwara, Karen Makishima, Tatsuya Miyamoto, Shinji Matsui, Yoshihisa Umekita, Masanori Hisaoka, Yugo Tanaka","doi":"10.70352/scrj.cr.24-0156","DOIUrl":"https://doi.org/10.70352/scrj.cr.24-0156","url":null,"abstract":"<p><strong>Introduction: </strong>Myofibroma is a rare benign tumor that often involves the skin, subcutaneous tissue, and/or bone in the head and neck, typically developing in children. Adult cases, particularly in the chest wall, are extremely rare.</p><p><strong>Case presentation: </strong>A 22-year-old asymptomatic Chinese man presented with an abnormal chest X-ray showing a shadow in the left lung apex. Chest computed tomography (CT) revealed a 2.5 × 2.0 cm nodule infiltrating the second rib. Positron emission tomography showed an accumulation of ¹⁸F-fluorodexyglucose in the nodule. A CT-guided biopsy revealed spindle-shaped cells positive for alpha-smooth muscle actin (α-SMA), β-catenin, and p16 but was inconclusive for malignancy. Since a malignant tumor could not be ruled out, the decision was made to perform surgery. A 25 cm-high posterolateral incision was made, the latissimus dorsi muscle was preserved, and the trapezius and rhomboid muscles were split in the direction of their fibers to reach the bony thorax. The second rib and the chest wall tumor, including the first and second intercostal muscles, were resected with a 1.5 cm margin. The lesion involving the rib showed fibromyxoid/fibrosclerotic nodules with spindle cells in loose fascicles or whorls, hypercellular areas, and thin-walled hemangiopericytoma-like vessels. Immunohistochemistry was positive for α-SMA, NOTCH3, and PDGFR and negative for desmin and S100. Based on these findings, we diagnosed a myofibroma in the chest wall.</p><p><strong>Conclusions: </strong>This case demonstrates that myofibroma can occur in the chest wall of an adult. The imaging findings of myofibromas are similar to those of malignant tumors, making them difficult to diagnose. Resection offers a good prognosis, and because these tumors occur in young patients, surgery should be performed with consideration for preserving function.</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/PMC11994292/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143987966","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}