Prognostic value of somatostatin receptor-2 positivitiy in gastroenteropancreatic neuroendocrine tumors in reference to known prognostic factors.

BACKGROUND/AIMS: Identification of the predictive factors for the prognosis of gastroenteropancreatic neuroendocrine tumors is important but rather challenging due to the rarity of the condition. This study aimed to examine the association between somatostatin receptor-2 positivity and known prognostic factors for gastroenteropancreatic neuroendocrine tumor to identify the value of somatostatin receptor-2 positivity itself as a predictive factor for prognosis. MATERIALS AND METHODS: Records of 41 gastroenteropancreatic neuroendocrine tumor patients (24 females, 17 males) were retrospectively reviewed. The relations between somatostatin receptor-2 positivity and known prognostic factors including tumor stage, Ki-67 positivity, vascular or perineural invasion, lymph node metastasis, presence of necrosis, and soft tissue extension were analyzed. RESULTS: Sixty percent of the patients had histologically confirmed somatostatin receptor-2 positivity with 45% exhibiting focal and 15% showing diffuse staining characteristic. No significant relation was found between somatostatin receptor-2 positivity and any of the known prognostic factors for gastroenteropancreatic neuroendocrine tumor: versus stage, p=0.67; vs. lymph node metastasis, p=0.51; vs. vascular invasion, p=0.11; vs. extension to surrounding soft tissue, p=0.54; vs. necrosis, p=0.23; vs. lymphatic invasion, p=0.25; and vs. perineural invasion, p=0.42. CONCLUSIONS: Somatostatin receptor-2 positivity, either focal or diffuse, does not seem to predict prognosis in gastroenteropancreatic neuroendocrine tumors. However, growing evidence supports the benefits of somatostatin analogues as adjunctive treatment in this group of patients.

Xanthogranulomatous pancreatitis treated by duodenum-preserving pancreatic head resection.

BACKGROUND: Xanthogranulomatosis is an idiopathic, rare process in which lipid-laden histiocytes are deposited at various locations in the body. We present two cases who were treated by duodenum-preserving pancreatic head resection and eventually diagnosed as having xanthogranulomatous pancreatitis. METHODS: A 30-year-old caucasian man was admitted to our clinic for vague abdominal pain and epigastric dullness. Magnetic resonance cholangiopancreatography and endoscopic retrograde pancreatography suggested the existence of chronic pancreatitis. Another 34-year-old caucasian woman was admitted to our clinic because of right upper quadrant pain. Magnetic resonance cholangiopancreatography demonstrated a dilatation and stone of the main pancreatic duct. Based on a diagnosis of chronic pancreatitis, pancreatic head resection was planned and a laparotomy was performed in both of cases. RESULTS: In both cases, duodenum-preserving pancreatic head resection was performed. Macroscopic and microscopic findings revealed xanthogranulomatous inflammation, which led to a diagnosis of xanthogranulomatous pancreatitis. CONCLUSION: Although this type of pancreatitis is extremely rare, it is important to keep it in mind for a differential diagnosis because it may simulate chronic pancreatitis or a malignant tumor on imaging.

Ectopic fascioliasis mimicking a colon tumor.

Fasciola hepatica, a leaf shaped trematode that is common in cattle, sheep and goats, is acquired by eating raw water plants like watercress or drinking water infected with the encysted form of the parasite. The varied clinical presentations of fascioliasis still make a high index of suspicion mandatory. Besides having a wide spectrum of hepatobiliary symptoms like obstructive jaundice, cholangitis and liver cirrhosis, the parasitic infection also has extrabiliary manifestations. Until recently, extrahepatic fascioliasis has been reported in the subcutaneous tissue, brain, lungs, epididymis, inguinal lymph nodes, stomach and the cecum. In this report, a strange manifestation of the fasciola infection in a site other than the liver, a colonic fascioliasis, is presented.

The ongoing debate in thyroid surgery: should frozen section analysis be omitted?

Controversies concerning the role of frozen section (FS) have been a matter of debate. The aim of this study was to identify the role of FS analysis in intraoperative decision making and analyze the effect of the cost in detecting thyroid malignancies in Turkey. Out of 214 consecutive patients who had been operated on for thyroid cancer between January 1996 and August 2004, 178 patients were evaluated retrospectively. All 178 patients were subjected to FS. Intraoperative FS correctly identified the pathology as malignant in 58.4% of patients. A true-positive FS result changed the surgical strategy in 30 (27.6%) cases False negative FS lesions were defined histologically as papillary microcarcinoma in 54%, follicular variant of papillary cancer in 18% and follicular cancer in 8% of cases. The sensitivities of FNAB and intraoperative FS in thyroid cancer patients were 22.5% and 58.4%, respectively. False negative FS results increased the cost for each informative FS from euro25 to euro42.7. Despite limitations, results of this study reject the idea that the role of FS is becoming limited. We recommend routine frozen section in the operative assessment of thyroid nodules. Omitting FS may be suggested only in cases with a FNAB revealing malignancy.

Laparoscopic cholecystectomy in a patient with situs inversus totalis.

Currently, laparoscopic cholecystectomy is an undoubtfully optimal treatment of cholelithiasis. What about performing this procedure on a patient with situs inversus totalis and what are the difficulties of this operation for a right-handed surgeon? We presented a 35-year-old man with unknown situs inversus totalis who was admitted with epigastric pain and digestive problems. Ultrasonography and computed tomography of the abdomen confirmed the diagnosis of a gallstone. Besides, the liver and gallbladder were on the left side and the spleen was on the right. All systems were left-right reversal as mirror image in all diagnostic studies. Laparoscopic cholecystectomy was safely performed, despite of difficulties of situs inversus. The patient was discharged on postoperative day 1. It should be considered that existence of other anomalies may easily cause uninvited injuries. In the patients with situs inversus, laparoscopic cholecystectomy can be safely managed by an experienced surgeon through laparoscopy, and also hepatobiliary surgery.

Is D-dimer a predictor of strangulated intestinal hernia?

BACKGROUND: The goal of this study was to assess the relevance of serum D-dimer measurement as a possible reliable marker for the diagnosis of strangulated intestinal hernia. METHODS: Consecutive patients admitted with nontraumatic acute abdominal gastrointestinal disorders were recruited prospectively in a tertiary referral hospital. The study was conducted in 159 patients between August 2002 and April 2004. D-dimer, lactate dehydrogenase, serum amylase, and international normalized ratio (INR) levels were tested in the emergency room prior to surgical intervention. For each patient, 15 variables, including D-dimer, were available for analysis. RESULTS: Thirty-three (20.7%) of the 159 patients had intestinal ischemia, and 28 (85%) of these 33 patients had D-dimer level > 300 ng/ml. Plasma levels of D-dimer in patients with intestinal ischemia were significantly higher than in patients without ischemia (P < 0.05). There were 29 (18.2%) patients in the hernia group with incarceration (n = 22) or strangulation requiring resection (n = 7). D-dimer levels in patients requiring intestinal resection were insignificantly higher than in patients without resection (P > 0.05). Six (85%) of the 7 hernia patients requiring resection had D-dimer levels > 360 ng/ml. The D-dimer variable correlated best with the leukocyte count in patients with hernia requiring resection. Levels of lactate dehydrogenase, serum amylase, and INR did not show any correlation with D-dimer levels. CONCLUSIONS: To help predict ischemic events, the increasing use of the D-dimer assay in clinical practice could be extended to patients presenting with intestinal emergencies. An elevated D-dimer level on admission had a high sensitivity for identifying patients with intestinal ischemia, although it had a low specificity. Whether it is predictive or preventive for resection in strangulated intestinal hernia patients still remains a question.

Mechanical bowel obstruction due to colonic hemangioma: report of a case.

Colon hemangiomas are rare benign vascular lesions which are usually seen in teenagers. The frequent presentation is repetitive painless rectal bleeding. Colonic hemangiomas are occasionally found in the rectosigmoid area. A 62-year-old male patient was admitted to the hospital with the complaints of mechanical bowel obstruction. The radiological imaging techniques revealed a transverse colon tumor. Consequently, the patient was operated, and transverse colectomy and end-to-end anastomosis were performed. No postoperative complications occurred. The pathologic examination revealed cavernous hemangioma of the transverse colon. This report describes a very rare case of bowel obstruction due to colonic hemangioma.