The extension of HCC with tumor thrombus through the hepatic veins into the right atrium can cause sudden death due to heart failure and pulmonary embolism, even though the primary tumor may be relatively localized. We report a case of hepatic resection and tumor thrombectomy of hepatocellular carcinoma with tumor thrombus extending into right atrium using cardiopulmonary bypass and total hepatic vascular exclusion. A 65-year-old man, with a diagnosis of left liver mass, visited Yeungnam University Hospital. The patient had no noticeable edema in the lower extremities, but had dyspnea on exertion. Laboratory studies revealed a platelet count of 162 K/uL, total bilirubin of 1 mg/dL, albumin of 4.1 g/dL and a prothrombin time of 14.7 second. In addition, the retention of indocyanine green at 15 min was 13.5 %. The patient was anti-HCV was positive and his levels of alpha-fetoprotein and PIVKA-2 were 6.45 ng/mL and 582 mIU/mL, respectively. An abdominal CT scan, hepatic angiogram and echocardiogram showed a 4 cm sized HCC in the left lobe and a 4 to 5 cm sized tumor thrombus extending into the right atrium through the left and middle hepatic veins. No distant metastasis was detected in other studies. Total operative time, total duration of cardiopulmonary bypass and cardioplegic time were 13 hours, and 55 and 24 minutes, respectively. The total hepatic vascular exclusion time was 18 minutes. Unfortunately, the patients died 2 months later due to ARDS without being discharged from hospital.
Aged ; alpha-Fetoproteins ; Bilirubin ; Carcinoma, Hepatocellular* ; Cardiopulmonary Bypass* ; Death, Sudden ; Diagnosis ; Dyspnea ; Edema ; Heart Atria* ; Heart Failure ; Hepatic Veins ; Humans ; Indocyanine Green ; Liver ; Lower Extremity ; Neoplasm Metastasis ; Operative Time ; Platelet Count ; Prothrombin Time ; Pulmonary Embolism ; Thrombectomy* ; Thrombosis* ; Tomography, X-Ray Computed

The Peutz-Jeghers syndrome is an autosomal dominant hereditary disease characterized by hamartomatous polyps of the gastrointestinal tract and by mucocutaneous melanin deposits. This syndrome is clinically important because of the complication caused by the gastrointestinal polyp, leading to abdominal pain, gastrointestinal bleeding and intussusception. We experienced a case of Peutz-Jeghers syndrome associated with intussusception who was operated due to intussusception 14 years ago.
Abdominal Pain ; Gastrointestinal Tract ; Genetic Diseases, Inborn ; Hemorrhage ; Intussusception* ; Melanins ; Peutz-Jeghers Syndrome* ; Polyps

According to the development of new diagnostic techniques and the extension of aging population, the diagnosis of multiple primary malignant neoplasm has increased. We report a 76 years old man who had prostate cancer, colon cancer and stomach cancer metachronously and review literatures about the history, criteria, incidence and causes of the multiple primary malignant neoplasm.
Aged ; Aging ; Colonic Neoplasms ; Diagnosis ; Humans ; Incidence ; Prostatic Neoplasms ; Stomach Neoplasms

An acute fulminant amoebic colits rarely develops as a complication of amoebiasis, and is difficult to diagnose and treat when it occurs. It is a life-threatening disease, and associated with a very high mortality rate. Herein, a case 42-old-year man, who had a generalized peritonitis caused by an acute fulminant amoebic colitis, is reported, with a review of the literature. He died of multiple organ failure, following sepsis and disseminated intravascular coagulation, on the 19th day after his operation, despite treatment with aggressive surgery and anti-amoebic agents. An emergency laparotomy should be considered when an acute fulminant amoebic colitis deteriorates despite the use of intensive anti-amoebic therapy, especially when there is an acute episode suggestive of perforation. A primary total resection of the diseased colon is one of the treatments of choice.
Amebiasis ; Colon ; Disseminated Intravascular Coagulation ; Dysentery, Amebic* ; Emergencies ; Laparotomy ; Mortality ; Multiple Organ Failure ; Peritonitis* ; Sepsis

Type-I neurofibromatosis (NF-I) is an autosomal dominant hereditary condition that may affect the gastrointestinal tract in 25% of cases. Gastrointestinal stromal tumors(GISTs) are rarely noted in associated with NF-I as an gastrointestinal manifestation. We suggest that iron deficiency anemia in patient with NF-1 mandates the endoscopic and radiologic evaluation of the digestive tract to find or rule out neurofibromas and GISTs. Pheochromocytomas have been clinically identified in 0.1 to 5.5% of patients with NF-I. An adrenal mass may be incidentally discovered in any patients and must be evaluated in patients with NF-1 to exclude pheochromocytoma from diagnosis. This report describes the concomitant occurrence of a multiple duodeno-jejunal GISTs and an adrenal pheochromocytoma in patient with NF-I. Immunohistologically, the tumor cells were intensely positive for CD117, focally positive for S-100 and neuron-specific enolase (NSE), whereas negative for smooth muscle actin, and diagnosed as GISTs. The presence of spindle cell hyperplasia in the myenteric plexus may help to better explain the histogenesis of multiple GISTs.
Actins ; Anemia, Iron-Deficiency ; Diagnosis ; Gastrointestinal Stromal Tumors ; Gastrointestinal Tract ; Humans ; Hyperplasia ; Muscle, Smooth ; Myenteric Plexus ; Neurofibroma ; Neurofibromatoses ; Neurofibromatosis 1* ; Pheochromocytoma* ; Phosphopyruvate Hydratase

A hepatic angiosarcoma is a rare primary malignant neoplasm, which accounts for only 2% of all primary hepatic tumors. The prognosis of a hepatic angiosarcoma is very poor, and most patients die within a year of the initial diagnosis. We report a case of a hepatic angiosarcoma in a 57-year-old man. Although a dynamic CT had suggested a carvenous hemangioma 12 months earlier, the tumor size increased and spontaneously ruptured, so surgical resection was mandatory. A pathological examination, including immunohistochemical studies, showed positive staining for CD34 and Factor VIII, which confirmed the diagnosis of an angiosarcoma. Although dynamic CT is an excellent modality for the diagnosis of a cavernous hemangioma of the liver, hepatic angiosarcomas should be ruled out in selected cases, because they may present with very similar CT findings to benign hemangioma.
Diagnosis ; Factor VIII ; Hemangioma ; Hemangioma, Cavernous* ; Hemangiosarcoma* ; Humans ; Liver ; Middle Aged ; Prognosis ; Rupture, Spontaneous

In most cases of anal fistulas external openings are located within 2.5 cm of the anal verge. It is rare for an anal fistula to involve the scrotum diffusely. This article present a case of anal fistula with multiple external openings involving the scrotum. The fistula was transsphincteric. The internal opening was located at the dentate line in the anterior midline. Surgery was undertaken on outpatient basis. The primary fistula tract was cored out under local anesthesia, and the defect of the cored out tunnel in the sphincter muscles and mucosa were repaired by layered suture closure with absorbable suture material. The secondary tracts involving the scrotum were curetted and left open for drainage. The operative wounds had healed at the 6 months follow-up after surgery.
Ambulatory Surgical Procedures ; Anesthesia, Local ; Drainage ; Fistula ; Follow-Up Studies ; Humans ; Mucous Membrane ; Muscles ; Outpatients ; Rectal Fistula* ; Scrotum* ; Sutures ; Wounds and Injuries

We report a rare case of inflammatory fibroid polyp of the stomach that mimicked gastric cancer. A review of the associated literature is also reported. A 32 year old woman was admitted to our hospital with a history of vomiting and epigastric pain and a weight loss of 10 kg in one month. A radiologic and an endoscopic examination showed a protruding tumor, with diffuse ulceration at the posterior wall of the prepyloric antrum of stomach. Although no malignant cells were histologically confirmed in the biopsy specimens, a subtotal gastrectomy, with a lymphadenectomy, was performed because gastric cancer was suspected, preoperatively. The histopathological diagnosis was an inflammatory fibroid polyp of the stomach. If a submucosal tumor of the stomach is suspected in a preoperative diagnosis, an inflammatory fibroid polyp should be considered as one of the possible differential diagnoses.
Biopsy ; Diagnosis ; Diagnosis, Differential ; Female ; Gastrectomy ; Humans ; Leiomyoma* ; Lymph Node Excision ; Polyps* ; Stomach Neoplasms* ; Stomach* ; Ulcer ; Vomiting ; Weight Loss

Thyroid anomaly are rare embryological condition. The failure of the development of one lobe leading to unilateral agenesis is the rarest of all the thyroid anomalies, The cause of unilateral agenesis is unknown. Thyroid hemiagenes is common in females (3: 1) with the left lobe being absent. The common disease in the remaining lobe is a benign adenoma, a multinodular goiter, hyperthyroidism, chronic thyroiditis, and rarely carcinoma. The most common pathology involved in thyroid hemiagenesis is hyperthyroidism. This report the case of a 57-year-old woman with a right thyroid hemiagenesis.
Adenoma ; Female ; Goiter ; Humans ; Hyperthyroidism ; Middle Aged ; Pathology ; Thyroid Gland* ; Thyroiditis

PURPOSE: This study was done to review our clinical experience of fluorodeoxyglucose (FDG)-positron emission tomography (PET) in biliary-pancreatic malignancies, and evaluated its diagnostic accuracy and usefulness. METHODS: FDG-PET was performed in 15 patients with biliary-pancreatic malignancies, to determine the extent of the disease (n=9) and to detect the recurrence (n=6). RESULTS: Of the 9 patients with a suspected loco-regional spread, 6 patients were disclosed by FDG-PET as having multiple metastasis to the regional lymph nodes and extraperitoneal organs, but the other 3 showed no evidence of regional or distant metastasis. Thus, FDG-PET performed preoperatively to estimate the extent of the disease, showed sensitivity and specificity of 100%, respectively. However, for the detection of a recurrent disease only 3 out of 5 with recurrent diseases were detected by FDG-PET (sensitivity: 60%). FDG-PET revealed one suspected recurrent lesion, but a computed tomography (CT) scan showed no evidence of a recurrence. Due to the 2 false-negative results, the overall sensitivity and specificity of this study were 81.8 (9/11) and 100% (4/4), respectively. CONCLUSION: Unnecessary surgical procedures were avoided in 6 cases, and 3 curative surgeries aborted through the use of FDG-PET. Despite the lack of cases, FDG-PET was useful in estimating the extent of a disease, but was unsatisfactory in detecting a recurrent disease compared to CT. Coupled with conventional imaging, FDG-PET may also provide more helpful information for biliary-pancreatic malignancies as well.
Humans ; Lymph Nodes ; Neoplasm Metastasis ; Recurrence ; Sensitivity and Specificity