Tivadar Ifj. Bara

Esophageal carcinoma is an aggressive cancer with a poor therapeutic response and a significant risk of recurrence after radical resection. It usually metastasizes to the lung, bones, or liver. Unusual spread can be found in other organs, but only nine cases of pancreatic metastases have been reported in the Medline database. In the present paper, a literature review of nine cases with esophageal squamous cell carcinoma and pancreatic metastasis was carried out. In addition to these cases, we present our case, the tenth case in the literature. It involved a patient who underwent surgery for esophageal squamous cell carcinoma and developed metachronous pancreatic metastasis 67 months after esophagectomy. Histopathological examination confirmed a squamous cell carcinoma metastasis. Conclusions: Pancreatic metastasis of esophageal squamous cell carcinoma is extremely rare. Pancreatic metastasis may develop several years after the treatment of the primary lesion. The diagnosis of metastasis is difficult, requiring histopathological and immunohistochemical examination.

Background: In patients with synchronous colorectal cancer (SCRC), understanding the underlying molecular behavior of such cases is mandatory for designing individualized therapy. The aim of this paper is to highlight the importance of transdisciplinary evaluation of the pre- and post-operative assessment of patients with SCRCs, from imaging to molecular investigations. Methods: Six patients with SCRCs presented with two carcinomas each. In addition to the microsatellite status (MSS), the epithelial mesenchymal transition was checked in each tumor using the biomarkers β-catenin and E-cadherin, same as KRAS and BRAF mutations. Results: In two of the patients, the second tumor was missed at endoscopy, but diagnosed by a subsequent computed-tomography-scan (CT-scan). From the six patients, a total of 11 adenocarcinomas (ADKs) and one squamous cell carcinoma (SCC) were analyzed. All the examined carcinomas were BRAF-wildtype microsatellite stable tumors with an epithelial histological subtype. In two of the six cases, KRAS gene status showed discordance between the two synchronous tumors, with mutations in the index tumors and wildtype status in the companion ones. Conclusions: Preoperative CT-scans can be useful for detection of synchronous tumors which may be missed by colonoscopy. Where synchronous tumors are identified, therapy should be based on the molecular profile of the indexed tumors.

Introduction: Giant abdominal wall defects represent a major challenge for surgeons. CT scan can determine the ratio between the volume of the hernia sac and the abdominal cavity, determining the extent of the disproportion, which is related to the postoperative abdominal pressure value. Aim: Confirmation of the significance of CT examination in postoperative giant abdominal wall defects, effectiveness analysis of the reconstruction method by abdominal pressure measurement. Method: A prospective study is conducted on patients with giant incisional hernias, with preoperatively performed abdominal CT scan. Tension-free abdominal wall reconstruction is realized with retromuscular Prolene mesh and hernial sac. Abdominal pressure is measured during and after surgery. Patients' follow-up is performed through phone after 2-4-6 months. Results: We present our results through three cases. First case: 48-year-old woman presented a giant recurrent incisional hernia and multiple comorbidities. Maximum defect diameter was: 155 mm, hernia volume: 1536.63 cm(3), BMI = 43.6. The patient was discharged after seven days. Second case: 51-year-old male patient presented with multilocular giant incisional hernia, BMI = 26,85. Maximum diameter of the two wall defects were 123 mm and 105 mm, their total volume: 406.41cm(3). The patient was discharged after five days. Third case: A 67-year-old male patient presented with giant incisional hernia. The abdominal defect size was 100/100 mm (LL/CC), volume: 258.10 cm(3), BMI = 23.7. The patient was discharged after four days. Conclusion: The proper surgical technique can be established based on the preoperative CT scan. Abdominal wall reconstruction with retromuscular Prolene mesh and hernial sac provides a cheap, reliable, tension-free technique. The technique's short-term efficacy can be determined by abdominal pressure measuring through the bladder.

Background: Finding the appropriate treatment for advanced rectal cancer patients represents a challenge for surgeons. Determining the right diagnosis and the proper treatment requires multidisciplinary collaboration. Our aim is to present a case with advanced stage rectum cancer, who received successful multidisciplinary treatment. Material and method: A prospective multidisciplinary research is being conducted at our Department from 2018 within which patients with malignant rectal cancer are examined. Patients’ treatment is realized by the same multidisciplinary team. The patient’s preoperative investigations included MRI and a lymph node map designated by radiologists. Results: In case of a 60-year-old patient the preoperative MRI showed a stenotic formation in the middle level of the rectum that penetrated the seminal vesicle. During surgery, we found a 10x10 cm stenotic, perforated rectal cancer, which penetrated the bladder, seminal vesicle, prostate and sacrum, respectively a metastatic lesion in the livers 8th segment. During surgery R2 recto-sigmoid resection was performed with colostomy. The patient was mobilized on the first postoperative day and bowel movements were regained on the second day. The patient left the hospital on the eighth postoperative day. Conclusions: Adequate treatment of patients with advanced rectal cancer can be achieved only through multidisciplinary co-operation. Preoperative radiological examinations are mandatory. A map representing the positive colorectal lymph nodes, implemented by the radiologists, can significantly help the surgeons and pathologists.

Gastro-intestinal stromal tumours develop in the digestive tract wall, in the undifferentiated mesenchymal cells with a starting point at the level of the interstitial cells of Cajal. Gastro-intestinal stromal tumours often lead to peritoneal and hepatic metastasis. Assessment of aggressive behavior of GIST is difficult. A special attention should be paid to localization, serosal invasion, mucous ulceration, size of the tumor and mitotic index, in order to set the prognosis of the patient. We here by present two cases of gastro-intestinal stromal tumours one with gastric location and one jejunal tumor with ulceration and hemorrhage, of small sizes, initially diagnosed as benign but developing in the late evolution liver metastases. Right lobectomy was performed in both cases, in one case being associated with segment II resection. The patients have been followed-up at oncology and they received Imatinib, and when the metastasis reappeared was reintroduced, increasing the dose.

Absztrakt: A laparotomiák egyik késői szövődménye a posztoperatív hasfali sérv. A hegsérvek feszülő varratokkal való rekonstrukciója után gyakran alakul ki recidiva. A szövetbarát műanyag hálók beültetésével, azaz feszülésmentes technikával lényegesen jobb eredmények érhetők el. Klinikánkon 2001 és 2005 között a medián vonalban kialakult, nagy hasfali sérvek rekonstrukcióját 50 esetben retromuscularis pozicióba helyezett műanyag hálóval végeztük. A háló okozta szövődmények megelőzése céljából a hálót a sérvtömlőt képező peritoneum felhasználásával úgy a hasüreg, mint a sub-cutis felé is fedtük. Műtét után egy esetben az a. epigastrica inferior sérülésére visszavezethető haematoma alakult ki. A többi betegünk szövődménymentesen gyógyult. A feszülő varratokkal végzett sérvműtétekkel összehasonlítva lényeges eredménynek tartjuk a posztoperativ fájdalom enyheségét és a betegek korai mobilizálhatóságát. Következtetés: a rectus-hüvelybe helyezett és sérvtömlővel fedett műanyag háló egy alternatíva a nagy, medián hasfali defektusok rekonstrukciójában és a háló okozta szövődmények kivédésében.