Reappraisal of primary hepatic lymphoma: Is surgical resection underestimated?

Primary hepatic lymphoma (PHL) is defined as a lympho-proliferative disorder limited to the liver without any involvement of the spleen, lymph nodes, bone marrow or blood. Diffuse large B-cell lymphoma (DLBCL) is the most common histological type counting more than 60-80% of all PHL. Usually, it occurs in middle-aged men with aspecific symptoms and diagnosis is confirmed by histopathology. In order to expand current knowledge and to investigate an optimal therapeutic strategy, a systematic review of literature was conducted in February 2016. A total of 274 articles were retrieved, and after exclusion, 55 were retained, reporting 147 cases of PHL. Patients were mainly men (64.9%) with a median age at diagnosis of 57 years (range: 17-92) and right hepatic lobe involvement (69.6%). Among the 147 patients, 9% received no therapy while 77% underwent treatment including chemotherapy, surgery and radiotherapy in 64%, 26% and 1% of cases, respectively. Mean follow-up was 22.6 months (range: 0.2-360). Overall mortality was 29.2% with a 90-day mortality of 26%. Risk factors for increased mortality include; bilobar lesions (p = 0.001), right lobe localisation (p = 0.003) and non-surgical approach or the absence of any treatment (p = 0.001). A trend towards favourable outcomes for young patients (mean = 50.4 years) with a large liver lesion was achieved by surgical management of PHL but this did not achieve statistical significance. Statistical analysis indicates that in cases of resectable disease, an aggressive surgical approach in selected patients leads to increase long-term survival. Thus, two hypotheses should be assessed in further randomized studies: 1°) resectable PHL is a less severe form or 2°) hepatectomy is an effective treatment for PHL.

Duodenal tumors. Four case reports.

AIM: Reporting our experience in the treatment of duodenal neoplasms. MATERIAL OF STUDY: Management and treatment of four patients presenting a duodenal neoplasm. RESULTS: Three out of four patients died after surgery for dehiscence and/or bleeding. One, who underwent palliative bypass, died after four months from unknown causes. DISCUSSION: Duodenal neoplasms are rare and their diagnosis is difficult and late. In literature, there is no standardized management of this kind of neoplasm; the commonest surgical approaches are pancreaticoduodenectomy, segmental duodenal resection and palliative operations. The surgical choice is based on site and stage, both in Literature than in our experience. Regardless of the surgical decision, the patients have a poor outcome because of an advanced stage at diagnosis. CONCLUSIONS: It can be asserted that duodenal neoplasia offers many diagnostic and therapeutic difficulties. This may be due to its rarity, which does not allow the definition of a standard course of treatment, resulting in the inability to have a unique diagnostic and therapeutic approach. There is often a late diagnosis and the need to perform emergency surgery. Therefore prognosis is greatly aggravated by the high incidence of postoperative complications, in part due to the urgency in which the surgeries are carried out.