Open Access Case Report

Myxoid Type of Malignant Fibrous Histiocytoma (myxofibrosarcoma) - A Case Report of an Unexpected Histopathology of Intermuscular Mass

Rashmiranjan Sahoo, Amitkumar Bose, . Mustkim, . Srikanth, Navya Teja

Asian Journal of Case Reports in Surgery, Page 7-13

Malignant fibrous histiocytoma is a rare and highly aggressive neoplasm believed to originate from primitive mesenchymal cells; arising from soft tissue or bone, usually in the extremities (large muscles of thigh) or retroperitoneum. It is now referred to as undifferentiated pleomorphic sarcoma (UPS). This neoplasm is the most common soft tissue sarcoma of late adult life and has a slight male predominance. The mostcommon is storiform/pleomorphic that forms 50-60% of all such tumours while myxoid type is the second most common at 25%. A 57-year-old male presented to us with a swelling over the antero-lateral aspect of upper and middle third of left thigh measuring about 20 x 15 centimeters. He was thoroughly investigated and swelling was excised in toto. Soft swelling excised and on histopathology found to be an intermuscular myxoid type of malignant fibrous histiocytoma (high grade myxofibrosarcoma). Excisions of intermuscular lesions is not an uncommon story but most are confirmed to be benign myxomas or nerve sheath cell tumor. However, the entity of malignant fibrous histiocytoma should be kept in mind. Patients will usually present late with advanced local disease or metastasis, usually to lungs and lymph nodes. Treatment is surgical with wide local excision and neoadjuvant/adjuvant radiotherapy has been advocated as well. This case report is being presented as the tumor is rare and also an important consideration in the differential diagnosis of myxomas, intermuscular lipomas, peripheral nerve sheath tumor, hemangioma, hematoma and desmoid tumor. Another important feature is that the tumor can be diagnosed with certainty only after excision with histopathological examination.

Open Access Case Report

Spontaneous Regression of Focal Nodular Hyperplasia in a Male Patient using 3D Liver Volumetric Evaluation and Surgical Planning: A Case Report

Nan-ak Wiboonkhwan, Tortrakoon Thongkan, Thakerng Pitakteerabundit

Asian Journal of Case Reports in Surgery, Page 14-19

Background: The incidence of symptomatic focal nodular hyperplasia (FNH) is 0.03%. FNH has female predominance that accounts for 90% of cases. It is a hypervascular benign liver tumor and is sometimes difficult to diagnose if there is a lack of typical findings on imaging. In the management of FNH, guidelines recommend conservative treatment rather than surgical resection.

Case report: An elderly male presented with abdominal fullness, anorexia, and weight loss with absence of jaundice and fever. The patient underwent percutaneous biopsy that was inconclusive. Subsequent imaging showed regression of tumor demonstrated by 3D liver volumetric assessment with a 92.3% decrease in tumor volume. The patient underwent extended right hepatectomy with total caudate lobectomy. The postoperative period was uneventful and the patient was discharged on postoperative day 8. Histopathological examination of the surgical specimen confirmed the diagnosis of FNH.

Conclusion: Spontaneous regression of FNH in male patients over a 3-month period is rare. The injury due to the core needle biopsy was possibly the mechanism that resulted in vascular thrombosis with subsequent regression and secondary immune reaction. To the best of our knowledge, this is the first case report using a 3D liver volumetric regression evaluation, which demonstrated its feasibility and usefulness in the planning of complex liver surgery.

Open Access Case Report

Resistant Actinomycotic Mycetoma: A Case Report

D. B. Choksi, Digant Patel, Jagrut Patel, Karimireddy Jahnavi, Jigar Patel, Rutul Shah, Vivek Yadav, Sijoy Varughese

Asian Journal of Case Reports in Surgery, Page 25-28

Introduction: Mycetoma Pedis is the most common form of Eumycetoma known widely as the Madura Foot. Favourable respnoses have been reported with drug therapy alone even in long-standing lessions with involvement of bone and lymphatics. The case report aims to present a case of Madura Foot in an adult male residing in a geographically non-prevalent region for the disease; who required amputation because of failure of resolution after medical therapy alone.

Case Presentation: A 50-year-old male presented with complaints of Swelling and Discharge from Multiple Sites over the Right Leg x 3 years.

Discussion: The disease is usually seen in field workers like farmers of tropical and sub-tropical regions and generally affects males between 20 and 40 years.

Ideally, specific therapy depends on the identification of the causative agent and determination of its drug sensitivity. Only a few cases have been reported where amputation was required after medical therapy failure.

Conclusion: Favourable respnoses have been reported with drug therapy alone even in long-standing lessions with involvement of bone and lymphatics. Exploration and drainage of sinus tracts, debridement of diseased tissue, and removal of bone cysts assist greatly in healing especially in resistant cases.

Open Access Case Study

A Case Report on Liposarcoma of Breast

Chhabra Maninder K, Dogra Reetu, Sood Neelam, Chhibber Puneet

Asian Journal of Case Reports in Surgery, Page 1-6

Background: Liposarcoma of the breast is a rare entity accounting for 0.3% of breast sarcomas which in turn are responsible for less than 1% of breast malignancies. We present this case for rarity and for its being a histological surprise.

Case Summary:  We are reporting a case of 60 years female presenting with painless, progressively increasing lump in the right breast for 4 months. Examination revealed a 6*5 cm, firm, nontender, mobile, lump with smooth surface and clear margins in the right upper outer quadrant. Ultrasonography of breasts and mammography were suggestive of BIRADS III lesion. Trucut biopsy was suggestive of fibroepithelial lesion with cellular stroma. Keeping in view the age of the patient and size of the lump, excision biopsy was done. Histopathology report revealed liposarcoma arising in the fibrocellular stroma. Completion surgery with re-excision of the margins was done in the 2nd stage. Patient was asymptomatic with no evidence of recurrence after 1.5 years of follow up.

Discussion: Most of the liposarcomas have been found to arise in malignant phyllodes tumors, as opposed to primary liposarcomas of the breast which arise de novo from fibrocellular stroma. Our case was liposarcoma of breast which was identified on histopathology after excisional biopsy and was managed well with re-excision of the margins as per NCCN guidelines.

Conclusion: Liposarcoma of breast is rare. It can present as a benign lesion clinically. Treatment is by wide local excision with tumour-free margins or re-resection of margins in case of a histological surprise.

Open Access Case Study

Encysted Hydrocele of the Cord in a Nineteen-Year-Old Male Mimicking Irreducible Inguinal Hernia: A Case Report

Friday Emeakpor Ogbetere

Asian Journal of Case Reports in Surgery, Page 20-24

Hydrocele of the spermatic cord is a rare anomaly that occurs as a result of abnormal closure of the processus vaginalis during the descent of the testis into the scrotum. It is rarely seen in adults. There are two forms of a spermatic cord hydrocele: the encysted type which does not interface with the peritoneal cavity and the funicular variety that intercommunicates with the peritoneal cavity. The encysted hydrocele can be confused clinically with a number of conditions that present as groin swellings such as inguinal hernias, inguinal lymphadenopathy, and primary tumours of the spermatic cord. Presented herein is a rare case of encysted hydrocele of the spermatic cord in a 19-year-old male who presented with a right groin swelling, which clinically mimicked an irreducible inguinal hernia. The diagnosis of encysted hydrocele was made intraoperatively. Excision of the sac was performed and the patient was discharged with no complications.