Search

Pancreas cystadenoma tumors represent 10 to 15% of all cystic lesions of the pancreas. These tumors are asymptomatic in around 30% of patients, serous adenoma being the most common. Malignancy should be suspected when cystadenoma is compressive. We report the case of a 72-year-old man with a compressive serous cystadenoma associated to renal carcinoma.

Glucagonoma is a rare islet alpha-cell pancreatic tumor. Patients usually present with necrolytic migratory erythema, diabetes mellitus, thromboembolism, and weight loss. Diagnosis is based on the presence of a pancreatic tumor in association with hyperglucagonemia. Tumor characterization is made by computed tomography and/or pancreatic endoscopic ultrasonic and indium-labeled octreo-scan. Surgery is the main component of the treatment, in some cases in association with chemotherapy. We report the case of a 72-year-old patient who developed a recurrent glucagonoma, 20 years after surgical resection.

Objective: According to certain learned societies, acute pancreatitis mortality should not exceed 10%. The aim of our work was to review the etiology, severity and mortality of acute pancreatitis in a prospective series of patients admitted to a regional university hospital in France, using standardised collection of data assessing the medico-surgical habits in the management of acute pancreatitis., Methods: From February to September 1999, 86 patients (54 men and 32 women with a mean age of 58.5 years) were admitted for 88 episodes of acute pancreatitis. Data was collected from all the patients on admission and permitted measurement of the severity and prognosis scores and the study of the etiology, complications and management of the latter and the mortality with acute pancreatitis., Results: Ranson's score was a mean of 2.4. Balthazar's score was superior or equal to D in 45% of cases. The respective prevalence of lithiasis, alcoholism, tumors, others or undetermined was of 41%, 37.5%, 7%, 5.5% and 9%. Acute pancreatitis was severe (multi organ failure, pseudo-cyst, systemic or necrotic infection and occlusive syndrome) in 32% of cases. Complications were: infection (22%), pseudo-cyst (14%), pleural effusion (12.5%) and occlusive syndrome (3.5%). Fever of more than 38.5 degrees C was noted in more than half of the patients. The median duration of hospitalisation was of 11 days (range: 1-86 days). Global hospital mortality was of 13.6% (12/88), and of 43% (12/28) in cases of severe acute pancreatitis. Six deaths occurred within the first 8 days of acute pancreatitis, and 6 after 8 days. Seven deaths (59%) were due to multi organ failure, 4 (33%) to infectious causes and one to another cause., Conclusion: The standardized collection of clinical and progressive data used in this study permitted assessment of the medico-surgical habits in a regional university hospital.

We report an unusual case of gastric tumor: a stromal tumor with osteoclast-like giant cells. This type of cells has been described in epithelial tumors, especially in adenocarcinoma of the pancreas, lung, thyroid and breast. It has also been reported in smooth cell tumors such as uterine leiomyosarcoma and malignant fibrous histiocytoma. In our patient, this gastric stromal tumor with osteoclast-like giant cells was diagnosed in a man with adenocarcinoma of the colon in the context of a familial cancer syndrome. This is the first report of stromal tumor with osteoclast-like giant cells associated with Lynch syndrome.

We report the case of a 61-year-old-man with an eosinophilic esophagitis with esophageal motor disorder associated with toxocariasis. He complained of non cardiac chest pain and had eosinophilia leading to the detection of Toxocara canis infection. Pain persisted despite treatment of toxocariasis. Basal manometry was normal but ambulatory 24-hour manometry-pHmetry showed diffuse esophageal spasm. Ultrasonography showed a thickening of the esophageal musculature in the two inferior thirds of the esophagus. After failure of treatment with sodium cromoglycate steroids and esophageal dilatation, calcium antagonists were partially effective. A long esophageal myotomy was performed permiting the disappearance of symptoms. The histological examination of a side myotomy biopsy showed an eosinophilic infiltration of the esophageal muscle layer. This observation leads to discuss the possible relation between toxocariasis, the esophageal motor disorder and the eosinophilic infiltration of the esophageal muscle layer.

Graves' disease was diagnosed in a 35-year old woman with a history of myxoedema in childhood. Clinical data, ultrasonography and radioisotope scanning showed that the disease had developed in an ectopic subhyoid thyroid gland. Although numerous thyroid diseases associated with an ectopic thyroid have been described, Graves' disease does not seem to be frequent since only one case has been published so far.

This report is a retrospective analysis of the results of surgical treatment in 234 consecutive cases of adenocarcinoma of the colon; 56.4 p. 100 of patients were male with a mean age of 66. Sixty per cent of the carcinoma were situated in the sigmoid. Carcinoma was complicated in 26.1 p. 100 of cases. The tumor was confined to the bowel wall in 14.3 p. 100 of cases (stage A), involved the serosa in 36.3 p. 100 of cases (stage B), lymph nodes in 25.5 p. 100 of cases (stage C), and distal organs in 23.8 p. 100 of cases (stage D). Global operative mortality was 10 p. 100. Obvious anastomotic leakages occurred in two patients with one death. The overall five year survival rate was 35 p. 100. The stage-by-stage 5-year survival rates depended mainly on the differentiation and on the extension of the tumor: 59.2 p. 100 in patients with stage A lesions, 54.8 p. 100 in those with stage B lesions, 30.2 p. 100 in those with stage C lesions, 3.9 p. 100 in those with stage D lesions. On the other hand, survival was not significantly related to the duration of symptoms. This suggests that early diagnosis of symptomatic disease does not guarantee a better prognosis. This can only be achieved by prevention of the disease.