RESUMEN
A 56-year-old man diagnosed a having multiple hepatocellular carcinoma (HCC) with liver cirrhosis underwent transcatheter arterial embolization (TAE). Five months later, recurrent HCC was detected in the liver as well as in the left adrenal gland. A second TAE was performed to treat the intrahepatic recurrence, which was followed by hand-assisted laparoscopic surgery (HALS) for the metastatic tumor in the left adrenal gland. The combination of the two procedures successfully controlled HCC. To our knowledge, this is the first report describing an adrenalectomy by HALS for adrenal metastasis from an HCC.
Asunto(s)
Neoplasias de las Glándulas Suprarrenales/secundario , Neoplasias de las Glándulas Suprarrenales/cirugía , Adrenalectomía/métodos , Carcinoma Hepatocelular/secundario , Carcinoma Hepatocelular/cirugía , Laparoscopía/métodos , Neoplasias Hepáticas/patología , Neoplasias de las Glándulas Suprarrenales/terapia , Carcinoma Hepatocelular/terapia , Embolización Terapéutica , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/terapiaRESUMEN
BACKGROUND/AIMS: We report a case of solitary Peutz-Jeghers-type hamartomatous polyp of the duodenum in a 22-year-old Japanese woman along with the results of genomic analysis. METHODS/RESULTS: The patient was almost asymptomatic, though endoscopic examination revealed a solitary lobular polypoid lesion measuring 3 cm in diameter in the first portion of the duodenum. The lesion was resected endoscopically. Histopathological examination showed hyperplasia with a tree branch-like extension of the lamina propria derived from the muscularis mucosae, consistent with histological features of polyps of Peutz-Jeghers syndrome (PJS). No mucocutaneous pigmentation of the skin was evident and family history was negative. Analysis of the loss of heterozygosity at the locus of 19p 13.3 and mutation analysis of the STK11/LKB1 gene, which has recently been recognized as a susceptible gene in PJS, were performed. However, no evidence of genomic abnormality was found. CONCLUSION: The clinical and investigative findings in our case suggest that the solitary Peutz- Jeghers-type hamartomatous polyp can be regarded as a clinical entity separate from PJS.
Asunto(s)
Enfermedades Duodenales , Síndrome de Peutz-Jeghers , Adulto , Enfermedades Duodenales/genética , Enfermedades Duodenales/patología , Femenino , Humanos , Pérdida de Heterocigocidad , Síndrome de Peutz-Jeghers/genética , Síndrome de Peutz-Jeghers/patologíaRESUMEN
BACKGROUND: The present study was planned to investigate cumulative genetic changes during development and progression of gallbladder carcinoma (GBC) in clinical patients. MATERIALS AND METHODS: We examined GBC DNA from resected tissue isolated from 56 cases of GBC for loss of heterozygosity (LOH) at six loci on five chromosomal arms (1p36, 9p21, 13q14, 16q24, 17p13), using highly polymorphic microsatellite markers. RESULTS: High incidences of LOH at 1p36 (19/36: 53%), 9p21 (12/32: 38%), 13q14 (20/36: 56%), 16q24 (31/54: 61%), and 17p13 (15/36: 42%) were detected. When comparing genetic features with clinicopathological stages of these tumors, it appeared that only LOH at 16q24 had a high incidence (5/6: 83%) at an early stage (T1a: tumor invades lamina propria) of the disease, although large numbers of LOH were found on all chromosomal arms in tumors of more advanced stages (T1b, T2, T3, and T4). CONCLUSION: These results suggested that the putative tumor suppressor gene on 16q24 may be strongly related to an early step of carcinogenesis in GBC and that GBC acquires a high malignant potential when the tumor invades the muscle layer.
