Segmental branching pattern of the left portal vein: Anatomical characteristics and clinical implications.

The existing knowledge on anatomy of segmental branches of left portal vein (LPV) is limited. This study aims to describe the surgical anatomy and variations of LPV and its segmental branching pattern. Forty fresh cadaveric liver dissections were performed. The dissection of LPV was carried out from its emergence at the level of the portal vein bifurcation to its segmental branches penetrating the left hemiliver. LPV characteristics, the number, and situation of its segmental branches were recorded. LPV comprises two portions: a 28 ± 6.7 mm-long transverse portion (TPLPV) and a 34.9 ± 4.4 mm-long umbilical portion (UPLPV). Mean number of LPV branches to segments I, II, III, and IV was 2 ± 1 (1-6), 2 ± 1 (1-4), 2 ± 1 (1-5), and 8 ± 2 (4-14), respectively. A single large vein supplied segment II in 90% of the cases. Segment III constantly had one vein arising from the left horn of UPLPV with mean diameter of 5.9 ± 1.6 mm. Most of the veins to segment IV took origin from the right horn of UPLPV with a mean number of 5 ± 2 (2-8). Segmental veins arising from UPLPV and TPLPV and supplying segment IV were present in 90 and 45% of the cases respectively. Segmental veins arising from LPV are often multiple and variable in position. Detailed knowledge of these veins is mandatory in order successfully perform anatomical liver resections or monosegment graft harvest for pediatric liver transplantation. Clin. Anat. 31: 1122-1128, 2017. © 2017 Wiley Periodicals, Inc.

[Primary peritoneal yolk sac tumour. A case report]. / Tumeur vitelline péritonéale primitive. À propos d'une observation.

Yolk sac tumours are rare germinal neoplasms that often arise in ovary and testis. Extragonadal localisations such as mediastinum, retroperitoneum, brain and vagina are uncommon. Primary intraperitoneal tumours are exceedingly rare. We report a case of a 16-year-old girl who underwent laparotomy for an acute abdominal pain and circulatory dysfunction. Abdominal exploration disclosed a large mass involving mesentery of the transverse colon associated to three hepatic nodules and abundant peritoneal bleeding. Segmental hepatic resection was performed and the mesenteric mass was removed. Microscopic examination of the pathologic specimen concluded to a yolk sac tumour. Patient underwent intensive chemotherapy; she's free of disease 2 years after diagnosis. Through this case, clinicopathologic features of this rare neoplasm will be discussed.

[Non Hodgkin's lymphoma and chronic hepatitis C virus infection: a non-fortuitous association. Two case reports]. / Lymphomes non Hodgkiniens de type B et infection chronique par le virus de l'hepatite C: une association non fortuite.

Many authors suggest the role of hepatitis C virus (HCV) infection in the pathology of B-cell non Hodgkin's lymphomas; this is based on epidemiological, physiopathological and therapeutic arguments. The frequency of the association with hepatitis C virus infection is variable in the different study (1 to 30%). We report two cases of hepatitis C virus infection in association with non Hodgkin's lymphomas. The first case presented a low grad splenic and nodal non-Hodgkin's lymphoma associated with hepatitis C virus infection and complicated by hepato-cellular carcinoma. The second case presented a high grad nodal non-Hodgkin's lymphoma associated with HCV infection. Our cases report confirms the hypothesis of a key role of hepatitis C virus in the pathogenesis of B-cell lymphoproliferative disorders and in particular the non-Hodgkin's lymphoma. Although of several hypothesis concerning the ethiopathogenic mechanisms of this association, new studies will necessary to improve the real mechanism of this association

[Digestive polyposis. Retrospective study of 20 cases]. / Les polyposes digestives. Etude rétrospective d'une série de 20 patients.

BACKGROUND: Three main polyposis syndromes are transmitted as an autosomal dominant disorder: familial adenomatous polyposis (FAP), juvenile polyposis syndrome (JPS) and Peutz-Jeghers syndrome. AIM: Evaluate this management of digestive polyposis. METHODS: Our study included 20 patients which were collected in th departements of pathology surgery and garstroenterology of MT Maarmouri's Hospital, Nabeul city. RESULTS: We reported 15 cases of adenomatous polyposis with 2 family groups. We identified a family group of JPS with 3 members and 2 cases of Peutz-Jeghers syndrome. We found 11 cases of colonic adenocarcinoma out of the 15 patients affected by adenomatous polyposes. FAP is a generalized disorder involving the entire colorectum segment with numerous extra-colonic manifestations. The risk to develop colonic cancer is 100%. JPS is characterised by the development of numerous gastrointestinal juvenile polyps and occurs usually before 20 years old, the progression to cancer is rarely observed. CONCLUSION: Peutz-Jeghers syndrome consists in hamartomatous polyps associated to a characteristic mucosal pigmentation. The patients are usually young adults and have an increased incidence of cancer in extradigestive sites.

[Krukenberg tumor: a clinico-pathological study of 5 cases]. / Tumeur de Krukenberg: etude anatomo-clinique de cinq cas.

BACKGROUND: Krunkenberg tumor is defined as the ovarian metastases of a primary digestive tumor composed of a signet ring cells. AIM: Describe the different characteristics of Krukenberg's tumor to improve diagnostic criteria and the therapeutic approche. METHODS: Five cases of Krukenberg tumor are diagnosed in 5 year period between 2002 and 2005. The clinico-pathological feature are reported. RESULTS: The patient age was ranged from 31 to 58 years. Most ovarian tumors were diagnosed synchronously (3 cases). It was a gastric carcinoma in 3 cases and a colonic carcinoma in 2 patients. Histological diagnosis wass easy. We found in 2 cases a metastasis of colonic mucinous adenocarcinoma with signet ring-cell, in 2 other cases it was a gastric adenocarcinoma with exclusively signet ring cell and in the later case it was a gastric moderately differentiated adenocarcinoma with signet ring cell component. Surgical treatment was given in only 3 patients. CONCLUSION: Prognosis is always unfavourable. The only hope for improved prognosis is to search for ovarian metastasis in all cases of digestive tumor.

[Comparative study of appendical mucocela and pseudomyxoma peritonei. About 25 cases]. / Etude comparative des mucoceles simples et des mucoceles compliques de pseudomyxome. A propos de 25 observations.

AIM: to study the clinicopathological features of the different types of appendical mucocele and to compare them with those of pseudomyxoma peritonei. METHODS: 25 cases of appendical mucocele were operated in the Cap-Bon region in Tunisia during a period of 13 years from 1994 to 2006. RESULTS: 9 retentionnal cysts, 13 mucinous cystadenomas, one serrated adenoma, one hyperplasia of the mucosa and one cystadenocarcinoma were diagnosed. Five cystadenomas as well as the only case of cystadenocarcinoma were associated with pseudomyxoma peritonei. Pseudomyxoma peritonei occurred 20 years later than in simple appendiceal mucocèle and complicated 5 cases of cystadenoma with low grade dysplasia and 1 case of cystadenocarcinoma. CONCLUSION: Preoperative diagnosis of appendical mucocele and pseudomyxoma peritonei should be made on scannographic features in order to assess the adequate surgical management.

[Morgagni hernia in elderly patients: a study about two cases]. / La hernie de morgagni chez l'adulte: a propos de 2 cas.

Two cases of retrocostoxiphoid hernia are reported. Both patients were adults. The hernia was strangled in one case and symptomatic in the second case. The diagnosis was confirmed by radiology. Reduction of the visceral hernia and closure of the orifice was carried out after laparotomy. A review of literature and of clinicopathological features are given in the present article. Histogenesis and differential diagnosis are also discussed.

[True aneurysm of the common hepatic artery: a case report]. / Anévrysme vrai de l'artère hépatique commune: a propos d'une observation.

We report a case of hepatic artery aneurysm suggested by the appearance of epigastric mass. The diagnosis was confirmed by doppler sonography and helical CT. Surgical excision of the aneurysm without vascular reconstruction was carried out.

Clinico-Pathological Caracteristics, Therapeutic Features and Post-operative Course of Colorectal Cancer in Elderly Patients.

STATEMENT OF PROBLEM: Colorectal cancer is predominantly a disease of elderly people and is a major cause of morbidity and mortality in the elderly population. The geriatric colorectal population is a very heterogeneous group, including patients with excellent health status and others with comorbid conditions, functional dependency, and limited life expectancy. On the other hand, the effectiveness of surgery for colorectal cancer depends on it being carried out safely, which allows most patients to return to productive lives, with an improved post-operative life expectancy or at least one that is not diminished by the surgery. MATERIALS AND METHODS: This work is a descriptive study of a retrospective cohort, based on administrative databases, of all patients with colorectal cancer diagnosed or treated in our institution. We extracted data on sociodemographic characteristics, comorbidity, type of cancer, stage of cancer, type of treatment received, post-operative complications and cause of post-operative death. We compared differences between an elderly group (Group A) (age >75 years) and a group of patients below 75 years (Group B). RESULTS: We found that elderly patients with colorectal cancer were more likely to be operated in emergent conditions, had more non-specific complications and more post-operative mortality than patients below 75 years. On the other hand, tumours stages, tumours characteristics and post-operative specific morbidity have been proved to be similar, both in Group A and Group B patients. CONCLUSION: These results suggest that surgery is feasible and can be safe for patients above 75 years, but it needs much more evaluation of comorbidities, pre- and post-operative intensive care to avoid post-operative non-specific complications.

Retroportal lamina or mesopancreas? Lessons learned by anatomical and histological study of thirty three cadaveric dissections.

OBJECTIVE AND BACKGROUND: Despite its importance in pancreatic head carcinoma, the retroportal lamina is still under studied, with only two anatomical cadaveric dissections in the English literature, with recent controversies about the concept of a mesopancreas. METHODS: Resection of the mesopancreas was performed in 33 fresh cadavers. The pancreas and mesopancreas were separated from each other and the mesopancreas was immunohistochemically investigated. RESULTS: The retroportal lamina is roughly rectangular in shape. Its dimensions are: height 6.2 cm (5-8), 2.5 cm wide (1.5-4). It contains a right hepatic artery arising from the superior mesenteric artery in 13.3% of cases. Microscopic examination revealed areolar tissue, adipose tissue, peripheral nerve, nerve plexus, lymphatics and capillaries. However, fibrous sheath and fascia were not found around these structures. CONCLUSION: A right hepatic artery arising from the superior mesenteric artery is a frequent anatomic variation. Surgeons must be aware of this to ensure the integrity of the hepatic artery blood supply in patients treated by pancreaticoduodenectomy. Despite controversy about the reality of the mesopancreas (postulated in analogy to the mesorectum), because of the absence of fibrous sheath or fascia, its complete removal in pancreatic head carcinoma is feasible by a subadventitial dissection of the superior mesenteric artery which can be considered as the real limit of the mesopancreas.

Meckel's diverticulum: an exceptional cause of vesicoenteric fistula: case report and literature review.

UNLABELLED: Meckel's diverticulum is the most common congenital malformation of the gastrointestinal tract. It can cause complications in the form of ulceration, hemorrhage, intussusception, intestinal obstruction, perforation and, very rarely, vesicodiverticular fistulae as noted in six previously reported cases. 66-year-old woman was presented with an enterovesical fistula. Exploratory laparotomy revealed a vesico-diverticular fistula resulting from a perforated Meckel's diverticulum. Pathologic examination revealed that the diverticulum did not contain ectopic gastric or pancreatic tissue. The patient underwent a diverticulectomy and had an uneventful postoperative course. Unlike four of the six previously reported cases, our patient had no coexisting bowel or bladder disease occurring with her vesico-diverticular fistula. CONCLUSION: This is only the third reported case of a vesico-diverticular fistula resulting from a perforated Meckel's diverticulum that did not contain ectopic tissue.

Iatrogenic colorectal Kaposi sarcoma complicating a refractory ulcerative colitis in a human immunodeficiency negative-virus patient.

Kaposi sarcoma is a mesenchymal tumor associated to a human herpes virus-8. It often occurs in human immunodeficiency virus-positive subjects. Colorectal localization is rare. We report the case of a colorectal Kaposi sarcoma complicating a refractory ulcerative colitis treated with surgery after the failure of immunomodulator therapy in a human immunodeficiency virus-negative heterosexual man.

Huge desmoid tumor of the anterior abdominal wall mimicking an intraabdominal mass in a postpartum woman: a case report.

Desmoid tumors are benign neoplasms that most often arise from muscle aponeurosis and have been associated with both trauma and pregnancy. The etiology of desmoids has not been determined. We report the case of anterior abdominal wall desmoid tumor in a female patient with previous history of cesarean section. Preoperative ultrasound and computed tomography demonstrated a large mass mimicking a large hematoma or an intraabdominal mass. The tumor was removed by wide excision with safe margins. The abdominal wall defect was reconstructed with polypropylene mesh. Subsequent histology revealed a desmoid tumor. Desmoid tumors in females are often associated with pregnancy or occur post-partum. The reasons behind this association are unclear. The most common sites are in the abdominal muscles.

Solid pseudopapillary neoplasm of the pancreas in an old man: age does not matter.

Solid pseudopapillary tumor (SPN) of the pancreas is a rare tumor, but has favorable prognosis. It is typically observed in young women. Only few cases have been reported in young men. We report the observation of a 73-year-old man presented with a palpable mass in the left upper abdomen. CT scan showed 10 cm mass at the tail of the pancreas. This mass had mixed cystic and solid components. The patient underwent a distal pancreatectomy and splenectomy. SPN of the pancreas was diagnosed based on histopathological features. The patient recovered uneventfully and didn't receive adjuvant therapy. A CT scan performed 16 months postoperatively showed no evidence of disease recurrence. Although SPN of the pancreas is typically observed in young women, the diagnosis should not be discounted in old male patients. Male patients and those with old age, atypical histopathology and incomplete resection may have a higher risk of recurrence and death, deserving particular attention.

Inflammatory myofibroblastic tumor of the lung: a benign lesion with aggressive behavior.

Inflammatory myofibroblastic tumor is a rare solid tumor that most often affects children and young adults. They present as myofibroblastic cell proliferations accompanied by inflammatory cells made up mostly of plasma cells. Although benign, the tumor may be very aggressive locally. In this report we describe a 22-year-old woman with primary invasive myofibroblastic tumor of the left lower lobe leading to a left pneumonectomy.