Annali italiani di chirurgia
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Review Case Reports
Adductor canal compression syndrome: a forgotten disease.
Superficial femoral vessels entrapped at the level of the adductor canal are rarely described. We first report the case of a young patient who practices professional soccer, affected with superficial femoral vein and artery occlusion due to a hypertrophied vastus medialis and adductor magnus at the Hunter's canal outlet. A careful literature search through MedLine was performed to elucidate the fascinating aspect of this occurrence.
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Extragonadal teratomas are rare tumors in neonates and infants and can sometimes show unusual, distinctive feature such as an unusual location, a clinical sometimes acute, presentation and a "fetiform" histotype of the lesion. We have extrapolated, from our entire experience of teratomas, 4 unusual cases, mostly operated as emergencies; 2 of them were treated just after birth. Aim of this paper is to report the clinical and pathological findings, to evaluate the surgical approach and the long-term biological behaviour in these cases, in the light of survival and current insights reported in the literature. ⋯ Some extragonadal teratomas of childhood of may rarely arise in the solid organs (liver, kidney), in the retroperitoneal space or the cranio-facial region, and also show unique histotype childhood characteristics ("fetiform") which distinguish them from more common cases. Being congenital tumours, prenatal diagnosis by US scan is extremely important in order to organize proper perinatal care in appropriate facilities where it is possible to define the diagnosis and carry out emergency surgery. An emergency procedure is frequently dictated both by complications related to the mass eddect and by the need to define the histology of the whole mass rather than just small biopsy specimens, Some teratomatas can hide more or less extensive islands of immaturity signs of malignant transformation that are clinically evident. It should be remembered that high serum levels of alpha-fetoprotein and calcficationof the imaging study, that are usually pathognomonic elements for fiagnosis, nay be lacking in abdominal lesions. Moreover, some additional specific diagnostic problems can be faced by either the radiologist (differential diagnosis from acquired or congenital cystic lesions, identification of the primary site of origin in the liver kidney or retroperitoneal space). Or the histopathologist (exclusion of renal metastasis of a primary gonadal teratomas of a glomerular and tubular differentiation a Wilm's tumour). The prognosis is generally benign, although the AIEOP guideline pointed out that high levels of circulating markers, including AFP, in children affected by mature or immature teratomas, could indicate rhe presence of micro-foci of YST, marking them out as at high risk. The UKCCSG II and the SFOP indicates AFP values exceeding 10,000 ng/ml as the threshold identifying a group of patients with a severe prognosis. The treatment indicated is early, complete exeresis, followed by a careful, exstensive, microscopic examination, associated, if necessary, with adjuvant chemotherapy. Finally, to improve the prognosis, close, long-term clinical, laboratory and imaging surveillance is necessary, at shorter intervals during the first 5 years after the exeresis and annually thereafter.