Primary leiomyosarcoma (LMS) of the pancreas is a rare mesenchymal neoplasm (0.1% of pancreatic tumors) with only 35 cases reported in the world literature. We describe a 36th case. This tumor affects adults in the fifth...Primary leiomyosarcoma (LMS) of the pancreas is a rare mesenchymal neoplasm (0.1% of pancreatic tumors) with only 35 cases reported in the world literature. We describe a 36th case. This tumor affects adults in the fifth decade of life, especially men. Its diagnosis is difficult and is based on immunohistochemical analyses that reveal smooth muscle cell markers. We report the case of a patient with primary LMS in the head of the pancreas. He underwent a pancreaticoduodenectomy for both diagnosis and treatment after imaging was unable to provide a precise diagnosis. The discussion covers the clinical, diagnostic, immunohistochemical, and therapeutic characteristics of this neoplasm.
STUDY AIM: In view of the crisis anticipated in French surgery, this study sought to analyze the choices of specialties of interns who passed the most recent national ranking exam (NRE), as well as the plans for speciali...STUDY AIM: In view of the crisis anticipated in French surgery, this study sought to analyze the choices of specialties of interns who passed the most recent national ranking exam (NRE), as well as the plans for specialization of medical students and to determine the factors influencing these choices. SUBJECTS AND METHODS: Data about the specialty choices of students classified in the 2008 NRE were analyzed. In addition, at the beginning of the 2008 to 2009 academic year, French medical students were asked to complete a questionnaire that asked about their year of medical school, their sex, their professional plans, and the reasons for the choice. RESULTS: Analysis of the choices of the 5102 students who passed the NRE showed that medical (p<0.001) and anesthesia-resuscitation (p=0.04) specialties were more highly sought than surgical specialties. Surgery was chosen by 14 to 19% of the students among the first 100, 500, and 2500 students. The mean NRE ranking for future gastrointestinal surgeons was 1390, placing this specialty sixth. In all, 929 students (638 women, 69%) completed the questionnaire: 353 (38%) wanted to specialize in a medical field and 191 (21%) in a surgical field. This distribution was influenced by sex: 41.3% of the men and 22.9% of women planned to become surgeons (p<0.0001). Of the students planning to enter surgical fields, 54 wanted to become gastrointestinal surgeons (5.8% overall). The principal reasons for not choosing surgery were lack of interest (n=331, 73%) and too much work (n=109, 24%). CONCLUSION: This study confirmed that there is currently a lack of interest in gastrointestinal surgery, based largely on negative presumptions, especially about its workload.
Dermoid cysts involving the diaphragm are rare and their symptomatology is non-specific. CT is the principal diagnostic tool, but it may fail to distinguish whether a cyst is located above, below, or within the diaphragm...Dermoid cysts involving the diaphragm are rare and their symptomatology is non-specific. CT is the principal diagnostic tool, but it may fail to distinguish whether a cyst is located above, below, or within the diaphragm. Surgical excision of dermoid cysts is recommended because of the possibility of malignant degeneration.
We report the case of a 39 year-old woman with many years of intermittent abdominal pain who was found to have cystic masses evocative of cystic lymphangioma involving the posterior mediastinal and retroperitoneum. Worse...We report the case of a 39 year-old woman with many years of intermittent abdominal pain who was found to have cystic masses evocative of cystic lymphangioma involving the posterior mediastinal and retroperitoneum. Worsening abdominal pain led to a recommendation for laparoscopic unroofing and decompression of the cysts. During the postoperative period, hemorrhagic shock required reintervention with excision of the tumoral mass. Pathologic examination revealed lymphangioleiomyomatosis (LAM). On the 15th postoperative day, the patient developed a chylopneumothorax which required prolonged chest tube drainage. The presence of multiple polycystic lesions in the pulmonary parenchyma supported the diagnosis of diffuse LAM with primary extrapulmonary presentation. This diagnosis should be considered preoperatively since it modifies the treatment: a complete excision of the cystic lesions seems to be necessary in order to prevent bleeding and lymphatic extravasation.
OBJECTIVE: The aim of this study was to evaluate results of surgical management for sternal metastasis from differentiated thyroid carcinoma. METHODS: A retrospective study has been completed on patients treated in our d...OBJECTIVE: The aim of this study was to evaluate results of surgical management for sternal metastasis from differentiated thyroid carcinoma. METHODS: A retrospective study has been completed on patients treated in our department for sternal metastasis from differentiated thyroid carcinoma. RESULTS: Among the 235 patients who underwent thyroidectomy for thyroid cancer, seven (3%) had sternal metastasis during follow-up. These sternal metastasis were metachronous with an average delay of 10 years. Treatment corresponded to an excision of the upper half of the sternum including internal parts of the clavicle and the adjacent ribs (four cases), a reduction of the metastatic tumour mass (two cases) and one biopsy with no resection (one case). After sternal excision, reconstruction of the chest wall was obtained with the use of polyester prosthesis covered with pectoral muscle flap. Radioiodine was assigned to all patients as a complementary therapy. With an average follow-up of 58 months, no local or distant recurrence was observed in five patients (71%). Two patients had local and/or distant metastasis. CONCLUSION: Incidence of sternal metastasis is rare but does not preclude a large surgical resection. When possible, an aggressive management (surgical resection and radioiodine therapy) allows more than 70% relapse-free survival at 5 years.
BACKGROUND: Esophageal perforation due to foreign body (FB) ingestion is an unusual occurrence. This study aims to define diagnostic difficulties of esophageal perforation by FB. PATIENTS AND METHODS: A chart review of p...BACKGROUND: Esophageal perforation due to foreign body (FB) ingestion is an unusual occurrence. This study aims to define diagnostic difficulties of esophageal perforation by FB. PATIENTS AND METHODS: A chart review of patients on our service with FB esophageal perforation was carried out. Diagnosis of perforation was made by CT scan and/or esophagoscopy. Surgery was indicated when a FB could not be removed endoscopically or on a case-by-case basis according to clinical/laboratory, radiologic, and/or endoscopic findings. RESULTS: Seven patients (age range: 27 to 80 years) were admitted for esophageal FB perforation. All patients presented with dysphagia. Two patients presented with signs of sepsis more than 24 hours after FB ingestion. Perforation was diagnosed at initial evaluation in five cases (three by endoscopy, two by CT) and after FB extraction in two cases. Six patients underwent surgery (suture repair: n=4; esophageal exclusion: n=1; mediastinal drainage: n=1). Five surgeries were performed at the initial diagnosis and one after failure of medical management. Mortality was zero; one patient developed esophageal fistula. CONCLUSION: Diagnosis of FB esophageal perforation is difficult and is delayed in up to a quarter of patients. The perforation can be due to the FB itself or may be incurred during endoscopic extraction. Both CT and endoscopy are necessary for diagnosis and treatment. Most patients require surgical intervention.