RESUMEN
Although most patients with hepatitis C virus (HCV) infection have been cured since the introduction of direct-acting antiviral (DAA) treatments, whether patients with psychiatric disorders and chronic HCV infection receive benefits from DAA treatments remain unclear. The efficacy and safety of DAA treatment were compared between patients with and without psychiatric disorders. Data were retrospectively collected from medical records at the Suzuka General Hospital (Japan) between September 2014 and December 2021. The study was an observational, single-center study. Fisher's exact test, Mann-Whitney U test and Friedman's test were used for the comparisons between groups. Patients with HCV infection who had been started on DAA treatments were included. In total, 15 HCV cases with psychiatric disorders (P) and 209 HCV cases with nonpsychiatric disorders (NP) were started on DAA treatments for HCV infection. Patients in group P were younger (55±13.9 years) compared with those in group NP (68±13.0 years). A total of 12 patients (80%) in group P achieved and 188 patients (90%) in group NP achieved sustained virologic response (SVR), with no significant difference between the two groups. The remaining three patients in group P who did not achieve SVR included two drop-out cases. Regarding the laboratory data at the end of DAA treatments and SVR, there were no significant differences between the two groups. There were no cases of discontinuation or reduction of medication due to psychiatric disorders during DAA treatment. DAA treatment for HCV infection is effective, tolerable and safe for psychiatric patients, as well as patients without psychiatric disorders. Psychiatric patients with HCV infection should undergo DAA treatment to prevent progression to liver failure and/or cancer.
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Objective Pancreatic cystic lesions (PCLs) are known risk factors for pancreatic cancer. Therefore, this study explored the predictors identifying PCLs in a general population and developed a scoring system to help more efficiently diagnose these entities during medical checkups. Methods We reviewed 9,369 examinees of abdominal ultrasound (AUS) during medical checkups between January 2013 and November 2019. Predictors of PCLs were identified using a multivariate logistic regression analysis, and we constructed a scoring system based on these predictors. Results PCLs were detected in 118 (1.3%). Age 50-59 years old [odds ratio (OR) 2.52, 95% confidence interval (CI) 1.18-5.35], 60-69 years old (OR 3.91, 95% CI 1.86-8.26), and ≥70 years old (OR 10.5, 95% CI 5.03-21.7) as well as abdominal pain (OR 1.85, 95% CI 1.14-3.00), alcohol consumption (OR 1.72, 95% CI 1.03-2.89), a family history of pancreatic cancer (OR 2.41, 95% CI 1.09-5.34), and pre-diabetes or diabetes (OR 1.78, 95% CI 1.05-3.00) were predictors of PCLs. The following scores were assigned according to regression coefficients: age (50-59 years old, 1 point; 60-69 years old, 1.5 points; ≥70 years old, 2.5 points); abdominal pain, 1 point, alcohol consumption, 1 point; a family history of pancreatic cancer, 1 point; and pre-diabetes, 1 point. The PCL detection rate increased with the total score: 0.2% for total score 0 point, 5.4% for ≥4.0 points. The area under the curve of the scoring system was 0.75 (95% CI 0.70-0.79). Conclusion Our scoring system allows the risk of PCLs to be determined and may help more efficiently diagnose these entities.
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Quiste Pancreático , Neoplasias Pancreáticas , Estado Prediabético , Humanos , Persona de Mediana Edad , Anciano , Quiste Pancreático/diagnóstico por imagen , Quiste Pancreático/epidemiología , Páncreas/patología , Neoplasias Pancreáticas/diagnóstico por imagen , Neoplasias Pancreáticas/epidemiología , Dolor Abdominal/epidemiología , Dolor Abdominal/etiología , Neoplasias PancreáticasRESUMEN
Esophagogastroduodenoscopy in a 58-year-old man revealed a protruding lesion measuring 6 mm in diameter in the fornix. An endoscopic biopsy of the lesion indicated well-differentiated adenocarcinoma. The lesion was resected by polypectomy. According to the Japanese histologic diagnostic criteria, we made a final diagnosis of early gastric cancer (U, Gre, 6×6 mm, Type 0-I, tub1, pT1a (M), pUl0, Ly0, V0, pHM0, pVM0). A retrospective review of the endoscopic images showed that this lesion had already been present in the images taken 16 years ago. The size and morphology of the lesion were the same as those of the first detected lesion.
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Adenocarcinoma , Infecciones por Helicobacter , Helicobacter pylori , Rubus , Neoplasias Gástricas , Masculino , Humanos , Persona de Mediana Edad , Neoplasias Gástricas/diagnóstico por imagen , Neoplasias Gástricas/patología , Estudios Retrospectivos , Estudios de Seguimiento , Mucosa Gástrica/patología , Adenocarcinoma/diagnóstico por imagen , Adenocarcinoma/cirugía , Adenocarcinoma/patología , Infecciones por Helicobacter/complicaciones , Infecciones por Helicobacter/patologíaRESUMEN
A 58-year-old woman was admitted to Suzuka General Hospital with fever. She was diagnosed with infectious endocarditis based on the presence of anterior mitral leaflet vegetation on the echocardiography analysis and isolation of Pseudomonas guariconensis by blood culture. During treatment, the hepatic enzymes levels, including aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH) and alkaline phosphatase (ALP) were increased without any abdominal symptoms. Prolonged prothrombin time (PT) and prothrombin time international normalized ratio were observed, and acute hepatic failure was diagnosed. However, the hepatic injury resolved spontaneously with restoration of the PT value after the hepatic enzymes (AST, ALT, LDH and ALP) peaked. Diffusion-weighted imaging of hepatic magnetic resonance imaging showed diffuse high intensity of the entire liver except for part of the left lobe. The hepatic injury was diagnosed as ischemic hepatitis caused by embolization from the vegetation associated with infectious endocarditis. The recovery from hepatic ischemia was thought to be due to hepatic blood supply from extrahepatic collateral blood. After antibiotic treatment, the patient underwent resection of the vegetation on the anterior mitral valve leaflet. Hepatic artery occlusion is rare, but it may cause severe hepatic complications. During follow-up of infectious endocarditis, clinicians should be aware of the potential for whole organ ischemic damage caused by vessel occlusion, as well as hepatic ischemic damage.
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Primary clear cell adenocarcinoma (CCA) of the colorectum is rare. We report a case of a 57-year-old man with early-stage CCA with conventional tubular adenoma and tubular adenoma with clear cell change in the transverse colon, diagnosed with image-enhanced endoscopy. The tumor was then treated with endoscopic submucosal dissection. The endoscopic findings characteristic of clear cell adenoma/adenocarcinoma could not be identified. Therefore, similar diagnostic tools as for conventional colorectal adenoma/cancer were considered. The pathogenesis of the clear cell change was unknown, but it might appear with the progression of the malignancy.
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Adenocarcinoma de Células Claras , Adenoma , Resección Endoscópica de la Mucosa , Adenocarcinoma de Células Claras/complicaciones , Adenocarcinoma de Células Claras/cirugía , Adenoma/complicaciones , Adenoma/diagnóstico por imagen , Adenoma/cirugía , Colon , Humanos , Masculino , Persona de Mediana EdadRESUMEN
A 64-year-old woman was infected with hepatitis E virus (HEV) during chemotherapy for leukemia. By retrospective analyses of stored serum from the blood products and the patient, the source of the infection was determined to be platelet concentration (PC) transfused during chemotherapy. The partial nucleotide sequence of the HEV strain isolated from the donated PC and that from the patient's sera was identical and was subgenotype 3b. Clinical indicators such as alanine aminotransferase, HEV RNA titer, and anti-HEV antibodies in the serum were investigated from the beginning of the infection until 1 year after the termination of HEV infection. HEV RNA had propagated over 6 months and then cleared spontaneously after the completion of chemotherapy. Anti-HEV antibodies appeared in the serum just before the clearance of HEV RNA. Interestingly, HEV RNA was detected in the patient's urine, spinal fluid, and saliva. The HEV RNA titers in those samples were much lower than in the serum and feces. No renal, neurological, or salivary gland disorders appeared during the follow-up. We observed virological and biochemical progress and cure of transfusion-transmitted chronic hepatitis E in the patient despite an immunosuppressive status during and after chemotherapy against hematological malignancy.
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Anticuerpos Antihepatitis/sangre , Virus de la Hepatitis E/inmunología , Hepatitis E/sangre , Hepatitis E/transmisión , Leucemia Mieloide Aguda/sangre , Leucemia Mieloide Aguda/tratamiento farmacológico , Transfusión de Plaquetas/efectos adversos , Enfermedad Crónica , Femenino , Humanos , Persona de Mediana Edad , Remisión EspontáneaRESUMEN
A 74-year-old man developed hepatic injury after intravesical Bacillus Calmette-Guérin (BCG) therapy for bladder carcinoma. Although hepatitis-associated disseminated BCG was suspected, granulomatous formations were undetectable. The hepatic injury was considered to have resulted from an allergic reaction to BCG therapy because a histopathological assessment revealed enlarged portal areas with eosinophils and neutrophils. The hepatic injury was resolved by prednisolone. This case suggested that hepatic injury associated with BCG therapy might be due to an allergic mechanism unrelated to disseminated BCG disease. A liver biopsy is needed to confirm the histopathological findings of hepatic injury after BCG therapy in order to differentiate allergic hepatic injury from infectious hepatic injury.
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Vacuna BCG/uso terapéutico , Hepatitis/tratamiento farmacológico , Hipersensibilidad/tratamiento farmacológico , Hipersensibilidad/etiología , Hígado/fisiopatología , Prednisolona/uso terapéutico , Neoplasias de la Vejiga Urinaria/complicaciones , Neoplasias de la Vejiga Urinaria/tratamiento farmacológico , Administración Intravesical , Anciano , Hepatitis/etiología , Humanos , Masculino , Resultado del TratamientoRESUMEN
Primary clear cell adenocarcinoma (CCA) of the colorectum is a rare tumor. We report on a 48-year-old man with early stage CCA in the descending colon who underwent detailed examination with image-enhanced endoscopy, such as magnifying endoscopy with narrow-band imaging and crystal violet staining. The tumor was treated successfully with endoscopic mucosal resection at our hospital.
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Adenocarcinoma de Células Claras/diagnóstico por imagen , Neoplasias del Colon/diagnóstico por imagen , Colonoscopía/métodos , Aumento de la Imagen , Adenocarcinoma de Células Claras/patología , Adenocarcinoma de Células Claras/cirugía , Neoplasias del Colon/patología , Neoplasias del Colon/cirugía , Colorantes , Resección Endoscópica de la Mucosa , Violeta de Genciana , Humanos , Masculino , Persona de Mediana Edad , Imagen de Banda Estrecha , Estadificación de NeoplasiasRESUMEN
We experienced two cases of adenocarcinoma coexisting with a hyperplastic polyp arising from Helicobacter pylori-negative normal gastric mucosa. The first case was of a 59-year-old man. Esophagogastroduodenoscopy revealed a protruding lesion measuring 4 mm in diameter on the greater curvature of the middle gastric body. The second case was of a 47-year-old man. Esophagogastroduodenoscopy showed a protruding lesion measuring 5 mm located at the greater curvature of the upper gastric body. The absence of atrophic changes in the entire gastric mucosa was confirmed endoscopically in both cases. Multiple H. pylori tests were all negative. Endoscopically, these protruding lesions appeared as reddish, semipedunculated polyps. Hyperplastic polyps were suspected based on white light endoscopic findings. Magnified endoscopy with narrow band imaging could not predict the coexistence of cancer. However, histopathological examination of the resected specimen revealed focal cancer at the surface of the gastric hyperplastic polyps. Considering the possibility that cancer may be coexisting in polyps, when reddish polyps are detected in H. pylori-negative normal gastric mucosa, it is important to perform a biopsy, or a careful follow-up endoscopy.
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Adenocarcinoma/patología , Mucosa Gástrica/patología , Neoplasias Primarias Múltiples/patología , Pólipos/patología , Neoplasias Gástricas/patología , Biopsia , Endoscopía del Sistema Digestivo , Mucosa Gástrica/microbiología , Helicobacter pylori , Humanos , Masculino , Persona de Mediana EdadRESUMEN
A 75-year-old woman was discovered to have a pericardial effusion when she was admitted to our hospital because of a giant hepatic cyst. We could not detect the cause of the effusion and diagnosed idiopathic pericardial effusion. The patient underwent transcutaneous drainage of the hepatic cyst and an injection of antibiotics. There was no communication between the pericardial effusion and the hepatic cyst. Although the hepatic cyst was reduced in size, the pericardial effusion showed no remarkable change immediately after treatment; however, 5 months later, the pericardial effusion was found to be diminished. The pericardial effusion might have been caused by the physical pressure of the giant hepatic cyst and disturbance in the balance between the production and reabsorption of the pericardial fluid. When we experience a huge hepatic cyst, we should take into account its influence against the surrounding organs, including the intrapleural space.
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Quistes/cirugía , Hepatopatías/cirugía , Derrame Pericárdico/cirugía , Anciano , Quistes/diagnóstico por imagen , Drenaje/métodos , Femenino , Humanos , Hepatopatías/diagnóstico por imagen , Derrame Pericárdico/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
The Ephedra herb, which has been used in Kampo medicines, originates from terrestrial stems of Ephedra species. It is important to establish cultivation methods and cultivars to secure a stable supply of the Ephedra herb that would meet the quality standards for the ephedrine alkaloids content. In this study, we first grew Ephedra sinica plants derived from seeds in the field for 5 years. Then, for selective breeding of cultivars that could meet the quality standards for the ephedrine alkaloids content, we measured the content of total alkaloids (TAs), ephedrine (Eph), and pseudoephedrine (PEph) in individual plants derived from seedlings and grown for 4 years in the field. The range of the TA content in each individual plant was narrower than that among individual plants grown in the field. Therefore, individual plants were selected according to their TA content, Eph/PEph ratio, and stolon-formation capability. The selected individuals were propagated using stolons, and their TA content was studied for 2 years. In the second year, the TA content in terrestrial stems derived from stolons of the selected individuals was as high as that of their parents. Therefore, it was confirmed that the selected individuals that were propagated using stolons could produce TA reproducibly. This study suggested that selective breeding using stolon propagation is effective for stabilizing Ephedra herb TA content.
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Alcaloides/metabolismo , Ephedra sinica/metabolismo , Efedrina/metabolismo , Seudoefedrina/metabolismo , Alcaloides/análisis , Efedrina/análisis , Fitomejoramiento , Seudoefedrina/análisisRESUMEN
A 67-year-old male was diagnosed with advanced esophageal cancer. A computed tomography scan showed multiple intra-abdominal lymphadenopathies. Because the tumor was thought to be unresectable, we initiated chemotherapy. Twelve months later, the patient was admitted to our hospital because of hematemesis. Gastroduodenoscopy revealed oozing bleeding from the esophageal tumor. Hemostasis was not achieved with conservative treatment, and frequent blood transfusions were required. Endoscopic hemostasis was difficult to achieve because of the malignant esophageal stenosis. To treat the malignant esophageal stricture and esophageal tumor bleeding, we attempted to insert an esophageal covered self-expandable metallic stent. After the procedure, hemostasis was achieved by mechanical tamponade. Here we report a rare case of esophageal tumor bleeding that was managed with mechanical tamponade using an esophageal covered self-expandable metallic stent.
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Neoplasias Esofágicas/terapia , Estenosis Esofágica/terapia , Hemorragia Gastrointestinal/terapia , Stents , Neoplasias Esofágicas/complicaciones , Neoplasias Esofágicas/diagnóstico por imagen , Estenosis Esofágica/diagnóstico por imagen , Estenosis Esofágica/etiología , Hemorragia Gastrointestinal/diagnóstico por imagen , Hemorragia Gastrointestinal/etiología , Hemostasis Endoscópica , Humanos , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos XRESUMEN
A 75-year-old woman with epigastric pain was admitted to our emergency department. She was diagnosed with an acute exacerbation of chronic pancreatitis based on the results of blood tests and abdominal computed tomography (CT). The abdominal CT and magnetic resonance cholangiopancreatography revealed pancreas divisum. Abdominal CT also showed a stone in the minor papilla, with impaction of the stone being the most likely cause of the acute episode. Therefore, endoscopic sphincterotomy of the minor papilla and endoscopic naso-pancreatic duct drainage were performed to remove the stone and decrease the internal pressure of the pancreatic duct. These procedures improved the patient's clinical status. The naso-pancreatic drainage tube was removed, and her pancreatitis has not recurred. Herein, we report a rare case of an impacted minor papilla stone in a patient with pancreas divisum that caused an acute exacerbation of chronic pancreatitis.
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Calcinosis/diagnóstico por imagen , Enfermedades Duodenales/diagnóstico por imagen , Pancreatitis Crónica/complicaciones , Enfermedad Aguda , Anciano , Calcinosis/complicaciones , Calcinosis/terapia , Colangiopancreatografia Retrógrada Endoscópica , Progresión de la Enfermedad , Enfermedades Duodenales/complicaciones , Enfermedades Duodenales/terapia , Femenino , Humanos , Pancreatitis Crónica/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
A 54-year-old male patient underwent upper gastrointestinal endoscopy, which revealed a 25-mm brown region in the angular section of the greater curvature of the stomach. The region was histologically determined to be gastric mucosa with an accumulation of histiocytes containing eosinophilic substances in the cytoplasm and chronic inflammatory cell infiltration. Histiocytes were immunohistologically positive for CD68, IgG, and κ. Based on these findings, the patient was diagnosed with gastric crystal-storing histiocytosis comprised of histiocytes phagocytosing IgG-κ-type immunoglobulin. This is a rare disease of which there have been no previous reports that included long-term follow-up. Here, we report the case with a literature review.
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Histiocitosis/diagnóstico por imagen , Histiocitosis/patología , Gastropatías/diagnóstico por imagen , Gastropatías/patología , Biopsia , Gastroscopía , Humanos , Masculino , Persona de Mediana EdadRESUMEN
An 85-year-old woman with jaundice was referred to our hospital where she was diagnosed with obstructive jaundice due to carcinoma of the pancreatic head based on blood tests and abdominal computed tomography (CT). We performed endoscopic retrograde cholangiopancreatography (ERCP) for biliary drainage, but 5 days after the procedure, she complained of epigastric pain. Laboratory data revealed an elevated white blood cell count and a high serum amylase concentration. Follow-up CT 6 days after the ERCP revealed that the main pancreatic duct diameter had increased since the time of admission. Therefore, ERCP was performed for pancreatic ductal drainage. Purulent pancreatic juice was drained by endoscopic placement of a nasopancreatic drainage tube in the main pancreatic duct, resulting in marked alleviation of clinical symptoms;however, after removal of the tube, the abdominal pain recurred. Subsequent endoscopic placement of a pancreatic stent improved her clinical status once again. Herein, we report this rare case of acute obstructive suppurative pancreatic ductitis in a patient with carcinoma of the pancreatic head.
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Jugo Pancreático , Neoplasias Pancreáticas/diagnóstico , Pancreatitis/terapia , Enfermedad Aguda , Anciano de 80 o más Años , Colangiopancreatografia Retrógrada Endoscópica , Drenaje , Femenino , Humanos , Ictericia Obstructiva/etiología , Neoplasias Pancreáticas/complicaciones , Pancreatitis/etiología , Stents , Tomografía Computarizada por Rayos XRESUMEN
A 73-year-old man with a history of tarry stools was admitted to our hospital. Gastroduodenoscopy on admission revealed an ulcer with an exposed vessel at the duodenal bulb. During endoscopic clipping for prevention of re-bleeding, a large amount of bleeding from the vessel was observed. Hemostasis was achieved after the procedure. However, 7 days later, the patient passed a large amount of tarry stools and experienced hypovolemic shock. Endoscopic re-examination revealed a pulsatile aneurysmal vessel at the base of the duodenal ulcer. Abdominal contrast-enhanced computed tomography and abdominal angiography demonstrated an aneurysm of the gastroduodenal artery, which was successfully treated with transcatheter arterial embolization. Thus, here we report a rare case of an aneurysm of the gastroduodenal artery caused by a duodenal ulcer.
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Aneurisma Roto/etiología , Arterias/patología , Úlcera Duodenal/complicaciones , Duodeno/irrigación sanguínea , Hemorragia Gastrointestinal/etiología , Estómago/irrigación sanguínea , Anciano , Aneurisma Roto/terapia , Angiografía , Úlcera Duodenal/terapia , Duodenoscopía , Hemorragia Gastrointestinal/terapia , Humanos , MasculinoRESUMEN
A 47-year-old woman with a single-nodule hepatic tumor was referred to our hospital. She had no symptoms. The tumor was located at the surface of the right lobe of the liver; it showed peripheral low signal intensity on a magnetic resonance imaging apparent diffusion coefficient (ADC) map, and an influx of blood flow into the peripheral area of the tumor at the early vascular phase on perflubutane microbubble (Sonazoid(®)) contrast-enhanced (CE) ultrasonography. Since we suspected a malignant tumor, the patient underwent surgical resection. The hepatic tumor was resected curatively. Pathological examination revealed that the tumor was composed of epithelioid cells with an epithelioid structure and/or cord-like structure. Immunohistochemical staining was positive for cluster of differentiation 34 and factor VIII-related antigen. Based on the above, a final diagnosis of hepatic epithelioid hemangioendothelioma (EHE) was made. Hepatic EHE is a rare hepatic tumor: only a few cases of hepatic EHE with curative resection have been reported. We were unable to reach a diagnosis of hepatic EHE by imaging studies; however, an ADC map was useful in showing the malignant potential of the tumor, and CE ultrasonography was useful in revealing the peripheral blood flow of the tumor. When an unusual hepatic mass is encountered, hepatic EHE should be kept in mind, and the mass should be inspected with more than one imaging modality, including an ADC map, in the process of differential diagnosis.
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Hemangioendotelioma Epitelioide/patología , Hemangioendotelioma Epitelioide/cirugía , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/cirugía , Imagen por Resonancia Magnética , Antígenos CD34/análisis , Medios de Contraste , Femenino , Hemangioendotelioma Epitelioide/diagnóstico por imagen , Humanos , Inmunohistoquímica , Neoplasias Hepáticas/diagnóstico por imagen , Persona de Mediana Edad , Ultrasonografía , Factor de von Willebrand/análisisRESUMEN
A 68-year-old man was referred to our hospital because of left upper quadrant pain. Contrast enhanced computed tomography showed a low density mass with delayed contrast effects as well as para-aortic node swelling with homogenous contrast effects. Histological examination of specimens obtained by endoscopic ultrasound fine needle aspiration revealed a pancreatic neuroendocrine tumor (NET) G2, according to the World Health Organization 2010 classification, and lymph node metastasis. Distal pancreatectomy and lymph node dissection were performed. On histological examination, the tumor showed well-differentiated morphology with an organoid pattern. The Ki67 labeling index was 21.6 %, and the mitotic count was 25/10 high power fields. As mentioned above, we made a final diagnosis of the lesion as "NET G3," because the tumor presented with well-differentiated morphology. Chemotherapy with Everolimus was administered. Liver metastasis occurred 11 months after the first operation, and a partial hepatectomy was performed. Histological findings were similar to those of the first operation. Herein we present a case of pancreatic well-differentiated neuroendocrine tumor with a high proliferative rate referred to as "NET G3," and review the relevant literature.
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Tumores Neuroendocrinos/patología , Neoplasias Pancreáticas/patología , Anciano , Proliferación Celular , Biopsia por Aspiración con Aguja Fina Guiada por Ultrasonido Endoscópico , Hepatectomía , Humanos , Antígeno Ki-67/análisis , Neoplasias Hepáticas/secundario , Neoplasias Hepáticas/cirugía , Escisión del Ganglio Linfático , Metástasis Linfática , Masculino , Índice Mitótico , Tumores Neuroendocrinos/secundario , Tumores Neuroendocrinos/cirugía , Pancreatectomía , Neoplasias Pancreáticas/cirugíaRESUMEN
Carcinosarcoma is a biphasic malignant tumor consisting of both carcinomatous and sarcomatous components, and its occurrence in the duodenum is very rare. In the present report, we describe a case of so-called carcinosarcoma of the duodenum with a chondrosarcomatous component. A 79-year-old man was referred to our hospital because of anorexia, weight loss, and jaundice. A preoperative imaging examination showed a hypovascular mass located in the pancreatic head. Histological examination of specimens obtained through a forceps biopsy revealed anaplastic carcinoma (spindle cell type), and a pancreatoduodenectomy was performed. Histologically, the tumor showed an elevated lesion with a wide base in proximity to duodenal mucosal carcinoma. The tumor was found to be predominantly composed of sarcoma with carcinomatous and chondrosarcomatous components. There was a transitional zone between the carcinomatous and sarcomatous components, and a portion of the sarcomatous component was positive for cytokeratin, and negative for vimentin. As mentioned above, we diagnosed the lesion as so-called carcinosarcoma with a chondrosarcomatous component.
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Carcinosarcoma/patología , Neoplasias Duodenales/patología , Anciano , Carcinosarcoma/metabolismo , Carcinosarcoma/cirugía , Neoplasias Duodenales/metabolismo , Neoplasias Duodenales/cirugía , Humanos , Inmunohistoquímica , Queratinas/metabolismo , Masculino , Pancreaticoduodenectomía , Vimentina/metabolismoRESUMEN
A 79-year-old male was referred to the hospital with a history of abdominal discomfort. Abdominal computed tomography revealed a cystic tumor with irregular wall thickness, approximately 50 mm in diameter, along the lesser curvature of the gastric body. Magnetic resonance imaging visualized the mass as signal-hyperintense on T2-weighted imaging. Esophagogastroduodenoscopy showed a submucosal tumor with normal mucosa. Surgery was performed and the 60 × 50 × 50 mm mass was resected. The resected tumor comprised cystic and solid regions; the cystic region was filled by light bloody serous fluid. On histological examination, a solid region of the resected tumor showed a spindle-cell appearance. The diagnosis was gastric gastrointestinal stromal tumor (GIST) with predominant cystic formation. GISTs are usually solitary tumors, but in this case the tumor demonstrated extremely predominant cystic formation. Lesions with a hemorrhage or necrosis may form large cystic spaces. GISTs may show extensive cystic changes in response to tyrosine kinase inhibitor treatment; however, this patient had not undergone any such treatment before diagnosis. This represents an interesting case of a gastric GIST with predominant cystic formation occupying most of the tumor volume. Care should be taken to differentiate between GISTs and actual intra-abdominal cystic lesions.