Papillary thyroid carcinoma (PTC) represents ~80% of all thyroid cancers, most frequently presenting in women in the third and fourth decade of life. The first clinical manifestation of PTC commonly includes a palpable mass in the thyroid area or cervical lymphadenopathy in cases of metastatic disease. Hematogenous distant metastases are a sign of an advanced stage of the tumour. The present study reported an extremely rare occurrence of solitary metastasis of a PTC in the left breast of a 63-year-old male patient, mimicking primary male breast cancer (MBC). The presence of a male breast lesion that did not follow the typical imaging criteria for MBC aroused suspicion of a different primary origin. The combination of imaging methods, laboratory findings and fine-needle aspiration techniques enabling cytological and histopathological examination, with the use of a wide panel of immunohistochemical markers, is crucial to establishing a definitive and correct diagnosis.
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
INTRODUCTION AND IMPORTANCE: Acute appendicitis is one of the most common surgical diagnoses in clinical practice. In case of uncomplicated course, diagnosis and treatment do not cause significant difficulties. On the other hand, unrecognized or complicated appendicitis can rarely bring unusual complications that threaten the patient with delayed treatment rather than the course itself. Portal vein thrombosis, also known as pylephlebitis, with an incidence of 1/1000 acute admissions, certainly meets this statement. CASE PRESENTATION: In this study, we present a successful treatment of advanced acute appendicitis complicating treatment of biliary obstruction. Due to the advanced inflammation with forced intestinal resection in the extent of right-sided hemicolectomy. And then successful conservative treatment of portal vein thrombosis in the surgical facility lasting a total of 6 weeks when the patient was discharged to home care without sequelae. CLINICAL DISCUSSION: The epidemiology, presentation, diagnosis and strategy of treatments as well as their outcomes were discussed. CONCLUSION: Portal vein thrombosis after acute appendicitis is rare. In case of unfavorable postoperative course with high inflammatory markers, temperatures, discomfort and abdominal pain, a CT scan is in order, which can easily establish the diagnosis and subsequently target the treatment in the right direction. Treatment of pylephlebitis is conservative and long term. It consists in the application of low molecular weight heparin and targeted antibiotic treatment. The mortality rate is 32%.
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- časopisecké články MeSH
INTRODUCTION: Anastomotic leak after colorectal surgery is a major problem associated with higher morbidity and mortality. In most cases of contained leaks, treatment recommendations are clear and effective. However, in rare cases like necrotizing pelvic infection, there is no clear treatment of choice, despite the mortality rate almost 21%. We present successful management with endoscopic vacuum-assisted closure therapy. THE PRESENTATION OF A CASE: A 68-year-old female patient with BMI 26, hypothyroidism and high blood pressure was indicated to low anterior rectal resection because of high-risk neoplasia of lateral spreading tumor type of the upper rectum. Four days after the primary operation, sepsis (SOFA 12) with diffuse peritonitis and unconfirmed leak according to CT led to surgical revision with loop ileostomy. On postoperative days 6-10, swelling, inflammation and subsequent necrosis of the right groin and femoral region communicating with the leak cavity developed. The endoscopy confirmed a leak of 30% of the anastomotic circumference with the indication of debridement and endoscopic vacuum-assisted closure therapy. EVAC sessions with 3-4 day intervals healed the leak cavity. Secondary healing of the skin defects required 4 months. CONCLUSION: Necrotizing pelvic infection after a leak of the colorectal anastomosis is a very rare complication with high morbidity and mortality. Endoscopic vacuum-assisted closure therapy should be implemented in the multimodal therapeutic strategy in case of major leaks, affecting up to 270° of the anastomotic circumference.
- Publikační typ
- časopisecké články MeSH
