Gastrointestinal stromal tumor coexisting with disseminated peritoneal leiomyomatosis.

BACKGROUND: A case of gastrointestinal stromal tumor (GIST) coexisting with disseminated peritoneal leiomyomatosis (DPL) is rare. We report a case of GIST coexisting with DPL. CASE PRESENTATION: A 50-year-old woman underwent exploratory laparoscopy under a preoperative diagnosis of gastric GIST with an ovarian tumor or peritoneal dissemination in the pelvic space. Laparoscopy showed multiple peritoneal masses in the pelvic space. Intraoperative frozen sectioning of the pelvic tumors showed multiple spindle cells, suggesting leiomyomas or retroperitoneal tumors; however, it was difficult to rule out peritoneal dissemination from GIST. No disseminated lesion was noted near GIST, and hence, we believed that GIST and pelvic lesions had different origins. We achieved R0 resection by partial resection of the stomach, total hysterectomy, and bilateral salpingo-oophorectomy. The postoperative immunohistopathological examination confirmed the final diagnosis of GIST and DPL. The patient has been recurrence free for 10 years. CONCLUSIONS: Immunohistochemical examination is essential for correct diagnosis for GIST and DPL. R0 curative resection should be scheduled after immunohistochemical examination of specimens obtained from exploratory laparoscopy.

Coil embolization of a celiac artery aneurysm using the neck remodeling technique.

Aneurysms of the celiac trunk are rare. Untreated lesions enlarge progressively and may rupture spontaneously. We report the case of a 56-year-old man whose wide neck celiac aneurysm was successfully packed with coils with preservation of the native arterial circulation by percutaneous transcatheter embolization using the neck remodeling technique.

Comparison of survival rates between patients treated with transcatheter arterial chemoembolization and hepatic resection for solitary hepatocellular carcinoma.

The present study aimed to retrospectively compare the survival rates between patients treated with transcatheter arterial chemoembolization and hepatic resection for solitary hepatocellular carcinoma (HCC). According to our database, derived from three affiliated hospitals, the inclusion criteria for this study were: solitary HCC [Child-Pugh class A and International Union Against Cancer (UICC) stage T1-3N0M0] treated between July 1990 and October 2001. Subsequently, hepatic resection (149 patients) as well as chemoembolization (102 patients) groups were selected. Following stratification according to tumor stage [UICC, Cancer of the Liver Italian Program (CLIP) and Milan criteria], survival rates were compared between the treatment groups. Survival rates were calculated using the Kaplan-Meier method. Age, gender and size of the HCC did not differ significantly between the groups. Moreover, no significant difference in the survival rates (average hepatic resection, 58.9 months; average chemoembolization, 45 months; P=0.1697) was observed between the groups. In the subgroup analysis, according to tumor stage, the survival rate was significantly higher for the hepatic resection group than for the chemoembolization group in the UICC T3N0M0 (P=0.017) subgroup. However, no significant differences in survival rates were observed between the hepatic resection and chemoembolization groups for UICC T1 (P=0.7329), T2N0M0 (P=0.5741), CLIP0 (P=0.3593), CLIP1-2 (P=0.3287) and within (>5 cm; P=0.4429) and beyond Milan criteria (≤5 cm; P=0.4003) subgroups. Chemoembolization is as effective as hepatic resection in treating solitary HCC in subpopulations with UICC T1-2N0M0 or CLIP 0-2 HCC or Milan criteria and adequate liver function. In the subgroup with UICC T3N0M0 HCC, hepatic resection is superior to chemoembolization.

Successful portal-systemic shunt occlusion of a direct shunt between the inferior mesenteric vein and inferior vena cava with balloon-occluded retrograde transvenous obliteration following recanalization after placing a covered stent in the portal and superior mesenteric veins.

Extrahepatic portal-systemic shunts cause portal-systemic encephalopathy. Direct communication between the inferior mesenteric vein (IMV) and the inferior vena cava (IVC) is a relatively rare pathway among the variety of portal-systemic shunts. This report describes a case of successful occlusion of an IMV-IVC shunt. Based on laboratory data and computed tomography findings, a 69-year-old woman with liver cirrhosis was diagnosed with portal-systemic encephalopathy due to a shunt between the IMV and the IVC. Her hepatic coma had not been adequately controlled by oral or intravenous pharmacotherapy. First, we placed a covered stent in the main trunk of the portal vein and the superior mesenteric vein (SMV) to block the SMV hepatofugal flow and splenic vein hepatopetal flow, but this therapy showed only a transient therapeutic effect due to recanalization. Next, we performed balloon-occluded retrograde transvenous obliteration (BRTO) of the portal-systemic shunt. After the BRTO, she has had no episodes of portal-systemic encephalopathy for 2 years.

Small arteriovenous malformation of the common bile duct causing hemobilia in a patient with hereditary hemorrhagic telangiectasia.

We report a 54-year-old male patient with arteriovenous malformation located at the common bile duct and hereditary hemorrhagic telangiectasia. The patient was treated as gallstone pancreatitis at first. Three days after endoscopic nasobiliary drainage (ENBD) for biliary drainage to subside gallstone pancreatitis, hemobilia was drained from the ENBD tube and the serum hemoglobin level gradually decreased. Cholangioscopy and angiography revealed that hemobilia was due to a small arteriovenous malformation located at the common bile duct. Subsequently, the patient was successfully treated by endovascular intervention.