Gastric bleeding from a penetrating pancreatic pseudocyst with pseudoaneurysm of the splenic artery.

The successful management of gastric bleeding from a pseudocyst with a pseudoaneurysm of the splenic artery is reported here. A 62-year-old male patient was referred to our hospital with a complaint of hematomesis. On a computed tomography and an abdominal angiography, it was evident that he was actively bleeding from a splenic pseudoaneurysm caused by a pancreatic pseudocyst. A transcathetheral arterial embolization (TAE) was performed on the splenic pseudoaneurysm to control bleeding. After the TAE, we resected the pancreatic pseudocyst by distal pancreatectomy with partial gastrectomy. Gastrointestinal bleeding from a pseudoaneurysm caused by a pancreatic pseudocyst is a rare, but sometimes lethal, complication. As only conservative therapy or TAE often results in lethal re-bleeding, we propose to perform elective surgery after TAE.

Macrocystic serous cystadenoma mimicking branch duct intraductal papillary mucinous neoplasm.

A 29-year-old woman was referred to our hospital with a pancreatic cystic tumor diagnosed by computed tomography and magnetic resonance imaging. Endoscopic retrograde cholangiopancreatography was performed, wherein macrocystic serous cystadenoma of the pancreas was diagnosed. It was decided to observe the progress of the disease. The tumor diameter increased over 18 months to > 50 mm. Its growth rate was slower than the average rate of serous cystadenoma described in previous reports, but its form become warped and shaped like bunches of grapes. A branch duct variant of intraductal papillary mucinous neoplasm could not be excluded. Laparoscope-assisted distal pancreatectomy was performed, and the pathological diagnosis was macrocystic serous cystadenoma. Some macrocystic serous cystadenomas are like an intraductal papillary mucinous neoplasm, and differential diagnosis is very difficult. The macrocystic serous cystadenoma is a rare lesion, but it should be considered when diagnosing cystic tumors of the pancreas.

A case of retroperitoneal mucinous cystadenoma treated successfully by laparoscopic excision.

A case of retroperitoneal mucinous cystadenoma treated laparoscopically is reported. A 26-year-old woman, who complained of abdominal fullness, was referred to us after a large intra-abdominal mass was discovered at her local hospital. Ultrasound and computed tomography showed a fluid-filled mass, 9 cm in diameter, in the left retroperitoneal space. Laparoscopic surgery was performed. We found a smooth and thin-walled cystic tumor that displaced the descending colon to the right and arose from the retroperitoneum, loosely adhering to the psoas muscle. We successfully extirpated the tumor laparoscopically. The surgical specimen consisted of a multilocular, red to yellowish-gray, cystic mass with a smooth, glistening external surface, and inner lining. The mass was filled with thin, yellowish fluid. The histologic diagnosis was benign mucinous cystadenoma. The postoperative course was uneventful, and the patient remains free of recurrence 15 months after surgery. Retroperitoneal mucinous cystadenoma is a rare entity, and the treatment of choice is surgical excision. Laparoscopic extirpation should be considered for the treatment of selected retroperitoneal cystic lesions.

Lymphoepithelial cyst of the pancreas: report of a case.

The aim of this report is to describe the clinical and pathological features of a lympoepithelial cyst of the pancreas and to recommend fine-needle aspiration biopsy for the differential diagnosis of this lesion. A 55-year-old man was incidentally diagnosed as having a pancreatic tumor by abdominal ultrasonography. A hypoechoic cystic lesion was detected on the surface of the pancreatic body. A computed tomography revealed a cystic lesion surrounded by a smooth, flat wall. Magnetic resonance imaging revealed that the lesion was a low-intensity mass on the T1-image and a slightly high-intensity mass on the T2-image. The lesion was diagnosed as a benign cystic tumor, and enucleation of the tumor was scheduled. The fine needle aspiration biopsy was performed after laparotomy, and cytology of the contents was negative for malignant cells. The postoperative pathological diagnosis was a lymphoepithelial cyst of the pancreas. This cyst is an unusual but benign mass that requires minimal surgery.

Clinicopathological characteristics and outcome indicators of stage II gastric cancer according to the Japanese classification of gastric cancer.

BACKGROUND: The characteristics of stage II gastric cancer according to the Japanese Classification of Gastric Cancer (JCGC) were examined and the high-risk factors predicting poor prognosis were detected. PATIENTS AND METHODS: In total, 107 patients, who underwent clinically curative gastrectomy with D2 lymphadenectomy for stage II gastric cancer, were included. Survival curves of the depth of invasion, lymph node metastasis, the ratio of involved: resected lymph nodes and chemotherapy treatment were compared. RESULTS: The survival curves were related to tumor invasion depth and lymph node metastasis. The ratio of involved resected lymph nodes was a good prognostic indicator compared to the classification of regional lymph node metastasis (N classification). Survival rates with adjuvant chemotherapy were slightly higher than without adjuvant chemotherapy, but the difference was not significant. CONCLUSION: pT2pN1 (stage II) gastric cancers according to the JCGC, especially pSSpN1 cases, included stage IIIB and IV gastric cancers according to the International Union Against Cancer / American Joint Committee on Cancer (UICC/AJCC); therefore, the prognosis of these might be poor. With pSSpN1 cases, according to the JCGC, anticancer chemotherapy equivalent to that required for stage III gastric cancer cases is necessary.