Adrenal tumors: An experience of 10 years in a single surgical unit.

INTRODUCTION: Most of the adrenal masses are discovered incidentally by imaging techniques for reasons unrelated to adrenal diseases. Treatment is based on various factors such as, nature of adrenal mass, age of presentation, size of tumor, and the functional status of tumor. We report a series of 14 consecutive cases of adrenal tumors treated in a single surgical unit in our hospital. AIM: The aim of this study was to evaluate the clinical profile and outcome of treatment of adrenal tumors treated in a surgical unit. MATERIALS AND METHODS: It is a retrospective study data of 14 cases of adrenal tumors treated in a single surgical unit in University Hospital over 10 years have been analyzed. Various parameters such as gender, age, size of tumor, functional status, histopathology, type of management, and outcome have been reviewed. RESULTS: A total of 14 patients with adrenal masses were seen over a 10 year period (1997‑2006). All were referred cases, either from endocrinology or medicine wards. There were seven female and seven male patients. Mean age of patients was 48.6 years (range 14‑60 years). Mean size of tumor was 8.0 cm (5.9 cm for benign tumors and 9.7 cm for malignant tumors). There were six cases of adrenal carcinoma, four cases of adrenal myelolipoma, two cases of pheochromocytoma, and one each case of adrenal hyperplasia and histoplasmosis. There were only two functional tumors. All, except two malignant cases were treated operatively. A total of 5 year survival was 100% in benign cases and 27% in malignant tumors. CONCLUSION: Adrenal tumors need to be assessed for their functional status and malignant potential prior to treatment. Surgical excision is usually curative for benign lesion. Among malignant tumors the benefits of surgery depend on local extent and metastatic status of tumors.

Basilic vein aneurysm mimicking as arterio venous malformation.

Venous aneurysm is saccular or fusiform dilatation of vein, usually congenital origin. Among acquired variety post intravenous cannulation leading to venous aneurysm is extremely rare entity. Non invasive diagnostic procedure MRI and duplex scanning are very useful modality for anatomical localization of the aneurysm. Although an ascending venogram is an invasive test and should take a backseat for diagnosis of such aneurysm. Symptometic case needs surgical management. Anatomical delineation is an important pre requisite for planning surgery. Aneurysmorrhaphy preserves the affected venous segment because it does not produce luminal compromise.

Biological behavior and disease pattern of carcinoma gallbladder shown on 64-slice CT scanner: A hospital-based retrospective observational study and our experience.

Purpose: The aim of this diagnostic observational study was to assess the spread and biological behavior of gallbladder cancer using 64-slice computerized tomography (CT) scanner in this particular geographic belt (eastern Uttar Pradesh, western Bihar, and northern Madhya Pradesh provinces of North India). Indians are ethnically and culturally different from their Western counterparts among whom the incidence of this disease is comparatively low. Subjects and Methods: After systemic examination, all patients (87) were subjected to ultrasonographic examination. All cases were histopathologically proven. Confirmed cases were subjected to volumetric CT examination of abdomen and pelvis, plain, post contrast and delayed phase. Results: Majority of the cases were adenocarcinoma. There was female preponderance with majority belonging to fifth and sixth decades. Commonest presentation was diffuse, irregular, enhancing wall thickening in 49.4%. Majority had invasion of liver parenchyma (74.7%). Cholelithiasis was seen in 48.3% cases. Invasion of biliary radicals was high (13.8-18.4%). Eleven cases had invasion of portal vein and tumor thrombus, with hepatic artery invasion in one case. In two cases, both hepatic artery and portal vein invasion was seen. Portal and peripancreatic nodal metastasis was seen in 58.5%. Distant metastasis was reported. Conclusion: Few studies involving the Indian population have attempted to use multi-row detector CT to define the biological behavior of carcinoma gallbladder. The opinion whether the pathology is operable or non-operable can reasonably be given. This large-scale, single-center study gives insight about the epidemiology and biological behavior of carcinoma gallbladder.

Primary high-grade testicular leiomyosarcoma.

We herein present an extremely rare occurrence of primary intratesticular leiomyosarcoma. A 65-year-old patient presented with painless enlargement of the right testis. A high inguinal orchiectomy was done. Histopathological examination of the excised mass was consistent with high-grade leiomyosarcoma. Pertinent literature is reviewed and the importance of excluding the germ cell tumor and the paratesticular neoplasm is emphasized.

Abdominal compartment syndrome--an old syndrome, a new perspective.

The abdominal compartment syndrome is a life threatening condition resulting from pathologic elevation of the intraabdominal pressure. Prompt diagnosis is required to avoid significant sequelae. Diagnosis of this syndrome is based on clinical findings and intra abdominal pressure monitoring. Treatment consists of decompressive laparotomy, which corrects the pathology. Various surgical techniques are described to manage the open abdomen. Despite considerable attention accorded to this disorder, it is still associated with high morbidity and mortality. This review article deals with the identification of risk factors, pathophysiology, diagnostic criteria and treatment of critically ill patients with the abdominal compartment syndrome.

Management of polypoidal lesions of gallbladder in laparoscopic era.

The detection of polypoidal lesion of gallbladder (PLG) has increased particularly with widespread use of ultrasonography (US) as a diagnostic modality. Most of the PLG are diagnosed incidentally during scanning. Differentiation of benign from malignant PLG is a major concern and further management is based on this differentiation. DATA SOURCE: A Pubmed database search was performed. Abstract and articles were reviewed in detail. Other references were extracted by cross-reference. CONCLUSION: The risk factors for malignancy in PLG are identified. The newer investigative procedures may differentiate benign from malignant PLG. Follow up of the asymptomatic patient and indication for surgery is established in PLG.

Silent gallstones: a therapeutic dilemma.

Asymptomatic gall stones are defined as stones that have not caused biliary colic or other biliary symptoms. Nearly two-third of patients with gall stones are asymptomatic. Studies of the natural history of asymptomatic gall stones suggest that the cumulative probability of developing biliary colic after 10 years ranges from 15% to 25%. The incidence of other complications is much less. The operative mortality of elective cholecystectomy is <0.5% but increased mortality is seen in elderly persons (>60 year of age), particularly in those with complications such as acute cholecystitis. Most decision analysis studies do not favour prophylactic cholecystectomy for asymptomatic cholelithiasis. Nonetheless, many studies have listed certain criteria for carrying out elective cholecystectomy in asymptomatic patients. The authors, from their own experience and after reviewing the literature, propose the following criteria for cholecystectomy: life expectancy >20 years, calculi >3 cm in diameter, particularly in individuals in geographical regions with a high prevalence of gall bladder cancer or calculi <3 mm, chronically obliterated cystic duct, non-functioning gallbladder and calcified (porcelain) gallbladder. The widespread use of diagnostic abdominal ultrasonography has led to the increasing detection of clinically unsuspected gall stones. This, in turn, has given rise to a great deal of controversy regarding the optimal management of asymptomatic or 'silent' gall stones. While cholecystectomy is the undisputed gold standard treatment for symptomatic gall stones, the natural history of silent gall stones is not known well enough to recommend a definitive therapeutic strategy for such patients. The treatment options for asymptomatic or silent gall stones range from no treatment to selective cholecystectomy in at-risk group to elective cholecystectomy in all patients. There are a large number of proponents for each of these options so that each merits careful consideration. In this article, the authors examine the evidence for and against treating silent gall stones with the aim of providing more specific guidelines for the management of patients found to have asymptomatic gall stones.

Sonographic and colour doppler morphology in carcinoma gallbladder.

Conventional radiography has limitations in accurate diagnosis of gallbladder cancer (GBC). Ultrasonography (USG) allows correct diagnosis in 70-80% advanced and 23% early GBC. Present study was initiated to identify morphology and flow characteristics in GBC using conventional USG and Colour Doppler USG (CD-USG). In 100 patients, USG assessed morphology of mass lesion/wall thickening together with associated features. Of these, 60 cases were studied using CD-USG for intralesional/perilesional vascularity, peak systolic flow velocity (V max), resistive index (RI) and pulsatility index (PI). USG identified GB with mass lesion in 44% cases (Group-I) and only mass in GB fossa in 56% cases (Group-II). Findings identified calculi (73%), liver infiltration (74%), intrahepatic ductal dilatation (IHDD) (52%), lymphadenopathy (19%) and ascites (5%). CD-USG revealed vascularity, mainly pulsatile flow, in 78.3% cases (in 91.3% Group-I cases). Mean Vmax was 0.3037 m/sec (0.109 - 0.646 m/sec.), mean RI was 0.6621 (0.526 - 1.000) and PI was 1.282 (0.772 -2.140), Mean Vmax and PI were higher in Group-I compared to Group-II. Presence of calculus in 73% cases suggests a high association between calculus and malignancy. As flow signals were seen in 78% of all cases and 91.3% Group-I cases undergoing CD-USG, USG and CD-USG together can improve pickup rate of GBC.

Primary hepatic hydatid cyst with intrathoracic extension.

The case report of a 55-year-old male suffering from primary hepatic hydatid cyst with intrathoracic extension is described along with management of the case and review of literature.

Histoplasmosis: an unusual presentation.

Histoplasma capsulatum (HC) infection is rare in India. We document a case of unilateral adrenal histoplasmosis in a 56 year male. The patient presented with hepatosplenomegaly, unilateral adrenal mass and significant weight loss. Since FNAC of adrenal mass was inconclusive, he underwent splenectomy, adrenalectomy and liver biopsy, histology of these specimens revealed HC only in adrenal mass. Subsequently, histoplasmin test was also performed which was also found to be positive. He responded well to parenteral amphotericin B and is under regular follow-up with no complaints now.

Hepatic duct stones masquerading as Klatskin tumour.

We report woman who presented with painless progressive jaundice following cholecystectomy. Radiological investigations indicated proximal bile duct obstruction suggestive of hilar malignancy. Exploratory laparatomy revealed bilateral hepatic duct stone causing obstruction.

Role of rapid imprint cytology in the diagnosis of skin cancer and assessment of adequacy of excision.

Imprint cytotechnique was employed in 20 cases of maligant skin tumours (11 squamous cell carcinoma, 4 basal cell carcinoma and 5 malignant melanoma) to evaluate the reliability of the technique by comparing the results with histologic diagnosis. In ten cases margins of the excised tumours were also subjected to imprint and histopathologic studies to assess the clearance of malignancy. All the tumours were correctly diagnosed in imprint smears. Similarly 100% cytohistopathologic correlation was also obtained in the assessment of excisional margins of the tumours. The technique of imprint cytology may be employed for quick diagnosis of skin cancers and in assessment of clearance of surgical field during surgery.