A 60-year-old man presented with abdominal pain for 3 months. Clinical examination revealed a well-defined intra-abdominal mass lesion measuring about 5 ¥ 6 cm, which was located in the left of umbilical region and extending into the left lumbar quadrant. The mass was mobile, non-tender and had firm consistency. The rest of the clinical examination and routine investigations were normal. The patient was evaluated with ultrasound of the abdomen, which showed 7 ¥ 8 ¥ 7 cm 3 hypo-echoic and solid nature mass underneath the parietal wall, with no intervening bowel coils. Contrastenhanced computed tomography scan confirmed ultrasound findings; in addition, it showed mass in close proximity to loop of small bowel and its mesentery (Fig. 1a). The patient underwent exploratory laparotomy, and intraoperative mass was seen arising from anti-mesenteric border of the ileum about 50 cm proximal to ileocaecal junction (Fig. 1b). The mass was resected en-bloc with adjacent ileum and end-to-end anastomosis was performed. Resected specimen showed (Fig. 2) that the mass is arising from diverticulum of small bowel, that is, Meckel's diverticulum. Post-operative period was uneventful. Histopathology revealed both spindle and epitheloid-shaped tumour cells with marked nuclear atypia, suggestive of malignant gastrointestinal stromal tumour (GIST). Immunohistochemistry revealed tumour cells positive for CD 117(C-KIT). The patient was followed up after two years and showed no recurrence/metastasis.Meckel's diverticulum is the most commonly encountered congenital anomaly of the small intestine, occurring in approximately 2% of the population. 1 It is located on the anti-mesenteric border of the ileum, approximately 4560 cm proximal to ileo-caecal valve and results from incomplete closure of omphalo-mesenteric duct. An equal incidence is found among men and women. Meckel's diverticulum has lining mucosa similar to that of the adjacent bowel but may contain heterotopic mucosa, the most common of which is gastric mucosa in 50%, pancreatic mucosa in 5% and may also harbour colonic mucosa. The majority of Meckel's diverticula are incidentally discovered during autopsy, laparotomy or barium studies. The most common clinical presentations of Meckel's diverticulum are gastrointestinal bleeding (from chronic ulcer in ileum adjacent to Meckel's diverticulum containing gastric mucosa), intestinal obstruction and diverticulitis. Incidence of tumours within Meckel's diverticulum is 0.53.2%, most of them are benign tumours like leiomyomata, angiomas, lipomas and villous adenomas. Malignant neoplasms include adenocarcinoma, sarcoma, carcinoid tumour, melanoma, lymphoma and GIST. 2,3 GISTs are rare neoplasms that account for 0.1-1% of gastrointestinal malignancies. Described in 1983 by Mazur and Clark, 4 GISTs arise from interstitial cells of Cajal, the pacemaker cells of the gastrointestinal tract. 5 GIST occurs in adults at a median age of 58 years and most commonly arise from stomach (60%), small intestine (30%) and less than 10% in the oesophagus, c...
Retrosternal goitre as a surgical thyroid pathology is diminishing in incidence. Though surgery is the generally accepted treatment modality, lot of uncertainties exist regarding the approach for surgery in consideration with the prognostication, surgical morbidity and the post-operative outcome. Median sternotomy, in addition to being more morbid, is generally out of the general surgeons’ perview and therefore its need necessitates preoperative arrangements for assistance by a thoracic surgeon. Cervical approach is sufficient for most of the lesions but the surgeon should be conversant with median sternotomy as to perform it expediently and without hesitation when it is indicated. The generally indications for sternotomy are extension of goitre below the aortic arch, involvement of the posterior mediastinum, large thyroid tissue extending towards tracheal bifurcation, and primary ectopic thyroid tissue in the mediastinum. Here the available literature was reviewed to identify the preoperative predictors of a sternotomy in the management of substernal goitre in order to provide better preoperative planning and patient consent in managing the patient with reference to a recently encountered case.
Testicular tumors are very common among man under the age of 45 years. The case of bilateral synchronous testicular seminoma is very rare. We present a case of bilateral synchronous testicular seminoma stage-I in a 42-year old Indian male who came to our hospital with chief complaints of dull ache in the abdomen and groin, bilateral scrotal swelling and heaviness, left-sided scrotal swelling since last four years, and right-sided since last two years. He underwent bilateral orchidectomy followed by radiotherapy. In this case we throw light on this rare condition and discuss the management.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.