Clinico-pathological features and outcome of management of pediatric gastrointestinal lymphoma.

PURPOSE: The purpose of this study is to evaluate pediatric GIT lymphomas as regards clinico-pathological features, controversies in surgical treatment, role of chemotherapy and the prognostic features. PATIENTS AND METHODS: This study included forty three patients with pediatric GIT Non-Hodgkin's lymphoma collected over 7 years at the NCI Cairo University between January 1997 and December 2003. The data of every patient included: Age, sex, presenting symptoms and signs, preoperative investigations, extent of the disease at diagnosis and the type of resection performed, histopathological examination, details of chemotherapy and state at follow up. Overall and disease free survival were calculated and correlated with all parameters. RESULTS: The study included 30 boys and 13 girls with median age 5.00 years (range: 0.4:17). The lesions were located in the small intestine (n=15), the large intestine (n=14), the ileocecal region (n=10), stomach (n=2), and multifocally (n=2). Burkitt's lymphoma was the commonest histological type (n=24). The majority were stage IIE and IIIE (22 and 17 respectively). Exploration was done in thirty nine patients (complete resections were done in 23 cases, incomplete resections (debulking) were done in 14 cases and in 2 cases only lymph node biopsies were done). All patients received a sort of systemic chemotherapy. The median follow up duration was 44 months (range 4- 116 months). The only parameters that had significantly affected the overall survival were localized disease, complete resection, earlier stage and response to chemotherapy with p values, (0.005, 0.001, 0.005 and <0.001 respectively). As regards the disease free survival the only significant factor was localized disease (p=0.035). CONCLUSION: The extent of disease at presentation is the most important prognostic factor in pediatric GIT lymphoma. Surgery still plays an important role such as complete resection in localized disease, management of complicated disease and diagnostic biopsy. There is no value of debulking and surgery is not advised for gastric lesions. Chemotherapy represents a cornerstone in the treatment and offers an excellent chance for long term, disease free survival.

Management of parapharyngeal space tumors at the National Cancer Institute, Egypt.

PURPOSE: The purpose of this study is to evaluate parapharyngeal space (PPS) tumors as regards clinicopathological features, preoperative assessment, different surgical approaches, perioperative complications, patterns of recurrence and the role of non-surgical treatment. MATERIALS AND METHODS: This study included twenty-five patients with (PPS) tumors presented to NCI, Cairo University, from October 2001 to March 2003. The data of each patient included age, sex, presenting symptoms and signs, provisional diagnosis, preoperative investigations, operative data, histopathological examination, non-surgical treatment and state of follow up. All were collected and analyzed. RESULTS: This study included 12 males and 13 females. The mean age was 37.1 years. The main presenting symptom and sign was neck swelling. All patients were subjected to CT scan, while 9 patients had MRI. Nineteen patients underwent fine needle aspiration cytology (FNAC) which was conclusive in only 16 patients. Benign lesions were found in 12 patients (48%) and malignant lesions in 13 patients (52%). Parotid gland tumors (40%) and neurogenic tumors (16%) were the commonest. Surgical excision was done in 22 cases. There was no postoperative mortality and overall postoperative morbidity was 9% (2/22). Eight patients received postoperative radiotherapy. Three patients with lymphoma were treated with chemotherapy and two of them received involved field radiotherapy to the Waldyer's ring region. On follow up to 12-30 months, there were only one local and two distant recurrences in the malignant group. CONCLUSION: Surgery is the mainstay treatment for tumors of the (PPS). The addition of postoperative radiotherapy in certain indications in malignant tumors of the (PPS) will improve the local control.

Ileocecal interpositional graft for gastric replacement after total gastrectomy.

PURPOSE: The aim of this study is to evaluate the technique of ileocecal segment interpositional graft after total gastrectomy for gastric cancer with assessment of its advantages and disadvantages. PATIENTS AND METHODS: This is a prospective study carried out at the National Cancer Institute, Cairo University. Twenty four patients with gastric carcinoma were identified from December 1998 to February 2003. All of them were submitted to surgery after preoperative clinical, radiological and endoscopic diagnosis. Total gastrectomy with ileocecal interpositional graft were done (19 subdiaphragmatic reconstruction and 5 intrathoracic reconstruction). Patients were followed up for at least 12 months for postoperative morbidity, body weight, reflux and dumping symptoms. Gastrografin swallow, barium swallow, upper GIT endoscopy were routinely done in all patients and pouch emptying time by Tc-99m sulpher colloid was done in 11 patients only. RESULTS: Perioperative mortality was 8.3% (2/24). No patient reported reflux symptoms or showed endoscopic findings of reflux esophagitis in the subdiaphragmatic reconstruction group and mild reflux was noted in only one patient in the intrathoracic reconstruction group. No patient reported dumping symptoms. Emptying time showed good capacity as a reservoir of food. Postoperative decrease in body weight averaged less than 10% of preoperative weight. CONCLUSIONS: Ileocecal interposition graft after total gastrectomy has the advantages of preventing reflux esophagitis and providing functional replacement of the stomach as a reservoir for ingested food. It can be done with acceptable morbidity and mortality. It is simpler than some of the pouch reconstructions and deserves more attention.