Diverticulosis has become a common condition in developed

Diverticulosis has become a common condition in developed countries, and its prevalence increases with age. Diverticulosis may occur anywhere in the gastrointestinal tract, with the sigmoid region accounting for > 85% of the cases. Diverticulitis, an infection of the diverticula, can lead to hemorrhage, abscess, or fistula development, and bowel obstruction or perforation.1Among these, fecal peritonitis is the most severe complication, carrying a mortality of 40–70%. The optimal management strategy for treating sigmoid diverticulitis with a perforation is Hartmann\'s procedure. An attempt to suture a perforation because of a diverticular disease in the sigmoid colon is likely to fail, because the tissues are edematous and an established abscess cavity is often present as well. Thus, the chance that peritoneal contamination by fecal organisms occurs is considerably high. Mortality from oversewing a sigmoid perforation varies from 5% to 46%. There is also a high incidence of postoperative fistula following this procedure, with 19% in an Australian audit and 100% in Colcock\'s series. We considered the unstable hemodynamic condition of the patient in our report, and he received a laparoscopic simple closure; his postoperative course was uneventful.
Introduction The term phyllodes is derived from the Greek word phyllon (meaning leaf) and refers to a rapidly growing, large breast tumor that can cause breast distortion and pressure necrosis of the overlying skin. The tumor appears leaflike in cross section and originates from the periductal stromal purchase Homoharringtonine of the breast. Such tumors account for <1% of all breast neoplasms. Invasive carcinoma arising in malignant phyllodes tumors (PTs) has been reported in previous studies. In this paper, we present a rare case with the initial impression of PT. The final diagnosis was invasive ductal carcinoma and ductal carcinoma in situ arising in a borderline PT.
Case report A mammography showed a high-density mass approximately 6.6 cm in length with an obscured margin over the upper outer quadrant of the left breast (Fig. 1). An ultrasonography revealed a well-defined, lobulated, and hypoechoic mass, approximately 6 cm × 4 cm in size, in the left breast without enlarged lymph nodes over the bilateral axillary region (Fig. 2). A histological study revealed a well-circumscribed tumor with a focal infiltrative border composed predominantly of fibroadenoma-like areas focally arranged in a leaflike architectural pattern created by extensive branching of the epithelial component. In addition, stromal hypercellularity with spindle-cell nuclei was found (Fig. 3). The mitotic activity was increased with moderate cellular pleomorphism. The ductal epithelia exhibited a variable degree of hyperplasia. Several ducts were arranged as invasive islands, often angulated, in which well-defined spaces were formed by arches of cells (a sieve-like or cribriform pattern). Part of the tumor was composed of a single layer of epithelial cells enclosing a clear lumen. These tubules were generally ovate or rounded. The tumor cells were small and regular with little evidence of nuclear pleomorphism. Mitoses were clearly observed in several areas. In addition, a prominent reactive-appearing fibroblastic stroma was present. The formal pathology report stated that the tumor consisted of Grade 1 invasive ductal carcinoma and cribriform type, intermediate grade, borderline in situ ductal carcinoma arising in a PT, with the largest invasive carcinoma being 2.5 cm × 1 cm in size. The carcinoma component stained 99% for estrogen receptor, 90% for progesterone receptor, and 1+ for HER2/neu (Fig. 4). The absence of basal myoepithelial lining was confirmed by negativity for p63. The surgical margin was <1 mm from the PT.
Discussion PTs are fibroepithelial tumors composed of epithelial and cellular stromal components. They were first described by Johannes Mueller in 1838. Histologically, they may be considered benign, borderline, or malignant, depending on certain features including degree of stromal cellular atypia, type of tumor margin (infiltrative vs. circumscribed), mitotic activity, and the presence or absence of stromal overgrowth.