Phyllodes tumors are rare fibroepithelial neoplasms of the breast. In the literature, borderline or malignant tumors have been reported to present with unusual characteristics including a short clinical history and extremely rapid tumor growth. Skin necrosis and infection sometimes accompanies these malignancies. Giant phyllodes tumors have a good prognosis when treated with total mastectomy, but reconstruction of the chest wall has been a challenge because of the need for a wide-range excision.We report a case of a malignant phyllodes tumor that was initially diagnosed as borderline because sudden growth of the tumor contrarily induced sparse to moderate stroma cellularity in the sections of the tumor that were biopsied. Total mastectomy without axillary lymph node resection and chest wall reconstruction using a full-thickness mesh skin graft was performed. The patient has remained free from infection and recurrence for over a year since diagnosis.

This report introduces the reverse slider technique to obtain proximal sealing effectively in endovascular aneurysm repair in short or angulated necks. It is the deployment process of the stent graft main body by repeatedly rotating and reversing the external slider with slight loosening of the suprarenal stent. This method helps obtain accurate placement of the proximal edge and effective sealing on the greater curvature side even in short and angulated necks. It is an effective method of extending the proximal sealing zone. It is gained by changing the deployment process with the Endurant stent graft (Medtronic, Santa Rosa, Calif) as an existing popular device.

A 26-year-old man with mild coronavirus infection (COVID-19) was presented with left lower limb ischemia. The acute thromboembolism was found in the terminal aorta, bilateral iliac and popliteal arteries. Repeated embolectomies were performed three times in addition to surgical fasciotomy of the lower extremity because of re-occlusion. However, he was complicated with toe necrosis and paralysis. Additional percutaneous angioplasty to the bilateral popliteal and calf arteries were performed to prevent toe amputation. In the present study, We experienced a case of arterial thrombosis in mild COVID-19 patient, even though he is young and without significant atherosclerosis or congenital coagulopathy. In a literature search, we also found reports of lower extremity arterial thromboembolism even in mild cases of COVID-19.

The case was that of a 47-year-old woman with a mobile tumor detected in the inferior vena cava on ultrasonography performed during a medical examination. Detailed examination revealed a mass extending its entire length from the right internal iliac vein to the inferior vena cava. Thrombosis was suspected, and the patient was treated with anticoagulation therapy. However, no change in the tumor mass was observed. Complete resection of tumor was indicated, because of the possibility of a tumor growth or pulmonary embolism. Initially, the mass was determined to be resectable with laparotomy alone. However, a transesophageal ultrasonographic examination performed immediately before the operation revealed that the tumor had adhered to the wall of the right atrium. Thus, the tumor was completely resected in a one-stage surgery with thoractomy and laparotomy combined with extracorporeal circulation and occulusion balloon catheter. The pathological diagnosis was intravenous leiomyomatosis. The postoperative progress was uneventful. The patient has had no recurrence and is currently under observation 2 years after surgery.

Jamieson DVT type I 13 Table 1 Patient characteristics comparing Japanese and International registries Current study n=22 Japanese registry 3 n=519 International registry 4 n=679 Age, y, median [Q1; Q3]