Huge Bartholin’s cyst managed by primary marsupialization: A case report

BACKGROUND

We report on the case of a 21-year-old female who could not walk due to a huge Bartholin's cyst occupying the right vulvar region. The patient was treated by marsupialization of the Bartholin’s cyst and postoperative antibiotic therapy.

CASE SUMMARY

A 21-year-old female without a medical history of sexually transmitted diseases presented to our outpatient clinic with complaints of a painful vulvar lump and a green-yellowish discharge for 4 d. A large Bartholin’s cyst, 10 cm in diameter, was suspected over the right side of the vulva. She was advised to be admitted to the ward for intravenous antibiotic treatment and to perform marsupialization several days later. However, the patient requested immediate surgery because of time limitations. The patient underwent marsupialization under local anesthesia. The procedure was well-tolerated. After making the incision, a significant amount of malodorous pus (approximately 30 mL) was removed from the abscess. The patient was followed up for 1 wk postoperatively. The Bartholin’s cyst regressed, and the surgical wound healed well.

CONCLUSION

Our case shows that an initial marsupialization followed by oral antibiotic therapy can be an appropriate treatment option for a large Bartholin’s cyst. However, depending on the patient’s condition, a suitable treatment, either cystectomy or marsupialization, can be considered.

Huge Long Standing Staghorn Rhinolith in a Young Adult

Rhinolith is an uncommon condition that usually happens due to mineralisation of calcium and magnesium salts over a retained foreign body inside the nasal cavity for long period of time. Here we report one such case of a 33-year-old lady who presented to us with long standing intermittent epistaxis and on examination rhinolith was discovered.

Giant Colloid Cyst

Giant colloid cysts are defined as cysts of more than 3 cm in maximal diameter. Few cases of giant colloid cysts have been reported in the literature. We herein describe a giant colloid cyst. A 15-year-old female presented with headache, blurred vision, and episodic behavioral changes for three months. Neurological examination was limited due to agitation and confusion. Fundoscopy was notable for bilateral papilledema. Brain CT revealed a giant third-ventricular lesion, causing obstructive hydrocephalus. The patient underwent urgent ventriculoperitoneal shunt insertion initially and then cyst excision. The histopathological sections of the lesion were compatible with a colloid cyst. Five years following surgical resection, a brain MRI did not demonstrate any evidence of residual or cyst recurrence. To our knowledge, giant colloid cysts have been rarely reported and pose a management dilemma in the literature. The present article highlights the symptomatology, radiological findings, and outcome of a giant colloid cyst.

An asymptomatic huge primary retroperitoneal pseudocyst: a case report and review of the literature

Background

Retroperitoneal non-pancreatic or idiopathic pseudocysts are very rare lesions. This case report aimed to present our patient and to check all the available literature on this kind of rare disease.

Case presentation

Our patient was a 67-year-old Iranian man admitted with mild abdominal discomfort for three months. Ultrasonography and CT scan revealed a huge cystic structure within the retroperitoneal space. The lesion was excised through midline laparotomy and opening of the retro-peritoneum. The histopathology of the cyst wall revealed a benign cystic lesion with no epithelial lining. A histologic diagnosis of non-neoplastic retroperitoneal pseudocyst was made.

Conclusion

The primary non-pancreatic retroperitoneal pseudocysts are rare lesions and have to be distinguished from other differential diagnoses of retroperitoneal lesions, and a surgeon should be aware of the possible occurrence of these lesions with unknown origin. Surgical excision is the only way to exclude malignancy and confirm the diagnosis.

Huge intraligamental leiomyoma: Two cases and review of the literature

Intraligamental leiomyomas are usually small and asymptomatic. On very rare occasions, it can become so enlarged as to occupy the whole abdominopelvic cavity. Here, we report the clinical presentations and peri-operative management of two cases with massive intraligamental leiomyoma which weighed 11.1 kg and 3.7 kg respectively. Both of the cases presented with indolent symptoms lasting for months. One patient underwent hysterectomy, whereas the other underwent myomectomy. The postoperative courses were uneventful. Huge intraligamental leiomyomas are challenges even for experienced surgeons and thus need careful attention. The operation for every patient should be individualized to avoid the risk of injury to adjacent organs and incur massive blood loss.

Laparoscopic liver resection for huge (≥10 cm) hepatocellular carcinoma: A coarsened exact-matched single-surgeon study

INTRODUCTION

Laparoscopic liver resection (LLR) is increasingly being utilised worldwide for the management of both benign and malignant liver tumours. However, there is limited data to date regarding the safety and feasibility of this approach for huge (≥10 cm) hepatocellular carcinomas (HCCs). We present here our early experience performing LLR for huge HCCs.

METHODS

We conducted a retrospective review of 280 consecutive patients who underwent LLR by a single surgeon from 2012 to August 2020.15 patients had a preoperative radiological diagnosis of huge (≥10 cm) HCC. Coarsened exact-matched (CEM) weighting was used to compare them to 101 patients who underwent LLR for non-huge HCC.

RESULTS

After CEM-weighting, both groups were well-balanced for baseline variables. There was no difference in the rates of open conversion. The huge HCC patients had a higher mean Iwate difficulty score than the non-huge HCC patients (9.13 vs 6.53, p = 0.007). As such, the median operating time for the huge HCC group was longer (360 min vs 240min, p = 0.049). However, there were no significant differences in estimated blood loss, proportion of patients requiring blood transfusion, utilization of Pringle maneuver or median Pringle duration. Post-operatively, there were no significant differences in median LOS, overall and major morbidity rates, and 90-day mortality rates between both groups. Median resection margins were also similar for both cohorts.

CONCLUSION

LLR may be performed successfully for selected patients with huge HCC, with encouraging perioperative outcomes and no compromise in oncologic efficacy.

Combined Transarterial Chemoembolization and External Beam Radiotherapy in a Patient with Recurrent Huge Hepatocellular Carcinoma after Hepatic Resection

The optimal treatment strategy for unresectable huge hepatocellular carcinoma (HCC) is yet to be established. Non-surgical monotherapy demonstrated insufficient oncologic outcomes in previously reported studies. To improve the clinical outcomes of unresectable huge HCC, combined locoregional treatments can be considered in selected cases. Here, we report a case of 58-year-old male patient who was treated with combined transarterial chemoembolization (TACE) and external beam radiotherapy for recurrent HCC after a previous hepatic resection. After combined TACE and radiotherapy for the intrahepatic lesion, two metastases were diagnosed in the pelvic bones and lung; each lesion was successfully treated with salvage radiotherapy. During the long-term follow-up period (around 8 years 7 months after combined TACE and radiotherapy for the recurrent huge HCC), no definite viable tumors were observed in any of the treated liver, bone, and lung lesions.

Prognostic Factors and Survival Outcomes of Surgical Resection of Huge Hepatocellular Carcinomas

INTRODUCTION

The aim of the study was to analyze the various prognostic factors that influence survival and clinical outcomes in patients undergoing liver resection for huge hepatocellular carcinomas.

MATERIALS AND METHODS

The records of patients who underwent curative surgery between 1991 and 2011 for huge hepatocellular carcinoma were analyzed. Various prognostic factors that influenced the survival were studied. The patients were followed up till November 2016.

RESULTS

The number of patients who underwent liver resection with huge hepatocellular carcinoma during the study period was 17; this included 14 males and 3 females. The median age of the study population was 52 years. The median serum AFP in the study population was 132.3 ng/ml (range 2 to 187,000 ng/ml). 41.2% of the patients were hepatitis B positive. The overall morbidity was 6%. The mortality rate was nil. The mean size of the resected specimen was 13.9 cm ± 3.6 cm. The overall recurrence rate was 76.5%. The local recurrence rate was 29.4%. The median time to recurrence was 8 months. The 5-year disease-free survival and overall survival of the study group were 26% and 32%, respectively. The factors that predicted an adverse survival outcome after the log-rank test for univariate analysis using life-table method were presence of lymphovascular invasion (p = 0.047), age ≤ 55 years (p = 0.021), and raised serum AFP (p = 0.041).

CONCLUSION

The factors that predict an adverse outcome after surgery in patients with huge hepatocellular carcinomas were the presence of lymphovascular invasion, raised serum AFP, and age ≤ 55 years.

Huge bilateral temporal horn entrapment: a congenital abnormality and management

BACKGROUND

Temporal horn entrapment is a rare disorder subsequent to obstruction around the trigone of the lateral ventricle caused by inflammations, tumors, infections, or after surgical processes. Most reports are unilateral and acquired but congenital ones have not been reported yet.

METHODS

Here we report the first congenital case of huge bilateral temporal horn entrapment. A six-month-old boy was admitted to our service with progressive intracranial hypertension who was managed with bilateral ventricular catheters and Y tube connected to one peritoneal catheter.

Stormy Course of a Huge Submitral Aneurysm Causing Low Cardiac Output State

Submitral aneurysm is a rare structural abnormality of congenital or acquired aetiology. Most reported cases are from Africa. Unless promptly treated surgically this condition is invariably fatal. We report a case of a young Indian male who presented with dyspnea of recent onset, diagnosed to have a massive submitral aneurysm causing low cardiac output and compression of cardiac structures.

Radiofrequency ablation for huge hepatic hemangiomas: How far from being the first-line treatment

Huge hepatic hemangiomas (≥ 10 cm) are often growthful and harmful. Surgical resection is the traditional treatment for this disease, however, this treatment modality is rather invasive and the operative morbidity and mortality are relatively high. To avoid surgical risk, many minimally invasive procedures have been developed to treat hepatic hemangiomas. In the recent decade, radiofrequency ablation (RFA) has been performed successfully in patients with huge hepatic hemangiomas, showing many advantages over resection, including minimal invasiveness, low complication rate, reduced cost, short hospital stay and increased patient compliance. The treatment strategy for huge hepatic hemangioma is changing from the traditional surgical resection to the minimally invasive treatment with RFA. In the current review, we discuss the present situation and prospect of RFA application in the treatment of huge hepatic hemangiomas.

Anesthetic concerns in a huge congenital sublingual swelling obscuring airway access

Presence of intraoral pathology poses a great challenge during management of pediatric airway. We report management of big intraoral cystic swelling physically occupying the entire oral cavity restricting access to airway. Preintubation aspiration of swelling was done to decrease its size and make room for airway manipulation, followed by laryngoscopy and intubation in lateral position. Airway patency is at risk in postoperative period also, in this case, though the swelling decreased in size postoperatively but presence of significant edema required placement of tongue stitch and modified nasopharyngeal airway. Case report highlights simple maneuvers to manage a difficult case.

A huge primary ovarian leiomyoma with degenerative changes-an unusual

Primary ovarian leiomyoma is a rare benign tumour of the ovary, which is seen in women who are aged between 20 years to 65 years. Ovarian leiomyomas can be confused with other spindle cell tumours which display gross anatomical and histological similarities. A case of a primary leiomyoma of the ovary in a pre-menopausal female is being presented here, due to its huge size and unusual presentation.

Huge ossifying fibroma of the maxilla

Ossifying fibroma of bone is a central neoplasm of bone. It is more common in young adult with marked predilection for mandible. It is more common in females. Lesion is generally asymptomatic until growth produces a noticeable swelling and deformity. It presents an extremely variable roentographic appearance depending upon stage of development. This lesion is composed basically of many delicate interlacing collagen fibres, seldom arranged in discrete bundle, interspersed by large numbers of active, proliferating fibroblasts. The lesion should be excised conservatively. We present a case of huge ossifying fibroma arising from maxilla.