The relationship between telomere length and clinicopathologic characteristics in colorectal cancers among Tunisian patients.

Alterations in telomere dynamics have emerged as having a causative role in carcinogenesis. Both the telomere attrition contribute to tumor initiation via increasing chromosomal instability and that the telomere elongation induces cell immortalization and leads to tumor progression. The objectives of this study are to investigate the dynamics of telomere length in colorectal cancer (CRC) and the clinicopathological parameters implicated. We measured the relative telomere length (RTL) in cancerous tissues and in corresponding peripheral blood leukocytes (PBL) using quantitative PCR (Q-PCR) from 94 patients with CRC. Telomere length correlated significantly in cancer tissues and corresponding PBL (r = 0.705). Overall, cancer tissue had shorter telomeres than PBL (p = 0.033). In both cancer tissue and PBL, the RTL was significantly correlated with age groups (p = 0.008 and p = 0.012, respectively). The RTL in cancer tissue was significantly longer in rectal tumors (p = 0.04) and in the late stage of tumors (p = 0.01). In PBL, the RTL was significantly correlated with the macroscopic aspect of tumors (p = 0.02). In addition, the telomere-length ratio of cancer to corresponding PBL increased significantly with late-stage groups. Shortening of the telomere was detected in 44.7%, elongation in 36.2%, and telomeres were unchanged in 19.1% of 94 tumors. Telomere shortening occurred more frequently in the early stage of tumors (p = 0.01). This study suggests that the telomere length in PBL is affected by the macroscopic aspect of tumors and that telomere length in cancer tissues is a marker for progression of CRC and depends on tumor-origin site.

[Primary necrosis of the ligamentum teres hepatis]. / Nécrose primitive du ligament rond du foie.

AIM: report a new case of primary necrosis of the ligamentum teres hepatis and discuss preoperative diagnosis strategy and therapeutic options. OBSERVATION: This is a patient of 76 years, hypertensive, who was admitted for an acute abdomen. The diagnosis of acute pancreatitis was referred to the poor clinical examination and amylase to six times normal. Abdominal CT scan showed a normal pancreas appearance and hypodense infiltration extended along the round ligament of the liver to the anterior abdominal wall that did not take the contrast. The patient was operated 24 hours after admission to the signs of clinical and biological severity. There was gangrene of the round ligament and the suspensory ligament of the liver. We performed a resection of all necrotic tissue and cholecystectomy. The postoperative course was uneventful. CONCLUSION: Primary necrosis of the round ligament of the liver is an extremely rare cause acute abdomen. Its diagnosis is difficult despite the contribution of the abdominal CT scan. Treatment is surgical.

Spontaneous fistulization of hepatic hydatid cyst into the duodenum: an exceptional complication.

Hydatid disease is a worldwide zoonosis and is localized in the liver in most cases. Its complications are numerous and include those related to the compression of adjacent viscera, infection of the cyst's contents or perforation of the cyst. Spontaneous rupture of the hepatic hydatid cyst into the duodenum is an extremely rare complication. The communication is, typically, not discovered until surgery. We present two cases of perforation of a liver cyst into the duodenum. One of them was diagnosed pre-operatively by a barium study. The surgical treatment of the lesion and its complications was complex but successful in both cases.

Jejunal GIST causing acute massive gastrointestinal bleeding: role of multidetector row helical CT in the preoperative diagnosis and management.

In this report, we describe a 34-year-old man with a jejunal gastrointestinal stromal tumour (GIST) accompanied by an unusual severe haemorrhage. Because oesophagogastroduodenoscopy proved inconclusive in determining the source of the bleeding and also because of gradually dropping haemoglobin levels and persistence of the melena not allowing colonic preparation, colonoscopy was cancelled and a mesenteric angio-computed tomography (angio-CT) was deemed necessary. The results of this analysis showed a 5-cm heterogeneous mass located in the jejunal loop surrounded by abnormal arterial structures. This multidetector computed tomography (MDCT) appearance was highly suggestive of GIST. The patient then underwent an urgent laparotomy and, peroperative findings being compatible with angio-CT descriptions, a small-bowel resection was performed. The results of the histopathological examination confirmed the diagnosis of GIST. Angio-CT helps define the size of GIST as well as its range and location and can be used as the primary routine test for patients suffering from lower-GI bleeding.

Unusual presentation of a colonic sarcoidosis.

Sarcoidosis is a multisystemic disorder of unknown cause that affects almost every tissue in the body. Colon is an extremely rare location of this disease. Clinical presentation, endoscopic appearances, and radiologic findings are not specific and may mimic much other affection. We report the case of a 64-year-old woman with inactive pulmonary sarcoidosis who presented alternating constipation and diarrhea. Colonoscopy revealed a stenotic tumor in the ascending colon. Histology failed to determine the nature of the lesion. Radiologic findings are those of a long stenotic tumor of the ascending colon associated with a multiple satellite lymphadenopathy. Endoscopic and radiologic descriptions are highly suggestive of a malignancy. The patient underwent a laparotomy, and a right hemicolectomy was performed. Examination of the resected specimen showed follicular structure with central epitheloid and giant cells and surrounding fibroblasts. These findings made the diagnosis of colonic sarcoidosis. The nonspecificity of the endoscopic and radiological signs of gastrointestinal sarcoidosis and the extreme rarity of colonic location make the preoperative diagnosis unlikely. The diagnosis will be then made only on histological examination of surgical specimens. We describe, through this observation, the results of paraclinical investigations that can suggest diagnosis and perhaps avoid surgery.

A new case of spontaneous regression of inflammatory hepatic pseudotumor.

Introduction. Inflammatory pseudo-tumors (IPT) of the liver are rare and difficult to diagnose, because mimicking malignant tumors. Aim. We report a case of IPT of the liver wich diagnosis was made on clinical, radiological and evolutif features. Observation. A 15-year-old man had a 4-month history of abdominal pain in the right upper quadrant with fever and cought. Two successives ultrasonographies revealed a hypoechoic lesion occuping the segment VIII with 8 cm of diametre. Physical examination was normal. Laboratory investigation showed normal blood counts, liver function test and tumoral markers. Another ultrasonography was interpretated as normal. Tomodensitometry had showon a 3-cm lesion wich enhanced later after contrast injection. A second tomodensitometry done one mounth later described a 2-cm sub capsular heaptic lesion. Discussion. On routine activiy, pre operative diagnosis of IPT of the liver is difficut, and rarely made with certitude because mimicking a malignant tumor. In our cae report here, the analysis of previous history, of clinical, biological and radiological presentation, had permittes us to pose the diagnosis of PTI of the liver and this despite the absence of histological confirmation by percutaneous biopsy.

A rare cause of lower gastrointestinal bleeding.

BACKGROUND: Leiomyoma of the colon are rare benign smooth muscle tumours. AIM: Report a new case of colic leiomyoma revealed by gastrointestinal bleeding. CASE: A 71-year-old man, diabetic, consulted the emergencies for acute per-rectal bleeding. The physical examination was essentially normal. Haemoglobin level was 3.7 g/dl.. The upper digestive endoscopy was normal. The colonoscopy showed an active bleeding from the right colon but it was enable to specify the nature and the exact seat of the bleeding lesion. An emergent operation showed a tumor of the right colic angle of 8 cm. A right hemicolectomy was performed with immediate ileocolic anastomosis. Pathology showed a leiomyoma. Postoperative course mentioned a nosocomial pneumopathy. CONCLUSION: Colic leiomyomas are rare benign tumours. The determination of the mitotic index is of primary importance to differentiate them from the leiomyosarcomas of low rank of malignancy whose prognosis is unfavourable.