Rationale:We present a case of appendicitis with an uncommon course due to rare anatomical location of the appendix in the right retroperitoneal space below the diaphragm and above the liver.Patient’s concern:A 32-ye...Rationale:We present a case of appendicitis with an uncommon course due to rare anatomical location of the appendix in the right retroperitoneal space below the diaphragm and above the liver.Patient’s concern:A 32-year-old,previously healthy male with a history of congenital diaphragmatic hernia repair in childhood,presented with 3 days of mild,colicky,central abdominal pain associated with fever,nausea and vomiting.At presentation,pain was localized to the right lower quadrant.Diagnosis:Even though diagnosis of appendicitis was clear,we decided to confirm it with computer tomography(CT).CT revealed elevation of the right dome of the diaphragm and perforated appendix located above the liver.Intervention:Appendectomy was performed via right subcostal approach instead of usual incision in the right lower quadrant.Outcome:Patient recovered well and was discharged on the 5th day after operation.Lessons:Previous congenital diaphragmatic hermia repair may change the location of the appendix.The appendix at rare locations could lead to an uncommon course of appendicitis.On this very note,surgeons should have a high index of suspicion,and CT may help avoid inadvertent complications.展开更多
Background The development of angiosarcoma in oedematous tissue is referred to as Stewart-Treves syndrome （STS）. This rare and fatal complication is associated with chronic post mastectomy lymphoedema and radiothera...Background The development of angiosarcoma in oedematous tissue is referred to as Stewart-Treves syndrome （STS）. This rare and fatal complication is associated with chronic post mastectomy lymphoedema and radiotherapy for breast cancer. Angiosarcoma spread is facilitated by the formation of blood vessels （angiogenesis） and lymph vessels （lymphangiogenesis）. In the future antiangiogenic therapy may improve the poor outcome of current treatments. There was evidence that blocking the angiogenenesis would inhibit progression of angiosarcoma. It seems reasonable to hypothesize that blocking the lymphangiogenesis may yield similar results. Although angiosarcomas commonly derive from blood vessels, in case of STS angiosarcomas chronic lymphoedema may suggest its lymphatic origin. The goal of this study was to visualize interstitial space and lymphatics in the central and peripheral regions of STS angiosarcoma. Methods On tissue samples obtained from STS angiosarcoma we have performed： first colour stereoscopic lymphography to visualise the morphology of lymphatic vessels and extracellular spaces, second immunohistochemical staining specific for lymphatic vessels endothelium （LYVE-1） and blood endothelial cells （CD31, factor VIII） and prolymphangiogenic vascular endothelial growth factor （VEGF-C） for precise identification of lymphatic endothelia. STS angiosarcoma morphology was assessed by comparison of pictures obtained on lymphography, microscopy and confocal microscopy. Results STS angiosarcomas present heterogenous morphology with areas dominated by hemangiosarcoma and lymphangiosarcoma structures. STS angiosarcoma expressed phenotypes of both blood and lymphatic endothelia. LYVE-1 and VEGF-C is expressed by STS angiosarcoma and may be used to discriminate tumour differentiation. Morphology of lymphatic vessels and spaces in the tumour suggest absence of their normal lymphatic function. Conclusions Our results confirmed both hemangio- and lymphangiogenic origin of STS angiosarcoma. Expression of VEGF-C makes STS angiosarcoma a good candidate for targeted antilymphangiogenic therapy. However, morphology of intratumoral lymphatics on colour lymphography suggested their impaired function, which can hamper drug distribution.展开更多
文摘Rationale:We present a case of appendicitis with an uncommon course due to rare anatomical location of the appendix in the right retroperitoneal space below the diaphragm and above the liver.Patient’s concern:A 32-year-old,previously healthy male with a history of congenital diaphragmatic hernia repair in childhood,presented with 3 days of mild,colicky,central abdominal pain associated with fever,nausea and vomiting.At presentation,pain was localized to the right lower quadrant.Diagnosis:Even though diagnosis of appendicitis was clear,we decided to confirm it with computer tomography(CT).CT revealed elevation of the right dome of the diaphragm and perforated appendix located above the liver.Intervention:Appendectomy was performed via right subcostal approach instead of usual incision in the right lower quadrant.Outcome:Patient recovered well and was discharged on the 5th day after operation.Lessons:Previous congenital diaphragmatic hermia repair may change the location of the appendix.The appendix at rare locations could lead to an uncommon course of appendicitis.On this very note,surgeons should have a high index of suspicion,and CT may help avoid inadvertent complications.
文摘Background The development of angiosarcoma in oedematous tissue is referred to as Stewart-Treves syndrome （STS）. This rare and fatal complication is associated with chronic post mastectomy lymphoedema and radiotherapy for breast cancer. Angiosarcoma spread is facilitated by the formation of blood vessels （angiogenesis） and lymph vessels （lymphangiogenesis）. In the future antiangiogenic therapy may improve the poor outcome of current treatments. There was evidence that blocking the angiogenenesis would inhibit progression of angiosarcoma. It seems reasonable to hypothesize that blocking the lymphangiogenesis may yield similar results. Although angiosarcomas commonly derive from blood vessels, in case of STS angiosarcomas chronic lymphoedema may suggest its lymphatic origin. The goal of this study was to visualize interstitial space and lymphatics in the central and peripheral regions of STS angiosarcoma. Methods On tissue samples obtained from STS angiosarcoma we have performed： first colour stereoscopic lymphography to visualise the morphology of lymphatic vessels and extracellular spaces, second immunohistochemical staining specific for lymphatic vessels endothelium （LYVE-1） and blood endothelial cells （CD31, factor VIII） and prolymphangiogenic vascular endothelial growth factor （VEGF-C） for precise identification of lymphatic endothelia. STS angiosarcoma morphology was assessed by comparison of pictures obtained on lymphography, microscopy and confocal microscopy. Results STS angiosarcomas present heterogenous morphology with areas dominated by hemangiosarcoma and lymphangiosarcoma structures. STS angiosarcoma expressed phenotypes of both blood and lymphatic endothelia. LYVE-1 and VEGF-C is expressed by STS angiosarcoma and may be used to discriminate tumour differentiation. Morphology of lymphatic vessels and spaces in the tumour suggest absence of their normal lymphatic function. Conclusions Our results confirmed both hemangio- and lymphangiogenic origin of STS angiosarcoma. Expression of VEGF-C makes STS angiosarcoma a good candidate for targeted antilymphangiogenic therapy. However, morphology of intratumoral lymphatics on colour lymphography suggested their impaired function, which can hamper drug distribution.
