[Gastrointestinal stromal tumors]. / Les tumeurs stromales du tube digestif.

There are two main types of gastrointestinal connective tissue tumors: differentiated connective tissue tumors arising from smooth muscle tissue, schwanommas or fibroblastic tissue, and non-differentiated connective tissue tumors with no precise origin. Pathologically non-classifiable tumors comprise a group of real gastrointestinal stromal tumors. Stromal tumors are rare and generally develop in the stomach. Immunohistochemistry has been able to identify three entities: stromal tumorswith skenoid fibers, gastoinestinal autonomic nerve tumors, and intraabdominal desmoplastic small round-cell tumors. After resection, survival is almost 50% at 5 years and depends particulary on tumors size, the presence of synchronous metastases and mitosis count.

[Stromal tumors in the digestive tract. A case of duodenal localization]. / Les tumeurs stromales du tube digestif. Un cas localisé au duodénum.

BACKGROUND: Stromal tumors of the digestive tract are undifferentiated connective tissue tumors which are difficult to characterize even with immunohistochemistry. CASE REPORT: A stromal tumor of the duodenum (the most frequently encountered location) was resected entirely. Histochemistry was unable to provide a precise identification of the histological nature. The tumor was considered to be low grade due to the low mitosis index despite its large size and the presence of necrosis. Careful surveillance was indicated. DISCUSSION: The risk of these tumors is uncertain and may be assessed on the basis of histological prognosis factors such as tumor size, mitosis index and ploidy. Echoendoscopy can be particularly useful for diagnostic purposes providing information on location in the duodenal musculosa.

Treatment of adenocarcinoma of the pancreas with somatostatin and gonadoliberin (luteinizing hormone-releasing hormone). The French Associations for Surgical Research.

Experimental studies have shown a significant inhibition of adenocarcinoma of the pancreas by gonadoliberin (luteinizing hormone-releasing hormone [LH-RH]) and somatostatin. The aim of this prospective randomized study was to compare the potential value of somatostatin (250 micrograms every 8 hours), LH-RH (3.75 mg monthly), or combined, to a control group. One hundred sixty-three patients with adenocarcinoma of the pancreas who did not undergo resection for cure were divided into 4 groups that did not differ in terms of clinical, biologic, or pathologic data. The mean survival times were 6 months in the LH-RH plus somatostatin group, 5.5 months in the LH-RH group, 4.3 months in the control group, and 3.8 months in the somatostatin group. However, the life-table analyses for all randomized patients, and separately according to sex, the lymph node extension, and metastatic spread were not different between groups. Improvement of patient status was observed in 20% of the patients receiving hormone therapy without any difference noted between the treatment regimens. These disappointing results may be explained by the degree of extension of pancreatic carcinoma in the patients studied. The results suggest that different hormone therapy regimens might be considered according to the age and the sex of patients, as well as to the presence or absence of hormone receptors.

[Thyroid cancer and familial rectocolonic polyposis]. / Cancer thyroïdien et polypose recto-colique familiale.

Thyroid carcinoma and familial intestinal polyposis are not accidentally associated. A new case is described which, along with the other 32 cases already published, reveals an incidence of thyroid carcinoma 100 times higher in patients with polyposis than in the general population, and 160 times higher in female patients under 35 years of age. Several features of these thyroid carcinomas can be pointed out: greatest incidence in women, occurrence at a young age, existence of a papillary tumor appearing independently from the evolution of the polyposis, and probably familial disease. It is therefore necessary to systematically examine the thyroid body in all subjects with familial intestinal polyposis.

[Esophageal stenosis caused by carcinomatous mediastinitis secondary to epidermoid carcinoma of the anal canal]. / Sténose oesophagienne par médiastinite carcinomateuse secondaire à un carcinome épidermoïde du canal anal.

A case of oesophageal stenosis due to mediastinal carcinosis from squamous carcinoma of the anus, treated five years before by radiotherapy, is reported. Radiosensitivity of the tumor ensured a good results with complete resolution.

[Technic of the surgical excision of villous tumors]. / Technique d'exérèse chirurgicale des tumeurs villeuses.

Villous tumours of the colon and rectum are characterized by a high incidence of malignancy (50%) and by their tendency to recur. Invasive malignant villous tumours require wide excision in the same way as adenocarcinomas. Non-invasive tumours (stage 0 and stage I) should be treated like benign villous tumours. Villous tumours of the colon, i.e. situated more than 15 cm from the anus, are removed by a short colonic resection. Villous tumours of the rectum which are small and pedunculated or sessile, situated less than 8 cm from the anus can be excised via the trans-anal route, provided a margin of healthy mucosa is removed around the villous zone. High rectal tumours which are very large or diffuse are removed by a trans-sacral approach, low extensive tumours are removed by a coccyperineal or trans-sphincteric approach. Recurrences (30 to 40%) always occur after incomplete excision, especially after a trans-anal resection. Benign tumours can also recur, although remaining benign, and require a further local excision.

Comparison of diagnostic methods for selection of patients for antireflux operations.

In cases of reflux disease the therapeutic indications are of special significance. The number of patients in need of operation is limited, thus the patients must be chosen carefully. Different diagnostic methods have been compared to standard acid reflux test in a series of 22 consecutive cases. Radiology was the least reliable method for detecting reflux or reflux complications, whereas endoscopy confirmed the diagnosis in 18 of 22 cases. Three-point stepwise manometry did not give reliable data of the lower esophageal sphincter pressure but yielded valuable information about the location of lower esophageal sphincter zone and of esophageal motility. In contrasts to earlier reports, no considerable overlap regarding lower esophageal sphincter pressure values in healthy and diseased individuals were noted.