Penile metastasis disclosing cancer of the rectum. Apropos of a case

A case report of penile metastasis from a rectal cancer in a 58 year old man is described. The authors insist on the rarity of this penile metastatic localization. Many primary tumors can be involved in this penile localization, mainly urinary tract tumors such as bladder or prostate, but rectal cancer is very rare and only 47 cases have been reported to date. The modalities of extension are analysed: direct invasion or venous extension. The prognosis of such metastases is very poor, but some long-term survivals (from 21 months to 9 years) have been seen after aggressive surgical treatment when the primary tumor was rectal cancer. Radiotherapy and are not effective.     

Isolated arterial hypertension during pregnancy disclosing a malignant tumor of the kidney. Apropos of a case

The authors report an observation of isolated hypertension during pregnancy; this hypertension has revealed a cancer of kidney. As hypertension has regressed after ablation of the tumor, the authors evoke physiopathological hypothesis. They insist about X Ray of kidney after pregnancy, for hypertensive pregnancy. It seems to be the best exam to discover an uropathy.     

Synchronous bilateral cancer of the kidney in the adult. Apropos of a case

Following a case of synchronous bilateral renal cancer, we carried out a review of the literature and defined the specific therapeutic and prognostic characteristics of this clinical condition. Conservative surgery should be proposed as first line treatment. Results in terms of survival depend on the histological characteristics of the more affected kidney. The prognosis is relatively good in general and better than that of unilateral cancer.     

Postoperative pyoderma gangrenosum and cancer of the breast. Apropos of a case]

Pyoderma gangrenosum (PG) consists of extensive necrotic ulceration with bluish and purplish red margins. This disease is often associated with ulcerative colitis, systemic, hematologic or rheumatic diseases. However post-surgical idiopathic PG can occur. One post-mastectomy case is reported. PG can first be suspected on clinical appearance and the lack of a specific etiology. PG is a diagnosis of exclusion that is made only after other possibilities have been ruled out. The treatment is surgical excision and systemic corticosteroids.     

Zenker's diverticulum. Apropos a case

The authors report a case of Zenker's diverticulum in a patient 72 years old who underwent surgery. The pharyngoesophageal function was investigated before and after cricopharyngeal myotomy and diverticulopexy, with oesophageal manometry. Preoperative manometry showed an incomplete relaxation of the upper oesophageal sphincter and increased of pharyngeal pressure. This diverticulum has a pulsion pathogenesis and in this case is not associated with gastroesophageal reflux. It is important to check whether an associated oesophageal pathology exist once Zenker's diverticulum has been diagnosed: X-ray examination of oesophagus and stomach are capable of identifying the presence of diverticulum as well as other pathological association. In the case showed the clinical manifestation are represented by: cervical dysphagia, sensation of foreign body while eating due to the accumulation of ingested food in the diverticulum, and noisy deglutition. The surgical treatment in this case consist of diverticulopexy with cricopharyngeal myotomy. This case is treated with diverticulopexy for two reason: because is not very big and to reduce post-operative period. In conclusion the authors shows the importance of this surgery for not very large sized pouches, and emphasise the importance of manometric and radiographic control in pre and post-operative period. This kind of surgery reduce post-operative complication and the period to stay in bed.     

Gastric metastases of cancer of the breast. Apropos of a case. Review of the literature

Since they are rare and often latent, gastric metastases from breast cancer, principally lobular, are difficult to diagnose particularly at the isolated stage. The primitive and non specific nature of their symptomatology and the negativity of endoscopic biopsies should lead to early explorative laparotomy. Surgery is often palliative to reduce tumor load and seldom involves complete excision, and can only hope to obtain prolonged survival if followed by chemotherapy, hormone therapy or indeed radiotherapy. Following a recent personal case a review of the worldwide literature was carried out and the principal pathogenic hypotheses were analysed.     

Paravesical hemangiopericytoma. Apropos of a case

Paravesical hemangiopericytoma is a vascular tumour that develops at the expense of the pericyts surrounding the blood capillaries. Its dim prognosis relates to its high potential of malignancy. With respect to the first case examined at the Dakar C.H.U. (the 10th case world wide), a literature review has been done. The diagnosis is based on histology while arteriography provides guiding elements. This particular case strikes especially the young individual, with no preference for a given sex. Therapy-wise, radiotherapy seems efficient. But, surgery remains, at the moment, the choice treatment of paravesical hamangiopericytoma. It consists of a large exeresis associated with radiotherapy. Chemotherapy still hold a limited place within the therapeutic arsenal against paravesical hemangiopericytoma.     

Cervical chordoma. Apropos of a case

The chordomas are malignant tumors arising from the remnants of the posterior spinal chord. The chordomas of the cervical spine are rare (5% of the spinal chordomas). A new case of spine chordoma at C5 level in a 76 years old woman is reported. The diagnosis depends on the results of the histological studies and especially the studies of the labelled elements as Protein S100 or Cytokeratin. Firstly a double osteosynthesis was realized by an anterior and posterior approach. There was no radiotherapy after this operation. A new operation for a fracture of odontoid process was necessary one year later. There was no recurrence. The patient was complaining from pains, two years after the first operation in relation to lateral recurrence. A third operation by an anterior approach was realized. A radiotherapy of 50 Gy was applied on the same level. The first osteosynthesis was with acrylic cement and the second one with an autologous bone graft and a plate after removing the cement without problem. Actually she is in good health, 78 years old.     

Malignant hyperthermia. Apropos of a case

We present the clinical case of a thirteen-year-old male patient who suffered a malignant hyperthermia syndrome after an adenoidectomy under general anaesthesia. The recovery of the patient was successful with the specific treatment of dantrolene. We believe it is interesting to publish all the cases of malignant hyperthermia in order to have a better knowledge of the real incidence in our country.     

Emphysematous pyelonephritis. Apropos of a case

Emphysematous pyelonephritis is a rare form of pyelonephritis that carries a very poor prognosis. This article reports a review of the literature on this condition and describes the clinical and roentgenographic criteria for diagnosis. Diagnosis rests on the presence of clinical manifestations of pyelonephritis with intrarenal air-filled images on the roentgenograms. Both the author's personal experience and the data from the literature confirm the need for urgent treatment combining antimicrobial agents effective against Escherichia coli, the most common causative agent, and surgery, which usually consists in a nephrectomy.     

Splenic pseudocysts. Apropos of a case

The authors report a case of pseudocyst of the spleen. This is a rare entity which is part of nosological type of nonparasitic splenic cysts. It has most often a post-traumatic origin. The diagnosis is evoked in front of a mass of the left hypochondrium and has to be confirmed by further examinations, in particular by sonography and scanner. A microscopic examination of the surgical specimen is the only way to establish the diagnosis of a pseudocyst. The histological characteristic of pseudocyst is absence of epithelium. The splenic pseudocysts require a surgical treatment. In most cases, a splenectomy is performed. A the moment, cyst resection and partial splenectomies are performed by a few authors. This is the type of technique that we prefer especially when the patient is young.     

Ileocaecal tuberculosis. Apropos of a case

The authors report a case of ileocaecal tuberculosis in a 27-year-old man with no particular risk factor for this disease. The initial diagnosis was terminal ileitis discovered at appendicectomy. The diagnosis of ileal tuberculosis was suspected in the presence of giant cell follicles on ileal biopsies, and was confirmed by the presence of AFB in the gastric intubation fluid. This patient presented known atypical pulmonary images for several years, which had never been investigated in more detail. A favourable course was observed in response to triple-agent, then double-agent antibiotic therapy. This case illustrates the fact that ileal tuberculosis still exists today, and that it does not exclusively affect "high-risk" patients.