CT and US findings in pancreatic ductal tumours. A report of an unusual case and review of the literature.

Pancreatic cystadenomas and cystadenocarcinomas are rare tumours usually occurring in women. The first symptoms are pain, occasionally associated with a palpable tumour in the left upper quadrant, and in rare cases the clinical and laboratory findings are suggestive of a pseudocyst. US shows a cystic neoplasm with a wall enclosing several polypoid areas. CT allows the diagnosis of the type of septa within the cyst and shows the extension of the lesion and calcifications into the wall. It also permits the assessment of the probable pathological complications associated with the tumour; therefore CT cannot differentiate cystadenoma from cystadenocarcinoma. The analysis of these different phenomena is based on one observation and a review of the literature.

[The lesser omentum. Normal aspect and tumor pathology in ultrasonography and x-ray computed tomography]. / Le petit épiploon. Aspect normal et pathologie tumorale en échographie et tomodensitométrie.

The lesser omentum is a peritoneal partition that can be divided into two portions: superior or gastrohepatic ligament and inferior or duodenohepatic ligament, although differentiation is sometimes difficult. Ultrasound and CT scan imaging allowed perfect definition of vascular and glandular elements contained in the omentum, and normal morphology is described. Masses developing between the two leaves of which it is constituted usually project in front of adjacent vascular structures and/or prolonged into the liver hilum, and a fatty layer separates them from large prevertebral vessels. These different guidelines allow them to be distinguished from retroperitoneal celiomesenteric adenopathies. These expansive processes are almost always of glandular origin secondary to primary digestive, retroperitoneal, pelvic and even bronchial tumors. In contrast, primary tumors are rare in this region.

[Congenital esophagotracheal fistulas in adults. Apropos of 2 cases]. / Fistules oeso-trachéales congénitales chez l'adulte. A propos de 2 cas.

Repeated bronchopneumopathies are the principal manifestation of congenital esophagotracheal fistulae detected at a late stage. Diagnosis is suggested by air distention of the esophagus on the thoracic image. Esophageal barium swallow examination in the standing position is usually negative: esophageal transit is too rapid, the diameter of the fistula is too small, and its ascending pathway does not allow filling by the contrast medium. Examinations should be conducted in precubitus, after the passage of an esophageal sound, employing barium sulphate as the contrast medium, and with a horizontal beam and profile projection. Kinetic exploration, employing ampliphotography is necessary. The fistula pathway is seen as a thin opaque line, oblique from above forwards, and pushing from the anterior surface of the esophagus to the posterior surface of the trachea. There is associated filling of the tracheobronchial tract.

[Tomodensitometric aspects of sarcoma of the soft tissue of the extremities in adults]. / Aspects tomodensitométriques des sarcomes des parties molles des membres de l'adulte.

A group of 21 adults patients with soft tissues sarcomas of the extremities were studied by CT. CT was a diagnostic procedure in only one case. However it has always permitted a precise local work-up particularly in demonstrating the vasculo-nervous connections of the lesions. The place of CT with regard to the other radiological procedures is discussed. by its contribution to the locoregional and general pretherapeutic work-up and to a better determination of radiotherapeutical dosimetry, CT appears to have an up standing place in the staging and the follow-up of soft tissues sarcomas.

[Spontaneous regression of pulmonary images interpreted as metastases of kidney cancer. Apropos of 2 cases]. / Régression spontanée d'images pulmonaires interprétées comme métastases de cancer du rein. A propos de deux cas.

The authors report two cases of spontaneous regression of pulmonary metastases from hypernephroma; this is an exceptional event that occurs in 0.8% of metastasized renal carcinomas; spontaneous regression in all cancers as a group occurs in 0.0014% of cases. The theories postulated up till now to explain this phenomenon are unconvincing. The authors suggest the possibility of tumorous emboli: this event, that occurs mainly in those carcinomas with a propensity for extension to veins, such as renal carcinoma, choriocarcinoma, hepatoma and liver metastases, does not necessarily give rise to a metastasis. The evidence that leads to advocate nephrectomy in metastasized renal carcinoma are recalled and discussed.

[The request for surgical biopsy in mammography. Apropos of 140 verified cases]. / La demande de biopsie chirurgicale en mammographie. A propos de 140 cas vérifiés.

The authors present a series of 140 patients who underwent surgical biopsy guided by an isolated anomaly on mammography without any clinical sign. 27 cases presented an opacity with a long axis less than 10 mm, 59 cases presented isolated areas of micro-calcification and 54 cases presented images of focal distorsion of the glandular architecture. By means of pre- and intra-operative radiographic guidance, the histological analysis of serial sections of these abnormalities was possible in every case, resulting in the diagnosis of 54 cases of benign dysplasia, 31 transitional lesion, including 16 in situ carcinomas and 55 carcinomas, including 34 invasive cancers. The advantage and limitations of this diagnostic approach are analysed. The discovery of a large number of sub-clinical carcinomas, the favourable implications for preservation of the breast and the survival justify the indications for surgical biopsy on the discovery of an isolated mammographic abnormality.