INTRODUCTIONSolid pseudopapillary neoplasm (SPPN) was first characterized by Virginia Frantz in 1959. The duodenum-preserving pancreatic head resection (DPPHR) has been described as treatment for low-grade malignant tumors of the head of the pancreas including eight cases of SPPN.PRESENTATION OF CASE: A 16-year-old white female patient presented with abdominal pain and dyspepsia. Computed tomography scan of abdomen showed a 10 × 9 × 10 cm3 lesion on the pancreatic head. After radiological diagnosis of SPPN the patient was submitted to DPPHR. Resection was achieved with clear margins. Immunohistochemical study demonstrated positivity for progesterone receptor, β-catenin, cytoplasmic paranuclear dot-like CD99, negativity for chromogranin and S100 protein and Ki 67 index of 1%.DISCUSSIONA large encapsulated pancreatic mass with well-defined borders that contains areas of calcifications and intratumoral hemorrhage on CT scan in a young female is virtually diagnostic of an SPPN. A particular dot-like intracytoplasmic expression of CD99 appears to be highly unique for SPPNCONCLUSIONDPPHR should be considered in cases of SPPN in the pancreas head if there is no compromise with oncologic radicality.

TO THE EDITOR:Thymomas and thymic carcinomas are rare, accounting for 20% of all mediastinal tumors. They are usually diagnosed as incidental findings on chest imaging performed for another reason or performed because of the presence of mass effect-related symptoms or paraneoplastic syndrome, such as myasthenia gravis. They have similar incidence in men and women and most commonly occur in the 40-to 60-year age group. There are no risk factors. (1,2) We would like to present the case of a 79-year-old female patient who presented to our facility with a two-month history of weight loss and constipation. She was admitted to the hospital with signs of intestinal obstruction, abdominal bloating, and vomiting. A nasogastric tube drained 3,000 mL of stool-like secretion. Abdominal X-ray and ultrasound revealed a dilated stomach with an air-fluid level ( Figures 1A and 1B). Upper gastrointestinal endoscopy revealed no points of mechanical obstruction; there was erosive reflux esophagitis, exuberant gastric dilatation associated with gastric stasis, and hypertrophic pyloric stenosis. Serology for Chagas disease was negative.The assessment continued with abdominal CT, which showed no evidence of any obstructive factor or tumor, and chest CT, which identified a well-demarcated anterior mediastinal mass with a maximum diameter of approximately 5 cm and no invasion of adjacent structures ( Figure 1C). Given the possibility of paraneoplastic syndrome, video-assisted thoracoscopic resection was performed, and pathological examination showed small cell neoplasm of uncertain malignant histogenesis and immunohistochemistry, confirming the diagnosis of type B1 thymoma.Following tumor resection, the patient experienced a lower frequency of vomiting and was able to tolerate the diet. Gastrography was performed which showed contrast progression and a normal-sized stomach with peristalsis ( Figure 1D). A second endoscopy revealed a normal stomach with strong peristaltic waves and no sign of previous hypertrophic pyloric stenosis. The patient was discharged on an oral diet. Serum antibody testing for myasthenia gravis and paraneoplastic syndrome was ordered.Gastroparesis consists of delayed gastric emptying of solids in the absence of mechanical obstruction. The A B C D Figure 1. In A and B, abdominal X-ray showing gastric bloating. In C, CT scan showing a well-demarcated anterior mediastinal tumor. In D, gastrography showing normal gastric emptying.

-Background -First described 70 years ago, intraoperative cholangiography is an effective method of study of the biliary tract. There are several ways of its realization. Aim -To add a new technique of cholangiography in relation to the classical one using only two radiographs for static and dynamic interpretation. Methods -Cholangiography is made with two X-rays, the first with overpressure and the second three minutes later, in emptying time. It was performed on 39 patients with gallstones undergoing cholecystectomy by laparotomy. The evaluation of the radiographs was based on a radiographic classification created by the authors, varying in degrees in the overpressure from 0 to 3 and emptying of 1 to 3. Results -The complete or almost complete filling of the biliary tree was found in 66.7% of patients in the phase of overpressure. In the emptying phase, 59% of patients had 1/3 or less contrast on biliary tree. There was a need to add additional radiographs in 5% of patients after seven minutes, with complete emptying. Conclusion -The proposed technique proved feasible, simple, fast and effective. ABCDDV/799RESUMO -Racional -Descrita há mais de 70 anos, a colangiografia transoperatória é método eficaz de estudo da via biliar. Existem diversas formas de sua realização. Objetivo -Acrescentar uma nova forma de colangiografia em relação à técnica clássica usando somente duas radiografias para interpretação estática e dinâmica. Métodos -A colangiografia é feita com duas radiografias, a primeira em hiperpressão e a segunda três minutos após, em esvaziamento. Ela foi realizada em 39 pacientes portadores de colecistolitíase, submetidos à colecistectomia por laparotomia. A avaliação dos radiogramas foi feita com base em uma classificação radiográfica, criada pelos autores em graus que variam na hiperpressão de 0 a 3 e no esvaziamento de 1 a 3. Resultados -O enchimento total ou quase total da árvore biliar foi encontrado em 66,7% dos pacientes na fase de hiperpressão. Na fase de esvaziamento, 59% dos pacientes estavam com um terço ou menos de contraste. Houve a necessidade de acrescentar radiografia adicional em 5% dos pacientes após sete minutos, com esvaziamento completo. Conclusão -A proposta técnica mostrou-se exequível, simples, rápida e eficaz.

Gastric cancer is a common malignancy of surgical treatment. D2 lymphadenectomy is the standard procedure with curative intent. The authors report the use of laparotomic hook as an alternative technique for lymphadenectomy.

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