The abdominal wall is a very rare site for endometrial cancer metastases. Its appearance generally indicates advanced cancer with poor prognosis. We report a case of a 55-year-old female who presented with an incisional hernia 4 years after abdominal panhysterectomy for endometrioid adenocarcinoma in 2009. Open hernia mesh repair was performed but on follow-up, she complained of pain and a swelling at the repair site. This was radiologically diagnosed as fibromatosis, but tru-cut biopsy confirmed presence of fibromatosis as well as a metastatic endometrial carcinoma. She was started on neoadjuvant chemotherapy, but had poor response, and therefore, radical excision was performed. She remained well with no metastatic recurrence at 12-month follow-up. This case illustrates late appearance of abdominal wall metastasis from abdomino-pelvic malignancies and highlights the need to exclude the presence of recurrence or metastases prior to surgical repair of incisional hernia occurring after the resection of abdominal or pelvic malignancy.
Coronary artery disease (CAD) is one of the most common public health problems worldwide. The overall prevalence of coronary artery disease in Saudi Arabia is 5.5%. 1 Coronary artery bypass graft surgery has gained momentum over the last years effectively treating CAD. Either arteries or veins can be used as conduits for coronary artery bypass graft (CABG) surgery. There are many sites that the conduit can be harvested from, including saphenous vein, left or right internal thoracic artery, radial artery, inferior epigastric artery, right gastroepiploic artery, and splenic artery. 2 The internal thoracic artery, also called internal mammary artery (IMA) graft, is currently the gold standard for myocardial revascularization. It offers long-term patency and provides a long conduit which resists atherosclerosis postimplantation. 3 Internal mammary artery grafts are not detached fully from their original site. IMA graft remains connected to its natural site of origin, and only one end is detached from the chest wall. This end is reattached to the coronary artery intended for the bypass Figure 1(A). 4 IMA gives out multiple vessels at the chest wall that supply the breast, sternum, mediastinum, and thymus. Although the breast is also supplied by the lateral mammary artery and the posterior intercostal branches of the Aorta, Figure 1(B), the IMA compromises the major source of breast vascularization (almost 60%) through the anterior intercostal perforators. 5,6 The harvesting of IMA in CABG procedure is associated with many complications. They are mostly wound related, ranging from skin dehiscence to complete avascular necrosis of the sternum. 7 Ipsilateral breast necrosis following CABG surgery is a rare incident due to the abundant vascularity of the breast and has been sporadically reported in the literature. However, contralateral breast necrosis after CABG procedure had not been reported in the literature up to date.Breast fat necrosis can result from different surgical, pathological, and traumatic causes. It usually presents as a breast lump which can imitate breast cancer. This is especially concerning in elderly patients where a higher probability of both breast cancer and CAD co-exist. The main clinical features of fat necrosis are hard palpable masses with irregular borders. In some cases, they can be tender and associated with skin tethering, bruising,
Spontaneous pneumothorax secondary to sunitinib, a vascular endothelial growth factor receptor (VEGFR) inhibitor, is an extremely rare side effect of this class of medications. In this report, we present the case of a patient with metastatic renal cell carcinoma (RCC) who developed bilateral pneumothoraces after starting on sunitinib. This case report recognizes pneumothorax as a life-threatening side effect of sunitinib.
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