[Adrenal metastasis of a papillary thyroid cancer]. / Métastase surrénalienne d'un cancer papillaire de la thyroïde.

Adrenal metastases of the papillary thyroid carcinoma (PTC) are very rare. We report one case. A 63-year-old woman had undergone 15 years earlier left lobo-ishmectomy for a papillary thyroid cancer (PTC) and 7 years earlier right adrenalectomy for a tumor. Histologic examination showed a benign cortical tumor. In 1999, when the patient was admitted for worsening of glycemic control, a recurrence of the adrenal mass was detected. According to the hormone evaluation it was a non-functional tumor. Adrenalectomy was performed in June 2002 because the patient had initially declined surgery. Histologic examination and thyroglobulin immunochemistry identified metastatic PTC. Re-reading the histology slide of the first adrenalectomy agreed with the diagnosis. Thyroidectomy was completed in March 2003. Although iodine-131 therapy and thyroxine treatment were given, bone metastases were detected in August 2004. PTC usually spreads to the cervical and mediastinal lymph nodes. Distant spread may occur to bone or lung, but exceptionally to the adrenal gland. The adrenal localization is often associated with lung or bone metastasis. In our patient, the adrenal metastasis remained isolated for many years. It has been reported that survival rate decreases considerably after appearance of a distant metastasis. Although given delayed radical treatment, our patient remained alive 13 years after.

[Varicocele: endoscopy versus surgery]. / La varicocèle: coelioscopie versus chirurgie.

Varicocele is a frequent and benign pathology, well known since the antiquity, his treatment has progressed by a better acquaintance of physiology and the effects on fertility. In the surgery department of FSI hospital, we compared the results of 2 surgical methods: the Ivanisevich's technique (open surgery) and the laparoscopic approach. The objective was to compare morbidity, recurrence rate, hospital stay, and effects on pains and fertility. From May 1993 to December 1998 we treated 72 patients with symptomatic varicocele: 40 patients by laparoscopy and 32 by open surgery. The recurrence rate was of 32% for surgery and 21% for laparoscopy. But duration of surgical operation was longer for laparoscopy: 50 mn against 30 mn for unilateral cure and 70 mn against 55 mn for bilateral cure. We did not observe a difference between the 2 groups in hospital stay, morbidity, pains and fertility. At the end of the study we propose laparoscopy for bilateral cure and open surgery for unilateral. Decrease of recurrences needs the realisation of a phlebography before surgery, but this investigation weight routinely "take charge" of patients; we reserve it to recurrences. Echography coupled to Doppler is essentially used for preoperative diagnosis of varicocele and for surveillance of postoperative recurrences.

[Hydatic cyst of the psoas muscle. Apropos of 3 cases]. / Le kyste hydatique du muscle psoas. A propos de trois cas.

In the three patients, the localization and the hydatic origin have been determined by preoperative ultrasonography in two instances, the diagnosis was confirmed by CT scan. Ultrasonography and computed tomography allowed a direct and simple surgical approach of the cyst.