RESUMEN
This patient visited our hospital for the purpose of detailed examination of prostate cancer in his seventies. Abdominal contrast-enhanced computed tomography(CT)revealed a low-density mass of 2 cm in the pancreatic head. He was diagnosed with pancreatic cancer. Pancreaticoduodenectomy was performed after 2 courses of gemcitabine and S-1 therapy were performed as neoadjuvant chemotherapy. An intraoperative clamp test of the gastroduodenal artery showed that the pulsation of the common hepatic artery and the proper hepatic artery was weak but sufficient, so the gastroduodenal artery was cut and the operation was completed as planned. A blood test on the 1st day after the operation showed elevated levels of AST 537 U/L, ALT 616 U/L, and 7 hours later blood sampling showed further increases in AST 1,455 U/L, ALT 1,314 U/L. After a detailed review of the preoperative CT, celiac artery stenosis due to compression of the arcuate ligament was suspected, and urgent median arcuate ligament release was performed on the same day. Dissection of the arcuate ligament significantly improved the pulsation of the common hepatic artery and proper hepatic artery. Postoperatively, hepatic enzymes improved and ISGPS showed Grade B pancreatic juice leakage, but the patient was discharged from the hospital on the 49th postoperative day without any other complications. He took S-1 as adjuvant chemotherapy, and no signs of recurrence have been observed 9 months after the operation.
Asunto(s)
Adenocarcinoma , Arteria Celíaca , Neoplasias Pancreáticas , Pancreaticoduodenectomía , Humanos , Adenocarcinoma/cirugía , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Arteria Celíaca/cirugía , Constricción Patológica/cirugía , Desoxicitidina/análogos & derivados , Desoxicitidina/uso terapéutico , Desoxicitidina/administración & dosificación , Combinación de Medicamentos , Gemcitabina , Síndrome del Ligamento Arcuato Medio/cirugía , Ácido Oxónico/uso terapéutico , Ácido Oxónico/administración & dosificación , Neoplasias Pancreáticas/cirugía , Tegafur/uso terapéutico , Tegafur/administración & dosificaciónRESUMEN
Whether pancreatoduodenectomy or papillary resection should be performed to achieve curative treatment for neuroendocrine tumors of the minor duodenal papilla with a diameter of ≤2 cm is controversial. We report a 35-year-old male patient with a rare case of a neuroendocrine tumor of the minor duodenal papilla. The patient was referred to our hospital from a different clinic for dilatation of his minor duodenal papilla. Duodenoscopy revealed a smooth mass of 2 cm in diameter in the minor papilla, and the biopsy specimen was diagnosed as neuroendocrine tumor G1. The patient underwent subtotal stomach-preserving pancreatoduodenectomy. Histological evaluation showed a single nodule of 15 mm in diameter in the mucosa with metastasis to the regional lymph node. The tumor cells exhibited immunoactivity against synaptophysin and chromogranin A. The molecular immunology Borstel-1 index was less than 1%, and the grade was neuroendocrine tumor G1. We reviewed the characteristics of 24 cases of patients who underwent PD for NETs of the minor duodenal papilla in English literature. In 22 of these cases, the tumor depth was described. Lymph node metastasis was observed in none of the three cases (0%) in which the tumor was limited to the intra-sphincter; however, it was noted in three (30%) of the 10 cases in which the tumor had invaded the duodenal submucosa and in eight (89%) of the nine cases in which the tumor had invaded the muscularis propria, pancreas, peripancreatic/periduodenal tissues, or duodenal serosa. Making a definitive diagnosis preoperatively or intraoperatively whether the tumor invades beyond the sphincter or not and whether regional lymph node metastasis is present may not be possible. Therefore, we believe that pancreatoduodenectomy with lymphadenectomy is preferable for curative treatment of neuroendocrine tumors of the minor duodenal papilla.
RESUMEN
A 98-year-old woman presented with hematochezia and a circumferential type 2 tumor in the rectum Rb identified on fiberoscopy. We a performed laparoscopic Hartmann's operation and D2 lymphadenectomy for advanced rectal cancer. A sigmoid colostomy was created via the intraperitoneal route. On the postoperative day 12, the patient experienced abdominal pain. Computed tomography showed that the small intestine formed a closed loop in the pelvic space. The patient was diagnosed with a strangulated bowel obstruction of the small intestine for which an emergency exploratory laparotomy was performed. The small intestine, which had passed through a defect between the lifted sigmoid colon and the left abdominal wall, was strangulated by the lifted sigmoid colon. We performed partial resection of the small intestine. The patient died on postoperative day 32 of acute deterioration of aortic valve stenosis. There have been few reports of strangulated bowel obstruction resulting from internal hernia associated with colostomy. These findings demonstrate that it is important to select the appropriate route for colostomy creation in each case.
Asunto(s)
Obstrucción Intestinal , Laparoscopía , Neoplasias del Recto , Femenino , Humanos , Anciano de 80 o más Años , Neoplasias del Recto/complicaciones , Neoplasias del Recto/cirugía , Obstrucción Intestinal/etiología , Obstrucción Intestinal/cirugía , Recto/cirugía , Colon Sigmoide/cirugía , Laparoscopía/métodos , ColostomíaRESUMEN
A 79-year-old man visited the hospital because of constipation. Colonoscopy showed a transverse colon carcinoma. Dynamic CT showed a renal neoplastic lesion and 2 lesions in the liver with early staining and late wash out, and the liver lesions showed ring enhancement on EOB-MRI. The preoperative diagnosis was either transverse colon cancer, renal cell carcinoma, hepatocellular carcinoma, or metastatic liver cancer. The patient underwent partial transverse colon resection, partial right nephrectomy, and partial hepatic resection. Additional to the 2 liver lesions in S6, an intraoperative ultrasound showed 1 tumor in S5; therefore, 3 partial hepatectomies were performed. Histopathological findings revealed that the tumors in S5 and S6 were liver metastases of transverse colon cancer and renal cell carcinoma, respectively. The final diagnosis was transverse colon cancer, pT4a, pN0, pM1, pStage â £a and papillary renal cell carcinoma, pT1a, pN0, pM1, pStage â £. For 9 months postoperatively, there was no apparent recurrence.
Asunto(s)
Carcinoma Hepatocelular , Carcinoma de Células Renales , Colon Transverso , Neoplasias del Colon , Neoplasias Renales , Neoplasias Hepáticas , Masculino , Humanos , Anciano , Carcinoma Hepatocelular/secundario , Neoplasias Hepáticas/secundario , Colon Transverso/cirugía , Carcinoma de Células Renales/cirugía , Neoplasias del Colon/cirugía , Neoplasias Renales/cirugía , Neoplasias Renales/patologíaRESUMEN
A 54-year-old woman visited to a doctor nearby medical clinic complaining of loss of appetite. She was diagnosed with right hydronephrosis on abdominal ultrasonography, and referred to our hospital for further examination. Contrast abdominal computed tomography(CT)revealed that a 6.2 cm tumor with a contrast-enhancing effect inside in the retroperitoneum near the lower pole of the right kidney. She was diagnosed with hydronephrosis due to infiltration of the right kidney of a retroperitoneal tumor. The tumor was suspected of invading the duodenum and inferior vena cava, but no obvious lymph node or distant metastasis was observed. Abdominal MRI revealed a tumor showed hyperintensity on T2-weighted and diffusion-weighted images. We performed pancreaticoduodenectomy with inferior vena cava resection and right nephrectomy. The pathological diagnosis was leiomyosarcoma originating from retroperitoneum and pT2, pN0, pM0, pStage â ¢A. The postoperative course was good, and she was discharged 10 days after the operation. Thoracoabdominal CT showed a tumor 4 cm at the hepatic hilum three months after surgery, and EOB-MRI showed many tumors other than the same site, so multiple liver metastases were diagnosed as recurrence. Doxorubicin has been started and is still being treated.
Asunto(s)
Hidronefrosis , Leiomiosarcoma , Neoplasias Hepáticas , Neoplasias Retroperitoneales , Femenino , Humanos , Persona de Mediana Edad , Neoplasias Retroperitoneales/diagnóstico por imagen , Neoplasias Retroperitoneales/cirugía , Neoplasias Retroperitoneales/patología , Pancreaticoduodenectomía , Leiomiosarcoma/diagnóstico por imagen , Leiomiosarcoma/cirugía , Leiomiosarcoma/irrigación sanguínea , Neoplasias Hepáticas/cirugía , Vena Cava Inferior/cirugía , Vena Cava Inferior/patologíaRESUMEN
BACKGROUND: Among patients with colorectal cancer (CRC) treated with oxaliplatin (L-OHP)-based chemotherapy, delayed chemotherapy-induced nausea and vomiting (CINV) have not been well controlled. METHODS: We pooled data from two prospective observational studies in Japan and one phase III clinical trial to assess whether delayed CINV could be controlled with a combination of three antiemetics adding a neurokinin-1 receptor antagonist and identified individual risk factors, using an inverse probability treatment-weighted analysis. RESULTS: A total of 661 patients were evaluable in this study (median age: 64 years; 391 male, and 270 female). 3 antiemetics controlled delayed nausea (33.18% vs. 42.25%; p = 0.0510) and vomiting (4.15% vs. 16.08%; p < 0.0001) better than with 2 antiemetics. Female and 2 antiemetics were risk factors for both delayed nausea (female-odds ratio [OR]: 1.918; 95% confidence interval [CI]: 1.292-2.848; p = 0.0012; 2 antiemetics-OR: 1.485; 95% CI: 1.000-2.204; p = 0.0498) and delayed vomiting (female-OR: 2.735; 95% CI: 1.410-5.304; p = 0.0029; 2 antiemetics-OR: 4.551; 95% CI: 2.116-9.785; p = 0.0001). CONCLUSIONS: Identifying individual risk factors can facilitate personalized treatments for delayed CINV. We recommend a 3-antiemetic combination prophylaxis for CRC patients treated with L-OHP-based chemotherapy, especially for female patients.
Asunto(s)
Antieméticos/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Neoplasias Colorrectales/tratamiento farmacológico , Náusea/tratamiento farmacológico , Vómitos/tratamiento farmacológico , Anciano , Capecitabina/efectos adversos , Ensayos Clínicos Fase III como Asunto , Quimioterapia Combinada , Femenino , Fluorouracilo/efectos adversos , Humanos , Japón , Leucovorina/efectos adversos , Masculino , Persona de Mediana Edad , Náusea/inducido químicamente , Antagonistas del Receptor de Neuroquinina-1/uso terapéutico , Estudios Observacionales como Asunto , Compuestos Organoplatinos/efectos adversos , Oxaloacetatos/efectos adversos , Ensayos Clínicos Controlados Aleatorios como Asunto , Factores de Riesgo , Factores Sexuales , Vómitos/inducido químicamenteRESUMEN
OBJECTIVE: To evaluate the efficacy and safety of CAPOX plus bevacizumab as second-line chemotherapy for metastatic colorectal cancer. METHODS: In this multicenter phase â ¡ study, the planned number of patients was 48, but owing to poor case accumulation, registration was discontinued for 20 patients. The primary endpoint was the response rate(RR). Secondary endpoints were progression-free survival(PFS), overall survival(OS), disease control rate(DCR), and safety. RESULTS: First-line treatment was combined with irinotecan in 14 cases and bevacizumab in 12 cases. The median number of second- line treatment courses was 7, and the median treatment period was 203 days. The reason for discontinuation of treatment was disease progression in 13 cases, adverse events in 4 cases, and other reasons in 3 cases. The best response was PR in 5 cases, SD in 8 cases, and NE in 4 cases. The RR was 25%, and the DCR was 65%. The median PFS was 7.2 months, and the median OS was 18.6 months. Grade≥3 adverse events were neutropenia in 3 cases and diarrhea and peripheral neuropathy in 2 cases each. There were no treatment-related deaths. CONCLUSION: CAPOX plus bevacizumab was a safe and effective second-line treatment option for metastatic colorectal cancer.
Asunto(s)
Neoplasias Colorrectales , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Bevacizumab/uso terapéutico , Camptotecina/uso terapéutico , Capecitabina/uso terapéutico , Neoplasias Colorrectales/tratamiento farmacológico , Supervivencia sin Enfermedad , Fluorouracilo/uso terapéutico , Humanos , Oxaliplatino/uso terapéutico , Resultado del TratamientoRESUMEN
BACKGROUND: The characterisation of desmoplastic reaction (DR) has emerged as a new, independent prognostic determinant in colorectal cancer. Herein, we report the validation of its prognostic value in a randomised controlled study (SACURA trial). METHODS: The study included 991 stage II colon cancer patients. DR was classified by the central review as Mature, Intermediate or Immature based on the presence of hyalinised collagen bundles and myxoid stroma at the desmoplastic front. All clinical and pathological data, including DR characterisations, were prospectively recorded and analysed 5 years after the completion of the registration. RESULTS: The five-year relapse-free survival (RFS) rate was the highest in the Mature group (N = 638), followed by the Intermediate (N = 294) and Immature groups (N = 59). Multivariate analysis revealed that DR classification was an independent prognostic factor, and based on Harrell's C-index, the Cox model for predicting RFS was significantly improved by including DR. In the conditional inference tree analysis, DR categorisation was the first split factor for predicting RFS, followed by T-stage, microsatellite instability status and budding. CONCLUSIONS: Histological categorisation of DR provides important prognostic information that could contribute to the efficient selection of stage II colon cancer patients who would benefit from postoperative adjuvant therapy.
Asunto(s)
Neoplasias del Colon/patología , Recurrencia Local de Neoplasia/patología , Células del Estroma/patología , Anciano , Neoplasias del Colon/terapia , Terapia Combinada , Femenino , Estudios de Seguimiento , Humanos , Masculino , Recurrencia Local de Neoplasia/terapia , Pronóstico , Estudios Prospectivos , Tasa de SupervivenciaRESUMEN
A patient was 70-year-old female. Because unknown fever following operation of left knee in December 20XX-1, abdominal simple CT was performed, diagnosed as cholecystitis and liver abscesses. However, her unknown fever did not improve with antibiotics therapy. Abdominal enhanced CT and MRI revealed to gallbladder cancer with liver invasion and metastases. These lesions were relatively localized in liver S4a/S5 and gallbladder, hepatoduodenal mesentery. Because unknown fever was exhausting, cholecystectomy, S4a+S5 hepatectomy with extrahepatic bile duct resection and lymph node dissemination were performed in January 20XX+1. In these pathological findings, there were moderate to poorly differentiated adenocarcinoma with squamous cell differentiation in almost area of gallbladder, diagnosed as adeno-squamous carcinoma with liver invasion and metastasis(pT3a[SI][H-inf], int, INF-ß, ly1, v3, pn1, pN1, pM1, pStage â £B). One months after operation, abdominal CT revealed multiple liver metastatic recurrences. She died 7 months after operation. Although gallbladder adeno-squamous carcinoma has a poor prognosis, these many cases had a tendency to local infiltration accompanied with tumor fever. If curative resection might be obtained and the symptoms might be improved, aggressive resection should be performed.
Asunto(s)
Adenocarcinoma , Carcinoma de Células Escamosas , Neoplasias de la Vesícula Biliar , Neoplasias Hepáticas , Anciano , Femenino , Neoplasias de la Vesícula Biliar/cirugía , Humanos , Hígado , Neoplasias Hepáticas/cirugíaRESUMEN
A 69-year-old female underwent a mesh repair for an abdominal incisional hernia 4 years previously in our hospital. She visited local hospital for abdominal pain and fever. Abdominal CT showed a localizes abscess formation above the mesh, then she was taken to our hospital. We suspected mesh infection and performed emergent mesh removal. After the operation, we examined for her anemia. Her colonoscopy and CT findings pointed to transverse colon cancer. We performed right hemicolectomy, and final diagnosis was transverse colon cancer pT4aN0M0, pStage â ¡b. She underwent adjuvant chemotherapy, and 9 months after surgery, no recurrence was found.
Asunto(s)
Colon Transverso , Neoplasias del Colon , Anciano , Colectomía , Colon Transverso/cirugía , Neoplasias del Colon/complicaciones , Neoplasias del Colon/tratamiento farmacológico , Neoplasias del Colon/cirugía , Femenino , Humanos , Recurrencia Local de Neoplasia , Mallas QuirúrgicasRESUMEN
Small-bowel obstruction (SBO) during pregnancy is uncommon and can be difficult to diagnose. Therefore, the condition is associated with significant maternal and fetal mortality. We report a case of successful laparoscopic treatment of SBO in early pregnancy. A 37-year-old woman presented with diffuse abdominal pain and vomiting at 8 weeks of gestation. She had a history of abdominal surgery. Exploratory laparoscopy was performed by a gastrointestinal surgeon because SBO, and specifically strangulated ileus, was strongly suspected. On entry into the abdomen, dilated small bowel was visible in the pelvis; this was attached to the pelvic wall and twisted near the right adnexa. The small bowel initially appeared dark and congested, but after releasing the adhesions, it regained its normal color, was viable, and peristalsis was observed. Therefore, bowel resection was not required. No recurrence was observed after food ingestion, and the patient was discharged 12 days after surgery.
RESUMEN
INTRODUCTION: Oxaliplatin-induced peripheral neuropathy (OIPN) is a common adverse events that can limit a patient's quality of life during/after chemotherapy. However, no appropriate methods have been established yet for monitoring the risk of progression of OIPN. METHODS: A simple assessment tool using gem clips, the CLIP test, was established and its performance in predicting the risk of progression to ≥grade 2 peripheral sensory neuropathy (CTCAE ver. 4.0) was investigated in patients receiving chemotherapy with oxaliplatin. RESULTS: Among 101 patients included in this study, 71 patients developed CTCAE ≥grade 1 peripheral neuropathy (grade 1, n = 67; grade 2, n = 4) at a median of 63 (range, 14-259) days after the start of treatment. Of the 67 patients with grade 1 peripheral neuropathy, 17 showed progression to ≥grade 2 neuropathy after a median interval of 84 (range, 21-246) days. Of these patients, 27 showed a positive result of the CLIP test at a median of 91 (range, 14-224) days, excluding one patient who already showed a positive result of the test at the baseline. Therefore, the risk ratio for the development of CTCAE ≥grade 2 peripheral neuropathy was 8.3 in the patients who showed a positive result on the CLIP test. Multivariate analysis confirmed that a positive results on the CLIP test was significantly correlated with the risk of future development of CTCAE ≥grade 2 peripheral neuropathy (odds ratio, 9.37; P = 0.002). CONCLUSION: A positive result on the CLIP test predict is predictive of the risk of progression of OIPN during chemotherapy with oxaliplatin.
Asunto(s)
Oxaliplatino/efectos adversos , Enfermedades del Sistema Nervioso Periférico/inducido químicamente , Calidad de Vida/psicología , Adulto , Anciano , Antineoplásicos/uso terapéutico , Progresión de la Enfermedad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Oxaliplatino/farmacología , Estudios ProspectivosRESUMEN
BACKGROUND: Chemotherapy in relapsed colorectal cancer patients treated with oxaliplatin as adjuvant chemotherapy is under debate. REACT study aimed to investigate the efficacy of reintroducing modified FOLFOX6 (mFOLFOX6) or CAPOX with or without bevacizumab in recurrent colorectal cancer patients after oxaliplatin adjuvant chemotherapy. METHODS: Patients that participated in this trial had a medical history of adjuvant chemotherapy, including oxaliplatin with a cumulative dose greater than 400 mg/m2, and recurrence that was diagnosed more six months post adjuvant chemotherapy. Primary endpoints were response rate (RR) and disease control rate (DCR), while key secondary endpoints were time to treatment failure (TTF), progression-free survival (PFS), overall survival (OS), and safety. RESULTS: A total of 31 patients were enrolled between October 2012 and October 2016. Of the 29 eligible patients, 7 received mFOLFOX6 and 22 received CAPOX. The RR was 62.1% (95% confidence interval 42.3-79.3) and the DCR was 82.8% (95% confidence interval 64.2-94.2). The RR for oxaliplatin-free interval was 100.0% in months 6-12 and 56.0% after 12 months. Median TTF, PFS, and OS were 6.3, 10.8, and 28.7 months, respectively. Grade 3 or worse peripheral sensory neuropathy developed in 6.5%. Allergic reactions occurred in 12.9% of the patients, with one (3.2%) grade 3 episode. There were no other severe treatment-related adverse events. CONCLUSION: Reintroduction of oxaliplatin was feasible and achieved high RR or DCR in patients after more than 6 months post oxaliplatin adjuvant chemotherapy.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias Colorrectales/tratamiento farmacológico , Adulto , Anciano , Anciano de 80 o más Años , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Bevacizumab/administración & dosificación , Capecitabina/administración & dosificación , Quimioterapia Adyuvante , Neoplasias Colorrectales/mortalidad , Neoplasias Colorrectales/patología , Neoplasias Colorrectales/cirugía , Femenino , Fluorouracilo/administración & dosificación , Fluorouracilo/efectos adversos , Fluorouracilo/uso terapéutico , Humanos , Leucovorina/administración & dosificación , Leucovorina/efectos adversos , Leucovorina/uso terapéutico , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/tratamiento farmacológico , Compuestos Organoplatinos/administración & dosificación , Compuestos Organoplatinos/efectos adversos , Compuestos Organoplatinos/uso terapéutico , Oxaliplatino/administración & dosificación , Enfermedades del Sistema Nervioso Periférico/inducido químicamente , Estudios Prospectivos , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
In December 20XX-1, abdominal enhanced CT of a 73-year-old female patient showed a 28mm-in-diameter pancreatic tail cancer with splenic venous invasion. She underwent neoadjuvant GEM/TS-1 combination chemotherapy but abandoned this chemotherapy due to melena and exanthema. She underwent a distal pancreatectomy with lymph node dissemination. In these pathological findings, the tumor was diagnosed as a pancreatic tail cancer with splenic venous invasion(T3, N0, M0, Stage â ¡A). She underwent adjuvant GEM chemotherapy, but she abandoned this chemotherapy due to exanthema and was managed with observation. In September 20XX, she had a postoperative bowel obstruction and was treated with natural light. However, she had a postoperative bowel obstruction again in July, 20XX+1. Fluoroscopic images revealed stenosis in the intestine located 170 cm from the nasal cavity. She underwent open surgery to manage the bowel obstruction. There was a peritoneal tumor with adhesion to each intestine serosa in 3 areas located 80 cm, 100 cm, and 150 cm from the Treitz ligament. Therefore, she underwent a small intestine resection and anastomosis 70 cm to 110 cm from the Treitz ligament. Pathological findings showed that there was a 3mm-in-diameter adenocarcinoma in this peritoneal tumor. In these findings, this final diagnosis was an adhesive intestinal obstruction caused by peritoneal metastasis. Curative resection for single peritoneal recurrent metastasis might be useful for prognosis prolongation.
Asunto(s)
Obstrucción Intestinal , Neoplasias Pancreáticas , Neoplasias Peritoneales , Anciano , Femenino , Humanos , Obstrucción Intestinal/etiología , Pancreatectomía , Neoplasias Pancreáticas/cirugía , Neoplasias Peritoneales/secundario , PeritoneoRESUMEN
A man in his 60s with a large Type 3 gastric cancer presented with the chief complaint of epicardial discomfort. We decided to perform laparoscopy. The patient was diagnosed with cT4aN2M1(CY1), cStage â £ disease and was treated with XP(capecitabine plus cisplatin[CDDP])plus trastuzumab(HER). After chemotherapy, CY0 was confirmed using laparoscopy. The patient underwent total gastrectomy and D2 lymph node dissection. Histopathological examination revealed ypT4aN3M0, ypStage â ¢C disease. Therefore, adjuvant treatment with XP plus HER was continued. Four months after surgery, liver, lung, and # 16b1latLN metastases were observed on CT. The metastatic foci were observed even after 3 courses of ramucirumab plus paclitaxel. Nivolumab was administered as the third-line treatment; after 3 courses, the liver metastasis increased markedly. Hence, our final diagnosis was hyperprogressive disease(HPD).
Asunto(s)
Antineoplásicos Inmunológicos/uso terapéutico , Nivolumab/uso terapéutico , Neoplasias Gástricas , Protocolos de Quimioterapia Combinada Antineoplásica , Gastrectomía , Humanos , Masculino , Recurrencia Local de Neoplasia , Neoplasias Gástricas/tratamiento farmacológicoRESUMEN
A 50-year-old woman was admitted to our hospital due to intermittent epigastric pain and vomiting for 2 months. Contrast enhanced CT scan showed stenosis in the upper jejunum. She was diagnosed with small intestinal ileus. A small enteroscopy revealed a peripheral type 2 lesion in the upper jejunum, approximately 10 cm from the Treitz's ligament. Upon biopsy, she was diagnosed with a well-differentiated adenocarcinoma. A laparoscope-assisted extracorporeal operation was performed due to the ease of raising the umbilical wound. Swollen lymph nodes were found in the mesentery. A surgical margin of 5 cm on the oral side and 20 cm on the anal side was secured. We performed partial resection of the small intestine, including the mesentery with the enlarged lymph nodes. The histopathological diagnosis was a Type 2, 3×2 cm, tub2, pT4aN1aM0, pStage â ¢b small intestinal cancer. Due to the development of small intestinal ileus, the small bowel cancer was diagnosed preoperatively. Hence, it was slightly we will report including the literature consideration of.
Asunto(s)
Neoplasias Duodenales , Neoplasias del Íleon , Neoplasias del Yeyuno , Laparoscopía , Femenino , Humanos , Intestino Delgado/cirugía , Neoplasias del Yeyuno/cirugía , Persona de Mediana EdadRESUMEN
The patient was a 79-year-old woman. In January 20XX, upper gastrointestinal endoscopy revealed a duodenal tumor with bleeding and ulceration. This tumor was diagnosed as a duodenal neuroendocrine tumor(NET)based on biopsy findings. In March 20XX, the patient underwent pancreatoduodenectomy with lymph node dissemination. Based on these pathological findings, the tumor was diagnosed as a duodenal NET(G2)with a lymph node metastasis(T2, N1, M0, Stage â ¢). Twenty months after the operation, abdominal CT revealed multiple liver metastases(S4, S7, and S8). After this recurrence, she underwent the subcutaneous somatostatin analogue injection therapy every 28 days, and transarterial chemoembolization( TACE)when these recurrent tumors showed remarkable regrowth, once a year, accounting for her age. She has maintained good disease control for 5 years.
Asunto(s)
Carcinoma Hepatocelular , Quimioembolización Terapéutica , Neoplasias Duodenales , Neoplasias Hepáticas , Tumores Neuroendocrinos , Anciano , Neoplasias Duodenales/tratamiento farmacológico , Neoplasias Duodenales/cirugía , Femenino , Humanos , Neoplasias Hepáticas/tratamiento farmacológico , Neoplasias Hepáticas/cirugía , Recurrencia Local de Neoplasia , Tumores Neuroendocrinos/cirugía , PancreaticoduodenectomíaRESUMEN
A 78-year-old woman had undergone subtotal stomach-preserving pancreatoduodenectomy for acinar cell carcinoma (ACC)of the pancreatic head approximately 2 years before presentation, and the pathological diagnosis had been pT2pN0pM0, fStageâ B(JPS 7th). Adjuvant chemotherapy was discontinued after 3 months because of side effects. Contrast- enhanced CT and PET-CT 2 years postoperatively revealed a tumor measuring 2 cm with a high concentration of FDG in the minor curvature of the stomach. During laparotomy, a 3 cm large lymph node was palpated in the minor curvature of the stomach, and a small lymph node was found adjacently. We diagnosed the patient with multiple lymph node recurrences and performed gastric lymph node dissection of the minor curvature. The pathological diagnosis was a single 2 cm large ACC lymph node metastasis. The patient did not consent to postoperative adjuvant chemotherapy and showed no recurrence for 1 year and 7 months postoperatively. Pancreatic ACC is a rare pancreatic tumor, and its clinicopathologic features are still largely unknown. In recent years, there have been reports of active resection or long-term survival with anti-cancer drug treatment even in recurrent cases, such as the present case. However, the indication and method of anti-cancer treatment are unclear and might need the accumulation of many more cases.
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Carcinoma de Células Acinares , Neoplasias Gástricas , Anciano , Carcinoma de Células Acinares/cirugía , Femenino , Humanos , Escisión del Ganglio Linfático , Ganglios Linfáticos , Recurrencia Local de Neoplasia , Páncreas , Tomografía Computarizada por Tomografía de Emisión de Positrones , Neoplasias Gástricas/tratamiento farmacológico , Neoplasias Gástricas/cirugíaRESUMEN
A 60's woman was admitted to our hospital because of palpitations that occurred with exertion. Coronary angiography computed tomography(CT)of suspected angina detected a tumor in the pancreatic head region. Abdominal CT showed a poorly enhanced 40×32 mm solid tumor in the hepatoduodenal ligament that contained a fatty component and calcification. During surgery, the tumor was located in the hepatoduodenal ligament, adhered to the pancreatic head, common hepatic artery, gastroduodenal artery, portal vein and common bile duct. However, the tumor was resected by preserving them. The tumor contained stratified squamous epithelium, a sebaceous gland, nerve, a pancreatic gland, and an adrenal gland. The histological diagnosis was a mature cystic teratoma. The patient showed no recurrence in 2 years and 10 months post-surgery. Mature teratomas in the hepatoduodenal ligament are extremely rare. Some reports showed that combined resection was performed when the tumor was in contact with the common bile duct, portal vein, and arteries. However, in our case, the tumor was removed relatively safely without combined resection.
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Recurrencia Local de Neoplasia , Teratoma , Femenino , Humanos , Ligamentos/cirugía , Hígado , Epiplón , Teratoma/cirugíaRESUMEN
An 84-year-old woman with a chief complaint of right lower abdominal pain was admitted to our hospital in November 20XX. Abdominal CT scan revealed a 9.6×4.1 cm diameter low density area proximal to the 13 mm diameter appendix, which led to perforated appendicitis with a huge abscess. The patient underwent an open appendectomy with partial cecum resection. The appendix was found to be twisted by 540°. The pathological diagnosis was low-grade appendiceal mucinous neoplasm(LAMN). Recent research has found that the use of laparoscopic surgery for the treatment of LAMN has been increasing. Appropriate surgical intervention should be considered for LAMN because it is a borderline malignancy. Careful treatment with laparoscopic surgery might be considered as one of the treatment options for LAMN. We hope to accumulate more cases of LAMN to confirm our results.