Hakim Elkaoui

Is there any advantage to combined trastuzumab and chemotherapy in perioperative setting her 2neu positive localized gastric adenocarcinoma

We report here a 44-year-old Moroccan man with resectable gastric adenocarcinoma with overexpression of human epidermal growth factor receptor 2 (HER2) by immunohistochemistry who was treated with trastuzumab in combination with chemotherapy in perioperative setting. He received 3 cycles of neoadjuvant chemotherapy consisting of trastuzumab, oxaliplatin, and capecitabine. Afterwards, he received total gastrectomy with extended D2 lymphadenectomy without spleno-pancreatectomy. A pathologic complete response was obtained with a combination of trastuzumab and oxaliplatin and capecitabine. He received 3 more cycles of trastuzumab containing regimen postoperatively.We conclude that resectable gastric carcinoma with overexpression of the c-erbB-2 protein should ideally be managed with perioperative combination of trastuzumab with chemotherapy. Further research to evaluate trastuzumab in combination with chemotherapy regimens in the perioperative and adjuvant setting is urgently needed.

Medial Pancreatectomy for a Neuroendocrine Tumor Invading the Splenic Artery and Vein

CONTEXT Pancreatic tumors in the midportion have traditionally been treated by an extended right or left pancreatectomy. A medial or central pancreatectomy is an alternative technique for benign or low-grade malignant neoplasms located to the left of the gastroduodenal artery and close to the splenomesenteric confluence. CASE REPORT A 38-year-old woman with no previous surgical history presented with epigastric abdominal pain. A computed tomography scan showed a 4 cm heterogeneous lesion within the pancreatic body. This tumor invaded the splenic artery and vein. There was no postoperative diabetes mellitus or exocrine insufficiency. The patient continues to be well after a 10-month follow-up without pancreatic insufficiency or local recurrence, and CT has demonstrated splenic perfusion by the collateral vessels. CONCLUSION We believe that a medial or central pancreatectomy may be a safe procedure where there is involvement of the large splenic vessels by a low grade malignant pancreatic tumor and that a systematic splenectomy is not justified.

Anévrysme du tronc cœliaque: À propos d’un cas

Resume Les anevrysmes du tronc cœliaque sont rares, leur principale complication est representee par la rupture. Un traitement chirurgical est classiquement propose chaque fois que possible. Nous presentons un cas d’anevrysme du tronc cœliaque traite chirurgicalement. (J Mal Vasc 2006 ; 31 : 284-286).

A new case of solitary true pancreatic cyst

A true cyst of the pancreas is extremely rare, and few cases have been reported in adult patients. The authors report a new case of this rare pathological entity. A 35-year-old male patient was admitted to our unit with a cystic mass, about 6cm in diameter, located in the pancreatic head, in proximity to the duodenum, vena cava, biliary tree and right kidney. Clinical features and imagery were suggestive for a benign neoplasm, as did surgical findings. Cystoduodenostomy was done. Histological finding revealed a cyst lined by cuboidal epithelium without morphologic alterations. Analysis of the cyst fluid showed a high level of CA 19-9 (10,000Uml(-1)). After 1-year follow-up, the patient was found to be doing well without any abdominal symptoms. Ultrasound images revealed no cyst recurrence.

Small bowel schwannoma revealed during an inguinal hernia: a case report

IntroductionThe association of bowel tumor and inguinal hernia is rare. We report according to our research the first case of the migration of a small bowel schwannoma into an inguinal hernia.Case presentationWe report the case of a 51-year-old Moroccan malen admitted for a non-reducible right inguinal hernia in which surgical exploration showed the presence of a small bowel tumor that had migrated into his hernia sac. A histopathological examination of the tumor was in favor of a small bowel schwannoma.ConclusionSmall bowel schwannoma is an exceptional clinical entity for which the diagnosis is difficult; its confirmation needs histological and immunohistochemical studies.

Pancreatic-pleural fistula in chronic pancreatitis.

Pancreatic-pleural fistula is a rare condition and few data related to its diagnosis and treatment are available. A fistulous connection linking the pancreas with the pleura via the diaphragm or mediastinum through the retroperitoneal area is formed. We report on a case with pancreatic-pleural fistula at its early stages in an alcoholic male patient aged 45 years with known chronic pancreatitis. The operation by Roux-en-Y jejuno-pseudocystostomy was followed by chest tube drainage.

Isolated Neurofibroma of the Sigmoid Colon: a Case Report and Review of the Literature

Neurofibromas are typically benign neoplasms consisting of neural and connective tissue components. These tumors are constantly seen in neurofibromatosis type 1 (NF1, Von Recklinghausen’s disease) andmultiple endocrine neoplasia type 2b (MEN 2b), and have been reported to undergo malignant transformation, with a higher risk when associated with neurofibromatosis. Their occurrence outside the settings of other clinical features of NF1 and MEN 2b is very rare [1], and we ignore if these lesions represent different phenotypic manifestations of NF1 and MEN 2b or whether they represent separate entities.

Pancreatic Cystic Mass

A 61-year-old man was hospitalized due to a palpable mass and abdominal pain with weight loss of more than 6 kg over the previous 6 months. On admission, vital signs were unremarkable and upon physical examination, he slightly felt a painful intumescence in the epigastria. The results of initial laboratory data showed a leukocytosis (WBC=11,500/mm ~) and an elevated blood sedimentation rate (BSR = 85). Hydatidosis serology was negative, while serum CEA, α-FP and CA 19-9 levels were within normal limits. Serum amylase and lipase were normal. Ultrasound imaging showed the tumour to be located under the liver; it was sharply delimited, with a 16-cm diameter and mixed texture. CT scan revealed a cystic mass of the head of the pancreas; this lesion was heterogeneous and appeared septated on the arterial phase. No secondaries or enlarged intra-abdominal lymph nodes were seen (Fig. 1). Investigative laparotomywas eventually performed and the tumour was localized on the head of pancreas, it was adjoining but not infiltrating the mesenteric vein and artery. The tumour was excised with the part of the pancreas to which it was attached (Fig. 2). The patient tolerated the procedure well. At 1-year follow-up, there has been no recurrence. Histological study revealed a cystic pancreatic endocrine neoplasm. Pancreatic endocrine tumours (PET) are rare neoplasms of the pancreas accounting for less than 5 % of all primary pancreatic malignancies [1]; the fraction of PETwith cystification was thought to be limited to less than 2 % [2]. The cystic types usually present at a relatively young age (mean 41.37 years) with a slight female preponderance (9 of 16) [3]. Nonfunctioning PET are pancreatic tumours with endocrine differentiation and hormonally Bsilent^; they may produce a precursor hormone that is functionally inert [1]. They are slow growing and occur most commonly in the head of the pancreas. This lesion usually present with symptoms related to pressure or infiltration of adjacent organs, such as obstructive jaundice, abdominal pain, weight loss or the appearance of an abdominal mass; sometimes, they can present with advanced metastatic and relatively few symptoms. In our case, a palpable mass and abdominal pain with weight loss were the principal symptoms [4]. Transabdominal ultrasound is a cheap and widely available imaging modality. It has sensitivity in detecting PETs ranging from 9 to 64 %. Multi-detector computerized tomography is the investigation of choice and is in fact the initial test performed due to its widespread availability; features that aid in the differentiation of nonfunctioning endocrine tumour from

Léiomyosarcome de l'estomac : quelle prise en charge ?

RésuméLe léiomyosarcome primaire de l’estomac est rare, il représente 1 % des tumeurs gastriques malignes. La symptomatologie reste pauvre, l’échoendoscopie avec biopsie est l’outil le plus performant pour faire le diagnostic. La résection chirurgicale complète est le traitement de choix pour léiomyosarcomes gastriques. Nous rapportons un cas rare de léiomyosarcome géant de l’estomac, chez une patiente de 40 ans sans symptomatologie spécifique, et dont le diagnostic a été posé après une laparotomie exploratrice. La patiente a été traitée par gastrectomie partielle élargie à la rate.AbstractPrimary leiomyosarcoma of the stomach is rare, representing 1% of all malignant gastric tumours. Little is known about its symptomatology, and ultrasound endoscopy with a biopsy is the most effective way of making a diagnosis. Full surgical resection is the most common treatment for gastric leiomyosarcoma.We are reporting on a rare case of a massive leiomyosarcoma of the stomach, in a patient aged 40 years with no specific symptomatology, and in whom the diagnosis was made following an exploratory laparotomy. The patient was treated with a partial gastrectomy, extended to the spleen.