Retroperitoneal desmoid-type fibromatosis: a case report.

Desmoid-type fibromatosis (DF) is a rare subtype of soft tissue sarcomas that most commonly occurs in the anterior abdominal wall. When occurring in the retroperitoneum, DF is usually part of familial syndromes while only rarely sporadic. This makes it imperative to report any instance of experience with DF and the oncological outcomes of the different approaches to management. We report two cases of sporadic and severe DF occurring in the retroperitoneum at our institution. Case presentation: The first case is a male that presented with urinary obstruction symptoms and underwent surgical resection of the tumor that extended into the left kidney. The second case is a female with a history of recurrent desmoid tumors of the thigh and was incidentally diagnosed with retroperitoneal DF on imaging. She underwent tumor resection and radiotherapy; however, the tumor recurred with urinary obstruction symptoms that required another surgical resection. Histopathological characteristics and radiological imaging of both cases are described below. Clinical discussion: Desmoid tumors often recur, thus significantly influencing the quality of life which is reflected in one of our cases. Surgery remains a mainstay treatment, and both cases presented in this report required surgical resection of the tumors as symptomatic and curative measures. Conclusion: Retroperitoneal DF is a rare entity, and our cases add to the scarce literature available on the topic, which may well contribute to the formulation of practice-changing recommendations and guidelines focused on this rare variant of DF.

Impact of sedation type on adenoma detection rate by colonoscopy.

BACKGROUND & AIMS: Endoscopic detection of polyps and adenomas decreases the incidence and mortality of colorectal cancer. The available data concerning the relationship between the sedation type and adenoma detection rate (ADR) or polyp detection rate (PDR) is inconclusive. The aim of our study was to evaluate the impact of conscious vs. deep (propofol) sedation on the ADR/PDR in diagnostic and screening colonoscopies. METHODS: This was a retrospective cohort study. Patients aged 50-75 years old presenting for a first screening or diagnostic colonoscopy were included. Baseline demographic characteristics were collected, as well as PDR and ADR. Endoscopic withdrawal time and quality of bowel preparation rated in a binary fashion were also collected. Two multivariate logistic regression models were used to evaluate the independent predictors of endoscopic detection of polyps and adenomas. RESULTS: 574 patients met our inclusion criteria. Mean age was 59.26 ± 7.21 with 52.4% females and an average BMI of 28.08 ± 4.89. 374 patients (65.2%) underwent screening colonoscopies, and deep sedation was performed in 200 patients (34.8%). Only 4.7% had bad bowel preparation. PDR was 70% and ADR was 52%. On bivariate analysis, no significant difference was shown in PDR and ADR between conscious and deep sedation groups (0.70, 0.71; p = 0.712 and 0.50, 0.54; p = 0.394, respectively). On multivariate analysis for PDR, age and withdrawal time were independent predictors. For ADR, age, female sex, and withdrawal time were independent predictors. Sedation type and the indication did not reach statistical significance in both models. CONCLUSION: The use of deep sedation didn't influence the ADR/PDR quality metrics in our mixed cohort of screening and diagnostic colonoscopies.

Parental Attitudes Toward Fertility Preservation in Female Adolescent Cancer Patients in Lebanon.

STUDY OBJECTIVE: To measure parental attitudes toward fertility preservation (FP) in female adolescent cancer patients in a Middle Eastern country to understand barriers to decision-making and decisional conflicts. DESIGN AND SETTING: A questionnaire was distributed to parents of all female adolescents at a tertiary care center from February 2018 to September 2018. PARTICIPANTS: A total of 70 families. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Parental attitudes toward FP. RESULTS: The educational level of parents was associated with the knowledge about the side effects of treatment (P < .001). FP options were not offered to parents in 60/70 (85.6%) of cases. Oocyte cryopreservation was an acceptable option for 23/70 (32.9%) of interviewed parents who agreed on collecting the oocytes using vaginal ultrasound. The fear of disrupting the hymen was the main reason for disapproval in 20/70 (28.6%) of cases. The religious preference of the family was a significant factor in the acceptance of vaginal ultrasound and vaginal oocyte retrieval. The educational level of parents, the monthly income, and the current employment status were not linearly associated with their acceptance to approve their daughters' undergoing oocyte cryopreservation through the vaginal route (χ2 = 100.651; P < .001). CONCLUSION: Parents are not aware of the effect of cancer treatment on future fertility of their daughters. Ethical, social, and religious barriers affect the decision-making for FP. However, a major interest exists among parents for FP, highlighting the importance of development of an oncofertility program, involving a multidisciplinary team to initiate proper counseling and guidance.