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Volume 76 - 2013 - Fasc.2 - Case reports

Ultra-late recurrences of gastro-intestinal carcinoma after primary resection : the mechanism of dormancy

Curative resection of limited gastro-intestinal carcinoma does not always mean curation with tumor-free long-term survival. We present two cases of ultra-late recurrence 14 years after initial treatment. In the first case a 50-year-old male underwent in 1997 a subtotal esophagectomy with tubulation of the stomach for a local- ized Barrett carcinoma. Postoperative staging showed a poorly dif- ferentiated adenocarcinoma, pT1N1 (stage IIB). In May 2011, 14 years after the initial resection, multiple bone metastases were di- agnosed and a biopsy confirmed the poorly differentiated carcino- ma with the same characteristics as the primary tumor. Investiga- tions showed no evidence for a new primary tumor. The second case is a 52-year old man who underwent a low ante- rior resection for a small rectal cancer in 1997, histologically a well differentiated adenocarcinoma, stage IB (pT2N0). In December 2011 multiple metastases were diagnosed and a biopsy showed a metastasis from a mucinous carcinoma, suggestive for a colorectal carcinoma. There was also no evidence for a new primary tumor. Although the prognosis of limited esophageal and colorectal cancer is good, recurrence is always possible and an ultra-late recurrence may exceptionally occur. The mechanism of tumor dormancy is described. (Acta gastroenterol. belg., 2013, 76, 251-254).


Colocolonic intussusception secondary to juvenile polyp, case report

Colocolonic intussusception is a rare event because the descend- ing colon lies fixed in the retroperitoneal position. We present a case of colocolonic intussusception in a 17-year-old boy due to multiple juvenile polyps. The patient was treated by left hemi- colectomy. (Acta gastroenterol. belg., 2013, 76, 255-256).


Successful management of inoperable klatskin's tumour by high dose intra luminal brachytherapy without the need for post radiation stenting

We present a case of Klatskin's tumour managed by high dose Intra Luminal Brachytherapy without the need for post radiation stenting. We achieved significant reduction in the cost of treatment and avoided complications associated with stenting. We were able to attain a symptom and disease free survival period of 30 months till the patient finally succumbed to metastatic peritoneal disease. We assume that small Klatskin's tumours as in the presented case with a size less than 3 cms when subjected to high dose Intra Luminal Brachytherapy with the help of 3D computed planning ensuring good tumour coverage may not require post radiation as- sisted biliary drainage. (Acta gastroenterol. belg., 2013, 76, 257-259).