Matthew J. Blecha

External iliac artery dissection secondary to endofibrosis in a cyclist

Endofibrosis of the external iliac artery is an uncommon disease affecting primarily young, otherwise healthy, endurance athletes. Thigh pain during maximal exercise with quick resolution postexercise is characteristic of the so-called cyclists iliac syndrome. We report an unusual case in which the typical endofibrotic plaque was accompanied by dissection of the external iliac artery. The patient was treated surgically with excision of the affected artery segment and placement of an interposition graft. This case highlights an unusual finding in association with external iliac artery endofibrosis and provides an opportunity to briefly review the literature on the subject.

Primary Pulmonary Synovial Sarcoma

Primary sarcoma of the lung and/or pleural cavity is a rare finding accounting for <0.5% of all thoracic malignancies. Histologically, mesothelioma predominates in this subcategory of neoplasms; its relationship to asbestos exposure and cigarette smoking is well documented. Other tumor types include fibrosarcoma, malignant fibrous histiocytoma, angiosarcoma, leiomyosarcoma, synovial sarcoma, and Ewing sarcoma. Standard evaluation with bronchoscopy and radiographically guided biopsy are frequently nondiagnostic and require open biopsy to provide an adequate tissue sample.

Spontaneous Rupture of a Saccular Intrahepatic Artery Aneurysm

Hepatic artery aneurysms are the second most common visceral aneurysm but are still relatively uncommon. Over the last century, methods for treating these lesions have evolved substantially. The presented case covers the presentation, diagnosis, and treatment of a 65-year-old woman with an aneurysm of the intrahepatic portion of the hepatic artery. This case demonstrates the variety of techniques available for managing these lesions and the importance of both a thorough knowledge of the available treatments and the flexibility to switch among them when necessary.

Case Report of a Ureterocutenous Fistula Post Aortobifemoral Bypass Graft Removal in a Patient With Obstructive UPJ Calculus

Ureterocutaneous fistulas are rare, often iatrogenic complications. We present a case of a 60 year old woman suffering a ureterocutaneous fistula in association with an infected vascular graft. Percutaneous diversion of urinary fluid with a nephrostomy tube is an acceptable form of management.

Esophageal adenocarcinoma with solitary renal metastasis.

Esophageal cancer is a less common malignancy of the gastrointestinal tract and continues to have a dismal prognosis despite screening programs for high-risk patients. Patients frequently present with advanced disease, and 5-year survival is 18.1 % on average [1]. Of esophageal cancers in the USA, 59 % are adenocarcinomas, while squamous cell lineages represent another 34.5 % [1]. Metastases are common at the time of presentation with 18–50 % of patients having distant or unresectable disease [1–3]. Despite poor overall survival, surgical resection remains a mainstay of curative therapy for esophageal cancer [4]. Most esophageal tumors are responsive to chemotherapy or combined chemoradiotherapy, and thus neoadjuvant therapy is recommended for patients with node-positive disease and those found to have T3 tumors on preoperative endoscopic ultrasonography. This treatment results in down-staging the primary tumor and eventual resection [2]. In practice, 40– 63 % of patients who undergo curative esophagectomy ultimately develop recurrence of their disease [4–7]. The median time to recurrence is 11–12 months [4, 5]. The pattern of esophageal cancer recurrence and metastasis is of interest given the emphasis on surgical treatment of these patients and the ongoing controversy as to whether an interventional approach to recurrence offers any survival benefit compared to symptomatic treatment [4, 5]. Visceral metastases and recurrences, including the kidney, are common [3, 6, 8–11]. Most metastases, however, are small, multiple, and bilateral [7, 9, 11, 12]. Solitary, isolated metastases from any cancer to the kidney are rare [12, 13]. There have been occasional reports of renal metastases from esophageal squamous cell carcinoma, but not from esophageal adenocarcinoma as is reported in this case [7, 9, 11, 14].