Surgical outcomes of resected cystic neoplasms of pancreas: Experience from a tertiary care centre in India.

Objectives: Cystic neoplasms of the pancreas form a rare heterogeneous group of pancreatic tumors with variable clinical and diagnostic characteristics. Its incidence has increased in recent years due to improvements in cross-sectional imaging methods and awareness amongst surgeons. Material and Methods: This study aimed to study the demographic, clinical, imaging, and histopathologic characteristics, incidence of malignancy and outcome of surgical resection of pancreatic cystic neoplasms. Retrospective analysis of 91 patients who underwent surgical resection for cystic neoplasm of the pancreas between 2006 to 2017 at a tertiary care institute was done. Results: There was a female preponderance in the study with a mean age of 47.2 years. Abdominal pain (46.1%) and jaundice (23.1%) were the most common symptoms. Computed tomography and endoultrasound (EUS) were the most commonly used imaging methods in the study and demonstrated good surgical correlation. Pancreaticoduodenectomy (37.1%) was the most commonly performed procedure followed by distal pancreaticosplenectomy (31.8%). Of the lesions, 9.8% were found malignant. Solid pseudopapillary epithelial neoplasm (SPEN) (37.3%) was the most common neoplasm followed by serous (21.9%), intraductal papillary mucinous neoplasm (IPMN) (15.3%) and mucinous neoplasm (14.3%). Preoperative radiological diagnostic correlation was found to be 75-100% implying the importance of imaging in cystic neoplasms of the pancreas. Morbidity and mortality in the study group were 28.5% and 2.1%, respectively. Conclusion: Pancreatic cystic neoplasms were mostly benign with female preponderance and presented in the younger age group with prevalence of SPEN higher than IPMN in our subcontinent. These can be reliably diagnosed on preoperative cross-sectional imaging, and surgical resection is associated with favourable outcome and acceptable morbidity.

Solitary Fibrous Tumors of the Mesocolon: A Report of Two Cases and Review of Literature / 대한소화기학회지

Solitary fibrous tumors (SFTs) are an uncommon group of neoplasms. The visceral pleura is the most common site of origin of these tumors. The colonic mesentery is an unusual site of origin of SFTs. A pre-operative diagnosis of SFT is challenging as there are no pathognomonic clinical or radiological signs. Most patients reported thus far were diagnosed post-operatively with the aid of immunohistochemical markers. Complete surgical excision is the treatment of choice for SFTs. Recurrences are uncommon. However, they can occasionally show aggressive behavior. In this report, we describe two cases of rare colonic mesentery SFTs.

Primary Hepatic Choriocarcinoma with Pregnancy: A Diagnostic and Therapeutic Challenge / 대한소화기학회지

Choriocarcinoma occurs mainly in the gonads, but an extragonadal origin has been reported, albeit infrequently. Primary hepatic choriocarcinoma (PHC) is a rare malignancy, with only 11 cases reported. Most cases reported were in males, with none reported in pregnant females. A 23-year-old primigravida presented with a large liver lesion involving the right lobe of the liver at 28 weeks of pregnancy. Preoperative imaging was suggestive of hepatocellular carcinoma. She underwent a non-anatomical resection of the liver lesion. Surprisingly, her postoperative histopathology revealed a diagnosis of PHC. Her blood workup showed elevated beta human chorionic gonadotrophin. She underwent a termination of her pregnancy at 32 weeks. Before initiating adjuvant chemotherapy four weeks after surgery, a whole-body PET scan revealed multiple bi-lobar liver and pelvic deposits. After a multidisciplinary team discussion, she was started on adjuvant chemotherapy. She is currently under regular follow-up, seven months post-surgery. PHC, one of the vascular lesions of the liver, poses a diagnostic and therapeutic challenge, warranting a multidisciplinary approach.

Clinicopathologic study of neuroendocrine tumors of gastroenteropancreatic tract: a single institutional experience.

BACKGROUND: The gastroenteropancreatic neuroendocrine tumors (GEPNET) have a characteristic histologic appearance unrelated of the exact site of origin. However the behavior of these tumors are different in each of these sites. In this article we study the clinicopathological features of GEPNET. These tumors were classified and graded according to WHO 2010 criteria. The immunohistochemical (IHC) features were evaluated and the grade of the tumor was correlated with Ki67. METHODS: A total of 40 cases of GEPNET diagnosed on biopsies as well as resected specimens were analyzed from January 2012 to June 2015. RESULTS: There were 28 resected specimens and 12 biopsies. Majority of the gastric neuroendocrine tumors (NET) showed classic morphology of cells arranged in islands. There were 3 cases each of grade 1 and grade 2 and one was diagnosed as mixed adenoneuroendocrine carcinoma (MANEC). All the duodenal NET were well differentiated (grade 1). There were 8 cases in colon and rectum, of which 4 cases were grade 3 and 3 cases were grade 2. Majority of the pancreatic tumors were grade 1. The mean mitotic count along with ki67 had good correlation in NET of stomach, duodenum colon and rectum. CONCLUSIONS: The most common site was small intestine followed by pancreas. Majority of the tumors were NET G1. Tumors from colorectal region were mostly NEC G3. There was a strong correlation by spearman correlation analysis between Ki67 and mitotic count and moderate correlation between ki67 and tumor grade as well as mitotic rate and tumor grade. Ki67 was helpful in grading these tumors.

Solid-pseudopapillary neoplasm of the pancreas: a clinicopathological and immunohistochemical study of 33 cases from a single institution in Southern India.

BACKGROUND: The clinicopathological and immunohistochemical data of solid-pseudopapillary neoplasm (SPN) from India are limited. Our objectives were to evaluate various histopathological parameters and immunomarkers to elucidate the best possible immunomarker combination that can accurately diagnose these tumors. MATERIALS AND METHODS: Clinicopathological features of 33 consecutive cases of SPN were retrospectively analyzed. Immunohistochemistry (IHC) was performed on a tissue microarray of 31 of these cases with antibodies to pan-cytokeratin (CK), vimentin, CD 10, E-cadherin, ß-catenin, estrogen receptor (ER), progesterone receptor (PR), chromogranin. RESULTS: Totally, 32 of 33 patients were females with a mean age of 26 years (range 12-62 years). Majority presented with abdominal pain (93.93%) and/or abdominal mass (48.48%). Location in pancreas included tail (14), head (7), body and tail (6), body (5) and neck (1). The mean diameter of the tumor was 8.6 cm (range 0.5-16 cm). Surgical exploration was done in all cases. On IHC, tumor cells were consistently positive for vimentin and negative for chromogranin (100%). CK was positive in 12 cases (38.7%), CD 10 showed perinuclear dot positivity in 14 (45.16%) cases and cytoplasmic positivity in 05 (16.12%) cases. All cases showed loss of membranous staining for both ß-catenin and E-cadherin with nuclear positivity in 90.32% and 70.16% cases, respectively. PR was positive in 20 (64.51%) cases, while all of them were negative for ER. CONCLUSION: Solid-pseudopapillary neoplasm is a tumor commonly affecting young females. Loss of membrane expression of ß-catenin and E-cadherin with nuclear positivity can be used confirm the diagnosis of SPN.

Disconnected duct syndrome: refractory inflammatory external pancreatic fistula following percutaneous drainage of an infected peripancreatic fluid collection. A case report and review of the literature.

CONTEXT: Inflammatory external pancreatic fistulas behave differently from postoperative external pancreatic fistulas in that the former are less likely to close without intervention and take a longer time to do so. The principal determinants of closure of an external pancreatic fistula are the anatomy of the fistulous tract (end versus side, main duct versus side branch), the presence of downstream ductal obstruction, ongoing peripancreatic inflammation and etiology of the fistula (inflammatory versus postoperative). While the approach to diagnosis and management of postoperative pancreatic fistulas has been standardized, the same is lacking for inflammatory external pancreatic fistulas, partly due to the absence of a unifying definition of the latter and a paucity of data on the topic. CASE REPORT: We report the case of disconnected duct syndrome, an end inflammatory fistula, following percutaneous drainage of an infected pancreatic fluid collection with two failed attempts at endoscopic treatment, treated successfully by surgery, and we also attempted to review the literature on the topic. CONCLUSIONS: "Disconnected duct syndrome", an end inflammatory fistula, following percutaneous or surgical treatment of severe acute pancreatitis is a distinct entity as spontaneous closure is exceedingly uncommon. Surgery is almost always required and is successful in the majority of cases.

Central pancreatectomy for neoplasm of mid pancreas - a report of four cases.

Central pancreatectomy (CP) originally done for pancreatic trauma and focal pancreatitis is recently being performed for benign and low grade malignant neoplasm of mid pancreas. It offers the advantage of conserving pancreatic tissue and preserving gastroduodenal-biliary anatomy, important for maintenance of endocrine and exocrine pancreatic function. We reviewed our database between Jan. 2005 and June 2007. Four patients (2 males and 2 females) in the age range of 12 to 55 years underwent CP for a mass in the mid pancreas. Two were known diabetic. Histology reported solid variant of serous cystadenoma (1), solid pseudopapillary tumor (1), focal pancreatitis (1) and ductal adenocarcinoma (1). Postoperatively one patient had transient pancreatic fistula which was managed conservatively. There was no mortality. On follow-up (7 to 43 months) none of the patients required enzyme supplements and diabetes did not worsen. Patient with ductal adenocarcinoma progressed within 7 months. CP may be a viable option for mid pancreatic lesions of benign or low grade malignant potential.

Postcholecystectomy surgical site infection by Salmonella enterica var. Weltevreden.

BACKGROUND: Surgical site infections (SSI) are the most common complication of gastrointestinal surgery. The most common endogenous organisms encountered are the enteric pathogens. METHODS: We report a rare case of S. enterica var. Weltevreden as a cause of SSI after cholecystectomy and common bile duct exploration. Pertinent literature is reviewed. RESULTS: The infection was due to bile spillage and contamination during surgery. The organism was found to be sensitive only to imipenem, and the patient recovered following intravenous treatment with that carbapenem. CONCLUSIONS: This case illustrates the fact that cholecystectomy with bile spillage is a definite risk factor for SSI. Although controversial, isolation of the pathogen from the bile and the surgical site must be made to allow this rare pathogen to be identified. Appropriate antibiotic could then be directed against the pathogen.