Los tumores desmoides son afecciones benignas raramente reconocidas de manera inicial por su baja incidencia. Se caracterizan por un comportamiento local agresivo y altas tasas de recurrencia. Su presentación puede ser extraabdominal o intraabdominal. Presentamos el caso de una paciente de 15 años con cuadro de dolor abdominal de 3 meses de evolución, en la que se documentó una gran masa intraabdominal con diagnóstico histológico de tumor desmoide y fue sometida a múltiples intervenciones quirúrgicas con las que se logró una resección R1 (microscópicamente positivo). Se descartó su asociación con embarazo, trauma abdominal, cirugías previas y síndromes genéticos.
IntroductionEven though the use of nerve monitoring during parotid gland surgery is not the gold standard to prevent damage to the nerve, it surely offers some advantages over the traditional approach. Different from thyroid surgery, where a series of steps in intraoperative nerve monitoring have been described in order to con rm not only the integrity but -most importantly -the function of the recurrent laryngeal nerve, in parotid gland surgery, a formal guideline to follow while dissecting the facial nerve has yet to be described.
MethodsA ve-year retrospective study was done reviewing the intraoperative records of patients who underwent parotid gland surgery under neural monitoring. The operative ndings regarding the neuromonitoring process, particularly in regard to the amplitude of two main branches, were revised. A literature search was done in order to search for guidelines to follow when a facial nerve loss of signal is encountered.
ResultsFifty-six patients were operated on using the Nim 3 Nerve Monitoring System (Medtronic, Jacksonville, FL USA); thirty-three were female patients, 46 patients had benign lesions. Minimum changes were observed in the amplitude records after a comparison was made between the rst and the last stimulation. There were only three articles discussing the term loss of signal during parotid gland surgery.
ConclusionToday, no su cient attention has been given to facial nerve monitoring process during parotidectomy.This study proposes and discusses a formal guideline to follow during this procedure in order to develop a uniform technique of facial nerve stimulation.
Parathyroid carcinoma is a rare tumor with occasional hormonal activity and symptoms of severe hypercalcemia. Diagnosis is achieved through pathology study and intraoperative findings. Surgery is often the treatment of choice. This is the case of a 61-year-old woman with a preoperative diagnosis of a 4 cm left thyroid nodule-follicular neoplasm (Bethesda category IV) treated with surgery, and with final diagnosis of parathyroid carcinoma. Surgical management and adjuvant therapy with radiotherapy were administered.
Desmoid tumors are clinical entities rarely diagnosed at an initial presentation because of its low incidence, they are characterized by a locally aggressive presentation and high rates of local relapse. Its presentation can be intra-or extra-abdominal. We present a clinical case of a female, a 15-year-old patient, with 3 months of abdominal pain, a giant intra-abdominal mass was diagnosed with histologic diagnosis of desmoid tumor. Several surgical procedures were performed, having a R1 resection (focally microscopic margins). In this case, association with pregnancy, abdominal trauma, previous surgeries, and genetic syndromes were discarded.
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