[Papillary renal cell carcinoma; clinic and pathological study about 27 cases]

Background: Papillary renal cell carcinoma [PRCC] represent 10 to 15% of renal tumours in adults. They contain more than 75% of tubule-papillary structure and are divided histologically into two subtypes. The distinction between these two sub-types is essential because of different prognosis

Aim: To describe the main clinical, radiological, therapeutic and prognostic features of these tumors. A comparative analysis between the two sub histological types was performed. Methods: This is a retrospective study, from January 2000 to December 2010, concerning 27 patients operated for PRCC. Clinical data was taken from medical observations and radiological analysis was based on CT findings. A second analysis of blades was made in doubtful cases to clarify the histological subtype

Results: PRCC represented 11.3% of renal tumors operated during this period. Mean patients' age was 62 years with a male predominance [sex ratio 3.5]. All tumors were unilateral and mean tumor size was 7 cm. There was no clinical or radiological sign suggestive of this histological type. Treatment consisted of radical nephrectomy in 74% of the cases and nephron sparing surgery in 26% of the cases. We found 17 subtype 1 tumors and 10 subtype 2 tumors. The five year overall and disease-free survival rate were, respectively 86% and 90% in type 1 tumors and 57% and 54% in type tumors

Conclusion: PRCC is the second most common renal cancer in adults. They have no clinical or radiological specific signs suggesting their diagnosis. The distinction between these two sub histological types is essential as subtype 1 tumors have a better prognosis

[Atypical renal cysts]

Background: Atypical renal cysts are suspicious for malignancy. It is hard in some cases to give a sharp radiological diagnosis and propose an appropriate management

Aim: To give the histological results of the operated atypical renal cysts and to establish a correlation between the radiological findings and histological features

Methods: Between January 2001 and December 2012, 22 patients have been operated in our department for atypical renal cysts. There were 10 type III and 12 type IV Bosniak lesions. We have reported clinical, epidemiological and radiological findings. We have analyzed the histological results taking into consideration the radiological findings

Results: According to histological findings, 7 among the 10 type III lesions were benign [70%]. However, only one case of benign tumor was noted in type IV lesions [8.3%]. There was no evident correlation between tumors size and histology. With a median follow up of 48 months, three patients died because of locally advanced tumors

Conclusion: Management of atypical renal cysts remains difficult. A careful computed tomography staging is essential before treatment. Type III and type IV Bosniak cysts were malign in 30% and 91% of cases, respectively. There was no correlation between tumor size and malignancy. A nephron sparing surgery should be proposed whenever possible

[Colo-urachal-cutaneous fistula in an adult]

An infected urachal cyst is an uncommon finding in adults. To report a case of a sigmoid- urachal- cutaneous fistula. A 51 years old adult male presented with fecaloid leaking from rupture of an infected urachal cyst. Definitive management consisted of resection of the urachus with a bladder cuff, along with removal of the affected bowel segments. Colo-urachal-cutaneous fistula is a rare condition; its management is rather complex

Retroperitoneal ganglioneuroma: a case report

Ganglioneuroma is a rare, benign, neurogenic tumor originating from the neural sheath and frequently localized in the retroperitoneum. Report of a new case. We report a case of a 36-year-old woman presenting isolated right lumbar pain. Computed tomography revealed a heterogeneous, right, retroperitoneal mass, 13 cm in diameter. Complete resection of the tumor and right nephrectomy were performed. Histology confirmed the diagnosis of ganglioneuroma. Follow-up was 10 months with no recurrence. Through this case, we discuss diagnostic, therapeutic and prognostic aspects of this disease

Retroperitoneal leiomyosarcoma: report of 3 cases

Retroperitoneal leiomyosarcomas are neoplasma which are best treated with complete exeresis. We reported three new cases of retroperitoneal Leiomyosarcoma operated during last ten years. The authors reported 3 cases of Retroperitoneal leiomyosarcomas in 3 patients [2 men and a woman] aged respectively 53, 55 and 57 year-old .Incomplete resection was performed in the 3 cases because of the important local extension. All patients died 18,19 et 51 months after diagnosis

[Vesico-sigmoid fistula secondary to diverticulitis: a case report]

Vesico-sigmoid fistula is a rare complication of colic diverticular disease. It develops when the bladder sticks to an flammatory colon making of a communication between the bladder and the digestive segment. Usually the sigmoid. Liquid usually passes from the colon to the bladder because of the existing pressure gradient. Hence, urinary symptoms are the most frequent. Surgery is the treatment of choice. The present case is about a 72-year-O1d man who had a total hematuria for 3 months. The diagnosis of a fistula secondary to colic diverticulitis was established by cystoscopy, colonoscopy and cystography Surgery was undertaken and the postoperative outcome was excellent. Through this case the clinical features, special investigations and treatment of vesico-sigmoid fistula, are reported

Facteurs predictifs de morbidite et de mortalite de la chirurgie du vieillard

The aim of the study was to determine prognostic factors of post operative morbidity and mortality for patients aged 80 years and older. We compared two groups of patients aged 80 and over operated to determine predictive factors of morbidity and mortality group of patients who presented post operative complication within 30 days after surgery and group of patients without any complication. Comparison of the two groups for global morbidity using univariate analysis showed only one prognostic factor: surgery of diabetic foot [p = 0.034]. Predictive factors of mortality according to univariate analysis were: pre-operative shock [p = 0.001], abdominal wall pathology [p = 0.027], gastric or duodenal ulcer diseases [p= 0.011] and global morbidity [p = 0.006]. After logistic regression, only pre-operative shock was an independent predictive factor of mortality [p = 0.0023]. Risk for morbidity after surgery in the elderly 80 years and over is linked with type of surgery and not with soil. Likewise, risk for mortality is linked with advanced stage of disease that is presence of pre-operative shock and not with soil