IntroductionBreast cancers, particularly those that are locally advanced, may rarely present with acute severe bleeding. They usually appear in the form of fungating and/or ulcerating tumors. This condition can be difficult to manage through a surgical procedure. Interventional radiology has gained an increased role in coping with this problem. The most frequently used method to achieve safe and efficacious hemostasis is transcatheter arterial embolization (TAE). This method was also reported to ensure a reduction in tumor size. Case PresentationA woman aged 47 years who had recently undergone a toilet mastectomy plus axillary dissection for locally-advanced breast cancer, presented with sudden severe bleeding from a loco-regionally recurrent tumor that had developed rapidly. She had been diagnosed as having locally-advanced left breast cancer with axillary metastasis at the age of 46 years, which was histopathologically determined as a triplenegative breast cancer. The tumor had remained unresponsive to the neoadjuvant of chemotherapy (NACT), therefore she underwent toilet mastectomy plus axillary dissection to prevent further complications. However, in the very early postoperative period, a locoregional recurrent tumor began to develop on the chest wall and in the axillary region. Recurrent masses, especially the ones in the axilla, tended to ulcerate over the course of time. Owing to ulceration, radiotherapy (RT) was not considered as an option in the treatment. Finally, approximately three months after the operation, the patient presented with sudden severe bleeding from the recurrent breast tumor. She was admitted to our general surgery clinic for treatment of this acute bleeding. On physical examination, the patient was alert, conscious, and cooperative. She had moderate pallor. Her initial blood pressure was 100/60 mmHg, and heart rate of 90 bpm. Inspection of the chest wall showed that there was a very large loco-regionally recurrent breast tumor on the left side along the incision line; the bleeding originated from the deep part of the left axilla where many large ulcerated recurrent tumors were located. She also had an apparent upper limb edema. The results of the lab tests on admission showed a low hemoglobin level of 6 mg/dL and hematocrit of 20.9%. The platelet count was found 241 x 10 3 /microliter. INR and aPTT were within normal ranges. First, a temporary control of bleeding was performed by dressing the wound with sterile gauze pads and compressing them with an elastic bandage around the chest wall. Soon after, an intravenous access was established and replacement of isotonic fluid was initiated. Three units of red cell suspension were transfused consecutively as quickly as possible. Following these resuscitative measures, her vital signs improved with a blood pressure of 120/90 mmHg, and heart rate of 76 bpm. Hemoglobin and hematocrit increased to 11.1 mg/dL and 33.7%, respectively.An interventional radiologist's opinion was requested to aid in providing safer hemostasis and the patient was tra...
Results: A total of 42 patients aged 17-81 years (mean age 46.9 years) were enrolled in the study. The most common symptom was abdominal pain, which was seen in 31 (73.8%) patients. gastroenteropancreatic neuroendocrine tumors were detected in the stomach (n=5, 35.7%), appendix (n=11, 26.2%), rectum (n=6, 14.3%), pancreas (n=4, 9.5%), ileum and colon (n=2, 4.8%), and duodenum and jejunum (n=1, 2.4%). Local excision was performed in seven (16.7%) patients. Nine (21.4%) patients underwent gastric wedge resections, either by a laparoscopic procedure (n=3) or by open surgery (n=6). Total gastrectomy and laparoscopic subtotal gastrectomy were performed on three (7.1%) patients and two patients (4.8%), respectively. After the surgical procedures, the patients were followed up for a mean period of 36 months (15-57 months); the one-year and three-year survival rates were determined to be 100% and 97.6%, respectively. Conclusion:Management of gastroenteropancreatic neuroendocrine tumors requires accumulation of knowledge and experience to establish a standardized approach. Therefore, we believe that collecting regular national data from these cases in every country will contribute to understanding the details of this entity worldwide.Keywords: Chromogranin A, endoscopy, gastroenteropancreatic neuroendocrine tumor, ki-67 antigen, mitosis, synaptophysin ABSTRACT Turk
Introduction: Hydatid disease is a parasitic infestation caused by tapeworms of the genus Echinococcus. It may be located anywhere in the human body. The most common organs involved are the liver (52-72%) and the lungs (10-40%). Hydatid disease can rarely develop in muscular structures, accounting for 1-5% of all cases.Case Presentation: In this study, we report the case of a 53-year-old male patient who presented with a swelling on his left lumbar region and was diagnosed with hydatid disease within the quadratus lumborum muscle. Conclusion:If any patient living in endemic countries as Turkey presents with a swelling in soft tissues and if he or she should be undergone investigations such as biopsy or cyst aspiration, then it will be mandatory to make a cautious physical examination and accurate imaging studies by keeping in mind the hydatid disease as a probable diagnosis.
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