A 43-year-old male Caucasian house-builder presented with a tumor in the left forearm that had grown in size progressively for 5 months. On examination, the lesion measured approximately 10 cm in the largest axis, with irregular shape and hard consistency, fixed to the superficial and deep planes (panel A and B). He underwent complete resection of the mass under local anesthesia, with preservation of vascular-nervous and muscular structures (panel D, E, F, and G). He had a favorable postoperative course without complications. Pathological examination of the tumor confirmed a malignant mesenchymal neoplasm that showed moderate atypia but no necrosis, ulceration or unequivocal vascular invasion. Free resection margins were observed. The mitotic index was 23 mitoses per 10x field. Immunohistochemical analysis (Leica/Dako automated system) revealed positive staining for vimentin (Clone V9) and Ki67 (Clone M7240); and negative staining for desmin (Clone SP 138), anti-human S-100, alfa-smooth muscle actin (Clone 1A4), myogenin (Clone F5D), transducin-like enhancer of split 1 (Clone 1F5), epithelial membrane antigen (Clone E29) and cytokeratin 7 (Clone OV-TL 12/30). The above analyses confirmed a diagnosis of high-grade fibrosarcoma. The patient received an adjuvant radiochemotherapy therapy. He had a favorable therapeutic response. No tumor recurrence was noted after one year of post-operative follow-up (panel C).
Received date: July 30, 2018
Accepted date: August 19, 2018
Published date: August 21, 2018
None
None
© 2018 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC-BY).
This article presents a unique surgical case of a 75-year-old Chinese woman with a parotid lesion, highlighting the unpredictability of human anatomy. It underscores the critical need for flexibility in surgical techniques, especially when faced with deviations in the facial nerve's pathway. Traditional intraoperative landmarks proved unreliable due to significant anatomical displacement, prompting a shift from the conventional anterograde to a retrograde dissection approach. This case study serves as a crucial reminder of the importance of tailor-made strategies in surgery, offering invaluable insights for medical professionals in navigating complex cases and ensuring patient safety.
This article presents a crucial case report on potential wound healing complications linked to fremanezumab, a calcitonin gene-related peptide-targeting antibody for migraine prevention. It documents the first known instance of delayed wound healing following a free flap breast reconstruction, underscoring the need for heightened clinical vigilance and individualized patient assessment in perioperative settings. Highlighting significant safety data gaps, the report advocates for comprehensive research and rigorous post-marketing surveillance. The findings emphasize the importance of balancing the risks of delayed wound healing with the need for effective disease control, especially when using biologic agents for chronic conditions. This article is essential for medical professionals managing patients on biologic therapies, offering critical insights and advocating for a personalized approach to optimize patient outcomes. By presenting novel observations and calling for further investigation, it serves as a vital resource for enhancing patient care and safety standards in the context of biologic treatments and surgical interventions.
Zogbi L. Forearm high-grade fibrosarcoma. Ann Surg Perioper Med. 2018;1(1):2. https://doi.org/10.24983/scitemed.aspm.2018.0078
PDF