A Comprehensive Anatomical Characterization and Radiographic Study of Stage III Testicular Cancer in a 31-Year-Old Male Patient

Presented as a poster at 2020 IUSM Education Day.The purpose of this investigation was to characterize an unusual case of stage III testicular germ cell tumor (TGCT) in a 31-year-old male with metastases to nodes, bone, viscera and brain, and to understand all possible routes of metastatic disease. Testicular cancer (TC) has an increasing incidence worldwide, and its etiology, risk factors and pathogenesis are not completely understood. Medical records were reviewed, and the cadaveric specimen evaluated by physical examination and gross dissection. Paraffin embedded tissue sections of the primary tumor were stained with Hematoxylin and Eosin (H&E) for histological study. To examine metastatic spread, pre- and post-mortem digital radiologic image acquisition was done using x-ray films, and high-resolution CT Scans and MRI Scans. Image analysis, multi-planar reformatting, and three-dimensional (3-D) reconstruction were done on radiographic series. Dissection showed masses bilaterally from the apex through the lung base; masses on the internal thoracic wall, and hepatomegaly and splenomegaly with multiple tumor masses. Testicular parenchyma was composed of primitive germ cells that formed glomeruloid or embryonal-like structures, as well as areas with a micro-cystic histologic pattern and areas of fibrous dysplasia. Medical imaging 3-D video radiographic dissection was notable for a 38.45 mm diameter, mid-brain tumor; extreme hepatomegaly with numerous tumors, a large penetrating tumor of the left ilium, and multiple tumors throughout both lungs and the thoracolumbar spine (T5-S1). This study provides insight into the histology and metastatic spread of TGCT that is essential for clinicians to understand in the evaluation and treatment of TC patients

Sinistroposition: A case report of true left-sided gallbladder in a Vietnamese patient

INTRODUCTION: Left-sided gallbladder without situs viscerum inversus (LSG-woSVI) is defined as a gallbladder located under the left lobe of the liver; to the left of the round/falciform ligament, but with all other viscera maintaining normal anatomical relationships. This is a rare congenital anomaly with a reported prevalence that ranges from 0.04% to 1.1%. It is usually an incidental intraoperative finding, and can be associated with anatomic abnormalities of the biliary tree, portal system and vasculature. LSG and associated variations may present significant challenges even for experienced surgeon. PRESENTATION OF CASE: LSG-woSVI was unexpectedly discovered in a 49-year-old, Vietnamese female during laparoscopic cholecystectomy. There were no pre-operative indications of sinistroposition. The cystic duct joined the common hepatic duct on the right side, and the cystic artery crossed anterior to the common bile duct in a right-to-left direction. Antegrade cholecystectomy was performed without intraoperative or postoperative complications. DISCUSSION: LSG is a rare anatomical variation that often remains undetected with ultrasound and pre-operative tests. Several hypotheses suggest underlying embryologic mechanisms for LSG and associated anomalies in ductal, portal and vascular anatomy, but the exact cause remains a mystery. Safe laparoscopic cholecystectomy can be done; however, there is an increased risk of injury to the major biliary structures compared to orthotopic gallbladder. CONCLUSION: Laparoscopic antegrade cholecystectomy is feasible for LSG. However, surgeons need to be cognizant of anatomy, so that rapid modifications of surgical technique can ensure positive patient outcomes