ABSTRACT
Although many types of pancreatic tumors exist, pancreatic solid serous cystadenoma stand as the most rare. Despite advances in medical imaging, definitive diagnosis remains complex. Here, we report a case of a 63-year-old man with a suspicious lesion of the pancreas discovered during a positron emission tomography-computed tomography. Despite an echo-endoscopy being performed, no biopsies were contributive. The magnetic resonance imaging did highlight another lesion in the liver. Due to the suspicion of a neuroendocrine tumor of the pancreas with liver metastases, a cephalic duodenopancreatectomy with partial hepatectomy was performed. During the procedure, another hepatic lesion was resected. The final histological diagnosis was a serous solid adenoma of the pancreas associated with a cholangiocarcinoma. During the follow-up, the patient presented a massive metastatic hepatic relapse even after the administration of a palliative chemotherapy.
ABSTRACT
Anorectal melanoma is a rare disorder. There have only been a few cases reported and there is no consensus of treatment. We report a case of 50-year-old Caucasian man presenting intermittent prolapse of an anorectal mass during 6 months with occasional bleeding. Biopsies came up with the diagnosis of malignant melanoma. No distant metastases were found. He underwent an abdominoperineal resection due to internal sphincter invasion. A second tumour was diagnosed in final histologic examination: a dysplastic rectal polyp invaded by the melanoma (collision tumour). At 12 months of follow up he presented loco-regional recurrence (a single pelvic lymph node) and hepatic metastases. He was included in a study protocol comparing new medical treatments (nivolumab versus ipilimumab or both).
ABSTRACT
PURPOSE: Chylothorax is an uncommon complication of cardiac surgery. We report two cases of the thoracoscopic management of persistent postoperative chylothorax by thoracic duct thermofusion and section with the LigaSure device. MATERIALS AND METHODS: A 6-year-old boy and a 3-year-old girl developed persistent chylothorax following an aortic coarctation repair and a Fontan procedure, respectively. The former presented with a left chylothorax due to direct surgical injury, and the latter, a right chylothorax due to indirect lymphatic rupture secondary to increased venous pressure. In both patients, voluminous chylous drainage persisted for more than 3 weeks despite maximal medical treatment. Ultimately, a right thoracoscopic coagulation and section of the thoracic duct with the 5-mm LigaSure device was performed. The LigaSure is a computer-controlled bipolar diathermy system designed to seal blood vessels up to 7 mm in diameter, with no specific recommendations regarding the lymphatics. RESULTS: The lymph leakage ceased within 2 days in the first patient and immediately in the second one, with no recurrence after oral intake resumption on day 5. Both patients are free of recurrence at 1 year. CONCLUSION: Thoracoscopic coagulation and section of the thoracic duct above the diaphragm with the LigaSure device appears to be a simple, effective, and safe therapeutic option for treatment of refractory postoperative chylothorax in children.
Subject(s)
Chylothorax/surgery , Diathermy/instrumentation , Thoracic Duct/surgery , Thoracoscopy , Aortic Coarctation/surgery , Child , Child, Preschool , Diathermy/methods , Female , Humans , Male , Postoperative ComplicationsABSTRACT
Nonparasitic splenic cysts are uncommon lesions, for which partial splenectomy offers a definitive treatment while preserving splenic function. We report the use of radiofrequency energy for laparoscopic partial splenectomy to treat two children with nonparasitic splenic cysts by creating a 1-cm thick coagulated parenchyma resection plane, allowing bloodless splenic transection. This approach spares the need for blood transfusions, reduces hospital stay, and offers great promise for partial splenectomy in children.
