Islam H. Metwally

Meckel’s diverticulum complicated with gastro-intestinal stromal tumor: Case report

INTRODUCTION Meckels diverticulum is a common congenital anomaly, mostly asymptomatic. Tumors may arise rarely in these diverticulae. We claim presenting a new problem to the medical staff in Egypt. CASE PRESENTATION We report a case of a 49year old male patient who attended our center with pelvic mass insinuated between the bladder and the rectum. On exploration the mass was found arising at the tip of a Meckels diverticulum, Gastro-intestinal stromal tumor (GIST) was confirmed by pathology. DISCUSSION In review of recently published cases most of these tumors were presented with vague abdominal pain as in our case. Tumors were treated by resection with or without adjuvant Imatinib. CONCLUSION Surgeons and oncologists should bear in mind this rare diagnosis and know how to treat it.

Primary ovarian carcinoid: A report of two cases and a decade registry

OBJECTIVES This study aims at reporting 2 cases of primary ovarian carcinoid tumor, and providing an adequate registry of such cases and how they were managed. METHODS 2 female patients with primary ovarian carcinoid were diagnosed and treated in our center. Discussion of their presentation, pathology and treatment is entitled. Also a thorough search of all published registries and case reports of ovarian carcinoid was done with analysis of reported data. RESULTS 164 cases of primary ovarian carcinoid tumor were detected since 2005 with the predominance of the insular variant. Carcinoid syndrome occurs in nearly 14% of these cases. Most of the cases were treated with hysterectomy. Unfortunately, the prognosis was not documented in most series. CONCLUSION Primary ovarian carcinoid is a relatively rare disease with an indolent course and excellent outcome. Carcinoid syndrome, especially carcinoid heart disease may worsen the prognosis. Total abdominal hysterectomy with bilateral salpingo-oophorectomy has been commonly used as the treatment of choice of primary ovarian carcinoid tumors.

Transanal Total Mesorectal Excision for Rectal Cancer: Short Term Outcomes from Two Centers

BACKGROUND Rectal cancer is now an increasing problem in both developed and developing countries. In the last 7 years, minimally invasive surgery for this disease has entered a new era of transanal resection with/without laparoscopic assistance. MATERIALS AND METHODS We present here a prospective study done in Egypt (probably the earliest experience) and Spain on the feasibility of hybrid NOTES in rectal cancer. RESULTS From September 2015 till November 2017, 18 cases underwent transanal total mesorectal excision with no detected mortality and with morbidities in 44% of cases, from which 5 were class III on Clavien-Dindo scale requiring intervention. Good quality total mesorectal excision was obtained in more than three quarters of our patients. CONCLUSIONS In our experience, the technique was technically demanding with a long learning curve; however, the short term results were very good in alliance with other few similar reports.

Redo transanal total mesorectal excision (Re-TaTME) after initial TaTME; is it possible?

Rectal cancer is one of the commonest human malignancies. Treatment of this serious disease conventionally involves resection with/without anastomosis. Anastomotic site stenosis is a serious complication of rectal resection for which treatment is still evolving. We report a male patient treated with minimally invasive abdominal and anal approach for stenosis after initial transanal total mesorectal excision (TaTME) for rectal cancer. Surgeons are encouraged to put this technique in their mind while treating similar cases.

Ovarian cancer with metastatic inguinal lymphadenopathy: A case series and literature review

BACKGROUND Ovarian cancer is the 4th commonest cancer among Egyptian women. It can spread through 3 different lymphatic pathways to para-aortic/paracaval lymph nodes, to pelvic lymph nodes and only occasionally through the round ligament of the uterus to the inguinal nodes. These rare cases are staged IVb on FIGO system. PRESENTATION We present a series of 4 cases of ovarian cancer metastasizing to inguinal nodes. The literature review revealed only 17 published similar cases. Management controversies as well as prognosis are discussed in our study. CONCLUSION Inguinal metastasis from ovarian cancer seems more frequent than previously thought. Examination of inguinal region should be mandatory in all cases diagnosed with ovarian cancer.

Resection of rectal GIST using a novel technique: a report of two cases

Rectal gastrointestinal stromal tumours (GISTs) are uncommon tumours and usually present with large sizes. We present two cases of rectal GIST. Imatinib was used in the setting of neoadjuvant and adjuvant therapy. Both tumours were resected transanally by the transanal endoscopic operation (TEO) platform. Oncosurgeons are recommended to implement sphincter-sparing surgeries for these cases.

Huge lactating adenoma of the breast: Case report

INTRODUCTION Lactating adenoma is the commonest benign breast lesion seen during pregnancy and puerperium. It is commonly seen in young primigravideous women in the second or third decade during the third trimester of their pregnancy. Occasionally, lactating adenoma is large and rapidly growing and must be differentiated from malignant breast masses that could be seen during pregnancy and lactation. The diagnosis is usually established by cytological and histopathological examination. CASE PRESENTATION Here we have presented a rare case with huge lactating adenoma arising in the left breast of 38 years old Egyptian multiparous lady during lactation. Enucleation of the mass was done with good aesthetic outcome. CONCLUSION The case we have presented was unique in its huge size and in being diagnosed in a multiparous lady and furthermore it was successfully treated by enucleation without any need for reconstruction.

Metastatic neuroendocrine tumor of soft tissue: a case report

Neuroendocrine tumors (NETs) are relatively rare tumors arising from neural crest cells, mainly in the gastrointestinal tract and lung. Soft-tissue NETs have been occasionally reported in the literature. To our knowledge, we report the first case in the Middle East and the sixth case in the literature of a metastatic NET arising in the thigh. An Egyptian lady in the sixth decade of life came to our hospital with a NET in the thigh, metastatic in both the lung and the iliac region. Staged resection of the primary tumor followed by the nodal metastasis was done after a short period of neoadjuvant chemotherapy and Sandostatin. Diagnosis of these cases is difficult and no studies addressing their management are available. Our approach, pathological findings, and prognosis are discussed in comparison with previously registered cases worldwide. Surgical oncologists should bear in mind that NETs may occur in soft tissue and that surgical treatment is the only known effective treatment.