Giant, primary, hydatid cyst of the gluteal region

Background: Primary hydatid disease in the muscle is extremely rare, resulting in either the spread of cysts spontaneously or after operations for hydatidosis in distant regions. Methods: Report of an unusual case of primary hydatid cyst in the gluteus muscle, behaving as enlarging soft-tissue tumour, with a review of the literature. Results: Magnetic resonance imaging revealed an intramuscular cyst in the gluteus muscle; and no cyst existed in any other location. The cyst was excised totally, and the diagnosis of muscular cystic hydatidosis was confirmed by histopathologic examination. In follow-up of two years after the operation, there has been no recurrence in either patient. Conclusion: The involvement of the gluteus maximus muscle without the evidence of hepatic or pulmonary disease is rare, characterized by slow development, but a major local extension must be considered in the differential diagnosis of a cystic mass with well-defined margins in the extremities of individuals from endemic regions. Physical examination, serology results and radiological findings should be interpreted with care, especially in hydatid cyst endemic countries. Surgery is still the treatment of choice, with total cyst excision.

Intradural spinal, extramedullary, T4-T5 cavernous hemangioma - case report

A very rare, purely intradural, spinal, extramedullary cavernous hemangioma was fortunately discovered in a 56 years old woman, presenting with bilateral brachial paresthesia. Using conventional spin-echo T1 proton density, T2-weighted magnetic resonance and gadolinium images an intradural spinal T4-T5, an extramedullary cavernous hemangioma was discovered. The patient underwent surgery, with laminectomy and microsurgical resection followed by an uneventful postoperative clinical course. Similar as in cerebral locations a mixed signal intensity in all sequences on magnetic resonance images might be indicative of cavernous hemangioma, rendering a presumptive preoperative diagnosis of the lesion and surgical planning for a good microsurgical resection.

5 -year complex clinical and histopathological follow-up of a case of early gastric carcinoma (signet ring cells type)

The paper presents the case of a male patient, hospitalized for acute abdomen due to perforated callous ulcer. Though the clinical appearance suggested a benign pathology, the histopathological exam of the resection piece showed multicentric early gastric carcinoma, signet ring cell type. At the patient's request, total gastrectomy was not performed, a conservative solution being chosen instead. Superior digestive endoscopy with biopsy and oncological dispensarization was performed one month after surgery, then at every 6 months. After 2 years of benign results, the histopathological exam revealed the presence of malign singlet ring cells in the bioptic specimen. Respecting the patient's option of preserving a good quality of life, subtotal gastrectomy with Pean type gastroenteroanastomosis was performed followed by postoperatory chemotherapy. Endoscopic and oncological follow-up were performed at every six months for another 3 years (up to present), and the evolution was favorable with no local or metastatic recurrence. Histopathological examination was of great help in the surgical management of this case, allowing a fortunate early diagnosis, a conservative surgical approach, and the preserving of a good quality of life.

A very rare, petro-clival, neurothekeoma tumor. Case Report

Known as nerve sheath myxoma too, neurothekeoma are benign tumors, usually arise in the skin of the head, neck region and upper extremities, in young females. Cerebral neurothekeoma are very rare, a few cases were already described in the parasellar area, in the middle cranial and posterior fossa. We present a petro-clival neurotekoma. A 78-year-old male was admitted for two years left fronto-temporal headache completed in the last 6 months with left trigeminal V1 neuralgia, left facial hypoesthesia, diplopia, swallowing disorders for liquid foods, balance disorders. From his medical records we noticed: stage 2 chronic kidney disease, hypertension, prostate adenoma, dyslipidemia hypercholesterolemia. The MRI showed a macronodular petroclival mass in hiper T2, hipo T1, flair iso signal; normal cerebral angiography. The patient was operated on using a left retrosigmoid, retromastoidian approach. A 4/3/3 cm tumor, gray, encapsulated, soft consistency, partially cystic, less bleeding, attached to the dura, displacing the basilar artery and brain stem controlateral, encasing the trigeminal nerve. The tumor was totally removed with a good postop evolution. Six months follow up he had no more facial pain, but only persistant left facial hypoesthesia. Histologically the tumor had lobular appearance with spindle or stellate cells embedded in abundant myxoid background. The tumor cells were diffusely positive for S100, PGP9.5’, CD 34” positive in vessels, Ki67’positive in 5%. Cranial MRI performed one month after surgery did not show any residual tumor. Also known as nerve sheath myxomas, neurothekoma are rare benign tumors. For intracranial neurothekoma surgical indication is mandatory

Splenic sarcoidosis -- a case report

Patient aged 66 years, was admitted for splenomegaly grade III/IV, haematological hypersplenism and medium / large secondary anemia, diagnosed in the hematology clinic, where a myeloproliferative syndrome was denied. Was performed splenectomy, splenic lodge toilet and drainage. Histopathology was established the diagnosis of splenic sarcoidosis. Good postoperative evolution. Main issues discussed are etiopathogeny, diagnostic and therapeutic, that this rare disease of unknown etiology is giving.

[Amyand's hernia--case presentation and a discussion about diagnosis problems and surgical treatment]

We present the case of a 62 years old patient, with multiple associated tares, which was operated in emergency for an Amyand's hernia. The appendix was perforated and generated a big pussy collection (aprox. 200 ml) in the hernia sac. The impossibility of mobilization of the appendix, which was just 2/3 in the hernia sac, made us perform a median laparotomy for safety reasons. The position and fixation of the cecum made impossible the exteriorization of the appendix in the hernia sac. The postoperative evolution, under a complex supervision, was favorable. Due to the rarity of the clinical entity, of the specific issues and of the literature review, we decided to communicate the clinical observation.

[Jejunal ulcer--therapeutical and diagnosis difficulties]

We present a female patient of 70 years, admitted in emergency department for signs of high bowel obstruction. After preoperative intensive care, surgical intervention was performed. A complete stenosis of the bowel lumen was found about 15 cm from the duodenojejunal angle, due to a process of sclerosis. Segmental enterectomy was performed with lateroterminal enteroenteralanastomosys, with poor outcome due to a lung infection, which occurred amid COPD. The patient died in intensive care unit requiring mechanical ventilation postoperative. Jejunal ulcer diagnosis was established after pathological examination. Particular issues in discussion are: etiological, clinical, diagnostic and therapeutic ones, that this rare condition posed in practical care.

[Clinical and morphological features in a case of recent gastric carcinoma (the signet ring cell carcinoma type)]

The article presents the case of a male patient, hospitalized due to severe pain in the upper abdomen area, nausea, and vomiting. The patient was diagnosed with surgical acute abdomen, for which emergency surgery is performed. Upon penetration into the peritoneal cavity, stomach inspection shows at the medio-gastric level, on the greater curvature, a callous gastric ulcer, with a central perforation. A large excision is decided up to the healthy (normal) gastric tissue, and the resulting pieces are sent to the pathological anatomy laboratory. The histopathological exam reveals signet ring cell recent gastric carcinoma. The biopsy performed 1 month after surgery, prelevated from the antropyloric zone, reveals antropyloric gastritis with moderate activity and Helicobacter pylori positive. Due to the fact that such cases when this gastric cancer type is diagnosed in recent stages are extremely rare, we considered it useful to present it and look into its macroscopic and microscopic aspects, as well as into the differentiating diagnosis.

[Gastric metastasis of clear cell renal carcinoma]

We report the case of a patient operated in 2003 for renal clear cell carcinoma (CCRC), when left nephrectomy was performed. In the years following occur: lung (2004) and brain (2006) metastasis, pathological bone fracture in right femur (2007), which needed a complex treatment: polichimiotherapy, cobaltotherapy, right temporal metastasectomy, right femoral fixation with metal rod. In our clinic was hospitalised for serious upper gastrointestinal bleeding, severe anaemia (haemoglobin 5.8 g%, hematocrit 18.3%) produced by a ulcerated gastric metastasis. The inefficiency of medical treatment, patient and family desire to operate, have led us to practise Péan type gastrectomy necessary for palliative role (raising the hemorrhagic metastasis). Scarcity of the gastric metastasising of CCRC are discussed and also the surgical indication in the context of a plurimetastatic patient.

Basal cell carcinoma miming cutaneous melanoma

In the last decades, the incidence of skin cancer is in continuous growth, but the mortality remains at the same level thanks to the new imaging diagnosis methods and surgical treatment. A real problem regarding differential diagnosis between cutaneous melanoma and non-melanotic skin tumor appear, despite advanced technologies, which have a major impact on treatment management. We reported two cases with clinical and dermoscopic aspects of cutaneous melanoma, sustained by positive lymphoscintigraphy. The histopathological exams established that the skin tumor was a pigmented basal cell carcinoma. In such difficult cases, the accuracy of diagnosis is certified only by the microscopical examination with clinical, treatment and prognosis changes.

Diagnosis and treatment protocols of cutaneous melanoma: latest approach 2010

Cutaneous melanoma is the most aggressive skin malignancies with increasing rate of incidence in the latest decades. New imaging technique plays an important role in melanoma management: dermoscopy and computer dermoscopy, ultrasound, MRI, CT, PET and PET/CT. Due to the dermoscopy and lesion diagnosis in early stages the increasing number of curative melanoma are registered. Sentinel lymph node biopsy became a compulsory phase for patients with tumor thickness > 1 mm. Serological biomarkers proved to be a necessary investigation for melanoma diagnosis, follow-up and treatment response. Current TNM melanoma staging is based on AJCC classification since 2001 witch includes new elements like histopathologic ulceration in stage I and II and lymph node micro- and macrometastases in stage III. Treatment protocols include surgical tumor excision with only 1-2 cm safety margins and radical lymphadenectomy is performed after positive sentinel lymph node biopsy. The adjuvant treatment in advanced stages including chemotherapy, unspecific immunotherapy and interferon offers poor results regarding free disease terms rate of survival. The advanced therapeutic procedure like golden nanospheres and gene therapy are recently studied and represent an alternative for future treatment of melanoma. Follow-up protocols have a great importance for detection of the melanoma recurrences and include clinical, serological and imaging evaluation. Despite all new knowledge and technological support the advanced stage melanoma management still remain an unsolved problem.

[Porcelain gallbladder--diagnostic and therapeutic features]

Porcelain gallbladder (PG) is a rare entity. It's frequently associated with cholecyst lithiasis (90%). Diagnosis is established based on imaging assays (simple abdominal radiography, ultrasound and/or abdominal CT). Pathologically is an extensive process of calcification of the gallbladder wall. The literature mentioned strongly PG association with cancer of the gallbladder. Therefore laparoscopic cholecystectomy was formally contraindicated. We present two cases of PG laparoscopically operated and with this occasion we review particular aspects of diagnosis and treatment of the disease.

[Tumoral form of abdominal and retroperitoneal actinomycosis]

We present a case of abdominal and retroperitoneal actinomycosis, clinicaly evidenced by a large tumor in the left inferior abdominal quadrant, in a 72-year-old male. Following clinical and laboratory investigations (imaging), strong suspicion of a left colon neoplasm was raised. Surgery consisted in an exploratory laparotomy and multiple biopsies of the great omentum and retroperitoneal space, the case being considered above the therapeutic resources. Histopathological diagnosis was a surprise by setting actinomycotic etiologies and enabled the establishment of a proper antibiotic treatment, followed by a favorable evolution. Postoperative follow-up revealed disappearance of lesions and healing.

[Merkel cell carcinoma in unusual location]

We present a case of Merkel cell carcinoma with buttock location at a 70 years old patient. In literature there are described about 600 observations, of which more than half located in the head and neck. Despite early diagnosis--less than five months after occurrence--a thorough exploration (ultrasonography of soft tissues, pelvi-abdominal CT, histopathological and immunohistochemical examination), correct treatment (broad surgical exeresis, local postoperative radiotherapy) and appropriate follow-up, the patient had a negative evolution. Death occurs 17 months after diagnosis by the occurrence of liver metastases, invading the hepatic hilum and hence jaundice.

TLC of some free amino acids from sanguine plasma

This research presents the results obtained from analysis by thin layer chromatography (TLC) of some free amino acids from sanguine plasma samples in the different degree progress in maladies: diabetes, renal syndrome and hepatic cirrhosis. The chromatograms were evaluated with a Shimadzu CS-9000 dual-wavelength flying-spot scanner. Better results were obtained in the case of hepatic cirrhosis.