Invasive Candida albicans fungal infection requiring explantation of a noncrosslinked porcine derived biologic mesh: a rare but catastrophic complication in abdominal wall reconstruction A bdominal wall hernias are a generally underappreciated but morbid complication of abdominal laparotomy. In high-risk settings, the incidence rate of developing postoperative hernia can be as high as 69%. 1 Unfortunately, simple primary tissue repair of these hernias is fraught with poor results, and worsens every time another operation is performed. 2 Thus, in contemporary practice, mesh is typically used to augment the fascial reapproximation, as its use is associated with a reduced rate of hernia recurrence. 3,4 This benefit is such that prophylactic use of mesh in elective surgery to prevent potential future ventral hernias is recommended. 5 Synthetic meshes are now used ubiquitously in most surgical settings involving elective groin and ventral abdominal wall repairs. While synthetic mesh has been a tremendous advancement, benefitting countless patients, these products have unfavourable characteristics, particularly when infected. Although rare, synthetic mesh infections are disastrous for patients when they occur. Therefore, when an abdominal wall repair is either contemplated or necessitated in a contaminated operative field, biologic meshes are used as an alternative. Biologic meshes are derived from either porcine or bovine tissue, can be either crosslinked or not, and have been purported to be more resistant to infection. 6-9 Further, it has been suggested that noncrosslinked meshes have reduced infection rates compared with crosslinked biologic meshes. 10 The same finding has previously been reinforced by our own group, and we thus feel especially obligated to caution surgeons to not perceive biologic mesh to be "infection-resistant" or "infection-proof." 8 We report a devastating case of infiltrative infection of a noncrosslinked biologic mesh (Strattice) with Candida albicans following a ventral abdominal wall repair, where clinical improvement was seen only after explantation of the infiltrated mesh and treatment with systemic antifungal medications.

Gardner fibroma (GF) is a benign soft-tissue tumor that is associated with Gardner syndrome and can progress to, or co-occur with, desmoid fibromatosis (DF). Herein, we report a unique case of an 11-year-old boy who presented with a rapidly growing soft-tissue mass after biopsy of a stable fat-rich lesion present in the calf muscles since infancy, with Magnetic resonance imaging findings suggesting an intramuscular adipocytic tumor. The resection showed GF and DF. DF arising from a preexisting GF (the so-called “GF-DF sequence”) is a well-documented phenomenon. Although immunohistochemistry was negative for nuclear β-catenin expression, a CTTNB1 S45F mutation, which has been associated with aggressive behavior in DF, was identified in both components using a next-generation sequencing-based molecular assay. This is the first time a mutation in CTNNB1 has been identified in GF and the GF–DF sequence, thus expanding our knowledge of the molecular pathogenesis of the GF–DF sequence and highlighting the role of molecular testing in pediatric soft-tissue tumors. The histologic findings of an adipocyte-rich intramuscular GF also are unique, expanding the morphological spectrum of GF and adding GF to the differential diagnosis of intramuscular lesions with an adipocytic component.

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