Inflammatory pseudotumor of the spleen associated with a cavernous hemangioma diagnosed at intra-operative cytology: report of a case and review of literature.

This report presents a case of a 40 year old Caucasian female with a 15 cm inflammatory pseudotumor (IPT) of the spleen with associated areas of splenic hemangioma of the cavernous type. Abdominal CT showed a largely fatty splenic mass with enhancing septations, and scattered calcifications, and a small density in the liver. Grossly, the splenic lesion showed a lobulated cut surface with areas of myxoid change, necrosis, hemorrhage and cystic softening. The diagnosis of IPT was suggested at intraoperative consultation using cytologic smears and was, subsequently confirmed on permanent sections. Histologically, the lesion consisted of a densely collagenized spindle cell stroma with patchy aggregates of lymphocytes and plasma cells, and scattered foci showing hemosiderin-laden macrophages extracellular calcium deposits and osseous metaplasia. The stromal spindle cells were immuoreactive for smooth muscle actin and vimentin confirming their myofibroblastic phenotype. There were extensive areas of infarction within the mass. The patient, however, remained asymptomatic preoperatively. Histologic analysis in this case raises the possibility that low grade, perhaps repetitive, trauma to the hemangioma may have resulted in intralesional hemorrhages which, through a process of organization, may have evolved into this sizable inflammatory pseudotumor. In addition, this report reviews the current literature on the clinical significance and presentation, morphologic and immunohistochemical findings, prognosis, differential diagnosis, pathogenesis and therapy of the splenic IPT.

Liver metastases from soft tissue sarcomas.

Twenty-three patients with liver metastases from soft tissue sarcoma were reviewed. Patients with metastases to the liver first had poorer survival than those who developed spread to other sites first (P = .0035). The median time from diagnosis of the primary tumor to diagnosis of liver metastases was 14 months; the median time from diagnosis of liver metastases to death was 7 months. The median survival from diagnosis for four patients who underwent liver resection was 54 months compared to 20 months for those who did not undergo resection (NS). Soft tissue sarcomas rarely metastasize to the liver; when this occurs it is usually late in the course of the disease and after it has spread to other sites. The opportunity for successful liver resection is infrequent but may prolong survival.

Complications of biliary stents in obstructive pancreatic malignancies. A case report and review.

Biliary stents have become a common palliative measure in the treatment of unresectable obstructive pancreatic cancer. Survival after endoscopic stenting rivals that of surgical bypass. Complications involving stents are not uncommon and can be categorized as related to placement, obstruction, migration, or fracture. A case report and review of stent-related morbidity is presented. Overall complication rates range from 15 to 34%, often requiring stent replacement and occasionally requiring surgical intervention.

Role of open lung biopsy in diagnosing pulmonary complications of AIDS.

Over a 4-year period, 25 patients with pulmonary complications of acquired immunodeficiency syndrome underwent open lung biopsy for diagnosis. Results of the biopsy led to a change in therapy in 15, and of this group, 8 patients improved clinically and were discharged. We believe that a select group of acquired immunodeficiency syndrome patients with pulmonary disease will benefit from open lung biopsy. Our indications for open lung biopsy are (1) a nondiagnostic bronchoscopy, (2) failed medical therapy after a diagnostic bronchoscopy, (3) failed empiric medical therapy after a nondiagnostic bronchoscopy or after a second nondiagnostic bronchoscopy, and (4) when any of the forementioned are accompanied with a worsening chest roentgenogram. Patients with acquired immunodeficiency syndrome who have a deteriorating respiratory status or require mechanical ventilation should not undergo open lung biopsy.

Morbidity and mortality after pelvic exenteration for colorectal adenocarcinoma.

A retrospective analysis was made of the complications from pelvic exenterations performed over the past 30 years for colorectal adenocarcinoma at the Roswell Park Cancer Institute. Seventy-five patients underwent exenteration, 51 for primary disease (PD) and 24 for recurrent disease (RD). Both total and posterior exenterations were included. Twenty of the fifty-one patients (39%) undergoing exenteration for PD developed severe complications, with an operative mortality rate of 6%. The most common complications were injuries to the ureter or bladder, intra-abdominal abscesses, and anastomotic leaks from the urinary diversion. After exenteration for RD, 12 of 24 patients (50%) developed severe complications, with an operative mortality rate of 4%. The most common major complication was an anastomotic leak from the urinary diversion; this occurred in 33% of all patients with RD (8/24). The authors conclude that, although exenteration for colorectal adenocarcinoma may be performed with a low operative mortality rate, patients must be carefully selected because the associated morbidity rate remains high.

Patterns of recurrence after pelvic exenteration for colorectal adenocarcinoma.

We performed a retrospective review of 68 patients who underwent pelvic exenteration for colorectal adenocarcinoma. Forty-seven patients had surgery for primary disease and 21 for recurrence. Clinical recurrence developed in 30 (44%) of 68 patients overall. Of these, 17 (57%) developed locoregional disease only as their first recurrence. This included nine (56%) of 16 patients with primary disease and eight (57%) of 14 patients with recurrent disease. Clinical recurrence developed in 16 (34%) of 47 patients with primary disease and 14 (66%) of 21 patients with recurrent disease. The overall 5-year survival rates were 43% and 20%, respectively. We conclude that locoregional recurrence remains a significant problem for primary or recurrent colorectal carcinoma even after radical pelvic surgery.