Gastric Collision Tumors: An Insight into Their Origin and Clinical Significance

Collision tumors are rare neoplasms displaying two distinct cell populations developing in juxtaposition to one another without areas of intermingling. They are rare entities with only 63 cases described in English literature. Tumors encountered are gastric adenocarcinomas colliding with lymphomas, gastrointestinal stromal tumors, squamous cell carcinomas, and neuroendocrine tumors. Their cell origin is obsolete by the time of diagnosis. Different tumorigenesis theories have been suggested to explain their behavior, yet none has managed to provide satisfactory explanation for all cases. Clinically they are indistinguishable from the dominant tumor. Lack of data does not allow detailed assessment of their behavior yet they seem aggressive neoplasms with dismal prognosis. The majority of cases have been diagnosed postoperatively during histologic examination of specimens. There are no guidelines or concrete evidence to support best way of adjuvant or other types of treatment. However, these rare neoplasms might help in unlocking secrets of cancer behavior including tumorigenesis, differentiation, and adhesion and thus clinicians should be aware of their existence

Rapunzel Syndrome: A Rare Presentation with Giant Gastric Ulcer

The Rapunzel syndrome refers to an uncommon and rare form of trichobezoar that extends past the stomach into the small intestines. The Rapunzel syndrome is usually found in young female patients with a history of psychiatric disorders, mainly trichotillomania and trichophagia. We describe a case of Rapunzel syndrome in a 15-year-old girl who presented with abdominal pain, vomiting, and weight loss. We performed a surgical laparotomy and successfully removed a huge trichobezoar extending into the small intestine

Metastasis to Sartorius Muscle from a Muscle Invasive Bladder Cancer

Bladder cancer constitutes the ninth most common cancer worldwide and approximately only 30% of cases are muscle invasive at initial diagnosis. Regional lymph nodes, bones, lung, and liver are the most common metastases from bladder cancer and generally from genitourinary malignancies. Muscles constitute a rare site of metastases from distant primary lesions even though they represent 50% of total body mass and receive a large blood flow. Skeletal muscles from urothelial carcinoma are very rare and up to date only few cases have been reported in the literature. We present a rare case of 51-year-old patient with metastases to sartorius muscle 8 months after the radical cystectomy performed for a muscle invasive bladder cancer

Favoring D2-Lymphadenectomy in Gastric Cancer

The role of extended lymphadenectomy in the surgical treatment of gastric cancer has been debated for many years. So far six prospective randomized trials and a number of meta-analyses comparing D1- to D2-lymphadenectomy in open surgery have been published with contradicting results. The possible oncologic benefit of radical lymphadenectomy has been blurred by a number of reasons. In most of the trials the strategies under comparison were made similar after protocol violations. Imperfect design of the trials could not exclude the influence of cofounding factors. Inappropriate endpoints could not detect evidently the difference between the two surgical strategies. On the other hand radical lymphadenectomy was characterized by increased morbidity and mortality. This was mostly caused by the addition of pancreatico-splenectomy in all D2-dissections, even when not indicated. A careful analysis of the available evidence indicates that D2-lymphadenectomy performed by adequately trained surgeons without resection of the pancreas and/or spleen, unless otherwise indicated, decreases Gastric Cancer Related Deaths and increases Disease Specific Survival. This evidence is not compelling but cannot be ignored. D2-lymphadendctomy is nowadays considered to be the standard of care for resectable gastric cancer

Morphology and correlation of morphometric characteristics of abdominal arteries with morphometric characteristics of abdominal viscera

Research interest on abdominal aorta branches and abdominal viscera morphometry is renewed by technologic evolution and development of new radiologic and clinical applications including grafted stents and chemoembolization materials. Despite that, data on morphometry of abdominal aorta branches and abdominal viscera are lacking. To investigate this subject authors performed a morphometric study on 50 adult fresh and embalmed Caucasian cadavers and examined abdominal aorta branches’, kidney’s and spleen’s morphometry. Our results on arteries’ morphometry did not differ significantly from those of the literature yet we discovered significant differences between fresh and embalmed cadavers on viscera morphometry, spleen and kidneys. We also found previously unreported correlations between abdominal aorta branches’ morphometric characteristics. Even more we identified correlations between regional arteries and viscera morphometric characteristics, proposing a new factor determining viscera development. Finally we performed an extensive literature review so to place our results in an anatomic, embryologic and even more a clinical context. We believe that our results add knowledge on abdominal aorta branches and viscera morphometry and are valuable for clinical, radiological and surgical applications including visceral arteries’ aneurysms investigation and treatment, chemoembolization procedures, grafted stents design and transplantation.Το ερευνητικό ενδιαφέρον στην μορφομετρία των κλάδων της κοιλιακής αορτής και των κοιλιακών σπλάγχνων ανανεώνεται από την τεχνολογική εξέλιξη και ανάπτυξη των νέων ακτινολογικών και κλινικών εφαρμογών περιλαμβανομένων των θυριδωτών ενδοπροθέσεων και των υλικών χημειοεμβολισμού. Παρά αυτό, τα δεδομένα στην μορφομετρία των κλάδων της κοιλιακής αορτής και των κοιλιακών σπλάγνων είναι ελλιπή. Προκειμένου να ερευνήσουμε αυτό το θέμα, οι συγγραφείς σχεδιάσαμε μια μελέτη σε 50 φρέσκα και ταριχευμένα παρασκευάσματα 50 ενηλίκων Καυκασίων. Κατά την μελέτη αυτή εξετάσαμε την μορφομετρία των κλάδων της κοιλιακής αορτής, των νεφρών και του σπλήνα. Τα αποτελέσματά μας στην μορφομετρία των αρτηριών ήταν παρόμοια με των ήδη υπαρχόντων στην διεθνή βιβλιογραφία αλλά ανακαλύψαμε σημαντικές διαφορές στην μορφομετρία των σπλάγχνων ανάμεσα σε φρέσκα και ταριχευμένα παρασκευάσματα. Βρήκαμε επίσης συσχετίσεις ανάμεσα στην μορφομετρία των κλάδων της κοιλιακής αορτής. Επίσης αναγνωρίσαμε συσχετίσεις ανάμεσα στην μορφομετρία των επιχωρίων αρτηριών και των αγγειούμενων σπλάγχνων, προτείνοντας έτσι έναν νέο παράγοντα καθορισμού του μεγέθους τους. Τέλος επιτελέσαμε μια εκτεταμένη ανασκόπηση της βιβλιογραφίας ώστε να θέσουμε τα ευρήματά μας σε ένα ανατομικό, εμβρυολογικό και ακόμα περισσότερο ένα κλινικό πλαίσιο. Πιστεύουμε ότι τα ευρήματά μας προσθέτουν στην γνώση της μορφομετρίας των κλάδων της κοιλιακής αορτής και των σπλάγχνων και είναι πολύτιμα για διάφορες κλινικές, ακτινολογικές και χειρουργικές εφαρμογές περιλαμβανομένων της διερεύνησης και αντιμετώπισης των ανευρυσμάτων των σπλαγχνικών αρτηριών, του χημειοεμβολισμού, του σχεδιασμού θυριδωτών ενδοπροθέσεων και της μεταμόσχευσης

Gastric Collision Tumors: An Insight into Their Origin and Clinical Significance

Collision tumors are rare neoplasms displaying two distinct cell populations developing in juxtaposition to one another without areas of intermingling. They are rare entities with only 63 cases described in English literature. Tumors encountered are gastric adenocarcinomas colliding with lymphomas, gastrointestinal stromal tumors, squamous cell carcinomas, and neuroendocrine tumors. Their cell origin is obsolete by the time of diagnosis. Different tumorigenesis theories have been suggested to explain their behavior, yet none has managed to provide satisfactory explanation for all cases. Clinically they are indistinguishable from the dominant tumor. Lack of data does not allow detailed assessment of their behavior yet they seem aggressive neoplasms with dismal prognosis. The majority of cases have been diagnosed postoperatively during histologic examination of specimens. There are no guidelines or concrete evidence to support best way of adjuvant or other types of treatment. However, these rare neoplasms might help in unlocking secrets of cancer behavior including tumorigenesis, differentiation, and adhesion and thus clinicians should be aware of their existence

Amyand's hernia: a review

BACKGROUND: The presence of a vermiform appendix in an inguinal hernia sac is known as Amyand’s hernia. The aim of this systematic review was to gather information concerning its prevalence, clinical image, diagnosis, and treatment. DATA SOURCES: The MEDLINE database was thoroughly searched using the keyword “Amyand’s hernia.” Additional articles were gathered and evaluated. CONCLUSIONS: The true prevalence of Amyand’s hernia seems lower than classically described. Its usual clinical image is identical to that of an incarcerated hernia, and thus it is almost impossible to diagnose preoperatively, although ultrasound and computed tomography can help. Treatment includes hernioplasty with or without appendectomy and/or mesh repair depending on the vermiform appendix’s inflammation status, the patient’s general condition, and other factors. Amyand’s hernia generally has a good prognosis, although serious complications have been described. Surgeons should be prepared if they encounter Amyand’s hernia because appropriate treatment ensures hernia repair without complications and with avoidance of recurrence. (C) 2014 Elsevier Inc. All rights reserved

Anatomical Considerations on Surgical Anatomy of the Carotid Bifurcation.

Surgical anatomy of carotid bifurcation is of unique importance for numerous medical specialties. Despite extensive research, many aspects such as precise height of carotid bifurcation, micrometric values of carotid arteries and their branches as their diameter, length, and degree of tortuosity, and variations of proximal external carotid artery branches are undetermined. Furthermore carotid bifurcation is involved in many pathologic processes, atheromatous disease being the commonest. Carotid atheromatous disease is a major predisposing factor for disabling and possibly fatal strokes with geometry of carotid bifurcation playing an important role in its natural history. Consequently detailed knowledge of various anatomic parameters is of paramount importance not only for understanding of the disease but also for design of surgical treatment, especially selection between carotid endarterectomy and carotid stenting. Carotid bifurcation paragangliomas constitute unique tumors with diagnostic accuracy, treatment design, and success of operative intervention dependent on precise knowledge of anatomy. Considering those, it becomes clear that selection and application of proper surgical therapy should consider anatomical details. Further research might ameliorate available treatment options or even lead to innovative ones