Infección de prótesis mamaria por Haemophilus influenzae / Breast implant infection by Haemophilus influenzae

Presentamos el caso de una paciente con un implante de mama tras reconstrucción mamaria posmastectomía que tiene una infección de la prótesis por Haemophilus influenzae. Acudió a nuestro centro, de urgencia, por infección aguda del implante que obligó a la retirada del mismo. Como antecedente refería infección de vías respiratorias altas resuelta 15 días antes. Hasta donde hemos podido comprobar en la literatura, este es el primer caso descrito de infección de prótesis de mama por Haemophilus influenzae

We present the case of a patient with breast implant for mammary reconstruction after mastectomy, that shows implant infection caused by Haemophilus influenzae. Patient came to our hospital with an acute mammary implant infection that was removed. She only referred a respiratory infection 15 days before. We haven't found nowadays a previous case of breast implant infection associated to Haemophilus influenzae

Colgajo miocutáneo de recto abdominal vertical (VRAM): reconstrucción pélvica, vaginal y perineal tras resección abdominoperineal / Vertical rectus abdominis myocutaneus flap (VRAM): pelvic, vaginal and perineal reconstruction following abdominoperineal resection

Tras la resección abdominoperineal del recto surge un incremento de las complicaciones de la herida perineal por la radioterapia neoadyuvante que altera la cicatrización y por la exéresis amplia requerida para obtener unos márgenes libres. Presentamos el caso de una paciente con carcinoma epidermoide de canal anal que infiltraba la cara posterior de la vagina y que tras tratamiento neoadyuvante fue sometida a amputación abdominoperineal con colpectomía y reconstrucción de vagina y periné con colgajo miocutáneo de recto anterior del abdomen. La evolución postoperatoria fue favorable, no se presentaron complicaciones y se logró una buena calidad de vida

After abdominoperineal resection of the rectum there are an increase in perineal wound complications due to neoadjuvant radiotherapy that alters healing and because of the wide excision required to obtain free margins. We present a case of squamous cell carcinoma of the anal canal that infiltrates the posterior aspect of the vagina, that passes through the treatment with an abdominoperineal amputation with colpectomy and reconstruction of the vagina and perianal area with myocutaneous flap of the anterior rectus abdominis. The postoperative evolution was favorable; there was no complication and the patiente presented a good quality of life

Reparación de defecto de nervio femoral tras iatrogenia / Femoral nerve defect repair after iatrogenic injury

Las lesiones del nervio femoral, en su mayor parte, son secundarias a iatrogenia tras intervenciones quirúrgicas. Presentamos un caso de lesión del nervio femoral tras extirpación de un tumor retroperitoneal, con una recuperación funcional aceptable después de reparar el defecto nervioso con injertos de nervio sural. El defecto tenía 10 cm y la recuperación obtenida MRC (Medical Research Council) fue de 4/5. Consideramos que en estos casos, la reparación precoz es fundamental para obtener un resultado adecuado, incluso en situaciones en la que se necesitan largos injertos nerviosos

Femoral nerve injuries are mostly secondary to iatrogenic after surgical interventions. We present a case of lesion of the femoral nerve after the removal of a retroperitoneal tumor, with an acceptable functional recovery after repair of the defect with sural nerve grafts. The defect was 10 cm length and the recovery obtained MRC (Medical Research Council) was 4/5. We considerer that early repair is essential to obtain an acceptable result, even in situations of being necessary long nerve grafts

Isolated AA Amyloidosis of the Radial Nerve.

BACKGROUND: Amyloidosis affecting peripheral nerve is usually seen in primary amyloidosis. METHODS: We are reporting on the case of a 74-year-old man with a 16-month history of progressive left radial nerve paralysis. Perioperative imaging detected an enlarged radial nerve in the middle-distal part of the arm. The patient had an antecedent of amyloid deposits in the lung. RESULTS: A radial nerve amyloidosis was suspected and confirmed with a biopsy assisted by ultrasonography, resulting in a secondary amyloidosis form. CONCLUSIONS: Isolated radial nerve palsy due to nerve damage by amyloidosis has been reported before, but not in AA or secondary amyloidosis.

Merkel cell carcinoma: An algorithm for multidisciplinary management and decision-making.

Merkel cell carcinoma (MCC) is a rare and aggressive neuroendocrine tumor of the skin. Therapeutic approach is often unclear, and considerable controversy exists regarding MCC pathogenesis and optimal management. Due to its rising incidence and poor prognosis, it is imperative to establish the optimal therapy for both the tumor and the lymph node basin, and for treatment to include sentinel node biopsy. Sentinel node biopsy is currently the most consistent predictor of survival for MCC patients, although there are conflicting views and a lack of awareness regarding node management. Tumor and node management involve different specialists, and their respective decisions and interventions are interrelated. No effective systemic treatment has been made available to date, and therefore patients continue to experience distant failure, often without local failure. This review aims to improve multidisciplinary decision-making by presenting scientific evidence of the contributions of each team member implicated in MCC management. Following this review of previously published research, the authors conclude that multidisciplinary team management is beneficial for care, and propose a multidisciplinary decision algorithm for managing this tumor.

Dermatofibrosarcoma Protuberans of the Vulva With Myoid Differentiation.

Dermatofibrosarcoma protuberans (DFSP) is an uncommon soft-tissue tumor characterized by a relatively high risk for local recurrence and low risk for metastasis. Many histopathologic variants of DFSP have been described, including the fibrosarcomatous and myoid variants, which may obscure the diagnosis in some cases, especially when arising in unusual locations. Of all the variants described so far, the only one with prognostic relevance is the FS-DFSP variant, which implies tumor progression and a higher possibility for metastasis. The authors report a case of a giant DFSP, located on the vulvar area, which histopathologically showed areas of fibrosarcomatous and myoid differentiation, and discuss the importance of the myoid variant in regards of the debated histogenesis of DFSP.

Subungual Acral Fibromyxoma Involving the Bone: A Mimicker of Malignancy.

Superficial acral fibromyxoma (SAF) is a recently recognized myxoid tumor that usually occurs on the fingers and toes of middle-aged adults. We report the case of a 53-year-old man with a SAF on the first left toe that had been slowly growing for 2 years. Hispathologically, the lesion was nonencapsulated and was composed of stellate and spindle cells, arranged in a myxoid matrix. No atypia or mitotic figures were found. Neoplastic cells showed positive staining for CD34 and negative staining for epithelial membrane antigen, actin, desmin, keratins, S-100 protein, and HMB45. Main differential diagnoses of SAF include benign and malignant myxoid and spindle cells tumors, such as myxoid fibrous histiocytoma, superficial angiomyxoma, myxoid neurofibroma, myxoid dermatofibrosarcoma protuberans, and low-grade fibromyxoid sarcoma.

Recurrent basal cell carcinoma of the lower limb with tibial invasion.

BACKGROUND: Basal cell carcinoma (BCC) is the most common skin malignancy and is most prevalent on the head and neck region, although BCC can occur in other sites, including the lower limbs. OBJECTIVE: We report the case of an 85-year-old female patient who experienced recurrent BCCs in the lower limb with tibial invasion. METHODS: Treatment consisted of wide skin excision, tibial osteotomy, intraoperative cryotherapy, and coverage with an internal gastrocnemius muscle flap. RESULTS: The computed tomographic scan showed local bone control of the BCC, with no recurrence, so we avoided limb amputation. CONCLUSION: The reported case is uncommon because of the site, the extent of bone infiltration, and local treatment with cryotherapy.