Very rare localization of a retroperitoneal hemangiopericytoma revealed by lumbosciatalgia: A case report.

INTRODUCTION: Hemangiopericytoma is a rare vascular tumor representing about 1% of all vascular tumors and approximatively 5% of all soft tissues sarcomas that arises from the pericytes of Zimmerman surrounding capillaries and postcapillaries vessels. Retroperitoneal hemangiopericytomas are rare among the localisations as it usually occurs in lower and upper extremities. PRESENTATION OF CASE: We present a case of 31-year-old man with a well-defined retro peritoneal mass measuring about 105 × 73 × 83 mm at right lower quadrant of the abdomen anterior to right psoas muscle. Intraoperatively, an large mass measuring 10 × 8 cm was found arising from the retro peritoneum. A monobloc excision was performed. The postoperative course was uneventful. Histopathological examination with immune histochemistry revealed that tumoral cells were positive for desmin, CD34, smooth muscular antigen. Final diagnosis of hemangiopericytoma was made. On the last follow up at one year, he was symptom free. DISCUSSION: Hemangiopericytoma is a rare tumor. It takes origin from pericytes presenting as intervals along the walls of capillaries and post-capillary venules. Retroperitoneal hemangiopericytoma is a rare location. It is often discovered at late course, and can be revealed by various symptoms with the compression of the adjacent organs by the tumor Surgical resection should be considered in symptomatic cases or in case of diagnostic dilemma. CONCLUSION: Retroperitoneal hemangiopericytoma can be benign but it should be treated the same way as aggressive tumors. It requires a careful and long term follow up.

Isolated Roux loop pancreaticojejunostomy versus conventional pancreaticojejunostomy after pancreaticoduodenectomy: A case-control study.

OBJECTIVES: The aim of this study was to compare the postoperative outcomes of isolated Roux loop pancreaticojejunostomy (IPJ) and conventional pancreaticojejunostomy (CPJ) after pancreaticoduodenectomy (PD). METHODS: Data of patients who underwent IPJ were compared with those of a pair-matched equal number of patients undergoing CPJ. The matching was performed according to age, gender, nature of the lesion indicating PD and the texture of the pancreas. The primary outcome was the rate of postoperative pancreatic fistula (POPF). Secondary outcomes included operative time, day to resumption of oral feeding, postoperative morbidity and mortality. RESULTS: Seventy patients treated by PD (35 patients in each group) were included in the study. The two groups were comparable with regards to the pre-operative and intra-operative parameters. Postoperative pancreatic fistula developed in 10 out of 35 patients in the CPJ group and 3 out of 35 patients in the IPJ group (p = 0.031). Nine CPJ patients and one IPJ patient had POPF of type B or C (p = 0.006). Re-laparotomy was significantly more frequent in the CPJ group (11.1% versus 34.6%; p = 0.04). Time to resumption of oral feeding was shorter in the IPJ group (p = 0.001). CONCLUSIONS: The use of IPJ is associated with decrease in the rate of postoperative PF in patients undergoing PD. In addition, patients with IPJ reconstruction have lesser need for re-laparotomy and early resumption of oral feeding.

Pelvic abscess complicating sigmoid colon perforation by migrating intrauterine device: A case report and review of the literature.

INTRODUCTION: Intrauterine devices (IUDs) are commonly used as a contraceptive method. However, they may cause rare but potentially serious complications such as migration through the uterine wall and gastrointestinal perforation. PRESENTATION OF CASE: We report a case of a 26-year woman, carrying an IUD for 2 years, who presented to the emergency with pelvic pain with breakthrough bleeding. Abdominal imaging revealed the presence of two devices the first of which was located in the uterine cavity and the other in the wall of the sigmoid colon associated with a 5-centimeter pelvic collection. Intraoperatively, the IUD was found to be embedded in the wall of the sigmoid colon which was removed by wedge resection of the involved segment followed by a closure of the puncture with drainage. DISCUSSION: The Intrauterine Device (IUD) is an effective method of contraception, relatively well tolerated, reversible, inexpensive and widely used. However, it is not without risk. Indeed, serious complications can occur such as uterine perforation and migration to adjacent abdomino-pelvic structures. Our observation illustrates its rarity given the fact that this complication has been observed the first time in our department over the last ten years. CONCLUSION: The migration of IUD must be treated even in asymptomatic patients due to the risk of severe complications.

Ossifying fibromyxoid tumor of the trunk mimicking hydatid cyst: A case report.

INTRODUCTION: Ossifying fibromyxoid tumor (OFMT) is a rare lesion that generally occurs in the soft tissues of proximal limbs, head or neck and presents as a slowly growing mass. Abdominal or trunk locations are extremely rare. PRESENTATION OF CASE: We report a case of 50-year-old man who presented with a painless, slow growing epigastric mass for 5 years. Radiologic assessment revealed a well circumscribed median subcutaneous parietal mass lesion present in front of the xiphoid process suspicious of a calcified hydatid cyst. Diagnosis of OFMT was made on histopathological examination of the resected specimen. DISCUSSION: OFMT most often presents as a single swelling arising from the subcutaneous soft tissues or skeletal muscles of the extremities. Multifocal presentation is exceedingly rare. Radiologically, a peripheral shell of bone is seen in more than 50% cases. On MRI, myxofibrous stroma appears isointense to muscle on T1 and of intermediate to high signal intensity on T2. Surgical excision is the mainstay of treatment. Histologically, the tumor has a thick fibrous capsule with a complete or partial underlying layer of metaplastic woven or lamellar bone. Tumor is composed of uniform round, ovoid, or spindle-shaped cells arranged in nests and cords embedded in a variably myxoid and collagenous Alcian blue-positive stroma. On immunochemistry, the tumor cells are positive for S100 protein and desmin in 90% and 50% cases respectively. CONCLUSION: OFMT is a rare soft tissue tumor with malignant potential often misdiagnosed as a benign lesion. Complete surgical excision should be performed to prevent local recurrence.

Large bronchogenic cyst of stomach: A case report.

INTRODUCTION: Bronchogenic cysts are congenital cysts arising as an abnormal budding from primitive tracheobronchial tree. They are lined by pseudostratified columnar or cuboidal ciliated epithelium and contain smooth muscle fibers, submucosal bronchial glands and/or cartilage. They are most frequently located in the mediastinum or the lung parenchyma. Intramural occurrence of bronchogenic cyst in the gastric wall is very rare. PRESENTATION OF CASE: We present a case of 65-year-old lady with a 7×8cm lesion in the gastric cardia suspicious of gastrointestinal stromal tumor. Because of the large size, total gastrectomy with Roux-en-Y esophagojejunal anastomosis was performed. The postoperative course was uneventful. Histopathological examination revealed a sub-mucosal cyst lined by PCCE with presence of smooth muscle fibers and focal mucous glands. Final diagnosis of bronchogenic cyst was made. On the last follow up at one year, she was symptom free. DISCUSSION: On extensive Medline/Pubmed search, only 38 cases of gastric bronchogenic cysts were found to be reported till date. They are typically located in the posterior gastric wall close to the gastric cardia. On radiological imaging, they appear as well defined intramural cystic lesion without any characteristic features. Surgical resection is considered in symptomatic cases or in case of diagnostic dilemma. CONCLUSION: Gastric bronchogenic cysts often mimic gastrointestinal stromal tumor on preoperative imaging. They should be included in the differential diagnosis while dealing with an intramural gastric lesion close to the cardia or gastroesophageal junction.