Laryngotracheal non-Hodgkin's lymphoma.

OBJECTIVES: Malignant lymphomas of larynx and trachea are rare tumors and require special diagnostic and therapeutic attention. The authors present an unexpected case of nonHodgkin Lymphoma localized in the subglottic larynx and upper cervical trachea. The clinical presentation, diagnostic and therapeutic approach, evolution and prognosis are discussed. METHOD: We report a case of 25-year-old male patient, with progressive dyspnea, presented in our ENT Department with severe airway obstruction caused by a large subglottic tumoral mass migrated in the glottic space during an accidental fall. An emergency tracheotomy was performed. The flexible endoscopy and CT-scan revealed a large mass arising from the subglottic larynx and anterior wall of upper cervical trachea with the obstruction of 2/3 of the laryngotracheal lumen. RESULTS: After a complex assessment, the tumor was excised by external approach (median thyrotomy). The histopathologic exam of the surgical specimen showed malignant nonHodgkin lymphoma and the immunohistochemical profiles were evaluated in order to establish the therapeutic strategy including chemotherapy in the Department of Oncology. CONCLUSIONS: Invasion of the subglottic larynx and trachea by lymphoma is an uncommon problem which can cause severe airway obstruction and requires multidisciplinary approach (ENT, pneumology, oncology/hematology). The clinicopathological features of this case have been described and compared with previously reported cases.

[Torsion and infarction of an accessory liver lobe]. / Lob hepatic accesoriu torsionat si infarctat.

Anatomical abnormalities of the liver are extremely rare. We report a case of a 32 year old female who has admitted with acute epigastric pain and vomiting. Physical exam revealed a mobile mass in right middle abdominal quadrant. Ultrasound and contrast--enhanced CT demonstrated a heterogeneous vascular left mass. Small bowel enema shows left jejunal loops displacement. Surgical findings: twisted, congested swelling, attached by a long pedicle to the liver's third segment. Histological examination showed recent hepatic infarction.

[Malignant peritoneal mesothelioma tumours. Evolution, treatment, prognosis]. / Tumorile maligne mezoteliale peritoneale evolutie, tratament, prognostic.

Malignant mesothelioma of the peritoneum is a rare neoplasm with a rapidly fatal course. The median survival range is from 5 to 12 months in untreated cases with little improvement seen in patients receiving multimodality therapy. Although most cases occur in the fifth and sixth decades, peritoneal mesothelioma can be seen in any age group. Approximately 30% of all mesotheliomas arise solely from the peritoneum. Asbestos exposure, primarily of the crocidolite variety, has been implicated in the pathogenesis of this malignancy, as was established in South Africa in the 1960s. Half of reported cases have a history of asbestos exposure. The diagnosis of peritoneal mesothelioma is often delayed, in part because of the usually long latent period (peaking at 40-45 years from the time of initial exposure to asbestos) and because the common presenting symptoms of weight loss, usually with a full abdomen, malaise, and abdominal discomfort, are mild and nonspecific. This paper aim is to present a case report regarding a patient diagnosed with malignant peritoneal mesothelioma with an unpredictable evolution.

[MRI in the differential diagnosis of liver focal lesions]. / Irm în diagnosticul leziunilor focale hepatice.

51 patients with focal liver abnormalities at ultrasound were examined by MRI. The cases with liver metastasis of known origin submitted for staging and cholangiocarcinomas of the external bile ducts or gall bladder with liver invasion were not included in the study. Most of the examinations were performed for suspected hepatocarcinoma. MRI studies, using 2D T1 and T2 weighted FSE sequences and T1 weighted 3D SPGRE contrast enhanced sequences were able to differentiate between different kinds of benign lesions e.g. large hemangiomas or FNH or even complicated hydatic cysts from hepatocarcinoma.

Features of pathological assessment in rectal cancer.

Rectal cancer diagnosis is established by collaboration between oncological surgeons, oncologists, pathologists and imaging specialists. By examining the macroscopic and microscopic aspect of the surgical specimen, the pathologist could provide the surgeon with information regarding the surgical procedure. Staging represents the clinical or pathological assessment of the extent of tumour spread. The clinical staging is a preoperative evaluation based on clinical and radiological information being used to determine the appropriate treatment for each case. The pathological staging permits the postoperative assessment that brings prognostic information. The aim of this paper is to present the suggestions of our multidisciplinary team for an accurate pathology assessment of rectal cancer.

[Malignant peritoneal mesothelioma]. / Mezoteliomul malign peritoneal.

Mesothelioma is a neoplasm originating from the mesothelial surface lining cells of the serous human cavities. It may involve the pleura, less frequently the peritoneum rarely, the pericardium, the tunica vaginalis testis and ovarian epithelium. Asbestos has been widely used in industry. A causal relationship between asbestos exposure and pleural, peritoneal and pericardial malign mesothelioma was suggested, the risk of cancer being correlated to cumulate exposure. Studies from National Cancer Institute, USA, show that the malignant mesothelioma is a rare and aggressive asbestos related malignancy. The symptomatology is insidious and poses difficult problems in diagnosis and treatment. This paper presents the case of a 59 year old patient with malignant peritoneal mesothelioma who worked almost 40 years as an electrician, exposed to asbestos fibers. He was hospitalized for important weight loss, abdominal pain and tiredness being diagnosed after imaging tests with a giant tumor, localized at the abdominal upper level, which seems to originate from the spleen's superior pole. During surgery we discovered a tumor with cystic parts, intense vascularized, which turn to be adherent in the upper side to the lower face of the left midriff cupola, to the spleen superior pole and 1/3 middle level of the great gastric curve. It was performed surgical ablation of the tumor, splenectomy with favorable postoperative evolution, the patient being now under chemotherapy treatment.

[MRI in acute pancreatitis]. / IRM in pancreatita acuta.

26 patients with clinical and biological suspicion of acute pancreatitis were examined by MRI. The general indications for pancreatic MRI were: suboptimal or equivocal CT or ultrasonography findings (e.g. focal pancreatic enlargement with no mass discernable on CT or US), contraindications to iodinated contrast administration (e.g. contrast allergy history and renal failure). Using fast scanning techniques most of them with breath holding and fat saturation MRI was able to depict the lesions involved (e.g. the presence and distribution of necrotic areas and fluid collections, the existence of subsequent chronic pancreatic changes) which are consistent with CT findings. MRCP demonstrated etiology, like cholelithiasis.

[Giant retroperitoneal lipoma]. / Lipoame gigante retroperitoneale.

70 retroperitoneal tumors (10 with an adipous origin out of which 8 were lipomas) have been operated upon in our clinic since 1985. Four cases of giant lipomas are presented in this paper. They weighed 4.5-7.5 kg. and had a diameter over 15 centimeters. Their close proximity with the kidney, duodenum, colon, inferior vena cava etc made there extirpate difficult. The post-operative condition of the patients was good. Although the histopathological tests proved that all these giant lipomas were benign after two to four years, their relapse required a new surgical intervention. The histopathology of the relapsed lipomas revealed a malign degeneration in 3 out of the four cases. The origin of this malign degeneration was in the fibrous part of the tumors.

Therapeutical aspects of the plasmocytoma localized at the level of head and neck.

The authors present a study on 7 cases of extramedullary plasmocytoma localized in E.N.T. area, hospitalized and solved in the E.N.T. Department of the the "Sf. Spiridon" Universitary Hospital, in the last 15 years, between 1983-1997. We insist on the last solved case, presenting a double isolated localization, a laryngeal and a rhinosinusal one. We consider that the most indicated treatment in the isolated extramedullary plasmocytoma, is the radiosurgical therapy with a good rate of survival.

[A practical study of the absorbed doses at the level of the organs at risk during the radiotherapy of bronchopulmonary cancer]. / Studiul practic al dozelor absorbite la nivelul organelor de risc, în cursul radioterapiei cancerului bronhopulmonar.

The radiotherapy of lung cancer with curative total doses (56-60 Gy), is limited by the presence of critical organs (esophagus, spinal cord). The use of computed TPS (Therapy Planning System) allows to the radiotherapist to calculate the values and to obtain dose distribution to the organs at risk, in the limit of biological tolerance levels. In our work, we present the calculation of the absorbed doses of Co60, at the spinal cord, at a patient with a cancer of the right lung, during irradiation.