ABSTRACT
Prediction of malignancy or invasiveness of branch duct type intraductal papillary mucinous neoplasm (Br-IPMN) is difficult, and proper treatment strategy has not been well established. The authors investigated the characteristics of Br-IPMN and explored its malignancy or invasiveness predicting factors to suggest a scoring formula for predicting pathologic results. From 1994 to 2008, 237 patients who were diagnosed as Br-IPMN at 11 tertiary referral centers in Korea were retrospectively reviewed. The patients' mean age was 63.1 +/- 9.2 yr. One hundred ninty-eight (83.5%) patients had nonmalignant IPMN (81 adenoma, 117 borderline atypia), and 39 (16.5%) had malignant IPMN (13 carcinoma in situ, 26 invasive carcinoma). Cyst size and mural nodule were malignancy determining factors by multivariate analysis. Elevated CEA, cyst size and mural nodule were factors determining invasiveness by multivariate analysis. Using the regression coefficient for significant predictors on multivariate analysis, we constructed a malignancy-predicting scoring formula: 22.4 (mural nodule [0 or 1]) + 0.5 (cyst size [mm]). In invasive IPMN, the formula was expressed as invasiveness-predicting score = 36.6 (mural nodule [0 or 1]) + 32.2 (elevated serum CEA [0 or 1]) + 0.6 (cyst size [mm]). Here we present a scoring formula for prediction of malignancy or invasiveness of Br-IPMN which can be used to determine a proper treatment strategy.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Adenocarcinoma, Mucinous/pathology , Carcinoembryonic Antigen/blood , Carcinoma, Pancreatic Ductal/pathology , Carcinoma, Papillary/pathology , Magnetic Resonance Imaging , Multivariate Analysis , Neoplasm Invasiveness , Neoplasm Staging , Pancreatic Neoplasms/pathology , Predictive Value of Tests , ROC Curve , Tomography, X-Ray ComputedABSTRACT
The incidence of acute deep vein thrombosis after multiple trauma has been reported to range from 1.7 to 10%. In general, a thrombus of the calf vein migrates to the proximal vein. An isolated inferior vena cava (IVC) thrombosis without a peripheral venous thrombosis is rare. A 35-year-old woman was admitted as a result of a large subcapsular hematoma in the right hepatic lobe after a blunt injury caused by an automobile accident. The thrombus in the IVC was detected incidentally during a follow up CT scan three weeks after the trauma. A compression of the IVC by the displaced hepatic parenchyme as a result of a large subcapsular hematoma is a possible mechanism for the IVC thrombosis because there was no distal venous thrombosis and no evidence of hypercoagulability. A retrievable caval filter (Gunther-Tulip(TM), Cook Inc. Bloominton, USA) was placed in the suprarenal vena cava via the right internal jugular venous approach. After placing the retrieval caval filter, aspiration thrombectomy was attempted through the right femoral vein. The luminal patency of the IVC was restored immediately after retrieving the thrombus. The subcapsular hematoma in the right hepatic lobe disappeared two months later and there was no evidence of a residual thrombus in the inferior vena cava.
Subject(s)
Adult , Female , Humans , Automobiles , Femoral Vein , Follow-Up Studies , Hematoma , Incidence , Multiple Trauma , Phenobarbital , Thrombectomy , Thrombophilia , Thrombosis , Tomography, X-Ray Computed , Veins , Vena Cava, Inferior , Venous Thrombosis , Wounds, NonpenetratingABSTRACT
BACKGROUND: Intrahepatic stones are common in East Asia and pose serious complications such as biliary stricture, liver atrophy, liver abscess, sepsis and sometimes cholangiocarcinoma. The management of primary intrahepatic stones is difficult and it is also difficult to remove all stones during operation. METHODS: Eighty seven patients with hepatolithiasis were admitted to the department of surgery, Keimyung University Dongsan Medical Center during 4 year period between 1994 and 1997. We reviewed medical records retrospectively for these patients. RESULTS: The peak incidence of age was 50's and the male to female ratio was 1:1.2. Intrahepatic stones were located in the left lobe in 62.1%, right lobe 17.2% and both lobe 20.7%. Stones were found only within the liver (I type) in 34.5% and both inside and outside the liver (IE type) in 65.5%. Analysis of the composition of intrahepatic stones revealed calcium bilirubinate as the most common compound (over 75%) and E. coli was the most common organism in bile culture. We classified intrahepatic stones as four types. Type I (45.9%) is cases with liver atrophy on abdominal CT, type II (20.6%) is cases without liver atrophy as IE type, type III (16.0%) is cases with dilatation of extrahepatic bile duct as I type, and type IV (17.2%) is cases without liver atrophy nor extrahepatic bile duct dilatation. Of the 72 operated patients, liver resection was done in 43 (59.7%) and 9 patients (20.0%) had residual stones. Cholangiocarcinoma was found in 3 (7.0%) of the total 43 patients who underwent liver resection. CONCLUSION: Hepatic resection should be performed in selected patients with intrahepatic stones because of lowest presence of residual stones and no difference of postoprative complications compared with drainage procedure.
Subject(s)
Female , Humans , Male , Atrophy , Bile , Bile Ducts, Extrahepatic , Bilirubin , Cholangiocarcinoma , Constriction, Pathologic , Dilatation , Drainage , Asia, Eastern , Incidence , Liver , Liver Abscess , Medical Records , Retrospective Studies , Sepsis , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: Solid and papillary epithelial neoplasm(SPEN) of the pancreas is a rare tumor with low grade malignant potential and usually found in young female patients. The prognosis of this lesion is reported to be much more favorable than other pancreatic neoplasms. METHODS: We report four cases of SPENs of the pancreas treated at the department of surgery, Keimyung University Dongsan Medical Center. Three were women and one was a man and their mean age at the time of surgery was 19 years with the ranges between 11 and 29 years of age. Two patients were admitted with a palpable abdominal mass and another two patients with abdominal pain. Results of laboratory studies including serum amylases and tumor markers were all within normal limits. Diagnosis was made preoperatively in three patients by MRI and needle biopsies. Tumors were located in the head portion in three patients and in the body of the pancreas in one patient. RESULTS: All patients underwent complete resection which involved three enucleations and one pancreaticoduodenectomy. All patients are alive at the time of this report with mean follow up period of 69.5 month (the ranges between 8 and 105 months) without evidence of recurrence. CONCLUSION: In our experience, complete resection of this neoplasm is the treatment of choice and the prognosis is excellent.