Background: Hibernoma or lipoma of brown fat is a rare benign tumor, representing 1.6% of the neoplasms of this tissue. Because of its histological characteristics can be wrongly classified as liposarcoma, therefore a correct differential diagnosis is necessary to provide appropriate treatment.
Case presentation: The patient on which this case study is based is a 44-year-old male with a painless soft mass in his axilla located by his 4th and 5th ribs. The resected specimen did not have the classic macroscopic features of lipoma or fibrolipoma. Microscopically, the report described a proliferation of unilocular adipocytes with eccentric nucleus and, in less frequency, multilocular adipocytes with central nucleus. He had no recurrence after excision.
Conclusions: Despite radiology studies and other technologies such as magnetic resonance imaging, computerized axial tomography (CAT), etc., the clinical diagnosis of hibernoma could be difficult. Lipoma-like hibernoma only have a few multilocular cells and can be wrongly classified as liposarcoma. Well-differentiated liposarcoma resembles it on low-power examination. Due to this it is especially important to perform a differential diagnosis with lipoma, fibroma, and even with liposarcoma. In this study we describe the histological features, the molecular markers and cytogenetic aspects that contribute to differentiate hibernoma from others tumors.
Background: Abdominal Actinomyces infections are rare complications of surgery. A case of Actinomyces neuii presenting as a severe postoperative pelvic infection is described.
Case: A 30 year-old nulligravid female was transferred from an outside hospital for a postoperative fluid collection, fever, leukocytosis, and abdominal pain following exploratory laparotomy and bilateral ovarian cystectomy. She rapidly decompensated requiring emergent exploratory laparotomy, bilateral salpingooophorectomy, and abdominal washout. Cultures isolated A. neuii. Following a prolonged ICU admission, she was treated with prolonged antibiotics and made a complete recovery.
Conclusions: Rare pathogens, such as A. neuii, may cause severe infections following gynecologic surgery. Multidisciplinary care at tertiary care facilities is critical.
Morgagni hernias are rare defects which comprise approximately three percent of congenital diaphragmatic hernias. They are often found incidentally but may present with symptoms of bowel obstruction due to viscera entering the hernia sac. Here we present a case series of two Morgagni hernias. The first case is an elderly woman who presented with strangulated transverse colon in the hernia sac, and the other is a young man who complained of vague chest discomfort. These cases exemplify the varied clinical presentation of Morgagni hernias, the importance of being cognizant of their pathology, and their treatment.
Background: Laparoscopic appendectomy is the gold standard for treatment of appendicitis. Stapled closure of the appendiceal stump is commonly performed and has several advantages. Few prior cases have demonstrated complications from free staples left within the abdomen after the stapler has been fired.
Case report: A 29-year-old female underwent laparoscopic appendectomy for acute uncomplicated appendicitis during which the appendix and mesoappendix were divided using laparoscopic gastrointestinal anastomosis (GIA) staplers. Her initial recovery was uncomplicated. She returned on postoperative day 17 with sharp mid-abdominal pain, obstipation, and emesis. Her abdomen was distended, and she had a mild leukocytosis. Computed tomography (CT) demonstrated twisted loops of dilated small bowel in the right lower quadrant with two transition points, suggestive of internal hernia with closed loop bowel obstruction. Diagnostic laparoscopy was performed through the three prior appendectomy incisions. An adhesion between the Veil of Treves and the mesentery of the ileum caused by a solitary free closed staple, remote from the staple lines, had caused an internal hernia. The hernia was reduced, and the small bowel was noted to have early ischemic discoloration. The adhesion was lysed by removing the staple from both structures. The compromised loops of bowel began to show peristaltic movement and color returned to normal, and the procedure was concluded without resection. She was discharged home the following day.
Conclusions: Gastrointestinal staplers are commonly used due to ease of use and low complication rate. It is not uncommon to leave free staples in the abdomen as retrieval can be difficult and time consuming. Our case is only the second in the literature reporting an internal hernia with closed loop bowel obstruction as a complication of retained staples. Choosing the most appropriate size staple load to reduce the number of extra staples, removing free staples, or the use of an endoloop can prevent potentially devastating complications.
Nocardia cerebral abscess is uncommon. It accounts for 1%-2% of all cerebral abscesses. It typically occurs in immunocompromised patients but cases in immunocompetent hosts been reported. Diagnosis of Nocardia brain abscess can be difficult and misleading. In this report we report a case of Nocardia abscessus brain abscess that was misdiagnosed initially as brain tumor. The patient has been successfully managed medically along with surgical evacuation twice.
The aberrant course of the intratympanic carotid artery is a rare congenital vascular anomaly. We report the case of a 7-year-old patient who presented with bilateral conductive hearing loss, originally attributed to otitis media with effusion. After myringotomy, massive pulsatile bleeding occurred on the right side. The bleeding was successfully controlled with packing without any residual complication. Imaging confirmed aberrant internal carotid arteries abutting the tympanic membranes bilaterally.