Gastrointestinal Stromal Tumor Associated with Neurofibromatosis Type 1 Simulating a Neurofibrosarcoma in a Black African Adult Patient.

Gastrointestinal stromal tumor (GIST) is the most prevalent mesenchymal tumor encountered in patients with neurofibromatosis type I (NF1). This association is rarely reported in black African adult patients. Clinical signs such as abdominal pain, intestinal bleeding, and palpable abdominal nodules may contribute to the diagnosis of GIST. However, these clinical signs may also indicate the presence of other solid intestinal tumors such as a neurofibrosarcoma which is an intestinal complication of NF1. The immunohistochemistry staining of the resected tissue is mandatory that allows establishing a correct diagnostic of GIST. The immunohistochemistry is also a challenging method in African countries with limited resources. Herein, we report a case of multiple intestinal involvement of GIST associated with NF1 revealed by a recurrent intestinal bleeding in a black African adult patient. The GIST diagnosis was suspected on a computed tomography scan images and laparotomy findings, which were confirmed by histopathological and immunochemistry examinations of the resected nodules. The immunohistochemistry staining of the tissue was positive for CD34 and CD117 indicating the presence of GIST in black African patient with NF1. The surgical treatment was consisted of a double intestinal resection with anastomosis that removed all palpable nodules located on the intestinal antimesenteric wall. No additional chemotherapy was administered to the patient who is so far under follow-up. The patient has not presented any episode of intestinal bleeding since the surgical treatment. We emphasize in this case report the importance of a recurrent intestinal bleeding in patient with NF1 that may indicate the presence of GIST and, the need of performing a large intestinal resection, as the most valuable treatment in limited resource countries.

Thirteen-year disease-free survival after surgery for cystic duct carcinoma: a case report.

Cystic duct carcinoma is known to have a better prognosis compared to its location in other biliary ducts. Only one case with a survival over ten years has been previously published. The authors report a case of survival over 13 years without recurrence or metastasis. Preoperative diagnosis of cystic duct tumor was carried in a 66-year-old male. Under the diagnosis of carcinoma of the cystic duct, the patient underwent en bloc resection of the gallbladder, cystic duct, hepaticocholedochus and lymph node dissection. A Roux-en-Y hepaticojejunostomy was performed. Histological examination revealed a moderately differentiated adenocarcinoma of the cystic duct. Five months later the patient underwent second look surgery for benign obstruction of the hepaticojejunal anastomosis. The patient is still doing well 13 years later without any local recurrence or metastasis. To our knowledge, this is the longest disease-free survival ever published in the literature. This case sustains that better and longer survival is possible with a real chance of potential cure if radical surgery is performed.

[Digestive burns by simultaneous oral and rectal self-administration of ingestion sulphuric acid: an unusual mode of suicide]. / Brûlures digestives d'origine caustique par double voie simultanée haute et basse: un mode inhabituel d'autolyse à Abidjan.

The authors report an unusual mode of suicide in two patients admitted to the Teaching Hospital of Yopougon. One 26-year-old woman swallowed sulphuric acid and then self-administered more of the same product rectally. She presented with abdominal pain, vomiting, bloody diarrhoea, without fever (T=37,9 degrees C). The abdomen did not appear to require surgery. Endoscopy showed erosive cesophagitis on day 5 (D5) and ulcerated bleeding inflammation of the entire colon and rectum on D26. She died on D30, during generalized convulsions. The second patient, a 31-year-old women, ingested sulphuric acid in the same way. She presented initially with diffuse abdominopelvic pains; clinical examination showed neither guarding nor contraction. Her temperature was 37,8 degrees C. Oesogastric endoscopy observed cesophagitis stage II B and III A and gastritis III A and III B. On D9, acute and generalized peritonitis was discovered, leading to surgical exploration. The patient died at the end of the operation. This unusual mode of suicide induces grave clinical presentations despite their apparent calm. The prognosis is worse because of the double localization of the lesions, the toxicity of the product, and the underestimation of its gravity.