Disappearance of recurrent intra-abdominal extrahepatic hydatid cyst following oral albendazole administration

A 44-year old male patient with a past medical history of a complete surgical excision of pelvic hydatid cyst two years previously presented with constant pelvic floor pain and plasma IgG anti-echinococcal antibody titres of 14.27 U/mL. Based on that and the imaging findings of abdominal ultrasound (US), Computed Tomography (CT) and Magnetic Resonance (MR) the diagnosis of a recurrent retrorectal pelvic hydatid cyst was made. Three courses of oral albendazole treatment were administered and sixteen weeks later, the patient was admitted for a planned elective operation. At that time, a new CT scan revealed disappearance of the cyst, while the serological tests showed a decrease in the IgG anti-echinococcal antibody titres to 0. 71 U/mL. Four different species of the Echinococcus tapeworm can produce infection in humans. E granulosus and E multilocularis are the most common, causing cystic and alveolar echinococcosis respectively, while E vogeli and E oligarthrus, have only rarely been associated with human infection. Although surgical resection remains the treatment of choice for hydatid disease, the present case could suggest that especially in cases of recurrent intraabdominal extrahepatic hydatid cyst, treatment with albendazole may lead to disappearance of the recurrent cyst therefore, should constitute a first line therapeutic option prior to any planned reoperation.

Disappearance of recurrent intra-abdominal extrahepatic hydatid cyst following oral albendazole administration.

A 44-year old male patient with a past medical history of a complete surgical excision of pelvic hydatid cyst two years previously presented with constant pelvic floor pain and plasma IgG anti-echinococcal antibody titres of 14.27 U/mL. Based on that and the imaging findings of abdominal ultrasound (US), Computed Tomography (CT) and Magnetic Resonance (MR) the diagnosis of a recurrent retrorectal pelvic hydatid cyst was made. Three courses of oral albendazole treatment were administered and sixteen weeks later, the patient was admitted for a planned elective operation. At that time, a new CT scan revealed disappearance of the cyst, while the serological tests showed a decrease in the IgG anti-echinococcal antibody titres to 0. 71 U/mL. Four different species of the Echinococcus tapeworm can produce infection in humans. E granulosus and E multilocularis are the most common, causing cystic and alveolar echinococcosis respectively, while E vogeli and E oligarthrus, have only rarely been associated with human infection. Although surgical resection remains the treatment of choice for hydatid disease, the present case could suggest that especially in cases of recurrent intraabdominal extrahepatic hydatid cyst, treatment with albendazole may lead to disappearance of the recurrent cyst therefore, should constitute a first line therapeutic option prior to any planned reoperation.

Primary rhabdomyosarcoma of the lung arising over cystic pulmonary adenomatoid malformation.

The authors report the case of a 2-year-old girl with pulmonary cystic adenomatoid malformation type II who presented with a mass on the lower lobe of the left lung. Resection and histological examination revealed pleomorphic rhabdomyosarcoma. Chemotherapy and radiotherapy followed the operation and the girl is alive and in perfect condition 10 years after the operation. The literature on primary rhabdomyosarcoma of the lung in children is reviewed.

The significance of perioperative anemia in patients with resectable gastrointestinal tract tumors.

Cancer-related anemia occurs in more than 50% of patients with malignancies and constitutes a common finding in patients with gastrointestinal tract tumors. In the present article we present the possible pathogenetic mechanisms as well as the appropriate clinical and laboratory investigations for the anemia, which is associated with gastrointestinal tract malignancies. Moreover, we conducted a MEDLINE database search between 1992- 2003, focusing on the currently available methods for perioperative correction and treatment of anemia. The currently available evidence suggests that perioperative allogenic blood transfusion is associated with increased rates of postoperative infections and constitutes an independent adverse prognostic factor in gastrointestinal malignancies; autologous blood transfusions are of no clinical benefit compared to allogenic transfusions, as autologous blood is not immunologically neutral; and the shortterm results of erythropoietin (EPO) use remain controversial, while its long-term results remain unknown. Correction of anemia in every patient with resectable gastrointestinal malignancy is mandatory, because it improves surgical stress response, wound healing process and quality of life. Although EPO administration constitutes the treatment of choice for patients receiving chemotherapy and/ or radiotherapy, the best perioperative method for anemia correction remains unknown and further prospective randomized studies are required. From the surgical point of view, any effort for "bloodless surgery" should be attempted.

Metastatic renal clear cell carcinoma mimicking stage IV lung cancer.

We present a 63-year-old man who was investigated for a lesion in the apex of the left lung and a coexisting osteolytic lesion in the right major trochanter. FNA of the thoracic mass was suggestive for malignancy yet not diagnostic regarding the tumor type and the site of the primary tumor. A diagnosis of a stage IV lung cancer was favored and he underwent a left exploratory thoracotomy in view to resect the primary tumor. An extrapulmonary mass localized to the pleura not involving the ipsilateral lung was disclosed. Multiple biopsies revealed metastatic clear cell RCC. A 5 x 7 cm left renal tumor was revealed in a postoperative abdominal CT scan. He was treated with combination of interferon A and vinblastin followed by radical nephrectomy. Twenty-four months after the diagnosis he is alive without evidence of local or distant recurrence. Pleural metastases from RCC are mainly presented as malignant pleural effusions. Thoracic metastatic lesions localized to the pleura, forming solitary or multiple mass(es) have been rarely reported. We review the literature regarding this rare clinical manifestation of the disease and we discuss diagnostic and therapeutic options.

Altered expression of the cell cycle regulatory molecules pRb, p53 and MDM2 exert a synergetic effect on tumor growth and chromosomal instability in non-small cell lung carcinomas (NSCLCs).

BACKGROUND: Recent in vitro studies provide evidence that the cell cycle molecules pRb, p53 and MDM2 form a tightly regulated protein network. In this study, we examined the relationship of this protein network in a series of non-small cell lung carcinomas (NSCLCs), with the kinetic parameters, including proliferative activity or proliferation index (PI) and apoptotic index (AI), and ploidy status of the tumors. MATERIAL AND METHODS: A total of 87 NSCLCs were examined using immunohistochemical and molecular methods in order to estimate the status of the pRb-p53-MDM2 network. The kinetic parameters and the ploidy status of the tumors were assessed by in situ assays. The possible associations between alterations of the network, kinetic parameters and ploidy status of the carcinomas were assessed with a series of statistical methods. RESULTS: Aberrant expression of pRb (Ab) and overexpression of p53 (P) and MDM2 (P) proteins were observed in 39%, 57%, and 68% of the carcinomas, respectively. The comprehensive analysis revealed that concurrent alterations in all three cell cycle regulatory molecules were the most frequent pattern, pRb(Ab)/p53(P)/MDM2(P); this "full abnormal" phenotype represented approximately 27% of the cases. This immunoprofile obtained the highest PI/AI value; whereas, the "normal" phenotype was the lowest one (p = 0.004). Furthermore, the pattern pRb(Ab)/p53(P)/MDM2(P) acquired the highest PI (p < 0.001) and lowest AI (p < 0.001) scores. Interestingly, the groups of carcinomas with impaired expression of one or two molecules attained PI/AI ratio values clustered in a narrow range placed in the middle of the scores exhibited by the "normal" and "full abnormal" phenotypes. These tumors had significantly lower AI, but similar PI values, compared with those noticed in the normal pattern. In addition, it was observed that the pRb(Ab)/p53(P)/MDM2(P) phenotype was also significantly associated with aneuploidy (p = 0.002) and a tendency was observed when the expression of two components was altered (p = 0.055). CONCLUSIONS: Our findings suggest that simultaneous deregulation of all members of the pRb-p53-MDM2 network confers an additive effect on tumor growth. The apoptotic pathway seems to be more susceptible to its defects than the cell proliferation machinery. The findings of the ploidy analysis, which are in parallel with those regarding the proliferative activity and the apoptotic rate study, further support the concept that these molecules constitute a tightly regulated network participating in cell cycle control and chromosomal stability.

Biliary bacteriology based on intraoperative bile cultures.

This paper presents a study of bile cultures taken during 174 operations on the extrahepatic biliary tract. Twenty-six per cent of the cultures were positive. Septic complications developed in 33.3% in this group. Since septic complications must be the result of intraoperative contamination from the infected bile, an argument is presented for prophylactic preoperative antibiotic administration as well as for routine culture of the bile at time of surgery.