Gallbladder Hydatid Disease Complicated with Multiple Hepatobiliopancreatic Fistulae: A Case Report.

Gallbladder is a rare localization for hydatid disease. Complications are even rarer and precise diagnosis is quite difficult even with radiological assistance. We report a rare case of 41-yr-old male patient presenting with the rupture of a gallbladder hydatid cyst with multiple fistulae to intra and extrahepatic bile ducts and pancreas, at Kocaeli State Hospital, Turkey in 2021. The patient had abdominal pain and abdominal CT scan reported a bizarre "contrast enhanced cholangiography" sign - radiopaque contrast substance in gallbladder, intra and extrahepatic bile ducts and pancreatic ducts, with concomitant acute cholecystitis. Surgery was performed and intraoperatively gallbladder hydatid cyst with multiple fistulae was noted. Cholecystectomy with total cyst excision was performed. Endoscopic retrograde cholangio pancreatography (ERCP) was utilized to irrigate and eradicate the parasite in the fistulae tracts localized near pancreas and intra/extrahepatic ducts. Postoperative period was uneventful, antiparasitic treatment was started, and in the yearly follow-up patient had no recurrence. Multidisciplinary and minimal invasive management is crucial in such bizarre, complicated cases.

Does rapid discharge after breast cancer surgery have an impact on wound healing and complications? COVID-19 pandemic experience.

The COVID-19 pandemic has challenged the health systems worldwide. Because of high volume of COVID-19 patients, all hospitals in our region were re-configured as COVID-19 centres and elective surgery procedures were cancelled. Our clinic was the only active centre in the region and grave increase in our patient volume urged our clinic to modify our discharge protocol. This retrospective study included all breast cancer patients underwent mastectomy and/or axillary dissection, in the Breast Surgery Clinic of Kocaeli State Hospital, a regional pandemic hospital, between December 2020 and January 2021. Patients were mostly discharged the day of surgery with drains because of congestion, while some of the patients had traditional stay, when beds were available. The patients were evaluated postoperatively (the first 30 days) in terms of wound complications, Clavien-Dindo classification grade, satisfaction, presence of pain and nausea, and treatment costs during the follow-up period of the study. Outcomes were compared between early discharged patients and patients who had traditional long stay. Compared with long-stay patients, in the early discharged group, postoperative wound complications was significantly lower (P < .01) with significant cost savings. There were no significant changes in variables such as surgery type, ASA class, satisfaction, need for additional medication and Clavien-Dindo between the groups. Adaptation to an early discharge protocol for breast cancer surgeries may be an efficient way of practicing surgery in a pandemic. Early discharge with drains may be beneficial for patients.

Benign multicystic peritoneal mesothelioma mimicking mucinous ovarian neoplasm with pseudomyxoma peritonei.

Cystic mesothelioma, also known as benign multicystic peritoneal mesothelioma (BMPM), is a rare neoplasm and one of the five main histological types of peritoneal mesothelioma. Although it is usually considered benign histologically, it is increasingly accepted as a 'borderline malignancy' because the local recurrence rate is high. It is more common in middle-aged women and is generally asymptomatic. Considering that BMPM is often found in the pelvis, it is difficult to differentiate from other pelvic and abdominal lesions, such as cystic ovarian masses, especially mucinous cystadenoma-adenocarcinoma, pseudomyxoma peritonei, etc. Preoperative diagnosis is very difficult due to its rarity and lack of specific diagnostic imaging and clinical findings. Definitive diagnosis is made only by pathological evaluation. In this article, we aimed to present the imaging findings of a BMPM case in a woman who was diagnosed with mucinous ovarian neoplasm with pseudomyxoma peritonei preoperatively and underwent cytoreductive surgery with hyperthermic intraperitoneal chemotherapy.

Utility of positron emission tomography for determination of axillary metastasis of breast cancer.

Objectives: The involvement of axillary lymph nodes plays a key role in breast cancer staging. Positron emission tomography is a promising modality for detecting axillary lymph node metastasis. In addition, nomograms are used to predict the status of axillary lymph nodes. In this study, the role of positron emission tomography in determining axillary metastasis and its correlation with the nomogram was evaluated. Material and Methods: The axillary maximum standard uptake value (SUVmax) values of the patients in the preoperative period, the features in the perioperative and postoperative specimen and Memorial Sloan Kettering Cancer Center nomogram data were evaluated. Results: As axillary SUVmax detected by Positron emission tomography in the preoperative period increased, so did the likelihood of lymph node involvement. Axillary SUVmax value were compared with Memorial Sloan Kettering Cancer Center nomogram data but no correlation was found. Age, lymph node number, histopathology results, mass diameter, presence or absence of lymphovascular invasion and/or perineural invasion, tumor type, estrogen receptor status, Ki67 and Cerb-B2 statuses were not correlated. However, axillary SUVmax was inversely correlated with grade and progesterone receptor status. Conclusion: Results from positron emission tomography of axillary lymph nodes in breasts cancer patients showed that SUVmax was only inversely related to cancer grade and progesterone receptor status while not correlating with other accepted parameters for tumor assessment. Thus there is insufficient reliability for the use of axillary SUVmax alone for accurate assessment of tumor characteristics at present.

The effect of mesenchymal stromal cells in the microenvironment on cancer development.

Inflammatory signals secreted from the tumor microenvironment are thought to promote tumor growth and survival. It has been reported that stromal cells in the tumor microenvironment have similar characteristics to tumor-associated cells. In addition miRNAs play critical roles in various diseases, including cancer. In this study, we aimed to investigate the effects of co-culture of cancer cells and stromal cells isolated from normal and malignant breast tissue on each other and the possible effects of miRNAs on these interactions. The characterized stromal cells were co-cultured with an MDA-MB-231 cancer cell line. The proliferation capacity of the experimental groups was evaluated using the WST-1 assay. The expression of breast cancer-specific miRNAs and related genes were assessed by real-time PCR. ELISA assay was performed to determine the concentration of some cytokines and chemokines. We found that the microenvironment plays an important role in the development of cancer, confirming the changes in the expression of oncogenic and tumor suppressor miRNA and their target genes after co-culture with malignant stromal cells. As a result of the studies, specific gene expressions of related signaling pathways were detected in correlation with miRNA changes and the effects of tumor microenvironment on tumorigenesis were revealed in detail. miRNAs have been shown to play an important role in cancer development in recent studies. The idea that these small molecules can be used in diagnosis and treatment is becoming stronger day by day. We believe that new treatment approaches involving the tumor microenvironment and using miRNAs as markers are promising.

A Very Rare Reason for Gastric Perforation, Caused by Gastric Metastasis of Breast Cancer: Case Presentation.

Breast cancer is the mostly seen malignancy of women. Breast cancer causes lung, bone, liver and brain metastasis. On the other hand, gastric metastasis of breast cancer is a rarely seen metastasis. For this reason, it may be misdiagnosed or diagnosed after its morbid or mortal complications occurred. This may also result as a delay of breast cancers primary treatment. If occurred the best tool is immunohistochemical panels especially gross cystic disease fluid protein 15 (GCDFP-15) for exact diagnosis. In our case, a gastric metastasis of breast cancer is presented which was admitted with the acute abdominal findings caused by its result as gastric perforation and diagnosed by GCDFP-15 immunohistochemical panel.

Characteristics of Special Type Breast Tumors in Our Center.

OBJECTIVE: Breast cancer is a heterogeneous disease with different histological types. Ductal breast cancer constitutes the vast majority of the breast cancers. However limited data are present in the rest of breast cancers called special or rare type breast cancers. Here in this study, we tried to describe the clinical features of special type breast cancers in our center. MATERIALS AND METHODS: Retrospective descriptive study was performed in Kocaeli University School of Medicine, Department of General Surgery between January 2000 and January 2016. Women diagnosed with primary breast cancer other than ductal carcinoma were included to the study. In total, 101 patients were evaluated according to histologic types, molecular types, Tumor Node Metastasis (TNM) stages, and grades. Survival of the patients was also evaluated. RESULTS: Medullary and metaplastic types showed basal type; tubular, mucinous, micropapillary carcinoma, cribriform, lobular and apocrine tumors showed luminal type molecular pattern. Neither the existence of ductal carcinoma nor any histologic types had any effects on survival. Apocrine tumors were presented in younger ages. CONCLUSION: Histologic types of breast cancer are closely related with the molecular types of the breast cancer. Tumor size, grade, stage of the disease can show differences among histological types which might be due to the genetic background, late onset or limited number of patients. In order to achieve more significant results, multicenter national studies are needed.

Rett syndrome with colon cancer presented with sigmoid volvulus: Report of a case.

INTRODUCTION: Rett syndrome is a progressive neurodevelopment disorder in which MECP gene mutations are responsible and might be related to cancer. PRESENTATION OF CASE: A 22 year-old girl with Rett syndrome was hospitalized for abdominal distention and shock. Abdominal tenderness and distention were revealed in physical examination. Radiological investigations revealed sigmoid volvulus and colonic obstruction. Sigmoid volvulus, sigmoid colon perforation due to sigmoid cancer with liver metastasis were observed at laparotomy. Hartman procedure performed. The patient died on the second postoperative day. DISCUSSION: Rett syndrome has several gastrointestinal pathologies related with inadequate parasympathetic control. Genetic mutations in methyl-CpG-binding protein 2 (MECP2) which has role in several cancer mechanisms is the reason of Rett syndrome. Colon cancer with the underlying gastrointestinal pathologies complicated our case. CONCLUSION: Rett syndrome patients need a high level of concern for gastrointestinal emergencies with cancer risk.

Laparoscopic treatment of ileal intussusception due to heterotopic gastric mucosa in an adult patient.

Adult intussusception, which is a rare condition, generally requires surgical treatment. A 25-year-old-male with abdominal pain was diagnosed as ileal intussusception with computerized tomography. The patient underwent diagnostic laparoscopy, laparoscopic small bowel resection and anastomosis. The pathologic evaluation revealed heterotopic gastric mucosa. Heterotopic gastric mucosa is rarely seen in ileum and is difficult to diagnose preoperatively. Excision is the choice of treatment. Laparoscopic treatment can be preferred in adult intussusception even in urgent cases.