Paraganglion, a pitfall in diagnosis after regular cholecystectomy.

INTRODUCTION: Neuroendocrine neoplasm of the gallbladder is an extremely uncommon diagnosis. We present a case of a benign gallbladder paraganglion that was initially incorrectly diagnosed as a neuroendocrine tumour (NET). PRESENTATION OF CASE: A 27-year-old female with symptomatic gallstone disease underwent an uncomplicated laparoscopic cholecystectomy. Routine histopathologic examination suggested the presence of a small adventitial NET. However, histopathological revision was performed by our pathologist because of regional gallbladder carcinoma (GBC) treatment evaluation. The revision demonstrated the presence of a normal paraganglion, a preexistent structure that is only rarely encountered during routine histopathologic examination of the gallbladder. DISCUSSION: Neuroendocrine neoplasms of the gallbladder are extremely rare. Treatment varies from a simple cholecystectomy to extensive surgical resections. Chemotherapy is usually reserved for metastatic disease. In contrast, a gallbladder paraganglion is a benign entity not requiring additional treatment. CONCLUSION: A neuroendocrine neoplasm of the gallbladder may closely resemble a benign paraganglion. If a NET is suspected, the clinician should be aware of the histopathologic mimicry of a paraganglion prior to initiating additional treatments.

[Treatment of thoracic esophageal perforations]. / Tratamiento de las perforaciones del esófago torácico.

OBJECTIVE: To evaluate the results of the treatment of patients with thoracic esophageal perforation in order to determine the most appropriate management of this entity. PATIENTS AND METHOD: We performed a retrospective study of 21 patients (mean age 59 years; 24-82) who presented with thoracic esophageal perforation to our hospital between 1991 and 2004. RESULTS: In 13 patients (62%) treatment was performed within 24 hours. In the remaining 8 patients the mean delay was 7.2 (2-12) days. In 4 patients (26%) the perforation was confined to the mediastinum and conservative treatment was provided. Of these patients, 1 developed empyema and underwent esophageal resection. Extramediastinal involvement was confirmed in 17 patients (73%) and was treated by a variety of surgical procedures: esophagectomy (n=2), drainage alone (n=2), primary closure (n=2) and reinforced primary repair (n=11). Two patients with simple closure and 1 with reinforced primary closure developed leakage of the suture line resulting in death. The 3 patients who underwent esophagectomy survived. In patients with perforation confined to the mediastinum mortality was 0%, whereas in those with extramediastinal involvement mortality was 23%. CONCLUSIONS: Thoracic esophageal perforation leads to high mortality rates and requires early diagnosis and immediate treatment. Conservative management is appropriate in only a few selected patients. When surgical treatment is indicated, we advocate reinforced primary repair regardless of the interval between injury and operation, except when the esophagus is in such poor condition that esophagectomy is the only option.