Comments on: Metastasis dependancy on the primary tumor? http://forsurgeons.net/general-surgery/metastasis-dependancy-on-the-primary-tumor surgery blog for surgeons Fri, 21 May 2010 11:06:22 -0700 http://wordpress.org/?v=2.8.1 hourly 1 By: bouazza http://forsurgeons.net/general-surgery/metastasis-dependancy-on-the-primary-tumor/comment-page-1#comment-36 bouazza Tue, 10 Nov 2009 19:42:20 +0000 http://forsurgeons.net/general-surgery/metastasis-dependancy-on-the-primary-tumor#comment-36 In Africa the surgeons put Silvadene inside a deep wound of a diabetic foot to help it heel better. Does this make any sense? Thanks ! In Africa the surgeons put Silvadene inside a deep wound of a diabetic foot to help it heel better.
Does this make any sense?
Thanks !

]]> By: bouazza http://forsurgeons.net/general-surgery/metastasis-dependancy-on-the-primary-tumor/comment-page-1#comment-35 bouazza Tue, 10 Nov 2009 19:40:14 +0000 http://forsurgeons.net/general-surgery/metastasis-dependancy-on-the-primary-tumor#comment-35 Do you guys evacuate a hematoma that collects into a subcutaneous chemotherapy reservoir area ? Do you guys evacuate a hematoma that collects into a subcutaneous chemotherapy reservoir area ?

]]> By: Ivo Mitsiev http://forsurgeons.net/general-surgery/metastasis-dependancy-on-the-primary-tumor/comment-page-1#comment-11 Ivo Mitsiev Sun, 21 Dec 2008 18:43:30 +0000 http://forsurgeons.net/general-surgery/metastasis-dependancy-on-the-primary-tumor#comment-11 Thank you for the valuable comment, Rahul! :) To your questions: 1. The liver lesion was solid and good palpable at the time of the laparotomy. We didn't do a biopsy of the liver lesion because of the resection we did with plenty of material for histology. 2. The main problem with this patient was that the tumors were seen in the imaging but nothing could be gained by multiple biopsies. This was the reason for making the decision to remove the duodenal tumor and to see first what is the histological finding before doing a liver resection. The latter could be performed after we diagnosed the GIST. Meanwhile the patient set on Imatinib (Gleevec©) which could have altered the course. We discussed the abscess as a possible diagnosis and I agree that this is likely. A liver abscess did not explain though the whole clinical situation (neither does any of the other ideas). But I think that exactly this is what makes cases like this one interesting. :) Btw. you have a nice blog. I'll add it as a link here. :) Thank you for the valuable comment, Rahul! :)

To your questions:

1. The liver lesion was solid and good palpable at the time of the laparotomy. We didn’t do a biopsy of the liver lesion because of the resection we did with plenty of material for histology.

2. The main problem with this patient was that the tumors were seen in the imaging but nothing could be gained by multiple biopsies. This was the reason for making the decision to remove the duodenal tumor and to see first what is the histological finding before doing a liver resection. The latter could be performed after we diagnosed the GIST. Meanwhile the patient set on Imatinib (Gleevec©) which could have altered the course.

We discussed the abscess as a possible diagnosis and I agree that this is likely. A liver abscess did not explain though the whole clinical situation (neither does any of the other ideas). But I think that exactly this is what makes cases like this one interesting. :)

Btw. you have a nice blog. I’ll add it as a link here. :)

]]> By: rahul http://forsurgeons.net/general-surgery/metastasis-dependancy-on-the-primary-tumor/comment-page-1#comment-10 rahul Tue, 09 Dec 2008 19:07:31 +0000 http://forsurgeons.net/general-surgery/metastasis-dependancy-on-the-primary-tumor#comment-10 Indeed this is a very interesting case. GIST of the 3rd part of duodenum itself is very rare. To top it, the lesion in liver was very nicely documented. You mentioned about exploratory laparotomy in july 2008 in which right lobe of the liver was not touched. I have a few questions regarding that... 1. What was the lesion like at that time, was it cystic, solid or mixed. 2. If a dignosis of tumor in the duodenum with liver metastasis was made, why an extensive procedure like whipple's was undertaken and not a simple gastrojejunostomy. To me that lesion in liver looks more like an abscess. It is unlikely for mass (tumor) to regress so fast over a period of 4-5 months Indeed this is a very interesting case. GIST of the 3rd part of duodenum itself is very rare. To top it, the lesion in liver was very nicely documented. You mentioned about exploratory laparotomy in july 2008 in which right lobe of the liver was not touched. I have a few questions regarding that…
1. What was the lesion like at that time, was it cystic, solid or mixed.
2. If a dignosis of tumor in the duodenum with liver metastasis was made, why an extensive procedure like whipple’s was undertaken and not a simple gastrojejunostomy.

To me that lesion in liver looks more like an abscess. It is unlikely for mass (tumor) to regress so fast over a period of 4-5 months

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