Evaluation of margins in pelvic lymph nodes and prostate radiotherapy and the impact of bladder and rectum on prostate position.

PURPOSE: The aims of this study were: determination of the CTV to PTV margins for prostate and pelvic lymph nodes. Investigation of the impact of registration modality (pelvic bones or prostate) on the CTV to PTV margins of pelvic lymph nodes. Investigation of the variations of bladder and rectum over the treatment course. Investigation of the impact of bladder and rectum variations on prostate position. PATIENTS AND METHODS: This study included 15 patients treated for prostate adenocarcinoma. Daily kilo voltage images and weekly CBCT scans were performed to assess prostate displacements and common and external iliac vessels motion. These data was used to calculate the CTV to PTV margins using Van Herk equation in the setting of a daily bone registration. We also compared the CTV to PTV margins of pelvic lymph nodes according to registration method; based on pelvic bone or prostate. We delineated bladder and rectum on all CBCT scans to assess their variations over treatment course at 4 anatomic levels [1.5cm above pubic bone (PB), superior edge, mid- and inferior edge of PB]. RESULTS: Using Van Herk equation, the prostate CTV to PTV margins (bone registration) were 8.03mm, 5.42mm and 8.73mm in AP, ML and SI direction with more than 97% of prostate displacements were less than 5mm. The CTV to PTV margins ranged from 3.12mm to 3.25mm for external iliac vessels and from 3.12mm to 4.18mm for common iliac vessels. Compared to registration based on prostate alignment, bone registration resulted in an important reduction of the CTV to PTV margins up to 54.3% for external iliac vessels and up to 39.6% for common iliac vessels. There was no significant variation of the mean bladder volume over the treatment course. There was a significant variation of the mean rectal volume before and after the third week of treatment. After the third week, the mean rectal volume seemed to be stable. The uni- and multivariate analysis identified the anterior wall of rectum as independent factor acting on prostate motion in AP direction at 2 levels (superior edge of, mid PB). The right rectal wall influenced the prostate motion in ML direction at inferior edge of PB. The bladder volume tends toward significance as factor acting on prostate motion in AP direction. CONCLUSIONS: We recommend CTV to PTV margins of 8mm, 6mm and 9mm in AP, ML and SI directions for prostate. And, we suggest 4mm and 5mm for external and common iliac vessels respectively. We also prefer registration based on bony landmarks to minimize bowel irradiation. More CBCT scans should be performed during the first 3weeks and especially the first week to check rectum volume.

[Hydatid cyst of the kidney in children: a retrospective study of 10 cases]. / Le kyste hydatique du rein chez l'enfant: étude rétrospective de dix cas.

INTRODUCTION: The hydatid cyst disease of the kidney is rare in children, it ranks third among the liver and the lung. MATERIAL: We report a series of 10 pediatric case of hydatid cyst of the kidney, managed in the department of surgery pediatric of Rabat, between 1990 and 2008. RESULTS: The median age was 9 years (4-15 years). The clinical presentation was pain (7 cases) and/or abdominal mass (6 cases). Diagnostic accuracy has been improved since the wide use of ultrasonography in eight cases. In all cases, the resection of the prominent dome was usually sufficient. CONCLUSION: In the light of these 10 observations, the ultrasonography may be sufficient and the surgical conservative treatment is still necessary.

[Splenogonadal fusion: a case report]. / Fusion splénogonadique : à propos d'un cas.

Splenogonadal fusion is a rare congenital abnormality. Preoperative diagnosis is difficult but can be based on scintigraphy using technetium 99m. In most cases, the splenic tissue can be dissected off the gonadal structures easily, and if there are any doubts concerning the nature of the swelling, an intraoperative frozen section can be performed to avoid an unnecessary orchidectomy. We report the case of a 4-year-old child in whom an inguinal mass indicated surgical exploration, which documented the histological diagnosis of splenogonadal fusion.

[Portal vein thrombosis after splenectomy in childhood: report of 4 cases]. / Thrombose portale après splénectomie chez l'enfant: à propos de 4 observations.

Portal vein thrombosis is a major complication of splenectomy. Its frequency is underestimated because of asymptomatic cases. Mesenteric occlusion with intestinal infarcts is the first cause of mortality. Secondarily, in the absence of repermeabilisation, a portal hypertension can occur. We present in this study 4 cases of portal vein thrombosis in childhood. Portal vein thrombosis is frequent (8% of splenectomies) and may be asymptomatic. Doppler postoperative surveillance is justified. Thrombocytosis seems to be a determinant factor. Early diagnosis and treatment may reduce lethal outcome.

[Cystic adenomatoid malformations of the lung: a retrospective study of 12 cases]. / Malformations adénomatoïdes kystiques du poumon : étude rétrospective de 12 observations.

The authors present a retrospective study of 12 cases of cystic adenomatoid lung malformations in clinical surgery unit "A" at the Rabat Children's hospital, between 1999 to 2006. Two pregnancies with lung malformation were identified. All of the patients were symptomatic. The treatment was surgical in all cases (lobectomy: 11 cases; pneumonectomy: one case). The evolution was good after an average of three years. In the light of these 12 malformations, the authors try and demonstrate the value of early diagnosis in order to surgically treat the anomaly in optimum conditions. Moreover, the authors insist on the exeresis not only of the malformation, but of the entire lobe involved in anomaly to guarantee a recurrence-free result.

[Mesenchymal hamartoma of the liver in a child: a case report]. / Hamartome du foie chez l'enfant : à propos d'un nouveau cas.

Mesenchymal hamartoma of the liver is a rare, benign tumor that presents mostly before the age of 2 years. Its pathogenesis is poorly understood. We present the case of a 2.5-year-old female patient who had a large cystic mass of the liver of which the hamartomatous nature was confirmed by the pathological examination of the surgical specimen. We discuss the clinicopathological, imaging, and histological features of this unusual tumor through a review of the literature.

[Peritoneal hydatidosis in children. Report of a historical case]. / L'hydatidose péritonéale chez l'enfant. A propos d'un cas historique.

Peritoneal hydatidosis is a rare localisation of hydatic disease, most often secondary to a hydatic cyst of the liver. Its primitive form is considered due to a haematogenous diffusion through arterial vessels. We report a historical case of peritoneal hydatidosis concomitant to a hepatic localisation, in a 13-year-old girl. Diagnosis was performed by ultrasounds and CT scan, and a strong positive serology. Surgical cure has been completed by pharmacologic treatment with the aim of avoiding a relapse. A brief reminder of the therapeutic management of the disease is provided.

[Pheochromocytoma in children. Two case reports]. / Le phéochromocytome de l'enfant. A propos de deux cas.

Severe sustained hypertension occurs in only 0.1% of the pediatric population and only about 2% of these patients will have an underlying endocrine cause. Pheochromocytoma as a catecholamine secreting tumour causing severe hypertension is exceedingly rare in children. A high index of suspicion and an awareness of the clinical spectrum are therefore necessary to make the diagnosis. We report two cases of pheochromocytoma occurring in two a 12 year-old boys who's presented with sustained hypertension, headache, sweating, and visual blurring. Measurement of 24 hour urinary catecholamines showed a marked increase and localization of adrenal unilateral pheochromocytoma was determined by ultrasonography and computed tomography. The approaches to the adrenal gland were transverse transperitoneal and the excision of the tumors was followed of return to the normal of tensional numbers.

[Laryngeal dyspnea caused by cervical hydatidosis: apropos of a case]. / Dyspnée laryngée révélatrice d'une localisation cervicale d'hydatidose: à propos d'un cas.

Hydatid cysts rarely present as a cervical tumor. We report a case of hydatid cyst of the neck in a child with multiple hydatid cysts in the liver, which was revealed by laryngeal dyspnea. Symptoms occurred in a six year-old country dweller, who presented with progressive laryngeal dyspnea. The chest radiographs showed extrinsic tracheal compression. A cervical ultrasonography showed a liquid filled mass evocative of hydatid cyst type 1. Explorative cervicotomy confirmed the diagnosis. The treatment was conservative after destruction of the parasite using a hypertonic saline solution. The immediate result was the disappearance of the laryngeal dyspnea.