Association of a retroperitoneal liposarcoma and an adrenal medullary hyperplasia feigning a pheochromocytoma

A 45-year old woman presented with a recent paroxysmal hypertension and a flush syndrome. Physical examination revealed an abdominal mass with positive left lumbar contact. The urine metanephrine was high. The CT scan and the Magnetic Resonance imaging [MRI] showed a 10 cm retgroperitoneal tumour apart from the left adrenal gland and driving back the left kidney. The diagnosis of ectopic pheochromocytoma was suspected and the patient was operated. A tumour resection widened to the left adrenal gland and to the kidney was performed The specimen histology showed a well-differentiated liposarcoma associated to an adrenal medullary hyperplasia [AMH] Postoperatively blood pressure was stabilizsed at normal levels. The review of literature show that AMH mimicking a pheochromocytoma is rare and its association with a giant retroperitoneal liposarcoma has never been reported before

Management of perforated duodenal ulcer

Final surgical treatment of perforated duodenal ulcer is not admitted by all authors. The aim of this study is to evaluate final treatment of perforated duodenal ulcer among 110 patients. 74.5 percent were aged less than 41 years. 107 patients underwend surgery. Treatment was based on: truncal vagotomy with phlorophasty [99 cases], truncal bagotomy with closure of duodenal per-faration and gastroentrero-anastomosis [5 cases]. Truncal vagotomy with antrectomy [1 case] and simple closure of the duodenal perforation [2 cases]. Moratlity of truncal vagotomy with pylorophasty was about 1 percent. According to the visick evaluation, clinical results were good in 95.3 percent cases without recurrent ulcer with a mean follow up of 4 years. According to out results truncal vagotomy with pyloroplasty seems to be a safe procedure in the management of perforated duodenal ulcer and more over gives good long-term results in control of peptic disease