Enteropathy-associated T-cell Lymphoma (EATL) with intracranial metastasis : a rare and dismal condition.

BACKGROUND: Enteropathy-associated T-cell lymphoma (EATL) is a rare type of gastrointestinal non-Hodgkin's Lymphoma. EATL with intracranial metastasis is even rarer. We report a case of EATL with intracranial metastasis. CASE PRESENTATION: A 36-years old man presented with five weeks history of intractable diarrhea. Colonoscopy was normal, but abdominal computed tomography (CT) scan revealed mural thickening at duodenojejunal junction, and subsequent jejunofiberoscopy showed a circumferential ulceration at the jejunum. Histo-immunopathology confirmed the diagnosis of enteropathyassociated T-cell lymphoma (EATL) type II. His disease course proved to be aggressive and refractory to standard front-line chemotherapy, and eventually progressed through second-line salvage regimen with CNS and intracranial involvement. He died nine months after the initial diagnosis. CONCLUSION: EATL with brain metastasis is a very rare occurrence with dismal prognosis.

Laparoscopically assisted vaginal hysterectomy for large uterus: a comparative study.

OBJECTIVE: To examine the safety and feasibility of laparoscopically assisted vaginal hysterectomy (LAVH) for uteri weighing 500 g or more as compared to uteri weighing less than 500 g in the management of benign gynecological diseases. METHOD: In this prospective comparative study, 189 women with different benign gynecological diseases were scheduled for laparoscopically assisted vaginal hysterectomy. They were divided into two groups, with uterine weight greater than 500 g and uterine weight less than 500 g. Outcome measures for both the groups were studied comparatively in terms of length of operative time, amount of blood loss, requirement of blood transfusion and length of hospital stay. RESULTS: Length of operation and amount blood loss were significantly greater in the uteri >o r = 500 g group than in the <500 g at 91.1 +/- 28.7 min versus 77.4 +/- 26.6 min (P < 0.01), and 570.5 +/- 503.6 ml versus 262.5 +/- 270.0 ml (P < 0.001), respectively. However, there was no difference in length of hospital stay and overall incidence of operative complications between the two groups. None of the women had any major complications though 17 minor complications were noted. There was no incidence of switching to abdominal laparatomy during the operation except for one patient who required "minilaparotomy" for removal of large surgical specimen (2400 g). Extreme intra-operative hemorrhage of more than 1000 ml occurred in five patients, however, they made full recovery after blood transfusion. Rate of blood transfusion was significantly lower in the uteri <500 g group (4.8% versus 34.9%, (P < 0.001). CONCLUSION: This study demonstrates that despite the increased operating time and blood loss, LAVH can be safely performed for large uterus. However, surgeons need to be aware of the high risk of blood transfusion in these patients.