Leiomyosarcoma of the penis. Case report and review of the literature.

The twenty-third case of penile leiomyosarcoma in the literature is reported, and all cases are reviewed. Clinically and pathologically these tumors fall into two groups, superficial and deep. Superficial tumors grow slowly, and tend to recur locally, but have a high salvage rate and good prognosis. The recommended treatment is local excision with negative margins. Recurrences are usually amenable either to re-excision or amputation with some degree of success. Deep tumors exhibit a more aggressive behavior, and have a poorer prognosis. Despite radical surgery the salvage rate is low, and most patients die from disseminated disease one or two years after diagnosis. Metastases to inguinal lymph nodes are uncommon, and should be treated aggressively in the absence of distant metastases. The role of adjuvant radiotherapy and chemotherapy in treating deep tumors should be investigated.

Substernal gastric bypass for palliation of esophageal carcinoma: rationale and technique.

A review of sixteen consecutive patients who underwent substernal gastric bypass (SSGB) for middle and upper thoracic esophageal cancer is presented. All patients were alcoholics and heavy smokers with significant medical risk factors. All had locally advanced, long, circumferential, obstructing lesions with regional metastases. The operative mortality rate was 36% in this group of high-risk patients with advanced disease. This high mortality rate may decrease with the modifications discussed. The previously described technique of SSGB is detailed with special reference to a modification for widening the thoracic inlet. The palliation afforded was excellent in all survivors, and the median survival time was a surprisingly long 10 months. Alternative approaches are discussed in a review of the literature. SSGB provides quite possibly the superior approach for palliative management of these difficult lesions.