Primary malignant melanoma of the adrenal gland.

Primary malignant melanoma of the adrenal gland is an established entity. Fewer than 20 cases have been reported in the published literature. Because of the high frequency of adrenal gland metastases from malignant melanoma and pigmented pheochromocytoma, several rigid diagnostic criteria have been established for accepting an adrenal melanoma as primary. A new case is reported in this article. This observation is an opportunity update the literature on the diagnostic difficulties in this rare pathology.

[Feasibility and value of the isotope sentinel node mapping technique in prostate cancer]. / Faisabilité et intérêt de la technique isotopique du ganglion sentinelle dans le cancer de la prostate.

OBJECTIVE: Use of an isotope sentinel node mapping technique in prostate cancer to study its feasibility, lymphatic prostate drainage and its value in pelvic lymph node staging. MATERIAL AND METHOD: The sentinel node mapping technique was performed in 34 patients with clinically localized prostate cancer. A transrectal intraprostatic injection of Technetium 99m-labelled nanocolloidal particles was performed on the day before radical prostatectomy. Sentinel node mapping was performed by intraoperative lymphoscintigraphy and gamma probe. A standard pelvic lymphadenectomy was systematically performed. RESULTS: Preoperative lymphoscintigraphy allowed identification of sentinel nodes in 85.3% of patients. Four of the five failures had a history of pelvic surgery. Sentinel node mapping and biopsy were possible in 23 patients (67.7%). The majority of sentinel nodes were located in the hypogastric region (58.4%). A microscopic lymph node metastasis was identified in 4 patients (11.7%), located in a sentinel node in 3 cases. In 2 cases, the micrometastasis was situated in a sentinel node outside of the pelvic chain. These four patients had a pretreatment PSA > 10 ng/ml and a Gleason score > or = 7 (on the prostatectomy specimen). CONCLUSION: This study confirms the feasibility of the sentinel node technique in prostate cancer and the diversity of lymphatic drainage of the prostate. Pelvic lymphadenectomy alone also appears to be insufficient for precise staging in patients with pretreatment PSA > 10 ng/ml and a Gleason score > 6. This isotope technique could therefore improve the yield of lymphadenectomy by limiting its extent.

[Evaluation of non-enhanced spiral CT in the assessment of renal colic: prospective series of 81 patients]. / Evaluation du scanner hélicoïdal non injecté dans la prise en charge des coliques néphrétiques: série prospective de 81 malades.

OBJECTIVE: For many years, intravenous urography has been the first-line investigation for renal colic. Since the middle of the 1990s, non-enhanced spiral CT has become a more efficient, less invasive and less expensive alternative to IVU. The aim of this study was to compare non-enhanced spiral CT and IVU in the assessment of renal colic and to evaluate the possibility of exclusive CT assessment in this disease. MATERIAL AND METHODS: Prospective study including 81 patients all undergoing urgent non-enhanced spiral CT, while the first 30 patients were investigated by non-enhanced spiral CT and IVU. RESULTS: Comparison of IVU versus CT: better sensitivity of CT for the diagnosis of renal colic (96% vs 92%) and for the detection of stones (95% vs 59%). CT diagnosis: A definitive diagnosis of renal colic was established in 72/81 patients: stone visualized in 64 cases and post colic syndrome in 8 cases, while the other 9 patients presented a non-urological abdominal disease. DISCUSSION: Comparison of our series with results reported in the literature confirms the superiority of CT over IVU with better visualization of the stone at a lower cost, with a shorter examination time, without injection and allowing the detection of non-urological disease. Analysis of CT signs emphasizes the importance of secondary signs for the diagnosis of renal colic (dilatation, perirenal or ureteric oedema, rim sign). Delayed excretion demonstrated by IVU and not directly evaluable by non-enhanced CT is no longer an argument in favour of IVU as first-line examination for the assessment of renal colic. CONCLUSION: The superiority of CT for the diagnosis of renal colic has now been demonstrated. Renal colic can now be assessed exclusively by first-line non-enhanced helical CT. IVU or contrast-enhanced CT may be indicated in rare cases when there is a doubt about the diagnosis on non-enhanced CT.

[Benign retroperitoneal schwannoma: report of three cases]. / Schwannome rétropéritonéal bénin: à propos de trois cas.

Schwannoma is a tumour arising from Schwann cells. It has a variable presentation and its preoperative diagnosis is difficult. Retroperitoneal schwannoma is an exceptional site. Although the great majority of schwannomas are benign, malignant forms also exist, frequently associated with Von Recklinghausen syndrome (4% of cases) or other neurofibromatoses. The authors report three cases of benign retroperitoneal schwannoma discovered in a context of low back pain, altered bowel habit or incidentally, The frequency, diagnosis, imaging and treatment of this rare tumour are discussed.