Evaluation of phosphatase and tensin homologue (PTEN) expression in gastric cancer and its relationship with histopathological findings / Evaluación de la expresión del homólogo de fosfatasa y tensina (PTEN) en el cáncer gástrico y su relación con los hallazgos histopatológicos

Introduction Phosphatase and tensin homologue (PTEN) is an important tumour suppressor in multi-step tumorigenesis. To establish the role of PTEN in gastric cancer progression, we examined the PTEN expression degree in gastric cancer tissues. We also explained the connection between PTEN expression and histopathological findings. Materials and methods Our study was cross-sectional and made up of 50 patients with known gastric cancer. Immunohistochemical staining for PTEN was done on gastric cancer tissues. Tumour behaviour was estimated by histopathological assessments. Results Twenty-seven (54%) of the 50 patients had PTEN staining. The evaluation of the connection between PTEN expression and demographic data and tumour behaviours revealed no meaningful relationship between PTEN expression and patients’ age, gender, tumour site and size, tumour type, tumour grade and stage, neural, and lymphovascular invasion (P-value>0.05). Conclusion PTEN expression level is expected to be a significant molecular event in the progression of gastric cancer and may be a predictive marker for gastric cancer behaviours dependent on society. (AU)

Introducción El homólogo de fosfatasa y tensina (PTEN, por sus siglas en inglés) es un importante supresor tumoral en la tumorigénesis de múltiples pasos. Para establecer el papel de PTEN en la progresión del cáncer gástrico, examinamos el grado de expresión de PTEN en tejidos gástricos cancerosos. También explicamos la conexión entre la expresión de PTEN y los hallazgos histopatológicos. Materiales y métodos Nuestro estudio fue transversal y se realizó en 50 pacientes con cáncer gástrico comprobado. La tinción inmunohistoquímica para PTEN se empleó en tejidos de cáncer gástrico. Los comportamientos tumorales se estimaron mediante evaluaciones histopatológicas. Resultados De 50 pacientes, 27 (54%) tenían tinción PTEN. La evaluación de la conexión entre la expresión de PTEN y los datos demográficos y los comportamientos del tumor no reveló una relación significativa entre la expresión de PTEN y la edad, el sexo, el sitio, el tamaño del tumor, el tipo de tumor, el grado o el estadio del tumor, la invasión neural ni tampoco la invasión linfovascular de los pacientes (valor de p>0,05). Conclusión Se espera que el nivel de expresión molecular de PTEN sea unhito en la progresión del cáncer gástrico y resulte un marcador predictivo de los comportamientos del cáncer gástrico dependientes de la sociedad. (AU)

Evaluation of phosphatase and tensin homologue (PTEN) expression in gastric cancer and its relationship with histopathological findings / Evaluación de la expresión del homólogo de fosfatasa y tensina (PTEN) en el cáncer gástrico y su relación con los hallazgos histopatológicos

Introduction Phosphatase and tensin homologue (PTEN) is an important tumour suppressor in multi-step tumorigenesis. To establish the role of PTEN in gastric cancer progression, we examined the PTEN expression degree in gastric cancer tissues. We also explained the connection between PTEN expression and histopathological findings. Materials and methods Our study was cross-sectional and made up of 50 patients with known gastric cancer. Immunohistochemical staining for PTEN was done on gastric cancer tissues. Tumour behaviour was estimated by histopathological assessments. Results Twenty-seven (54%) of the 50 patients had PTEN staining. The evaluation of the connection between PTEN expression and demographic data and tumour behaviours revealed no meaningful relationship between PTEN expression and patients’ age, gender, tumour site and size, tumour type, tumour grade and stage, neural, and lymphovascular invasion (P-value>0.05). Conclusion PTEN expression level is expected to be a significant molecular event in the progression of gastric cancer and may be a predictive marker for gastric cancer behaviours dependent on society. (AU)

Introducción El homólogo de fosfatasa y tensina (PTEN, por sus siglas en inglés) es un importante supresor tumoral en la tumorigénesis de múltiples pasos. Para establecer el papel de PTEN en la progresión del cáncer gástrico, examinamos el grado de expresión de PTEN en tejidos gástricos cancerosos. También explicamos la conexión entre la expresión de PTEN y los hallazgos histopatológicos. Materiales y métodos Nuestro estudio fue transversal y se realizó en 50 pacientes con cáncer gástrico comprobado. La tinción inmunohistoquímica para PTEN se empleó en tejidos de cáncer gástrico. Los comportamientos tumorales se estimaron mediante evaluaciones histopatológicas. Resultados De 50 pacientes, 27 (54%) tenían tinción PTEN. La evaluación de la conexión entre la expresión de PTEN y los datos demográficos y los comportamientos del tumor no reveló una relación significativa entre la expresión de PTEN y la edad, el sexo, el sitio, el tamaño del tumor, el tipo de tumor, el grado o el estadio del tumor, la invasión neural ni tampoco la invasión linfovascular de los pacientes (valor de p>0,05). Conclusión Se espera que el nivel de expresión molecular de PTEN sea unhito en la progresión del cáncer gástrico y resulte un marcador predictivo de los comportamientos del cáncer gástrico dependientes de la sociedad. (AU)

Evaluation of phosphatase and tensin homologue (PTEN) expression in gastric cancer and its relationship with histopathological findings.

INTRODUCTION: Phosphatase and tensin homologue (PTEN) is an important tumour suppressor in multi-step tumorigenesis. To establish the role of PTEN in gastric cancer progression, we examined the PTEN expression degree in gastric cancer tissues. We also explained the connection between PTEN expression and histopathological findings. MATERIALS AND METHODS: Our study was cross-sectional and made up of 50 patients with known gastric cancer. Immunohistochemical staining for PTEN was done on gastric cancer tissues. Tumour behaviour was estimated by histopathological assessments. RESULTS: Twenty-seven (54%) of the 50 patients had PTEN staining. The evaluation of the connection between PTEN expression and demographic data and tumour behaviours revealed no meaningful relationship between PTEN expression and patients' age, gender, tumour site and size, tumour type, tumour grade and stage, neural, and lymphovascular invasion (P-value>0.05). CONCLUSION: PTEN expression level is expected to be a significant molecular event in the progression of gastric cancer and may be a predictive marker for gastric cancer behaviours dependent on society.

The value of SOX10 expression in predicting perineural invasion in gastric cancer / El valor de la expresión de SOX10 en la predicción de la invasión perineural en el cáncer gástrico

Background: SRY-related HMG-box 10 (SOX10) protein has a confirmed role in the regulation of neural cell proliferation and differentiation. It is now suggested that the changes in SOX10 expression may be linked to neural invasion by cancer cells. We aimed to assess the value of SOX10 expression in predicting perineural invasion in gastric cancer. Methods: A cross-sectional study was performed on 40 patients with gastric cancer. To assess perineural invasion, Hematoxylin & Eosin stained slides were examined. The expression of SOX10 was also examined by immunohistochemistry. Results: Our study showed higher perineural invasion in those with SOX10 positivity as compared to those without SOX10 expression (64.0% vs. 6.7%, p=0.001). No association was revealed between other baseline variables and SOX10 positivity. The expression of this marker increased the chance of neural invasion up to 17 times as indicated by the multivariable regression modeling. Multivariable regression modeling indicated that the chance of neural invasion increased up to 17 times in cases of SOX10 positivity. Conclusion: Overexpression of SOX10 is closely associated with the risk of perineural invasion in gastric cancer.(AU)

Antecedentes: La proteína HMG-box 10 (SOX10) relacionada con SRY tiene un papel confirmado en la regulación de la proliferación y diferenciación de células neurales. Ahora se propone que los cambios en la expresión de SOX10 pueden estar relacionados con la invasión neuronal de las células cancerosas. Nuestro objetivo fue evaluar el valor de la expresión de SOX10 en la predicción de la invasión perineural en el cáncer gástrico. Métodos: Este estudio transversal se realizó en 40 pacientes con cánceres gástricos. Para evaluar la invasión perineural, se planificó la evaluación histopatológica mediante tinción con hematoxilina y eosina. El estado de expresión de SOX10 también se examinó mediante la técnica de inmunohistoquímica. Resultados: Nuestro estudio mostró una mayor invasión perineural en aquellos con positividad de SOX10 en comparación con aquellos sin expresión de SOX10 (64,0% versus 6,7%; p=0,001). No se reveló ninguna asociación entre otras variables basales y la positividad de SOX10. La expresión de este marcador aumentó la posibilidad de invasión neural hasta 17 veces, como indica el modelo de regresión multivariable. Conclusión: La sobreexpresión de SOX10 está estrechamente asociada con el riesgo de invasión perineural en el cáncer gástrico.(AU)

Antibiotic Resistance Pattern in Intensive Care Units in a Large Referral Hospital in Iran.

Background & Objective: Antibiotic resistance, especially in the form of multidrug-resistant (MDR), is a big problem, especially in intensive care units (ICUs). This study aimed to evaluate antibiotic resistance and MDR patterns among patients hospitalized in the ICUs in one of the large referral centers in Iran. Methods: The present study was conducted at Imam Khomeini Hospital in Tehran (a great referral hospital), which admits critically ill patients requiring ICU services. To determine the rate of positive cultures for resistant strains, the patient's blood specimens were sent to the laboratory of the hospital for inoculation on proper culture media within 2 hours of extraction. Antimicrobial susceptibility tests were done using the Bauer-Kirby disk diffusion method. Results: A total of 1,755 samples were collected from the patients to assess microbial strains and antibiotic resistance. The most common microbial strains detected in the cultures extracted from peripheral blood samples were Klebsiella pneumonia (22.1%), Staphylococcus epidermidis (7.9%) and another coagulase-negative Staphylococcus (15.0%). The antibiogram test showed antibiotic resistance in 1,509 cases, leading to a resistance prevalence rate of 85.9%. The most common antimicrobial resistance observed was against cotrimoxazole (61.7%), ciprofloxacin (51.3%), imipenem (50.0%), and ampicillin (49.6%). The rate of MDR was found to be 96.3%. Conclusion: In Iran's ICUs, a significantly high level of antibiotic resistance may be seen especially the MDR pattern, which indicates the need to change the pattern of prescribing and managing these drugs in ICU centers.

Thyrotoxicosis as a rare presentation in acute suppurative thyroiditis: a case report.

BACKGROUND: Acute suppurative thyroiditis is a rare and potentially life-threatening disease. A few cases of acute suppurative thyroiditis associated with thyrotoxicosis have been reported in adults. We report a case of acute suppurative thyroiditis that was associated with thyrotoxicosis. CASE PRESENTATION: We report the case of a 49-year-old Iranian female presented with a painful neck swelling for a week. Computed tomography showed a well-defined gas-filled collection in the left thyroid lobe with an enhancing margin. The patient underwent two-phase surgery, first left thyroid abscess drainage and then total thyroidectomy. The result of histopathology examination was multinodular goiter with abscess formation without malignancy. CONCLUSION: Abscess formation and thyrotoxicosis is a very rare condition that occurs at the same time in acute suppurative thyroiditis. Despite antibiotic therapy being the first line of treatment, surgery is also required when antibiotic therapy fails.

Cardiovascular foreign body retrieval and its management algorithm.

Application of central venous catheters become more common however a rare complication, embolization, can occur which lead to high mortality rate. Therefore, cardiovascular foreign bodies should be immediately remove with a safe and effective method and algorithm. So, we investigate the results of cardiovascular foreign body retrieval in our center based on a designed algorithm. In this case series study, patients who had cardiovascular foreign body embolization were managed by our algorithm. Our approach was based on the time duration of foreign body embolization in cardiovascular system and also its location. If the embolization time was less than 48 h, based on the location of foreign body, insertion site would be right femoral or jugular vein. If the time of foreign body embolization was more than 48 h, echocardiography should be done to assess thrombosis around foreign body. Retrieval was done with snare technique in all patients. Over 12 patients, 9 patient had port catheter foreign body in SVC and atrium, 1 patient had port catheter in atrium, 1 patient had port catheter in pulmonary artery and 1 patient had hemodialysis catheter in inferior vena cava (IVC) and atrium. Foreign body retrieval was successful in all 11 patient. The IVC and atrium were the common site of port catheter fragments. According to our experience, we organize a useful algorithm for retrieval of cardiovascular foreign body based on time of embolization and its location.

Evaluation of Lymphovascular Invasion by CD31 Expression in Gastric Adenocarcinoma.

Background & Objective: Lymphovascular tumoral invasion is a typical histopathological feature of gastric carcinomas and supports the recognition of high-risk patients for the recurrence. We aimed to study CD31 expression in diverse subtypes of gastric carcinomas and to show its association with the histopathologic findings of the carcinoma to assess the prognosis. Methods: This cross-sectional study was conducted on 40 established patients with gastric adenocarcinoma from radical gastrectomy. The patients were classified according to the pathology assessments. Tumoral tissues were assessed by immunohistochemical staining for CD31 expression. Malignant behavior was estimated by histopathological evaluations. Results: CD31 positivity was described in 23 (57.5%) of all evaluated patients. In assessment of CD31 expression and tumor features presented, no significant association between the CD31 expression and patients' age, sex, tumor site, size, grade and stage, subtypes of carcinoma, perineural invasion, and also lymphovascular invasion was found. (P>0.05). Conclusion: Lymphovascular invasion may make valuable additional evidence and may be useful to detect gastric carcinoma patients at high risk for recurrence, who could be candidates for more supplementary therapies. However, in our study, CD31 expression did not show any association with the aggressive histopathologic features of this tumor.

Endovascular management of post PCNL vascular injuries.

Although percutaneous nephrolithotomy (PCNL) is a gold standard treatment of large kidney stones, vascular injuries like pseudoaneurysm (PA) and arteriovenous fistula (AVF) may occur due to renal punctures. These endovascular complications need urgent intervention to be diagnosed and managed early. In this case series, 14 patients who had hematuria after PCNL were managed by using angiography to identify the vascular pathology. Among them, we identified 10 patients with PA and 4 patients with AVF, 1 patient with both subscapular hematoma and PA. Angiographic embolization was done successfully in all patients. Based on our results, in cases with peripheral parenchymal damage, PA was common and in cases with hilar damage, AVF was common. No other complication and rebleeding was detected after embolization. Based on our study, angiography can be used as a safe and effective method to detect and treat vascular injuries immediately and successfully.

Genetic and Epigenetic Alterations in Parathyroid Neoplasms.

The exact etiology of parathyroid carcinomas (PC) is still unknown. Their associations have with several inherited syndromes or specific genetic lesions have been established. The management of PC is challenging for clinicians. The complexity of molecular phenotypes increases with tumor aggressiveness. Lack of parafibromin on immunohistochemistry staining and HRPT2 mutation would be helpful in differentiation of carcinoma from adenoma. Lack of parafibromin expression, the gene product of HRPT2 is now used as a diagnostic, prognostic, and predictive marker for parathyroid carcinoma. The epigenetic alteration, for example, DNA methylation and modifications in the chromatin structure, are known as significant events involved in the parathyroid tumorigenesis. We suggest that adjuvant genetic and epigenetic target therapy should be considered in treatment of the patients with PC.

The value of BCL2 and CK20 expression in predicting behavioral patterns of bladder cancer, a cross sectional study.

Background: Several biomarkers have been investigated to predict the biological behavior and prognosis of patients with bladder cancer. We evaluated the role of two important markers including BCL2 and CK20 in evaluating the biological behavior of bladder tumors. Methods: This cross-sectional study was performed on 30 patients suffering from one of the neoplasms of the bladder. To evaluate the expression of BCL2 and CK20 markers, the neoplastic tissue sample was initially extracted and immunohistochemistry staining was employed. Results: The positivity of CK20 and BCL2 in the patients' specimens was found to be 53.3% and 10.0%, respectively. There was no association between CK20 and BCL2 expressions and tumor size, tumor stage, or tumor-related vascular invasion, but BCL2 expression was shown to be higher in the low-grade specimens, while the expression rate of CK20 was found to be significantly higher in high grade samples. Conclusion: Evaluation of the expression of CK20 and BCL2 markers can be very valuable in predicting bladder tumor grade.

Volvulus of the transverse colon after resection of the sigmoid volvulus: A case report.

Sigmoid volvulus is a common cause of colon obstruction, while volvulus of the transverse colon rarely causes bowel obstruction. The occurrence of transverse colon volvulus after resection of the sigmoid colon volvulus is extremely rare. This report presents a 73-year-old man who presented with abdominal pain and peritonitis. The patient underwent exploratory laparotomy, and sigmoid volvulus and cecum perforation were confirmed. A right hemicolectomy, end-to-side ileotransverse colon anastomosis for the cecal perforation, and sigmoidectomy with end-colostomy (Hartmann's procedure) for the sigmoid volvulus were performed. A month later, the patient returned to the emergency room with abdominal distention and the blockage of colostomy. Abdominal CT revealed a transverse colon volvulus. A transverse and descending colon resection and ileorectal anastomosis were performed. The patient's condition was stable at the time of discharge from the hospital. The management of metachronous colon volvulus should include surgical intervention. If patients are not diagnosed immediately, their condition may deteriorate dramatically because of bowel infarction or peritonitis. It is essential to highlight this case, as many surgeons may not have attended a transverse colon volvulus after sigmoid volvulus, which might lead to high morbidity or mortality. Overall, metachronous colonic volvulus must be considered in the differential diagnosis of bowel obstruction, particularly in patients with significant risk factors.

Retroperitoneal Unicentric Castleman's disease, a case report.

Introduction: Castleman's disease (CD) is an unusual nonmalignant lymphoproliferative disorder which presented with enlarged hyperplastic lymphoid tissue and had three subtypes, hyaline-vascular, plasma cell, and mixed form according to histologic findings. Case report: We report a 31-year-old woman who presented with abdominal pain from 3 months ago. Imaging studies showed a well-defined mass on back of pancreas without any invasion. The histopathological examination revealed lymphoid tissue with prominent vascular proliferation and hyalinization of the vessel walls compatible with Hyaline vascular CD. So, pathological assessment is essential for the diagnosis. Conclusion: Unicentric CD must be considered as differential diagnosis in a solid solitary abdominal mass. In patients with abdominal mass of an ambiguous nature, surgical resection is necessary as diagnostic tool and the first treatment approach.

IgG4-related cholecystitis misinterpreted as gallbladder cancer, a case report.

Introduction: Immunoglobulin G4-related disease (IgG4-RD) is a new defined entity with features that factually have been overlapped with other diseases with distinctly diverse treatments and prognoses. Case presentation: This report describes a 50-year-old woman who presented with abdominal pain from 3 months ago. The patient underwent open cholecystectomy with Roux-en-Y hepaticojejunostomy due to suspicious of malignancy. The histological examinations revealed acute on chronic cholecystitis with extensive fibrosis and many inflammatory cells infiltration composed of plasmacells and eosinophils without any evidence of malignancy. Pathological and immunohistochemical examination for IgG4 compatible with IgG4-RD. So, pathological assessment is essential for the diagnosis. Conclusion: IgG4-RD in gastrointestinal tract frequently misinterpret as malignancy before surgery, and surgeon should notice this disease in the differential diagnosis in order to choose the treatment.

Seizure along with gastroenteritis: An atypical manifestation of appendicitis- A case report.

Introduction and importance: Appendicitis is a common cause of acute abdomen in children. Due to its distinct clinical manifestations, often, its diagnosis is not very challenging. At younger age cases with atypical manifestations of appendicitis have been reported in the literature. In this study, we report seizure as another manifestation of appendicitis. Case presentation: A young man presented to our clinic with diarrhea, abdominal pain, fever and history of seizure in past few days. After para-clinical examinations, he was primarily diagnosed as case of viral encephalitis and referred to our center. As his condition worsened, further work-up were done and he was finally diagnosed as perforated appendicitis. Conclusion: Since perforated appendicitis could present with gastroenteritis accompanied by seizure, we believe in patients without a neurological history who present with seizures and loss of consciousness, abdominal problems must be considered.

Short-Term Changes on Body Composition After Sleeve Gastrectomy and One Anastomosis Gastric Bypass.

Introduction: Changes in body composition after different bariatric surgeries have been studied extensively, but most of them have emphasized on Roux-en-Y gastric bypass. Only a few studies have assessed the effects of sleeve gastrectomy (SG). Also, the effect of one anastomosis gastric bypass (OAGB) on body composition is not fully apprehended. Furthermore, there is no agreement on how much fat-free mass (FFM) loss is tolerable in weight loss interventions. Therefore, we decided to assess the reduction in fat mass (FM) and FFM at 1, 3, 6, and 12 months after two types of bariatric surgery in a single center. Methods: In the current retrospective cross-sectional study, the patients' hospital records were analyzed. We included patients who had SG or OAGB and a complete 1-year follow-up record. We recorded demographic data as well as weight, body mass index (BMI), FM, and FFM before and at 1, 3, 6, and 12 months after surgery in a predesigned checklist. Results: We analyzed 311 patients (43 males and 268 females) in the SG (N = 192, 61.7%) and OAGB (N = 119, 38.3%) groups. Both the SG and OAGB groups demonstrated a statistically significant reduction in weight, BMI, FM, and FFM indices at 12 months after the intervention (P < .001). Moreover, no statistically significant difference was observed between the SG and OAGB groups regarding the mean of all body composition indices at 3, 6, and 12 months after the intervention. Conclusion: We found that SG and OAGB effectively decreased weight and body composition indices, comprising FM and FFM, with no significant difference between each other.

COVID-19 patients presenting with gangrenous acalculous cholecystitis: Report of two cases.

Introduction and importance: COVID-19 virus is thought to complicate underlying conditions, including acalculous cholecystitis. Two COVID-19 patients with gangrenous gallbladder are reported who were not involved with severe pneumonia. Case presentation: We present two non-critically ill patients with COVID-19 presenting with acalculous cholecystitis. Both patients had gangrenous gallbladder and had to undergo cholecystectomy. Upon surgery, one of the patients showed patchy gangrene on gallbladder and the other, a fully gangrenous gallbladder. Conclusion: There may be a possibility for COVID-19 patients with cholecystitis to develop ischemic gallbladder.

Endovascular reconstruction of aortoiliac occlusive disease in a case with claudication and an ectopic pelvic kidney.

INTRODUCTION AND IMPORTANCE: Ectopic kidney is a rare anomaly with an incidence of about 1 in 2500 birth in the population. Concurrency of pelvic kidney and iliac occlusion is rare, and the treatment is challenging because the pelvic kidney is associated with an atypical blood supply. CASE PRESENTATION: We reported a 68-year-old man with aortoiliac stenosis, right pelvic kidney, and high-risk cardiovascular comorbidities. He presented with the right lower extremity claudication that has been present for four years. Computed tomography angiograms showed total occlusion of right common and external iliac arteries. CLINICAL DISCUSSION: The old method for treating iliac artery stenosis is open surgery, which needs cross-clamping of the aorta. During this procedure, the chance of renal thrombosis and ischemia is high. Thus, the patient underwent an endovascular angioplasty that was done successfully for the patient without any disturbances in kidney function. CONCLUSION: Traditional treatment of iliac artery stenosis, especially in patients with high-risk cardiovascular comorbidities, may be associated with complications. Endovascular intervention is a safe and effective approach for treating aortoiliac occlusion in patients with ectopic pelvic kidneys. More research and case series are needed to review the results and compare the success rate of this method versus open surgery.

Incus Autograft Partial Ossicular Reconstruction Prosthesis vs. Titanium Angular Clip Prosthesis in Patients with Incudostapedial Joint Erosion Caused by Chronic Otitis Media; A Randomized Clinical Trial.

Chronic otitis media (COM) is a common disease that can cause damage to the middle ear ossicles and thus lead to conductive hearing loss. The purpose of this study was to compare two methods of incus partial ossicular reconstruction prosthesis (PORP) and reconstruction with titanium angular clip prosthesis in patients with incudostapedial joint erosion. In this interventional randomized clinical trial carried out in a tertiary referral hospital, patients with chronic otitis media and incudostapedial joint erosion who were candidates for surgery, were randomly allocated into two groups of incus PORP surgery and reconstruction with a titanium angular clip prosthesis. Audiometry was performed for the patients prior to and six months after surgery. Pre- and post-operative air-bone gap (ABG) and bone conduction (BC) thresholds were calculated and means were compared by analysis of variances (ANOVA). A P value of <0.05 was considered statistically significant. The study consisted of 24 and 14 subjects in the incus PORP and angular clip groups, respectively. There was no statistically significant difference between the mean pre- and post-operative ABG, BC thresholds and ABG reduction in the compared groups. Considering issues such as high cost and inaccessibility of titanium angular clips in all centers, incus PORP may be a more acceptable method.

Management of huge splenic artery aneurysm with new hybrid procedure including endovascular and open surgical approach: Case series.

INTRODUCTION: Splenic artery aneurysms (SAAs) account for more than half of all visceral artery aneurysms. Small SAAs are usually asymptomatic, but giant aneurysms are more likely to cause symptoms and result in life-threatening complications; these aneurysms treatment can be challenging. Splenic artery aneurysms treatment includes laparotomy, laparoscopy, or endovascular techniques. CASE PRESENTATION: This case series reports the details of successful management of three patients with huge splenic artery aneurysms who underwent hybrid surgery, endovascular inflow control with a balloon, and open aneurysm resection. DISCUSSION: Although endovascular treatment options are increasingly favored, only selected aneurysms are suitable for these procedures, as marked tortuosity of the artery or SAA in the proximal splenic artery may not be suitable for endovascular management. CONCLUSION: Open surgery escorted by endovascular techniques can be considered an ideal treatment of SAA in the proximal region of the splenic artery.