Journal of Surgical Academia

Hypercalcaemic Paraneoplastic Syndrome in a Young Woman with Malignant Phyllodes of the Breast: A Case Report

2025-12-02T09:49:16+00:00

Paraneoplastic syndromes, though uncommon, present systemic effects secondary to primary malignancies or metastases. We presented a case of a 25-year-old nullipara with a left breast malignant phyllodes. Pre-operative investigations revealed hypercalcaemia. Her staging computed tomography scan did not demonstrate any enlarged parathyroid gland. Her serum intact parathyroid hormone level was not raised. After correction with saline hydration, she underwent a left mastectomy, axillary dissection and a supercharged bipedicle TRAM flap. The following day, due to flap congestion, she underwent flap exploration but unfortunately, the flap necrosed. She required temporary coverage with a split-skin graft to allow her post operative sepsis to resolve. She underwent a delayed extended latissimus dorsi myocutaneous pedicled flap for chest wall closure. The cause of hypercalcemia was attributed to be a paraneoplastic syndrome which has not been reported previously in a malignant phyllodes tumor. The hypercalcaemia is postulated to have caused the thrombosis leading to flap failure

Dual Pathology Breast Carcinoma: A Report of Two Cases

2025-12-02T09:50:07+00:00

Dual pathology breast carcinoma, whether unifocal, multifocal or multicentric may significantly impact patient prognosis. Certain histological combinations are associated with favourable outcomes, while others may indicate a more aggressive disease. We presented a report of two women with different pathological combinations. The first case had multicentric cancers of the left breast. She underwent neoadjuvant chemotherapy, then nipple-sparing mastectomy with axillary dissection and immediate transverse rectus abdominis myocutaneous (TRAM) breast reconstruction. Histopathological assessment revealed a combination of metaplastic carcinoma and invasive micropapillary carcinoma; both aggressive subtypes. Post adjuvant radiotherapy, she remained disease-free for five years. The second case had a unifocal right breast cancer managed with breast-conserving surgery and sentinel lymph node biopsy. Histopathology revealed a combination of invasive carcinoma of no special type (NST) and invasive papillary carcinoma. These subtypes are associated with a more favourable prognosis. Post radiotherapy and on endocrine therapy, this patient remains well at 2 years follow-up. These cases demonstrate the prognostic variability in dual histopathology breast cancers and highlights the importance of individualised treatment. Both patients remain disease free despite having dual pathology breast carcinoma which seem to suggest a more aggressive disease behaviour.

Laparoscopic Salvage of Percutaneous Endoscopic Gastrostomy Tract Dehiscence Following Blind Reinsertion: A Case Report

2025-11-26T11:13:37+00:00

Percutaneous endoscopic gastrostomy (PEG) is a commonly performed and generally safe method for long-term enteral nutrition. Nevertheless, accidental dislodgement is a well-recognised complication, and premature or unguided reinsertion may result in severe morbidity. We described a 60-year-old man with a history of cerebrovascular accident who developed peritonitis following blind reinsertion of a dislodged PEG tube. Diagnostic laparoscopy revealed partial tract dehiscence and intraperitoneal contamination, necessitating laparoscopic refashioning and peritoneal lavage. His postoperative course was complicated by recurrent dislodgement and stomal stenosis, successfully managed with endoscopic reinsertion under direct visualisation. Blind reinsertion of PEG tubes carries significant risk even in apparently mature tracts. Laparoscopy provides both diagnostic confirmation and therapeutic control in cases of tract dehiscence or peritonitis. Image-guided or endoscopic techniques should be prioritised to minimise recurrence and ensure safe re-establishment of enteral access. Early recognition and image-guided management are essential to prevent peritonitis and preserve long-term enteral access. Laparoscopy remains the preferred modality for both diagnosis and salvage in complex PEG-related complications.

Prostatic Artery Embolisation for Refractory Haematuria in Advanced Prostate Cancer: A Case Report of PSA Normalisation

2025-11-26T08:55:55+00:00

Prostatic artery embolisation (PAE) is a well-established minimally invasive procedure for the management of lower urinary tract symptoms secondary to benign prostatic hyperplasia. In patients with advanced prostate cancer, its primary role has been palliative, particularly for controlling refractory haematuria. However, emerging evidence suggests that PAE may offer additional cytoreductive benefits. We presented the case of an 85-year-old male with advanced prostate cancer and multiple comorbidities, including severe aortic stenosis and stage 4 chronic kidney disease, who developed refractory gross haematuria unresponsive to conservative management. Due to high surgical risk, bilateral PAE was performed via a single right femoral artery access. The procedure resulted in complete resolution of haematuria, allowing early catheter removal. Remarkably, his prostate-specific antigen (PSA) declined from 5.28 ng/mL to 0.45 ng/mL over seven months, in the absence of systemic therapy. The patient remained haematuria-free with improved voiding symptoms. This case highlights the effectiveness of PAE for haemostatic control in advanced prostate cancer and suggests potential cytoreductive effects, evidenced by sustained PSA normalisation. PAE may serve a dual role in symptom control and disease modulation in patients unsuitable for surgery or systemic therapy. Further studies are warranted to explore its oncologic impact.

Giant Placental Chorioangioma: An Unusual Cause of Adverse Foetal and Neonatal Outcome

2025-11-26T11:17:40+00:00

Chorioangioma is the most common benign tumour of the placenta, accounting for 1% of the pregnant cases. Giant chorioangiomas are known to be correlated with a higher rate of adverse fetal and neonatal complications, including fetal cardiac failure, fetal anemia, hydrops, intrauterine death and neonatal demise. Early detection and serial ultrasound monitoring are essential for timely intervention to ensure a favourable pregnancy outcome. We report a case of giant chorioangioma complicated with polyhydramnios with poor fetal and neonatal outcome.