Lymphangiomas constitute a group of very rare diseases and occur with a frequency of 1/250,000 to 1/20,000 of hospitalizations. Even though they are benign lesions, their complications may turn into a life-threatening condition. They usually occur in children (90%), they are either congenital or they appear before the child’s second birthday. Occassionally they are found in adults. Lymphangiomas are usually localized around neck, but also near armpits and in the groin area. Less than 1% of lymphagiomas are detected in the retroperitoneal space and intestinal mesentery. Vascular lesions derived from lymphatic vessels can be divided into ordinary ones, usually known as capillary, cavernous, and cystic. The cystic tumor (lymphangioma mesenteri) is the least common. It occurs mostly in the retroperitoneal space, mesentery of the colon, or extremely rarely in the mesentery of the small intestine. Preoperative diagnosis is difficult due to non-specific clinical symptoms and noncharacteristic image in the diagnostic tests. Lymphangioma complications, such as intestinal obstruction or perforation, and persistent pain, are the cause of exploratory laparotomy. Final diagnosis requires microscopic examination of material collected during an operation. This article presented the case of a 40-year-old female, operated due to the obstruction of the gastrointestinal tract, in whose case the lymphangioma was recognised in postoperative histopathological examination of the tumor from the jejunal mesentery. Since patients with these tumors have good chances of complete recovery - if there are no serious complications - it appears that the optimal therapeutic procedure should be early surgery, which reduces the possibility of complications.
Autosomal dominant polycystic kidney disease is the most common genetic cause of renal failure. Apart from kidney involvement, patients are at risk of extra-renal manifestations, including vascular lesions. The etiology of vascular changes is diverse and depends, among other factors, on polycystin gene mutation, increased activity of the renin-angiotensin-aldosterone system and the occurrence of hypertension. The observed vascular system complications include cerebral artery aneurysms, cervico-encephalic arteries' dissection, aortic aneurysm and dissection and intracranial arterial dolichoectasia. This article discusses the etiopathogenesis, symptomatology, principles of prevention and treatment of the aforementioned diseases of the vascular system accompanying polycystic kidney disease.
This study presents three cases of cystic adventitial disease, a rarely occurring vascular pathology that mainly affects the arteries. The nature of the disease consists in the occurrence of adventitial cysts filled with mucous, and leads towards vascular destruction and stenosis as well as limb ischemia. The popliteal artery is most often concerned in this etiology, and male patients predominate. However, the etiology of the disease remains unknown. One can observe a similar chemical content of adventitial and Baker's cysts, and their occurrence near the joints. Adventitial cystic disease may result in atypical intermittent claudication. This disease is characterized by the absence of pulse during flexion of the knee joint. Duplex color ultrasonography plays an important role in the diagnosis of the disease, as well as arteriogaphy, where one can observe hourglass or semilunar vascular lumen stenosis. Surgical management is the method of choice. This study presents three cases of cystic adventitial disease. Two cases concerned the popliteal artery and one the common femoral artery. All three patients were male with symptoms of lower limb ischemia. The three patients underwent surgical treatment and were diagnosed with cysts - localized intravascularly - that were constricting the vessels and filled with a jelly-like content. Two patients with significant lesions required surgical excision of the changed vascular fragment and bypass grafting. The third patient was subjected to local cyst excision. Percutaneous cystic content aspiration is also a method of treatment.
The aim of this study was to assess short-term outcomes of surgical treatment of pancreatic cystic tumors (PCTs). Material and methods: We retrospectively reviewed medical records of 46 patients (31 women and 15 men) who had undergone surgery for pancreatic cystic tumors in our department. Results: Pancreatic cystic tumors were located within the pancreatic head (21), body (11), tail (13), and whole pancreas (1). The following surgical procedures were performed: pancreatoduodenectomy (20), central pancreatectomy (9), distal pancreatectomy (3), distal pancreatectomy with splenectomy (3), distal extended pancreatectomy with splenectomy (2), total pancreatectomy (1), duodenum preserving pancreatic head resection (1), local tumor resection (4), and other procedures (2). Histopathological tumor types were as follows: serous cystadenoma (14), intraductal papillary mucinous adenoma (5), intraductal papillary mucinous carcinoma (5), solid pseudopapillary tumor (5), mucinous cystadenoma (5), mucinous cystadenoma with border malignancy (1), mucinous cystadenocarcinoma (2), adenocarcinoma (4), and other tumors (5). Early postoperative complications were observed in 14 (30.43%) patients. Reoperations were performed in 9 (19.56%) patients. The perioperative mortality rate was 6.52%. Conclusions: Serous cystadenoma was the most common pancreatic cystic tumor in the analyzed group. PCTs were most frequently located within the pancreatic head. Pancreatic resection was possible in most patients, and pancreatoduodenectomy was the most common pancreatic resection type.
Introduction: Detection of the frequency of pancreatic cystic lesions has increased in the recent years. The majority are pseudocysts, the remaining cysts are mainly neoplasms. Proven risk of malignancy affects intraductal papillary mucinous neoplasms (IPMN) and mucinous cystic neoplasms (MCN). The aim of this study was to analyze clinical data of patients with pancreatic cysts or pancreatic cystic neoplasms on operate at Department of General and Transplant Surgery in the Barlicki Hospital in Lodz. Material and methods: In 2007-2016, there were 145 patients operated on at the Department of General and Transplant Surgery in Barlicki Hospital in Lodz, due to pancreatic cystic lesion. The type of operation, histopathological diagnosis and basic demographic data were analyzed. Results: Non-neoplastic cyst (mainly pseudocysts) was found in 66.9% of patients, neoplasms were detected in 33.1%. The mean age was significantly higher in patients with neoplasm than without neoplasm (57.06 years vs. 50.88 years, p=0.009). Neoplastic cyst occurred more frequently in women (68.75% of women, 31.25% of men, p=0.001). Malignant tumor was found in 14.58% of neoplasms cases and in 4.83% of all pancreatic cystic lesions. Conclusions: According to the analyzed material, there is a significant risk of malignancy in patients with pancreatic cyst. Neoplastic cysts are more common in women. Discussion: Pancreatic cystic tumors are treated mainly by resections of pancreas. In case of benign lesions with low risk of malignancy, there are less extensive operations performed, such as enucleations of lesions. There are no guidelines that could be used satisfactorily in follow up of patients with pancreatic cysts.
Authors present a case of 54-year-old female treated for intramedullary epidermoid cyst. Patient complained of atypical pain and dysesthesia in lumbosacral region for many years. Patient’s complains increased before admission and were unbearable. Performed clinical and imaging examination revealed intramedullary tumour located in the terminal cone at the level of L2 vertebra. The patient underwent surgical treatment with total tumour removal. Histological examination confirmed epidermoid cyst. Intramedullary location of epidermoid cyst is very rare and constitutes of about 0.7% of all spinal tumours. Due to compression on nervous structures surgical treatment of epidermoid cyst is a method of choice. Authors discuss signs, clinical history, treatment and its results as well as histological findings.
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Celem pracy było przedstawienie przypadku występowania torbieli naskórkowej o bardzo rzadkiej, śródrdzeniowej lokalizacji w odcinku lędźwiowym kręgosłupa u 54-letniej pacjentki. Chora od wielu lat cierpiała z powodu nietypowych dolegliwości bólowych umiejscowionych w odcinku lędźwiowym kręgosłupa, połączonych z występowaniem parestezji w postaci mrowienia w okolicy krocza oraz z zaburzeniami oddawania stolca – zaparciami. Przed hospitalizacją dolegliwości nasiliły się i według kobiety były nie do zniesienia. W wykonanych badaniach obrazowych (rezonans magnetyczny) uwidoczniono guz położony wewnątrzrdzeniowo na wysokości trzonu kręgu L2. Pacjentkę leczono neurochirurgicznie, usuwając całkowicie guz śródrdzeniowy. W przeprowadzonym badaniu histopatologicznym materiału pooperacyjnego rozpoznano: epidermoid cyst. Lokalizacja wewnątrzrdzeniowa torbieli naskórkowej jest bardzo rzadka – stanowi 0,7% wszystkich guzów kręgosłupa. Guz ten jest łagodną wrodzoną lub nabytą zmianą pochodzenia ektodermalnego. W pracy autorzy przedstawiają wywiad chorobowy i przebieg kliniczny schorzenia, sposób i wynik leczenia oraz omówienie histopatologii tej zmiany.
Endometriosis develops in about 10% of women in their fertile age, it is estrogen-dependent and is an important clinical problem. The main symptoms are: chronic pain of the minor pelvis, dysmenorrhea, and dyspareunia, with about 50% of patients being infertile; relapses of the disease are frequent. There are many theories linked to the etiopathogenesis: 1) implantation of the endometrium through salpinges to the abdominal cavity and organs located in the minor pelvis, 2) local immunodeficiency, 3) changes in cellular adhesion and cytokine profile, 4) environmental factors, 5) angiogenesis disorders, 6) genetic predispositions. In our report, we described a case of a patient, age 46, nullipara. The patient’s examination revealed a mass that was palpable in the abdomen and could be felt up to the level of four fingers below the navel. Serum CA-125 was 40.4 U/mL. The ultrasound examination per rectum showed a slightly enlarged uterus with normal endometrium, the right ovary without any pathological changes, and the left ovary changed into a cyst of 15 centimeters in diameter with the superior border not clearly visible. Typical clinical symptoms for endometriosis, like persistent pain in the abdomen, flatulence, bloating, dysmenorrhea, urinary incontinence were not observed in that patient. Surgery was performed in which 1000 mL of fluid were evacuated from the endometrial cyst.
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Endometrioza rozwija się u około 10% kobiet, głównie w wieku rozrodczym, jest chorobą estrogenozależną i stanowi istotny problem kliniczny. Dominującymi objawami są: przewlekły ból w miednicy mniejszej, bolesne miesiączkowanie i współżycie płciowe, a około 50% kobiet jest niepłodnych; często występują nawroty choroby. Istnieje wiele teorii związanych z jej etiopatogenezą: 1) implantacja endometrium poprzez jajowody do jamy otrzewnej i narządów miednicy mniejszej, 2) osłabienie układu immunologicznego (głównie lokalnego), 3) zmiany w adhezji komórkowej, profilu cytokin, macierzy komórkowej, 4) czynniki środowiskowe, 5) zaburzenia w procesie angiogenezy, 6) predyspozycje genetyczne. W pracy opisano przypadek 46-letniej pacjentki, nieródki. W badaniu palpacyjnym brzucha stwierdzono opór sięgający cztery palce poniżej pępka. Poziom CA-125 w osoczu wynosił 40,4 U/ml. Badanie ultrasonograficzne per rectum wykazało macicę nieco powiększoną z linijnym endometrium, jajnik prawy prawidłowej wielkości, lewy zmieniony w około 15-centymetrową torbiel, której górny biegun nie był dokładnie widoczny. U pacjentki nie występowały typowe objawy kliniczne dla endometriozy, takie jak pobolewanie, bolesne miesiączki czy też nietrzymanie moczu. Przeprowadzono zabieg operacyjny, w którym ewakuowano 1000 ml płynu z torbieli.
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