Giant cell tumors usually arise in the epiphyseal region of the limbs, and their occurrence in the ribs is unusual. We presented a case of a 26-year-old male with a 2 years progressively growing lump on his right anterolateral chest. There was no pain and cardiopulmonary symptoms. Chest radiograph revealed an osteolytic lesion over the right 10^th rib with chondroid matrix and a wide transition zone that grew expansively accompanied with the destruction of the 10^th rib. Abdominal computed tomography scan confirmed a soft-tissue mass with 15 cm × 11 cm × 10 cm in dimension with the destruction of anterolateral 10^th rib. The patient underwent en bloc-wide excision, including the 9^th–11^th ribs, followed by diaphragm repair and chest wall reconstruction.

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Despite the high resolution of modern imaging technology including computed tomography and magnetic resonance imaging, cystoscopy remains the gold standard method for detecting bladder cancer. Cystoscopy is conventionally conducted with white light visualization, and the pitfalls of white light cystoscopy are well-recognized. Novel technologies to enhance visualization of bladder lesion have emerged during the past 20 years. Among them, blue-light cystoscopy (BLC) and narrow-band imaging (NBI) are the most promising and well-studied. Many clinical trials have suggested the benefit of these two technologies. In this review, we aim to summarize the data, evidence, and current role of BLC and NBI in clinical practice.

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Splenic congenital anomalies are many. Wandering spleen (WS) is a rare anomaly account for about 0.2%. It is usually associated with absent or maldevelopment of one or all splenic ligaments that hold the spleen in its place. A 15-year-old girl had complaints of repeated attacks of mid-abdominal pain for the last month. Abdominal examination revealed a central fixed and slightly tender abdominal mass in the umbilical region. Complete blood count revealed platelets (790 × 10³/mL), white blood cells (9700 × 10³/mL), and hemoglobin (8 g/dL), and other investigations were normal, but unfortunately ultrasound and computed tomography report revealed WS. Abdominal exploration revealed the spleen not in the anatomical place, and there is a mass in the umbilical region surrounded by dense adhesions. The adhesions were released and this mass discovered to be WS, splenectomy was done. Vaccination against pneumococci and Haemophilus influenza were given, and the patient discharged uneventfully on the fourth postoperative day. Asymptomatic WS could be found incidentally during surgery or during abdominal imaging for any reason. Furthermore, WS can present with an acute abdomen or recurrent abdominal pain. The only treatment is surgery even in asymptomatic cases because of the high possibility of complications. Splenopexy can be done if the spleen showed no torsion or splenomegaly or hypersplenism otherwise splenectomy is the second option.

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Thymoma is an uncommon neoplasm that derived from thymic epithelial cells. Clinically, it is slow-growing and most patients are over 40 years old. Thymoma corresponds to 30% of anterior mediastinal tumors in adults but <1% in pediatric patients. However, thymoma in pediatric group is considered to be highly aggressive. We report a case of invasive thymoma in a 3-year-old girl, presented as respiratory distress with massive pleural effusion. She developed a superior vena cava syndrome soon after admission. A subsequent computed tomography demonstrated a large mediastinal mass with compression of great vessels. Due to the rare occurrence of thymoma at such a young age, an accurate diagnosis was made only after an open biopsy had been performed. The patient underwent a near-complete resection of the mass as well as adjuvant chemotherapy. She has remained well at the 6-year follow-up.

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Cowden syndrome (CS) is a rare genetic disease which puts patients at an increased risk of developing mucocutaneous lesion, multiple hamartomas, breast cancer, thyroid cancer, and Lhermitte–Duclos disease (LDD). This article reviews the role of LDD in the diagnosis of CS. It is important for all clinicians to identify these patients due to the high risk of other associated malignancies.

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Background: Source control (SC) procedure aiming to control the morbidity and mortality is essential in managing complicated intra-abdominal infection (cIAI). This study aims to review factors influencing the outcome of SC in cIAI cases at Cipto Mangunkusumo Hospital. Methods: CIAI patients undergoing SC procedure in 2017 in our hospital were retrospectively reviewed. Prevalence, etiology, demography, types of procedure, and outcomes were the variables subjected to analysis. Results: There were 110 (11.7%) cIAI cases of 945 abdominal surgeries, comprised of 74 (67.3%) males and 36 (32.7%) females. Median age was 43.9 years, including 24.5% participants aged >60 years. The most common etiology of mortality in cIAI was postoperative infection (POI) (36.4%), and the most frequently affected organ was lower gastrointestinal tract (GIT) (23.6%), especially colon which contributed to high mortality rates (34.6%). Operative mortality in participants who underwent drainage and debridement was 36% and 16.5%. Klebsiella pneumonia (36%) and Candida spp. (28.6%) infections were found in patients with poor outcome. Overall mortality was 20.9%. Conclusions: High rates of operative mortality commonly happened in emergency cases, relaparotomy, and cases treated with definitive procedure. Lower GIT cases had the highest frequency of cIAI. POI was the most common indication of SC procedure. Candida spp. and Klebsiella pneumonia infections were the most frequent organisms found with poor outcome. SC surgery was performed in all cIAIs.

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Background: Robotic nipple-sparing mastectomy (R-NSM), which uses the da Vinci surgical platform (Intuitive Surgical, Sunnyvale, CA, USA), could perform NSM and immediate breast reconstruction through small and inconspicuous extramammary axillary incision. Its application in the management of early breast cancer or risk-reducing mastectomy had been reported in some series and a growing number of R-NSM were performed worldwide. The authors would like to present a single-center experience of R-NSM as well as review of the current literature.Materials and Methods: The medical records of patients who underwent R-NSM for breast cancer during the period from March 2017 to July 2018 were retrieved from a prospectively collected database. A review of case series of R-NSM in the current literature were also performed through the PubMed database to determine the effectiveness and oncologic safety of R-NSM.Results: A total of 37 breast cancer patients who received 46 R-NSM procedures were included in the study. Thirty-nine cases (84.8%) were performed for therapeutic purpose. No R-NSM procedure was converted to conventional or endoscopic mastectomy. One (2.6%, 1/39) R-NSM procedure was found to have positive margin involvement. The rate of total nipple-areolar complex (NAC) necrosis was 0%, and no implant loss or local recurrence was observed during a mean follow-up of 10.9 ± 8.2 months. In the joint collective analysis and review of the current literature, a total of 138 R-NSM procedures were available for analysis, and 59 of them were for therapeutic indications. The overall conversion rate was 2.2% (3/138), total NAC necrosis rate was 0%, implant loss rate was 0.8% (1/128), and margin involved rate was 1.7% (1/59). No local recurrence case was reported.Conclusion: From our preliminary experience and review of the current literature, R-NSM is a feasible and safe alternative for NSM in the management of breast cancer. The long-term oncological outcomes, however, will only be determined with longer follow-up.

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This study aimed to review pediatric cases of acute gastric volvulus, explore the distinguishing features, and outline the diagnosis and management of this life-threatening condition. We searched PubMed, ScienceDirect, and Ovid Medline in March 2018 for cases of gastric volvulus in the pediatric age range (<18 years). Citations that were not published in English, or did not discuss gastric volvulus mainly in its topics, or that it included reports only on cases of adults, or abstract only were excluded from the search. All relevant articles were accessed in full text. The manual search included references of retrieved articles. We extracted data on patients' age, gender, and presentation of acute or chronic, volvulus-type, clinical presentations, associated pathologies, diagnostic tools, and treatment. We analyzed the data and reported the results in tables and text. There have been 63 cases of gastric volvulus in the pediatric group published in English between 1979 and 2017, with a total of 65 cases by adding our two cases. We divided the 37 acute cases for investigation. Cases' ages ranged from newborn to 18-year-old adolescents, with 14 cases (37.8%) in mesenteroaxial axis, 15 cases (40.5%) in organoaxial type, and one in combine type. The most common symptom is emesis, which was counted in 25 cases, with a ratio of 67.6%, abdominal pain or distention in 17 cases (45.9%), and pulmonary symptoms were observed in 10 cases. In the associated pathologies, congenital diaphragmatic hernia (CDH) is the most commonly associated pathology, which was counted in 15 cases (40.5%). Within the 37 cases, 7 cases (18.9%) underwent laparoscopic surgery and 30 cases (81.1%) underwent laparotomy. Gastropexy was performed in 19 cases, and 17 cases underwent a repair of CDH. One case underwent gastric reduction, repair of congenital heart disease, and perforation, but this patient ultimately died of gastric perforation-induced sepsis. Surgical intervention is always applied to an emergency treatment of acute gastric volvulus, and laparoscopic, even single port surgery, is also a choice for these patients.

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