PHAEOCHROMOCYTOMA: EXPERIENCE FROM A REFERRAL HOSPITAL IN SOUTHERN INDIA

Background : Phaeochromocytoma has been traditionally called the ‘Tumour of Tens’. Many investigators have reported the prevalence of extra-adrenal phaeochromocytoma to be more than 10%. Methods : All consecutive adult patients diagnosed to have phaeochromocytoma by the departments of endocrinology and surgical endocrinology of the Christian Medical Hospital, India, over a period of 10 years from 1988 to 1998, were included in the study. Results : A total of 30 patients were diagnosed to have phaeochromocytoma. Extra-adrenal phaeochromocytoma accounted for 26.6% of cases. Ten per cent of cases were bilateral, 6.6% were malignant and one patient had a familial tumour (multiple endocrine neoplasia IIB). The tumours were localized pre-operatively in all patients. Multicentric extra-adrenal tumours were not found in this series. All patients except one were explored by the anterior transperitoneal approach. Persistent hypertension was noted in 30% of patients. Conclusions : Our series shows a higher prevalence (26.6%) of extra-adrenal tumours than the traditionally described 10%. With accurate pre-operative localization, a transperitoneal approach may not be necessary. The laparoscopic approach needs to be evaluated in light of these findings.     

Urethral rhinosporidiosis. Analysis of 27 cases

An analysis of 27 cases of urethral rhinosporidiosis is presented. Only 11 cases have been previously reported. The disease is chronic and causes no systemic derangement. The key to diagnosis is its characteristic histology and diathermy excision provides the best treatment.     

Palliative gastrectomy in advanced gastric cancer: is it worthwhile?

BACKGROUND: Gastric cancer remains one of the leading causes of cancer-related deaths. Many patients present late, and therefore, resections are often palliative in nature. The aim of this study was to assess the feasibility of resectional operation and the survival advantage of surgical resection in advanced gastric cancer. The effectiveness of palliation and the quality of life following operation for gastric cancer were assessed. METHODS: One hundred and fifty-one patients who underwent operation for gastric cancer at a tertiary centre in South India during a 5-year period between 1999 and 2003, were included in this study. Four sites of tumour spread were used as indicators of incurability in these patients. These were unresectable primary tumour or macroscopic residual primary tumour (T+), unresectable lymph nodal metastasis (L+), unresectable liver metastasis (H+) and peritoneal metastasis (P+). The resectability rate and survival were assessed in relation to these four factors. RESULTS: The resectability rate decreased as the number of sites of tumour spread increased. The overall survival was significantly better in the subgroup of patients who had a resectional operation (total gastrectomy or subtotal gastrectomy), as opposed to the subgroup who had non-resectional operation (exploratory laparotomy or laparotomy with gastrojejunostomy) (P = 0.0003). This survival advantage of resectional operation disappeared when more than two sites of tumour spread were present. The quality of life was significantly better when a resection operation was carried out. CONCLUSION: In advanced gastric cancer, palliative resection has a survival advantage if the tumour spread is restricted to two or less sites. Patients who undergo resectional operation have better palliation of symptoms and their postoperative quality of life is significantly better.     

Kimura’s disease mimicking thyroid neoplasm

A swelling in the anterior neck in an individual who had reportedly undergone previous thyroid surgery for a tumour of the thyroid gland, clinically suggested a diagnosis of recurrent thyroid neoplasm. Excision biopsy of an enlarged supraclavicular node established the diagnosis of Kimura’s disease. The clinicopathological features of this rare disorder are discussed.