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1.
Surg Case Rep ; 7(1): 90, 2021 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-33847839

RESUMO

BACKGROUND: Pancreatic acinar cell carcinoma (PACC) is a rare exocrine malignant tumor. Its widespread intraductal extension into the main pancreatic duct (MPD) is also rare. CASE PRESENTATION: We report the case of a 71-year-old man with PACC with MPD extension. The patient was assessed with laboratory and radiographic investigations that facilitated a preoperative diagnosis. Endoscopic ultrasonography (EUS) and dynamic thin-slice multi-detector row computed tomography (MDCT) were useful for determining the resection line of the pancreas. EUS-guided fine needle aspiration (EUS-FNA) was also helpful in determining the tumor biology and treatment strategy. Distal pancreatectomy was performed. The MPD was occupied by the tumor 35 mm downstream and 5 mm upstream. Histopathologically, the pancreatic tail tumor extended continuously into the MPD. The tumor was solid with cells showing eosinophilic and granular cytoplasm, indicating the diagnosis of PACC. This is an interesting case of PACC with intraductal extension into the MPD. We discuss the possible mechanisms of tumor extension in this rare case together with a review of the literature. CONCLUSIONS: We describe a rare pancreatic acinar cell carcinoma that could be adequately treated using preoperative precise imaging and histopathological evaluations. When an intraductal tumor extension in the MPD is encountered, the diagnosis of a rare pancreatic tumor should be considered, as in our case.

2.
Am J Case Rep ; 22: e927562, 2021 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-33424018

RESUMO

BACKGROUND Type 1 neurofibromatosis (NF1) is known to be associated with not only neurogenic tumors but also gastrointestinal (GI) neoplasms. However, there are few reports on vascular lesions and the incidence is unknown. CASE REPORT We report here the case of a 45-year-old woman with a history of NF1 referred to our hospital for the purpose of detailed examination for positive fecal occult blood test. On the basis of the investigation reports, she was diagnosed with a neuroendocrine tumor (NET)-G1. We planned a subtotal stomach-preserving pancreaticoduodenectomy. The abdominal structures, including the vascular system, were abnormally fragile, and it was very difficult to achieve satisfactory hemostasis. The total amount of intraoperative blood loss was 7580 mL. Fulminant intra-abdominal bleeding occurred on postoperative day (POD) 3. Urgent angiography showed a rupture of the gastroduodenal artery. Transarterial embolization was performed, but the patient died of multiorgan failure on POD5. On histological examination, neurofibroma cells proliferating into the surrounding blood vessels were seen; moreover, immunohistochemistry staining with S-100 antibody showed positive neurofibroma cells surrounding the vascular wall. The pathological diagnosis was duodenal NET-G1 with multinodal involvement. CONCLUSIONS This case is a rare presentation of a NET with multiple gastrointestinal stromal tumors associated with NF1, which led to a fatal outcome due to the extreme fragility of the vessel walls. Since patients with NF1 might have vulnerable vessel walls, adequate surgical preparation for major surgical treatment is necessary.


Assuntos
Neoplasias Duodenais , Tumores do Estroma Gastrointestinal , Neoplasias Intestinais , Tumores Neuroendócrinos , Neurofibromatose 1 , Neoplasias Duodenais/complicações , Neoplasias Duodenais/diagnóstico , Neoplasias Duodenais/cirurgia , Feminino , Tumores do Estroma Gastrointestinal/complicações , Tumores do Estroma Gastrointestinal/diagnóstico , Humanos , Pessoa de Meia-Idade , Tumores Neuroendócrinos/complicações , Tumores Neuroendócrinos/diagnóstico , Neurofibromatose 1/complicações , Neurofibromatose 1/diagnóstico
3.
Int J Surg Case Rep ; 79: 302-306, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33493860

RESUMO

INTRODUCTION AND IMPORTANCE: The incidence of intestinal malrotation is 1 in 6000 births, and 90% of cases occur within the first year of life. Adult cases are rare, with a reported incidence of 0.2%-0.5% of all cases. The significance of reporting this case is to recognize that some adult-onset cases require surgery even in the absence of intestinal necrosis. CASE PRESENTATION: A 36-year-old man was infected with streptococcus and treated with antibiotics. He developed appetite loss and his weight decreased 12 kg in 4 months. His abdomen was flat and soft with no tenderness. A computed tomography scan showed that the horizontal duodenal leg was not anchored to the retroperitoneum. Rotation of the mesentery, which was wrapped around the superior mesenteric artery in a clockwise direction, was observed, suggesting midgut volvulus. We performed emergency surgery and Ladd's procedure. CLINICAL DISCUSSION: A previous study reported that the most common symptom in the chronic course of intestinal malrotation was abdominal pain in 41.2% of cases, and weight loss was observed in only 2.6% of patients. The high degree of intestinal adhesion suggests that repeated torsion and release and the development of collateral vessels may have contributed to the asymptomatic course. CONCLUSION: Adult-onset intestinal malrotation should be considered as a differential diagnosis in the presence of weight loss and gastrointestinal symptoms. The timing of surgery is still controversial. In chronic cases, severe adhesion might be expected and laparoscopic surgery should be considered carefully.

4.
Clin J Gastroenterol ; 14(1): 370-374, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33063294

RESUMO

Pancreatic lymphoepithelial cysts (LECs) are rare cystic lesions filled with a keratinous substance and lined by squamous epithelium with underlying lymphoid tissue. Because pancreatic LECs are entirely benign, correct preoperative diagnosis is important to avoid unnecessary surgery. However, the imaging features of pancreatic LECs are not specific and preoperative diagnosis has proven difficult. A pancreatic mass was incidentally detected through abdominal ultrasonography in a 63-year-old male presenting without any symptoms. Computed tomography showed an exophytic cystic lesion in the pancreatic head. The lesion had heterogeneous high signal intensity with partial low intensity on T2-weighted magnetic resonance imaging (MRI) and high signal intensity on diffusion MRI. Endoscopic ultrasound (EUS) examination showed an encapsulated cystic lesion with relatively homogenous and highly echoic contents. EUS-guided fine-needle aspiration (EUS-FNA) revealed caseous appearance and rare fragments of apparently benign squamous epithelium on a background of keratinous debris, cyst contents, and scattered lymphocytes. We diagnosed a pancreatic LEC and opted for conservative management without surgery. Pathological evaluation based on images obtained through EUS-FNA showed macro- and microscopic features that were critical to determining the management strategy. In conclusion, the imaging and pathological features of pancreatic LECs can inform preoperative diagnosis, which may enable conservative management.


Assuntos
Cisto Pancreático , Neoplasias Pancreáticas , Tratamento Conservador , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Endossonografia , Humanos , Masculino , Pessoa de Meia-Idade , Pâncreas/diagnóstico por imagem , Cisto Pancreático/diagnóstico por imagem , Cisto Pancreático/terapia
5.
Gan To Kagaku Ryoho ; 47(13): 2038-2040, 2020 Dec.
Artigo em Japonês | MEDLINE | ID: mdl-33468793

RESUMO

An 86-year-old woman underwent mastectomy with sentinel lymph node biopsy for cStage ⅡA breast cancer. The subtype of tumor was triple negative breast cancer. Pulmonary metastasis was found 1 month after surgery. Chemotherapy was done because of her good performance status(PS)and her hope. Administration of S-1 produced SD status of tumor for 8 months. However, NCC-ST-439 was increased and tumor size was enlarged. Therefore, the second line of chemotherapy by low-dose- biweekly paclitaxel and bevacizumab was planned because of her high age and good PS. Thereafter, tumor maker levels dramatically decreased and lung metastasis turned to be small. This therapy had been continued without any severe adverse events for 9 months. Unfortunately, this therapy was failed because of proteinuria, but pulmonary metastasis kept favorable efficacy during administration. Biweekly low-dose paclitaxel and bevacizumab therapy can be safe and effective therapy even for elderly patient with recurrent and metastatic breast cancer.


Assuntos
Neoplasias da Mama , Paclitaxel , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Bevacizumab/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/cirurgia , Feminino , Humanos , Mastectomia , Recidiva Local de Neoplasia/tratamento farmacológico , Paclitaxel/uso terapêutico
6.
J Med Case Rep ; 12(1): 314, 2018 Oct 27.
Artigo em Inglês | MEDLINE | ID: mdl-30367665

RESUMO

BACKGROUND: Most colorectal cancer liver metastases form nodules within the hepatic parenchyma, and hepatectomy is the only radical treatment for synchronous metastases. There is concern about intrabiliary tumor growth which may affect the surgical margin, resulting in local recurrence after hepatectomy for colorectal cancer liver metastasis; however, there has been no report of the dissemination in the bile duct after hepatectomy. Here, we report an unusual case of biliary dissemination of colorectal cancer that caused recurrent intrabiliary growth after hepatectomy, and discuss the management of intrabiliary metastasis of colorectal cancer. CASE PRESENTATION: A 69-year-old Japanese man underwent treatment for liver dysfunctions 3 years after aortic valve replacement. Computed tomography revealed an enhanced tumor within the hilar bile duct and dilatation of the left hepatic duct, typical of hilar cholangiocarcinoma. Endoscopic retrograde cholangiopancreatography revealed tumor shadow in his bile duct, and the cytology confirmed malignant cells in the bile. We performed extended left hepatectomy with bile duct resection; his postoperative course remained good without acute complications. After 3 months postoperatively, he was readmitted for subacute cholangitis and obstructive jaundice. Immediately, percutaneous transhepatic cholangiography drainage was performed, followed by cholangiography that exhibited intrabiliary tumor growth in the remnant liver. On immunohistochemical examination, tumor cells were positive for cytokeratin 20 and CDX2 but negative for cytokeratin 7. Then, computed tomography revealed an enhanced tumor-like lesion at the descending colon. After 3 months, left hemicolectomy was performed. Meanwhile, the percutaneous transhepatic cholangiography drainage fluid turned bloody, which was considered to be bleeding from a residual bile duct tumor. Accordingly, radiotherapy was initiated to prevent tumor bleeding around the hilar bile duct, but, unfortunately, the effects were short-lived, and cholangitis rebooted after 1 month leading to our patient's death due to septic liver failure. Autopsy revealed a remnant tumor in the bile duct, but no noticeable nodular metastasis was observed, except for a single small metastasis in the lower lobe of the left lung. CONCLUSIONS: The intrabiliary growth of metastatic colorectal cancer mimics cholangiocarcinoma occasionally. To date, as the effect of chemotherapy or radiotherapy remains uncertain, the complete resection of a bile duct tumor is the only method which could result in a better prognosis.


Assuntos
Neoplasias dos Ductos Biliares/patologia , Ductos Biliares/patologia , Colangiocarcinoma/patologia , Neoplasias do Colo/patologia , Hepatectomia , Neoplasias Hepáticas/secundário , Fígado/patologia , Idoso , Neoplasias dos Ductos Biliares/cirurgia , Neoplasias do Colo/cirurgia , Evolução Fatal , Humanos , Neoplasias Hepáticas/cirurgia , Masculino , Recidiva Local de Neoplasia , Tomografia Computadorizada por Raios X
7.
Am J Case Rep ; 19: 133-136, 2018 Feb 06.
Artigo em Inglês | MEDLINE | ID: mdl-29402880

RESUMO

BACKGROUND Primary small bowel cancer is a rare malignancy; the common histopathological types are carcinoid and adenocarcinoma. Inflammatory bowel diseases and familial adenomatous polyposis are known risk factors for small bowel cancer. Additionally, cases of surgery-induced small bowel adenocarcinoma are sometimes reported after ileostomy. CASE REPORT A 84-year-old woman, who had undergone ileotransversostomy for intestinal obstruction due to postoperative adhesion following appendectomy at the age of 31 years, was referred to our hospital for further examination after experiencing abdominal pain in the right lower quadrant for 2 weeks. Laboratory data showed elevated serum levels of carcinoembryonic antigen (CEA, 102.9 ng/ml) and carbohydrate antigen 19-9 (CA19-9, 104 U/ml). Enhanced computed tomography (CT) revealed a 10-cm mass in the terminal ileum and a distention of the ileum and colon in the blind loop, with retention of feces. The patient was suspected of having ileal cancer by preoperative examination; therefore, right hemicolectomy with en bloc resection was performed. The tumor was histopathologically diagnosed as a well-differentiated and mucinous adenocarcinoma of the ileum. At over 12 months after surgery, tumor recurrence had not been observed. CONCLUSIONS Difficulties in diagnosis can cause delays in treatment and lead to poor prognosis, mainly because tumors in the small bowel rarely cause clinical symptoms. Adenocarcinoma of the ileum should be considered in postoperative patients with ileotransversostomy.


Assuntos
Adenocarcinoma/diagnóstico , Neoplasias do Íleo/diagnóstico , Ileostomia , Adenocarcinoma/cirurgia , Idoso de 80 Anos ou mais , Apendicectomia/efeitos adversos , Feminino , Humanos , Neoplasias do Íleo/cirurgia , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Fatores de Tempo
8.
Ann Med Surg (Lond) ; 10: 57-60, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27547398

RESUMO

INTRODUCTION: Sevelamer is an anion exchange resin used to treat hyperphosphatemia. A common adverse effect of sevelamer is constipation. According to a review of the available literature, colon perforation associated with this resin agent was less common. PRESENTATION OF CASE: A 66-year-old man complaining of lower abdominal pain was transferred to our hospital. The patient had been undergoing hemodialysis for chronic renal failure due to rapidly progressive glomerulonephritis, and had been receiving sevelamer hydrochloride 4.5 g/day for 8years as treatment for hyperphosphatemia. Abdominal computed tomography revealed ascites, free air in the abdominal cavity, multiple diverticula of the sigmoid colon, as well as increased fat tissue surrounding the sigmoid colon. We diagnosed colonic perforation and performed emergency surgery, which revealed a 5 × 5 mm perforation in the sigmoid colon surrounded with soft stool. Histopathologically, sevelamer crystals were detected at the perforation site. DISCUSSION: We theorize that physical stimulation by sevelamer crystals contributed to colon perforation at the already vulnerable diverticulum site. CONCLUSION: When sevelamer is administered to patients with hemodialysis, the risk of intestinal perforation should be considered.

9.
J Endovasc Ther ; 21(4): 589-97, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25101592

RESUMO

PURPOSE: To report a rare and complicated case of immunoglobulin (Ig) G4-related periaortitis involving both the aortic wall and the retroperitoneum without aneurysmal formation. CASE REPORT: A 79-year-old man with IgG4-related periaortitis suffered aortic rupture despite a normal caliber aorta after 6 months of steroid therapy (20 mg/d). Endovascular repair with an aortic cuff sealed the rupture. Steroid therapy was halted 2 weeks later due to infection. Four months later, a biopsy during esophagogastroduodenoscopy to investigate gastrointestinal bleeding suggested a relapse of IgG4-RD in the duodenum. Subsequent aortoduodenal fistula formation proved fatal. Generally, IgG4-related periaortitis does not result in such complications due to the absence of aneurysm formation and a thick aortic wall. CONCLUSIONS: Our report highlights a rare case of IgG4-related periaortitis where complications resulted following steroid therapy and surgical intervention, emphasizing the difficulties in dealing with IgG4-related cardiovascular lesions.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Ruptura Aórtica/cirurgia , Aortite/imunologia , Duodenopatias/imunologia , Procedimentos Endovasculares/efeitos adversos , Imunoglobulina G/análise , Fístula Intestinal/imunologia , Fístula Vascular/imunologia , Idoso , Aneurisma da Aorta Abdominal/diagnóstico , Aneurisma da Aorta Abdominal/imunologia , Ruptura Aórtica/diagnóstico , Ruptura Aórtica/imunologia , Aortite/complicações , Aortite/diagnóstico , Aortite/tratamento farmacológico , Aortografia/métodos , Biópsia , Implante de Prótese Vascular , Duodenopatias/diagnóstico , Endoscopia Gastrointestinal , Infecções por Escherichia coli/imunologia , Infecções por Escherichia coli/microbiologia , Evolução Fatal , Hemorragia Gastrointestinal/imunologia , Humanos , Hospedeiro Imunocomprometido , Fístula Intestinal/diagnóstico , Masculino , Fatores de Risco , Esteroides/efeitos adversos , Fatores de Tempo , Tomografia Computadorizada por Raios X , Fístula Vascular/diagnóstico
10.
Cancer Immunol Immunother ; 63(5): 479-89, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24633336

RESUMO

Cancer vaccine therapy is one of the most attractive therapies as a new treatment procedure for pancreatic adenocarcinoma. Recent technical advances have enabled the identification of cytotoxic T lymphocyte (CTL) epitopes in various tumor-associated antigens (TAAs). However, little is known about which TAA and its epitope are the most immunogenic and useful for a cancer vaccine for pancreatic adenocarcinoma. We examined the expression of 17 kinds of TAA in 9 pancreatic cancer cell lines and 12 pancreatic cancer tissues. CTL responses to 23 epitopes derived from these TAAs were analyzed using enzyme-linked immunospot (ELISPOT), CTL, and tetramer assays in 41 patients, and factors affecting the immune responses were investigated. All TAAs were frequently expressed in pancreatic adenocarcinoma cells, except for adenocarcinoma antigens recognized by T cells 1, melanoma-associated antigen (MAGE)-A1, and MAGE-A3. Among the epitopes recognized by CTLs in more than two patients in the ELISPOT assay, 6 epitopes derived from 5 TAAs, namely, MAGE-A3, p53, human telomerase reverse transcriptase (hTERT), Wilms tumor (WT)-1, and vascular endothelial growth factor receptor (VEGFR)2, could induce specific CTLs that showed cytotoxicity against pancreatic cancer cell lines. The frequency of lymphocyte subsets correlated well with TAA-specific immune response. Overall survival was significantly longer in patients with TAA-specific CTL responses than in those without. P53, hTERT, WT-1, and VEGFR2 were shown to be attractive targets for immunotherapy in patients with pancreatic adenocarcinoma, and the induction of TAA-specific CTLs may improve the prognosis of these patients.


Assuntos
Adenocarcinoma/imunologia , Antígenos de Neoplasias/imunologia , Vacinas Anticâncer/imunologia , Neoplasias Pancreáticas/imunologia , Adenocarcinoma/mortalidade , Idoso , Epitopos de Linfócito T/imunologia , Feminino , Citometria de Fluxo , Humanos , Estimativa de Kaplan-Meier , Masculino , Neoplasias Pancreáticas/mortalidade , Reação em Cadeia da Polimerase em Tempo Real , Linfócitos T Citotóxicos/imunologia , Telomerase/imunologia , Proteína Supressora de Tumor p53/imunologia , Receptor 2 de Fatores de Crescimento do Endotélio Vascular/imunologia
11.
Oncol Rep ; 30(4): 1561-74, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23863893

RESUMO

The eligibility criteria of liver transplantation (LT) for hepatocellular carcinoma (HCC) must clearly confirm the prognosis not only from pathological diagnosis but also from pre-operative imaging diagnosis. In the present study, we evaluated published eligibility criteria for LT based on both pre-operative imaging diagnosis and pathological diagnosis using living donor liver transplantation (LDLT) recipients at our hospital by α-smooth muscle actin (SMA)-positive cancer-associated fibroblasts (CAFs) in HCC. The Up-to-seven (Up-to-7), Asan and Tokyo criteria were evaluated, in both overall survival and HCC disease-free survival, to be statistically significantly beneficial criteria to define post-LDLT prognosis. Recipients only within Up-to-7 criteria based on both pre-operative imaging diagnosis and pathological diagnosis survived without HCC recurrence. Recipients with proliferation of α-SMA-positive CAFs in HCC had significantly poorer prognosis. All survival recipients without HCC recurrence, who were above the Up-to-7 criteria in pathological diagnosis, had no proliferation of α-SMA-positive CAFs. As a result of multivariate analysis, the significant independent factors defining prognosis of recipients after LDLT for HCC were Up-to-7 criteria and proliferation of α-SMA-positive CAFs. The ideal eligibility criteria for LDLT with HCC is Up-to-7 criteria and α-SMA-positive CAFs was considered to be an important factor in HCC recurrence. LDLT should be limited to recipients within Up-to-7 criteria or without proliferation of α-SMA-positive CAFs.


Assuntos
Carcinoma Hepatocelular/cirurgia , Definição da Elegibilidade/métodos , Neoplasias Hepáticas/cirurgia , Transplante de Fígado , Doadores Vivos , Actinas/metabolismo , Carcinoma Hepatocelular/metabolismo , Intervalo Livre de Doença , Feminino , Humanos , Neoplasias Hepáticas/metabolismo , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/cirurgia , Estadiamento de Neoplasias , Seleção de Pacientes , Prognóstico , Resultado do Tratamento
12.
World J Gastroenterol ; 19(20): 3161-4, 2013 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-23716999

RESUMO

We present the first case of an intraductal papillary neoplasm of the bile duct (IPNB) accompanying a mixed adenoneuroendocrine carcinoma (MANEC). A 74-year-old woman presented with fever of unknown cause. Laboratory data revealed jaundice and liver injury. Contrast-enhanced computed tomography revealed a 20 mm polypoid tumor in the dilated distal bile duct, which exhibited early enhancement and papillary growth. Upper gastrointestinal endoscopy revealed mucus production from the papilla of Vater, characterized by its protruding and dilated orifice. Endoscopic ultrasonography visualized the polypoid tumor in the distal bile duct, but no invasive region was suggested by diagnostic imaging. Therefore, the initial diagnosis was IPNB. After endoscopic nasobiliary drainage, a pylorus-preserving pancreaticoduodenectomy was performed. Pathological examination of the resected bile duct revealed papillary proliferation of biliary-type cells with nuclear atypia, indicating pancreaticobiliary-type IPNB. In addition, solid portions comprised of tumor cells with characteristic salt-and-pepper nuclei were evident. Immunohistochemistry revealed expression of the neuroendocrine marker synaptophysin in this solid component, diagnosing it as a neuroendocrine tumor (NET). Furthermore, the MIB-1 proliferation index of NET was higher than that of IPNB, and microinvasion of the NET component was found, indicating neuroendocrine carcinoma (NET G3). This unique case of MANEC, comprising IPNB and NET, provides insight into the pathogenesis of biliary NET.


Assuntos
Adenocarcinoma/patologia , Neoplasias dos Ductos Biliares/patologia , Carcinoma Neuroendócrino/patologia , Carcinoma Papilar/patologia , Neoplasias Complexas Mistas/patologia , Neoplasias Primárias Múltiplas/patologia , Adenocarcinoma/química , Adenocarcinoma/cirurgia , Idoso , Neoplasias dos Ductos Biliares/química , Neoplasias dos Ductos Biliares/cirurgia , Biomarcadores Tumorais/análise , Biópsia , Carcinoma Neuroendócrino/química , Carcinoma Neuroendócrino/cirurgia , Carcinoma Papilar/química , Carcinoma Papilar/cirurgia , Drenagem , Endoscopia Gastrointestinal , Endossonografia , Feminino , Humanos , Imuno-Histoquímica , Neoplasias Complexas Mistas/química , Neoplasias Complexas Mistas/cirurgia , Neoplasias Primárias Múltiplas/química , Neoplasias Primárias Múltiplas/cirurgia , Pancreaticoduodenectomia , Valor Preditivo dos Testes , Tomografia Computadorizada por Raios X
13.
J Hepatobiliary Pancreat Sci ; 20(5): 518-24, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23430053

RESUMO

PURPOSE: Hepatectomy of segments 4a and 5 (S4a+5) is the recommended treatment for pT2 gallbladder cancer. However, gallbladder bed resection is also occasionally used. Using nationwide data from the Japanese Biliary Tract Cancer Registry and a questionnaire survey, we retrospectively compared these 2 methods of treatment. METHOD: The study involved 85 patients with pT2, pN0 gallbladder cancer (55 treated with gallbladder bed resection, and 30, with S4a+5 hepatectomy). The prognosis and mode of tumor recurrence following treatment were analyzed retrospectively, with overall survival as the endpoint. RESULTS: The 5-year survival rate did not differ significantly between the 2 groups. Univariate analysis showed that bile duct resection and perineural tumor invasion were significant prognostic factors, but the extent of hepatectomy, location of the major intramural tumor, regional lymph node excision, and histological type were not. Multivariate analysis identified perineural tumor invasion as a significant prognostic factor. Recurrence occurred most frequently in both lobes than S4a+5 of the liver following gallbladder bed resection. CONCLUSION: In the present study of cases of Japanese Biliary Tract Cancer Registry, it was not possible to conclude that S4a+5 hepatectomy was superior to gallbladder bed resection.


Assuntos
Neoplasias da Vesícula Biliar/cirurgia , Hepatectomia/métodos , Idoso , Feminino , Neoplasias da Vesícula Biliar/epidemiologia , Neoplasias da Vesícula Biliar/patologia , Humanos , Japão/epidemiologia , Excisão de Linfonodo , Masculino , Gradação de Tumores , Invasividade Neoplásica , Recidiva Local de Neoplasia , Complicações Pós-Operatórias/epidemiologia , Prognóstico , Sistema de Registros , Estudos Retrospectivos , Inquéritos e Questionários , Taxa de Sobrevida
14.
Mol Clin Oncol ; 1(3): 418-422, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-24649185

RESUMO

Although pancreatic carcinoma frequently extends posteriorly beyond the pancreatic parenchyma, retroperitoneal organs such as the inferior vena cava (IVC) and the adrenal gland are rarely involved. The fusion fascia lies between the pancreas and these retroperitoneal organs. This study investigated the role of the fusion fascia in the prevention of infiltration of retroperitoneal structures by pancreatic carcinoma. This study was conducted on 140 patients who underwent pancreatic carcinoma resection at our hospital. Retropancreatic infiltration was divided into three grades as follows: Grade 0, carcinoma confined within the pancreatic parenchyma; grade 1, carcinoma infiltrating beyond the parenchyma but within the fusion fascia; and grade 2, infiltration of retroperitoneal tissues beyond the fusion fascia. Grade 0 was found in 24%, grade 1 in 73% and grade 2 in 3% of the cases. There was no significant difference in the prevalence of grade 2 between pancreatoduodenectomy (PD) and distal pancreatectomy (DP). Pancreatic carcinoma infiltrated posteriorly beyond the parenchyma in over 70% of our cases; however, grade 2 infiltration was a rare finding and tumor invasion was confined within the fusion fascia in almost all the cases. Thus, the fusion fascia may act as a barrier against retroperitoneal tissue infiltration by pancreatic carcinoma.

15.
Surg Today ; 43(9): 1058-61, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22886607

RESUMO

This report presents a case that was successfully treated for acquired factor VIII inhibitor after extensive visceral surgery. A 71-year-old male who underwent surgery for bile duct cancer had active bleeding in the abdominal drainage tube on postoperative day (POD) 5, and prolonged activated partial thromboplastin time (aPTT) was detected (83.1 s) on POD 7. An extensive coagulation work-up revealed factor VIII deficiency (1 %), and a diagnosis of an acquired factor VIII deficiency was established when a factor VIII inhibitor of 8 Bethesda units was demonstrated. The patient was treated with activated prothrombin complex concentrate (aPCCs) and bloody discharge was stopped within 3 days. Inhibitor elimination was started using prednisolone on POD 20; rituximab, was administered on POD 74 and 81. Factor VIII inhibitor had disappeared by POD 124, and factor VIII (72 %) and aPTT recovered to 45.9 s. This case report demonstrated the efficacy of aPCCs and rituximab in the treatment of acquired hemophilia associated with visceral surgery.


Assuntos
Inibidores dos Fatores de Coagulação Sanguínea/sangue , Fatores de Coagulação Sanguínea/uso terapêutico , Fator VIII/antagonistas & inibidores , Hemofilia A/tratamento farmacológico , Complicações Pós-Operatórias/tratamento farmacológico , Hemorragia Pós-Operatória/tratamento farmacológico , Hemorragia Pós-Operatória/etiologia , Idoso , Anticorpos Monoclonais Murinos/uso terapêutico , Neoplasias dos Ductos Biliares/cirurgia , Biomarcadores/sangue , Hemofilia A/complicações , Hemofilia A/diagnóstico , Hemofilia A/etiologia , Humanos , Masculino , Tempo de Tromboplastina Parcial , Cuidados Pós-Operatórios , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Rituximab , Fatores de Tempo , Resultado do Tratamento
16.
Asian J Surg ; 35(2): 57-61, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-22720859

RESUMO

BACKGROUND/OBJECTIVE: Recently, endoscopic and radiological procedures for various symptoms related to cirrhosis have improved. Thus, the role of Hassab's operation (gastroesophageal decongestion and splenectomy) has changed for cirrhotic patients. METHODS: Hassab's operation was performed on patients who had gastroesophageal varices that were difficult to control with balloon occluded retrograde transvenous obliteration or an endoscopic procedure, or had hypersplenism. Thirteen consecutive patients underwent this operation, and the outcomes of all patients were reviewed retrospectively. RESULTS: There was no operative morbidity or rebleeding varices. In the preoperative endoscopic injection sclerotherapy treated group (n=6), only one patient (16.7%) developed recurrent varices. Mean platelet counts were significantly higher 6 months after surgery (201 ± 65 × 10(3)/mm(3)) than preoperatively (64 ± 54 × 10(3)/mm(3)). In patients with hepatocellular carcinoma, percutaneous therapies, such as radio frequency ablation, were safely performed with adequate therapeutic effect. Interferon therapy was given to patients with hepatitis C virus (HCV)-related cirrhosis without interruption. CONCLUSION: Hassab's operation is a satisfactory approach to controlling varices, especially when combined with preoperative endoscopic treatment. Platelet counts were significantly higher after surgery. This therapy was important for cirrhotic patients contraindicated for liver transplantation in that they could continue their therapy for hepatocellular carcinoma (HCC) and HCV as needed.


Assuntos
Varizes Esofágicas e Gástricas/cirurgia , Esôfago/cirurgia , Hemorragia Gastrointestinal/cirurgia , Hiperesplenismo/cirurgia , Cirrose Hepática/complicações , Esplenectomia , Adulto , Idoso , Terapia Combinada , Varizes Esofágicas e Gástricas/etiologia , Varizes Esofágicas e Gástricas/terapia , Esôfago/irrigação sanguínea , Feminino , Seguimentos , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Humanos , Hiperesplenismo/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Escleroterapia , Resultado do Tratamento
17.
Surg Today ; 41(6): 859-64, 2011 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-21626338

RESUMO

Metastasis of the small intestine that derives from a primary hepatic neoplasm is rare. We encountered a case of intrahepatic cholangiocarcinoma (ICC) with jejunal metastasis after resection of a primary lesion. A 61-year-old male patient was referred to us with a diagnosis of liver tumors. Partial hepatectomy was performed, and the pathological diagnosis was ICC. Seventeen months after surgery, the patient was found to have a mass in the jejunum and lymph node swelling by positron emission tomography-computed tomography. The jejunal tumor was preoperatively diagnosed as a metastasis of ICC from a biopsy specimen obtained by double balloon endoscopy, and the tumor was resected. The patient received systemic chemotherapy but succumbed with ICC recurrence 46 months after the primary surgery. To the best of our knowledge, this case is the first report of jejunal recurrence of ICC. In addition, this report suggests the usefulness of double balloon endoscopy to make the correct diagnosis of the jejunal tumor.


Assuntos
Neoplasias dos Ductos Biliares/patologia , Ductos Biliares Intra-Hepáticos , Colangiocarcinoma/secundário , Neoplasias do Jejuno/secundário , Neoplasias dos Ductos Biliares/cirurgia , Colangiocarcinoma/cirurgia , Endoscopia Gastrointestinal , Evolução Fatal , Hepatectomia , Humanos , Neoplasias do Jejuno/cirurgia , Masculino , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios X
18.
Nihon Geka Gakkai Zasshi ; 112(3): 164-9, 2011 May.
Artigo em Japonês | MEDLINE | ID: mdl-21688459

RESUMO

Curative resection has been shown to be one of the key factors affecting the survival of patients with carcinomas of the head of the pancreas. However, local recurrence is very common, and Esposito and colleagues stated that: "Most pancreatic cancer resections are R1 resections." In 2002, we developed a new method for en bloc resection of the pancreatic head including the superior mesenteric artery (SMA) and vein (SMV) for pancreatic head carcinoma with portomesenteric invasion, called "augmented regional pancreatoduodenectomy (ARPD)." The technical and general eligibility criteria for ARPD are: 1) presumed achievement of R0 status; 2) tumor infiltration proximal to the SMV and SMA; and 3) tumor respecting the hepatic artery, splenic artery, and celiac trunk and neither hepatic nor paraaortic nodal metastasis. Between 2002 and 2010, 17 patients underwent ARPD in our institution. Postoperative death occurred in 2 patients. One death occurred after full-dose radiotherapy and the other after rupture of an aortic aneurysm. The surgical margins (R0) were histologically negative in 14 patients (82%). The overall 5-year survival probabilities were 24% in R0. Three patients survived more than 5 years. The ARPD procedure has advantages in obtaining sufficient margins at the uncinate and posterior site in patients with pancreatic head carcinoma.


Assuntos
Artéria Mesentérica Superior/cirurgia , Veias Mesentéricas/cirurgia , Pancreatectomia/métodos , Neoplasias Pancreáticas/cirurgia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/mortalidade , Taxa de Sobrevida
19.
J Gastrointest Surg ; 15(1): 229-31, 2011 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-20532665

RESUMO

We report a patient of lower esophageal carcinoma with reversed intestinal rotation and major vascular anomalies including pre-duodenal pre-pancreatic portal vein, absence of the confluence of the splenic vein with the superior mesenteric vein, and deficiency of the common hepatic artery. We performed subtotal esophagectomy with three-field lymphadenectomy following reconstruction with the stomach. The postoperative course was uneventful. This might be the first case that had such complicated anatomical anomalies and radical esophagectomy was performed. As we had preoperatively recognized these anatomical anomalies on radiographic examinations, we could successfully perform esophagectomy and reconstruction without any complications.


Assuntos
Neoplasias Esofágicas/cirurgia , Esofagectomia/métodos , Artéria Hepática/anormalidades , Veias Mesentéricas/anormalidades , Veia Esplênica/anormalidades , Malformações Vasculares/complicações , Angiografia , Diagnóstico Diferencial , Neoplasias Esofágicas/complicações , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Malformações Vasculares/diagnóstico por imagem
20.
Oncol Rep ; 24(6): 1433-41, 2010 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21042737

RESUMO

The immunological response in the regional lymph nodes (LN) of gastric cancer patients who had metastasis was studied by investigating both the degree of metastasis and the maturation status of dendritic cells (DCs). A total of 732 LNs was obtained from 29 gastric cancer patients, including 25 patients whose LNs were pathological metastasis-negative and 4 patients with metastasis-positive LNs. Micrometastasis (MM) in the LNs was analyzed by immunohistochemical staining of cytokeratin (CK) (IHC-MM) and by amplifying CEA and CK19 mRNA by quantitative real-time RT-PCR (PCR-MM). Distribution and density of mature DCs were evaluated in 119 LNs from pathological metastasis-positive cases by examining CD83 expression immunohistochemically. Then, following the examination of PCR-MM, immunological responses were analyzed by amplifying CD83, CD86, CD1a and IFNγ mRNA by quantitative real-time RT-PCR in 613 LNs from 25 pathological metastasis-negative cases. Among 119 LNs from 4 patients with LN metastasis, 20 LNs had histological metastasis and 6 histological metastasis-negative LNs had IHC-MM. The distribution and density of mature DCs were identical in the LNs regardless of metastasis status. Among 613 LNs from 25 patients without histological LN metastasis, 15 LNs (2.45%) from 6 cases (24%) were PCR-MM positive. The expression levels of CD83 and CD86 mRNA were significantly higher in the 15 PCR-MM-positive LNs than in the 598 PCR-MM-negative LNs. The expression levels of CD83 and CD86 mRNA in 136 PCR-MM-negative LNs from 6 PCR-MM-positive cases were also higher than those in 462 LNs from 19 PCR-MM-negative cases. In gastric cancer patients, activation of the immune response by maturation of DCs is wide-spread in regional lymph nodes at a stage before metastasis is detected histologically, including detection by IHC-MM.


Assuntos
Carcinoma/imunologia , Carcinoma/patologia , Imunidade Inata/fisiologia , Linfonodos/imunologia , Linfonodos/patologia , Neoplasias Gástricas/imunologia , Neoplasias Gástricas/patologia , Adulto , Idoso , Biomarcadores Tumorais/análise , Biomarcadores Tumorais/genética , Antígeno Carcinoembrionário/genética , Antígeno Carcinoembrionário/metabolismo , Carcinoma/genética , Carcinoma/cirurgia , Estudos de Casos e Controles , Células Dendríticas/imunologia , Células Dendríticas/metabolismo , Células Dendríticas/patologia , Feminino , Gastrectomia , Humanos , Imunidade Inata/genética , Queratina-19/genética , Queratina-19/metabolismo , Linfonodos/metabolismo , Metástase Linfática , Masculino , Pessoa de Meia-Idade , RNA Mensageiro/metabolismo , Neoplasias Gástricas/genética , Neoplasias Gástricas/cirurgia , Evasão Tumoral/genética , Evasão Tumoral/fisiologia
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