Objective The purpose of this study was to determine if an endosurgical approach that mimics open exploration would improve the accuracy of simple diagnostic laparoscopy. Summary Background Data Most patients with peripancreatic malignancy are found at exploration to be unable to undergo resection. Laparoscopy has been suggested as a sensitive method for detecting metastatic disease in this group of patients. However, the ability to assess resectability with simple diagnostic laparoscopy remains relatively low (<40%). Methods Between December 1992 and August 1994, 115 patients with radiologically resectable peripancreatic tumors underwent extended laparoscopy before undergoing a planned curative resection. This technique required assessment of the peritoneal cavity, liver, lesser sac, porta hepatis, duodenum, transverse mesocolon, and celiac and portal vessels. Results Sixty male and 55 female patients were included in the current study. The pancreatic head was involved in 74 patients (64%), followed by the body in 21 (18%), tail in 8 (7%), ampulla in 8 (7%), duodenum in 3 (3%), and distal bile duct in 1 (1%). An abdominal computed tomography (CT) scan was performed for all patients before laparoscopy, ultrasonography for 74 patients (64%), endoscopic retrograde choleangiopancreatography for 59 patients (51%), and mesenteric angiography for 9 patients (8%). Pneumoperitoneum was established successfully in all but 2 cases (98%). A complete examination of 108 patients was performed. Sixty-seven patients were considered to have resectable disease, and 61 resections were performed. Laparoscopy failed to identify hepatic metastases in 5 patients and portal venous encasement in 1 patient. Unresectable disease was identified in 41 patients. Hepatic metastases were observed in 20 patients, mesenteric vascular encasement in 14, extrapancreatic/peritoneal involvement in 16, and celiac or portal lymphatic metastases in 8. There were no intraoperative or postoperative complications related to the laparoscopic procedure. The positive predictive index, negative predictive index, and accuracy of laparoscopy were 100%, 91%, and 94%, respectively. Conclusions This study demonstrates that extended laparoscopy is accurate and safe and makes exploration unnecessary in many patients with potentially resectable peripancreatic malignancy. In this series, 76% of patients explored were resected, compared with the authors' experience between 1983 and 1993 of 35%. The authors believe that laparoscopy is an important component in the staging of this group of patients and should be performed before exploration.

The value of minimal access surgery in the staging of patients with potentially resectable peripancreatic malignancy

// Fan Feng 1,* , Yangzi Tian 2,* , Zhen Liu 1,* , Guanghui Xu 1 , Shushang Liu 1 , Man Guo 1 , Xiao Lian 1 , Daiming Fan 1 and Hongwei Zhang 1 1 Department of Digestive Surgery, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China 2 Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China * These authors have contributed equally to this work Correspondence to: Hongwei Zhang, email: // Keywords : gastrointestinal stromal tumor, colon, feature, prognosis Received : November 30, 2015 Accepted : April 16, 2016 Published : May 05, 2016 Abstract Background: Due to the extremely rare incidence, data about colonic GISTs are limited. Therefore, aim of the present study was to explore clinicopathological characteristics and prognosis of colonic GISTs. Patients and Methods: Colonic GISTs cases were obtained from our center and from case report and clinical studies extracted from MEDLINE. Clinicopathological features and survivals were analyzed. Results: There were 79 colonic GISTs patients with a female predominance. The median age was 66 years (range 0.17-84). The median tumor size was 5.8 cm (range 0.5-29). The most common location was sigmoid colon (45.8%), followed by transverse colon (19.5%). The majority of colonic GISTs were high risk (70.8%). Mitotic index was correlated with gender ( P = 0.002) and tumor size ( P = 0.005), and tumor location was correlated with age ( P = 0.017). The five year DFS and DSS were 57.4% and 61.6%, respectively. Mitotic index and NIH risk classification were associated with prognosis of colonic GISTs. However, mitotic index was the only independent risk factor. The distribution of tumor size and NIH risk classification were significantly different between colonic and gastric GISTs (both P = 0.000). The DFS and DSS of colonic GISTs were significantly lower than that of gastric GISTs ( P = 0.012 and P = 0.002, respectively). Conclusions: The most common location for colonic GISTs was sigmoid colon. Most tumors were high risk. Mitotic index was the only independent risk factor for prognosis of colonic GISTs. Colonic GISTs differ significantly from gastric GISTs in respect to clinicopathological features. The prognosis of colonic GISTs was worse than that of gastric GISTs.

/pdf/clinicopathological-features-and-prognosis-of-mesenteric-4jy276v0yf.pdf

Clinicopathological features and prognosis of mesenteric gastrointestinal stromal tumor: evaluation of a pooled case series

Mounting evidence demonstrates the presence of extragastrointestinal stromal tumor (EGIST) which originates from tissues outside the gastrointestinal (GI) tract and shares overlapping immunohistological features with gastrointestinal stromal tumor (GIST). GIST emanating from prostate is extremely rare. To our knowledge, there are only 3 definitely reported cases of primary prostatic EGIST. Herein, we report a case of prostatic EGIST in 31-year-old man with low urinary tract symptoms who was initially misdiagnosed as sarcoma of prostate. Imaging studies assist in determining the origin and location of EGIST. Immunohistochemical assessment (DOG-1, CD117, and CD34) helps in differentiating such lesion from other stromal tumors and in addressing an appropriate and optimal therapeutic strategy.

A young man with primary prostatic extra-gastrointestinal stromal tumor: a rare case report and review of the literature

Cystic lymphangioma is a rare, benign malformation of the lymphatic vessels which may be observed on various locations. Retroperitoneal location is less common than mesenteric location. Cystic lymphangioma has a polymorphic clinical presentation. Diagnosis is based on imaging but requires histological confirmation. Surgery is the treatment of choice. The aim of our study is to analyze the clinical manifestations, complications, diagnostic and therapeutic aspects of this tumor. We report a case series of 5 patients with retroperitoneal cystic lymphangioma (4 women and 1 man) operated in our department between the years 2004 and 2014. Their medical records were reviewed retrospectively. Follow-up was based on clinical examination and abdominal CT scan. The average age was 45 years. The mean follow-up was 32.6 months. The most common symptoms indicative of retroperitoneal cystic lymphangioma were pains and/or an abdominal mass. Abdominal CT scan was the most useful diagnostic test. Total resection was immediately achieved in 4 patients and it was deferred for up to 5 years in one patient. He underwent annual ultrasound monitoring. One patient underwent nephrectomy. No recurrence or complications were noted in 5 patients. Retroperitoneal cystic lymphangioma is a rare condition. Its therapeutic management is based on complete resection in patients with symptomatic lesions or complications, in order to limit the risk of recurrence. Complete resection may be deferred in asymptomatic patients.

Le lymphangiome kystique rétropéritonéal: à propos de 5 cas et revue de la littérature

The development of immunohistochemical methods has outlined a particular group of tumors, with very specific features and treatment, originating in the Cajal cells of the muscularis propria or related stem cell-like precursors present in the wall of the digestive tract called gastrointestinal stromal tumors (GISTs). A sub-segment with similar features may develop outside the digestive tract, namely extra-gastrointestinal stromal tumors (EGISTs). From the small category of EGISTs, we report on a case of a primary epithelioid EGIST of the greater omentum, which is seldom reported in literature. The tumor was diagnosed in a man with non-specific symptoms who presented for abdominal enlargement. The tumor was characterized and there was a preoperative suspicion of a non-digestive tumor located in the greater omentum. The tumor was surgically removed showing no contact with adjacent organs. Immunohistochemical examination was consistent with a primary EGIST of the greater omentum. Treatment with Imatinib mesylate was started and at two-year follow-up, the patient is disease free. The case raises problems regarding pathogenesis, immunohistochemical features, behavior, evolution and prognosis of omental EGIST, for which no significant or conflicting data are available in the literature.

EGIST of the greater omentum - case study and review of literature.

Primary omental gastrointestinal stromal tumors

Le lymphangiome kystique (LK) est une tumeur vasculaire qui prend naissance aux depens des vaisseaux lymphatiques C’est une dysplasie benigne et rare qui est l’apanage de l’enfant; les formes de l’adulte sont exceptionnelles Son expression est essentiellement cervicale ou axillaire, avec de rares localisations dans la cavite abdominale Nous rapportons le cas d’un LK retroperitoneal avec etude des differents aspects cliniques, diagnostiques et therapeutiques des LK localises en retroperitoineal

Lymphangiome kystique rétropéritonéal

La linite rectale primitive est une tumeur rare mais extremement agressive, diagnostiquee le plus souvent a un stade tardif, ce qui rend le pronostic tres pejoratif. Nous rapportons le cas d’un jeune patient de 31 ans traite par radiochimiotherapie pour une linite rectale primitive.

La linite plastique rectale primitive: une tumeur exceptionnelle

Resume Bien qu’elles soient rares, les tumeurs stromales gastro-intestinales (GIST), sont les tumeurs mesenchymateuses les plus frequentes du tube digestif (Mignon et al. [1] ), souvent de localisation gastrique, antrale et fundique, rarement cardiale. L’objectif de notre travail est d’etudier la localisation cardiale exceptionnelle de ces tumeurs, qui pose a la fois un probleme diagnostique et therapeutique. Nous rapportons le cas d’une patiente âgee de 54 ans, sans antecedents particuliers qui a presente quatre mois avant son admission une dysphagie aux solides d’installation progressive associee a un amaigrissement non chiffre. Le bilan paraclinique a montre l’existence d’une lesion du mediastin inferieur tres probablement a point de depart digestif. En peroperatoire ; il s’agit d’une tumeur de la jonction œso-gastrique. Une œso-gastrectomie polaire superieure sans curage ganglionnaire est realisee. Le complement immuno-histochimique etait en faveur d’une tumeur stromale de la jonction œso-gastrique.

Tumeur stromale de la jonction œso-gastrique

L’association pheochromocytome et grossesse est rare, ce qui explique la difficulte de son diagnostic, d’autant que le pheochromocytome peut se manifester comme une hypertension arterielle gravidique banale. Le pronostic maternel et foetal est conditionne par un diagnostic precoce et une prise en charge medicale multidisciplinaire qui prepare a l’exerese de la tumeur. La certitude diagnostique est donnee par des tests biologiques qui sont simples et fiables a condition d’y penser. La tumeur est localisee par echographie ou scanner. La preparation par alphabloquant permet de choisir, en fonction du terme, de retirer la tumeur avant ou apres l’accouchement. Cette strategie permet de reduire une mortalite maternelle et foetale qui est tres elevee quand le diagnostic est meconnu.

Phéochromocytome et grossesse. À propos d’un cas

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