Giant uterine tumor and miscarriage: how to proceed?

Expanding uterine masses can be the cause of pregnancy loss and add technical difficulties to uterus evacuation due to the intense anatomical distortion of the endocervical canal and uterine cavity. The literature is scarce in the peculiarities of the management of missed abortions in uterus with important distorted anatomies. We report a case of a primigravida patient who presented a rapid and expressive increase of abdominal volume due to a giant uterine mass, evolving to miscarriage. Ultrasound can be a useful tool, allowing visualization of the endocervical path and uterine cavity, helping to perform uterine evacuation in the presence of anatomical distortion without compromising the reproductive future. To the best of our knowledge, no such case has been previously reported.

Giant multilocular prostatic cystadenoma:a case report and literature review / 现代泌尿外科杂志

【Objective】 To investigate the clinical characteristics and treatment strategy of giant multilocular prostatic cystadenoma(GMPC). 【Methods】 The clinical data of a GMPC patient treated in our hospital in July 2021 were retrospectively analyzed. The patient was 73 years old. The clinical manifestations were urgent urination and frequent urination. The prostate specific antigen (PSA) increased slightly. MRI showed giant cystic solid space occupying lesion of the prostate. Domestic and foreign cases of prostate cystadenoma from 2000 to 2021 were retrieved for literature review. 【Results】 Transabdominal laparoscopic radical prostatectomy was performed successfully. The postoperative pathological diagnosis was GMPC. Two weeks after operation, the urinary catheter was removed, and there was no discomfort such as urinary frequency or urinary incontinence. After follow-up for more than 8 months, there was no tumor recurrence or metastasis. 【Conclusion】 There are still some disputes about the oncological characteristics and diagnosis and treatment of GMPC, and there is a lack of long-term follow-up results. Laparoscopic prostatectomy is safe and feasible. Most patients have a good prognosis after surgical treatment. It is necessary to formulate an individualized standard treatment plan based on surgery combined with different patients’ conditions to actively improve the prognosis.

Tumor de estroma gastrointestinal extraintestinal gigante: reporte de un caso y revisión de bibliografía / Giant extraintestinal gastrointestinal stromal tumor: Case report and bibliography review

Resumen Los tumores del estroma gastrointestinal (GIST) son tumores infrecuentes del tracto digestivo. Sus localizaciones más frecuentes son el estómago, intestino delgado, colon y recto; su aparición en otros lugares fuera del trato gastrointestinal como el mesenterio, epiplón o retroperitoneo es infrecuente. La tomografía axial computarizada (TAC) y la resonancia magnética (RM) son los estudios de imágenes de primera elección. La recesión quirúrgica es el estándar de oro para los tumores localizados y en los tumores avanzados o metastásicos son tratados con imatinib. A continuación, se presenta el caso de un paciente masculino de 53 años de edad sin antecedentes de patologías previos con cuadro clínico de dolor abdominal generalizado, pérdida de peso de 20 kg aproximadamente, distención abdominal, melena, hematemesis y astenia; en el examen físico presentó abdomen distendido y en la palpación se encontró endurecimiento epigástrico y mesogástrico, y marco colónico izquierdo. En la tomografía de abdomen se observó una masa tumoral de aspecto infiltrativo de aparente origen gástrico, con crecimiento extragástrico e infiltración del bazo, páncreas, raíz mesentérica, epiplón mayor, colon transverso, asas intestinales delgadas e infiltración en el hilio hepático, y metástasis hepática. Además, el cuadro se asoció con enfermedad respiratoria por coronavirus del síndrome respiratorio agudo grave de tipo 2 (SARS-CoV-2; neumonía por coronavirus de 2019 [COVID-19]). Se realizó una biopsia percutánea ecodirigida en el hipocondrio izquierdo y la histología reportó un GIST. En este artículo se revisa la clínica, diagnóstico y tratamiento del GIST gigante extradigestivo.

Abstract Giant extraintestinal gastrointestinal stromal tumors (GIST) are rare tumors of the digestive tract. Its most frequent locations are the stomach, small intestine, colon, and rectum. Its appearance in other places outside the gastrointestinal tract such as the mesentery, omentum, or retroperitoneum is infrequent. Computerized axial tomography (CT) and magnetic resonance imaging (MRI) are the imaging studies of the first choice. Surgical recession is the gold standard for localized tumors and advanced or metastatic tumors are treated with imatinib. This study presents the case of a male patient of 53 years with no history of previous pathologies. The patient was admitted with a clinical condition of generalized abdominal pain, weight loss of approximately 20 kg, abdominal distention, melena, hematemesis, and asthenia. Physical examination revealed a distended abdomen and palpation revealed epigastric and mesogastric hardening and left colonic frame. The abdominal tomography revealed a tumor mass with an infiltrative appearance of apparent gastric origin, with extragastric growth and infiltration of the spleen, pancreas, mesenteric root, greater omentum, transverse colon, thin intestinal loops, and infiltration in the hepatic hilum, and liver metastases. Moreover, the condition was related to the severe acute respiratory syndrome type 2 coronavirus (SARS-CoV-2). An ultrasound-guided percutaneous biopsy was performed in the left upper quadrant and histology reported a GIST. In this article medical condition, diagnosis, and treatment of the Giant extraintestinal gastrointestinal stromal, is reviewed.

Giant malignant insulinoma

Insulinomas are the most common pancreatic neuroendocrine tumors. Most insulinomas are benign, small, intrapancreatic solid tumors and only large tumors have a tendency for malignancy. Most patients present with symptoms of hypoglycemia that are relieved with the administration of glucose. We herein present the case of a 75-year-old woman who presented with an acute hypoglycemic episode. Subsequent laboratory and radiological studies established the diagnosis of a 17-cm malignant insulinoma, with local invasion to the left kidney, lymph node metastasis, and hepatic metastases. Patient symptoms, diagnostic and imaging work-up and surgical management of both the primary and the metastatic disease are reviewed.

Presentación de una paciente con mioma gigante del útero / Report of a Patient with Giant Uterine Myoma

Se presentó una paciente de 32 años de edad, de la raza negra, con historia obstétrica de dos abortos espontáneos en el primer trimestre del embarazo, nulípara, que acudió a la Consulta de Ginecología en enero de 2010 en el Hospital de Kabgayi, Rwanda, África, y refirió aumento de volumen del abdomen y además, constipación, tenesmo vesical y sangrados abundantes, que le causaban anemia severa. Después del interrogatorio y examen físico se encontró una tumoración gigante de la cavidad abdominal que ocupaba todo el hemiabdomen inferior y sobrepasaba la cicatriz umbilical que parecía ser un mioma uterino, diagnóstico que se corroboró posteriormente con la ultrasonografía abdominal. Se decidió tratamiento quirúrgico con histerectomía total, y se obtuvo una pieza correspondiente a un mioma uterino con un peso de 4,7 kg.

A 32- year- old patient of black race, with obstetrical history of two spontaneous abortions in the first trimester of pregnancy, nullipara, who was attended at Gynecology Service in January 2010, Kabgayi Hospital in Rwanda, Africa. The patient´s abdomen increased and the clinical manifestations were constipation, vesiacal tenesmus and profuse bleeding that caused severe anemia. After the patient’s interview application and the physical examination was done a giant tumor of the abdominal cavity was found that filled the lower abdomen and surpassed the umbilicus that clinically impressed: a uterine myoma that was later confirmed by abdominal ultrasonography. Surgical treatment was performed with total hysterectomy, and showed a giant tumor of 4.7 kg.

Immediate Mastopexy after Giant Breast Tumor Resection

Differential diagnosis of benign giant tumors includes a circumscribed fibrocystic disease, giant fibroadenoma, juvenile fibroadenoma, lipoma, cystosarcoma phylloides, and hamartoma. Current general surgery textbooks describe excision through an inframammary incision and state that reconstructive procedures with flap rotation and prosthesis are inappropriate because the breast remnant generally returns to a normal configuration and contour following removal of a benign breast tumor. Although we agree with this recommendation for smaller fibroadenomas, the distortion and asymmetric stretching that occur with the larger tumors call for a breast reconstructive technique to achieve symmetry. We report 3 cases of giant benign tumors which were treated by excision and reconstruction using mastopexy technique. It's highly recommended that patients with benign giant tumors of breast should be treated by plastic surgeons with reconstructive techniques.