Prediction of infective complications after retrograde intra renal surgery using Machine learning.

BACKGROUND: To compare the models obtained with classical statistical methods and machine learning (ML) algorithms to predict postoperative infective complications (PICs) after retrograde intrarenal surgery (RIRS). MATERIAL AND METHODS: Patients who underwent RIRS between January 2014 and December 2020 were retrospectively screened. Patients who did not develop PICs were classified as Group 1 and patients who developed as Group 2. RESULTS: Three-hundred and twenty-two patients were included in the study; 279 patients (86.6%) who did not develop PICs were classified as Group 1, and 43 patients (13.3%) who developed PICs were classified as Group 2. In multivariate analysis, the presence of diabetes mellitus, preoperative nephrostomy, and stone density were determined to be factors that significantly predicted the development of PICs. The area under the curve (AUC) of the model obtained by classical Cox regression analysis was 0.785, and the sensitivity and specificity were 74% and 67%, respectively. With the Random Forest, K- Nearest Neighbour, and Logistic Regression methods, the AUC was calculated as 0.956, 0.903, and 0.849, respectively. RF's sensitivity and specificity were calculated as 87% and 92%, respectively. CONCLUSION: With ML, more reliable and predictive models can be created than with classical statistical methods.

The effect of single or multiple arteries in the donor kidney on renal transplant surgical outcomes.

BACKGROUND: As the number of end-stage renal disease (ESRD) patients is increasing, but there are not enough living donors, it is necessary to broaden the criteria for candidates who can undergo donor nephrectomy. Thanks to surgeons' increasing experience with laparoscopic donor nephrectomy (LND), multiple renal artery grafts, previously considered a relative contraindication to donor nephrectomy, have become candidates for LDN. We aimed to compare the outcomes of donors and recipients with single artery and with multiple arteries in LDN. METHODS: A total of 214 patients were included in the study. Patients were divided into two groups according to the number of donor arteries: donors with one artery (group 1) and donors with multiple arteries (group 2). The number of donor arteries, operative time, warm ischemia time (WIT), cold ischemia time (CIT), arterial anastomosis time, venous anastomosis time, the extent of bleeding, and preoperative complications were recorded to evaluate the preoperative data. RESULTS: The mean operation time in group 1 was 90.3 ± 11.8 min, while in group 2, it was 102.1 ± 5.5 min (p = 0.000). WIT group 1 was 90.9 ± 4.3 s and group 2 100.6 ± 2.1 s (p = 0.000). Arterial anastomosis time was 12.25 ± 3.8 in group 1 and 22.5 ± 4.5 in group 2 (p = 0.000). No statistically significant difference was found between the two groups in other parameters. CONLUSION: Increasing the number of donor arteries in renal transplantation (RT) operations prolonged the operation time on both the donor and recipient sides. Still, it had no negative impact on complications or graft function in the postoperative period.

Comparison of Incision Types Used for Kidney Extraction in Laparoscopic Donor Nephrectomy: A Retrospective Study.

PURPOSE: Laparoscopic donor nephrectomy (LDN) is the most commonly used method for kidney removal in kidney transplantation and, various incisions are used for kidney extraction. In this study, we aimed to compare the results of LDN operations using iliac fossa incision and Pfannenstiel incision. MATERIAL AND METHOD: LDN cases performed in our institute between June 2016 and February 2020 were retrospectively analyzed. Patients with previous abdominal surgery, bleeding coagulation disorders, ectopic kidneys, and patients who were converted to perioperative open surgery were excluded. Demographic data of the patients, operation times, warm ischemia times, complications were recorded and the patients were divided into two groups according to incision types. RESULTS: After the inclusion and exclusion criteria, 203 patients were included in the study. Iliac fossa incision was used in 65% of the patients and the Pfannenstiel incision was used in 35% of the patients to remove the donor's kidney. There were no difference in age, body mass index, gender, and Charlson Comorbidity Index (CCI) scores between the two groups. Operation time and warm ischemia time were significantly longer in the Pfannenstiel group (p = 0.001 and p = 0.016 respectively). There was no significant difference between the two groups in terms of bleeding amount, length of hospital stay, need for narcotic analgesic, visual analog scale scores, and postoperative complications. CONCLUSION: Both types of incisions can be used successfully and safely for the extraction of the kidney in LDN. Although WIT and operation time has been observed to be longer when a Pfannenstiel incision is made, complications and analgesic use are not different between Pfannenstiel incisions and iliac fossa incisions.

Testicular salvage: using machine learning algorithm to develop a predictive model in testicular torsion.

PURPOSE: To compare the models developed with a classical statistics method and a machine learning model to predict the possibility of orchiectomy using preoperative parameters in patients who were admitted with testicular torsion. MATERIALS AND METHODS: Patients who underwent scrotal exploration due to testicular torsion between the years 2000 and 2020 were retrospectively reviewed. Demographic data, features of admission time, and other preoperative clinical findings were recorded. Cox Regression Analysis as a classical statistics method and Random Forest as a Machine Learning algorithm was used to create a prediction model. RESULTS: Among patients, 215 (71.6%) were performed orchidopexy and 85 (28.3%) were performed orchiectomy. The multivariate analysis revealed that monocyte count, symptom duration, and the number of previous Doppler ultrasonography were predictive of orchiectomy. Classical Cox regression analysis had an area under the curve (AUC) 0.937 with a sensitivity and specificity of 88 and 87%. The AUC for the Random Forest model was 0.95 with a sensitivity and specificity of 92 and 89%. CONCLUSION: The ML model outperformed the conventional statistical regression model in the prediction of orchiectomy. The ML methods are cheap, and their powers increase with increasing data input; we believe that their clinical use will increase over time.

Comparison of Open and Robot-Assisted Kidney Transplantation in terms of Perioperative and Postoperative Outcomes.

Background: The gold standard treatment method for end-stage renal disease (ESRD) is renal transplantation (RT). RT can be done with open or minimally invasive surgical methods. We aimed to compare the outcomes between patients who underwent robot-assisted renal transplantation (RART) and open renal transplantation (ORT). Methods: Data of the patients who underwent ORT or RART in two institutions between June 2015 and February 2020 were retrospectively reviewed. Patients who underwent live donor RT were included, and all donor nephrectomy procedures were performed by the laparoscopic technique. Demographic data, ischemia times, anastomosis times, operation times, and postoperative complications were recorded. Results: 98 patients were included in the ORT group, while 91 patients were included in the RART group. There was a significant difference between the two groups regarding mean patient age. While total ischemia time was 86.9 ± 7 minutes in the RART group, it was calculated as 71.2 ± 3.3 minutes in the ORT group, with a significant difference. The anastomosis time was significantly shorter in the ORT group than in the RART group. The incision length and duration of hospital stay were significantly shorter, visual analogue scores were significantly lower, and estimated blood loss was less in the RART group than in the ORT group. Conclusion: Both ORT and RART are effective and safe methods for treating ESRD. According to our study, RART is associated with relatively longer ischemia times but lower complication rates and higher patient comfort.

Evaluation of the efficacies of methylphenidate and biofeedback treatments in giggle incontinence: One-year follow-up study.

INTRODUCTION: Giggle incontinence is a type of urinary incontinence (GI) that occurs with laughing due to the urinary bladder's involuntary contraction leading to complete emptying. There are studies in the literature that biofeedback therapy or methylphenidate can be effective in the treatment of this condition. OBJECTIVE: This study aimed to compare the efficacies of biofeedback therapy and methylphenidate treatment in patients with GI. STUDY DESIGN: In this non-randomized observational study, children aged 5-18 years who were diagnosed with GI between January 2014 and December 2019 were included in the study. Patients who were treated by biofeedback were assigned to Group 1, while patients who were given methylphenidate treatment were placed in Group 2. Patients in Group 1 were treated with biofeedback, which was planned once a week for four weeks and once a month for the following two months. They continued their pelvic floor strengthening exercises at home for the following nine months. Patients in Group 2 were prescribed 5 mg oral methylphenidate qid for three months. Patients in both groups were followed up with 3-month intervals within a year. The results were classified as complete response, partial response or no response as per The International Children's Continence Society (ICCS) recommendations. RESULTS: The study population consisted of 38 patients with GI. Mean age of the patients was 7.7 (5-11). Among these patients, 31 (81.5%) were female, while 7 (18.4%) were male. Two groups were similar regarding mean patient age and gender distribution. There was no difference between the two groups regarding treatment responses evaluated during the 1st, 3rd, and 6th-month outpatient clinic encounters (p > 0.05). However, treatment responses assessed during the 12th-month outpatient clinic encounter revealed 15 (94.1%) patients with complete response in Group 1, while there were 10 (55.6%) patients who showed complete response in Group 2, with a significant difference (p = 0.03). DISCUSSION: Our study showed that treatment responses were reduced after discontinuation of methylphenidate. We achieved high complete response rates in the first, third, sixth, and twelfth-month assessments by biofeedback treatment. CONCLUSIONS: Significantly more favorable treatment outcomes were achieved with biofeedback therapy than methylphenidate treatment after completion of 1-year. Multi-center, randomized studies are needed to evaluate efficacy and safety.

Machine learning algorithms can more efficiently predict biochemical recurrence after robot-assisted radical prostatectomy.

OBJECTIVES: To develop a model for predicting biochemical recurrence (BCR) in patients with long follow-up periods using clinical parameters and the machine learning (ML) methods. MATERIALS METHOD: Patients who underwent robot-assisted radical prostatectomy between January 2014 and December 2019 were retrospectively reviewed. Patients who did not have BCR were assigned to Group 1, while those diagnosed with BCR were assigned to Group 2. The patient's demographic data, preoperative and postoperative parameters were all recorded in the database. Three different ML algorithms were employed: random forest, K-nearest neighbour, and logistic regression. RESULTS: Three hundred and sixty-eight patients were included in this study. Among these patients, 295 (80.1%) did not have BCR (Group 1), while 73 (19.8%) had BCR (Group 2). The mean duration of follow-up and duration until the diagnosis of BCR was calculated as 35.2 ± 16.7 and 11.5 ± 11.3 months, respectively. The multivariate analysis revealed that NLR, PSAd, risk classification, PIRADS score, T stage, presence or absence of positive surgical margin, and seminal vesicle invasion were predictive for BCR. Classic Cox regression analysis had an area under the curve (AUC) of 0.915 with a sensitivity and specificity of 90.6% and 79.8%. The AUCs for receiver-operating characteristic curves for random forest, K nearest neighbour, and logistic regression were 0.95, 0.93, and 0.93, respectively. All ML models outperformed the conventional statistical regression model in the prediction of BCR after prostatectomy. CONCLUSION: The construction of more reliable and potent models will provide the clinicians and patients with advantages such as more accurate risk classification, prognosis estimation, early intervention, avoidance of unnecessary treatments, relatively lower morbidity and mortality. The ML methods are cheap, and their powers increase with increasing data input; we believe that their clinical use will increase over time.

Can robot-assisted kidney transplantation provide higher quality of life than open kidney transplantation during the early postoperative period?

PURPOSE: Purpose of this study is to investigate the quality of life (QoL) in patients with end-stage renal disease who underwent open or robot-assisted kidney transplantation (OKT and RAKT). MATERIALS AND METHODS: Patients who underwent OKT and RAKT at Bakirkoy Sadi Konuk Training and Research Hospital between June 2016 and December 2018 constituted the target population of this study. The patient group was divided into two groups as per the surgical technique (ie, open vs. robot-assisted). Demographic data, preoperative and postoperative data of all patients were collected prospectively. The QoL of the patients was assessed preoperatively and on the postoperative 30th day. RESULTS: Sixty-seven patients who underwent OKT and 60 patients who underwent RAKT were included. The mean patient age and BMI were calculated as 40.9 ± 11.6 years and 24.4 ± 2.9 kg/m2 , respectively. Patients in the RAKT group were significantly younger than the patients in the OKT group (P = .002). There were no significant differences between the two groups in terms of gender, BMI, ASA and the ratio of premptive patients. The mean preoperative hemoglobin level was significantly higher in the OKT group than the RAKT group (P = .003). While mean total ischemia time was shorter in the "open" group, intraoperative blood loss and incision length were shorter in the RAKT group. Duration of surgical drainage and hospital stay was shorter in the "robot-assisted" group. There was no significant difference between the groups in terms of SF-36 subparameters preoperatively. The physical component scores of the QoL questionnaire revealed that postoperative impairment of quality of life in the early postoperative period was more significant in the OKT than the RAKT. CONCLUSION: Patients who underwent RAKT have a higher QoL than the patients who were treated with OKT as per their self-reported QoL scores in the early postoperative period.

An Unexpected Complication After Extracorporeal Shock Wave Lithotripsy: Emphysematous Pyelitis.

Emphysematous urinary tract infections (UTI) are life-threatening conditions caused by gas-forming organisms. Emphysematous pyelitis (EP) is a rare, acute bacterial UTI characterized by gas formation only in the renal collecting system. Extracorporeal shock wave lithotripsy (ESWL) treatment was performed for 10-mm sized stone in the left renal pelvis in an 81-year-old female patient with no known comorbidities other than hypertension. In the 10th hour following ESWL treatment, the patient referred to the emergency department with fever and left flank pain. Gas was noticed in the left renal collecting system in non-contrast computed tomography (NCCT). A wide spectrum antibiotic was given to the patient due to EP diagnosis and a nephrostomy catheter was placed in the left renal pelvis. EP should be considered in the patient with fever and flank pain after ESWL and NCCT should be performed for further examination. Quick diagnosis, examination and treatment of these patients in the emergency department are important.

Robot-assisted radical perineal prostatectomy: a review of 95 cases.

OBJECTIVES: To assess the early functional and oncological outcomes of a large series of patients who underwent robot-assisted radical perineal prostatectomy (RPP). MATERIALS AND METHODS: We retrospectively analysed the patients who underwent robot-assisted RPP for localized prostate cancer between November 2016 and September 2018. Patients who had locally advanced disease proven on biopsy or were suspected to have locally advanced disease on multiparametric magnetic resonance imaging and patients who had a contraindication for the exaggerated lithotomy position were not included in this study. Patient demographics, preoperative and postoperative variables, complications and follow-up times were recorded. RESULTS: A total of 95 patients were included. Their mean ± sd age was 61.5 ± 6.5 years. The median (interquartile range [IQR]) preoperative prostate-specific antigen level was 6.1 (3.7) ng/mL, the median (IQR) operating time was 140 (25) min, and the mean ± sd blood loss was 67.4 ± 17 mL. Pelvic lymph node dissection (PLND) was performed for 12 patients (12.6%). The median (IQR) hospital stay was 1 (1) days. Positive surgical margins were present in eight patients (8.4%). After catheter removal, the immediate continence rate was 41%. Continence rates were 78%, 87% and 91%, respectively, 3, 6 and 12 months after surgery. Potency rates were 49%, 69% and 77%, respectively, 3, 6 and 12 months after surgery for patients who had adequate potency preoperatively. The median (IQR) follow-up time was 13 (3.1) months. CONCLUSION: We conclude that robot-assisted RPP is a reliable and effective surgical technique that can be employed in the treatment of localized prostate cancer regardless of prostate volume, especially in patients with a history of abdominal surgery. As an additional advantage, PLND can be performed through the same incision.

Comparison of Common Surgical Procedures in Non-complicated Pilonidal Sinus Disease, a 7-Year Follow-Up Trial.

BACKGROUND: Pilonidal disease is a common problem in primary health care which may require immediate surgical referral. Although various management options have been proposed, so far there is no gold standard treatment. The aim of the present study was to determine which of the following techniques was superior as regards postoperative complications and recurrence, midline unshifted adipofascial turn-over flap, midline shifted adipofascial turn-over flap or Karydakis flap. METHODS: A randomized clinical trial was conducted in the Department of General Surgery. Patients with non-complicated pilonidal sinus were enrolled in the study from April 2009 to January 2012. All patients were randomized the day of surgery at the coordinating center by means of a computer program. Patients were randomized to receive midline unshifted adipofascial turn-over flap, midline shifted adipofascial turn-over flap or Karydakis flap. All procedures were performed under local anesthesia and patients were discharged 6 h after surgery. Demographic characteristics, skin color, body hair type, family history, preoperative complaints and duration of symptoms, cyst size, intraoperative iatrogenic cyst rupture, the presence of a tuft of hairs in the cyst, surgical techniques, duration of drainage, length of hospital stay, postoperative complications and recurrence were evaluated. RESULTS: One hundred and ninety-two patients with non-complicated pilonidal sinus were enrolled. Seventy-two patients were randomized to midline unshifted adipofascial turn-over flap, 67 patients to midline shifted adipofascial turn-over flap and 53 patients to Karydakis flap. The mean age was 25.66 ± 7.67 years. At 76-month follow-up, the overall complications and recurrence rates were not significantly different between groups (p > 0.05). CONCLUSION: In cases of non-complicated pilonidal sinus, we recommend surgical management using local anesthesia, outpatient surgery and the surgical approach with which the surgeon is most familiar.

The impact of single positive surgical margin features on biochemical recurrence after robotic radical prostatectomy

ABSTRACT Objective: Parameters predictive of biochemical or clinical recurrence after Radical Prostatectomy (RP) were determined as pre-treatment PSA value, pathologic tumor stage, tumor grade and presence of Positive Surgical Margin (PSM), extracapsular extension and seminal vesicle invasion and the status of pelvic lymph nodes. The aim of our study is to evaluate the effect of additional features in patients undergoing RP in our clinic. Materials and Methods: We studied 556 RP operations performed between 2009 and 2016 for prostate cancer at this clinic. Preoperative and postoperative data of the patients were retrospectively reviewed. RP specimens were examined by two pathologists specialized in this subject. Of these patients, 78 (14.02%) patients with PSM were included in the study. The pathology slides of these patients were reassessed. The length of PSM (mm), localization (apex, basis and posterolateral) and Gleason pattern at this margin was determined and statistical correlations with BCR were calculated. Results: The mean follow-up after the RP of 41 patients included in the study was 37.4 ± 13.2 months. During the follow-up period of the patients, BCR was observed in 16 patients (39.02%). No statistically significant difference was observed in age and prostate volume between the groups with and without BCR development (p > 0.05). Preoperative PSA level was found to be statistically significantly higher in the group with BCR development compared to the group without recurrence (p = 0.004). In-group comparisons in each aforementioned Gleason score groups were performed in terms of BCR development and the preoperative Gleason score in the group with development of recurrence was found to be statistically significantly higher compared to the group without recurrence (p = 0.007). The length of the surgical margin was measured as 7.4 ± 4.4 mm in the BCR-developing group and 4.7 ± 3.8 mm in the no-BCR- developing group; it was statistically significantly higher in the group with development of recurrence (p = 0.03). Conclusion: Length and location of the PSM and the Gleason score detected in the PSM region could not predict biochemical recurrence according to the results of this present study. However high preoperative PSA value is an independent prognostic factor for biochemical recurrence.

The impact of single positive surgical margin features on biochemical recurrence after robotic radical prostatectomy.

OBJECTIVE: Parameters predictive of biochemical or clinical recurrence after Radical Prostatectomy (RP) were determined as pre-treatment PSA value, pathologic tumor stage, tumor grade and presence of Positive Surgical Margin (PSM), extracapsular extension and seminal vesicle invasion and the status of pelvic lymph nodes. The aim of our study is to evaluate the effect of additional features in patients undergoing RP in our clinic. MATERIALS AND METHODS: We studied 556 RP operations performed between 2009 and 2016 for prostate cancer at this clinic. Preoperative and postoperative data of the patients were retrospectively reviewed. RP specimens were examined by two pathologists specialized in this subject. Of these patients, 78 (14.02%) patients with PSM were included in the study. The pathology slides of these patients were reassessed. The length of PSM (mm), localization (apex, basis and posterolateral) and Gleason pattern at this margin was determined and statistical correlations with BCR were calculated. RESULTS: The mean follow-up after the RP of 41 patients included in the study was 37.4 ± 13.2 months. During the follow-up period of the patients, BCR was observed in 16 patients (39.02%). No statistically significant difference was observed in age and prostate volume between the groups with and without BCR development (p > 0.05). Preoperative PSA level was found to be statistically significantly higher in the group with BCR development compared to the group without recurrence (p = 0.004). In-group comparisons in each aforementioned Gleason score groups were performed in terms of BCR development and the preoperative Gleason score in the group with development of recurrence was found to be statistically significantly higher compared to the group without recurrence (p = 0.007). The length of the surgical margin was measured as 7.4 ± 4.4 mm in the BCR-developing group and 4.7 ± 3.8 mm in the no-BCR- developing group; it was statistically significantly higher in the group with development of recurrence (p = 0.03). CONCLUSION: Length and location of the PSM and the Gleason score detected in the PSM region could not predict biochemical recurrence according to the results of this present study. However high preoperative PSA value is an independent prognostic factor for biochemical recurrence.

Single plus one port robotic radical prostatectomy (SPORP); Initial experience.

OBJECTIVE: This article reports on patients with early stage prostate cancer treated with single plus one port robotic radical prostatectomy (SPORP). MATERIALS AND METHODS: Since January 2014, we performed SPORP in 8 patients with localized prostate cancer. Age of patients, clinical stage, operation time, intraoperative and postoperative complications, blood loss, histopathological evaluation, postoperative continence, serum level of PSA were evaluated. RESULTS: Mean age of the 8 patients was 59.85 years. All operations were completed without conversion to standard robotic procedure or open surgery. No intra operative complications occurred. Mean operating time was 143 minutes; prostate excision 123 minutes and urethrovesical anastomosis 20 minutes. Mean blood loss was 45 ml. Preoperative Gleason scores were (3 + 4) in one patient and (3 + 3) in 7 patients. Postoperative Gleason scores were (3 + 4) in 2 patients, and (3 + 3) in 6 patients. All these 8 cases were in T1c clinical stage. Early postoperative complications were drain leakage (n = 1), atelectasis (n = 1), wound infection (n = 1) and fever (n = 1). There was no positive surgical margin. The serum level of PSA was less than 0.2 ng/ml and no other complications happened during the 4 to 12 months follow-up period. Postoperative continence and cosmetic results were excellent. CONCLUSIONS: It is relatively easy for urologists who are skilled in traditional laparoscopic and robotic surgeries to master SPORP. However long-term outcomes of this surgery need further investigations.

Masked urinary bladder injury with a bullet expulsed spontaneously during voiding.

We report a case with gunshot to the pelvis. The injury site was the soft tissue between the rectum and urinary bladder. Several days later, the bullet was expulsed spontaneously during voiding. In the literature, only a few case reports have described spontaneous expulsion of an intravesical bullet. A 19-year-old male was wounded on the left hip by gunshot. Radiographic examinations showed a bullet in the pelvis, which was localized in the soft tissue between the rectum and urinary bladder, with no accompanying visceral injury on abdominopelvic computerized tomography. Macroscopic hematuria was noticed after urethral catheterization. Rectosigmoidoscopy and retrograde cystoscopic examinations were both negative. The patient was monitored closely and treated conservatively with no surgical intervention. The urinary catheter was removed on the fifth postoperative day, and the bullet was expulsed spontaneously via the urethra during normal voiding three hours after catheter removal. Thereafter, a retrograde urethrography was performed, which showed no evidence of urinary tract or bladder injury.

Technetium-99m HMPAO brain SPECT in autistic children and their families.

The purpose of the study was to investigate perfusion patterns in autistic children (AC) and their families. Ten AC (9 boys, 1 girl; mean age: 6.9+/-1.7 years) with autistic disorder defined by DSM-III-R criteria, five age-matched children (3 boys, 2 girls) as a control group, and the immediate family members of eight AC (8 mothers, 8 fathers, 7 siblings; mean ages: 39+/-4 years, 36+/-5 years and 13+/-5 years, respectively) were included in the study. Age- and sex-matched control groups for both the parents and the siblings were also included in the study. Brain perfusion images were obtained 1 h after the intravenous injection of an adjusted dose of Tc-99m HMPAO to children and the adults. Visual and semiquantitative evaluations were performed. Hypoperfusion was seen in the right posterior parietal cortex in three AC, in bilateral parietal cortex in one AC, bilateral frontal cortex in two AC, left parietal and temporal cortex in one AC, and right parietal and temporal cortex in one AC. Asymmetric perfusion was observed in the caudate nucleus in four AC. In semiquantitative analyses, statistically significant hypoperfusion was found in the right inferior and superior frontal, left superior frontal, right parietal, right mesial temporal and right caudate nucleus. In parents of AC, significant hypoperfusion was noted in the right parietal and bilateral inferior frontal cortex. In siblings of AC, perfusion in the right frontal cortex, right nucleus caudate and left parietal cortex was significantly decreased. This preliminary study suggests the existence of regional brain perfusion alterations in frontal, temporal, and parietal cortex and in caudate nucleus in AC and in their first-degree family members.

Mazabraud's syndrome: intramuscular myxoma associated with fibrous dysplasia.

The association of fibrous dysplasia and intramuscular myxoma is a rare disease known as Mazabraud's syndrome. Both lesions tend to occur in the same anatomical region. The relationship between fibrous dysplasia and myxoma remains unclear, where an underlying localized error in tissue metabolism has been proposed to explain this occasional coexistence. Another example of this syndrome in a 52 year-old woman is reported. The patient presented with a soft tissue mass at the anteromedial mid part of the left thigh. After excision of the mass, three separate bone lesions were detected in her control MRI. The soft tissue mass was misdiagnosed as liposarcoma in another center, and the bone lesions were interpreted as metastasis. The hypocellularity and the indistinct vascular pattern of the lesion were consistent with myxoma. The Jam-Shidi needle biopsies of the osseous lesions were diagnosed as fibrous dysplasia. The recognition of this entity is important for appropriate management of the patient. Patients with soft tissue myxomas should be thoroughly examined for fibrous dysplasia. The greater risk of sarcomatous transformation in fibrous dysplasia with Mazabraud's syndrome should also be kept in mind.

Malignant struma ovarii.

Malignant struma ovarii is a rare form of ovarian germ cell tumors. Because of its rarity, diagnosis and management of the tumor has not been clearly defined. A 52-year-old female with follicular variant of papillary carcinoma arising in struma ovarii is presented. There was no evidence of clinical malignancy or metastases. However on the basis of histopathologic findings, the case was diagnosed as malignant struma ovarii. It was accepted as stage Ia tumor and no other treatment was considered after radical excision. Due to its fairly good prognosis, surgical excision has been the preferred treatment for those who do not have disseminated disease. Nevertheless, long-term follow-up is necessary to determine the course of the disease.