Diagnostic challenges in synchronous ovarian metastasis from rectal cancer: A case report.

INTRODUCTION: Ovarian metastases from rectal cancer are infrequent; thus it might be hard to diagnose and treat them. Our study introduces a challenging case which highlights our method in addressing such an issue. PATIENTS CONCERNS: A 74-year-old woman was admitted to our Unit showing abdominal pain, vomit, and a gross abdominal mass located in the right iliac fossa and mesogastrium. Oncological markers recorded following abnormalities: carbohydrate antigen 19.9 (Ca19.9) = 453.40 U/mL, carbohydrate antigen 125 (Ca125) = 88.3 U/mL. DIAGNOSIS: Such a metastatic tumor being difficult to diagnose, we could not achieve a precise preoperative diagnosis. We entered the operating room with a histologic diagnosis that was highly suspicious of colon adenocarcinoma. During surgery, frozen section analysis was positive for primary ovarian cancer. Thanks to the immunohistochemistry test on the histologic specimen, which might be very helpful in diagnosing such metastatic tumor, final pathology report documented ovarian metastasis from rectal cancer. INTERVENTIONS: We performed total hysterectomy with bilateral salpingo-oophorectomy and low anterior resection of the rectum with a terminal colostomy. Adjuvant chemotherapy was administered for 6 months using FOLFOX plus panitumumab in first-line therapy. OUTCOME: At 8 months from surgery, during follow-up, a local pelvic progression of disease was detected, leading to second-line chemotherapy treatment. CONCLUSION: Correct differential diagnosis between primary and metastatic ovarian tumors is paramount in choosing the best treatment which leads to the best possible outcome. In ovarian metastatic tumors, immunohistochemistry could represent an optimal diagnostic tool.

Gluteal, abdominal, and thoracic multiple impalement injuries: A case report on management of a complex polytrauma.

RATIONALE: Historically, traumatic injuries include penetrating and blunt lesions. Impalement injury represents one of the rarest and potentially dramatic forms of penetrating trauma. If patient reaches hospital alive and is hemodynamically stable, there is a good chance that patient overcomes the traumatic event. However, non-removal of foreign body represents the cornerstone in initial treatment of this type of patients. PATIENT CONCERNS: A stable 55-year-old woman was admitted to the Emergency Department after falling out of a tree onto a wooden fence. One fence pole transfixed left gluteus, left abdominal wall, left abdominal cavity, and left thoracic wall by transdiaphragmatic way. DIAGNOSIS: Due to patient stability, a chest-abdomen CT scan with contrast medium was performed. It showed multiple parietal and visceral traumatic penetrating injuries from a foreign object. INTERVENTIONS: After primary and secondary advanced trauma life support (ATLS) assessment, patient underwent successful surgery. OUTCOMES: Patient was discharged on 9th postoperative day in good general clinical condition. LESSONS: Impalement injury represents a rare and potentially lethal traumatic event. Unstable patients rarely reach Emergency Department alive. On the contrary, stable patients have a good chance of successful treatment, if they are quickly taken to tertiary Trauma Center. In this case, chest X-ray and Focused Assessment with Sonography for Trauma (FAST) represent useful diagnosing investigations, although CT scan remains gold standard. Conservative treatment is not possible, while thoracoscopy/laparoscopy/laparotomy is/are mandatory.

Incidental thyroid carcinoma (ITC): a retrospective study in a series of 737 patients treated for benign disease.

AIM: Aim of the study is to evaluate correlations between incidental thyroid carcinoma (ITC) and benign thyroid pathologies (BTP), to determine the most represented histotype and to point out the total thyroidectomy's possible advantages in terms of radicality, follow-up management and incidence of complications. MATERIALS AND METHODS: During 10 years, 739 patients underwent thyroid surgery for BTP. Fine needle biopsy (FNAB) was negative in all cases; 503 total thyroidectomies (TT), 5 subtotal thyroidectomies (ST) and 231 emithyroidectomies (ET) were performed. RESULTS: The specimens pathological examination revealed the presence of a ITC in 82 patients (11.1%); the prevalent histotype was the papillary one with a less than 1cm diameter in almost the totality of cases but with nodes metastasis in the 3.6% of cases. Complications were detected in 117 patients with a morbidity rate of 15.8%. DISCUSSION: In our study the ITC prevalence was of 11.1% similar to literature with a higher incidence in patients affected by multinodular than uninodular goiter. No statistical significant differences were found between euthyroid and toxic pathologies. In our series hyperthyroidism doesn't seem to hold a protective role towards the ITC onset. CONCLUSIONS: The ITC incidence is relevant; the prevalent histotype is papillary and nodes metastasis are present even if in a low percentage of cases. Besides, the complications of TT are similar to conservative procedures. The recurrence of goiter and ITC require a second surgical procedure, with a higher risk of complications. So we can claim that the standard surgical treatment of bilateral PBT would be represented by TT.