Implantation and diagnostics of endometrial receptivity.

OBJECTIVE: Literature review of endometrial receptivity in embryo implantation and its diagnostic possibilities. DESIGN: Literature review. SETTING: Department of Obstetrics and Gynecology, University Hospital, Faculty of Medicine, Palacky University, Olomouc; Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University, Olomouc. RESULTS: Endometrial tissue is very dynamic, undergoing cyclic proliferation, differentiation and cell transportation, especially of immune system cells under the influence of circulating estradiol and progesterone. Endometrial remodelling during embryo implantation is controlled by decidual cells senescence and effectivity of their immunologic destruction. Endometrial receptivity can be assessed by transcriptomic profiling of endometrial biopsy using ERA system or proteomic analysis of either endometrial secretome or cervical mucus by gel electrophoresis (DIGE) or mass spectrometry (MS). CONCLUSION: With respect to recent discoveries in endometrial physiology and molecular biology, clinical application of proteomic approaches in research of potential biomarkers of endometrial receptivity could be of interest.

[Various approaches of endometrial preparation for frozen-thawed embryo transfer]. / Moznosti prípravy endometria ke kryoembryotransferu.

OBJECTIVE: Various approaches of endometrial preparation for frozen-thawed embryo transfer. DESIGN: Retrospective analysis. SETTING: Department of Obstetric and Gyneacology, Faculty of Medicine, Palacky University, University Hospital Olomouc. METHODS: Effectivity of frozen-thawed embryo transfers was carried out between January and August 2017 in the IVF unit at the University Hospital Olomouc. Results were compared among groups A, B, C with various approaches of endometrial preparation. Group A - natural ovulating cycle, group B - artificial cycle with oral estrogen, vaginal gestagen and group C - artificial cycle with transdermal estrogen and vaginal gestagen. One blastocyst (two blastocyst in five cycles) was transferred on day 6 post ovulation (group A) or after 6 days of using gestagens (group B, C). RESULTS: The highest pregnancy rate was observed in group C (56%), similar pregnancy rate was found in group B (52%) and the lowest was seen in group A (22%). All pregnancies in group A continued over 12 weeks, in group B continued 57 percent and in group C continued 56 percent of pregnancies. CONCLUSION: Frozen-thawed embryotransfers in natural cycles are highly time-consuming. Our study has demonstrated the lowest effectivity of frozen-embryotransfer in natural cycles. Artificial cycles managed by oral or transdermal form of estrogen have shown better results.

[Recurrent implantation failure and thrombophilia]. / Opakované selhání implantace embrya a trombofilie.

OBJECTIVE: Bring a comprehensive overview of the available knowledge about the importance of thrombophilic mutations in patients with recurrent implantation failure and summary of therapeutic options. DESIGN: Overview study. SETTING: Department of Obstetric and Gynecology, University Hospital Olomouc. METHODS: Analysis of literary sources and databases Ovid, Medline. CONCLUSION: Failure of implantation in the context of assisted reproduction is associated with impaired endometrial receptivity. In women with normal anatomy may affect the implantation of embryos during stimulation hormonal changes, immunological factors or thrombophilic mutations. Recurrent implantation failure patients should be tested for the presence of thrombophilic mutations. Subsequently, these patients should be individually consulted and low molecular weight heparin should be used only in indicated cases. According to the available data treatment is recommended only in patients with known acquired or inherited thrombophilic disorder.

[Acute abdomen in elderly patients]. / Náhlé príhody brisní v seniorském veku.

BACKGROUND: Ageing of Czech population and the increase of numbers of elderly people gives new tasks to whole medicine and surgery too. METHOD AND RESULTS: Presented paper shows some aspects of occurrence, diagnostics and treatment of acute abdomen diseases--inflammatory and intestinal obstruction--in patients older than 60 years. It compares the occurrence and treatment results at an identical surgical department 30 and 60 years ago and nowadays. CONCLUSIONS: Number of the treated patients older than 60 years increased four times during the followed period. Opposite to that, death rate of operated patients declined from 37.2% to today's 16.4%--undoubtedly thanks to modern good-quality perioperational treatment.

[Malignant somatostatinoma (brief overview and a case review)]. / Maligní somatostatinom (strucný prehled a kazuistika).

INTRODUCTION: Somatostatinoma is a rare, slowly growing tumor with malignity potential, most commonly located in the pancreas or duodenum. By the time its diagnosis is established, it is usually large and liver metastases are present. Increased concentrations of somatostatin, produced by pancreatic D cells or by intestinal mucosa, inihibit secretion of a number of GIT hormones, endocrine and exocrine pancreatic secretion. The clinical findings include symptoms of diabetes, dyspepsia, diarrhoea, steatorhoea, abdominal pain, hypochlorhydria, anemia. Sometimes, the finding is accidental. A CASE REVIEW: The authors present a case of somatostatinoma, detected accidentaly in a 72-year-old male. The tumor originated from the pancreatic head, partially spreading invasively into surrounding organs (duodenum), invading blood vessels and metastazing into peripancreatic lymphonodes. The tumor was asymptomatic and was detected as an accidental finding on ultrasound and CT abdominal examinations for the patient's urological disorder (vesicolithiasis). Pylorus saving hemipancreatoduodenectomy was performed and, on microscopic and subsequent immunohistochemical examination of the resecate, a well- differentiated endocrine, somatostatin- producing pancreatic carcinoma was verified.

[Idiopatic bowel disease]. / Idiopatické strevní zánety--profil chirurgicky resených nemocných.

On the basis of retrospective five years analysis the authors process the problematic of idiopatic bowel disease--Morbus Crohn and ulcerative colitis. They pay main attention to surgical issue--types of operations, differences between acute and elective surgery, perioperative problems and results.

[Reconstruction procedures following pelvic exenterations]. / Rekonstrukcní výkony po exenteraci pánve.

OBJECTIVE: Review of reconstruction procedures following pelvic exenterations. DESIGN: Review article. SETTING: Department of Obstetrics and Gynecology, Department of Urology, 1st Department of Surgery, Faculty Teaching Hospital and 1st Medical Faculty of the Charles University, Prague. METHODS: Review and critical assessment of published data. CONCLUSIONS: Reconstruction procedures are important part of pelvic exenterations. The procedures are crucial for following quality of life. Currently the most frequently used techniques for isolated pelvic floor support are omental flaps (carpets), for combined reconstruction of pelvic floor and vagina TRAM (transverse rectus abdominis musculocutaneus flap). Reconstructions prolong operation time; however they are accompanied with low morbidity and some techniques decrease total morbidity of exenterative procedure. Total and posterior exenterations require sigmoideostomy in vast majority of cases. Low rectal anastomosis might be used in cases of supralevator procedures. They cause high morbidity especially in patients following radiotherapy. In these patients temporary diverting colostomy is being recommended. A bowel segment is usually used for urinary diversion following total or anterior exenteration. Golden standard remain the incontinent ureteroenterostomies using ileum or colon transversum. Currently continent diversions are considered more often due to encouraging results and good quality of life. Heterotopic diversions, with continent conduit and cutaneous stoma, are frequently used. Risk of serious complications, especially fistulas and stoma stenosis, after all types of diversions is possible to reduce by using appropriate bowel segment not handicapped by previous radiotherapy.

GIST of pancreas.

Authors present the case (from the year 2003) of a 38 years old patient, female with large tumor in the abdominal cavity. Preoperative differential diagnostic examination showed either tumor of pancreas or left liver lobe. The surgery confirmed large tumor body of the pancreas. Histological and immunohistochemical examination determined gastrointestinal stromal tumor (GIST) of the pancreas from autonomous nerves with malignant character. Tumor was radically removed. In the postoperative period regular follow up was done at the department of oncology, abdominal ultrasound every 3 months, CT scan every 6 month. 2.5 years after operation the patient has no problems, CT scan is without signs of recurrent diseases. The analysis of GIST was performed in agreement with contemporary knowledge. According to the references, our case report GIST of pancreas is the first of this kind (till 2003).

[Prevention, diagnosis and treatment of iatrogennic lesions of biliary tract during laparoscopic cholecystectomy. Management of papila injury after invasive endoscopy. Part 1. Prevention and diagnosis of bile duct injuries]. / Prevence, diagnostika a chirurgická lécba poranení zlucovodu behem laparoskopické cholecystektomie. Lécení poranení papily v dusledku invazivní endoskopie. Cást 1.--Prevence a diagnostika poranení zlucovodu.

INTRODUCTION: Endoscopic invasive procedures in 70th and 80th years leaded to decrease reoperations on biliary tree. Iatrogenic injury of the biliary tract have increased in incidence in the first decade with the introduction of laparoscopic cholecystectomy. Athough a number of factors have been identified with a high risk of injury ( and number of technical steps have been emphasized to avoid these injury, the incidence of the bile duct injury has reached at least double the rate observed with open cholecystectomy. Cholecystectomy is most frequently performed abdominal operation and the most serious complication associated with this procedure is accidental injury to the common bile duct (0.3-0.4%). This preventable technical error has tradicionally been thought to occur in one or more of three situations: 1. When the operator attempts to clip or ligate a bleeding cystic artery and also clips the common hepatic duct (Fig. 3a). 2. When too much traction has been exerted on the gallbladder so that the common bile duct has tented up into an albow, which was either tied off with ligature or clipped (Fig. 3b). 3. When anatomic anomalies were not recognized and the wrong structure is divided, for example, when the cystic duct winds anterior to the common bile duct and enters on the left side, or when the cystic duct joins the right hepatic duct rather than the junction of the common hepatic and the common bile ducts (Fig. 1, 2, 3cd). In anatomical incertain cases is discussed about cholangiography and cholecystocholangiography during laparoscopy cholecystectomy. Most patients sustained a bile duct injury are recognized in the weeks folloving laparoscopic cholecystectomy. Careful preoperative preparation should include control of sepsis by draining any bile collections or fistulas and komplete cholangiography. Long-term results are best achieved in specialized hepatobiliary centres performing biliary reconstruction with a Roux-Y hepaticojejunostomy. Success rates over 90% have been reported from several centres to date with intermediate follow-up. Papila injury increased with introduction of a invasive endoscopy. Risk of deadly retroperitoneal inflamation is very high. Injury require same surgery procedure as duodenum injury. OWN EXPERIENCES: In an article a review of experiences of the 1st surgery department of General hospital in Prague since 1971 in 1 017 reoperations on biliary tree was carried out. There was in 311 patients 164 hepatohepatostomies and 147 hepaticojejunostomies used (Tab. 1). By laparoscopic injuries were high hilar injuries (Bismuth IV) in last decade and hepaticojejunostomy was done in all cases. Died 6%, long term results are acceptable by injured patients with hepaticohepaticostomies in 70%, by hepaticojejunostomies in 90%. Reoperated were 10% patients (Tab. 1). Remnant patients were dilated endoscopicaly. Postoperatively morbidity was high, above 26%. In years 1995-2003 were 8 patients with papila injury and inflamation in retroperitoneum operated as a injured duodenum (Tab. 2). CONCLUSIONS: Better experiences with treatment of injured biliary tree and papila are in centres interested in hepatobilliary surgery which knowledge anatomy of hilus of liver and can make wide hepaticojejunostomy. Transfer of drained injured patient to centre is possible.

[Prevention, diagnosis and surgical treatment of injuries of the biliary tract during laparoscopic cholecystectomy. Treatment of papilla injuries caused by invasive endoscopy. Part 2. Surgical treatment of biliary tract injuries]. / Prevence, diagnostika a chirurgická lécba poranení zlucovodu behem laparoskopické cholecystektomie. Lécení poranení papily v dusledku invazivní endoskopie. Cast 2.--Chirurgická lécba poranení zlucovodu.

INTRODUCTION: Introduction of endoscopic invasive procedures in the 70th and 80th years leaded to decrease reoperations on biliary tree. latrogenic injury of the biliary tract have increased in incidence in the first decade with the introduction of laparoscopic cholecystectomy. Athough a number of factors have been identified with a high risk of injury (and number of technical steps have been emphasized to avoid these injury, the incidence of the bile duct injury has reached at least double the rate observed with open cholecystectomy. Most patients that sustained a bile duct injury are recognized in the weeks following laparoscopic cholecystectomy. Careful preoperative preparation should include control of sepsis by draining any bile collections or fistulas and complete cholangiography. Long-term results are best achieved in specialized hepatobiliary centers performing biliary reconstruction with a Roux-Y hepaticojejunostomy. Success rates over 90% have been reported from several centres to date with intermediate follow-up. Introduction of an invasive endoscopy. Very dangerous is injury after endoscopic papilotomy. OWN EXPERIENCES: In an article of a review of experiences of the Ist Department of Surgery of General hospital in Prague since 1971 in 1 017 reoperations on biliary tree has been carried out. There were in 311 patients 164 hepato-hepatostomies and 147 hepaticojejunostomies used (Tab. 1). By laparoscopic injuries in the last decade were hilary injuries (Bismuth IV) and hepaticojejunostomy was done in all cases. Died 6%, long-term results are acceptable by injured patients with hepatico-hepaticostomies in 70%, by hepaticojejunostomies in 90%. Reoperated were 10% patients. Remnant patients were dilated endoscopically. Postoperatively morbidity was high, above 26%. In years 1995-2003 were 8 patients with papila injury and inflammation in retroperitoneum operated as a injured duodenum (Tab. 2). CONCLUSIONS: Better experiences with treatment of injured biliary tree and papila are in centres interested in hepatobiliary surgery which know anatomy of hilus of the liver and can see wide hepaticojejunostomy. Transfer of drained injured patient to centre is possible.

[Exenteration procedures in the pelvis]. / Exenteracní výkony v páinvi.

Exenteration pelvic procedures are surgical options for treatment of locally advanced pelvic tumors. Due to the procedure's success rates, it has become a standard therapeutic procedure, when indicated. From the medical point of view, the following factors characterize the level of seriousness of these procedures: the fact that the procedure is extensive, its complicated reconstruction phase and high postoperative morbidity rates. From the patient's point of view, it is characterized by a principal change in the quality of life. In this case review the authors present their experience with a multidisciplinary approach to these procedures.

The role of laparoscopy in the treatment of morbid obesity.

BACKGROUND: Laparoscopic surgery was established as a regular surgical technique 11 years ago. There are still some controversies among surgeons about the benefits of this method. METHOD: A retrospective 3-year analysis of immediate and long-term complication rates, hospitalization length, and weight loss following laparotomic and laparoscopic nonadjustable gastric banding in 150 and 145 patients, respectively, was undertaken. Some of the criteria usually used for comparison of results in laparotomy and laparoscopy in general surgery were used in this analysis as background for the comparison of the two groups of obese patients. One example of the different results of the laparotomic and laparoscopic approaches in bariatric surgery was provided by obese monozygotic twins who underwent surgery the same day in our department, one by laparotomy and the other by laparoscopy. There was a significant difference in hospitalization length, in required postoperative analgesia, and in levels of c-reactive protein. RESULTS: There was no statistical difference in intraoperative complication rates in the two groups, but there was a significant difference in immediate and long-term postoperative complications of wound discharge and incisional hernias. The obese twins illustrate the significant difference in postoperative c-reactive protein levels and in length of operating time and hospitalization in favor of laparoscopy, and this difference supports our results in much larger groups of genetically unrelated patients who were studied. CONCLUSION: At the end of the 10-year period of laparoscopic surgery for bariatric procedures, the results were impressive. The laparoscopic approach to surgery for morbid obesity was of considerable value in terms of low morbidity and mortality.

Some complications after laparoscopic nonadjustable gastric banding.

BACKGROUND: Bariatric surgery is the only currently available, effective, long-term method for controlling morbid obesity. Gastric banding as one of the possible surgical treatments was repeatedly described during the last 10 years. It is a reversible surgical procedure which is primarily performed laparoscopically. METHODS: From 1993 to 1998 at the 1st Surgical Department Faculty General Hospital Charles University in Prague we performed nonadjustable gastric banding laparoscopically in 487 patients with morbid obesity (body mass index [BMI] 34 to 49 kg/m2). There were 429 females and 58 males in this group. RESULTS: In 487 patients who underwent laparoscopic nonadjustable gastric banding (LNGB): early postoperative complications occurred in 29 cases (5.9%)-swelling of the gastric mucosa at the site of the nonadjustable band. In three cases (0.6%)--gastric perforations, and in two patients (0.4%)--bleeding from gastric ulceration at the site of the band. Swelling was treated conservatively with a nasogastric tube and antisecretory and antiedematic drugs. Bleeding was treated by gastrofibroscopy and gastric perforation by open suture of the lesion. Late complications after LNGB occurred in eight patients (1.7%)--gastritis or esophagitis (but at the site of the band in only two patients [0.4%]), and in 13 patients (2.7%)--small upper pouch dilatation. In 24 cases (4.9%), we discovered slippage of the anterior stomach wall above the band. In three patients (0.6%), the band migrated through the gastric wall in 6-12 months following surgery. In the majority of cases, treatment of these complications was conservative. In eight patients we removed the band by laparoscopy, and in three patients we removed the migrating band from the stomach by open gastrotomy. Other complications have been treated conservatively by correcting the diet, prokinetic drugs, and antisecretory treatment. CONCLUSIONS: According to our long-term results, LNGB by experienced bariatric and laparoscopic surgeons is a viable method with low morbidity. In our 487 patients, there were major complications (necessitating reoperation) in 3.2% and minor complications (treated conservatively) in 10.4%.

Bariatric surgery in some "Central and East-European (former Eastern bloc)" countries- current status and prediction for the next millennium.

BACKGROUND: Obesity is increasing globally, including in the formerly "Eastern Bloc" countries. METHODS: A survey was made of obesity and bariatric surgery. RESULTS: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. CONCLUSION: Most countries were found to provide inadequate treatment for obesity. The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.

History and technical aspects of bariatric surgery in the Czech Republic.

BACKGROUND: Central Europe and the Czech Republic are specific in the prevalence of obesity which has increased by 10-40% during the last 10 years. METHODS: In the Czech republic there is 30 years of experience of a comprehensive approach to obesity treatment which includes: dietary treatment; exercise; behavioral modification; drug treatment; and bariatric surgery. Each of these approaches has its place in complex obesity management. Since 1983 bariatric surgery has been established in the Czech Republic for the treatment of morbid obesity. Vertical banded gastroplasty (VBG), gastric banding, laparoscopic nonadjustable and adjustable gastric bandings have been used over the years. Since 1993 laparoscopic gastric banding has been the only method used in our department. RESULTS: The comprehensive approach for obesity treatment in the Czech Republic has resulted in the development of obesity management and research centers, regional obesity units, obesity out-patients clinics and weight reduction clubs. The surgical treatment is a well-established part of this system and the long-term results of surgical treatment are acceptable both in terms of weight loss and complication rate. There has been no statistical difference in weight loss results following VBG and laparoscopic gastric banding, but there is a significant decrease in morbidity, and shorter hospital stay associated with laparoscopic gastric banding. CONCLUSIONS: The surgical approach in obesity treatment has an important place in the comprehensive care of obese patients. Laparoscopic gastric banding in the hands of an experienced surgeon is a method with low morbidity, short hospital stay and long-term weight loss results which are fully comparable with the results of other surgical approaches.

Bariatric surgery at the 1st Surgical Department in Prague: history and some technical aspects.

BACKGROUND: Obesity has been increasing in the Czech Republic over the last 20 years. In 1983 we were one of the first surgical departments in the country which performed bariatric surgery on a regular basis. METHODS: From 1983 to 1986 we performed vertical banded gastroplasty (VBG). Because of a high rate of various complications arising both from the stomach and the wound, we switched in 1986 to 'less aggressive' nonadjustable gastric banding (GB). In 1993 we performed the first laparoscopic nonadjustable banding, and in 1994 we started laparoscopic placement of adjustable gastric bands. RESULTS: In the group of 52 patients who underwent VBG and were followed-up, acceptable weight loss results (-40.5 kg) were achieved in the 24 months following surgery. The postoperative complications were high; 17.3% gastric staple-line disruption and 15.3% wound complications (incisional hernias, discharge, etc.). Since 1986, we have performed nonadjustable GB in 150 patients and achieved weight loss of -38.4 kg in the 24 months following surgery. There was no change in the wound complication rate, but the complications arising from the stomach and the band decreased to 6.3%. Since June 1993, we have performed 268 procedures laparoscopically, either with nonadjustable bands or, since 1994, with the adjustable bands. The wound complication rate decreased to 0.9%, and one complication (6.6%) was related with the adjustable band. CONCLUSIONS: Because of the high rate of postoperative complications in our experience with VBG, we started GB in 1986. Since then the number of complications arising from the stomach has decreased substantially. With the laparoscopic technique, there was a further decrease in wound healing problems. With the adjustable GB, a significant decrease in the stomach-related complications occurred. Shorter hospital stays were possible with the laparoscopic technique. Long-term weight loss results have not been significantly different among the above mentioned procedures.

Assessment of the outcome of laparoscopic nonadjustable gastric banding and stoma adjustable gastric banding: surgeon's and patient's view.

BACKGROUND: The results of nonadjustable gastric banding (NAGB) and stoma adjustable gastric banding (SAGB) in the treatment of morbid obesity are compared. Of 300 patients operated laparoscopically with NAGB since 1993 and of 25 with SAGB since 1994, 65 in the NAGB and 11 in the SAGB group were available for a 3-year follow-up study. METHODS: For assessment of the outcome of our laparoscopic approach in terms of weight loss, length of hospitalization, immediate and late postoperative wound complications, postoperative changes in the band and pouch area, were compared in patients from both groups. The patient's opinion on the outcome of the operation and the quality of postoperative digestion was recorded. RESULTS: There was no significant difference in the length of hospital stay and wound complication rate in the two groups or the weight loss at 36 months after surgery. There was a statistically significant lower incidence of postoperative food intolerance and vomiting and a lower rate of immediate and long-term reoperation rate in the SAGB group. CONCLUSION: SAGB is a method with less postoperative complications in food intolerance and vomiting in comparison with NAGB.

Gastric banding in the treatment of morbid obesity.

BACKGROUND/AIMS: Obesity appears to be an epidemic problem now. Thirty percent of men and 40% of women in the fifth decade are obese (> 20% over ideal weight). Extreme obesity in itself decreases life expectancy and is associated with the early development of cardiopulmonary disorders, hypertension, diabetes and many other disorders. The non-operative treatment of extreme obesity rarely leads to permanent weight reduction. Various operative procedures such as vertical banded gastroplasties, malabsorptive operations or gastric bandings have been suggested for the production of permanent weight loss. A relatively high incidence of morbidity following "laparotomy" procedures for obesity treatment prompted us to start laboratory studies in 1991 on laparoscopic gastric banding. MATERIAL AND METHODS: In June 1993 we performed the world's first "laparoscopic" gastric banding in a human and since then, we have operated on more than 60 patients using this method. RESULTS: The 5-year mean post-operative weight loss of -37.4 kilograms, with significant blood pressure decreases at 1-year follow-up and with no significant changes noted in the levels of RBC, electrolytes and transaminase. CONCLUSION: The "laparoscopic" approach in gastric banding enabled us to shorten hospital stay and decrease post-operative complications significantly.

A randomized trial of pefloxacin plus klindamicin and cefoxitin in hepatobiliary and pancreatic surgery.

BACKGROUND/AIMS: The efficacy and safety of pefloxacin plus klindamicin with cefoxitin were studied in patients undergoing hepatobiliary or pancreatic surgery. MATERIALS AND METHODS: Seventy-five patients with biliary tract, hepatic, or pancreatic pathology were randomly allocated in a prospective open study to receive a combination of either i.v or oral pefloxacin (800mg per day) plus klindamicin (2,400mg per day) or an i.v. cefoxitin (4,000mg per day). RESULTS: Twenty patients had to be withdrawn from the trial because of negative baseline culture or because of isolation of bacteria resistant to the study drugs. In the remaining fifty-five patients, the clinical cure rates were excellent in more than ninety five percent and similar for both groups, the bacteriological success rates were 100% in the pefloxacin plus klindamicin group and 89.1% in the cefoxitin group. No patients were withdrawn from the study because of side effects. CONCLUSION: In our study we have shown the excellent results of the antibacterial therapy with pefloxacin and klindamicin of the patients who underwent complicated hepatobiliary and pancreatic surgery.

Pancreatic tumor of mesenchymal origin--an unusual surgical finding.

Recently, a patient with an unusual pancreatic tumor of smooth muscle origin, presented at the First Surgical Clinic, Charles University Hospital, Prague. Leiomyosarcoma, a malignant smooth muscle tumor, may arise almost anywhere in the body. Pancreatic localization is very unusual. A number of authors have surveyed the literature on pancreatic tumors of mesenchymal origin. As many as fifty cases have been reported in autopsy studies since 1882. Only six operated cases of pancreatic sarcomas were found in surgical series.