Jejunal mesenteric lymphangioma treated by pancreaticoduodenectomy: A case report.

INTRODUCTION: A lymphangioma is a benign congenital malformation of the lymphatic system that generally appears in the head, neck, and axillary regions. Small bowel mesenteric lymphangiomas have been described in less than 1% of lymphangiomas. PRESENTATION OF CASE: We report the case of a 20-year-old woman who presented with abdominal pain. Computed tomography revealed a large (22 cm in diameter) multi-cystic lesion inferior to the processus uncinatus of the pancreas. As the presumptive diagnosis was a lymphangioma of the jejunal mesentery, we decided to perform a laparotomy. Intraoperatively, the peritoneal cavity was found to be fully occupied by a multi-cystic lesion that arose from the root of the jejunal mesentery and the processus uncinatus of the pancreas. It was adherent to the duodenum and inseparable from the duodenum and the processus uncinatus. A subtotal stomach-preserving pancreaticoduodenectomy was performed. The tumor was diagnosed as a lymphangioma of the jejunal mesentery after histopathological analysis. DISCUSSION: Although lymphangioma is benign, complete resection, including resection of the involved organs, is necessary. Incomplete resection has a 10% postoperative recurrence rate and may also be associated with complications. To the best of our knowledge, this is the first reported case of a mesenteric lymphangioma treated by pancreaticoduodenectomy. CONCLUSION: Although the lymphangioma was pathologically benign, a pancreaticoduodenectomy was required to remove it completely. When a tumor's location and size cause impingement on surrounding structures, surgeons should consider performing a pancreaticoduodenectomy to treat similar cases.

An Autopsy Case of Idiopathic Pleuroparenchymal Fibroelastosis with Left Vocal Cord Paralysis and a Rapid Deterioration without an Acute Exacerbation.

Idiopathic pleuroparenchymal fibroelastosis (IPPFE) is a generally slow-progressing rare disorder of unknown etiology. The direct cause of death in cases of IPPFE is rarely investigated. We experienced an autopsy case of a Japanese man with IPPFE and found aspiration pneumonia to be the major trigger of death. The individual had left vocal cord paralysis at admission, which may have contributed to aspiration pneumonia, and which probably was affected by the fibrous adhesion of the left apex of the chest wall resulting from IPPFE. The prevention of aspiration pneumonia is important for maintaining the respiratory function, especially in IPPFE patients with repeated pneumothorax.

Testicular rhabdomyosarcoma after chemotherapy for metastatic germ cell tumors.

A 36-year-old male was referred to our hospital with left scrotal swelling. Computed tomography revealed a massive tumor in his left scrotum. The tumor extended along the gonadal vein extraperitoneally forming a massive tumor. Pathological examination showed a mixed-type germ cell tumor. Despite several chemotherapeutic treatments, the tumor continued to grow, and the patient died 28 months later after his first presentation at our institution. Autopsy revealed that the tumor comprised rhabdomyosarcoma and mature teratoma. We could not find useful tumor markers to facilitate the diagnosis of rhabdomyosarcoma. However, we recommend rebiopsy or palliative operation as options for re-diagnosis in case of resistant germ cell tumor. Here, we present a case of testicular tumor that exhibited different pathological examination results before and after treatment.