A lymph node ratio of 10% is predictive of survival in stage III colon cancer: a French regional study.

Lymph node ratio (LNR) (positive lymph nodes/sampled lymph nodes) is predictive of survival in colon cancer. The aim of the present study was to validate the LNR as a prognostic factor and to determine the optimum LNR cutoff for distinguishing between "good prognosis" and "poor prognosis" colon cancer patients. From January 2003 to December 2007, patients with TNM stage III colon cancer operated on with at least of 3 years of follow-up and not lost to follow-up were included in this retrospective study. The two primary endpoints were 3-year overall survival (OS) and disease-free survival (DFS) as a function of the LNR groups and the cutoff. One hundred seventy-eight patients were included. There was no correlation between the LNR group and 3-year OS (P=0.06) and a significant correlation between the LNR group and 3-year DFS (P=0.03). The optimal LNR cutoff of 10% was significantly correlated with 3-year OS (P=0.02) and DFS (P=0.02). The LNR was not an accurate prognostic factor when fewer than 12 lymph nodes were sampled. Clarification and simplification of the LNR classification are prerequisites for use of this system in randomized control trials. An LNR of 10% appears to be the optimal cutoff.

Rectal stenosis caused by foreign body reaction to sodium polystyrene sulfonate crystals (Kayexalate).

Sodium polystyrene sulfonate (SPS) (Kayexalate) is a cation-exchange resin used to treat hyperkaliema. Administered with sorbitol, it usually has minor adverse effects, but it may cause colonic or intestinal necrosis in uremic patients. We report an unusual case of rectal stenosis due to SPS crystals in a 46-year-old man. The patient had been involved in a car accident with severe thoracic and abdominal trauma. During his hospitalization, he presented traumatic acute pancreatitis with ischemic colitis because of hypotension, and acute renal insufficiency treated by hemofiltration and Kayexalate administered by nasogastric tube without sorbitol. Left colon was resected and Hartmann's procedure was performed. Restoration of the colon continuity was performed 13 months later. The rectal lumen was narrowed with a thickened rectal wall. Microscopic examination revealed fibrosis of the submucosa containing numerous basophilic polygonal crystals surrounded by macrophages. This is the first case report of rectal stenosis caused by foreign body reaction to SPS crystals after ischemic colitis.

[Angiomyofibroblastoma of the male genital tract. Pathological and immunohistochemical study of three cases]. / L'angiomyofibroblastome du tractus génital masculin. Etude anatomo-clinique et immunohistochimique de trois cas.

Angiomyofibroblastoma of the male genital tract is a rare tumor with only 20 cases reported in the literature to date. We report three cases in males aged from 23 to 44 years. They presented with painless inguinal, scrotal and perineal masses, ranging from 3 to 8 cm in diameter. On microscopic examination the tumors were composed of small spindle cells without atypia in a fibrous and myxoid stroma. There were scattered mononuclear inflammatory cells around capillaries. Immunohistochemical studies showed positive staining of the tumor cells for vimentin, and weak reactivity for CD34, bcl-2, CD99, EMA and CD117. Some tumor cells expressed estrogen receptors in all three cases, and progesterone receptors in only one case. There was no recurrence with a follow-up ranging form 12 to 21 months. Angiomyofibroblastoma of the male genital tract is a benign often hormone-dependent tumor. Its histogenesis is still unclear. It has to be distinguished from aggressive angiomyxoma and myxofibrosarcoma.

Groove pancreatitis and pancreatic heterotopia in the minor duodenal papilla.

Groove pancreatitis is a rare form of segmental chronic pancreatitis that involves the anatomic space between the head of the pancreas, the duodenum, and the common bile duct. We report 2 cases of groove pancreatitis with pancreatic heterotopia in the minor papilla. Patients were a 44-year-old woman and a 47-year-old man. Both had a past history of alcohol consumption and presented with abdominal pain, vomiting, and weight loss caused by duodenal stenosis. Abdominal computed tomography revealed thickening of the duodenal wall and enlargement of the pancreatic head in both patients. In 1 patient, ultrasound endoscopy showed a dilated duct in the head of the pancreas. Pancreaticoduodenectomy was performed to rule out pancreatic adenocarcinoma and because of the severity of the symptoms. In both cases, gross and microscopic examinations showed fibrous scar of the groove area. The Santorini duct was dilated and contained protein plugs in both patients, with abscesses in 1 of them. In both cases, there were microscopic foci of heterotopic pancreas with mild fibrosis in the wall of the minor papilla. Groove pancreatitis is often diagnosed in middle-aged alcoholic men presenting with clinical symptoms caused by duodenal stenosis. The pathogenesis of this rare entity could be because of disturbance of the pancreatic secretion through the minor papilla. Pancreatitis in heterotopic pancreas located in the minor papilla and chronic consumption of alcohol seem to be important pathogenic factors.

[Urologic presentation of acute appendicitis: a frequent cause of delayed diagnosis, including in HIV infected patients]. / Présentation urinaire d'une appendicite aiguë: une cause fréquente de retard diagnostique, également chez le sujet infecté par le virus de l'immunodéficience humaine.

Acute appendicitis rarely presents in the form or urinary tract symptoms. Atypical forms of acute appendicitis occur more frequently in subjects infected by the human immunodeficiency virus (HIV). The authors report a case of acute appendicitis in an HIV-infected subject mimicking acute pyelonephritis secondary to obstruction. Atypical forms of acute appendicitis must be diagnosed and treated as early as possible. Computed tomography plays an essential role in the diagnostic assessment of abdominal and lumbar symptoms in HIV-infected patients.