Papers by Nikolaos Salemis
Journal of Gastrointestinal Cancer, 2018
Gland surgery, 2017
Vascular tumors of the breast are rare and may pose a diagnostic challenge. Breast hemangioma is ... more Vascular tumors of the breast are rare and may pose a diagnostic challenge. Breast hemangioma is a very rare benign vascular neoplasm accounting for 0.4% of all breast tumors. It is most commonly detected as an incidental microscopic finding in biopsy specimens obtained for unrelated reasons. We describe here a very rare case of a sinusoidal breast hemangioma in a postmenopausal patient who presented with a palpable breast mass. A complete surgical resection was performed because the tumor exhibited atypical imaging features. We conclude that although in carefully selected cases of breast hemangioma a conservative management with follow up imaging is a reasonable option, in cases with atypical imaging or pathological characteristics a complete surgical resection of the vascular tumor is mandatory in order to exclude the possibility of an underlying angiosarcoma.
Journal of Natural Science, Biology and Medicine, 2016
Appendiceal mucocele (AM) is a rare clinical entity comprising 8% of all appendiceal tumors, and ... more Appendiceal mucocele (AM) is a rare clinical entity comprising 8% of all appendiceal tumors, and it is seen in 0.2-0.3% of all appendectomy specimens. Apart from sporadic cases, there are no enough published data about the incidence of synchronous appendiceal tumors in patients with colorectal cancer. We describe a very rare case of synchronous occurrence of AM, colon adenocarcinoma, and tubulovillous adenoma of the rectum and review the relevant literature. We conclude that thorough preoperative and perioperative evaluations are mandatory in patients undergoing surgery for colorectal cancer to exclude a synchronous colon or an appendiceal primary tumor. Larger prospective studies are necessary to accurately determine the incidence of synchronous appendiceal tumors and colorectal cancer.
Infectious Diseases in Clinical Practice, 2008
Radiofrequency ablation (RFA) is increasingly used in the management of patients with primary or ... more Radiofrequency ablation (RFA) is increasingly used in the management of patients with primary or metastatic liver disease and who are not candidates for curative surgical resection. A major complication of this procedure is the development of a liver abscess. We present a case of a liver abscess formation after combined resection and RFA of liver colon metastases in a 69-year-old male patient. Although the initial postoperative course was uneventful, the patient developed typical clinical and laboratory manifestations of an abscess at the ablation site 5 days later. He was treated with computed tomography-guided percutaneous drainage of the collection and intravenous antibiotics. Although rare, liver abscess formation should always be considered after RFA of metastatic colon adenocarcinoma. Patients with alterations of the biliary tree and immunocompromising conditions are at high risk of developing this major complication. Although the role of antibiotic prophylaxis remains controversial, it is, however, indicated in certain high-risk patients.
Breast disease, 2012
Myofibroblastoma of the breast (MFB) is a rare benign tumor of mesenchymal origin with only 80 ca... more Myofibroblastoma of the breast (MFB) is a rare benign tumor of mesenchymal origin with only 80 cases reported in the literature so far. It most commonly occurs in elderly males and postmenopausal females and grows slowly over a period of months to years. In this study we describe a very rare case of a MFB in a premenopausal woman who presented with a rapidly growing breast mass. Diagnostic evaluation and management of the patient are discussed along with a review of the literature. We conclude that despite its rarity, myofibroblastoma should always be considered in the differential diagnosis of mesenchymal breast tumors. No specific imaging features have been described. Thorough immunohistochemical analysis is crucial to obtain a definitive diagnosis. Local excision is the treatment of choice.
Journal of gastrointestinal cancer, 2007
Umbilical metastasis (Sister Mary Joseph's nodule) is a rare occurrence and indicates, in mos... more Umbilical metastasis (Sister Mary Joseph's nodule) is a rare occurrence and indicates, in most of the patients, an advanced intraabdominal malignancy. It may be the first sign of an underlying adenocarcinoma, originating mainly from the gastrointestinal or genitourinary tract. An extremely rare case of a Sister Mary Joseph's nodule is described herein, where the metastatic umbilical nodule was the first sign of a cecal adenocarcinoma and became evident 8 months before the onset of the disease. Diagnostic evaluation and surgical management are discussed along with a review of the literature. This case is presented in order to emphasize the need for thorough investigation of any umbilical lesion especially in elderly patients.
Breast disease, Jan 13, 2015
Florid papillomatosis (FP) of the nipple, or nipple adenoma, is a rare benign proliferative lesio... more Florid papillomatosis (FP) of the nipple, or nipple adenoma, is a rare benign proliferative lesion originating from the lactiferous ducts of the nipple. It most commonly affects women in their fourth and fifth decades of life. Clinically, in most cases FP presents with serous or serosanguinous nipple discharge while in many cases an erythematoid or eroded lesion, a nodule or a swelling of the nipple may coexist thus resembling Paget's disease. We describe a case of FP with a very unusual clinical presentation. Diagnostic evaluation and management of the patient are discussed along with a review of the relevant literature. We conclude that FP should be always considered in the differential diagnosis of patients presenting with a rapidly enlarging nipple nodule even in the absence of any skin lesions or nipple discharge. Early diagnosis and prompt treatment are essential. Simple complete excision in order to eliminate the risk of recurrence is the treatment of choice for FP. Altho...
Geriatrics & Gerontology International, 2009
Rectus sheath hematoma (RSH) presenting as acute surgical abdomen is a rare clinical entity. Fail... more Rectus sheath hematoma (RSH) presenting as acute surgical abdomen is a rare clinical entity. Failing to establish an early diagnosis will probably result in increased morbidity or unnecessary surgical intervention. We describe herein a case of an 85-year-old woman receiving anticoagulants who presented with typical clinical manifestations of acute surgical abdomen and a slightly palpable abdominal mass. Ultrasonography was inconclusive whereas computed tomography scans demonstrated a large right rectus sheath hematoma associated with hemoperitoneum. The patient was treated conservatively with success. It is therefore concluded that RSH must be considered in any elderly patient on anticoagulant therapy who presents with manifestations of acute surgical abdomen.
ANZ Journal of Surgery, 2009
Caeco-colic intussusception is a very rare complication following appendicectomy and the appendic... more Caeco-colic intussusception is a very rare complication following appendicectomy and the appendiceal stump is the lead point of the intussusception. 3 The caecal polyps causing intussusception in adults are usually malignant. 4 The aetiology of the intussusception in our patient was unique in the fact that the appendiceal stump was not the lead point and the polyp responsible was benign and not malignant. This is the first reported case of a benign caecal polyp presenting initially as acute appendicitis and subsequently as an acute intussusception, in the same patient.
ANZ Journal of Surgery, 2008
Acute colonic pseudo-obstruction (ACPO) is an uncommon clinical entity characterized by massive c... more Acute colonic pseudo-obstruction (ACPO) is an uncommon clinical entity characterized by massive colonic dilatation in the absence of mechanical obstruction. It occurs more frequently among hospitalized patients with serious underlying medical or surgical conditions and it is an important cause of morbidity and mortality. We would like to present a rare case of a giant acute colonic pseudo-obstruction with radiographic findings indicative of sigmoid volvulus. An 80-year-old man presented with a 3-day history of progressively worsening abdominal distention and constipation. His medical history was significant for ischaemic stroke and he remained in bed for the last 3months. He was also treated for a respiratory infection. Physical examination showed a massively distended abdomen with diminished bowel sounds. There was no abdominal tenderness and the patient was afebrile. A haemogram showed a haemoglobin level of 14.5 g/dL, a white cell count of 6300· 103/mL with 75.1% neutrophils, whereas biochemical tests showed hypokalaemia (2.6meq/L). A plain abdominal radiograph showed diffuse dilatation of the entire colon whereas a huge dilatation of the sigmoid measuring approximately 14 cm in diameter was also present corresponding to radiographic appearance of sigmoid volvulus (Fig. 1). Because of the imminent risk of ischaemia and perforation, a successful emergency decompression colonoscopy was carried out. The colonoscope was finally advanced to the splenic flexure through a hugely dilated sigmoid colon with mild mucosal ischaemia. A decompression tube left in place following the procedure. There was no need for repeat decompression, whereas complete colonoscopy carried out 3 days later showed dilatation of the entire colon in the absence of mechanical obstruction. The patient was discharged a month later because his respiratory infection required admittance to intensive care unit. Diagnosis of ACPO is mainly based on abdominal plain radiographs. In most cases, the most marked dilatation involves the
The American Journal of Emergency Medicine, 2009
Bacterial translocation (BT) is defined as the passage of viable bacteria from the gastrointestin... more Bacterial translocation (BT) is defined as the passage of viable bacteria from the gastrointestinal tract, across the intestinal wall, to the mesenteric lymph nodes or other extranodal sites and bloodstream. It has been shown in both animal and human studies and has been implicated as a source of sepsis in susceptible patients. Herein, a rare case of acute appendicitis in a nonimmunocompromised patient who presented with manifestations of Klebsiella pneumoniae septicemia, is described. Translocation of Klebsiella pneumoniae through the compromised appendix mucosa leading in dissemination of the infection into the bloodstream was likely the main causative factor for the atypical and toxic presentation of acute appendicitis. Thorough clinical investigation ruled out other sources of infection. Emergency physicians should be aware that septicemia may be the dominant presentation of acute appendicitis, due to dissemination of the infection into the bloodstream, secondary to bacterial translocation.
Intractable & Rare Diseases Research, 2021
The synchronous occurrence of primary breast cancer and lymphoid tissue malignant tumors has been... more The synchronous occurrence of primary breast cancer and lymphoid tissue malignant tumors has been rarely reported in the literature. We present an exceedingly rare case of synchronous breast invasive ductal carcinoma with an abdominal diffuse large B-cell lymphoma (DLBCL). A 78-yearold woman who was diagnosed with a luminal A invasive breast cancer on core biopsy, and complaint of progressively worsening low back pain. An abdominal computed tomography (CT) scan that was performed as part of the preoperative staging showed a large abdominal mass measuring 10.5 × 4.8 × 9.5 cm surrounding the lower part of the abdominal aorta, the right common iliac, right external, right internal iliac, and the left internal iliac arteries. A CT-guided fine-needle aspiration biopsy (FNAB) of the abdominal mass was then performed, to exclude the possibility of being an abdominal tumor metastasis of the known primary breast cancer. Histopathological findings were suggestive of DLBCL. Following a multidisciplinary team discussion, chemotherapy was initiated for DLBCL. The tumor however was refractory to multiple chemotherapy regimens and exhibited a highly aggressive clinical course. The diagnostic evaluation and management of the patient are discussed, along with a review of the relevant literature. This case underscores the fact that the presence of synchronous malignancies may pose both diagnostic and treatment challenges. Accurate staging of both malignancies and multidisciplinary team discussion is of utmost importance to guide an optimal therapeutic approach. Histopathological evaluation is essential for both tumors, for the second malignancy not to be misinterpreted as a secondary deposit of the primary one.
Diagnosis and surgical approach of popliteal artery entrapment syndrome: a retrospective study
Tubular adenomas, also known as pure adenomas, are rare epi-thelial tumors of the breast. Only a ... more Tubular adenomas, also known as pure adenomas, are rare epi-thelial tumors of the breast. Only a few cases have been reported in the literature, especially in young women of reproductive age. Postmenopausal women are very rarely affected. We describe here a very rare case of tubular breast adenoma in a postmenopausal woman who presented with a gradually enlarging breast lump. Clinical examination and imaging studies revealed a non-tender well circumscribed left breast tumor suggestive of a fibroadenoma. Due to the history of progressive enlargement of the breast lump, a surgical excision was performed. Histological findings were sug-gestive of a tubular breast adenoma. We conclude that although tu-bular breast adenoma is rare, it should always be considered in the differential diagnosis in postmenopausal patients presenting with a gradually enlarging breast mass. Preoperative diagnosis is difficult because tubular adenoma is indistinguishable from a fibroadenoma on physical examinat...
Intractable & Rare Diseases Research, 2020
neuroendocrine, carcinoma, breast Primary neuroendocrine carcinoma of the breast (NEBC) is a very... more neuroendocrine, carcinoma, breast Primary neuroendocrine carcinoma of the breast (NEBC) is a very rare occurrence accounting for less than 0.1% of all breast cancers. Typically, the tumor presents with ER-and PgR-positive and HER-2-negative status. Despite its luminal type, NEBC is associated with a more aggressive clinical course and poorer prognosis compared to the other types of invasive breast cancer. Clinical and radiological findings are nonspecific. The most common clinical manifestation is a palpable mass whereas in mammography the tumor most commonly appears as a round or oval mass without spiculated margins. Herein, a very rare case of NEBC is described in an asymptomatic patient who presented with an area of architectural distortion and the presence of microcalcifications that was incidentally detected on a screening mammography. A review of the literature has also been conducted. The diagnosis of NEBC requires a thorough investigation to exclude the possibility of a metastatic neuroendocrine tumor from another site because the two entities require different treatment approaches. Due to the rarity of the disease, the optimal therapeutic approach has not been clearly defined. Surgical resection is the mainstay of treatment. Further research is needed to better understand the molecular characteristics of NEBC and identify novel targeted therapies.
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Papers by Nikolaos Salemis