Mesenteric fibromatosis: a report of three cases and literature review.

Fibromatosis is a group of relatively uncommon benign diseases showing proliferation of fibrous tissues and is liable to be confused with fibrosarcoma, thereby causing diagnostic as well as therapeutic dilemmas. Even after the correct diagnosis is made, one is not sure about the most effective treatment is in a given setting. Surgery seems to provide the best results but is not feasible at many times due to the extent of the disease, hence the need for non-surgical modalities for unresectable and incompletely resected tumors. Mesenteric fibromatosis is one of the rarer forms of fibromatosis. Three such cases are being presented here with a brief review of the literature.

Small cell carcinoma of gall bladder.

Small cell carcinoma of the gall bladder is very rare. We report a 25-year-old woman with this tumor. These tumors typically occur in elderly women with cholelithiasis; chemotherapy is not known to improve survival.

Endoscopic palliation of malignant obstructive jaundice using resterilized accessories: an audit of success, complications, mortality and cost.

OBJECTIVE: To assess the success, complications and cost of endoscopic endoprosthesis placement for palliation of obstructive jaundice caused by malignancy. METHODS: Four hundred and two consecutive patients with obstructive jaundice due to nonresectable malignancy undergoing endoscopic stenting were studied. Commercial or home-made 7F or 10F endoprostheses were placed using minor modifications of the standard technique. The accessories were sterilized and reused. RESULTS: Endoprosthesis placement was successful in 291 patients (72.4%, 95% CI 67.7-76.7)-241 in one attempt, 49 in two attempts, and one in three attempts. Fifty nine patients (14.6%, 95% CI 11.4-18.6) had procedure-related complications, including cholangitis (30), pancreatitis (15), perforation (3) and bleeding (11). The incidence of cholangitis was significantly higher in bifurcation blocks than in other lesions (17.6% vs 4.7%, p = 0.0005). The success rate did not differ between distal and proximal lesions (68.1% vs 72.9%). The procedural cost per patient could be reduced from Rs 14,850 to Rs 6565 by reusing accessories after sterilization, and using home-made stents. CONCLUSIONS: Endoscopic endoprosthesis placement is a safe and effective method for palliation of malignant obstructive jaundice. Preparation of indigenous stents and reuse of accessories can reduce the cost of the procedure by over 50%.

Precut papillotomy using a needle knife: experience in 100 patients with malignant obstructive jaundice.

BACKGROUND: Precut papillotomy enhances the success of selective bile duct cannulation. Doubts have been raised about the relative safety of the procedure. This study was undertaken to assess the success rate and complications of precut papillotomy using a needle knife. METHODS: 100 consecutive patients undergoing precut papillotomy for biliary endoprosthesis placement were studied. A needle knife was used in these patients after bile duct cannulation was not successful using other techniques. The success rate, complications and mortality were determined. RESULTS: Selective bile duct cannulation was achieved in 65 patients. There were six complications: bleeding (3), pancreatitis (2), and perforation (1). One patient died following duodenal perforation. The success rate for endoprosthesis placement was increased by 14.2% following precut papillotomy. CONCLUSIONS: Precut papillotomy enhances the success of selective bile duct cannulation, with complication rates similar to standard papillotomy.

Adenocarcinoma arising in "J" pouch after total proctocolectomy for familial polyposis coli.

A patient of familial adenomatous polyposis (FAP) without extra intestinal lesions is presented. The patient underwent a proctocolectomy with J pouch ileal reservoir with an ileoanal anastomosis. The clinical course was further complicated by an adenocarcinoma developing in the J pouch. This was excised totally and a terminal illeostomy was constructed. The aim of doing a prophylactic proctocolectomy in familial polyposis coli is to prevent a malignancy developing and to restore function with an illeoanal pouch. However polyps can occur in the gastric, duodenal and intestinal mucosa, which can lead to malignancy. Greater awareness and close follow up is needed even after prophylactic proctocolectomy.

Synchronous adenocarcinoma and lymphoma of the colon.

Synchronous lymphoma and adenocarcinoma of the colon are extremely rare. A 32-year-old woman was referred to us for colon cancer. Investigations revealed two primary tumors, one in the cecum and the other in the sigmoid colon. Subtotal colectomy with ileorectal anastomosis was performed. Histology revealed the cecal tumor to be non-Hodgkin's lymphoma, diffuse small cell type with plasmacytoid features. The sigmoid colon tumor was moderately differentiated adenocarcinoma. The patient received 6 cycles of chemotherapy postoperatively for lymphoma but died of recurrent disease after 17 months.

Spontaneously occurring liver cell adenoma in an adult male.

Spontaneously occurring liver cell adenoma is an extremely rare event. One such tumour in an adult male which was resected surgically is reported here.

Solid and cystic papillary neoplasm of pancreas--a report of seven cases.

OBJECTIVE: To study the clinico-pathological features of patients with solid and cystic papillary neoplasm of the pancreas. METHODS: The clinico-pathological features of solid and cystic papillary neoplasm of the pancreas were studied in seven fully documented and confirmed cases presented during the last seven years. RESULTS: All the patients were women with a median age of 18 years (range 12-40). Four presented with epigastric pain and three had a painless abdominal lump. The median duration of symptoms prior to presentation was 3 months (range 1-6). The tumor size ranged from 6-16 cm (mean 10 cm). Preoperative diagnosis was established by fine needle aspiration cytology in three patients. All the seven underwent resection. Pericapsular adhesions were found in two patients. All the patients were free of disease on follow-up ranging from 3-60 months (median 16 mo). CONCLUSION: Occurrence in young females, solid and cystic areas on imaging, resectability in spite of large size, and good prognosis are the important features of this tumor.

Unusual bone metastasis as the initial symptom of gastric cancer--a report of four cases.

Four cases of gastric cancer presenting with bone pain due to metastasis as the initial symptom are reported. Investigations revealed solitary osteolytic metastasis in the mandible in one, and left scapula in one patient. Third patient had multiple osteosclerotic metastasis with elevation of acid phosphatase and another had multiple discrete osteolytic metastasis simulating multiple myeloma. All the primary gastric cancers were poorly differentiated adenocarcinoma and three were of Borrman type III on gross appearance. One patient had sparing of the liver inspite of extensive metastasis. Chemotherapy was in effective in two patients and the prognosis was uniformly poor.

Intraoperative fine needle aspiration cytology of pancreas: a study of 97 cases.

Intraoperative fine needle aspiration cytology (FNAC) for pancreatic and ampullary lesions was carried out under direct vision using transduodenal approach in 97 patients. Cytological findings were classified as follows: positive for malignancy, suspicious for malignancy, benign (normal) cells from duodenum or pancreas, inflammatory and non-representative smears. Suboptimal smears (non-representative, suspicious and inflammatory) were excluded for calculating decision analysis values. Sensitivity for malignancy was 90.5% and specificity 100%. Positive and negative predictive values were 100% and 50% respectively. We conclude that intraoperative FNAC is useful in diagnosing malignant lesions of the pancreas.

Role of endoscopic ambulatory laser therapy in palliation of malignant colorectal diseases.

BACKGROUND: Endoscopic laser therapy is widely used in the palliation of advanced malignant colorectal diseases. The role of this therapy in improving the quality of life of these patients needs adequate assessment. METHODS: Nine patients with advanced colorectal cancers and three patients with secondary colorectal involvement by pelvic cancers underwent endoscopic Nd:YAG laser therapy for palliation using non-contact laser guides for tumor bleeding alone (n = 12) or associated with obstruction (n = 7). The therapy was performed on an outpatient basis in 9 of the 12 patients. One patient was lost to follow up. RESULTS: Symptom control was achieved in all the 11 bleeding tumors and in 5 of the 7 obstructive tumors. There were no major complications. Three patients had no improvement in the quality of life in spite of control of symptoms. CONCLUSION: Ambulatory endoscopic laser therapy is a minimally invasive, safe and effective method of palliation for selected patients with non-resectable malignant colorectal tumors.

A prospective study of radiation induced damage of pancreatic ducts.

To study radiation-induced pancreatic duct damage, endoscopic retrograde pancreatograms of 11 patients with primary gastric lymphoma who had completed chemotherapy and moderate dose external radiation therapy were compared with those of 22 normal subjects. No significant alteration was seen in the length and caliber of the main pancreatic duct and number of side branches. Clubbing of one or two side branches was observed in four patients who had received radiation (p = ns). We conclude that significant structural changes do not develop in the pancreas following moderate dose upper abdominal radiation.

Palliative segment III biliary bypass (left cholangio-jejunostomy) in malignant block at porta hepatis.

Segment III cholangio-enteric anastomosis was performed in 17 patients with obstructive jaundice due to unresectable malignancies at the porta hepatis. The operative mortality was 6% (1/17) and morbidity 30% (5/17). More than 50% fall in bilirubin level with symptomatic improvement in pruritus was seen in 13 patients. Three patients had 25%-50% fall in bilirubin level. This procedure is safe and effective in palliation of unresectable hilar obstruction.

Familial polyposis coli with villous adenoma of ampulla of Vater.

Adenoma of the ampulla of Vater is one of the extracolonic manifestations of familial polyposis coli (FPC). We report three patients with FPC in whom villous adenoma of the ampulla was detected. An adenoma carcinoma sequence has been suggested in such lesions.