Rare Tumors of Skin: Malignant Cutaneous Adnexal Tumors and Clinicopathological Features

Background

Cutaneous adnexal tumors (CATs) are a large group of neoplasms of the skin and the pathological diagnosis can be challenging.

Objective

The aim of this study was to examine clinicopathological features of malignant cutaneous adnexal tumors (MCATs) and to identify therapeutic and prognostic implications.

Materials and Methods

Twenty-six patients diagnosed with MCATs and operated in our center were included. Demographic and clinical characteristics of patients, tumor size, histological subtype, perineural and lymphovascular invasion, re-excision status, lymph node metastasis, distant metastasis, recurrence, follow-up, and treatment choice were recorded. All lesions were excised with 1 to 2-cm surgical margin. Surgical margin was determined according to tumor size.

Results

Of 26 patients, 14 were males and 12 were females (median age: 66 years). Median follow-up was 52.08 months. Tumor location was the face in 69.2% (n = 18) patients, followed by scalp and neck region. Four patients had coexisting skin tumors. Majority of MCATs (69.2%, n = 18) originated from sweat glands. Median tumor diameter was 4 (range, 0.8 to 17) cm. There was a statistically significant correlation between presence of perineural invasion and advanced disease (P = 0.036). Majority of the patients had Stage 1-2 disease, while two patients had Stage 4 disease. In six patients (23.1%), re-excision was performed due to surgical margin positivity.

Conclusion

Incidence of MCATs has an increasing trend with advanced age and these tumors are more commonly seen in men and in visible sites of the body such as head and neck and scalp. Wide resection according to tumor size is the first-line treatment.

Effect of the pandemic on surgical procedures in a tertiary care hospital: A retrospective review

Objectives

The aim of this study was to examine the impact of performing surgeries with necessary precautions and to evaluate demographic characteristics of operated patients during novel coronavirus-2019 (COVID-19) pandemic and the infection rates during hospitalization and within 14 days after surgery.

Material and Methods

Between March 15^th, 2020 and April 30^th, 2020, a total of 639 patients who had been operated on in our center were retrospectively analyzed. According to the triage system, the surgical procedures were classified as emergency, time-sensitive, and elective procedures. Data including age, sex, indication for surgery, the American Society of Anesthesiologists (ASA) class, pre- and postoperative symptoms, the presence and/ or absence of reverse transcriptase-polymerase chain reaction (RT-PCR) test result, type of surgery, surgical site, and documented COVID-19 infections during hospitalization and within 21 days after surgery were recorded.

Results

Of the patients, 60.4% were males and 39.6% were females with a mean age of 43.08 ± 22.68 years. Malignancy was the most common indication for surgery (35.5%), followed by trauma (29.1%). The abdominal area and head and neck region were the most frequent surgical sites in 27.4% and 24.9% of the patients, respectively. Of all surgical procedures, 54.9% were emergency and 43.9% were time-sensitive procedures. Of the patients, 84.2% were in ASA Class I-II while 15.8% patients were in ASA Class III, IV and V. General anesthesia was the most common anesthesia type in 83.9% of the patients. The overall rate of COVID-19 infection was 0.63% in the preoperative period. The rate of COVID-19 infection during and after surgery was 0.31%.

Conclusion

With similar infection rates to the general population, surgeries of all types can be performed safely taking preventive measures in the preand postoperative period. It would be wise to perform surgical treatment without delay in patients with an increased risk for mortality and morbidity in accordance with strict infection control principles.

A new method for quantification of frontal retrusion and complex skull shape in metopic craniosynostosis: a pilot study of a new outcome measure for endoscopic strip craniectomy

OBJECTIVE

The objective of this study was to propose a new skull outline-based method to objectively quantify complex 3D skull shapes and frontal and supraorbital retrusion in metopic craniosynostosis using 3D photogrammetry.

METHODS

A standard section from 3D photogrammetry, which represents the trigonocephalic shape, was used in this study. From the midpoint of the area of this section, half diagonals were calculated to the skull outline at 5° increments in the anterior half of the head. These half diagonals were used to create a sinusoidal curve, and the area under the sinusoidal curve (AUC) was used to represent the mathematical expression of the trigonocephalic head shape. The AUC from 0° to 180° (90° from the midline to each side) was calculated and is referred to as AUC0→180. The AUC from 60° to 120° (30° from the midline to each side) was also calculated and is referred to as AUC60→120. A total of 24 patients who underwent endoscopic strip craniectomy and 13 age- and sex-matched controls were included in the study. The AUC values obtained in patients at different time points and controls were analyzed.

RESULTS

The mean preoperative AUC60→120 and AUC0→180 in the patients were significantly lower than those in control individuals. The increase in both AUC60→120 and AUC0→180 values is statistically significant at the discontinuation of helmet therapy and at final follow-up. Receiver operating characteristic curve analysis indicated that AUC60→120 is a more accurate classifier than AUC0→180.

CONCLUSIONS

The proposed method objectively quantifies complex head shape and frontal retrusion in patients with metopic craniosynostosis and provides a quantitative measure for follow-up after surgical treatment. It avoids ionizing radiation exposure.

Intraluminal fluid infusion in a rat jejunum ischemia/reperfusion model is associated with improved tissue perfusion and less mucosal damage

OBJECTIVE

This study used an experimental model mimicking early postoperative enteral feeding after the transfer of free jejunal flap and tested the hypothesis that jejunal infusion with dextrose or saline is associated with improved tissue perfusion and/or less mucosal damage after ischemia/reperfusion (IR) injury.

METHODS

Thirty-five male Sprague Dawley rats were randomly divided into five groups: sham group (no IR and no intraluminal infusion); IR control group (IR but not intraluminal infusion); IR plus intraluminal 0.9% NaCl infusion or 5% dextrose or 10% dextrose infusion groups. A jejunal segment of each rat was isolated. The animals had jejunal ischemia for 40 min, reperfusion, and intestinal infusion on the basis of their allocation. Jejunal tissue perfusion was measured with laser Doppler flowmetry at one hour and two hours after reperfusion, after which the animals were sacrificed and tissue samples were obtained for the scoring of histological damage at superficial and cryptic epithelium, villus structure, and inflammatory cell infiltration and tissue nitric oxide (NO), interleukin (IL)-1, IL-6, and matrix metalloproteinase-1 (MMP) level measurements.

RESULTS

At 1 h of reperfusion, IR plus 5% dextrose and 10% dextrose groups both had significantly higher perfusion rates than the IR control group (384.8 ± 26.7 and 462.4 ± 44.7 versus 270.3 ± 34.2 PU, respectively, p < 0.05 for both). These differences were maintained at 2 h of reperfusion (p < 0.05 for both). Saline infusion, however, resulted in improved tissue perfusion only at the early phase of reperfusion. Intraluminal infusion with dextrose solution, either 5% or 10%, was associated with higher tissue NO, IL-1, and IL-6 levels than that in the sham group (p < 0.05 for all). In addition, intraluminal infusion of any fluid resulted in less severe histological damage (8.1 ± 0.9 versus 5.8 ± 1.0, 5.4 ± 0.9, and 5.2 ± 1.9, for IR plus saline, 5% dextrose and 10% dextrose groups, respectively, p < 0.05 for all).

CONCLUSIONS

Intraluminal infusion of fluids, particularly dextrose solutions, may be protective against IR injury as demonstrated by improved tissue perfusion and less histological damage. In addition, increases in tissue NO, IL-1, and IL-6 levels in association with dextrose infusion may be explained by the activation of pro-inflammatory and anti-inflammatory protective pathways. These support early enteral feeding after free jejunum flap transfers; however, further studies are warranted.

Repair of critical size defects using bioactive glass seeded with adipose-derived mesenchymal stem cells

Bioactive glass has been demonstrated as a biocompatible bone substitute. However bone healing process can be prolonged due to late resorption of the material. Adipose derived stem cells (ASC) have osteogenic differentiation potential and hence can be a cell source for bone regeneration. The aim of this study was to test whether combination of bioactive glass with ASCs would enhance bone regeneration. Following creation of critical sized defects on the calvaria of 32 Wistar rats, the animals were randomly divided into four groups: Group C (control): Defects were left untreated; Group G: Defects were covered with autologous bone graft; Group BG: Defects were filled with bioactive glass; Group BG/ASC: Defects were filled with bioactive glass seeded with ASCs. The defect size was significantly greater in Group C compared to all other groups. Bone density was significantly lower in Group C compared to Group G and Group BG/ASC. Bone regeneration score of Group C was significantly lower than other groups. Group BG/ASC demonstrated lamellar bone and havers canal formation. The results of this study demonstrated that bioactive glass implanted with ASC is a biocompatible construct stimulating radiologically and histologically evident bone regeneration similar to autologous bone grafting. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 1002-1008, 2017.

Crossover replantation as a salvage procedure following bilateral transhumeral upper limb amputation: a case report

Cross-over replantation is a salvage option for cases with bilateral extremity amputations where the wound conditions do not enable an orthotopic replantation. Here, we present a 24-year-old patient who applied to our center with bilateral transhumeral amputations. Due to the wound conditions, a cross-over replantation was performed. 24 months after the initial operation, the patient exhibits good protective sensation at the distal levels and function to some degree, whereas the active range of motion is not as promising as previously expected. In this article, we present this case together with its immediate and long-term outcomes and the consequences of the cross-over replantation.