Valentino syndrome is a rare condition where a perforated peptic or duodenal ulcer presents as right iliac fossa pain, mimicking acute appendicitis. We report the case of an 18-year-old male presenting with a one-day history of abdominal pain, initially in the upper abdomen and later localised to the right iliac fossa. Clinical examination revealed tenderness and guarding in the right iliac fossa. Ultrasonography suggested an inflamed appendix with minimal free fluid, raising suspicion for appendicitis. However, diagnostic laparoscopy revealed bilious purulent fluid and a grossly normal appendix. Further exploration identified a prepyloric perforation, which was repaired with a modified Graham's patch. The patient had an uneventful recovery and was discharged on postoperative day 5. This case highlights Valentino syndrome as a critical but under-recognised differential diagnosis in patients presenting with right iliac fossa pain. Awareness is essential to avoid misdiagnosis and unnecessary appendectomy. Prompt surgical intervention remains the cornerstone of management.
Background: The role of upfront surgery in magnetic resonance imaging-defined cT3 rectal cancer with uninvolved circumferential resection margin remains debatable despite increasing evidence from MERCURY, OCUM, and QuickSilver. We evaluated long-term oncologic and survival outcomes of this approach. Materials and Methods: This single-center cohort included 144 patients with cT3a–cT3c rectal adenocarcinoma ≤12 cm from the anal verge, negative extramural vascular invasion, and uninvolved circumferential resection margin on magnetic resonance imaging who underwent curative resection between January 2018 and April 2022. All patients were evaluated by multidisciplinary team consultation. Only patients with at least 36 months of follow-up were analyzed. The endpoints included local recurrence, distant metastasis, overall survival, and disease-free survival. Results: During a median follow-up interval of 56 months (interquartile range, 42.75–68), a total of seven patients (4.9%) had local recurrence and 15 (10.4%) had distant metastasis. The 3-, 5-, and 7-year cumulative local recurrence rates were 3.6%, 5.3%, and 5.3% ( P = 0.97, stage II vs. III). Corresponding distant metastasis rates were 8.5%, 11.6%, and 11.6%, significantly higher in stage III ( P = 0.009). Overall survival at 3, 5, and 7 years was 94.4%, 88.2%, and 78.9% ( P = 0.13), whereas disease-free survival was 87.5%, 82.3%, and 78.8% ( P = 0.056). Conclusions: Among patients with cT3a/b/c rectal cancer, negative extramural vascular invasion, and uninvolved circumferential resection margin on magnetic resonance imaging, upfront laparoscopic surgery yielded encouraging oncologic and survival outcomes. These findings support surgery-first as a viable option in high-volume centers with structured multidisciplinary team programs, and may be particularly relevant in settings with limited radiotherapy access.
Background: Giant cell tumor of bone (GCTB) rarely affects elderly individuals, and its clinical characteristics in this population remain insufficiently defined. This study aimed to investigate epidemiologic features and age-related differences in the surgical management of GCTB using a nationwide registry. Methods: Patients with histologically confirmed benign GCTB recorded in the Japanese Bone and Soft Tissue Tumor (BSTT) Registry between 2006 and 2019 were analyzed. Clinical characteristics, treatment patterns, and postoperative outcomes were compared among peak-incidence (20–45 years), middle-aged (46–64 years), and elderly (≥65 years) groups. Results: Among 1,978 eligible cases, 173 patients (8.7%) were aged 65 years or older. Surgical intervention decreased with increasing age and was lowest in the elderly group (88%, 80%, and 75%, respectively; p < 0.001). After 2014, the proportion of elderly patients undergoing surgery declined significantly from 85% to 66% (p = 0.005). When surgery was performed, elderly patients more frequently underwent marginal or wide resection, whereas intralesional curettage predominated in younger adults. Conclusions: This nationwide registry analysis demonstrates age-related differences in the surgical management of GCTB. Although the proportion of patients undergoing surgery decreased after 2014, causal relationships with denosumab approval cannot be established in this registry-based study. Reduced use of surgery did not necessarily imply less extensive surgical management among patients who underwent surgery. These findings support individualized, age-sensitive treatment strategies.
