Extragastrointestinal stromal tumour of the lesser omentum: A case report and literature review.

INTRODUCTION: Extragastrointestinal stromal tumours (EGISTs) are very uncommon compared to their gastrointestinal counterparts. Most of them originate from the intestinal mesentery and the omentum. CASE REPORT: A 70 year-old Caucasian woman presented with a bulky abdominal mass which on laparotomy was found to originate from the lesser omentum and was completely resected. Histological examination revealed spindle cells with severe pleomorphism and high mitotic activity. Immunohistochemically, the tumour cells showed strong positivity for c-kit (CD117), DOG-1 and human haematopoietic progenitor cell antigen (CD34). An exon 11 deleterious mutation was identified and thus regular dosing of 400mg imatinib mesylate was initiated. DISCUSSION: There have been only a few previous reports of EGISTs arising in the lesser omentum. Although EGISTs seem to have morphological and immunohistochemical similarities with GISTs, their pathogenesis, incidence, genetic background and prognosis are not completely known because they are extremely rare. It is strongly believed that such tumours originate from cells, which have similar pathological characteristics and biological behaviour as the intestinal cells of Cajal. In most series of EGISTs, a female predominance, a greater size and a higher mitotic index than GISTs were observed. CONCLUSION: EGISTs are very rare mesenchymal tumours which originate from cells outside the gastrointestinal tract and tend to have a more aggressive biological behaviour than their GI counterparts. Complete surgical resection is the most effective treatment associated with the use of imatinib in the presence of adverse prognostic factors. In any case a strict follow-up is necessary due to high recurrence rates.

Prevalence, risk and aggravating factors of chronic venous disease: an epidemiological survey of the general population of Greece.

INTRODUCTION: Chronic venous disease (CVD) is a common disease all over the world, mainly in Western Europe and the USA. AIM: To evaluate the prevalence of CVD in the Greek general population and the characteristics of CVD. MATERIALS AND METHODS: The study sample included 1500 individuals, 15-64 years of age, who were citizens of Athens, Thessaloniki, or one of five Greek cities with more than 10,000 in the population. The sample was selected by a stratified, multistage, random sampling procedure based on the Greek Census 2001. Questionnaires were completed for each individual by personal interview. RESULTS: From 1500 individuals, 224 (14.9%) had symptoms and/or signs of CVD, 9.6% were men and 20.1% were women. The highest percentage of presenting CVD symptoms was among 45-54-year-olds (23.4%) and 55-64-year-olds (27%). The symptoms that were mostly mentioned among sufferers were 58% achy legs, 37.4% swollen legs and 25.3% heavy legs, whereas the frequent signs were broken capillaries - telangiectasia (19.2%) and varicose veins (14.8%). About 62.9% with CVD had an obese body mass index (BMI > 25). The prevalence of CVD in patients with prolonged standing hours at work (4+ hours) was 20.8%. The symptoms of CVD were worse during the summer period only in 26.8% of the patients whereas in 50.8% during all the year. Regarding quality of life, more than 40% of the patients had either health or cosmetic problems. Sufferers mentioned that they took first advice from physicians (28%), or from friends and relatives (27%) or from pharmacists (26%). CONCLUSION: This is a real whole-population study of Greece - a Mediterranean country that provides important and remarkable data on the epidemiology of CVD and highlights that we need improvement of relations within the triangle constituted by physicians, patients and disease.

Association between bone scintigraphy and serum levels of tumor markers in the detection of bone disease in breast cancer patients.

PURPOSE: To evaluate the diagnostic value of bone scan in association with measurements of serum CEA, CA 15-3 and TPA levels in breast cancer (BC) patients. PATIENTS AND METHODS: From September 1999 to January 2005, 89 women with BC who had undergone bone scintigraphy as part of their follow-up were retrospectively evaluated. Serum tumor markers levels were compared with the results of bone scintigraphy. Patients with positive bone scans were divided into 3 groups: group 1: 1-3, group 2: 4-5, group 3: >5 bone lesions. Serum CEA, CA 15-3 and TPA levels of 7 ng/ml, 35 U/ml and 90 U/I, respectively, were adopted as the upper limit of normal. RESULTS: Serum CA 15-3 was significantly higher in patients with a positive bone scan (p=0.017). For CEA and TPA, no significant difference was found between patients with and without bone metastases. Twenty-five of 70 patients (36%) with normal CEA had bone metastases. Four of 50 (8%) patients with normal CA 15-3 and 15 of 51 (29%) patients with normal TPA had a positive bone scan. The combination of CA 15-3 with TPA showed 100% sensitivity in detecting bone metastases in all patient subgroups. In all 42 patients without bone metastases, CA 15-3 and/or TPA levels were normal. CONCLUSION: CA 15-3 but not CEA or TPA is sensitive and specific for the correct determination of bone scintigraphy. CA 15-3 plus TPA represent the best combination in association with bone scanning. However, due to frequent false negative results of all tumor markers, it is not recommended to reject a bone scan on the basis of tumor markers levels.

The role of cytology in the diagnosis of benign and malignant anal lesions.

Squamous cell carcinoma is a rather infrequent neoplasm of the gastrointestinal tract. Nevertheless its frequency is increasing lately especially in high risk groups of the population infected from HIV or HPV viruses. Squamous cell carcinoma is a slowly and locally growing neoplasm which metastasizes in advanced stages. Its diagnosis must be accomplished by the least traumatic examinations possible. In our study we reviewed our five years experience that included 116 cases. In 89 of them cytological material from ulcerated positions of the anal region was examined. In the rest 27 cytological material was obtained by fine needle aspiration of subcutaneous or submucosal anal lesions. All 116 case reports were retrospectively evaluated. Cytological evaluation revealed 29 cases of normal anal epithelium, 13 granulomas, 12 cases of HPV infection, 28 anal squamous intraepithelial lesions (ASIL), 17 post radiation injuri-es of the anal mucosa and 17 carcinomas. The neoplasms were further subclassified in 12 well differentiated squamous cell carcinomas, 4 cloacogenic carcinomas and 1 leiomyosarcoma. Histological examination followed the initial cytological diagnosis in 75 cases. The correlation between cytological and histological reports did not reveal any false negative or any false positive result. The agreement between histological and cytological evaluation was absolute. Cytological examination is proved to be an easily accessible and totally reliable, low cost diagnostic method, not requiring any kind of anesthesia. It is well accepted by the patients and of paramount clinical utility for the initial diagnostic assessment, the long-term follow up after treatment of anal cancer patients. It is also valuable for the differential diagnosis among benign, premalignant and malignant anal lesions.

An evidence-based treatment algorithm for anal fissure.

Guidelines for the treatment of anal fissure have been published in the USA and UK but differ. Many centers follow guidelines based on local experience. In December 2005, we met with the aim of developing an evidence-based treatment algorithm for anal fissure, applicable to both primary and secondary care. This algorithm may rationalize the treatment of anal fissure in primary and secondary care settings.

Mucocele of the appendiceal stump due to benign mucinous cystadenoma.

Mucocele of the appendix is a rare lesion, characterized by distension of the lumen due to accumulation of mucus material. Correct preoperative diagnosis is seldom achieved. If left untreated, the mucocele may rupture producing a potentially fatal peritoneal spread. The type of surgical treatment is related to the dimensions and histology of the mucocele. In this paper, the case of a 49-year-old woman, with a previous appendectomy, suffering from a painful mass in the right lower quadrant of the abdomen, is reported. Imaging showed a large, cystic structure at the base of the cecum. Surgery revealed a 8x5.5 cm calcified tumor, which was excided together with the appendiceal remnant. Pathological diagnosis was that of a mucocele arising from the appendiceal stump due to the development of a benign mucinous cystadenoma.

Renal leiomyosarcoma: report of three cases and review of the literature.

In the present study three cases of renal leiomyosarcoma are presented. All the patients were complaint about pain at right or left lumbar area and microscopic or gross haematuria. The clinical examination did not confirm any pathologic finding. The ultrasonographic and CT scan investigation of the patients revealed a renal mass. Under the frozen section diagnosis of malignant tumor in two cases and the cytological diagnosis of renal cell carcinoma in the third case, a radical nephrectomy was performed. In all the cases the pathological diagnosis was renal leiomyosarcoma. Because of the rarity of this neoplasm, the literature is reviewed, presenting the symptoms, the radiological findings, the diagnostic criteria and the differential diagnosis of the tumor. Radical nephrectomy remains the treatment of choice for this tumor, which exhibits an aggressive biological behavior and an unfavorable prognosis.

Repeat liver resection for recurrent colorectal metastases.

Sixteen patients underwent 18 repeat liver resections for recurrence of colorectal hepatic metastases that had been previously resected. Only minor liver resection had been undertaken at the first operation; three were palliative. The second operation was major hepatectomy in ten patients, minor resection in five and orthotopic liver transplantation in one. In one patient, lung metastases were resected before the second operation. One repeat hepatectomy was palliative. After partial liver resection, there were no deaths and complications were observed in six of 15 patients. One patient died 2 weeks after liver transplantation. After the second resection, 2-, 3- and 5-year survival rates were 67, 57 and 30 per cent; the mean survival time was 33 (range 8-93) months. Tumour recurrence was observed in 11 of 14 patients 4-32 (mean 13) months after a second curative liver resection; two patients received a third curative operation for recurrent liver metastases. After the second curative hepatectomy, seven patients died from disease after a mean of 36 (range 14-61) months and seven are currently alive at a mean of 33 (range 8-93) months. Four of these patients are free from disease 26-93 months after resection and three are alive with recurrence. Repeat hepatectomy for recurrent colorectal metastases can prolong survival in selected patients and has low operative risk.

[Synergic effect of Dextran 70 at 32% and an antibiotic in the prevention of peritoneal adhesions. Experimental study in rats]. / Effet synergique du Dextran 70 à 32% et d'un antibiotique dans la prévention des adhérences péritonéales. Etude expérimentale chez le rat.

In an experimental study we evaluate the anti-adherential effect of four different solutions: physiological serum, Chloramphenicol, Dextran 70 (32%) and the association of these last two solutions. Synergic effect is shown when using an antibiotic (Chloramphenicol) with a non-bactericid solution (Dextran). Comparing our results with current literature, we are confident on the efficacity of similar association concerning other solutions than Dextran 70 (32%).

[Conservative surgery after radiotherapy with preoperative doses in the treatment of breast cancer]. / Chirurgie conservatrice après radiothérapie à doses pré-opératoires dans le traitement des cancers du sein.

Radiotherapy as primary treatment is one of the means of increasing the rate of conservative treatment in patients with a breast tumour more than 3 cm in diameter. Between 1980 and 1986, 232 patients were treated in the Curie Institute by irradiation followed by conservative surgery for T2NO or T2N1a tumours wider than 3 cm, which accounted for 66 percent of the cases; 126 of these 232 tumours were located in the upper and outer quadrant. Axillary dissection was combined with tumoral excision in 63 percent of the cases. Conservative surgery was performed in patients who, after preoperative irradiation (50 Gy), had a persistent tumour less than 3 cm in diameter. Tumorectomy was complete in 96 percent of the cases, and the operative specimen was sterilized in 20 percent. The mean follow-up period was 46 months. The overall survival rate was 83 percent at 5 years (91 percent for T2NON1a). No local recurrence was observed in 92 percent of the patients at 3 years and 87 percent at 5 years. Nine percent of these women developed lymphoedema of the upper limb. The cosmetic result was good in 70 percent of the cases, fair in 25 percent and poor in 5 percent. The survival rate being the same with this treatment as with mastectomy, and the local recurrence rate being relatively low (13 percent at 5 years), we feel authorized to suggest that this post-radiotherapy conservative surgery should be used, at least in women with T2NON1a breast cancer.

[Primary angiosarcoma of the spleen. Apropos of a new case]. / Angiosarcome primitif de la rate. A propos d'un nouveau cas.

The authors report a new case of primary angiosarcoma of the spleen and, after a review of the literature, they discuss its clinical, diagnostic and therapeutic problems. Primary angiosarcoma of the spleen is a very rare tumor. The diagnosis should be suspected in the case of a patient with splenomegaly and unexplained anemia, with no evidence of lymphoma, leukemia or myelofibrosis. In 30% of cases, the tumor presents in the form of spontaneous rupture of the spleen. The prognosis is very poor, as it is a highly malignant tumor, even more so in the presence of early metastases with or without spontaneous rupture of the organ. Splenectomy prior to rupture could increase the survival. Patients with or without metastatic disease may be treated by combination chemotherapy, which still remains empirical and palliative.