Histerectomia radical após parto cesáreo por adenocarcinoma de colo uterino: relato de caso / Radical hysterectomy after c-section in cervical adenocarcinoma: a case report

Mundialmente, o câncer de colo uterino ocupa o quarto lugar das neoplasias em mulheres, porém, nos países em desenvolvimento, as taxas de incidência superam de forma impactante os casos de países desenvolvidos. Apesar de ser um evento incomum durante a gestação, é cada vez mais observado, o que talvez possa ser atribuído às gestações programadas em idades mais avançadas. O caso descrito refere-se a uma paciente de 32 anos de idade, diagnosticada no terceiro trimestre da gestação com adenocarcinoma de origem endocervical com estadiamento anatomopatológico final (FIGO 2018) 1B2. Ela foi submetida à abordagem cirúrgica como tratamento inicial. Foi adotada como conduta a resolução da gestação, com boa vitalidade fetal, ao final da 34ª semana, após corticoterapia para maturação pulmonar fetal. Foi realizado parto cesariano seguido de histerectomia radical tipo C1 na classificação de Querleu e Morrow associado a linfadenectomia pélvica, no mesmo ato operatório.(AU)

Worldwide, cervical cancer ranks fourth in female cancers, but when assessing data from developing countries, incidence rates are significantly higher than in developed countries. Although it is an uncommon event during pregnancy, it is increasingly observed, which may perhaps be justified due to pregnancies postponed at older ages. The case described relates to a 32-year-old woman diagnosed in the third trimester of pregnancy with endocervical adenocarcinoma, whose final anatomopathological staging (FIGO 2018) was IB2. The same was submitted to the surgical approach as an initial treatment. It was adopted as a conduct, the resolution of pregnancy, with good fetal viability, at the end of the 34th week, after corticosteroid therapy for fetal lung maturation. The patient underwent cesarean section followed by radical type C1 hysterectomy in the classification of Querleu and Morrow associated with pelvic lymphadenectomy in the same surgery.(AU)

Adenocarcinoma mucinoso uracal / Urachal mucinous adenocarcinoma

Introducción: El uraco o conducto onfalomesentérico es una estructura embrionaria que conecta el intestino medio y el saco vitelino, que involuciona antes del tercer trimestre de embarazo. Objetivo: Presentar un caso con diagnóstico de adenocarcinoma uracal, neoplasia maligna rara. Desarrollo: Paciente de 50 años de edad sin antecedentes patológicos, con cuadro clínico inicial de ascitis y dolor abdominal, al examen físico masa palpable en hipocondrio-fosa iliaca izquierda que en la tomografía abdominal se observa una masa adyacente a la cúpula vesical y pared anterior del abdomen. El resultado de la biopsia reportó un adenocarcinoma mucinoso del conducto onfalomesentérico (uracal). Al momento del diagnóstico, el paciente se encontró en un estadio IVB según el sistema Sheldon y otros y un IV según sistema Mayo, etapa avanzada de la enfermedad que determina mal pronóstico. Se instauró tratamiento con quimioterapia neoadyuvante, quirúrgico y continuación con quimioterapia adyuvante, el cual continúa, actualmente, con una evolución estable. Conclusiones: Esta es una neoplasia rara. Sospechar su diagnóstico llevará a un diagnóstico temprano, lo que mejorará el pronóstico y sobrevida de los pacientes afectados(AU)

Introduction: The urachus or omphalomesenteric duct is an embryonic structure connecting the midgut and the yolk sac, which regresses before the third trimester of pregnancy. Objective: To report a case with a diagnosis of urachal adenocarcinoma, a rare malignant neoplasm. Case report: A 50-year-old patient with no pathological history, who had an initial clinical condition of ascites and abdominal pain. At physical examination, we found a palpable mass in the left hypochondrium - iliac fossa, which revealed a mass next to the bladder dome and anterior wall on the abdominal tomography of the abdomen. The biopsy result reported a mucinous adenocarcinoma of the omphalomesenteric duct (urachal). At the time of diagnosis, the patient was in stage IVB according to the Sheldon et al system and IV according to the Mayo system, an advanced stage of the disease that determines poor prognosis. Treatment with neoadjuvant and surgical chemotherapy was established and adjuvant chemotherapy to follow, which currently continues with a stable evolution. Conclusions: This is a rare neoplasm. Suspecting its diagnosis will lead to an early diagnosis, which will improve the prognosis and survival of affected patients(AU)

Metachronic breast and cerebellar neoplasm in a young patient / Neoplasias mamária e cerebelar metacrônicas em uma paciente jovem

Abstract Several factors trigger the development of genetic mutations that are responsible for causing a neoplasm. Medulloblastoma is a malignant and invasive cerebellar neoplasm, that affects children and young adults. Mucinous carcinoma is a special type of breast cancer. Being a special atypical subtype of invasive carcinoma, it most frequently affects women of advanced age and represents 1 to 7% of all breast cancers. The reported case aims to show the rarity of the occurrence of desmoplastic medulloblastoma and mammary mucinous carcinoma in a young patient in a short period of time, in different sites, without direct anatomical attachment and without occurrence of metastasis. Initially, this patient had a desmoplastic medulloblastoma and was treated with lumpectomy and radiotherapy. After 13 months, the patient was diagnosed with a mucinous breast carcinoma, underwent mastectomy, adjuvant chemotherapy and is currently undergoing endocrinotherapy. We conclude, based on the metachronous characteristic of the neoplasia and clinical characteristics, that the patient is likely to have Li-Fraumeni syndrome, an autosomal dominant disease with mutation of the TP53 gene, which is the the main involved. Because the patient does not present all the characteristics of the phenotype of the syndrome, she can thus be classified as having Li-Fraumeni variant or Li-Fraumeni-like syndrome.

Resumo Diversos fatores desencadeiam o desenvolvimento de mutações genéticas que são responsáveis por originar uma neoplasia. O meduloblastoma é uma neoplasia cerebelar maligna e invasiva que acomete crianças e adultos jovens. O carcinoma mucinoso é um tipo de câncer de mama especial por ser um subtipo atípico de carcinoma invasivo, que acomete com maior frequência mulheres de idade avançada e representa entre 1 a 7% do total de neoplasias mamárias. O caso relatado tem como objetivo mostrar a raridade da ocorrência do meduloblastoma desmoplásico e carcinoma mucinoso mamário em uma paciente jovem em um curto período de tempo, em diferentes sítios sem ligação anatômica direta e sem ocorrência de metástase. Inicialmente, esta paciente possuía um meduloblastoma desmoplásico e foi tratada com tumorectomia e radioterapia. Após 13 meses, a paciente foi diagnosticada com carcinoma mucinoso de mama, sendo submetida a mastectomia, quimioterapia adjuvante e atualmente está sendo tratada com endocrinoterapia. Concluímos, com base na característica metacrônica da neoplasia e características clínicas, que a paciente apresenta a síndrome de Li-Fraumeni, doença autossômica dominante com mutação do gene TP53, que é o principal gene envolvido nesta síndrome. Por não apresentar as características completas do fenótipo da síndrome, a paciente pode assim ser classificada como portadora de uma variante da síndorme de Li-Fraumeni ou síndrome do tipo Li-Fraumeni.

Enterovesical fistula caused by ileal primary adenocarcinoma / Fístula enterovesical causada por adenocarcinoma ileal primário

ABSTRACT Introduction: Small bowel neoplasms are rare entities, with only 3.2% of gastrointestinal tumors localized in this segment. Adenocarcinoma is the second most common histologic type among small bowel neoplasms. The disease's symptoms are non-specific, with abdominal pain being the most common. Among the complications, fistulas are a far rare condition. Case report: We present the case of an 86-year-old woman, hypertensive, diabetic, and former smoker, with lower abdominal pain, hematuria, fecaluria and fever associated with weight loss. Upon physical examination presented pale mucous membranes. Magnetic resonance imaging of the abdomen showed parietal thickening in the distal ileum segment with an anterior wall bladder fistula. Absence of metastases. Subjected to transurethral endoscopic biopsy of the bladder lesion, which anatomopathological study was compatible with invasive mucinous adenocarcinoma. An enterectomy was performed with primary enteroanastomosis, associated with partial cystectomy by videolaparoscopy. Anatomopathological study of the surgical specimens concluded mucinous adenocarcinoma with signet ring cells located in the small bowel and bladder. Immunohistochemical exam has identified findings compatible with mucinous adenocarcinoma of origin in the small bowel. The patient evolved well, being discharged, and returned to postoperative follow-up without signs of relapse of the disease. Conclusion: The relative inaccessibility of the small bowel and the malignant neoplasms' non-specific symptoms make an early diagnosis difficult. Discovery of the disease, often only at an advanced stage, results in complications and less effective therapy. The laparoscopic approach might be advantageous and effective in the treatment of advanced small bowel cancer with invasion of adjacent structures.

RESUMO Introdução: As neoplasias do intestino delgado são entidades raras com apenas 3,2% dos tumores gastrointestinais localizando-se neste segmento. O adenocarcinoma é o segundo tipo histológico mais comum entre as neoplasias do intestino delgado. Os sintomas da doença são inespecíficos, sendo a dor abdominal o mais comum, dificultando o diagnóstico precoce. Dentre as complicações, as fistulas são de ocorrência ainda mais rara. Relato de caso: Mulher de 86 anos, hipertensa, diabética e ex-tabagista. Quadro de dor em abdome inferior, hematúria, fecalúria, febre eventual e perda ponderal. Ao exame físico pele e mucosas hipocoradas. Ressonância Magnética de abdome evidenciou espessamento parietal em segmento do íleo distal com fístula para a parede vesical anterior. Ausência de metástases. Submetida à biopsia endoscópica transuretral da lesão vesical, cujo estudo anatomopatológico evidenciou adenocarcinoma mucinoso invasivo. Realizada enterectomia com enteroanastomose primária, associada à cistectomia parcial por videolaparoscopia. Estudo anatomopatológico das peças cirúrgicas concluiu adenocarcinoma mucinoso com células em anel de sinete localizado em intestino delgado e bexiga. A Imunohistoquímica identificou achados compatíveis com adenocarcinoma mucinoso de origem em intestino delgado. A paciente evoluiu bem no pós-operatório, recebendo alta e retornando para seguimento pós-operatório sem sinais de recidiva da doença. Conclusão: A relativa inacessibilidade do intestino delgado e os sintomas inespecíficos das neoplasias malignas deste sítio dificulta o diagnóstico precoce. O reconhecimento da doença, muitas vezes somente em estágio avançado, resulta em complicações e sequelas com terapêutica menos eficaz. A abordagem laparoscópica pode ser vantajosa no tratamento do câncer avançado do intestino delgado com invasão de estruturas adjacentes.

Neoplasias mucinosas papilares intraductales de páncreas en el Hospital Nacional Guillermo Almenara Irigoyen, Lima, Perú / Intraductal papillary mucinous neoplasms of the pancreas in Hospital Nacional Guillermo Almenara Irigoyen, Lima, Peru

Objetivo: Analizar en forma retrospectiva las características clínicas, radiológicas e histopatológicas, así como los resultados quirúrgicos de los pacientes con diagnóstico de neoplasia mucinosa papilar intraductal de páncreas (NMPI). Materiales y métodos: Usando la base de datos del servicio de Cirugía de Páncreas, Bazo y retroperitoneo del Hospital Nacional Guillermo Almenara Irigoyen (HNGAI) se identificaron a los pacientes con diagnóstico de NMPI sometidos a resección pancreática desde enero del 2006 a setiembre del 2013. Resultados: Se identificaron 11 pacientes (9 mujeres, 2 varones) con una edad promedio de 67,36 años. 2 casos fueron tipo conducto principal, 3 tipo rama y 6 tipo mixta. Todos los pacientes fueron sintomáticos, siendo el dolor el síntoma más frecuente, 27% presentaron pancreatitis. Para el diagnóstico 100% contaron con tomografía, 90% con resonancia magnética. En 10 pacientes se realizó una duodenopancreatectomía y en uno una pancreatectomía distal. Dos pacientes tuvieron fístula pancreática tipo C. Se reoperaron dos pacientes y hubo un fallecido. En 5 pacientes se observó displasia de bajo grado, en 2 displasia de moderado grado, en 1 displasia de alto grado y en 3 carcinoma invasor. Conclusiones: Esta patología está presente en nuestro medio, siendo más frecuente en mujeres. Las NMPI de tipo mixta son las de mayor frecuencia. La fístula pancreática es la complicación de mayor incidencia y la mortalidad es baja. El potencial de malignidad encontrado fue alto.

Objective: To analyze retrospectively the clinical, radiologic and pathologic features as well as the surgical results of the patients with diagnosis of intraductal papillary mucinous neoplasms of the pancreas (IPMN). Materials and methods: Patients with diagnosis of IPMN who underwent pancreatectomy were identified from January 2006 to September 2013, using the prospective data base of the Pancreas, Spleen and retroperitoneum HNGAI service. Results: A total of 11 patients were found (9 females and 2 males). The mean age was 67.36 years. 2 were main duct type IPMN, 3 branch type and 6 mixed type. All patients had symptoms. The pain was the most frequent symptom, 27% had pancreatitis. For the diagnosis 100% had CT scan, 90% MRI. 10 patients underwent pancreaticoduodenectomy and 1 distal pancreatectomy. 2 patients had type C pancreatic fistula. 2 patients underwent reoperation and 1 died. 5 patients had low grade dysplasia, 2 moderate dysplasia, 1 high grade dysplasia and 3 invasive carcinoma. Conclusions: This entity is present in our country being more common in women. The mixed type IPMN is the most frequent type. Complication with the highest incidence is the pancreatic fistula and the mortality rate is low. The IPMN´s malignancy potential founded was high.

Primary retroperitoneal mucinous tumor; report of two cases and review of literature

Primary retroperitoneal mucinous tumors are rare neoplasms and almost exclusively seen in women. In this case report we present two cases of this entity with their clinicopathologic features. The first patient was a 32 years old unmarried woman presented with abdominal pain. Ultrasound imaging demonstrated a solid and thick walled ovarian mass m. 105* 70*80 mm. At laparotomy a large retroperitoneal mass with extention to pelvis, dome of urinary bladder and upper abdomen was found and omentum was involved by the tumor. Histopathological examination revealed a mucinous adenocarcinoma with mural nodule contained high-grade anaplastic carcinoma in retroperitoneal space. The second case was a 36 years old woman with retroperitoneal mucinous cystadenoma. The first case died of disease at first month of her diagnosis. Primary retroperitoneal mucinous tumors that containing anaplastic carcinoma or sarcomas are highly aggressive tumors with poor prognosis showing metastasis by high-grade component

Solid Pancreatic Tumors with Unilocular Cyst-Like Appearance on CT: Differentiation from Unilocular Cystic Tumors Using CT

OBJECTIVE: To describe the computed tomography (CT) features of neuroendocrine tumors (NETs) and solid pseudopapillary tumors (SPTs) with unilocular cyst-like appearance, and to compare them with those of unilocular cystic tumors of the pancreas. MATERIALS AND METHODS: This retrospective study was approved by our Institutional Review Board, and informed consent was waived. We included 112 pancreatic tumors with unilocular cyst-like appearance on CT (16 solid tumors [nine NETs and seven SPTs] and 96 cystic tumors [45 serous cystadenomas, 30 mucinous cystic neoplasms, and 21 branch-duct intraductal papillary mucinous neoplasms]). Two radiologists reviewed the CT images in consensus to determine tumor location, long diameter, morphological features, wall thicknesses, ratio of wall thickness to tumor size, wall enhancement patterns, intratumoral contents, and accompanying findings. Fisher's exact test was used to analyze the results. RESULTS: All 16 solid tumors had perceptible walls (mean thickness, 2.7 mm; mean ratio of wall thickness to tumor size, 7.7%) with variable enhancement. Four NETs and seven SPTs had hemorrhage, calcifications, and/or mural nodules. Six CT findings were specific for solid tumors with unilocular cyst-like appearance: a thick (> 2 mm) wall, uneven thickness of the wall, high ratio of wall thickness to tumor size, hyper- or hypo-attenuation of the wall in the arterial and portal phase, and heterogeneous internal contents. When three or more of the above criteria were used, 100% specificity and 87.5-92% accuracy were obtained for solid tumors with unilocular cyst-like appearance. CONCLUSION: A combination of CT features was useful for distinguishing solid tumors with unilocular cyst-like appearance from unilocular cystic tumors of the pancreas.

Synchronous Triple Primary Lung Cancers: A Case Report

Synchronous primary lung cancers are relatively rare. The accurate diagnosis remains challenging, despite of the routine use of bronchoscopy and computed tomography (CT) of the chest. Herein we report a case of synchronous triple primary cancers of the right lung in a 72-year-old male patient in whom each tumor presented distinct CT imaging findings.

Idiopathic Phlebosclerotic Colitis: A Rare Entity of Chronic Ischemic Colitis / 대한소화기학회지

Colonic wall thickening is frequently encountered in various conditions, from acute or chronic inflammatory disease to colorectal carcinoma. Colonic wall thickening may be accompanied by calcifications in mucinous adenocarcinoma of the colon, leiomyosarcoma of the colon, schistosomiasis japonica, and phlebosclerotic colitis. Phlebosclerotic colitis is a rare entity of chronic ischemic colitis associated with sclerosis and fibrosis of mesenteric veins. Although its development is usually insidious, and, thus its diagnosis can be delayed, characteristic findings in phlebosclerotic colitis are calcifications of mesenteric veins as well as colonic wall thickening with calcifications. We report on a 71-year-old woman who presented with chronic diarrhea and intermittent hematochezia, who was first misdiagnosed as mucinous adenocarcinoma of the colon, but finally diagnosed as a rare entity of chronic ischemic colitis, phlebosclerotic colitis. Differential points of phlebosclerotic colitis from other diseases, including leiomyosarcoma and schistosomiasis japonica, are also described.

Synchronous Malignant Intraductal Papillary Mucinous Neoplasms of the Bile Duct and Pancreas Requiring Left Hepatectomy and Total Pancreatectomy / 대한소화기학회지

Intraductal papillary mucinous neoplasm of the bile duct (IPMN-B) and intraductal papillary mucinous neoplasm of the pancreas (IPMN-P) have striking similarities and are recognized as counterparts. However, simultaneous occurrence of IPMN-B and IPMN-P is extremely rare. A 66 year-old female presented with recurrent epigastric pain and fever. During the past 9 years, she had three clinical episodes related to intrahepatic duct stones and IPMN-P in the pancreas head and was managed by medical treatment. Laboratory test results at admission revealed leukocytosis (12,600/mm3) and elevated CA 19-9 level (1,200 U/mL). Imaging study demonstrated liver abscess in the Couinaud's segment 4, IPMN-B in the left lobe, and IPMN-P in the whole pancreas with suspicious malignant change. Liver abscess was drained preoperatively, followed by left lobectomy with bile duct resection and total pancreatectomy with splenectomy. On histologic examination, non-invasive intraductal papillary mucinous carcinoma arising from various degree of dysplastic mucosa of the liver and pancreas could be observed. However, there was no continuity between the hepatic and pancreatic lesions. This finding in our case supports the theory that double primary lesions are more likely explained by a diffuse IPMN leading to synchronous tumors arising from both biliary and pancreatic ducts rather than by a metastatic process. Herein we present a case of simultaneous IPMN of the bile duct and pancreas which was successfully treated by surgical management.

Metastatic Recurrence of Small Bowel Cancer in Crohn's Disease / 대한소화기학회지

No abstract available.

Carcinoma mucinoso de mama: experiencia de 10 años / Mucinous carcinoma of the breast: ten years experience

El carcinoma mucinoso es un carcinoma ductal invasor de bajo grado de malignidad que se caracteriza por células tumorales inmersas en cúmulos de moco extracelular. Representa el 1% al 7% de todos los cánceres de mama, siendo más frecuente en mujeres mayores. Conocer las características clínicas, factores pronósticos, variedades histológicas, tratamiento aplicado y sobrevida global en pacientes con el diagnóstico de carcinoma mucinoso de mama en el Instituto de Oncología “Dr. Miguel Pérez Carreño”. Estudio descriptivo, transversal, pacientes con el diagnóstico de carcinoma mucinoso de mama vistos entre los años 2002-2011. Se evaluaron las historias clínicas de 17 pacientes, encontrando que el grupo etario más afectado es el de 36-45 años con un 29,4%, la mama con mayor afectación fue la izquierda con un 58,8%, el nódulo palpable fue el síntoma predominante, el cuadrante mayormente afectado fue el súpero externo en un 41,20%, el estadio IIA fue el más frecuente 41,17%, carcinoma mucinoso puro se encontró en 94,11%. El diagnóstico inmunohistoquímico de luminal A fue el de mayor incidencia en 54,54% de los pacientes, 47,05% recibió neoadyuvancia, 76,47% se le practicó una mastectomía radical modificada. 41,7% pacientes presentaron una supervivencia global a los 10 años. Carcinoma mucinoso de mama es una entidad poco frecuente que muestra altas tasas de cura y control con un adecuado tratamiento.

The mucinous carcinoma is invasive ductal carcinoma of low grade malignancy is characterized by tumor cells embedded in extracellular clumps of mucus. They represent 1% to 7% of all breast cancers, are most frequently in older women. Determine the clinical characteristics, prognostic factors, the histological types, the treatment applied and the overall survival in patients with the diagnosis of mucinous carcinoma of breast, viewed at the Oncology Institute “Dr. Miguel Pérez Carreño”. We realized a descriptive study of patients with the diagnosis of mucinous breast carcinoma viewed between the years 2002-2011. We evaluated the medical records of 17 patients and found that the age group most affected is the 36-45 years old with 29.4%, the most affected breast was the left with 58.8%, the palpable nodule was the predominant symptom, the most affected quadrant was the upper outer in a 41.20%, stage IIA was the most predominate, 41.17% pure mucinous carcinoma was found in 94.11%, the immunohistochemistry diagnosis of luminal A was the most prevalent in 54.54% of the patients. 47.05% of all the patients received neoadjuvant treatment, 76.47% were practicing modified radical mastectomy. 41.7% patients had an overall survival at 10 years. The mucinous carcinoma of the breast is a rare entity showing high rates of cure and control with a proper and adequate treatment.

Adenocarcinoma mucinoso de anexo cutâneo: relato de caso / Mucinous Adenocarcinoma of Skin Annex: a Case Report

Introdução: O adenocarcinoma mucinoso é uma rara neoplasia formada por células apócrinas da pele hipersecretoras de muco. Pálpebras, couro cabeludo e outras regiões da cabeça e do pescoço são os sítios primários mais acometidos. Relatodo caso: Os autores descrevem o caso de uma lesão suspeita em couro cabeludo, cuja excisão e análise confirmaram um adenocarcino mamucinoso de anexo cutâneo. Mesmo após a ressecção, surgiram lesões metastáticas nas regiões retroauricular, cervical, supraclavicular e couro cabeludo. Fez-se, então, quimioterapia e radioterapia. Meses depois, a paciente relatou dor na coluna e no braço com irradiação para a mão e parestesias. Após exames, confirmou-se metástaseem linfonodos axilares, em ossos da coluna vertebral, com iminente compressão medular. A radioterapia, então, foi realizada nessas regiões. A paciente apresentou melhora significativa e mantém acompanhamento. Conclusão: O adenocarcinoma mucinoso é uma rara neoplasia e as características do relato apresentado tornam-no ainda mais raro. O diagnóstico da doença exige uma correlação clínica, radiológica e patológica. Quando submetidos a tratamento precoce, os pacientesapresentam um bom prognóstico com raras chances de metástases, embora recidivas sejam comuns.

Carcinoma mucinoso ecrino primario de la piel: reporte de un caso clínico patológico y revisión de la literatura / Primary mucinous eccrine carcinoma of skin: a case report and literature review

El carcinoma mucinoso ecrino primario de la piel es infrecuente, existen cerca de 100 casos publicados en la literatura. Fue descrito por primera vez por Lennox y colaboradores el año 1952. Presentamos un caso de carcinoma mucinoso ecrino primario de la piel, en un hombre de 82 años de edad, quien consultó por una masa cutánea retroauricular de 10 años de evolución, sin evidencias de enfermedad sistémica ni recurrencia local al año del control postoperatorio

The primary mucinous eccrine carcinoma of skin is infrequent, nearby 100 cases are published in the literature. It was described by the first time by Lennox and cols. at 1952. We present a case of primarily mucinous eccrine carcinoma of the skin, in an 82 year old man, who consulted for a retroauricular cutaneous mass of 10 years of evolution, without evidences of systemic disease or local recurrence at the year of the after surgery.

Submucosal Tumor-like Early-stage Mucinous Gastric Carcinoma: A Case Study / 대한소화기학회지

Mucinous gastric carcinoma (MGC) is an unusual histologic subtype, and early detection of MGC is very rare. Early-stage MGC appears as an elevated lesion resembling a submucosal tumor (SMT) due to abundant mucin pools in the submucosa or mucosa. We report a rare case of SMT-like early-stage MGC. Tumor type was predicted preoperatively based on characteristic endoscopic findings, in which an SMT-like mass was observed at the gastric fundus. The tumor was covered by nearly normal mucosa, but with an opening allowing for the passage of copious mucus discharge. A total gastrectomy with Roux-en-Y esophagojejunostomy was subsequently performed. Histopathology of the tumor revealed early-stage (lamina propria) mucinous adenocarcinoma.

Mucin-Producing Carcinoma of the Gallbladder: Evaluation by Magnetic Resonance Cholangiopancreatography in Three Cases

We report three cases of mucin-producing carcinoma of the gallbladder, along with the magnetic resonance (MR) findings, especially the findings on a MR cholangiopancreatography. In our cases, linear or curvilinear streaks were detected running along the long axis of an enlarged gallbladder (mucus thread sign). When such findings were seen, a mucin-producing carcinoma of the gallbladder should be included as a differential diagnosis. Thus, gadolinium-enhanced MR imaging is mandatory for the precise diagnosis of the mucin-producing carcinoma of the gallbladder.

Two Cases of Portal Annular Pancreas / 대한소화기학회지

Portal annular pancreas is one of the pancreatic fusion anomalies in which the uncinate process of the pancreas extends to fuse with the dorsal pancreas by encircling the portal vein or superior mesenteric vein. We report two consecutive patients with portal annular pancreas. The first case is a 71-year-old male patient who underwent a pancreaticoduodenectomy for intraductal papillary mucinous neoplasm in the head of pancreas. His preoperative computed tomography scan showed the suprasplenic type portal annular pancreas. The second case is a 74-year-old female patient who underwent a laparoscopic anterior radical antegrade modular pancreatosplenectomy (RAMPS) for pancreatic body cancer. In operative finding, portal confluence (superior mesenteric vein-splenic vein-portal vein) was encased with the uncinate process of pancreas in both cases. Therefore, they required pancreatic division at the pancreatic neck portion twice. During the postoperative period, grade B and A, respectively, postoperative pancreatic fistulas occurred and were controlled by conservative management. Surgeons need to know about this rare pancreatic condition prior to surgical intervention to avoid complications, and to provide patients with well-designed, case-specific pancreatic surgery.

A Case of Colloid Carcinoma Arising in Association with Intraductal Papillary Neoplasm of the Liver / 대한소화기학회지

Colloid carcinoma of the liver is very rare, and its clinicopathologic features have not been well characterized yet. We describe herein a case of colloid carcinoma of the liver. Imaging revealed a lobulated mass, measuring 12 cm in diameter at the right lobe of the liver with direct invasion of adjacent peripheral intrahepatic bile ducts. Right hemihepatectomy of the liver was performed according to the possibility of the tumor's malignant behavior. Histopathological examination of the specimen revealed large extracelluar stromal mucin pools containing floating cuboidal to columnar neoplastic cells without ovarian-like stroma. This case seemed to be colloid carcinoma arising in association with intraductal papillary neoplasm of the liver.

A Case of Mucinous Gastric Adenocarcinoma Mimicking Submucosal Tumor / 대한소화기학회지

A gastric carcinoma with the endoscopic features resembling a submucosal tumor (SMT) is rare, and reportedly accounting for 0.1% to 0.63% of all resected gastric carcinomas in Japan. A diagnosis of a SMT-like gastric carcinoma is often difficult as the tumors are almost entirely covered with normal mucosa. Furthermore mucinous gastric adenocarcinoma is uncommon histologic subtype of gastric cancer. These tumors are detected mostly in an advanced stage and rarely in an early stage. Early mucinous gastric adenocarcinoma is characterized as an elevated lesion resembling SMT due to abundant mucin pools in the submucosa. Here we report one case of SMT-like mucinous gastric adenocarcinoma, diagnosed by the usual endoscopic biopsy and treated with surgery.