Surgical treatment of gynecomastia could present unique challenges for the plastic surgeon. Achieving a good balance between effectiveness of the selected approach and the satisfactory aesthetic outcome often is a difficult endeavor. Optimal surgical treatment involves a combination of liposuction and direct excision. In the present study the charts of 11 patients treated with suction-assisted liposuction and direct surgical excision were retrospectively reviewed; a special emphasis is placed on the surgical technique. The mean follow-up period of the patients was 11.6 months. No infection, hematoma, nipple-areola complex necrosis and nipple retraction was encountered in this series. The combined surgical treatment of gynecomastia has shown to be a reliable technique in both small and moderate breast enlargement including those with skin excess.
Raluca Bulea, D.M Enescu, Steluţa Giuvelea, Simona Stoicescu, Raluca Alexandru and D Ioniţă
Introduction Infantile hemangiomas (IHs) are the most common benign tumors of the soft tissue in infants and children and they often represent a serious challenge for the treating physician. Hemangiomas located in the anogenital region represent only about 1% of all IHs, but raise special concerns as they have the propensity to ulcerate. This condition may appear spontaneously, or could result from therapeutic procedures. Ulceration is extremely painful and takes many weeks of conservative therapy to heal.
Material and Methods. The aim of this study is to present the surgical approach of the IHs located in the anogenital area and the outcomes of this treatment option.
Results. During a period of 36 months, 11 children (nine girls, two boys) were referred to our plastic surgery department with hemangiomas involving the anogenital, groin and perineum areas. The average follow-up period was of 8 months, during which 82% of cases experienced complications, especially ulceration. All the target hemangiomas were removed through a lenticular excision and the wound closed with a linear suture.
Conclusions. Our study has shown that surgical excision of a complicated anogenital hemangioma or of a “healthy” hemangioma at high risk for ulceration in the anogenital region is an effective treatment, with fast healing and complete resolution of the pathogenic condition. Lenticular excision and linear closure represent a convenient surgical technique that can be performed as early surgery, during the proliferative stage, or at any time later, when the patient needs treatment, in safety conditions and with good results.
Igor Ignjatovic, Vladimir Milosavljevic, Boris Tadic, Nikola Grubor and Slavko Matic
Lymphangioma usually occurs in children and usually involves the skin. Mesenteric lymphangiomas are extremely rare in adults (1,2,3). Lymphangioma of the small-bowel mesentery is rare, representing less than 1% of all lymphangiomas (4). We report a case of a 62-year-old female who presented with abdominal pain, discomfort, nausea and vomiting. Preoperative tests including abdominal ultrasonography and magnetic resonance imaging were performed, but they could not accurately determine the nature of the tumour. Laparotomy was performed; the tumour was excised completely, and a large cystic tumour of the small bowel mesentery was found. Histopathological examination diagnosed the tumour as a cystic lymphangioma. Lymphangiomas are extremely rare, especially in the abdomen of adults, and are asymptomatic for the most part; they often present as acute abdominal conditions, causing life-threatening complications such as secondary infection, rupture with haemorrhage, and volvulus or intestinal obstruction when the tumour increases in size, requiring emergent surgery. Lymphangioma is often diffi cult to diagnose, and surgical resection is selected in many cases for both diagnosis and treatment.
R.V. Costea, N. Zărnescu, A. Chirca, O. Rusu and S. Neagu
Introduction. Soft tissue sarcomas (STS) are a heterogeneous group of tumors with over 80 different subtypes that account for approximately 1-2% of adult malignancies. Primary sarcomas arise from a variety of soft tissues and bone, and include fibrous connective, fat, and smooth, or striated muscle, vascular, peripheral neural and visceral tissue. With difficulties in establishing cell origin and pathogenesis, this condition lacks an effective and durable therapy with no predictive biomarkers and rapid diagnosis. Materials and methods. We reviewed the cases of 21 patients treated in our clinic for soft tissue sarcoma over a 20-year period (1999-2018). We extracted the following information from each patient’s medical record: disease status at presentation, histological diagnosis, American Joint Committee on Cancer staging, surgical procedure, oncological outcome, length of hospitalization, and follow-up information. Results. All 21 patients (14 males and 7 females, aged between 19 and 88 years) underwent surgery and total excision with safety margins was performed with histopathological confirmation stating the tumor type and subtype. Some samples required immunohistochemistry for subtype differentiation. Chondrosarcoma and myosarcoma were the most common (5 patients). 8 patients presented local recurrence and metastatic disease with 6 cases receiving adjuvant chemotherapy. Only one patient presented for the 5-year follow-up. Conclusions. STS are a rare group of tumors with poor outcome with surgical treatment being represented by total excision. We chose to present our clinic’s experience to highlight the need for post-operative therapy advancements and to raise awareness on the difficulties in managing these cases.
L. Gurgas, N. D. Popescu, L. T. Hangan, S. Chirila and Natalia Rosoiu
The paper proposes new exposure data on etiopathogenesis basal cell epithelioma and present a clinical case investigated dermatoscopic, biochemically, treated surgically and guided to avoid relapses. The case presented is part of typical cases of pigmented basal cell carcinoma. Biochemical and haematological investigations performed one day before the excisional intervention (results 1) and 30 days (results 2) after the intervention: It is recommended to monitor biochemical investigations in which alterations were found, and ways for raising the immunological status.
M. Betekhtin, J. Ananiev, G. Tchernev, L. Zisova, S. Philipov and R. Hristova
Heidelberg 12. 220.
5. Giacomel , J. et al. Dermoscopy of basosquamous carcinoma. - Br. J. Dermatol., 169, 2013, № 2, 358-364.
6. Ananiev, J., G. Tchernev et M. Gulubova. Basal cell carcinoma with atypical localisation and uncommon clinical presentation: complete remission after surgicalexcision. - J. Med. pregled., 47 № 3, 60-63.
7. Brownell , I. Nodular basal cell carcinoma: when in doubt, cut it out. - J. Drugs Dermatol., 6, 2007, № 12, 1245-1246.
8. Kruse Gujer, A. L. Metastatic basal cell carcinoma
Olimpiu Hârceagă, Corina Baican and Rodica Cosgarea
14. Thissen MR, Neumann MH, Schouten LJ. A systematic review of treatment modalities for primary basal cell carcinomas. Arch Dermatol. 1999 Oct;135(10):1177-83. Review.
15. Silverman MK, Kopf AW, Bart RS,Recurrence rates of treated basal cell carcinomas. Part 3: Surgicalexcision. J Dermatol Surg Oncol. 1992 Jun;18(6):471-6.
16. Gulleth Y, Goldberg N, Silverman RP, Gastman BR. What is the best surgical margin for a Basal cell carcinoma: a meta-analysis of the literature. Plast Reconstr Surg. 2010 Oct;126
Anca Chiriac, Piotr Brzezinski, Adrian Năznean, Cristian Podoleanu and Simona Stolnicu
The present paper highlights the usefulness of 70% trichloroacetic acid in treating sebaceous hyperplasia in elderly patients. Esthetics are an important issue, and different therapeutic modalities can be used, such as systemic isotretinoin, surgical excision, electrocautery, cryosurgery, topical photodynamic therapy and laser, but all these methods are expansive and invasive procedures that may result in scars, which are more extensive than the original lesions.
Kaller Reka, Hălmaciu Ioana, Suciu Bogdan Andrei, Alexandru Strat, Toma Lucian, Mocian Adriana, Milutin Doina, Csilip Andrea, Brînzaniuc Klara and Mureșan Vasile Adrian
Liposarcoma (LPS) is one of the most common histologic subtypes of adult soft tissue sarcoma. Here, we report the case of a 52-year-old woman complaining of shortness of breath, chest pain, painful leg swelling 24 hour before presentation at our institution.
Despite a vascular, soft part ultrasound and CTA, which suspected a voluminous haematoma, a huge tumour was found and a myxoid liposarcoma was identified by surgical excision and a histological examination, respectively.
Stylianos Kapetanakis, Jiannis Papathanasiou, Antonios Dermon, Alexandra Dimitrakopoulou, Athanasios Ververidis, Pelagia Chloropoulou and Konstantinos Kazakos
Unusual Intramuscular Lipoma of Deltoid Muscle
Lipomas are common soft tissue tumors usually located under the skin. Nevertheless, intramuscular lipomas of deltoid muscle are unusual tumors. We present a case of 74 years old woman with an intramuscular like clepsydra lipoma of deltoid muscle. The lesion was a palpable soft mass at the lateral side of the humerus. The patient had no previous history of trauma. The main symptom was pain only in abduction and extension. Imaging, pathological findings and surgical excision are discussed.