ABSTRACT
While the presence of multiple primary malignancies in the same patient is a well described phenomenon, there is no clear association between various histological subtypes of renal cell carcinoma (RCC) and the synchronous presence of colon malignancies. We present the rare case of an 81-year-old female patient suffering from chromophobe renal cell carcinoma (chRCC) and an angiomyolipoma of her left kidney, synchronous with an adenocarcinoma of the caecum. While there is an established connection between RCC and colon cancer, a literature review is performed to specify this association in regard to chRCC and the synchronous presence of colon malignancies.
ABSTRACT
INTRODUCTION: Pilonidal sinus disease (PSD) is a highly debatable disorder regarding its surgical management, despite an assortment of surgical techniques described in the medical literature. The aim of this report is to provide an alternate semi-closed surgical method for treatment of PSD, with early recovery and a satisfactory cosmetic result. METHODS: In this retrospective study, 34 patients underwent surgical treatment for primary PSD; 32 male and 2 female. Patients were suffering from primary PSD, with the cyst located in the gluteal midline. Total excision of the cyst was performed, while the skin flaps were fixed on the postsacral fascia using absorbable sutures, leaving the wound semi-closed. RESULTS: Technical success was 100%, with an average operation time of 48.7 ± 3.8 min. No wound dehiscence or infections were recorded postoperatively. One reoperation was performed due to hemorrhage. All patients were discharged on the day after surgery, with a VAS pain score of 1.3 ± 1. Two incidents of late wound dehiscence were recorded at 4th and 6th postoperative day due to strenuous exercise. Patients resumed their work after the 5th postoperative day with no complications. The 6 month follow up was completed in 29 patients, with a VAS cosmetic score of 8.1 ± 0.9. No recurrences were observed during the follow up period. CONCLUSION: The presented semi-closed technique is a viable alternative for surgical management of PSD. It provides patients with a satisfying cosmetic result, while it allows for early and safe return to everyday activities with less pain experienced.
ABSTRACT
INTRODUCTION: Primary hyperparathyroidism is a common endocrine disorder mostly associated to parathyroid adenomas. Although those tend to be small in size, rare cases of giant parathyroid adenomas may be present. CASE PRESENTATION: A 42year old female was admitted in our department due to weakness and vague abdominal pain for the past 8 months. Preoperative laboratory exams indicated primary hyperparathyroidism as a cause to her symptomatology, with elevated values of parathormone and normal values of serum calcium. Ultrasound scan and 99m Tc-MIBI of her cervical region uncovered a giant 3×2cm parathyroid adenoma, located in the lower left thyroid lobe. Despite its size, the gland was successfully removed through implementation of minimal invasive parathyroidectomy. She was uneventfully discharged on the 1st postoperative day. DISCUSSION: Although a common reason for developing hyperparathyroidism, parathyroid adenomas may rarely present with exaggerated dimensions and weight. Physical examination is usually unremarkable, while patients may present with symptomatology associated with elevated calcium levels. Treatment of this medical condition consists of surgical removal of the pathologic parathyroid gland either by bilateral neck exploration or through minimal invasive parathyroidectomy. Preoperative localization plays an important role in the second case, since the method focuses on resection of a pre-op marked hyperactive parathyroid gland, through a small incision. CONCLUSION: Clinicians must be alerted of hyperparathyroidism in patients presenting with calcium associated symptomatology. Diagnosis is straightforward through laboratory exams, while surgery offers the only permanent treatment option.
