A high-grade primary osteosarcoma arising in the splenic flexure of the colon: an extremely rare entity.

Extraskeletal osteosarcoma (ESOS) is an uncommon malignant mesenchymal tumour deriving from soft tissues or visceral organs without any evidence of a primary bone osteosarcoma. Although ESOS has been mainly reported in the extremities, it can also occur in unusual locations such as the colorectal region. A 58-year-old man with a 3-month history of dyspepsia, constipation and soreness in the left upper abdominal quadrant was admitted to hospital. Computed tomography and magnetic resonance imaging demonstrated a huge, irregular, mixed cystic and solid, partially calcified mass measuring 116mm×140mm×200mm. Because of the patient's obstructive symptoms, surgery was performed. A tumour involving the splenic flexure of the colon was excised in line with oncological principles by extended left hemicolectomy with end-to-side colo-colonic anastomosis. The specimen was interpreted as a primary osteosarcoma of the colon after immunohistochemical straining. Considering the limited data regarding ESOS arising in colon, we present the second case to date that involves the transverse colon, to further elucidate its clinical aspects, prognosis and treatment options.

Videoanoscope-assisted stapled haemorrhoidopexy: analysis of 18 patients.

An optimal stapled haemorrhoidopexy requires the purse-string suture to be placed circumferentially at a constant distance from the dentate line and to pass through an appropriate thickness of rectal mucosa. An unsuitable purse-string suture may increase the risk of postoperative complications. We developed a new anoscope (the videoanoscope) to prevent the difficulties during application of the purse-string suture, and we used the videoanoscope in 18 stapled haemorrhoidopexy procedures. The videoanoscope is made up of three pieces. The front part is in the form of an open half-cylinder. The second piece is a sliding lid that covers the front piece. The rear part of the anoscope includes a hollow handle in which a scope can be inserted, and the whole procedure can be transmitted to a monitor via this scope. The opening on the anoscope can be adjusted by sliding the lid. A purse-string suture is placed on the rectal mucosa protruding through this adjustable opening. The anoscope is rotated to apply the subsequent suture bites and when the starting point is reached again the purse-string is completed. Then the stapled haemorrhoidopexy procedure is continued in the usual fashion. Videoanoscope-assisted stapled haemorrhoidopexy was easily performed in 18 patients (12 men, 6 women; mean age 48.9 years). The mean operative time was 32.8 minutes. The excised rectal mucosal rings were complete in all of the patients. Optimal purse-string depth was reflected in the presence of only mucosa and submucosa in all specimens, without incorporation of muscle cells. Postoperative complications were urinary retention in one patient and bleeding in five patients, one of whom requiring sutures for haemostasis. Further studies are required to assess the potential advantages of this technique.