S. Kyzer

Lymph node-revealing solution

PURPOSE: Detection of metastatic lymph nodes in colon cancer is essential for determining stage and, thus, therapeutic modalities. However, very small lymph nodes can easily be missed during routine examination. The aim of this study is to describe a new and easy technique for detecting tiny nodes in colonic specimens. METHODS: Thirty problematic cases, in which an unsatisfactory number of lymph nodes was found by the traditional method, were investigated. The entire mesocolonic fat was immersed for six hours in a lymph node-revealing solution (LNRS) composed of various traditional fixatives and fatty solvents. After six hours, the lymph nodes stood out as white, chalky nodules on the background of yellow fat. They were then excised, processed, and stained. RESULTS: Total number of lymph nodes found by the traditional method in the 30 cases was 88. After LNRS, 258 additional lymph nodes, measuring from 0.5 to 7 mm in largest diameter, were found. Of the 12 cases in which no lymph nodes were found by the traditional method, 8 became No and 4 became N1. Of the 14 cases first classified as No, 4 became N1; of the 4 classified at first as N1, 2 became N2 after LNRS. Upstaging from Dukes B to C occurred in eight cases. Quality of the sections and histochemical and immunohistochemical stains after LNRS was similar to that of formalin-fixed tissues. CONCLUSIONS: LNRS is an easy, rapid, and inexpensive technique for detecting very small lymph nodes. These may contain metastases, a fact that changes the stage of disease and influences the mode of therapy.

Giant splenomegaly caused by splenic metastases of melanoma

Splenic metastases are rare and usually occur in the setting of widespread visceral metastases. Splenomegaly as manifestation of metastatic spread is extremely rare. A patient with melanoma and metastases to the skin and lung is described. He developed a giant painful splenomegaly. The splenectomy specimen demonstrated that the spleen was occupied by metastases from the melanoma. Metastases of melanoma may cause extreme enlargement of the spleen. If the patients general condition is good, splenectomy is indicated in order to prevent spontaneous rupture of the spleen.

Massively Bleeding Gastric Pouch Ulcer after Silastic Ring Vertical Gastroplasty Successfully Treated Endoscopically: A Report of Two Cases

Two patients who developed massive bleeding from a gastric pouch ulcer are described. This rare complication occurred during the early postoperative course after silicone ring vertical gastroplasty (SRVG). In both cases the bleeding stopped after the ulcers were injected with epinephrine and alcohol. Both ulcers healed after 1 month of treatment with omeprazole (Losec®). The probable etiology of this rare complication is discussed.

Nodular lymphoid hyperplasia of the small bowel associated with two primary colonic adenocarcinomas

Abstract A patient presented with rectal bleeding and weight loss. On barium enema two space-occupying lesions, one in the cecum and the other in the right transverse colon, were demonstrated. He underwent right hemicolectomy. The surgical specimen demostrated diffuse nodular lymphoid hyperplasia (NLH) of the small intestine and two primary carcinomas of the colon, an association that to the best of our knowledge has not been previously described.

Actinomycosis involving the sigmoid colon and mimicking colonic neoplasm

SummaryActinomycosis involving the colon is rare. The aim of the present article is to report an additional case of this rare entity. A young female has been operated upon for suspected presence of sigmoid neoplasm. A mass involving the sigmoid colon, the apex of the urinary bladder, the fundus of the uterus and the left adnexa was found. En-block resection was performed. Histological examination confirmed the diagnosis of actinomycosis. Most of the cases of colonic actinomycosis were diagnosod postoperatively. Whether more accurate preoperative diagnosis should be possible in the future is still an unanswered question.ZusammenfassungEin Aktinomykosebefall des Kolons ist selten. Ziel dieses Beitrags ist der Bericht über einen weiteren Fall dieses seltenen Krankheitsbildes. Eine junge Frau wurde wegen des Verdachts auf ein sigmoidales Neoplasma operiert. Dabei fand sich ein raumfordernder Prozeß, der das Sigmoid, die Spitze der Harnblase, den Uterusfundus sowie die linke Adnexe involvierte. Wir führten eine En-bloc-Resektion durch. Die histologische Untersuchung bestätigte die Diagnose einer Aktinomykose. Die meisten Fälle einer Aktinomykose des Kolons wurden bisher postoperativ diagnostiziert. Ob in Zukunft eine genauere Diagnose präoperativ möglich sein wird, bleibt immer noch eine unbeantwortbare Frage.

Erroneous diagnosis of left ureteric injury leading to insertion of double J catheter to the left spermatic vein.

A case of erroneous diagnosis of left ureteric injury and its results is reported. An 86-year-old man was operated on for perforated diverticulitis. A tubular structure was injured at the left paracolic gutter and repaired over double J catheter. Six months later the proximal side of the catheter was found in the right ventricle, because it has been introduced into the spermatic vein and not into the left ureter.