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Unraveling a Thyroid Collision Tumor: A Rare Case of Concurrent Papillary and Follicular Carcinoma Gargarin Nabalah; Henky Agung Nugroho; Esti Yuniar Anggrimulya
Open Access Indonesian Journal of Medical Reviews Vol. 5 No. 3 (2025): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v5i3.713

Papillary thyroid carcinoma (PTC) represents the most common thyroid malignancy, accounting for 70-80% of cases, while follicular thyroid carcinoma (FTC) constitutes the second most prevalent differentiated thyroid cancer, comprising 10-15% of thyroid malignancies. The concurrent occurrence of PTC and FTC within the same thyroid gland, known as a collision tumor, is a rare phenomenon, posing diagnostic and therapeutic challenges. This case report aims to describe a unique presentation of this rare entity and discuss its clinicopathological features. We present the case of a 61-year-old female with a history of left thyroidectomy 25 years prior, who presented to our surgical oncology department with a palpable right breast mass. The initial workup revealed metastatic papillary thyroid carcinoma in the breast. Subsequent evaluation of the thyroid bed, including neck ultrasound and fine needle aspiration biopsy (FNAB) of a right thyroid nodule, led to the suspicion of a thyroid malignancy. The patient underwent completion thyroidectomy and central neck dissection. Final histopathological examination of the surgical specimen confirmed the rare diagnosis of a collision tumor, revealing the simultaneous presence of both PTC and FTC within the right thyroid lobe remnant. Immunohistochemical staining further characterized the distinct tumor components. The patient received postoperative radioactive iodine (RAI) ablation and thyroid hormone suppressive therapy. In conclusion, this case underscores the importance of considering the possibility of thyroid collision tumors in patients with thyroid nodules, especially in those with a history of thyroid disease or presentations of metastatic disease from an unknown primary. A comprehensive diagnostic approach, integrating clinical findings, radiological imaging, cytological examination, and detailed histopathological analysis with immunohistochemistry, is crucial for accurate diagnosis.

Unusual Presentation of Malignant Melanoma: A Case of Giant Amelanotic Involvement of the Hand Gargarin Nabalah; Henky Agung Nugroho
Open Access Indonesian Journal of Medical Reviews Vol. 5 No. 3 (2025): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v5i3.716

Malignant melanoma, a cancer originating from melanocytes, typically presents as a pigmented lesion. Amelanotic melanoma, a subtype lacking pigmentation, poses diagnostic challenges due to its varied clinical appearance. Acral amelanotic melanoma (AAM), occurring on the palms, soles, and subungual areas, is particularly rare. This case report describes an unusual presentation of a giant amelanotic malignant melanoma on the left hand, highlighting the diagnostic and management complexities. A 45-year-old male presented to the surgical oncology clinic with a three-year history of a progressively enlarging lump on his left hand. Initially small, the lesion rapidly grew in the past year, accompanied by ulceration and bleeding. Physical examination revealed an 8 cm x 6 cm x 4 cm rough-shaped, skin-colored mass with crusting and easily bleeding sores on the left palm. No axillary lymphadenopathy was noted. Histopathological examination of a biopsy sample indicated amelanotic malignant melanoma, which was confirmed by positive HMB-45 staining on immunohistochemistry. Magnetic Resonance Imaging (MRI) revealed a large soft tissue mass infiltrating the muscles of the left hand and causing bone marrow replacement in the 4th and 5th metacarpal bones. The patient subsequently underwent wrist disarticulation. Postoperative follow-up at one and six months showed good recovery without recurrence. In conclusion, this case underscores the importance of considering amelanotic melanoma in the differential diagnosis of unusual hand lesions, even in the absence of typical pigmentation. Proper histopathology and immunohistochemistry are crucial for accurate diagnosis and to rule out other malignancies. This report contributes to the limited literature on giant AAM of the hand and highlights the surgical management of this rare entity.

Temporal Dynamics of Postoperative Enterocolitis in Hirschsprung Disease: A Comparative Analysis of Earlier Onset After TAERPT versus the Duhamel Procedure Anisa Ika Pratiwi; Nunik Agustriani; Suwardi; Ida Bagus Budhi Surya Adnyana; Henky Agung Nugroho
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 1 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i1.1478

Background: Hirschsprung-associated enterocolitis (HAEC) remains the most formidable cause of morbidity in surgically corrected Hirschsprung disease (HD). While the transanal endorectal pull-through (TAERPT) and the Duhamel procedure are standard treatments, a critical knowledge gap exists regarding the timing of postoperative HAEC onset associated with each technique. This study aimed to investigate and compare the temporal dynamics of HAEC presentation following these distinct surgical reconstructions. Methods: This single-center, retrospective cohort study reviewed 64 HD patients who underwent either TAERPT (n=32) or a modified Duhamel procedure (n=32) between January 2022 and January 2023 at a tertiary referral hospital. The primary outcome was the incidence of severe HAEC (HAEC score ≥10). The principal secondary outcome was the time to onset of the first episode of mild-to-moderate HAEC (score <10). Due to the non-normal distribution of onset data, the Mann-Whitney U test was used for statistical comparison. Results: Baseline demographic and clinical characteristics were comparable between the two cohorts. The incidence of severe HAEC was 0% in both the TAERPT and Duhamel groups. All recorded complications were mild-to-moderate and managed non-surgically. A statistically significant and clinically profound difference in the timing of these complications was observed. The median onset of HAEC in the TAERPT group was 6.0 months (Interquartile Range [IQR], 3.0-6.0), which was significantly earlier than the median onset of 8.5 months (IQR, 3.0-24.0) in the Duhamel group (p < 0.001). The mean onset times were 5.50 ± 1.90 months and 16.09 ± 16.33 months, respectively. Conclusion: Although both TAERPT and the Duhamel procedure demonstrated excellent safety profiles regarding severe HAEC, their associated temporal patterns of mild-to-moderate enterocolitis are markedly different. The significantly earlier onset of complications following TAERPT suggests that postoperative surveillance strategies should be procedure-specific, with intensified clinical vigilance during the first postoperative year for TAERPT patients.

Temporal Dynamics of Postoperative Enterocolitis in Hirschsprung Disease: A Comparative Analysis of Earlier Onset After TAERPT versus the Duhamel Procedure Anisa Ika Pratiwi; Nunik Agustriani; Suwardi; Ida Bagus Budhi Surya Adnyana; Henky Agung Nugroho
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 1 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i1.1478

Background: Hirschsprung-associated enterocolitis (HAEC) remains the most formidable cause of morbidity in surgically corrected Hirschsprung disease (HD). While the transanal endorectal pull-through (TAERPT) and the Duhamel procedure are standard treatments, a critical knowledge gap exists regarding the timing of postoperative HAEC onset associated with each technique. This study aimed to investigate and compare the temporal dynamics of HAEC presentation following these distinct surgical reconstructions. Methods: This single-center, retrospective cohort study reviewed 64 HD patients who underwent either TAERPT (n=32) or a modified Duhamel procedure (n=32) between January 2022 and January 2023 at a tertiary referral hospital. The primary outcome was the incidence of severe HAEC (HAEC score ≥10). The principal secondary outcome was the time to onset of the first episode of mild-to-moderate HAEC (score <10). Due to the non-normal distribution of onset data, the Mann-Whitney U test was used for statistical comparison. Results: Baseline demographic and clinical characteristics were comparable between the two cohorts. The incidence of severe HAEC was 0% in both the TAERPT and Duhamel groups. All recorded complications were mild-to-moderate and managed non-surgically. A statistically significant and clinically profound difference in the timing of these complications was observed. The median onset of HAEC in the TAERPT group was 6.0 months (Interquartile Range [IQR], 3.0-6.0), which was significantly earlier than the median onset of 8.5 months (IQR, 3.0-24.0) in the Duhamel group (p < 0.001). The mean onset times were 5.50 ± 1.90 months and 16.09 ± 16.33 months, respectively. Conclusion: Although both TAERPT and the Duhamel procedure demonstrated excellent safety profiles regarding severe HAEC, their associated temporal patterns of mild-to-moderate enterocolitis are markedly different. The significantly earlier onset of complications following TAERPT suggests that postoperative surveillance strategies should be procedure-specific, with intensified clinical vigilance during the first postoperative year for TAERPT patients.

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