Schwannome présacré: à propos d’un cas

Introduction

Presacral schwannomas are rare benign tumors, representing 1% to 5% of all schwannomas. We report a case diagnosed by imaging modalities (CT-MRI) and treated by complete surgical resection.

Case report

A 55-year-old female has had a history of abdominal pain since one year without compressive signs. A pelvic retrorectal mass has been discovered clinically. CT and MRI were very suggestive of a presacral schwannoma. Histological examination after complete surgical removal of the mass confirmed the diagnosis of a benign schwannoma.

Discussion

Giant presacral schwannomas are rare pelvic tumors. Often asymptomatic, they are diagnosed lately. CT and MRI are very useful in assessing the diagnosis and evaluating the extent of the tumor. Surgery is the therapeutic modality of first choice. Prognosis is good if the tumor is benign but recurrence is frequent.

Conclusion

Presacral schwannoma can cause pelvic pain. Imaging modalities (MRI++) often guide surgical resection.     

Usefulness of Ultraslim Endoscopy with Flexible Spectral Imaging Color Enhancement for Detection of Gastric Neoplasm: A Preliminary Study

Purpose

Transnasal endoscopy with ultraslim endoscope has rapidly spread in Japan. Ultraslim endoscopy provides less resolution than that of conventional endoscopy and may lead to missed screening of early gastric carcinoma. We evaluated the efficacy of ultraslim endoscopy with flexible spectral imaging color enhancement (FICE) for the diagnosis of early gastric carcinoma.

Methods

This study included 20 consecutive patients in whom 22 gastric neoplasms were resected by endoscopic submucosal dissection (ESD) between April 2011 and January 2012 in Yamaguchi University Hospital. Prior to ESD, marking dots were made during observation with ultraslim endoscopy with FICE. We evaluated en bloc resection rate and tumor visibility with the FICE system.

Results

All tumors were resected with sufficient lateral margin. Only one case had tumor cells in the vertical margin. En bloc resection rate was 95.5 % (21/22 lesions). Ultraslim endoscopy with FICE more clearly visualized tumor margin than did conventional endoscopy. Especially, the effect was remarkable in discolored lesions (100.0 %, 3/3 lesions).

Conclusions

Ultraslim endoscopy with FICE improved visibility of gastric neoplasms.     

胸内孤立性纤维瘤3例报告并文献复习

Objective

The aim of this study was to investigate the imaging findings of intrathoracic solitary fibrous tumor (SFT), so as to improve its diagnosis and differential diagnosis.

Methods

The clinical, imaging and pathological data of three intrathoracic SFTs confirmed by surgical pathology were analyzed retrospectively. There three cases all received spiral CT plain scan and enhanced scan, among which two multi-planar reformation (MPR) and one MR plain scan. And literatures were reviewed to investigate the imaging findings of intrathoracic SFT.

Results

The three intrathoracic SFT located at intra-pulmonary, oblique fissure pleura and posterior chest wall visceral pleura, respectively. All were solitary masses. One case was a peripheral lung mass at dorsal segment of left lower lobe which CT plain scan showed as a soft tissue mass well circumscribed, enhanced scan showed that there were enhanced clustered, lineal small vascular signs in the mass during arterial phase, delayed scanning displayed that the mass showed heterogeneous enhancement and parts of solid content showed gradual enhancement, and there were shorter T₁ signals on MRI T₁WI, map-like high-low mixed signals on T₂WI, mainly with short T₂ signals. One case was an oblique fissure mass which plain scan showed as a homogeneous soft tissue mass with oval in shape and smooth edge, and enhanced scan showed moderate homogeneous enhancement. One case was a mass localized at posterior chest wall visceral pleura which CT plain scan showed as a heterogeneous mass, and enhanced scan showed that there was slight ring-like enhancement, large non-enhancing necrosis area in the mass and facing vessels in the vicinity region. All these three cases had no hilar and mediastinal lymphadenectasis. Operation and pathology results showed that the mass was well circumscribed, with capsule or false capsule. Under microscope, tumor cells were long fusiform, presenting bundle, turbulence or irregular arrangement. Hypocellular and hypercellular area appeared alternately, with interspersed coarse scar-like collagen fibers with hyalinization. There were hemangiopericytoma-like structures under parts of visual fields. There were bronchiole and alveolar epithelium in the legion at dorsal segment of left lower lobe in one case. The results of immunohistochemistry showed that the expressions of CD34 or CD99, Bcl-2 and vimentin were all strong positive.

Conclusion

Intrathoracic SFT might be rare, which imaging findings could have relative characteristic features and diagnosis must depend on histopathology and immunohistochemistry examination.     

彩色多普勒超声在乳腺导管内乳头状瘤中的应用(英文)

Objective:The aim of this study was to evaluate the application value of high-frequency color Doppler ultrasound in the diagnosis of intraductal papilloma (IDP). Methods:A retrospective analysis of 64 IDP cases was done, the pathology proven by surgery with 89 lesions. According to the ultrasonic performance, the lesions were divided into different types and the solid focal were evaluated according to the classification BI-RADS-US standard. Results:There were 47 patients corresponds with the 64 cases of surgical pathology, the accuracy was 73.4%, according to the ultrasonic performance could be divided into two types, named catheter type and solid type, catheter diagnostic accuracy was 22/25 (88%), compared the morphological features of the solid type, grouped according to their size (≥ 2 cm or < 2 cm lesions), discovered there was no statistically significant difference between the benign and malignant lesions by BI-RADS-US grading standard. Conclusion:Two-dimensional ultrasound and Color Doppler flow imaging (CDFI) can make a definite diagnosis and positioning for IDP, but there are still some limitations to differentiate the benign and malignant, it need to pay more attention to the clinical application of substantive IDP and improve the understanding, provide more relevant information for clinic, the focal will be earlier treated to reduce the possibility of malignant happened change.     

The diagnostic evaluation of fine needle aspiration cytology of thyroid and its clinical application

Objective

The aim of the study was to investigate the diagnostic value of fine needle aspiration cytology (FNAC) and its clinical application.

Methods

From April 2009 to February 2011, thyroid FNAC were performed in a total of 186 patients with thyroid nodule or mass in our hospital and 78 of those 186 patients subsequently underwent thyroidectomy. The FNAC findings were compared with the results of the corresponding histological diagnosis.

Results

The results of thyroid FNAC for 186 patients showed that, (1) 166 cases of benign lesions, the detection rate was 89.24% (166/186), including 96 cases of nodular colloid goiter (51.61%), 28 cases of simple colloid goiter (15.05%), 38 cases of Hashimoto’s thyroiditis (HT) (20.43%) and 4 cases of thyroid adenoma (2.15%); (2) 4 cases of suspicious malignant lesion, the detection rate was 2.15% (4/186); (3) 16 cases of malignant tumor, the detection rate was 8.60% (16/186). Seventy eight patients including malignant (16), suspicious malignant (4), HT (20) and nodular colloid goiters (38) cases diagnosed by FNAC were performed operation with thyroidectomy and the postoperative histopathologic results showed that there were 2 cases HT combined thyroid papillary carcinoma in HT 20 cases by FNAC, 15 cases of thyroid papillary carcinoma and 1 case of follicular carcinoma in 16 cases of malignant tumor by FNAC and 4 case of thyroid papillary carcinoma in 4 cases of suspicious malignant by FNAC.

Conclusion

Thyroid FNAC is a valuable and reliable method for the diagnosis of the thyroid nodules or mass or even most diffuse thyroid diseases. Diagnosis of HT and thyroid papillary carcinoma can be made by thyroid FNAC. There was larger hint value for nodular colloid goiter and simple colloid goiter according to thyroid FNAC.     

Intraoperative ultrasound for ethanol tumor ablation and liver resection for malignant tumors

Introduction

Intraoperative ultrasound (IOUS) is a safe and reproducible tool and it is considered an essential component of major hepatobiliary procedures. The aim of this study was to define the place of IOUS as an adjuvant for ethanol tumor ablation and liver resection.

Material and methods

A review of clinical files of patients operated with liver tumors between August 1998 and January 2001 was performed.

Results

Fifty-two patients (30 men, 22 women) age ranging from 17 and 86 years (mean=45) were included for analysis and 26 had primary liver carcinomas (24 HCC and 2 CCC), 16 were considered resectable by preoperative imaging studies. However, IOUS avoid resection in 6 patients (37.5%). in 2 patients (20%) a change in the plane of resection was made. Eight patients with large single HCC lesions were managed with a single session of large volume intraoperative ethanol injection. IOUS detected the distribution of ethanol within the lesion and helped determine the dosage. This technique detected spillage of ethanol into a hepatic vein and helped to avoid a major complication in one patient (12.5 %). Twenty patients presented liver metastases of which, 16 were resected. IOUS avoid resection in 4 patients (20%); a change in the plane of resection was made in 5 (31%). Of 6 benign liver tumors that were operated with an unconfirmed diagnosis, IOUS made the diagnosis in 4. In all, IOUS influenced in the final decision in 70% of patients.

Conclusion

IOUS has become in creasingly important in hepatic resection in our center and is an essential tool for intraoperative elthanol tumor ablation.     

Clinical-therapeutic management of thoracoscopy in pleural effusion: a groundbreaking technique in the twenty-first century

Introduction

The aim of this study was to investigate the effectiveness of thoracoscopy in the diagnosis of non-affiliated pleural effusions (PE).

Material and methods

A five-year prospective study including data from 110 patients that were clinically diagnosed as benign (14.5%), malign (34.5%) and non-affiliated (50.9%). PE in patents without oncology disease and negative biopsy or cytology were considered as benign. Malignant diagnosis was established according to a pleural biopsy, compatible cytology and/or clinical features. Remaining cases were considered as non-affiliated. Thoracoscopy was done under local anaesthesia and sedation.

Results

Thoracoscopy confirmed previous clinical diagnosis of benignity and malignity. Regarding non-affiliated patients, 30.35% were diagnosed after thoracoscopy as unspecific pleuritis, 17.86% mesothelioma and 1.79% pleural tuberculosis (TBC). The other 48.21% of patients reported as non-affiliated were diagnosed with pleural carcinoma. Statistical analysis did not reveal differences between frequencies analysed.

Conclusions

Our results indicate that thoracoscopy is a cost-effective and reliable technique for obtaining histological diagnosis in PE and also allows a directed pleurodesis if indicated.     

肛管直肠恶性黑色素瘤：42例诊断与治疗

目的：肛管直肠恶性黑色素瘤（AMM的）是一种罕见的和积极的恶性肿瘤,其治疗仍controversial.This调查研究和总结我们的经验诊断,治疗和AMM.Methods误诊：从1980年8月至十二月2009,42与AMM的患者在我们hospital.The这些患者治疗的临床资料进行回顾性分析,包括主要症状,治疗和prognosis.Further免疫抗体分析使用的S - 100蛋白,液压集成块- 45抗原和波形蛋白活性进行了22 specimens.Results：在42例的投诉主要是便血（四十二分之二十三,55.0％）,（42分之12,28.6％）,肛门群众,改变大便性状（4 / 42,9.5％）,和或肛门里急后重疼痛（3 / 42,7.1％）。误诊率是62％（42分之26）,最常见的误诊痔（9 / 26,34.6％）组成,息肉（11/26,42.3％）和直肠癌（6 / 26,23.1％）.28例腹会阴切除术,10例行局部广泛切除,3例行姑息性手术,手术和没有operation.After 1,15例患者进行放疗,化疗和21日进行了8个与这两个治疗。 22例1年内死亡,11在2年,5起3年内,并在四余年的平均存活时间为11个月,1 45 months.The的免疫组化结果最长,显示的S - 100蛋白存在于所有22例（100％）,液压集成块- 45是在22染色（95.5％）21 22（86.4％）和波形蛋白19。结论：AMM的是一个贫穷的预后和资质的罕见疾病被误诊。便血是最常见的symptom.Immunohistochemical染色利于AMM.Operation诊断是主要治疗,操作类型应该是个性化。     

Rhabdomyosarcome paratesticulaire chez l’adulte jeune : étude de neuf cas et revue de la littérature

Introduction

The rhabdomyosarcoma is a rare mesenchymal tumor. Its paratesticular location is the most common urogenital locations. It is a child tumour and is exceptional in adults. The prognosis is poor and treatment is based on the tripod surgery, chemotherapy, and radiotherapy.

Materials and methods

A retrospective study of nine cases of paratesticular rhabdomyosarcoma in adults, collected at the National Institute of Oncology in Rabat between January 1995 and December 2007, was performed. We discuss the diagnostic and therapeutic modalities based on literature data.

Results

The average age of our patients was 24 years (the extremes are 19 and 32 years). On admission, six patients had a painless scrotal mass and three patients had an impaired genral health.The tumor markers βHCG and αFP were normal in all patients. The ultrasound showed a heterogeneous paratesticular mass with a normal testis. Computed tomography of the chest, abdomen, and pelvis performed in all patients revealed five cases of lymph node metastasis (55.5%), three lung metastasis (33.3%), and only one liver metastasis. All patients had an inguinal orchidectomy and chemotherapy based on vincristine, actinomycin D, and cyclophosphamide. The retroperitoneal lymph node dissection was not performed for any patient. Two patients had radiotherapy for residual retroperitoneal masses. The average duration of follow up was 23 months (12–102 months), and survival rate at three and five years was respectively 66% and 22%.

Conclusion

The paratesticular rhabdomyosarcoma is an aggressive and fast growing tumor. The diagnosis is histological. Treatment is based on surgery and chemotherapy. The role of lymphadenectomy is controversial. Radiotherapy must be indicated in patients with residual tumor after chemotherapy or positive nodes at lymphadenectomy. An adequate long-term monitoring must be introduced to detect recurrences that are usually fatal.     

Immunohistochemical study of MRP5 expression in meningiomas

Purpose

Meningiomas are the most common benign intracranial tumor, accounting for 30 % of all primary intracranial tumors. Although benign meningiomas rarely recur after a complete resection, anaplastic tumors are associated with high recurrence rate and unfavorable outcome. In the current study, we investigated the expression of the multidrug resistance protein 5 (MRP5) in patients with meningiomas.

Methods

We retrospectively studied twenty patients with meningiomas that were treated surgically in our institute over a 3-year period. MRP5 protein expression was determined immunohistochemically.

Results

The immunohistochemical expression of MRP5 was observed only in anaplastic meningiomas. No MRP5 expression was detected in benign or atypical meningiomas. No significant correlation was found between MRP5 expression and Ki-67 index. After a mean follow-up period of 23 months, there were 4 cases of tumor recurrence. No correlation was found between extent of resection and tumor recurrence.

Conclusion

Immunohistochemical MRP5 protein expression was observed only in anaplastic meningiomas. Further research is needed to clarify whether MRP5 is indicative of malignant pathological features in meningiomas and whether possible therapeutic implications exist.     

Utility of an upright-type 11-gauge stereotactic vacuum-assisted biopsy device （Mammotome@） for the diagnosis of breast microcalcifications

Objective

The aim of this study was to evaluate the utility of an upright-type 11-gauge stereotactic vacuum-assisted biopsy device (Mammotome®) for the diagnosis of breast microcalcifications

Methods

Between May 2001 and October 2005, 154 biopsies in 152 patients with microcalcifications were performed using the upright-type 11-gauge stereotactic vacuum-assisted biopsy device. Patients in whom this biopsy was diagnosed as carcinoma or a borderline lesion, had a subsequent surgical excision of the lesion. Histopathological and radiological features of the two specimens were then compared with each other.

Results

Microcalcification was identified on specimen mammograms and microscopic slides in 97.4% of cases. Of 154 Mammotome biopsies 98 (63.6%) were benign, 51 (33.1%) were malignant, 3 (1.9%) showed atypical hyperplasia, and 2 (1.3%) were indeterminate, respectively. Of the 48 cases that received surgical excision, 6 of 36 ductal carcinomas in situ (16.7%) upstaged to invasive ductal carcinoma and 1 of 2 atypical ductal hyperplasias was upstaged to ductal carcinoma in situ. The positive predictive value of the 11-gauge Mammotome for the diagnosis of invasion in breast cancer was 100%. Linear calcification and pleomorphic calcification linear/segmental distribution was reliable indications of malignancy. The mean follow-up time of the benign lesions was 22 months, and without evidence of lesion growth. Complications included vasovagal reactions (6.3%), bleeding (0.6%) and hematoma (2.6%).

Conclusion

The upright stereotactic 11-gauge Mammotome procedure is an effective and reliable method for the diagnosis of breast microcalcifications. It has minimal side effects. For lesions diagnosed as ADH or DCIS with the 11-gauge Mammotome, subsequent surgical excision should be performed.     

毛黏液星形细胞瘤的临床病理观察(英文)

Objective:The aim of this study was to study the clinicopathological and immunohistochemical features of pilomyxoid astrocytoma(PMA).Methods:The clinical and pathologic features in six cases of PMA were analyzed.Immunohistochemical staining for glial fibrillary acidic protein(GFAP),synaptophysin(Syn),Chromogranin A(CgA),cytokeratin(AE1/AE3),epithelial membrane antigen(EMA)and Ki67 was performed on paraffin-embedded sections.Results:Among the six cases,five occurred in female patients,one was male,the age at diagnosis ranged from 2 to 15 years.Four cases were located in the hypothalamic area and optic pathway,one case in the third ventricle,and one case in left parietal lobe.On imaging,PMAs often appears as well-circumscribed mass.Microscopically,the tumor was composed of monomorphous bipolar(piloid)cells setting in a prominent myxoid background with an angiocentric radiating growth pattern in some areas.PMA lacked biphasic pattern,Rosenthal fibers and eosinophilic granular bodies which were usually typical in a classic pilocytic astrocytoma(PA).Immunohistochemcal study showed that the tumor cells were diffusely positive for GFAP.Syn positive staining was observed in one case.The Ki67 labeling index measured less than 5%.Conclusion:PMA is a distinct aggressive variant of pilocytic astrocytoma with special histological and immunohistochemical features.It is typically a rare tumor of early childhood.Immunohistochemical staining for GFAP and Syn is helpful in differential diagnosis.     

Appendiceal Mucocele. A retrospective Analysis of 19 Cases

Background

Appendiceal mucocele is an infrequent well-recognized entity that can present in a variety of clinical syndromes or can be asymptomatic and discovered incidentally.

Patients and Methods

Nineteen patients with a diagnosis of primary appendiceal mucocele treated in our institution between January 1, 1987 and December 31, 2006 were included in this retrospective analysis.

Results

The histological examination of the specimens revealed simple and hyperplastic appendiceal mucocele in nine cases (47%), mucinous appendiceal cystadenoma in eight cases (42%), and mucinous appendiceal cystadenocarcinoma in two cases (11%). Thirteen patients (68%) underwent appendectomy, five patients (26%) right colectomy, and two patients (6%) underwent right colectomy for invasive appendiceal cystadenocarcinoma and at the same time right nephrectomy and sigmoidectomy, respectively, for concomitant malignancy.

Conclusion

Mucocele of the appendix may be related to a benign or malignant appendiceal process, leading to individualized diagnosis and treatment.     

Low microvascular density at the tumor center is related to the expression of metalloproteases and their inhibitors and with the occurrence of distant metastasis in breast carcinomas

Background

The aims of this study were to evaluate the microvascular density (MVD) at the center of breast carcinomas, its relationship with the expression of metalloproteases (MMPs) and their inhibitors (TIMPs), and its connection with the distant metastasis rate.

Methods

An immunohistochemical study of four MMPs and two TIMPs was performed on cancer specimens from 97 women with a histological confirmed diagnosis of early invasive breast cancer.

Results

Expressions of MMP-9 by cancerous cells, or MMP-11 and TIMP-2 by stromal cells, were all negative and significantly associated with MVD, whereas MMP-7 score values were positive and also significantly associated with MVD. However, positive expression of MMP-1 by mononuclear inflammatory cells was significantly associated with MVD. Multivariate analysis demonstrated a significant and inverse relationship between MVD and the occurrence of distant metastasis.

Conclusions

Our data point out the clinical importance of low MVD at the tumor center as an independent prognostic factor of distant metastasis development in breast cancer.     

The Surgical Treatment and Outcome for Primary Duodenal Adenocarcinoma

Background

The purpose of this study was to investigate the early diagnosis and outcomes of surgical treatment of primary duodenal adenocarcinoma (PDAC) for curative purpose.

Method

Thirty-two PDAC patients treated surgically between February 1990 and September 2006 were analyzed retrospectively.

Results

All 32 patients underwent laparotomy, including 18 patients (56.3%) pancreaticoduodenectomy (PD), six patients (18.7%) segmental resection (SR), and eight patients bypass procedures. R0 resections were obtained in 22 patients; the other 10 procedures were palliative. The total 1-, 3-, and 5-year survival rates in this study were 86.2% (25/29), 48.3% (14/29), and 20.7% (6/29), respectively, moreover, the 1-, 3-, and 5-year survival rates in patients with R0 resection were 100.0% (19/19), 73.7% (14/19), and 31.6%(6/19), which were significantly higher than those (50.0%?=?5/10, 0%, and 0%) in patients with palliative operation (P?>?0.05), respectively. Furthermore, the 5-year survival rate was 27.8% (5/18) in pancreaticoduodenectomy patients and 16.7% (1/6) in segmental resection patients, and there was no significant difference between the above two procedures (P?>?0.05).

Conclusion

PD is suggested for tumor located at the first and second portion of the duodenum, and SR may be appropriate for the selected patients, especially for tumors of the distal duodenum.     

The Surgical Treatment and Outcome for Primary Duodenal Adenocarcinoma

Background

To investigate the early diagnosis and outcomes of surgical treatment of primary duodenal adenocarcinoma (PDAC) for curative purpose.

Method

Thirty-two PDAC patients treated surgically between February 1990 and September 2006 were analyzed retrospectively.

Results

All 32 patients underwent laparotomy including 18 (56.3%) pancreaticoduodenectomy (PD), six (18.7%) segmental resection (SR), and eight bypass procedures. And R0 resections were obtained in 22 patients; the other ten procedures were palliative. The total 1-, 3-, and 5-year survival rates in this study were 78.1% (25/32), 43.8% (14/32), and 18.8% (6/32), respectively; moreover, the 1-, 3-, and 5-year survival rates in patients with R0 resection were 100.0% (20/20), 70.0% (14/20), and 30.0% (6/20), which were significantly higher than those (41.7%?=?5/12, 0%, and 0%) in patients with palliative operation (P?<?0.05), respectively. Furthermore, the 5-year survival rate was 27.8% (5/18) in pancreaticoduodenectomy patients and 16.7% (1/6) in segmental resection patients, and there was no significant difference between the above two procedures (P?>?0.05).

Conclusion

PD is suggested for tumor located at the first and second portion of the duodenum, and SR may be appropriate for the selected patients especially for tumors of the distal duodenum.     

Analysis of Epstein-Barr virus reservoirs in paired blood and breast cancer primary biopsy specimens by real time PCR

Introduction

Epstein-Barr virus (EBV) is present in over 90% of the world's population. This infection is considered benign, even though in limited cases EBV is associated with infectious and neoplastic conditions. Over the past decade, the EBV association with breast cancer has been constantly debated. Adding to this clinical and biological uncertainty, different techniques gave contradictory results for the presence of EBV in breast carcinoma specimens. In this study, minor groove binding (MGB)-TaqMan real time PCR was used to detect the presence of EBV DNA in both peripheral blood and tumor samples of selected patients.

Methods

Peripheral blood and breast carcinoma specimens from 24 patients were collected. DNA was extracted and then amplified by MGB-TaqMan real time PCR.

Results

Of 24 breast tumor specimens, 11 (46%) were positive for EBV DNA. Of these 11 breast tumor specimens, 7 (64%) were also positive for EBV DNA in the peripheral blood, while 4 (36%) were positive for EBV DNA in the tumor, but negative in the blood.

Conclusion

EBV was found at extremely low levels, with a mean of 0.00004 EBV genomes per cell (range 0.00014 to 0.00001 EBV genomes per cell). Furthermore, our finding of the presence of EBV in the tumor specimens coupled to the absence of detection of EBV genomic DNA in the peripheral blood is consistent with the epithelial nature of the virus. Because of the low levels of viral DNA in tumor tissue, further studies are needed to assess the biological input of EBV in breast cancer.     

The Surgical Treatment and Outcome for Primary Duodenal Adenocarcinoma

Background

Primary duodenal adenocarcinomas (PDAC) are uncommon tumors characterized by non-specific symptoms and late diagnosis, and treatments of PDAC have some controversies.

Method

To investigate the early diagnosis and outcomes of surgical treatment of PDAC, 32 patients who were treated surgically between February 1990 and September 2006 were analyzed retrospectively.

Results

All 32 patients underwent laparotomy, including 18 patients (56.3%) with pancreaticoduodenectomy (PD), six patients (18.7%) with segmental resection (SR), and eight patients with bypass procedures. And, R0 resections were obtained in 22 patients; the other ten procedures were palliative. The total 1-, 3-, and 5-year survival rates in this study were 86.2% (25 of 29), 48.3% (14 of 29), and 20.7% (six of 29), respectively. Moreover, the 1-, 3-, and 5-year survival rates in patients with R0 resection were 100.0% (19 of 19), 73.7% (14 of 19), and 31.6% (six of 19), which were significantly higher than those (50.0%?=?5/10, 0% and 0%) in patients with palliative operation (P?<?0.05), respectively. Furthermore, the 5-year survival rate was 27.8% (five of 18) in pancreaticoduodenectomy patients and 16.7% (one of six) in segmental resection patients, and there was no significant difference between the above two procedures (P?>?0.05).

Conclusion

PD is suggested for the tumor located at the first and second portion of the duodenum, and SR may be appropriate for the selected patients, especially for tumors of the distal duodenum.     

Surgical management of benign solid and cystic liver lesions

Introduction

The aim is to evaluate the indications for and results of surgery in patients with benign solid and cystic liver lesions. Resection is the best method of management of symptomatic benign solid liver lesions. For cystic lesions fenestration or resection have been the most-used treatments. Recently, laparoscopy has changed the way we treat these lesions.

Material and methods

We reviewed the clinical files of all patients with benign solid and cystic liver lesions operated-upon between May 1995 and May 2003.

Results

There were 64 patients included in the present analysis (57 female; 7 male); median age was 48 years (range 21–74 years); 32 (50%) with benign solid liver lesions of which 22 were cavernous haemangiomas; 23 (35.9%) with non-parasitic liver disease (NPLD) and 9 (14%) had polycystic liver disease (PLD). There were 54 patients (84.3%) who had symptoms. Thirty-nine patients had liver resections performed (16 major and 23 minor), 15 patients were treated by open fenestration and 10 were treated by laparoscopic fenestration. There were 10 patients (15.6%) who presented complications; operative mortality was zero.

Conclusions

The presence of symptoms is the most common indication for treatment. Laparoscopic fenestration has become the first-line treatment tor symptomatic NPLD and selected patients with benign solid liver lesions and PLD. However, in our centre, a considerable proportion of patients is still operated-upon via the open approach. A careful selection of cases is necessary to ensure good outcomes.     

Cancer of the external auditory canal-diagnostic and treatment

Background

Ear squamous cell carcinoma (SCC) is a tumor with a poor prognosis, due to a late initial diagnosis because of a concealment by primarily benign symptoms and due to the unfavorable localization including the infiltration of important structures such as the middle ear, mandibular joint or dura.

Patients and methods

We retrospectively examined 10 patients, medium age: 63.8 ± 9.3 years between 2002 and 2008 with a histological confirmed SCC of the external auditory canal. The median follow-up period was 20.5 months (range 7–60 months).

Results

The treatment involving surgery, radiotherapy and/or chemotherapy yielded a survival rate of 38.3 ± 11.3 months for T1 and a survival rate of 17.0 ± 3.0 months for T2–T4 tumors. 3/10 patients at T1 stage are under follow-up, all 7/10 (70%) patients at T2 and T4 stage did not survive 5 years.

Conclusion

The prognosis for ear SCC primarily depends on early clinical and histopathological diagnostics and requires a sufficient and standardized staging to determine the therapy involving surgery and radiochemotherapy.