[Show abstract][Hide abstract] ABSTRACT: Localized malignant pleural mesothelioma (LMPM) is a rare occurrence, and gastrointestinal intra-luminal metastases have not previously been reported. Herein, we report a patient with LMPM who presented with a local recurrence 10 mo after initial en bloc surgical resection. Abdominal computed tomography was performed for intractable, vague abdominal pain with episodic vomiting, which showed a "target sign" over the left lower quadrant. Laparotomy revealed several intra-luminal metastatic tumors in the small intestine and colon and a segmental resection of metastatic lesions was performed. Unfortunately, the patient died of sepsis despite successful surgical intervention. Though local recurrence is more frequent in LMPM, the possibility of distant metastasis should not be ignored in patients with non-specific abdominal pain.
World Journal of Gastroenterology 08/2010; 16(31):3984-6. · 2.37 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Fibroadenoma accounts for 50-60% of all breast mass lesions in adolescents. It usually presents as a unilateral palpable breast mass. In contrast, bloody nipple discharge rarely occurs in childhood. We report the case of a 12-year-old pubertal girl who presented with a solitary breast mass and bloody nipple discharge. Physical examination and ultrasound showed a right breast subareolar homogenous mass, about 2.5 cm in diameter, near the lactiferous duct. Histologic diagnosis of the mass revealed a juvenile fibroadenoma with infarction and hemorrhage. The unusual clinical presentation and possible etiology in this patient is described, and the proper management of bloody nipple discharge in pediatric patients is discussed in association with a literature review.
[Show abstract][Hide abstract] ABSTRACT: One of the merits of endoscopic surgery is that it can be performed through small remote incisions made in inconspicuous areas. To improve cosmetic outcomes of surgical treatment of benign breast lesions, we performed endoscopic surgery through minimally sized axillary incisions with the goal of achieving scar-free breasts.
From August 2007 to August 2008, 18 patients with 20 benign breast lesions underwent endoscopic breast excision in our institution. Endoscopic resection of benign breast lesions was performed via the retromammary route with video assistance. Cosmetic results were evaluated using the five-item, four-step ABNSW scoring system, assessing breast asymmetry, breast shape, nipple shape, skin condition, and wound scars.
The median age of the patients was 27 years (IQR 23.0, 29.0). Median resected lesion size was 3.3 cm (IQR 2.9, 3.9). Median operative time was 85.0 min (IQR 70.0, 100.0). A marginally significant difference in operative times was noted between fibroadenoma and/or juvenile fibroadenoma cases and mastopathy or benign phyllodes cases (80.0 vs. 100.0; p < 0.06). Median total ABNSW score was 14 points. Postoperatively, 5 patients had mild local subcutaneous emphysema, and one had transient brachial palsy. No breast ecchymosis or deformity was noted. No major complications developed in any patient, and 89% of patients had good or excellent results.
Video-assisted endoscopic breast surgery has changed routine breast surgery, manifesting cosmetic effects that cannot be achieved by previous routine surgical techniques. Patients with multiple or large benign tumors who desire excellent cosmetic results are good candidates for this approach.
World Journal of Surgery 09/2009; 33(12):2572-8. DOI:10.1007/s00268-009-0225-x · 2.64 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Traditional breast surgery always leaves a scar not only on the breast but also on the mind of the patient. Endoscopic breast surgery, which was initially in cosmetic surgery, has made great progress in the past 10 years, and now is applied to resection of breast lesions, benign or malignant, in Western countries as well as in Asian countries, e.g., Japan, China mainland, Korea, and Hong Kong. In these previous reports, excellent cosmetic outcomes were achieved. Nevertheless, to the best of our knowledge, there are no such articles published in Taiwan. We hereby describe successful extirpation of multiple or large benign breast tumors in two young female patients, using endoscopic devices through a retromammary space approach. The patients were greatly satisfied with this method because of the final result of scar-free breasts. Video-assisted endoscopic breast surgery has made a great contribution to breast operations, and produces cosmetic effects that cannot be achieved by traditional surgery. Patients with multiple or large benign tumors, especially young females, are good candidates for this surgery. E ndoscopic surgery has been well-established in abdominal surgery and chest surgery. A characteristic of endoscopic breast surgery that differentiates it from laparoscopic and thoracoscopic surgery is the creation of adequate operative working space. The early articles on the use of endoscopic surgery in breast-related operations were written by Kompatscher1 and Johnson et al 2 , who performed breast augmentation via transumbilical insertion of saline-filled breast implants. Since then, endoscopic surgery has also been applied to deal with breast lesions. And due to great improvement of devices and technique, video-assisted endoscopic breast surgery has made great progress in Western countries as well as in Asian countries in the last decade. However, there were no written papers related to this field in Taiwan. Therefore, we would like to share our preliminary experience in this communication.