Malignant fibrous histiocytoma, now referred to as Undifferentiated Pleomorphic Sarcoma: A Case Report of an unexpected histology of a subcutaneous lesion.

INTRODUCTION: An 85year old male presented to his General Practitioner with a vague history of a lump on his back that was mobile and non tender. He had a previous history of advanced prostate cancer and radiotherapy treatment. PRESENTATION: We present an unexpected diagnosis of malignant fibrous histiocytoma of a subcutaneous lesion removed from the patient's back. DISCUSSION: Excisions of subcutaneous lesions along with cutaneous lesions form the majority of cases on a usual minor operations list. All lesions are sent for histopathological analysis and most are confirmed benign sebaceous cysts or lipomas. However the entity of malignant fibrous histiocytoma, now referred to as undifferentiated pleomorphic sarcoma (UPS) should be kept in mind. Patients will usually present late with advanced local disease or metastasis, usually to lungs and lymph nodes. Treatment is surgical with wide local excision and neoadjuvant/adjuvant radiotherapy has been advocated as well. CONCLUSION: Undifferentiated pleomorphic sarcoma should be a differential in subcutaneous lesions in older adults with a previous history of malignancy, radiation therapy and a mass in the subcutaneous tissue of the back.

Totally extraperitoneal laparoscopic inguinal hernia repair is a safe option in patients with previous lower abdominal surgery.

BACKGROUND: History of inguinal hernia repair changed over the decades from repair by tissue approximation to the insertion of synthetic mesh and the introduction of laparoscopic repair. Despite accounting for 15-20% of hernia operations worldwide, many surgeons considered previous lower abdominal surgery as a contraindication to performing totally extraperitoneal (TEP) repair. AIM: The aim of this study was to assess the feasibility of TEP in primary and recurrent inguinal hernias in patients with previous lower abdominal surgery. PATIENTS AND METHODS: This study was a retrospective review of patients who underwent TEP inguinal hernia repair from January 2001 to July 2005. Variables studied included patient demographics, type of hernia, type of previous surgery, conversion to open repair, postoperative complications, and overnight admission. RESULTS: One hundred eight patients (107 males, 1 female), with a median age of 55 years (range 87-24), underwent TEP repair. Ninety-four patients had primary inguinal hernias, and 13 patients had recurrent inguinal hernias. Seventeen patients had a previous lower abdominal surgery (13 primary and 4 recurrent inguinal hernias). There was 1 conversion to open repair and 1 case of postoperative bleeding that required an exploration-both in the group with no previous surgery. Postoperative complications were minimal. All cases were performed as day cases; however, patients with recurrent hernia stayed longer in the hospital than those with primary hernia (P = 0.006). CONCLUSION: TEP repair is feasible in patients with previous lower abdominal surgery. TEP was planned as a day-case procedure; however, patients with recurrent hernias needed a planned admission, as an overnight stay was required.