Biomedical subjects
Publications and source records attributed to J Nemeth.
We present here a very unusual case in Western countries of mass-forming intrahepatic cholangiocarcinoma in association with tumor growth in the extrahepatic bile duct and superficial spreading. We discuss the clinicopathologic features of this very rare variant of cholangiocarcinoma.
The authors report a case of leiomyoma of the second part of the duodenum and note in the light of 55 cases in the literature, the main characteristics of this tumour including digestive hemorrhage, especially melena, which is the commonest mode of presentation. They compare it with other muscle tumours, e.g. sarcoma and myoid tumours. A barium meal and eventually superior mesenteric arteriography are the two main aids in diagnosis which remains by chance in 15% of cases. The volume of the tumour, the intimacy of its relations with the bile ducts influence the choice of surgery. The risk of hemorrhage and the histological uncertainty almost always lead to surgical operation.
The authors report two cases of multiple cancers (three and four) and precise the criterions of multiplicity of cancers, their frequency and their localizations. The factors incriminated in multiple carcinogenesis, often not well known and complicated, are also studied, such as family ground, age, blood groups, hormones, viruses, immunologic deficiencies and some carcinogenic drugs. Moreover, the actual progress in therapy, leading to the healing of the first tumor, may favour the secondary supervening of one or more cancers, as the survival is longer.
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BACKGROUND/AIMS: The purposes of this study were to assess the relationship between the incidence of recurrence and the pathologic criteria usually applied to the selection of patients for curative local excision of rectal carcinoma and to determine whether failure to fulfill one of these criterias is always an indication for secondary abdominoperineal resection (APR). METHODOLOGY: From 1982 to 1992, 30 patients with rectal carcinoma (mean age: 69 +/- 10 years) were treated by local excision (LE). Univariate analysis of the cancer recurrence rate according to pathologic criteria was performed. RESULTS: The mean follow-up was 57 +/- 40 months (range: 6-145). Five patients (17%) had recurrent disease (local in 3, distant in 1, and local and distant in 1). Two of the three local cases were successfully treated. At the end of follow-up, 90% of the patients had no evidence of recurrence, and the rectal cancer-specific death rate was 10%. Although not significant, tumor penetration beyond the submucosa and vessel or nerve invasion were associated with an increased incidence of cancer recurrence. Tumor size and differentiation, and the presence of a mucinous component were not associated with a significant increase in recurrence. According to the usual pathologic criteria proposed for curative LE, 20 patients should, theoretically, have undergone secondary APR. However, 16 of them (80%) were treated by LE only, and at the end of follow-up, 17 (85%) were alive without recurrence. CONCLUSIONS: The rigid rule of systematically performing secondary APR after LE for rectal carcinoma when one or more pathologic selection criteria are not met should perhaps be reconsidered, especially for tumors exceeding 3 cm in diameter, moderately differentiated tumors, and in incidences when a mucinous component is present. However, in cases of vessel, nerve or muscular invasion, secondary APR is probably the best choice for cure.