RESUMO
Squamous cell carcinoma (SCC) developing in a Zenker's diverticulum (ZD) is an uncommon condition. The preferred treatment for SCC in the pharyngeal pouch is complete diverticulum resection. Only histopathological evaluation of the pouch can rule out SCC. Here, we present a case of a 62-year-old male patient, who was evaluated for repeated episodes of aspiration and dysphagia, and diagnosed to have a large ZD, the patient underwent Zenker's diverticulectomy with cricopharyngeal myotomy with wide margins due to clinically suspicious specimen. Histopathological examination revealed well-differentiated SCC arising within ZD, involving the whole thickness of the wall and almost touching the serosa (1 mm). The patient developed metastatic lung nodule on PET-CT, so metastatic lung nodule was excised with video-assisted thoracoscopic surgery (VATS), and chemotherapy and immunotherapy were given. On follow-up imaging patient is tumor-free to date, two years after the surgery. The occurrence of synchronous or metachronous lung cancer makes it one of the rarest cases.
RESUMO
Cowden syndrome is an uncommon autosomal dominant disorder characterized by multiple hamartomas in various tissues. It is associated with germline mutation in the phosphatase and tensin homolog (PTEN) gene. It has an increased risk of malignancies of various organs (commonly breast, thyroid, and endometrium) and benign overgrowth of tissues like skin, colon, and thyroid. Here, we present a case of Cowden syndrome in a middle-aged female who presented with acute cholecystitis with gall bladder polyps along with intestinal polyps. She underwent total proctocolectomy with ileal pouch-anal anastomosis (IPAA) with diversion ileostomy and cholecystectomy, which was further proceeded to completion of radical cholecystectomy based on the final histopathology report as incidental gall bladder carcinoma. To the best of our knowledge, this association is seen for the first time in the literature. In Cowden syndrome, patients should be counseled for regular follow-up and instructed to be aware of the signs and symptoms of different types of cancers with higher incidence.
RESUMO
INTRODUCTION: Hepatolithiasis (HL) is the presence of stones in the bile ducts proximal to the confluence of the hepatic ducts. This study aims to analyse the case presentations of HL in a tertiary care centre in South India and define the role of hepatic resection in these cases and their outcomes. METHODS: Retrospective data of all patients operated on for HL from 2012 to 2021 were analysed with regard to clinical parameters, biochemical parameters, and different types of surgical management. Descriptive data analyses were done. RESULTS: A total of 42 patients underwent surgical treatment for HL between 2012 and 2021 in our institution. Of the patients, 64% were females. A total of 50% of patients were affected by bilateral HL. Of the patients, 95% had abdominal pain, 57% had a fever, and 29% presented with jaundice. A total of 38% of patients had a history of previous biliary surgery. Atrophy was present in 38% of cases. Choledochoduodenostomy was performed in 26%, and hepatic resection with bilio-enteric anastomosis was done in 36% of patients. Endoluminal access loop was done in 21%. Hepaticojejunostomy alone was done in 14%. On follow-up visits (mean: 61.5 months), 60% of patients were asymptomatic with no recurrence. There was nil 30-day postoperative mortality. CONCLUSION: The treatment options for HL were based on the extent of liver involvement. The bilio-enteric anastomosis was done after the clearance of stones for uncomplicated HL. Complicated HL may need liver resection with hepaticojejunostomy, with an endoluminal access loop for a good outcome.
