Intrahepatic Cholangiocarcinoma: Clinical Aspects, Pathology and Treatment

Intrahepatic cholangiocarcinoma (ICC) is the second most common primary tumor of the liver. To further define its clinicopathology and surgical management, we reviewed our experience. Clinical presentations of 32 patients with ICC was similar to that with hepatocellular carcinoma. Jaundice occurred in only 27 percent. ICC was unresectable due to advanced disease stage in 81 percent. Six patients had curative resections with two 5 year disease free survivors. Underlying liver disease was associated with ICC in 34 percent of patients

Surgery for benign insulinoma: An international review

In a multiinstitutional review, data on 396 patients with benign solitary or multiple insulinomas operated on in 15 centers were collected. In these 396 patients, 419 laparotomies (375 primary procedures and 44 reoperations) were performed. The rate of unnecessary laparotomies was 1.7%. Complications occurred after 132 operations (31.5%), requiring 27 reinterventions (6.4%). Ten (2%) patients died within 30 days of surgery. The success rate of first procedures in the centers was 94.9%. After reoperation, all but 2 (99.5%) of these patients were cured. The overall cure rate including those patients who had their primary operations elsewhere was 97.5% . Compilant les dossiers de 15 établissements internationaux, nous avons colligé les données concernant 396 patients présentant un insulinome bénin unique ou multiple, opérés. Chez ces 396 patients, 419 laparotomies (375 interventions de première intention et 44 reprises) ont été effectuées. Le taux de laparotomie inutile était de 1.7%. Des complications sont intervenues à la suite de 132 opérations (31.5%), nécessitant 27 réinterventions (6.4%). Dix (2%) patients sont morts dans les trente jours après l'acte chirurgical. Le taux de succès des interventions de première intention dans les centres de l'étude était de 94.9%. Après réinterventions, tous les patients sauf 2 (99.5%) ont été guéris. Le taux global de guérison, y compris les patients ayant été opérés une première fois ailleurs, était de 97.5%. En una revisión multiinstitucional se recolectaron los datos sobre 396 pacientes con insulinomas benignos solitarios o múltiples operados en 15 centros. En estos 396 pacientes se efectuaron 419 laparotomías (375 procedimientos primarios y 44 reoperaciones). Se registró una tasa de laparotomías innecesarias de 1.7%; se presentaron complicaciones después de 132 operaciones (31.5%), las cuales requirieron 27 reintervenciones (6.4%). Diez (2%) pacientes murieron dentro de los primeras 30 días después de la cirugía. La tasa de éxito del procedimiento primario realizado en estos centros fue 94.9%. Después de las reoperaciones la totalidad de los pacientes, menos 2 (99.5%), fueron curados. La tasa global de curación, incluyendo los que tuvieron su operación primaria por fuera de los centros del estudio, fue 97.5%.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/41289/1/268_2005_Article_BF01658536.pd

Prognostic significance of calcitonin immunoreactivity, amyloid staining, and flow cytometric DNA measurements in medullary thyroid carcinoma

The proven power of DNA ploidy to predict mortality risk in medullary thyroid carcinoma (MTC) may be weakened when analyzed in conjunction with calcitonin immunoreactivity (CI) and amyloid staining (AS) of tumors. In this study 12 prognostic variables, including DNA ploidy, CI, and AS, were studied in 65 patients with MTC (57 sporadic; mean age 51 years) treated during 1946 through 1970. Cause-specific mortality rates at 10 and 15 years were 15% and 26%, respectively. By univariate analysis, TNM stages III or IV (p < 0.0001), tumor unresectability (p < 0.0001), male sex (p = 0.019), negative AS (p = 0.032), and low CI (p = 0.033) were significant predictors of increased mortality rates. DNA ploidy (p = 0.058) and inheritance pattern (p = 0.25) were nonsignificant. By multivariate analysis, only TNM stage, tumor resectability, and AS were independently significant (p < 0.005). A prognostic model was created, based on presence or absence of these independent risk factors, and four risk groups were defined, capable of predictably defining mortality rates in MTC (p < 0.0001). The model requires validation in larger series and independent verification by others. However, we believe that a risk-group scheme for MTC based on AS, disease stage, and completeness of tumor resection may have wide applicability and prove relevant to clinicians treating this disease