A 32-year-old woman was referred to our institution for a pelvic mass. She was asymptomatic and was found to have a mass on rectal examination. Magnetic resonance showed a large solid-cystic mass and the patient underwent complete surgical excision with pathologic findings suggesting retrorectal cyst-hamartoma. Tailgut cysts (or retrorectal cystic hamartomas) are rare congenital lesions settled in the retrorectal (presacral) space. They are made up of cysts lined by multiple types of epithelium, often predominantly mucin-secreting. The lesion requires complete surgical excision to prevent complications of recurrence, infection or carcinomatous degeneration.
Os autores relatam um caso de rabdomiossarcoma primário de diafragma, uma apresentação extremamente rara, com apenas 14 casos descritos na literatura mundial. D.K., masculino, 18 anos, apresentou 2 episódios de pneumotórax espontâneo. Tomografia computadorizada e ressonância magnética evidenciaram massa em superfície diafragmática direita; após biópsia o diagnóstico foi compatível com rabdomiossarcoma embrionário tipo fusocelular, sendo realizada pleuropneumonectomia direita devido à presença de implante tumoral em pleura visceral. Ele recebeu quimioterapia adjuvante e se encontra livre de doença 15 meses após a cirurgia. Os rabdomiossarcomas podem ser divididos em quatro grupos cirúrgico-patológicos, baseados nos critérios do Intergroup Rhabdomyosarcoma Study Group (IRSG) que levam em consideração a extensão da doença e a decisão cirúrgica; no grupo I (como no caso aqui relatado) os pacientes possuem doença localizada completamente ressecada, apresentando o melhor prognóstico. O rabdomiossarcoma é um tumor raro, podendo ter bom prognóstico quando totalmente ressecado.
The authors report a case of primary rhabdomyosarcoma of the diaphragm, an extremely rare presentation with only 14 cases reported in the literature. An 18-year-old male presented 2 spontaneous occurrences of pneumothorax. Computed tomography and magnetic resonance showed a tumoral mass on the right diaphragmatic surface, and after biopsy, the diagnosis was compatible with spindle cell rhabdomyosarcoma. Because the visceral pleura was invaded by the tumoral mass, a right pleuropneumonectomy was performed. The patient received adjuvant chemotherapy, and there was no evidence of disease 15 months after the operation. Based on the Intergroup Rhabdomyosarcoma Study Group (IRSG) criteria, which consider the extent of the disease and its surgical resectability, rhabdomyosarcomas can be classified into 4 groups. In clinical group I, which was the classification of our patient, the tumor is localized and completely resectable, which implies a good prognosis. Rhabdomyosarcoma is a rare tumor, and a good outcome may result if it is completely resected.
Teratoma intrapulmonar é uma doença rara com cerca de 43 casos descritos na literatura internacional. Descreve-se o caso de um homem de 28 anos com queixa de febre, tosse e hemoptise havia quatro meses. A radiografia de tórax e tomografia computadorizada evidenciaram opacificação de lobo superior esquerdo e a broncoscopia mostrou presença de pêlos nesta localização. Foi realizada lobectomia superior esquerda e o anatomopatológico foi compatível com teratoma cístico pulmonar maduro. O paciente evoluiu bem com o tratamento cirúrgico.
Lung teratoma is a rare disease to date. About 43 cases have been described in the literature. We report on a 28-year-old man who presented fever, cough and hemoptysis for four months. Chest X-ray and computerized tomography showed opacification of the left upper lobe and bronchoscopy revealed the presence of hair at the site. The patient's condition improved with surgical treatment.
The authors present two cases of unsuspected carcinoma of the gallbladder after laparoscopic cholecystectomy in which trocar site metastasis developed during their follow-up. In the first case, a 68 year-old woman with cholecystolithiasis underwent an uneventful laparoscopic cholecystectomy. Histologic examination revealed adenocarcinoma invading the mucosa and muscular layers of the gallbladder. The patient refused additional treatment. Seven months later, metastasis developed in the umbilical port site, which was excised. In the second case, laparoscopic cholecystectomy was performed for a symptomatic gallstone in a 78 year-old man. The gallbladder inspection showed thickenning of the infundibulum wall. Histological examination revealed adenocarcinoma invading serosa. No additional treatment was performed because of the patient's advanced age. A metastasis was identified in the 5 mm port site nine months after the operation. Two hepatic metastasis were also demonstrated by ultrasonography.