Veinous thrombectomy. Six case reports]

The aim of this study is to raise up the effect of surgical thrombectomy among other alternative therapies. This retrospective study reports 6 patients (mean age 63 years) admitted with phlegmasia cerulea dolens. All patients underwent surgical venous thrombectomy associated with infracava filter insertion in 2 cases. One patient died in the early postoperative course. In all other cases we noticed good early and late outcome both on clinical examination and duplex scanning assessment. In conclusion, surgical venous thrombectomy can be considered as a good and efficient procedure in the presence of phlegmasia cerulea dolens in order to relieve ischemia and to prevent whenever possible severe chronic venous disorders. However, fibrinolytic therapy might achieve as good results as surgery. Thus, the latter is to be reserved to very severe veinous ischemia with limb loss threatening where fibrinolytic therapy fails or is contre-indicated.     

Présentation insolite d’un sarcome embryonnaire indifférencié du foie : à propos d’un cas

Undifferentiated embryonal sarcoma of the liver is a rare tumor occurring in late childhood. This tumor is often characterized by a misleading clinical and radiological presentation. We report a case of primary hepatic embryonal sarcoma in a 15 years old girl erroneously assumed to be a rupture hydatic cyst and discuss its clinicopathologic, therapeutic and evolutive features.     

Pulmonary arterial aneurysms in Behçet's syndrome. Report of 4 cases

Pulmonary involvement in Behcet's disease is uncommon and pulmonary arterial aneurysms are present in about 1 to 7% of patients. But despite their scarcity, they represent a life-threatening complication and are usually regarded as of a poor prognosis. Our study aims to describe the epidemiological and therapeutic aspects of this condition. Among 180 patients with Behcet's disease according to the criteria of the international study group for Behcet's disease, four were diagnosed as having pulmonary artery aneurysms (2.22%). All were male, the mean age at the time of the diagnosis of pulmonary artery aneurysms was 29.8 years and the mean disease duration was 6.6 years. Hemoptysis was the presenting symptom in all cases. The patients were treated by corticosteroid, colchicine and cyclophosphamide pulses. The outcome was good with disappearance of hemoptysis in all cases and disappearance of pulmonary aneurysms in three. One patient had recurrence of aneurysms 40 months after the first episode and died 18 months later. So, we can hope, thanks to medical treatment, a better outcome than previously reported in this complication.     

Métastase calcanéenne d’un carcinome rénal : à propos d’un cas et revue de la littérature

Acrometastases of the bones of the foot are extremely rare.We are presenting the case of a male patient, aged 73 years who is being monitored for clear renal cell carcinoma with metastases to the lungs. He underwent a total nephrectomy procedure. Five months later, he was seen as an emergency due to pain in his left foot and functional impairment. Investigations highlighted calcaneal metastasis of the renal carcinoma. Our patient underwent tumour resection followed by cementoplasty then radiotherapy treatment; he has now been offered targeted therapy. He is currently still alive with a follow-up of 14 months. As a result of this rare calcaneal metastasis of a renal carcinoma, we are proposing to investigate clinical, radiological and therapeutic aspects of this rare entity as well as a review of the literature.     

Metastatic signet ring cell carcinoma to the breast from stomach]

Metastatic tumors in the breast are quite rare and constitute 0.5 to 6% of all breast malignancies. They often occur in a polymetastatic context. The most frequent primitive tumors are lymphoma, leukaemia and malignant melanoma. The gastric origin is seldom reported. We report here the observation of a 40-years woman operated in urgency for an acute abdominal syndrome. A gastric tumor was discovered intraoperatively with ovarian metastasis and peritoneal carcinosis. The pathological examination revealed a gastric signet ring cell carcinoma with an infiltration of the right ovary. Four months later, the patient presented with a lump of the right breast. The histologic examination corresponded to a mammary metastasis by a signet ring cell carcinoma from stomach. The objective of our work is to discuss through this observation the anatomoclinical and evolutionary characteristics of breast metastasis.