Intradiaphragmatic bronchogenic cyst: report of a rare new case.

Bronchogenic cysts (BCs) are congenital abnormalities commonly found within the mediastinum. Diaphragmatic location is extremely rare. We present a woman in her 60s with an asymptomatic intradiaphragmatic BC. The patient underwent complete surgical resection with primary closure of the left hemidiaphragm. BCs should remain a differential diagnosis of any soft-tissue mass in the region of the diaphragm. Complete surgical resection is recommended even in asymptomatic patients to avoid complications such as infection, rupture, bleeding or malignant transformation.

En-bloc resection of soft-tissue sarcoma of anterior chest wall and reconstruction with titanium bars and free anterolateral thigh flap.

Primary soft-tissue sarcomas (STSs) of the chest wall are uncommon. Complete surgical resection remains the mainstay of treatment being sternal resection ocassionally required. We present a 25-year-old man with an anterior chest wall STS. The patient underwent complete oncological resection with reconstruction using titanium bars combined with a free vascularised anterolateral thigh flap. STSs of the chest wall are very rare and they comprise a surgical challenge for both resection and reconstruction.

Role of sentinel lymph node biopsy for cutaneous melanoma in elderly patients: preliminary results in a Latin-American population.

INTRODUCTION: In melanoma, lymph node status constitutes the most important prognostic factor among patients with locoregional disease. It has been postulated that elderly patients present less metastatic involvement in sentinel lymph node (SLN). Our objective was to analyse the results and evolution of patients ≥ 70 years-old with cutaneous melanoma in whom sentinel lymph node biopsy (SLNB) was carried out. METHODS: Retrospective analysis of 194 patients with primary CM who had a SLNB between 2005 and 2020 was included. Demographic and tumour data, SLN status, recurrence rate, morbidity and evolution were evaluated. Patients were divided into two groups according to age: Group 1 (<70 years old) and Group 2 (≥70 years old). RESULTS: One hundred and fifty patients were included in Group 1 and 44 patients in Group 2. Median Breslow thickness was 1.7 mm in Group 1 and of 2 mm in Group 2 (p = 0.015).Forty-seven patients had positive SLNB; 38 (25%) belonged to Group 1 and 9 (20.5%) to Group 2 (p = 0.55). Recurrence was found in 34 patients: 25 belonging to Group 1 and 9 corresponding to Group 2 (p = 0.65). Morbidity was of 4% in Group 1 and 9% in Group 2 (p = 0.23). With an average follow-up of 30.6 months, 5-year overall survival was of 87% in Group 1 and of 63% in Group 2 (p = 0.04). CONCLUSION: Advanced age was not associated with differences regarding positivity of SLN and recurrence but difference in overall survival was observed. According to our results and the low morbidity rate, we consider SLNB should not be omitted in such age group, since it improves staging and gives the possibility to evaluate adjuvant treatment.

Resection of a giant retroperitoneal lipoma herniating through the inguinal canal.

Retroperitoneal lipomas are extremely rare with few cases reported so far in the literature. They can reach different sizes and present with a variety of symptoms. The differential diagnosis is mainly with well-differentiated liposarcoma (WDLPS). We present a 34-year-old woman with a retroperitoneal lipoma herniating through the inguinal canal into the proximal thigh. The patient underwent complete oncological resection using a Karakousis's abdominoinguinal incision. Retroperitoneal lipomas are a very rare condition and sometimes require resections technically challenging. MDM2 amplification is critical for its differential diagnosis with WDLPS.

Resection of retroperitoneal soft-tissue sarcoma involving the abdominal aorta.

Complete surgical resection of soft-tissue sarcomas (STSs) frequently requires complex multivisceral resections, which is the most important factor related to overall survival and local recurrence. Major vascular involvement is not rare in patients with primary retroperitoneal STSs. We present a 54-year-old woman with a retroperitoneal STS encasing the infrarenal abdominal aorta. The patient underwent complete oncological resection with vascular reconstruction using a bi-iliac vascular graft. Major blood vessel involvement is not a contraindication for STS surgery with a curative intent.

Isolated gallbladder metastasis of melanoma: Case report.

BACKGROUND: Although metastatic melanoma is most frequently found in liver, lungs, and brain, most metastases found in the gallbladder are from melanoma. Here, we present a case of isolated metastatic melanoma found during cholecystectomy. PRESENTATION OF CASE: 74-year-old male with a personal history of hypertension, diabetes mellitus, obesity, and arrhythmia. A skin lesion was found on the right malar region. An excisional biopsy was performed and histopathological examination showed an ulcerated nodular-type malignant melanoma, Breslow 7.6 mm, Clark IV. Surgical excision with margins of 2 cm and sentinel lymph-node biopsy was carried and were negative. Abdominal sonography at 6 months showed an 18 mm solid mass adhered to the wall of the gallbladder that was suggestive of a polyp. Thorax-abdomen-pelvis CT showed no abnormalities. The gallbladder lesion had increased in volume on the following sonography and therefore, cholecystectomy was performed. Histopathological study revealed melanoma infiltrating the mucosa and muscular layer. Written informed consent was previously obtained, and Institutional Review Board approval was not needed. DISCUSSION: Isolated metastatic melanoma in the gallbladder is uncommon. Follow-up controls with images are important in the diagnosis. As most metastatic melanoma to the gallbladder are asymptomatic, surgeons should have high level of suspicion. Cholecystectomy could prolong survival in these patients. CONCLUSION: Isolated gallbladder metastasis of melanoma is an uncommon presentation of this disease. Laparoscopic cholecystectomy is an adequate procedure in this particular situation and may improve patient survival. The presentation of this case may help surgeons to maintain a high level of suspicion regarding the condition.

Left adrenal ganglioneuroma: Report of a new case.

INTRODUCTION: Adrenal ganglioneuroma (AGN) represents about 20% of the reported cases. PRESENTATION OF CASE: We present a 37-year-old man referred to our institution for a history of abdominal discomfort and a left adrenal solid mass incidentally discovered in CT abdominal scan (24 × 20 mm). Patient underwent laparoscopic surgical excision of the tumor. CONCLUSION: The histopathology examination showed areas of spindle cells and scattered mature ganglionic cells compatible with AGN.

Primary retroperitoneal mucinous cystadenoma.

Mucinous cystadenomas and carcinomas of the ovary are well-established and common tumors. However, Primary retroperitoneal mucinous cystadenomas (PRMCs) are very rare. We present a 50-year-old woman referred to our institution with history of intermittent abdominal pain and palpable mass in her left flank. On CT-scan an unilocular cystic mass with thin wall measuring 171×155×108mm in the retroperitoneum was shown. Patient underwent surgical excision of the tumor. The histopathology examination showed a cystic mass with a fibrous wall and an epithelium composed of a single layer of columnar cells with mucin vacuoles compatible with PRMC.

Giant cavernous hemangioma of the adrenal gland.

INTRODUCTION: Cavernous hemangioma of the adrenal gland is a rare non-functioning benign neoplasm. PRESENTATION OF CASE: A 62-year-old woman with chronic obstructive pulmonary disease was diagnosed as having an incidental non-functioning adrenal tumor. Because of the impossibility of ruling out the presence of malignancy, conventional surgical resection was carried out. The histopathology revealed a 12.5cm×11.5cm×8cm adrenal mass with large and lacunae vascular spaces lined with mature endothelial cells. These findings were compatible with cavernous hemangioma. DISCUSSION: The majority of patients in the literature underwent surgical resection due to the impossibility of excluding malignancy, because of related symptoms in patients with large masses, or because of the risk of spontaneous tumoral rupture. CONCLUSION: These tumors are quite infrequent. Due to the low frequency and the lack of specific symptoms, most adrenal hemangiomas are diagnosed postoperatively.