ABSTRACT
Acinar cell carcinoma is a rare tumor that represents 1~2% of all pancreatic cancers. Clinical and radiologic findings are inconclusive in this disease. Acinar cell carcinoma is characterized by rapid progression and early metastasis, which lead to its poor prognosis. A 41-year-old man was admitted to our hospital for abdominal pain. Abdominal computed tomography (CT) and positron emission tomography-computed tomography (PET-CT) showed a splenic mass, which was being invaded by a pancreatic tail mass and which had increased 18F-fluorodeoxyglucose (FDG) uptake. Primary radical distal pancreatectomy and splenectomy were performed. Pathologic findings revealed an acinar cell carcinoma of the pancreas. The patient underwent a total gastrectomy three months later because of gastric recurrence. Four months later, multiple hepatic metastases were discovered, and the patient underwent a left hepatectomy. During treatment with capecitabine, there was no evidence of tumor progression for 14 months. We report a case of metastatic pancreatic acinar cell carcinoma, which did not progress for an extended period while the patient was being treated with capecitabine.
Subject(s)
Adult , Humans , Abdominal Pain , Acinar Cells , Carcinoma, Acinar Cell , Deoxycytidine , Electrons , Fluorouracil , Gastrectomy , Hepatectomy , Neoplasm Metastasis , Pancreas , Pancreatectomy , Pancreatic Neoplasms , Recurrence , Splenectomy , CapecitabineABSTRACT
Primary retroperitoneal mucinous cystadenocarcinoma is a very rare malignancy, and little is known concerning its pathogenesis, optimal treatment, and prognosis. A 29-year-old pregnant woman (21 weeks) presented with abdominal discomfort. CA 19-9, CA 125, and CEA were normal. Abdominal CT scanning revealed a 19x15x13 cm retroperitoneal tumor. Exploratory laparotomy and tumor excision were performed. Mucinous retroperitoneal implants were removed as completely as possible. Histologically, the tumor showed focal areas of capsular invasion, but free resection margins. The uterus and both ovaries were normal in appearance. No adjuvant therapy was pursued. Six months later, peritoneal and bilateral ovarian metastases were discovered.Hence, we report the details of this case of primary retroperitoneal mucinous cystadeno-carcinoma and present a review of the literature.
Subject(s)
Adult , Female , Humans , Cystadenocarcinoma , Cystadenocarcinoma, Mucinous , Laparotomy , Mucins , Neoplasm Metastasis , Ovary , Pregnant Women , UterusABSTRACT
PURPOSE: Colonic diverticulitis was rare in Korea in the past. However, it is progressively increasing probably because of a prolonged life span and a westernized diet pattern. Especially, right-sided colonic diverticulitis is difficult to differentiated from acute appendicitis. The purpose of this study was to verify the usefulness of laparoscopic-assisted surgery for the diagnosis and treatment of colonic diverticulitis. METHODS: We retrospectively reviewed 65 patients with colonic diverticulitis who underwent surgery from January 1998 to December 2002. RESULTS: The mean age of the patients was 36.3 years. Males were more prevalent than females (1.6:1). Abdominal ultrasonography (USG) was used as a diagnostic tool in 40 cases (61.5%), abdominal USG with colon enema in 8 cases (12.3%), and abdominal USG with abdominal CT in 4 cases (6.2%). The preoperative diagnosis was acute appendicitis in 52 patients (80.0%), perforated diverticulitis in 10 patients (15.4%), peritonitis in 2 patients (3.5%), and peptic ulcer perforation in 1 patient (1.5%). The postoperative diagnosis was simple diverticulitis in 47 cases (72.3%). The cecum was the most commonly involved area (55 cases, 84.6%). The types of open surgery were an appendectomy in 17 cases (26.1%), a right hemicolectomy in 17 cases (26.1%), a cecectomy in 6 cases (9.2%). The types of laparoscopic- assisted surgery were an appendectomy in 17 cases (26.1%), a laparoscopic-assisted right hemicolectomy in 4 cases (6.2%), and an anterior resection in 1 case (1.5%). The postoperative complication rate was 11.9% (5 cases). All of these occurred with the open technique, but no statistically significant difference existed between the complication rates for the two operative procedures (P=0.158). The mortality rate was zero for both operative procedures. The length of hospital stay (4.72+/-4.3 vs 10.1+/-6.2)(P=0.001) was significantly shorter in the laparoscopic-assisted group than in the open group. CONCLUSIONS: Preoperative diagnosis is sometimes difficult in patients with colonic diverticulitis. We consider laparoscopic-assisted surgery to be a useful diagnostic and therapeutic modality in such cases. The laparoscopic technique offers particular advantages to diverticulitis patients because of the short hospital stay and the low morbidity and mortality rates.
Subject(s)
Female , Humans , Male , Appendectomy , Appendicitis , Cecum , Colon , Diagnosis , Diet , Diverticulitis , Diverticulitis, Colonic , Enema , Korea , Length of Stay , Mortality , Peptic Ulcer Perforation , Peritonitis , Postoperative Complications , Retrospective Studies , Surgical Procedures, Operative , Tomography, X-Ray Computed , UltrasonographyABSTRACT
A 71 year-old man with persistent fever, right pleuritic pain and discomfort for 2 months was referred to hospital. An imaging study using ultrasonography, computed tomography and magnetic resonance imaging showed a huge hepatic mass, which was revealed to be a sarcoma-like mass of the right lobe of the liver. On laparotomy, 5, 6 and 7 segmentectomies were performed. The tumor was 18x16x15 cm in size. On cross section the tumor was a yellowish- fanning, diffusely soft, friable and clearly demarcated mass. Microscopically, the tumor cells were contained in the sarcomatous component (63%), tumor necrosis (36%) and adenocarcinoma component (0.6%) on histological mapping. Histologically, the tumor was composed of malignant osteoid tumor cells. Immunohistochemical staining for cytokeratin was positive in the sarcomatous components. These findings favored the possible epithelial origin of the sarcomatous cells. Thus, the diagnosis confirmed a sarcomatoid cholangiocarcinoma, with 2 osteosarcomatous components. After surgery, the pyrexia subsided, but early peritoneal and intrahepatic recurrence occurred 2 months postoperatively. He received systemic chemotherapy 6 times over 8 months, and partially responded. From our experienced the characteristics of this tumor have been found to be very aggressiveness, with poor prognosis.
Subject(s)
Aged , Humans , Adenocarcinoma , Cholangiocarcinoma , Diagnosis , Drug Therapy , Fever , Keratins , Laparotomy , Liver , Magnetic Resonance Imaging , Mastectomy, Segmental , Necrosis , Prognosis , Recurrence , Sarcoma , UltrasonographyABSTRACT
PURPOSE: An ischemia-reperfusion injury leads to profound functional and structural alterations of vascular smooth muscle cells (VSMC). It is still not clear whether hypoxia- reoxygenation and antioxidants affect the nitric oxide (NO) synthesis of VSMC. This study tried to investigate the effects of antioxidants on NO production, inducible nitric oxide synthase (iNOS) and the expression of NFkappaB p65, during the hypoxia-reoxygenation of VSMC cultures. METHODS: The VSMCs were primarily cultured from rat aortae, and confirmed by immunoreaction with the anti- smooth muscle myosin antibody. The condition of the hypoxia was verified by measuring the PO2 and PCO2 of the culture media. The concentrations of nitrite in the culture media were measured by the Griess reaction. Western blottings for the iNOS and NFkappaB p65 proteins were performed. L-NAME was used as an NOS inhibitor. Vitamins C and E, Glutathione (GSH), lipoic acid and dihydrolipoic acid (DHLA) were used as antioxidants. RESULTS: The iNOS protein was induced in the VSMC by 24 hours of hypoxia, which increased the nitrite in the VSMC culture medium. The reoxygenation profoundly increased the iNOS protein expression and nitrite concentration. The L- NAME, vitamins C and E, GSH, lipoic acid and DHLA decreased the nitrite productions during hypoxia and the hypoxia-reoxygenation, whereas, the expressions of the iNOS and NFkappaB p65 proteins were not influenced. CONCLUSION: We concluded that hypoxia-reoxygenation induced the iNOS protein, and the subsequent production of NO in the VSMC. The antioxidants and the NOS inhibitor decreased the NO production during the hypoxia-reoxygenation, but did not affect the expressions of the iNOS and NFkappaB p65 proteins
Subject(s)
Animals , Rats , 8,11,14-Eicosatrienoic Acid , Hypoxia , Antioxidants , Aorta , Blotting, Western , Culture Media , Glutathione , Muscle, Smooth , Muscle, Smooth, Vascular , Myosins , NG-Nitroarginine Methyl Ester , Nitric Oxide Synthase Type II , Nitric Oxide , Reperfusion Injury , Thioctic Acid , VitaminsABSTRACT
Familial adenomatous polyposis (FAP) is an autosomal dominant disease characterized by formation of multiple colorectal adenomas with nearly 100 percent potential for malignant transformation. FAP is a rare condition with an incidence of 1 in 10,000 live births. Germline mutations in the adenomatous polyposis coli gene (APC) located on chromosome 5q21 have been founded in many patients with FAP. Patients with FAP can have extracolonic manifestations of their disease. These include tumors of the upper gastrointestinal tract (hamartomatous polyps, adenomas, carcinomas), small intestine adenomas or cacinoma, bile duct adenomas, papillary thyroid carcinoma, osteomas of the mandible, skull, and long bones, a variety of soft tissue lesions, including fibromas, lipomas, and desmoid tumors, congenital hypertrophy of the retinal pigment epithelium (CHRPE) and hepatoblastoma. Hepatocellular carcinoma combined with FAP is a very rare condition. Just 8 cases of Hepatocellular carcinoma with a history of FAP have been reported in the literature. We now present a report of a case of Hepatocellular carcinoma with FAP (Gardner's syndrome) in a 19 year-old girl.
Subject(s)
Female , Humans , Young Adult , Adenoma , Adenoma, Bile Duct , Adenomatous Polyposis Coli , Carcinoma, Hepatocellular , Fibroma , Fibromatosis, Aggressive , Germ-Line Mutation , Hepatoblastoma , Hypertrophy , Incidence , Intestine, Small , Lipoma , Live Birth , Mandible , Osteoma , Polyps , Retinal Pigment Epithelium , Skull , Thyroid Neoplasms , Upper Gastrointestinal TractABSTRACT
PURPOSE: Two types of chitosan oligosaccharides (COSs), COS I and COS II, were investigated for the effects on ascitic tumor and enzymes for cancer chemoprevention. MATERIALS AND METHODS: Chitosan oligosaccharides were administered once daily for 10 days after the tumor implantation. The change of body weight was observed for 20 days, and the survival rate of mice was determined after 21 days. Chitosan oligosaccharides were administered once daily for 10 days before the tumor implantation (1 106 cells). The number of ascitic tumor cells were measured at 6 days after tumor implantation. Chemopreventive potential of chitosan oligosaccharides was examined by the induction of quinone reductase and inhibition of cytochrome P450 1A1. RESULTS: Chitosan oligosaccharides exerted antitumor activity by inhibiting the growth of Ehrlich ascites tumor cells in vivo. Mice given Ehrlich cells and 10 or 100 mg/kg body weight of chitosan oligosaccharides had 33% survival after 21 days. Quinone reductase activity was increased with chitosan oligosaccharides. There were 26% and 33% inhibition in the activity of cytochrome P450 1A1 enzyme with the treatment of COS I and COS II, respectively. CONCLUSION: These results suggest that chitosan oligosaccharides has antitumor activity and cancer chemo preventive potential by inducing QR activity and inhibiting cytochrome P450 1A1.
Subject(s)
Animals , Mice , Body Weight , Carcinoma, Ehrlich Tumor , Chemoprevention , Chitosan , Cytochrome P-450 Enzyme System , NAD(P)H Dehydrogenase (Quinone) , Oligosaccharides , Survival RateABSTRACT
PURPOSE: Tension-free hernioplasty has become the most popular procedure for the repair of groin hernias in the United States and United Kingdom. The purpose of this study is to describe a 7-year personal experience with Lichtenstein's tension-free groin hernia repair under local anesthesia. METHODS: We retrospectively studied the clinical outcome of 321 cases of Lichtenstein repairs, performed consecutively by an experienced surgeon between Jan. 1994 and Dec. 2000. RESULTS: Of the 321 cases, 242 (75.4%) were indirect, 34 (10.6%) were direct, 8 (2.5%) were femoral, 7 (2.2%) were pantaloon, and 30 (9.3%) were recurred hernias. The mean age was 55 years; 91% were male. The mean number of injections of analgesics required in the postoperative period was 3.2. The mean hospital stay following repair was 2.7 days. Complications occurred in 23 cases (7.1%). Most of these were minor, consisting of five cases of bruising or hematomas (1.6%), four superficial infections (1.3%), three seromas (0.9%), two hydroceles (0.6%), six patients with persisting groin pain for more than a month (1.8%), one foreign body granuloma, one urinary retention, and one testicular atrophy. There were no recurrences or operative deaths. CONCLUSION: Lichtenstein's tension-free hernioplasty is an easy and simple technique with less pain, minor complications and only rare instances of recurrence. This procedure can be performed on a same-day basis under local anesthesia. Lichtenstein repair may be the most promising technique for the repair of groin hernias.
Subject(s)
Humans , Male , Analgesics , Anesthesia, Local , Atrophy , Granuloma, Foreign-Body , United Kingdom , Groin , Hematoma , Hernia , Herniorrhaphy , Length of Stay , Postoperative Period , Recurrence , Retrospective Studies , Seroma , United States , Urinary RetentionABSTRACT
We experienced a case of submucosal gastric actinomycosis, presenting as bleeding. The 65-year-old woman had a symptom of epigastric pain, without any other intra-abdominal disease entity. A gastrofiberscopic study demonstrated a submucosal mass lesion with bleeding at the fundus. Because of the bleeding, laparotomy was undertaken, and a abscess containing a large mass was found at the gastric fundus, and total gastrectomy undertaken. Histological examination revealed a giant acute ulcer with a submucosal abscess due to actinomycosis. Because of its rarity, submucosal gastric actinomycosis is an entity overlooked by most surgeons. We report upon this case of submucosal gastric actinomycosis and include a review of the literature.
Subject(s)
Female , HumansABSTRACT
No abstract available.