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Extraskeletal chondromas are rare benign neoplasms comprising mature hyaline cartilage. A distinctive feature of these tumors is that they develop in soft tissues away from bone and cartilage. Extraskeletal chondromas account for 1.5% of benign soft tissue tumors. They occur predominantly at 30-60, in males, and in the hand or foot. In only 4% of cases, the tumor is located not on the extremities. Patients predominantly complain of increased mass, rarely on pain or a pulling sensation. The literature on the chondromas of the anterior abdominal wall is scarce. We present a rare case of a large extraskeletal left inguinal chondroma in a 71-year-old patient. The mass was over 6 cm large, and this is the only case of inguinal chondroma described in the literature. The mass was resected with surrounding tissues (a surgical margin of 1 cm) under combined endotracheal anesthesia and the histology confirmed the tumor to be a chondroma.

Introduction: Technetium-99m (99mTc) is a short-lived nanocolloid nuclide widely used by oncologists to diagnose and identify cancer dissemination. Aim: The aim of the current study was to develop the technique of radiopharmaceutical preparation (RPP) of Technefit99mTc aimed at examining sentinel lymph nodes (SLN) before surgery. Materials and methods: We performed a series of trials (33 patients). Based on the information obtained from the portable gamma detector NEO2000 during surgery, a biopsy of the sentinel lymph nodes was carried out when RPP Technefit 99mTc accumulated in a specific lymph node. Results: We determined maximum activities, volume, and peculiarities of administration of radioactive colloid Technefit99mTc in order to examine and perform the biopsy of SLN in the patients with malignant tumors. The most informative results in terms of scintigraphy images of sentinel lymph nodes were revealed in the first trial of the research, with all 5 cases (100%) showing positive results. The first trial included Technefit intradermal-hypodermal injection into one point above the tumor node, RPP activity of 75 to 200 mBq at a room temperature of 21°C, without preliminary anesthesia with Novocain solution. Conclusion: We determined the most efficient dosages of activities, volume, and characteristics of radioactive colloid administration aimed at the examination and biopsy of sentinel lymph nodes using the radiopharmaceutical preparation Technefit 99mTc in patients with malignant tumors of different localizations, namely breast cancer and skin melanoma. In some cases, we did not find any signs of considerable lowering of the Technefit 99mTc activity, which shows that there is a very slow filtration of Technefit 99mTc through the pores of lymph capillaries.

The sciatic nerve is the largest nerve in the human body. It originates from L4-L5 and S1-S3 spinal segments of the spinal cord and travels posteriorly through the lower limb providing significant portion of innervation to this anatomical region. The surgical procedures at the infragluteal region and transgluteal approaches to the sciatic nerve involves different incisions, level of dissection and are based on good knowledge of regional anatomy. During anatomical dissection of a 75 years-old cadaver, the course of the branches of the sacral plexus, the features of their origin and innervation zones were studied. To our knowledge there is only one report of a similar variation when the sciatic nerve bifurcates and then merges until its division into the tibial and fibular nerves.

Thyroid cancer is an emerging problem worldwide. Patients undergo surgery based on the results of cytology classified according to the Bethesda System for Reporting Thyroid Cytopathology. However, patients with Bethesda III and IV often undergo surgery due to “suspicion” of malignancy. In reality up to 68% of cases do not require surgery as the mass is not malignant. Core-needle biopsy (CNB) is an emerging new diagnostic method that can be useful to diagnose thyroid malignancies. It is potentially useful in cases of Bethesda III and IV as the obtained tissue can undergo immunohistochemistry and genetic testing. We present a case of 58-year old female initially diagnosed with a thyroid mass suspicious for thyroid cancer who undergone CNB that demonstrated benign nature of the tumor and eventually undergone organ-sparing surgery.

Polyacrylamide hydrogel mammoplasty is a simple and relatively affordable surgery. However, this procedure is associated with a significant frequency of late complications, prompting its suspension in 2006. Despite this, patients continue facing long-term consequences. These include hydrogel migration, changes in breast shape and volume, granulomas, fistulas, and abscess formation. The clinical case described here presents the surgical treatment after augmentation mammoplasty with polyacrylamide hydrogel performed 35 years ago.

Poland’s syndrome is an uncommon congenital anomaly of unknown etiology, the main characteristic of which is the absence of the major pectoral muscle. Thorax and upper limb malformations also may be present. Poland’s syndrome has been observed in clinical cases connected to a variety of neoplasia, primarily hematological disorders. Patients with Poland’s syndrome who have developed breast cancer have been reported incidentally. Here we report a case of Poland’s syndrome associated with breast cancer.

Extra-gastrointestinal stromal tumors arising from the pancreas are extremely rare. To date, just over 30 cases have been described in the world literature. A clinical observation of a 67-year-old patient with dull epigastric pain and a large cystic solid neoplasm instrumentally identified as an extra-gastrointestinal stromal tumor of the head of the pancreas is presented. The volume of surgical intervention consisted of pancreatogastroduodenectomy and right-sided hemicolectomy, since tumor invasion into the transverse mesocolon was detected intraoperatively. The final diagnosis of extra-gastrointestinal stromal sarcoma of the head of the pancreas with invasion into the mesocolon pT4N0M0, stage IIIb was made on the basis of histopathology and immunohistochemistry results. Extra-gastrointestinal stromal pancreatic tumors require careful differential diagnosis with other large abdominal masses. Timely diagnosis and use of modern treatment algorithms make it possible to avoid further disease progression.

Schwannomas are benign nerve sheath tumours that exhibit a slow rate of growth. In the vast majority of cases, schwannomas manifest as asymptomatic masses. The presence of symptomatic lesions may necessitate surgical removal. The incidence of schwannomas ranges from 4.4 to 5.23 cases per 100,000 population, accounting for approximately 7% of all primary tumours in the central nervous system. There is a limited number of case reports describing schwannomas outside the central nervous system. In rare instances, schwannomas may originate at the level of the thyroid gland. In such cases, incidental neck schwannomas may be mistaken for thyroid or parathyroid tumours. The increasing incidence of thyroid cancer draws more attention to all thyroid nodules, both benign and malignant. Thyroid nodules are detected in up to 65% of autopsies, with only 4–6.5% being malignant. Thyroid tumours are typically diagnosed by USG; however, they are often revealed incidentally during neck CT or MRI for other conditions. To rule out malignancy, tumour verification is required. The modern diagnosis of thyroid cancer is based on fine-needle aspiration (FNA) biopsy and cytology, which is classified according to the Bethesda classification system. However, not all FNAs are informative, and the differential diagnosis and treatment strategies in cases of unsatisfactory results are not standardized, leading to potential intraoperative challenges. We present a case study of a patient with a thyroid nodule that was ultimately diagnosed with a schwannoma of the neck according to core-needle biopsy.

Introduction: Renal lobulation (also known as fetal or embryonic lobulation) is a rare variation during development in which renal lobules have a visible anatomical space between them, and this can be seen in 0.5–4% of adults. Material and methods: this study was conducted on 54 human kidneys from patients who died due to causes unrelated to renal pathology which were fixed in a 10% formaldehyde solution and then carefully dissected. Results: The group with fetal lobulation (n = 16) was associated with a length M = 9.89 (SD = 0.6, p = 0.15). By comparison, the kidneys without lobulation (n = 38) were associated with a numerically longer length M = 10.29 (SD = 0.607, p = 0.098). To test the hypothesis that lobulation is associated with a statistically significant different length a Mann–Whitney test was performed, which indicated that the length of the kidneys is smaller in scase of lobulation U = 198, Z = −2.04, p = 0.04. Cross-tabulation also demonstrated that kidney lobulation may be influenced by the presence of polar arteries with r = 0.41 (p < 0.02). The likelihood ratio was 7.28, df 1, p = 0.003, with an odds ratio of 6.857 (CI 95% = 1.84–25.61). Logistic regression analysis demonstrated that kidneys with lobulation were 6.85 times more likely to have polar arteries than kidneys without lobulation. Conclusions: the data from our research indicate that even though no pathological conditions have been linked with lobulated kidneys, the incidence of vascular variations (specifically polar arteries) is higher when there is persistent fetal lobulation.

The celiac trunk is the first major branch of the abdominal aorta. It originates from the ventral aspect of the aorta at the level of T12–L1 vertebrae and was originally described as an artery that branches into the common hepatic artery, left gastric artery, and splenic artery. Absence of the celiac trunk and origin of the three arteries separately from the aorta is a rare entity that is reported in 0.38% to 2.6% of cases. It is even more uncommon that this variation can be accompanied by other vascular variations of the upper abdomen as accessory arteries to the liver, stomach, and pancreas. These cases arise during embryogenesis due to decreased arterial degeneration combined with decreased arterial fusion, which results in the anatomical variations present in the current case. Complex arterial variations are both a risk for iatrogenic injury during surgical procedures and beneficial during endovascular supply as they may provide additional access for embolization and chemotherapy.

Micro-arousals and the repeated desaturation of oxyhemoglobin, which are typical in obstructive sleep apnea syndrome (OSAS), have adverse effects on the health of patients, leading to a wide range of complications such as cardiovascular (arterial hypertension, pulmonary hypertension, chronic heart failure, arrhythmias, myocardial infarction), cerebrovascular (strokes), metabolic (insulin resistance, obesity, diabetes mellitus, metabolic syndrome), gastrointestinal (non-alcoholic liver disease), urinary (chronic renal failure), and neuropsychiatric complications as well as a wide range of malignancies. These, in turn, have multilateral effects on familial, occupational, and social life, as well as increasing the risks of road traffic accidents and accidents at the workplace. Awareness, timely screening, and the prevention of complications play important roles in diagnosing and treating comorbid conditions. This review focuses on comorbidities in OSAS and the effect of Continuous Positive Airway Pressure (CPAP) therapy on their prognoses.

The inflammatory myofibroblastic tumor, which was first described in 1939, is a rare neoplasm that accounts for 0.04%–0.7% of all lung neoplasms. These neoplasms occur most often in children, as they are the most common primary lung tumors in children. Preoperative diagnosis of such patients using bronchoscopy with endoluminal biopsy and transthoracic biopsy is not always informative and often the diagnosis can only be established during surgery. The presented case shows that on rare occasions, a giant myofibroblastic tumor of the lung may be encountered in adults, and radical intervention with subsequent rehabilitation can lead to full recovery.

Introduction: There are a number of thyroid gland diseases that require surgical treatment. Therefore, it is important to improve the surgical approaches and treatment tactics in patients that need such surgery.Aim: To provide an algorithm to prevent parathyroid gland damage during surgery.Materials and methods: This work was based on treatment results of 226 patients with different thyroid diseases. All patients received extrafascial surgical interventions using modern methodological approaches. For prevention of postoperative hypoparathyroidism, we used the “stress-test”, 5-aminolevulenic acid, and a method of double visual-instrumental registration of photosensitizer-induced fluorescence of parathyroid glands.Results: Transient hypoparathyroidism was registered in four (1.8%) cases after surgery. Permanent hypocalcemia in patients was not recorded. Autotransplantation of parathyroid gland was required only in one case (0.44%). A deficiency or low level of vitamin D was detected in 35% of the cases, and in the majority of those cases, it was due to secondary hyperparathyroidism. The deficiency was corrected with the administration of vitamin D in all cases. In 10.17% (23 patients) of cases, there was no proper visual glow effect after administration of 5-aminolevulinic acid (5-ALA), which required proceeding to the second part of the proposed method (a helium-neon laser and registration of fluorescence using a laser spectrum analyzer).Conclusions: The proposed methodological approach allows prevention of persistent hypoparathyroidism and reduces the frequency of transient hypoparathyroidism and other complications in surgical treatment of patients with various thyroid gland diseases.

Gallbladder trauma is a rare medical emergency in abdominal surgery because of its anatomic location. Gallbladder injury occurs in only 1.9%-2.1% of cases with abdominal traumas, with an isolated injury being ten times rarer. Despite the different mechanisms of injury, intravesical hypertension is the most important factor contributing to gallbladder rupture. A fall from a height is a rare cause of gallbladder injury, with only a few cases described in the literature. Laparoscopic cholecystectomy is the most common primary treatment. In the present case report, we present the diagnosis and management of a patient with a rare combined trauma. The patient was polytraumatized but had an isolated gallbladder injury in the absence of other abdominal injuries. Modern diagnostic methods, primarily ultrasound, can be critical in determining the best treatment strategy.

IntroductionPancreatic necrosis is one of the most severe acute abdominal conditions, accounting for 15%–20% of all patients with acute pancreatitis and characterized by significant rates of postoperative complications and mortality. Patients with pancreatic necrosis, in which pathological changes are localized in the proximal pancreas and retroperitoneal space, deserve special attention. This form of the disease includes patients with disconnected main pancreatic duct (MPD) syndrome who have a difficult prognosis.AimThe aim of the study was an improvement of treatment results in patients with necrotizing pancreatitis and signs of the dissociation of the pancreas duct system using the endoscopic transpapillary stent placement method.Material and methodsThis study was a retrospective cohort study. There were 32 patients with acute necrotizing pancreatitis who were managed using the endoscopic transpapillary stent placement method between 2019 and 2021. Disconnected MPD syndrome was diagnosed in all 32 patients. In total, 26 patients were admitted to hospital in the first 72 h, while 6 patients were admitted after 72 h. We diagnosed the necrotizing process located in the proximal and central areas of the pancreas and peripancreatic space in all these patients (“model III”).ResultsPositive results related to transpapillary stent placement were noted in 24 (75%) patients (first cohort). A total of 20 patients from this group were admitted to hospital in the first 48 h, and 4 patients were admitted later than 72 h from the onset of disease. Moreover, 8 patients (25%; second cohort) failed to succeed in transpapillary stent placement. Complications in the first cohort occurred in 3 (12.5%) patients: dislocation of the stent into the duodenum occurred in 1 patient, and bleeding after papillosphincterotomy took place in 2 patients. Meanwhile, infected necrotized pancreatitis developed in 5 patients, and 1 patient (5%) died. Complications among the second cohort occurred in 2 (25%) patients: erosive bleeding (after debridement). Infected necrotized pancreatitis developed in 4 patients, and 2 patients (25%) died.ConclusionsEndoscopic transpapillary stent placement is an effective minimally invasive approach in the management of patients with necrotizing pancreatitis.

Introduction: There are multiple studies about the developmental variations of the arterial and venous system of the kidneys. However, the description of developmental variations of the excretory system are not abundantly present in the literature. Material and Methods: The structure of the renal excretory system was studied by means of macroscopic dissection on 90 kidneys. Results: Intrarenal pelvis (type I) when the pelvis is completely located inside the sinus, closed by the parenchyma was encountered in 45 specimens, which corresponds to 50% of cases. The extrarenal pelvis that is located outside the sinus and is not covered by the renal parenchyma was encountered in 9 specimens (10% of cases). Extrarenal type of pelvis with an open posterior surface, when, the posterior surface of the pelvis is free from the parenchyma and the anterior one is covered by the groove of the kidney was encountered in 18 specimens (20% of cases). The mixed type, in which the pelvis is located partly inside the sinus, partly outside of it, was encountered in 16 specimens (17.78% of cases). A special type of pelvis, when the pelvis as such is anatomically absent, and two elongated large calyces, connect and form the ureter was found in 2 cases (2.22%). Pearson correlation analysis demonstrated that calyces’ lengths correlated best when there were two calyces (r=0.51; p

Testicular artery (previously known as internal spermatic artery or also known as gonadal artery) is an artery that branches from the anterolateral part of abdominal aorta at the level of the second lumbar vertebra and supplies the blood to the testes. Anatomical variations of the testicular vessels are not frequently reported in the literature. The available data demonstrates that there is an overall decrease in the number of cadaver studies published in the literature. The current case demonstrates a unique variation where the right testicular artery began as a common trunk with superior polar, inferior phrenic, capsular arteries and then had an unusual course covering the surface of the kidney. The left testicular artery, had a high origin from the aorta and also descended in an oblique course, covering the kidney. The current case is important because of its implications in renal transplantation, renal and adrenal surgery, vascular surgery, oncological surgery and other disciplines.

The heterogeneity of thoracic wall tumors often represents challenging clinical entities for surgeons due to diagnostic and treatment complexities. The primary tumors, metastases, or direct invasion from intrathoracic structures comprise almost half of all cases on average that are proved to be malignant. Surgery treatment usually leaves large chest defects that require further extensive reconstruction and multimodal management including radiotherapy and chemotherapy. We report a rare case of a giant (30 cm) post-traumatic bleeding thoracic sarcoma treatment in a 70-year-old female. The use of our modified Verneuil technique to close the extensive postoperative skin defect optimized surgical wound management and provided good functional and aesthetic results. Four-year follow-up outcomes after surgical and adjuvant radiation therapy reported a high level of tumor control and showed no evidence of postoperative disease recurrence.

Background: Precise knowledge of the topographic features of the splenic artery and its branches in the hilum region is of practical interest due to the various interventions on the vessels of the spleen. Materials and methods: The anatomy of the spleen was studied by means of macroscopic dissection on 330 organ complexes, which were carefully documented and analyzed statistically. Results: The analysis of the splenic artery trajectory led to identification of four types: straight (43.03%), sinusoidal (27.58%), serpentine (20.91%) and alternating (8.48%). To assess the relation between the trajectory of the splenic artery and its branches we performed a chi square test. Sinuous or serpentine trajectory was associated with the presence of long splenic artery branches (dorsal pancreatic artery or the great pancreatic artery), X2 (2, N = 330) = 12.85, p = 0.001. The artery was located suprapancreatic in 70.30% of cases, anteropancreatic in 4.55%, the vessel had an intrapancreatic course in 14.85% and in 10.00% of cases the artery was located retropancreatic. The presence of inferior polar arteries was associated with a longer pancreas (Spearman’s correlation; r = 0.37; p = 0.037). In a multiple regression analysis, inferior polar arteries predicted the length of the pancreas although only a small number of cases could be explained by this model (R2 = 0.127, Adjusted R2 = 0.098; Betta = 0.357; t(330) = 2.091; p = 0.045). There were 30 (9.09%) cases of accessory spleens. Conclusions: The arterial supply of the spleen is highly variable in its trajectory, terminal branches, and relation to other organs. The splenic artery tends to be sinuous or serpentine in zones when a large artery branches off (e.g., the dorsal pancreatic or greater pancreatic artery). Multiple short branches tend to stabilize the trajectory of the splenic artery. Inferior polar arteries and accessory spleens contribute to the length of the pancreas, most likely due to increased vascular supply to the tail of the gland.