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Background A variety of effective methods for treatment of hemorrhoids has been proposed. In recent years, there has been an increasing number of studies comparing transanal hemorrhoidal dearterilization (THD) and conventional hemorrhoidectomy (CH), but the focus of most studies has been about the early postoperative results. The data about long-term outcomes is still limited. We aimed to compare Doppler-guided THD and CH with regard to early and long-term postoperative results. Methods The conducted prospective research included 287 patients who underwent CH (167 cases) or Doppler-guided THD with mycopexy (120 patients) between November 2010 and December 2015. Information on hemorrhoidal stage, demographic data, presenting symptoms, complications, duration of hospital stay, postoperative pain, patients’ satisfaction and follow-up were obtained. Statistical tests were performed by SPSS 19.0. Results There was no significant difference between the studied groups according to gender, mean age, preoperative prolapse, pain and pruritus, hemorrhoidal stage and postoperative complications. Preoperative bleeding was more frequent in THD group (p = 0,002). The mean visual analog scale (VAS) pain scores in CH and THD groups on days 1, 2 and 7 were 7.01 vs 5.03, 5.07 vs 2.98, 2.39 vs 0,57 (p = 0,000). Practically, there was no difference in VAS on day 30 and patients’ satisfaction at the 18th month. Mean hospital stay was 5,13 (CH) and 3,38 days (THD), p = 0,000. The postoperative follow-up was between 18 and 78 months (mean 46 ± 16 months). During this stage, 5 patients (2,99%) in CH group required surgery for recurrence. In THD group, 3 patients (2,5%), all with 4th-degree hemorrhoids underwent additional procedures (p 0,802). Conclusions Doppler-guided THD seems to be an efficient and safe option for treatment of hemorrhoids, related to lower postoperative pain and excellent, similar long-term outcomes compared to CH. For advanced grades of hemorrhoids, Doppler-guided THD could be a valuable alternative, but there is a need for patients’ selection. Trial registration (retrospectively registered) researchregistry3090.

Highlights • Rosai–Dorfman diseasе (RDD) is a rare histiocytic disorder оf unclear etiology. • RDD is characterized by emperipolesis and presence of S-100 positive histiocytes. • RDD usually presents as a massive, bilateral enlargement of the neck lymph nodes. • Localization of RDD in the liver and gallbladder is extremely rare. • Treatment is recommended in cases with symptomatic localized or extended RDD., Introduction Rosai–Dorfman disease (RDD), also known as sinus histiocytosis with massive lymphadenopathy, is a rare histiocytic disorder of unclear etiology. Lymphadenopathy commonly affects the lymph nodes of the neck and the head, but extranodal involvement has been observed too. Presentation of case We describe an unusual case of RDD with involvement of the gallbladder, liver and cystic lymph node, clinically manifested as an exacerbated cholecystitis. The patient underwent a cholecystectomy with atypical liver resection because the finding was macroscopically suspected of gallbladder cancer. The diagnosis of RDD was confirmed by immunohistochemical study. Discussion Histological features of RDD include histiocytic proliferation, emperipolesis and positive immunostaining for S-100 protein and typically negative for CD1a. Gastrointestinal localization of RDD, especially in the liver and pancreas, is extremely rare. Typically, the liver is affected as a part of systematic spread of RDD. We have not found reports for involvement of the gallbladder. Conclusion The presented case is valuable due to its rarity and difficulty in differential diagnosis.

Background IgG4-related disease (IgG4-RD) is a newly recognized disorder, characterized by massive IgG4+ lymphocyte and plasma cell infiltration, storiform fibrosis, causing enlargement, nodules or thickening of the various organs, simultaneously or metachronously. Involvement of the gastrointestinal tract is very rare and can be presented as a diffuse wall thickening or polyp or mass-like lesion. Up to now, there have been reported only a few cases of isolated gastric IgG4-RD. Case presentation We present an unusual case of IgG4-RD of the stomach with involvement of the regional lymph nodes, clinically manifested as a gastric cancer with related pyloric stenosis. The patient underwent distal gastrectomy, omentectomy and lymph node dissection. The postoperative serum IgG4 level was increased. The diagnosis was confirmed by immunohistochemical study. Conclusions In the most of the reported cases there was not sufficient data about the regional lymph nodal status, although the majority of the patients had been operated with presumptive diagnosis of gastric neoplasm. Our case is rare and valuable because it presents a gastric IgG4-related lesion larger than all previously reported in literature, and IgG4-related lymphadenopathy, confirmed histologically, which contributes to better knowledge of the disease.

Introduction: Metastatic lesions account for approximately 8% of all ovarian neoplasms. About 12% of clinically apparent metastases from non-gynecological primary site originate from breast carcinomas with a variable period of manifestation and detection. Report of Case: We present a case of 58-year-old woman who underwent bilateral adnexectomy with small bowel resection during urgent operation for an incarcerated umbilical hernia. There was a slight enlargement in both ovaries and presence of cystic formation with some papillary structures in the right one. Histologically, bilateral infiltration of tumor cells with moderate cytological and nuclear atypia and tubular, nested and cystic growth pattern was observed. The patient had a long list of co-morbidities: liver cirrhosis, ascites, isolated cytology with presence of tumor cells, elevated level of CA125 and quadrantectomy of the right breast, performed 15 years ago. Diagnostic examination continued in differing primary ovarian carcinoma from metastatic process using immunohistochemical markers – Gross cystic disease fluid protein-15 (GCDFP-15), Mammaglobin, Wilms tumor protein (WT1), p53, Ki67 and hormone receptors for estrogen (ER), progesterone (PR) and human epidermal growth factor (HER2). Considering the clinical data and the results from the pathological examination we concluded that the patient had bilateral ovarian metastases from breast carcinoma. We share our stepwise approach to the diagnosis discussing some of the difficulties emerged in the process and some of the pitfalls reaching the final conclusion.