Primary choledocholithiasis. Apropos of a case, with review of the literature

A case study of recurrent bile duct stones, with history of six operations on the bile ducts, is mentioned for his documentary value. The authors give current definitions of recurrent bile stones and give some considerations on surgical and non surgical procedures to treat primary bile stones. Finally, they discuss operative bile duct lesions.     

Giant fibrovascular polyp of the esophagus. Apropos of a case. Review of the literature

Two operations were necessary to establish the diagnosis, in a patient with giant fibrovascular polyp of esophagus, imaging data suggesting an erroneous perioperative diagnosis of idiopathic mega-esophagus. This intraluminal tumor is benign and pedunculated, the symptoms arising from the esophageal obstruction. During vomiting, blockage at the laryngeal level by the fibrovascular polyp can provoke an acute asphyxia. Treatment is a function of polyp size, small tumors being removed endoscopically with the ever present risk of hemorrhage. Large tumors require surgery, the approach depending on the pedicle site.     

Cervicobulbar intramedullary lipoma. Apropos of a case with review of the literature]

The authors report a case of cervical intramedullary lipoma extending into the bulbomedullary junction. 99 cases of cervical and/or dorsal intramedullary lipomas without spinal dysraphism, reported since 1884, are reviewed. There is poor correlation between lipoma's length and age of onset. Only lipoma extended to all the spinal cord begin in the first years of life. Clinical presentation is in 58% of cases a slowly compressive myelopathy, a syringomyelic syndrome in 9.5% of cases, a Brown Sequard syndrome in 6.5% of cases or atypical clinical features in 26% of patients. Finding of a subcutaneous lipoma at the level of the lesion helps for diagnosis. C.T. scan and magnetic resonance imaging (M.R.I.) precise lipomatous constitution of the tumor, its limits and relations with neighbouring tissues. Surgery is necessary when clinical features are advanced. Surgery indication is debatable when neurological manifestations are poor or absent. Post operative course is generally good and is not related with type of intervention.     

Pancreatic cystadenocarcinomas. Apropos of a case and review of the literature

A patient with a pancreatic cystadenocarcinoma was treated initially for a false pancreatic cyst by means of a Y loop, and then by total pancreatectomy three weeks later. Although the prognosis for these tumors amongst the group of pancreatic carcinomas is usually greatly improved, the patient died 6 months after detection of the lesion. However, a literature review also suggested possible prolonged survival in these cases when the tumors are discovered early enough and local or regional spread is absent: wide excision of the tumor without the need for total pancreatectomy may then be sufficient. The "false cyst" appearance frequently taken by this slowly progressing malignant affection has to be emphasized, as well as the need for the renewed classification of these tumors: serous cystadenomas are always benign and must be separated from mucinous cystadenomas that are malignant or are potentially malignant. A CT scan appears to be the investigational procedure providing the most accurate data for determining the limits of surgical excision.     

Leiomyosarcoma of the scrotum: a case report and literature review

Leiomyosarcoma (LMS) is one of the most common forms of soft tissue sarcoma with approximately 2,500 cases per year in the United States. The symptoms LMS vary depending upon the location, size, and spread of the tumor. In early stages, it may not be associated with any obvious symptoms so diagnosis and treatment may be delayed. In some cases, it can grow quickly and behave aggressively. Most types of LMS occur in the abdomen or in the uterus; although, scrotal LMS can be a very rare presentation of the disease. Here we present our case of a large, ulcerated scrotal LMS originating from subcutaneous tissue but not invading spermatic cord or tunica. Radical orchiectomy with high ligation of spermatic cord was performed, and patient had an uneventful postoperative course. This disease entity remains rare in the literature, and warrants larger studies in order to better understand treatment and oncologic outcomes. When LMS is identified early and is removed by surgical excision, prognosis can be good and full recovery quite likely. When LMS is already large or has spread to other parts of the body, treatment is relatively more complex and the prognosis poor. Hence, prompt diagnosis and treatment of genitourinary LMS require prompt attention, referral to tertiary, referral center should be strongly considered.     

Leiomyosarcoma of the thumb: a case report and literature review

. Most smooth muscle tumors arise in the uterus or the gastrointestinal tract. Cutaneous and subcutaneous leiomyosarcomas (LS) are rare, but those that do occur usually develop on the extremities. There are only a few reported cases of LS of the finger. In this paper, we describe a patient with primary LS of the thumb.     

Duodenal leiomyoblastoma. Apropos of a new case and review of the literature

The authors report a new case of duodenal leiomyoblastoma. Since local anatomical factors were favorable, the tumor was removed by resecting the entire second portion of duodenum with reanastomosis of the remaining ends. This case can be added to the very small number of cases reported in the literature regarding leiomyoblastoma at this site in the gastrointestinal tract. Since diagnostic is difficult, and often made per-operatively following and acute complication, a precise topographical study of the region needs to be performed. It is only by this means that a completely safe operative procedure may be chosen and performed. From an anatomo-pathological viewpoint, several criteria exist to distinguish the potentially benign from the potentially malignant form. However, this remains to be confirmed given the controversial aspects of the subject. Study has mainly involved gastric localisations where a greater number of lesions have been found. At present, only time will show whether these tumors are benign or malignant.     

Cerebral aspergillotic granuloma. Apropos of a case and a review of the literature

The authors report a case of aspergillus granuloma of the brain, in a 28 year old woman, simulating a meningioma. Preoperative diagnosis of aspergilloma is difficult. However, it may be suspected in a patient who has associated pulmonary and paranasal sinus fungal infection. Peroperatively it may be confused with a brain tumour. The lesions usually are in the frontal lobes. Diagnosis can be made only by surgical biopsy with identification of fungal elements. Granuloma induce a good host response, and a high capacity to elaborate antibodies.     

Persistent sciatic artery. Apropos of a case, review of the literature

A case is reported of bilateral persisting sciatic arteries: complete on the right side but incomplete on the left, revealed by the onset of a distal embolism on the right side treated by exclusion and a right femoropopliteal shunt operation. The observation of this further case in France led to a review of the literature which demonstrated the rarity of this congenital anomaly, which usually however represents the only vascular axis to the lower limb, and the frequency of aneurysmal transformations with subsequent complications that are best treated by ligature combined with a femoropopliteal shunt.     

Cervical melanotic neurofibroma. Apropos of a case and a review of the literature

The authors report a case of cervical melanotic neurofibroma hour glass shaped, growing in the extra and intradural spaces. Melanotic aspect of spinal neurofibroma are rarely reported in the literature. Various etiopathologies have already been discussed.