Pattern of Lymph Node Metastasis Correlates with Tumor Location in Bladder Cancer

PURPOSE: Resection of a large number of lymph nodes (LNs) increases survival in patients with LN-positive disease; however, morbidity also increases. Here, we investigated the correlation between tumor location and LN metastasis in bladder cancer. MATERIALS AND METHODS: Thirty-six patients with pathological N1 or higher bladder cancer, who underwent radical cystectomy with extended lymphadenectomy, were reviewed retrospectively. The tumor location was classified as right, left, front, posterior, or whole bladder. The LN metastasis pattern was classified as right, left, or bilateral. The correlation between tumor location and LN metastasis was determined by chi-square test. Survival rates were compared by Kaplan-Meier analysis. RESULTS: The numbers of patients with a tumor on the right (group 1), left (group 2), posterior (group 3), or whole (group 4) bladder were 16 (44.4%), 16 (44.4%), 2 (5.6%), and 2 (5.6%), respectively. In group 1, 14 patients (87.5%) had right-sided ipsilateral LNs, and 2 patients (12.5%) had left-sided contralateral LNs. In group 2, 4 patients (25%) had right-sided contralateral LNs, and 12 patients (75%) had left-sided ipsilateral LNs. In group 3, both patients (100%) had right-sided posterior LNs. In group 4, both patients (100%) had positive LNs on both sides. Tumor location and LN metastasis were significantly correlated (p<0.05). Moreover, the survival rate was significantly higher in patients with no LN metastasis than in patients with ipsilateral or contralateral LN-positive bladder cancer. CONCLUSIONS: The location of the bladder tumor and direction of metastatic spread were significantly correlated. Mandatory bilateral lymphadenectomy during radical cystectomy should be questioned.

Impact of a Retrotrigonal Layer Backup Stitch on Post-Prostatectomy Incontinence

PURPOSE: To evaluate the impact of a retrotrigonal layer backup stitch (RTBS) during robot-assisted laparoscopic radical prostatectomy (RALP) on post-prostatectomy incontinence. MATERIALS AND METHODS: We compared the difference in continence recovery between 94 patients (group 1, as historical controls) and 57 patients (group 2). The only technical difference between our two groups was the incorporation of the retrotrigonal layer into the posterior aspect of the vesicourethral anastomosis (group 1: without RTBS; group 2: with RTBS). Postoperative continence recovery was defined as the use of no absorbent pads. RESULTS: In group 1, the continence rate at 3, 6, and 12 months postoperatively was 40.4%, 70.2%, and 90.4%, respectively;in group 2, the continence rate was 42.1%, 70.1%, and 89.7%, respectively. The median (95% confidence interval) time to continence recovery was four months (range, 1 to 12 months) in group 1 and four months (range, 1 to 9 months) in group 2. Kaplan-Meier curves showed no significant difference in the recovery of continence between the two groups (log rank test, p=0.629). CONCLUSIONS: A RTBS does not appear to improve urinary incontinence after RALP. Further anatomical study and prospective randomized studies will be needed to confirm this.

Large Oncocytic Adrenocortical Tumor with Uncertain Malignant Potential

Oncocytoma is a neoplasm consisting of oncocytes that is found in the salivary gland, kidney, and thyroid. Adrenocortical oncocytoma is particularly uncommon, and most cases reported are benign and nonfunctioning. Here, we report a 20 cm adrenal mass associated with necrosis that was identified as an oncocytic adrenocortical tumor with uncertain malignant potential through histopathological evaluation after its resection.

A Case of Robot-Assisted Laparoscopic Radical Prostatectomy in Primary Small Cell Prostate Cancer

Primary small cell carcinoma of the prostate is a rare and very aggressive disease with a poor prognosis, even in its localized form. We managed a case of primary small cell carcinoma of the prostate. The patient was treated with robot-assisted laparoscopic radical prostatectomy and adjuvant chemotherapy. Herein we report this first case of robot-assisted laparoscopic radical prostatectomy performed in a patient with primary small cell carcinoma of the prostate.

The Results of Aspiration Thrombectomy for the Endovascular Treatment of Ileofemoral Deep Vein Thrombosis

PURPOSE: This study was performed to evaluate the effect of aspiration thrombectomy for the treatment of ileofemoral deep vein thrombosis. METHODS: We reviewed the records of sixty-two patients who were treated with catheter-directed thrombolysis (CDT) at our institution between November 2001 and October 2007. The patients were divided into two groups: those who were treated by CDT with aspiration thrombectomy (AT) (the aspiration group; 33 patients) or those who were treated with using CDT alone (the CDT alone group; 29 patients). The obtained data included the demographics, the procedural details, the periprocedural evaluation and the thrombus resolution. RESULTS: The treatment time with using CDT only was 40.93+/-15.59 hours compared with 23.18+/-8.22 hours with using AT (P<0.001). The mean dose of urokinase with using CDT only was 2.48+/-0.82 million IU as compared with 1.60+/-0.54 million IU with using AT (P<0.001). The use of AT did not improve the overall lytic success (P=0.084), but more patients had complete thrombus resolution (13 vs. 22 patients, respectively). There was no difference in symptom improvement or the long term patency rate between the two groups. There was no major morbidity or mortality. The prophylactic IVC filters were inserted in 31 patients and entrapped thrombi were founded in 3 patients of the aspiration group. Evidence of venous reflux was identified in the CDT only group (3 patients; 10.4%). CONCLUSION: These results suggest that the use of AT offers more effective thrombus removal in less time and with using a lower dose of thrombolytic agents. When performing AT treatment, prophylactic IVC filter insertion should be considered for preventing floating thrombi.

The Efficacy of an Ultrasound-guided Core Needle Biopsy with an 18G Cutting Needle for the Diagnosis of Pancreatic Diseases

PURPOSE: The objective of this study is to evaluate the efficacy and safety of an ultrasound-guided core needle biopsy with an 18G cutting needle in patients suspected of having a pancreatic disease by analyzing the diagnostic performance and complication rate. MATERIALS AND METHODS: The study population comprised 35 consecutive patients who underwent an ultrasound-guided core needle biopsy using a high-speed biopsy gun accompanied with an 18G cutting-type needle between May of 2001 and October of 2005. The diagnostic performance (i.e., the acquisition rate and diagnostic accuracy) and complications associated with core needle biopsies were evaluated for its efficacy and safety. RESULTS: Thirty-six sessions of ultrasound-guided core needle biopsies were performed in 35 consecutive patients. All patients, except two (serous cystadenoma and autoimmune pancreatitis) were diagnosed with various subtypes of pancreatic cancer. The acquisition rate and diagnostic accuracy were 97% (35/36) and 94% (34/36), respectively. A complication occurred only in one patient (3%), which further proved to be a delayed complicaton (i.e., needle tract implantation). CONCLUSION: According to our findings, the ultrasound-guided core needle biopsy is a viable and safe method for the dignosis of pancreatic diseases. Moreover, it enables the diagnosis of the pancreatic cancer subtype.

The Pathologic Splenic Rupture of a Patient with Scrub Typhus: A Case Report

A pathologic splenic rupture is rare, occurring primarily in a spleen affected by infective, hematological, and neoplastic disease. To the best of our knowledge, no prior reports of a pathologic splenic rupture due to scrub typhus exist. Intrasplenic pseudoaneurysms and focal infarctions are visible on an initial CT scan. Moreover, the spontaneous splenic rupture occurred a week later. We report a case of nontraumatic-splenic rupture in a patient with scrub typhus.

A Case Report of a Ciliated Hepatic Foregut Cyst in the Liver

A ciliated hepatic foregut cyst (CHFC) is a rare cystic lesion consisting of a ciliated pseudostratified columnar epithelium, subepithelial connective tissue, a smooth muscle layer, and an outer fibrous capsule. A CHFC is usually unilocular and occurs at a higher frequency in males. A predilection exists at the medial segment located at the left lobe of the liver. We report the first case of a ciliated hepatic foregut cyst mimicking hepatic metastasis on a CT scan of a patient concurrently afflicted with gastric cancer.

Catheter Directed Thrombolysis for Deep Vein Thrombosis during the First Trimester of Pregnancy: Two Case Reports

Anticoagulation with heparin has been the standard management therapy of deep vein thrombosis during pregnancy. Pregnancy is generally considered as a contraindication for thrombolysis. However, anticoagulation therapy alone does not protect the limbs from post-thrombotic syndrome and venous valve insufficiency. Catheter-directed thrombolysis, combined with angioplasty and stenting, can remove the thrombus and restore patency of the veins, resulting in prevention of post-thrombotic syndrome and valve insufficiency. We report successful catheter-directed thrombolysis and stenting in two early gestation patients with a deep vein thrombosis of the left lower extremity.

CT and (18F)FDG PET/CT Findings of Esophageal Squamous Cell Papillomatosis: A Case Report

Esophageal squamous cell papillomatosis is a rare disorder that is usually found incidentally on an upper gastrointestinal endoscopy examination or autopsy. A 70-year-old woman presented with a two-month history of dysphagia and abdominal discomfort. A chest CT scan showed diffuse marked thickening of the esophageal wall along the entire length and multiple small enhancing polypoid projections in the distal esophagus. Diffuse circumferential FDG uptake in the entire esophagus was seen on [18F] FDG PET/CT. Squamous papillomatosis was diagnosed by an endoscopic biopsy. We report a case of extensive esophageal papillomatosis with imaging features on CT and [18F] FDG PET/CT, with a review of the clinical literature.

Radiologic Features of a Tailgut Cyst in a Neonate: A Case Report

A tailgut cyst is a rare congenital abnormality located in the retrorectal space and is usually manifested during childhood or adulthood. We report the MR, CT and ultrasound findings of a tailgut cyst in a 23-day-old neonate.

Recurring Fibromatosis of Breast Following Tumorectomy: A Case Report

A fibromatosis or desmoid tumor of the breast is an extremely rare benign tumor, which is often presented clinically and radiologically as a malignant tumor. Although benign, fibromatosis or desmoid tumors can grow aggressively in local infiltrating patterns. The recurrence is relatively common; hence a wide excision with a clear margin around the tumor is necessary. We report a case of a young female patient with a recurring fibromatosis of the breast after a local excision.

Saccular Aneurysm of Intraheparic Portal Vein Mimicking Hypervascular Hepatic Mass: A Case Report

A portal vein aneurysm is divided into two groups; an extrahepatic portal vein aneurysm and an intrahepatic portal vein aneurysm. The morphology of an aneurysm can be divided into types such as fusiform, bilobulated and saccular. A saccular aneurysm that arises from the intrahepatic portal branch is extremely rare. We report here a case of a saccular aneurysm of the intrahepatic portal branch mimicking an intrahepatic hypervascular mass, as seen on a dynamic CT scan, with the radiological findings.

CT and (18F)FDG PET/CT Findings of Subcutaneous Panniculitis like T-Cell Lymphoma: A Case Report

Subcutaneous panniculitis-like T-cell lymphoma (SCPTCL) is a rare subtype of peripheral T-cell lymphoma. This case report is of a 24-years-old man presented with subcutaneous nodules on his lower abdomen and buttocks. An abdominal CT revealed multiple nodules and increased streaky densities in the subcutaneous fat layer of the abdominal wall and buttocks. In addition, multiple focal FDG uptake lesions of the subcutaneous fat layer were detected from a 18FFDG PET/CT and the histologic diagnosis determination was SCPTCL. We report here one case of SCPTCL, determined by the CT and 18FFDG PET/CT imaging features and a review of the relevant literature.

Hypotensive Splenic Infarction: A Case Report

Splenic infarction occurs when parenchymal ischemia of the spleen is evoked by an occlusion of the arterial or venous circulation. The most common causes include infiltrative hematological disease and thromboembolic conditions, but a hypotensive splenic infarction may be a rare cause of splenic infarction. A 62-year-old female patient presented with a hypotensive splenic infarction after massive bleeding. CT showed geographic low-density lesions in the central part of the spleen on the tissue equilibrium phase of dynamic CT. Usually, a depressed scar occurs in the course of healing of a splenic infarction. However, in this case recovery of blood flow and regeneration of the infarcted spleen was seen during the follow-up CT scans. We report a case of hypotensive splenic infarction with a review of the literature.

Comparison of the Clinical Results between Endovascular and Open Bypass Surgery for Treating Iliac Artery Occlusion

PURPOSE: This study was constructed to review our experience for the treatment for iliac artery occlusion/stenosis with performing angioplasty/stenting and open bypass surgery. METHODS: We retrospectively evaluated the 86 primary endovascular and open bypass procedures that were done for iliac artery occlusion/stenosis between 2000 and 2005. The data was divided into two groups by the procedure: the endo group (31 limbs, 36%), and the bypass group (55 limbs, 65%). RESULTS: The outcomes were defined according to the reported standards of the Society for Vascular Consensus (TASC). The lesion types were significantly more severe in the patients in the bypass group (P=0.000). The initial technical & clinical success rates were 100% in both groups. The cumulative 48-month primary & secondary patency rates were 76.1% and 95.2% in the endo group and 78.0% and 93.8% in the bypass group, respectively. The perioperative complication rates were 6% in the endo group and 9% in the bypass group, respectively. The mean hospital stay was more significantly shorter in the endo group (5.4 days vs. 15.1 days, respectively, p=0.000). CONCLUSION: The treatment of iliac artery lesion with angioplasty/stenting was a safe and effective method in our experience. Selective angioplasty/stenting may be preferable to bypass surgery for treating TASC A and B type iliac artery occlusions.

Microvascular Injury of the Peribiliary Plexus Associated with Transarterial Chemoembolization: A Study of Surgical Specimens

PURPOSE: We attempted to evaluate the relationship between transarteiral chemoembolization (TACE) and injury to the peribiliary plexus by evaluating the number of microvessels in the peribiliary plexus of surgical specimen. MATERIALS AND METHODS: Surgical specimens were obtained from 78 hepatocellular carcinoma patients and 22 patients with liver metastases. They were divided into 4 groups (Group 1; hepatocellular carcinoma without TACE [n=30], Group 2; hepatocellular carcinoma receiving preoperative TACE once [n=37], Group 3; hepatocellular carcinoma receiving preoperative TACE more than two times [n=11] and Group 4; metastatic carcinoma of the liver patients without a history of liver disease [n=22]). Immunohistochemical staining for factor VIII-related antigen was performed in all the specimens and the number of microvessels in the inner capillary layer and the outer venous layer of the bile duct (> 200 micrometer in diameter) was counted. RESULTS: The mean numbers of microvessels in the inner capillary layer were 4.50, 4.08, 1.64 and 2.05, and those in the outer venous layer were 25.23, 20.00, 18.36 and 12.32 for the 4 groups, respectively. The number of microvessels in group 4 was statistically fewer than that of group 1 (p<0.01). In the hepatocellular carcinoma patients, the number of microvessels was decreased as the number of TACE sessions was increased. CONCLUSION: The number of microvessels in the peribiliary plexus is increased in chronic liver disease patients. It may be from the increased portal pressure and flow stagnation in the sinusoidal and portal venules. TACE can have an effect on microvascular injury of the peibiliary plexus, and this can be a cause of bile duct necrosis and biloma.

Hypervascular Hyperplastic Nodules Appearing in Chronic Alcoholic Liver Disease: Benign Intrahepatic Nodules Mimicking Hepatocellular Carcinoma

PURPOSE: Hypervascular hyperplastic nodules in those patients with chronic alcoholic liver disease and who are hepatitis B and C negative have recently been reported on. The purpose of this study was to correlate the radiologic and pathologic findings with the clinical significance of these hypervascular hyperplastic nodules in chronic alcoholic liver disease. MATERIALS AND METHODS: The study included eight hypervascular nodules of seven patients with chronic alcoholic liver disease, and these patients had abused alcohol for more than 20 years. Eight hypervascular nodules were seen on the arterial phase of dynamic CT scans, but the possibility of HCC was excluded pathologically (n=4) or clinically. The radiologic and pathologic findings, and the changes of these nodules on follow up CT scans were retrospectively analyzed. RESULTS: All nodules showed good enhancement on the arterial phase. The tissue equilibrium phase of the dynamic CT scans showed isodensity in seven patients and low density in one patient. Ultrasound scans revealed hypoechoic findings for three nodules, isoechoic findings for two nodules, hyperechoic findings for one nodule, and two nodules were not detected. Angiograms (n=6) showed late incremental tumor staining, and all the nodules were well seen on the sinusoidal phase. CT during hepatic angiography (n=4) showed well stained tumor. CT during arterial portography (n=4) showed no defect in three nodules and nodular defect in one nodule. The MR images (n=3) showed low signal intensity in two nodules and iso-signal intensity in one nodule on T2WI. Five of six cases for which follow up CT scans were performed showed decrease in size and one was disappeared. CONCLUSION: Radiologically, it is often difficult to differentiate the hypervascular hyperplastic nodules seen in the chronic alcoholic liver disease from hepatocellular carcinoma, and histological confirmation is needed for excluded hepatocellular carcinoma. However, late tumor staining during the sinusoidal phase without any blood supply by feeding vessels or any arterioportal shunt on the angiogram, isodensity during the tissue equilibrium phase of dynamic CT and low signal intensity on T2WI may suggest the presence of hypervascular hyperplastic nodule.

Schwannoma of the Appendix: A Case Report

Schwannoma is a benign neurogenic tumor arising from the nerve sheath, and it presents as a well defined mass. Isolated gastrointestinal schwannoma is a relatively rare finding and schwannoma of the appendix is extremely rare. We report here on a case of schwannoma that arose from the appendix, and this lesion was pathologically confirmed.

Prognosis and Treatment Outcomes of Gastric Cancer Patients with Hepatic Metastasis

PURPOSE: This study was conducted to evaluate the treatment outcomes and the prognosis for gastric cancer patients with hepatic metastasis. MATERIALS AND METHODS: This retrospective study was based on the medical records of 85 gastric cancer patients with hepatic metastasis (62 synchronous and, 23 metachronous) who received chemotherapy with or without resectional therapy from March 1990 to March 2006. The survival rate was analyzed according to clinicopathologic factors and therapeutic factors, such as whether or not a gastrectomy, a hepatic resection, and/or chemotherapy had been performed. RESULTS: The median survival of gastric cancer patients with hepatic metastasis was 11 months (synchronous: 11 months and metachronous: 17 months). The rates of gastrectomies and hepatic resections in the synchronous group were 24.1% and 16.1%, respectively. A 23.5% prevalence of extra-hepatic metastasis was observed. The median survivals of patients who underwent a gastrectomy with a hepatic resection, a gastrectomy alone, and non-surgical treatment were 60, 18, and 9 months, respectively (P<0.05). The disease-free median survival of the metachronous group was 8 (3~39) months. There was no difference in initial pathologic stage and frequency of hepatic metastasis after the gastrectomy in the metachronous group. In the synchronous group, extra-hepatic metastasis, a gastrectomy as the operative procedure, a hepatic resection as the operative procedure and the response to chemotherapy were statistically significant in the univariate analysis, and a hepatic resection as the operative procedure, the response to chemotherapy, and extra-hepatic metastasis were independant prognostic factors identified by the multivariate analysis. In the metachronous group, extra-hepatic metastasis, the response to chemotherapy and differentiation were statistically significant in the univariate analysis, and extra-hepatic metastasis was an independent prognostic factor identified by the multivariate analysis. CONCLUSION: An aggressive surgical therapy and effective chemotherapy are necessary in the treatment of gastric cancer patients with hepatic metastasis.