Recurrent Aggressive Cementoblastoma - A Rare Case Report.

Cementoblastoma is an odontogenic tumor of benign nature. It is of mesenchymal origin with a relatively low incidence of reappearance. Hereby we present a case report of a 14-year-old male patient with recurrent swelling on the right mandibular posterior region. Despite surgical removal of the tumor mass along with the right first molar, recurrence of the lesion was noticed. Hence, our report gives an insight on the treatment and management of the lesion by en-bloc resection on the right side of the mandible.

Comparative Analysis of Enbloc or Piecemeal Removal After Enbloc Resection of Gastrointestinal Stromal Tumors.

OBJECTIVE: To investigate the safety and prognosis of enbloc or piecemeal removal after enbloc resection of a gastric GIST by comparing the clinical data of endoscopic en block resection and piecemeal removal (EP) and en block resection and complete removal (EC) of gastric GISTs. METHODS: A total of 111 (43 endoscopic piecemeal, and 68 complete removal) patients with gastric GIST's ≥ 2 cm in diameter who underwent endoscopic therapy from January 2016 to June 2020 at the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed. In all cases, it was ensured that the tumor was intact during the resection, however, it was divided into EP group and EC group based on whether the tumor was completely removed or was cut into pieces which were then removed. The patients' recurrence-free survival rate and recurrence-free survival (RFS) were recorded. RESULTS: There was no statistically significant difference in RFS rates between the two groups (P = 0.197). The EP group had relatively high patient age, tumor diameter, risk classification, and operation time. However, there was no statistically significant difference in the number of nuclear fission images, postoperative hospitalization time, postoperative fasting time, complication rate and complication grading between the two groups (P > 0.05). CONCLUSION: Endoscopic piecemeal removal after en block resection of gastric GIST is safe and effective and achieves similar clinical outcomes as complete removal after en block resection.

Safety, feasibility, and quality of thulium laser en-bloc resection for treatment of non-muscle invasive bladder cancer.

BACKGROUND: Trans-Urethral Resection of Bladder Tumors (TURBT) is a critical step in diagnosis, staging and treatment of bladder tumors. Conventional TURBT (cTURBT) involves the electro-resection of the tumor into small fragments. This technique leads to concerns about the completeness of resection, under-staging, bleeding, cancer cell implantation, and most importantly, risk of tumour recurrence. To circumvent this, laser en-bloc resection of bladder tumors has been introduced. OBJECTIVES: Assessment of the safety, feasibility, and quality of Thulium Laser En-bloc Resection of Tumors (TmL-ERBT) for treatment of Non-Muscle Invasive Bladder Cancer (NMIBC) in various urinary bladder walls as a primary endpoint. The secondary endpoints were to investigate the feasibility of thulium laser use in the re-staging cystoscopy and to evaluate the learning curve of TmL-ERBT. METHODS: This is a prospective observational study including all newly diagnosed patients, above 18 years old, with a urinary bladder mass ≤ 4 cm in maximal dimension (measured via bladder ultrasound or CT or MRI). All patients underwent TmL-ERBT under regional anaesthesia in a lithotomy position. All intraoperative complications such as obturator nerve reflex, bladder perforation, and significant bleeding were recorded. Postoperative variables such as the mean catheterization time, bladder irrigation fluid volume and duration, and the mean of hospital stay as well as the postoperative complications were recorded. All patients were risk stratified and managed according to EUA guidelines then followed by a surveillance regimen per 3 months for 6 months. RESULTS: The study included 23 patients with a mean age of 53 ± 15.8 years. While 15 patients (65%) had a single tumor, the rest had multiple tumors, ranging from 2 to 3 in number with a total of 36 lesions. No cases required conversion to cTURBT and none of them experienced obturator nerve reflex or bladder perforation. Only one patient (4.3%) had an attack of clot urine retention. The mean hospitalization time was 31.2 ± 14.4 h and the mean catheterization time was 20.4 ± 13.3 h. The Detrusor muscle was present in 20 patients (87%) and the remaining 3 patients required a re-staging cystoscopy which was performed efficiently using thulium laser. None of the treated patients developed tumour recurrence during the follow-up period. In analysis, the duration of complete resection of 2-4 cm tumours was 23-27 min after the 7th case with a resection rate of 0.12-0.15 cm/min. CONCLUSION: TmL-ERBT is safe and feasible for complete resection of NMIBC with a short learning curve and adequate cancer control.

Diagnosis and Literature Review of Chondromyxoid Fibroma - A Pathological Puzzle.

INTRODUCTION: Chondromyxoid fibroma (CMF) is a benign rare bone tumor of slow-growing nature arising from chondroblastic derivation. CMF in most of the cases is a diagnosis of exclusion, and in this case report, we differentiate the histological and radiological findings of CMF and difficulties in diagnosis of CMF from potential differential diagnosis. CASE REPORT: A 38-year-old female patient presented with a history of limping for 5 months and on evaluation revealed an expansile osteolytic lesion in fibular head with septations and soft tissue component. Excision biopsy was done. Histological examination revealed a cellular neoplasm arranged as vague nodules in chondroid background with occasional mitotic figures and giant cells in periphery without any calcification. To rule out chondroblastoma, S-100 and epithelial markers were done which was negative establishing diagnosis of CMF by exclusion. CONCLUSION: CMF is often misdiagnosed being a radiological and pathological mimicker. Histology remains key to diagnosis. En bloc resection remains the mainstay of management in expendable bone-like fibula.

Lymphadenectomy in laparoscopic radical resection of distal cholangiocarcinoma / 中华消化外科杂志

Lymph node metastasis is the important survival predictor in patients with distal cholangiocarcinoma.With the application of laparoscopic pancreaticoduodenectomy in radical resection of distal cholangiocarcinoma,it is of great clinical significance to explore lymphadenectomy in laparoscopic radical resection of distal cholangiocarcinoma.The American Joint Committee on Cancer (AJCC) Cancer Staging Manual (8th ed) has became the new global guideline for cancer diagnosis and treatment since January 2018,which provides a new recommendation for lymphadenectomy of distal cholangiocarcinoma.This review provides an overview of the clinical significance of total lymph node count and number of involved lymph nodes,"en-block" procedure in lymphadenectomy,membrane anatomy for lymphadenectomy,experience and skills in lymph node dissection,lymph node sorting after surgery,adjuvant therapy in the treatment of distal cholangiocarcinoma.

Rare Aggressive Calvarial Osteoblastoma with Dural Invasion.

We report a rare case of an aggressive osteoblastoma (OB) involving the calvaria and infiltrating the dura, a finding that was not previously reported in the literature. A 50-year-old man presented with a progressive mass in the left frontoparietal skull with headaches and a six-month history of sudden mass growth. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a large skull lesion with areas of hemorrhage, calcification, restricted diffusion, and enhancement.  A left temporoparietal craniotomy with a complete resection of the tumor with grossly clean margins was performed. Follow-up at 60 months showed a stable clinical picture and no sign of local recurrence of the lesion on MRI.

Total Hilar En Bloc Resection with Left Hemihepatectomy and Caudate Lobectomy: a Novel Approach for Treatment of Left-Sided Perihilar Cholangiocarcinoma (with Video).

BACKGROUND: "Hilar en bloc resection" using a no-touch technique has been advocated as a standard procedure in right-sided hepatectomies for treatment of perihilar cholangiocarcinoma (PHC). In principle, it has never been reported for left-sided tumors. The aim is to describe the procedures of total hilar en bloc resection with left hemihepatectomy and caudate lobectomy (THER-LH) for advanced PHC and discuss feasibility and clinical significance of this novel technique. METHODS: A retrospective study using a prospectively maintained database was performed to identify eight patients who had received THER-LH for advanced PHC from January 2013 to December 2015. The clinicopathological features, surgical procedures, and outcomes of these patients form the basis this study. RESULTS: The operative time was 546 ± 158 (380-870) min, and estimated blood loss was 875 ± 690 (400-2500) ml. Time of vessel resection and reconstruction was 25.6 ± 12.3 min for the portal vein and 19.1 ± 4.9 min for the hepatic artery. Time of hilum clamping was 27.3 ± 11.9 (15-41) min. Two patients had Clavien-Dindo grade II and IVa complications of bile leakage with one developing intraabdominal abscess and bleeding. There was no perioperative mortality. Histopathologic examination revealed that all of eight patients had tubular adenocarcinoma with microscopic invasion to the resected hepatic arteries and portal veins in seven patients. Negative bile duct margins were achieved in all of them. Three patients developed recurrence and died at 11, 18, and 24 months postoperatively. The remaining patients were alive at the time of last follow-up. The median survival was 24 months with one patient achieving a disease-free survival of 50 months. CONCLUSION: THER-LH is a technically demanding procedure that is safe and feasible that may have some beneficial effects on the prognosis of these patients with advanced PHC. Further studies are required to confirm the oncological superiority and survival benefits of this novel technique.