High-grade dysplasia of the cystic duct margin: how should this be managed?

High-grade dysplasia (HGD) in the cystic duct is a rare epithelial lesion that may lead to biliary tract malignancy. Due to its association with aggressive multifocal cholangiocarcinoma, it is important to investigate for concurrent malignancy, remove all areas of HGD and monitor for recurrence or metastasis.We present a case of a woman in her 60s with cholecystitis who underwent a laparoscopic cholecystectomy. On histopathology, the patient was found to have incidental HGD involving the cystic duct margin. After ensuring the absence of concurrent malignancy on cross-sectional imaging, she underwent further resection until the margins were clear of dysplasia. In the absence of clear follow-up guidelines, the patient was closely monitored with outpatient scans for up to 5 years.

Brunner's gland adenoma: a robotic approach

This report describes an unusual case of a symptomatic Brunner's gland adenoma arising in a man in his 40s that underwent robotic transduodenal resection. Initial investigations revealed a polypoidal, submucosal lesion that was found in the first part of the duodenum. Microscopically, there was neither dysplasia nor evidence of adenocarcinoma, suggesting differentials of gastrointestinal stroma tumour and duodenal adenoma. Given the size of the lesion, he underwent a surgical resection. Symptomatic Brunner's gland adenoma is uncommon and should be considered as a differential diagnosis in patients presenting with obstructive symptoms.

A rare case of inflammatory breast cancer with delayed auto-amputation in modern times

Inflammatory breast cancer (IBC) is a rare but aggressive form of breast cancer, accounting for 0.5–2% of all diagnoses of invasive breast cancers. Yet, it is associated with very poor prognosis and outcomes, with documented 2- and 5-year survival rates around 84% and 40%, respectively, as compared to 90.6% of all breast cancers. Breast auto-amputation is also a rare complication of locally advanced breast cancer, associated with distressing symptoms for these patients. In this study, we report a 67-year-old female with a delayed diagnosis of IBC with a rare sequela of auto-amputation of the affected breast. The delay in diagnosis of >6 months led to a delay in the necessary treatment. She received neoadjuvant chemoradiotherapy and underwent a palliative right salvage mastectomy with level 2 axillary dissection.

Synchronous contralateral axillary lymph node metastasis in a recurrent breast cancer following previous axillary clearance

Ipsilateral axillary lymph node metastasis is common, while contralateral axillary lymph node metastasis (CAM) is uncommon. This report is of a patient that presented with a recurrence of left breast cancer and synchronous CAM, with a distant history of left breast conserving surgery and axillary dissection for invasive carcinoma. The CAM was confirmed following a non-routine lymphoscintigraphy and sentinel lymph node biopsy. This highlights the possibility of CAM representing as locoregional disease rather than advanced stage IV disease.

OUP accepted manuscript

Dropped or retained appendicoliths are uncommon complication of laparoscopic appendicectomies, and rarely they have been reported to cause complications such as pelvic abscesses or enterocutaneous fistulas. We reported on a rare presentation of a pelvic abscess masquerading as urachal malignancy in a 41-year-old male, 2 years after his laparoscopic appendicectomy. As urachal malignancy could not be unequivocally excluded on imaging findings alone, en bloc resection of this mass and partial cystectomy were performed. Histopathology study revealed pelvic abscess with no evidence of malignancy and a central calcification which corresponded to a faecolith identified on pre-appendicectomy imaging. We contributed this rare presentation to the limited existing literature about complications of retained appendicoliths. As laparoscopic appendicectomies are performed commonly as the standard of care of appendicitis, care should be taken to extract appendicoliths completely to prevent complications.

Hepatic small vessel neoplasm - A systematic review

Background

Hepatic small vessel neoplasm (HSVN) is a recently described vascular neoplasm of the liver that can mimic hepatic angiosarcoma (AS) because of its infiltrative nature but is considered biologically less aggressive. We carried out a systematic review of the literature after previously coming across a case of HSVN [1] to guide our surveillance.

Methods

We conducted a systematic review for all cases using PubMed, EMBASE, Cochrane Central Register of Controlled Trials, case report journals and Google Scholar according to the PRISMA guidelines using the terms “hepatic small vessel neoplasm” or “hepatic small vessel neoplasia” with no language restrictions. The review was registered with Research Registry (UIN: reviewregistry1127) [2].

Results

We identified 69 articles, of which 6 articles were eligible after screening. A total of 23 cases were identified. Median age was 58 (range 24–83 years) with a male preponderance (17 M:6F). Mean tumour size was 2.8 cm (range 0.2–15.9 cm). Mean follow-up was 7 months (range 1–24 months) with no reported evidence of recurrence in both patient groups with no residual disease or with positive margins after resection.

Discussion

HSVN appears to demonstrate a benign clinical course with no reported recurrences or metastatic disease. Long-term follow-up data will further supplement our understanding of these tumours and guide future management.

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HSVN is a recently described neoplasm with uncertain long-term malignant potential.

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23 cases have been identified, mean follow-up was 7 months (range 1–24 months).

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There is no reported evidence of recurrence in patients with no residual disease.

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There is no reported evidence of recurrence in patients with residual disease.

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Follow-up is limited in reported cases.

Hepatic small vessel neoplasm case report: A surveillance conundrum

INTRODUCTION

Hepatic small vessel neoplasm (HSVN) is a recently described vascular neoplasm of the liver that can mimic hepatic angiosarcoma (AS) because of its infiltrative nature but is considered benign or, at most, low-grade. HSVN appears to demonstrate a benign clinical course with no reported recurrences or metastatic disease, although its long-term malignant potential is uncertain.

CASE PRESENTATION

We present a 57-year-old man with an incidentally growing segment VII lesion that displayed features concerning for a neoplasm. He underwent a posterior sectionectomy and final histopathology confirmed a 27 mm HSVN. As the long-term malignant potential of HSVN is uncertain, he will be followed up with serial MRI scans over the next 5 years.

DISCUSSION

HSVN is a recently described entity, it is uncertain what the long-term malignant potential of HSVN can be. Reported cases have not shown any evidence of disease progression.

CONCLUSION

There are no clear guidelines established on the duration of the follow-up of HSVN. More research needs to be done to determine further the natural history of these tumours and possible radiological criteria.

The reassuring CT scan with a lethal diagnosis

We discuss an interesting case of a patient who presented with symptoms of abdominal and worsening chronic back pain with a known history of abdominal aortic aneurysm.

The Duari hernia and recognition of the femoral vein compression sign

Femoral hernias can be difficult to diagnose and are at high risk of strangulation. This report is of a rare case of an irreducible femoral hernia containing caecum and appendix presenting as an emergency. To the authors' knowledge, there have only been three cases reported, the first described by Duari. This case was incorrectly diagnosed preoperatively as an inguinal hernia, so the CT diagnosis of femoral hernias is reviewed, in particular demonstrating the radiological use of the femoral vein compression sign.

Thromboembolism in active ulcerative colitis

Inflammatory bowel disease (IBD) has a range of both intestinal and extraintestinal manifestations. Thromboembolism involving the arterial and/or venous systems is rare. Early recognition and treatment of thrombosis in patients with IBD may prevent progression and minimise complications. However, clear guidelines on the duration of treatment and indications for primary prophylaxis need to be established. We report a case of a young patient with ulcerative colitis, who developed multiple site arterial and venous thrombosis, all occurring within short intervals of each other.