A 71-year-old woman was referred with abdominal pain and weight loss. An abdominal CT showed a 5-cm heterogeneous mass in the head of the pancreas with involvement of the superior mesenteric vein and artery. Her carcinoembryonic antigen (CEA) and CA 19-9 were normal. Two endoscopic ultrasound/fine needle aspirates (EUS/FNAs) of the mass diagnosed her with a mesenchymal tumour of myogenic origin but did not show features of malignancy. Frozen section analysis of laparoscopic core biopsies also failed to show malignant features, hence requiring an open biopsy which confirmed the diagnosis of pancreatic leiomyosarcoma (PLMS). She was eventually treated with radiotherapy. To our knowledge this is the only case in recent English literature of inoperable locally advanced PLMS that has required an open biopsy to formalise the diagnosis despite prior EUS FNAs. We include a review of the literature, highlighting the deficiencies of various biopsy techniques.
A 51-year-old woman presented to our facility with an open wound in the left breast. This was associated with a hard, non-mobile, tender lesion palpable underneath. The wound contained central necrosis with surrounding purulent discharge and accompanying erythema. Following radical debridement of the breast down to the pectoralis fascia the patient had a vacuum-assisted closure (VAC) device dressing applied. Histological examination was consistent with necrotizing fasciitis of the breast.
A 52-year-old man presented to the emergency department a few hours post gastroscopy with biopsies of the second part of the duodenum (D2) and colonoscopy with severe acute abdominal pain. On examination he had peri-umbilical tenderness. Subsequent laboratory and biochemical investigations revealed acute pancreatitis. The patient went on to develop complications of acute pancreatitis including bilateral pleural effusions and ascites. He was managed conservatively and was discharged home on day 16 of admission with a plan for elective laparoscopic cholecystectomy in the future.
Traumatic haemorrhage of the thyroid is an uncommon injury, especially in patients without pre-existing thyroid disease. Goitrous glands have an increased risk of haemorrhage following trauma due to their increased size and vascularity. Traditionally, traumatic thyroid haematomas were indiscriminately managed with neck exploration. Over time, the role of the close observation in the management of these injuries was explored, and it became common for patients with traumatic haematomas in otherwise normal thyroid glands to be managed non-operatively if no signs of ongoing bleeding or airway compromise manifested. However, patients with known goitrous glands continued to undergo neck exploration and resection of the affected gland. Herein we discuss the case of a traumatic thyroid haematoma managed non-operatively in a patient with a goitrous gland and discuss its implications for the management of similar future cases.
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