HighlightsThis is a rare diagnosis, and the differential diagnosis often includes more common causes of inguinal masses.In this document, we aimed to present the rare case of a Nuck canal cyst.

BACKGROUND AND OBJECTIVESThe incidence of primary extrahepatic cystic echinococcosis (CE) is rare. Generally, radiological and serological findings can help establish the diagnosis of hepatic and pulmonary CE, but a CE in an unusual location with atypical radiological findings may complicate the differential diagnosis. The objective of this study is to present the characteristics of cases with extrahepatic CE in respect of sites of involvement, clinical presentations, radiological findings, serological diagnostic evaluations, and outcomes of infected patients.DESIGN AND SETTINGSA retrospective analysis of surgically treated CE was conducted between January 1993 and January 2014 in the General Surgery, Pediatric Surgery, Urology, Cardiovascular Surgery, Neurosurgery, and Orthopedics departments of University of Cukurova, Faculty of Medicine, Balcalı Hospital.PATIENTS AND METHODSAmong the 661 patients managed for CE, 134 had unusual sites of involvement. Radiological and serological examinations were used to differentiate CE from alveolar echinococcosis.RESULTSOf 134 cases with unusual sites of involvement, 32 cases had liver CE (23.9%), 7 cases had lung CE (5.2%), and 2 cases had concomitant liver and lung CE (1.5%). In 93 (69.4%) cases, unusual organ involvement was isolated without any liver or lung involvement. The mean age was 45 years. Abdominal pain was the main symptom and was found in 104 patients. Thirty-one (23.1%) of 134 extrahepatic CE cases were evaluated as negative with indirect hemagglutination (IHA). However, positive results were obtained in 54 cases evaluated with Echinococcus granulosus IgG Western blot (WB), including 10 IHA-negative cases.CONCLUSIONCE with unusual localizations may cause serious problems of diagnostic confusion. The combination of clinical history, radiological findings, and serological test results (especially the WB) are valuable in diagnosing extrahepatic CE.

In some patients of Fournier gangrene originated from perianal region, it is important to prevent fecal contamination in order to provide healing without wound infection. For this purposes, diverting colostomy or bowel management catheter methods were performed. In this study, it is aimed to carry out a comparison of prognosis and cost efficiency between diverting colostomy and bowel management catheter methods applied for preventing fecal contamination in Fournier's gangrene patients. Fourty-eight patients with diagnosis of Fournier's gangrene, serious perianal infections, and preserved sphincters and without rectum injury after debridement were included in the study. The cases were divided into two groups as patients who were subjected to colostomy for fecal diversion and who were subjected to bowel management catheter without colostomy. Then, the groups were compared in terms of age, predisposing factors, duration of hospital stay, mortality, additional surgery requirements, and cost. Fourty-eight patients were included the study. Sixteen patients were treated without colostomy. Decreased duration of total hospital stay, additional surgery requirements, and hospital expense in bowel management catheter group has determined. It is thought that preferring bowel management catheter method instead of colostomy in patients without rectum injury, who require diverting colostomy and have undamaged anal sphincters, can relieve patients, patients' relatives, healthcare organizations, and the national economy of a serious burden. In addition, although patients' satisfaction and workforce loss factors are not taken into consideration in this study, the bowel management catheter method is thought to have positive effects also on these parameters.

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Xanthogranulomatous cholecystitis (XGC) was first described as benign and pseudotumor of the gallbladder in 1970 by Christensen and Ishak [1]. It was in 1981 when it was first described as a distinct pathological condition by Goodman and Ishak [2]. Xanthogranulomatosis is an idiopathic, rare process in which lipid-laden histiocytes are deposited at various locations in the body. Xanthogranulomatous inflammation occurs in various organs such as skin, kidney, retroperitoneum, intracranium, gastrointestinal tract, genital organs, and gallbladder [3,4]. XGC is an unusual form of chronic cholecystitis that may simulate malignancy radiologically and pathologically [5]. Many studies have been performed investigating whether there are imaging findings that might permit differentiation of XGC from cancer, such as diffuse gallbladder wall thickening, intramural "nodules" related to macrophage deposition, an intact gallbladder mucosa, and calculi [5,6]. The clinical picture can take the form of acute or chronic cholecystitis and may manifest with different symptoms

Background/Aims: We sought to investigate the roles of maximum standardized uptake value (SUV max ) and serum carbohydrate antigen in predicting the histopathological features of periampullary tumors. Materials and Methods: Thirty-four patients with histologically confirmed periampullary tumors were classified into two groups, according to the localizations of their tumors (ampulla Vateri or pancreas). SUV max was obtained from [(18)F]-fluorodeoxyglucose positron emission tomography computed tomography (18F-FDG PET/CT). SUV max and CA 19-9 levels were measured and compared with histopathological features of the tumors. Logistic regression was used to assess the significance and independence of predictive factors. Results: 18F-FDG PET/CT SUV max (<2.5 vs. ≥2.5; p=0.031) and CA 19-9 level (normal vs. elevated; p=0.045) were significantly and independently predictive of the histopathological origin of the tumors (ampulla Vateri vs. pancreas). The ratio of CA 19-9 levels and SUV max were found to be higher in cases of poorly differentiated tumors and tumors greater than 2 cm in diameter. Conclusion: A surgical approach to treatment may be considered for patients who have both i) an established or suspected diagnosis of periampullary tumors and ii) low SUV max and CA 19-9 levels.

Background Periductal mastitis (PM) is a rare disease characterized by chronic inflammation of the terminal mammary ducts. Complete removal of terminal lactiferous ducts with Hadfield procedure is a previously defined technique in treatment but carries various complications risks. This study aims to evaluate the effectiveness of modified techniques in the treatment of PM. Methods Twenty women who underwent surgery due to PM between January 2012 and December 2019 were retrospectively analyzed. Types of PM were determined. All patients were operated on with three different incisions [Hadfield’s operation with periareolar incision (n:11), periareolar combined radial incision (n:7), and round block incision (n:2)]. Results The mean age was 37.5 ± 6.5 years (range: 24–49). Sixty percent of patients had type 3 PM. In Hadfield’s procedure, NAC retraction (n:2), seroma (n:1), and hematoma (n:1) were seen. In the periareolar incision combined radial incision group only one patient had complications (seroma) and none in the round block method. Follow-up was 12 ± 1.5 months and disease relapse occurred in two patients in the Hadfield group. Patients who underwent round block were more satisfied with the appearance of the nipple. Conclusions In the treatment of PM, the main principle of surgical treatment is the excision of the affected canal with a clear margin. Apart from the classical Hadfield procedure, the round block method and periareolar combined radial incision techniques can be performed in the treatment of PM.