Pancreaticoduodenectomy for hepatic portal lymph node metastasis after hepatic resection for hepatocellular carcinoma: A clinical case report.

INTRODUCTION: In 2018, Hepatocellular carcinoma (HCC) was predicted to be the sixth most commonly diagnosed cancer. Extra-hepatic metastasis due to HCC is a poor prognostic factor, depending on the stage of the disease. PRESENTATION OF CASE: We report a case of a 52-years old male who had undergone Segment 5 (S5) hepatectomy for HCC of 4.7 × 2 cm. Transcatheter arterial chemoembolization (TACE) four times postoperatively was performed based on a preoperative diagnosis of a recurrent tumour at the S1. After 2 years, the solitary tumour (7.5 × 2.5 × 3.5 cm) is located behind the right lobe of the liver and the head of the pancreas. The tumour was abnormally supplied with blood from the superior mesenteric artery (SMA) and the gastroduodenal artery (GDA). The patient was underwent pancreaticoduodenectomy (PD) to remove a large tumour. Postoperative pathology and immunohistochemical staining showed metastatic HCC. There was no tumour recurrence after 6 months. DISCUSSION: The organs in the body that liver cancer cells most often spread to are the lungs (44%), the portal vein (35%), the hepatobiliary ganglion (27%), and a small number of cases of bone, eye socket, bronchus metastases. Otherwise, recurrence of lymph nodes (LNs) after hepatectomy for HCC is very rare. CONCLUSIONS: HCC can metastasize to the hepatic pedicle LN after hepatectomy and maybe confused with recurrent liver tumours in the S1. Indications for PD are feasible for solitary metastatic at peri-pancreas. Pathology incorporating immunohistochemistry can determine the origin of metastases.

Monitoring fine root growth to identify optimal fertilization timing in a forest plantation: A case study in Northeast Vietnam.

Fertilizer is applied widely to improve the productivity of plantations. Traditionally, fertilization is conducted in spring and/or in the early rainy season, and it is believed to support the growth of planted trees in the growing season. Little attention to date has been paid on identification of the optimal timing of fertilization and fertilizer dose. In this study, application of the fine root monitoring technique in identifying optimal fertilization timing for an Acacia plantation in Vietnam is described. The study used two fertilizer doses (100 and 200 g NPK/tree) and three fertilization timings (in spring; in the early rainy season; and based on the fine root monitoring technique to identify when the fine roots reach their growth peak). As expected fertilization timings significantly affected growth and above-ground biomass (AGB) of the plantation. Fertilization based on the fine root monitoring technique resulted in the highest growths and AGB, followed by fertilization in the early rainy season and then in spring. Applying fertilizer at 200 g NPK/tree based on the fine root monitoring technique increased diameter at breast height (DBH) by 16%, stem height by 8%, crown diameter (Dc) by 16%, and AGB by 40% as compared to early rainy season fertilization. Increases of 32% DBH, 23% stem height, 44% Dc, and 87% AGB were found in fertilization based on fine root monitoring technique compared to spring fertilization. This study concluded that forest growers should use the fine root monitoring technique to identify optimal fertilization timing for higher productivity.