Extragastrointestinal stromal tumor presenting as a scrotal mass: First report from India.

INTRODUCTION: Gastrointestinal Stromal Tumours (GIST) are the most common mesenchymal tumours that arises from the wall of the gastrointestinal tract. Similar tumours elsewhere in the abdomen are called extra gastrointestinal stromal tumor (EGIST). PRESENTATION OF CASE: A 68 years male presented with a gradually enlarging scrotal mass over a period of 6month duration. On examination a mass was felt (5 cm × 4 cm) occupying left side of scrotum and abutting the lower pole of left testis. Left inguinal orchidectomy along with excision of mass was done. HPE revealed a spindle cell pattern with low cellularity and Immunohistochemical analysis revealed the tumor reactive for CD 117 and CD 34 which is suggestive of GIST. DISCUSSION: EGIST have been reported in unusual locations, including the pancreas, prostate, and abdominal wall. The occurrence of EGIST is extremely rare and little is known about their actual origin. The diagnosis is by the demonstration of a specific marker CD 117 and CD34. We describe an unusual case of extra gastrointestinal stromal tumor (EGIST) presenting as a primary scrotal mass. CONCLUSION: To the best of our knowledge, this is the first Indian case of an EGIST involving the scrotum as primary site and second such case worldwide.

Contemporary use of ultrasonic versus standard electrosurgical dissection in laparoscopic nephrectomy: Safety, efficacy and cost.

OBJECTIVE: To assess the safety, efficacy and cost-effectiveness of ultrasonic dissection (USD) compared with standard monopolar electrosurgery (ES) in laparoscopic nephrectomy (LN). PATIENTS AND METHODS: Retrospective analysis of patients' records who underwent elective LN was performed. Patients were divided in to two groups: USD and ES groups depending on the energy source used during LN. The preoperative (demographics, indication for surgery), intraoperative (conversion to open surgery, operative time, estimated blood loss [EBL], complications), and postoperative (morbidity/mortality, volume of drainage, hospital stay, cost) data were collected and analysed. RESULTS: Between February 2004 and February 2008, 136 patients were included. The indications for nephrectomy were: inflammatory (51 patients), non-inflammatory (64), and tumours (21). The two groups were similar for preoperative data. The conversion rate to open surgery (12.5%) and mean operative time did not differ significantly between the groups. However, intraoperative mean EBL was significantly less with USD, at 140.8 mL vs 182.6 mL for ES. There were no differences in postoperative parameters and morbidity. USD was significantly more expensive than ES (59 000 vs 26 000 Indian Rupees). CONCLUSIONS: ES is a safe and feasible tool like USD in LN when used with caution. USD facilitates completion of difficult cases and reduces intraoperative blood loss. However, the majority of LNs can be completed safely with ES. ES is sturdy and cheap; therefore, selective use of USD appears to be the most cost-effective policy in the developing world.