Herein is presented a case of aplastic anemia associated with adenocarcinoma of the stomach which seem- ed to be coincidental. A 52 year-old man was admitted with a 3 year history of dyspnea. Three years previously, he was diagnosed as bone marrow hypoplasia and had been treated with oxymetholone for 1 year. After confirmation of aplastic anemia during the first admission, he was followed up with fluoxymesterone and steriods. One year later, he was readmitted with melena. Fibergastroscopy and an UGl study revealed a fungating mass on the antrum suggestive of stomach cancer. Following perioperative platelet transfusions and intensive supportive care, a subtotal gastrectomy was performed and there were no postoperative complications. Pathologic examinations disclosed a moderately well differentiated adenocarcinoma. This is the first report in Korea of adenocarcinoma of the stomach occurring in a patient with aplastic anemia. He survived 17.5 months after the surgery and 5.4 years after the onset of aplastic anemia. Gastrointestinal bleeding in aplastic anemia may be incorrectly ascribed to steriod use and overlooked, thus the need to fully investigate gastric pathology by endoscopy as well as radiology is streesed. In a patient with pancytopenia, the major surgical procedures are frequently evaded by both surgeons and internists due to the possibility of morbidity from bleeding and infection. In this case, intensive perioperative supportive care and surgery were combined to prolong the patient's survival time.
Adenocarcinoma/*complications/secondary/surgery ; Anemia, Aplastic/*complications/drug therapy ; Case Report ; Human ; Male ; Middle Age ; Oxymetholone/therapeutic use ; Stomach Neoplasms/*complications/surgery

Peutz-Jeghers syndrome (PJS), which is characterized by multiple hamartomatous polyps of the gastrointestinal tract and mucocutaneous pigmentation, is a rare autosomal dominant disease. This syndrome is often represented as a surgical emergency with complications of the polyps such as intussusception, small bowel obstruction, bleeding, and volvulus. In particular, many studies have reported that patients with this syndrome have a high risk of gastrointestinal or extragastrointestinal malignancy including gastric, duodenal, jejunal, ileal, and colonic carcinoma as well as malignancies involving other organs such as the gallbladder, biliary tract, pancreas, tonsils, breast, and reproductive system. However, there are few reported cases of an association of this syndrome with extraintestinal malignancy. In addition to that, there is no reported case of this syndrome with malignant tumor or intraductal papillary mucinous tumor of pancreas in Korea. We experienced a case of PJS accompanying intraductal papillary mucinous carcinoma of the pancreas, therefore we report this case with literatures reviewed.
Adenocarcinoma, Mucinous/*diagnosis/pathology/secondary ; Carcinoma, Papillary/*diagnosis/pathology/secondary ; Humans ; Intussusception/surgery ; Jejunum/surgery ; Male ; Middle Aged ; Pancreatic Neoplasms/complications/*diagnosis/pathology ; Peutz-Jeghers Syndrome/complications/*diagnosis ; Tomography, X-Ray Computed

Peutz-Jeghers syndrome (PJS), which is characterized by multiple hamartomatous polyps of the gastrointestinal tract and mucocutaneous pigmentation, is a rare autosomal dominant disease. This syndrome is often represented as a surgical emergency with complications of the polyps such as intussusception, small bowel obstruction, bleeding, and volvulus. In particular, many studies have reported that patients with this syndrome have a high risk of gastrointestinal or extragastrointestinal malignancy including gastric, duodenal, jejunal, ileal, and colonic carcinoma as well as malignancies involving other organs such as the gallbladder, biliary tract, pancreas, tonsils, breast, and reproductive system. However, there are few reported cases of an association of this syndrome with extraintestinal malignancy. In addition to that, there is no reported case of this syndrome with malignant tumor or intraductal papillary mucinous tumor of pancreas in Korea. We experienced a case of PJS accompanying intraductal papillary mucinous carcinoma of the pancreas, therefore we report this case with literatures reviewed.
Adenocarcinoma, Mucinous/*diagnosis/pathology/secondary ; Carcinoma, Papillary/*diagnosis/pathology/secondary ; Humans ; Intussusception/surgery ; Jejunum/surgery ; Male ; Middle Aged ; Pancreatic Neoplasms/complications/*diagnosis/pathology ; Peutz-Jeghers Syndrome/complications/*diagnosis ; Tomography, X-Ray Computed

There have been reports of the coexistence of abdominal aortic aneurysm (AAA) with intra-abdominal malignancy including gastric, colonic, pancreatic, and renal. We herein report a case of a previously undiagnosed AAA and a presenting complaint consistent with acute cholecystitis. Following cholecystectomy, this was noted to be a rare form of chronic cholecystitis: xanthogranulomatous cholecystitis. There is a known possible association of this uncommon condition with gallbladder cancer. The management of concomitant pathologies can present a real challenge to the multidisciplinary team, especially with large aneurysms.
Adenocarcinoma/*complications/radiography/secondary/surgery ; Aged ; Aortic Aneurysm, Abdominal/*complications/radiography/surgery ; Biopsy ; Blood Vessel Prosthesis Implantation ; Cholecystectomy ; Cholecystitis/*complications/pathology/radiography/surgery ; Endovascular Procedures ; Female ; Gallbladder Neoplasms/*complications/pathology/radiography/surgery ; Granuloma/*complications/pathology/radiography/surgery ; Humans ; Tomography, X-Ray Computed ; Treatment Outcome ; Xanthomatosis/*complications/pathology/radiography/surgery

Adenocarcinoma, Clear Cell ; complications ; metabolism ; pathology ; surgery ; Adenoma ; pathology ; Adnexal Diseases ; pathology ; Adult ; Carcinoma, Renal Cell ; pathology ; secondary ; Cystadenoma, Papillary ; complications ; metabolism ; pathology ; surgery ; Diagnosis, Differential ; Fallopian Tube Neoplasms ; complications ; metabolism ; pathology ; surgery ; Female ; Follow-Up Studies ; Humans ; Keratin-7 ; metabolism ; Kidney Neoplasms ; pathology ; secondary ; Mucin-1 ; metabolism ; von Hippel-Lindau Disease ; complications ; metabolism ; pathology ; surgery

Gastric cancer patients with severe liver dysfunction secondary to hepatic metastases have limited treatment options. Most cytotoxic drugs have a narrow therapeutic index. Although both capecitabine and oxaliplatin have been well tolerated as single agents for patients with severe hepatic dysfunction, the combination of these drugs has not been investigated. We report here on a case of successful treatment of a patient suffering with severe liver dysfunction and metastatic gastric cancer; the patient was treated with a combination of capecitabine and oxaliplatin (XELOX). The initial bilirubin level of the patient was 10.9 mg/dL. After two cycles of treatment, his bilirubin level decreased to 2.1 mg/dL. He has experienced an excellent radiological response and he has received six cycles of XELOX chemotherapy. XELOX chemotherapy is feasible and it can be associated with positive outcomes for the patients suffering with metastatic gastric cancer and severe liver dysfunction.
Stomach Neoplasms/complications/*pathology/surgery ; Prodrugs ; Organoplatinum Compounds/*therapeutic use ; Middle Aged ; Male ; Liver Neoplasms/complications/*drug therapy/secondary ; Liver Function Tests ; Liver Failure/diagnosis/drug therapy/*etiology ; Humans ; Gastrectomy ; Follow-Up Studies ; Fluorouracil/*analogs & derivatives/therapeutic use ; Drug Therapy, Combination ; Deoxycytidine/*analogs & derivatives/therapeutic use ; Antineoplastic Agents/*therapeutic use ; Adenocarcinoma/complications/secondary/*therapy

OBJECTIVETo investigate the indications, safety and difficulties of one stage thyroidectomy and bilateral neck lymph node dissection for well-differentiated thyroid carcinoma.

METHODSA retrospective review was carried out in 36 well-differentiated thyroid carcinoma patients so treated from 1990 to 2004. Various incisions including H, L and modified Kocher types were selected according to the location of primary tumor and status of cervical lymph node metastasis. Either total thyroidectomy or sub-total thyroidectomy combined with bilateral neck lymph node dissection according to the principles of modified radical neck lymph node dissection: preserving the internal jugular vein, spinal accessory nerve and sternocleidomastoid muscles.

RESULTSThere was no operative death in this group. Postoperative complications included: 2 wound bleeding, 3 recurrent laryngeal nerve resection due to tumor involvement, 1 recurrent laryngeal nerve injury, 2 unilateral internal branch of superior laryngeal nerve injury, 9 unilateral external branch of superior laryngeal nerve injury, 3 unilateral accessory nerve injury, 5 unilateral sympathetic nerve injury, 2 unilateral phrenic nerve injury, 6 chylus fistula, 13 temporary hypoparathyroidism, 2 permanent hypoparathyroidism. The dissected lymph nodes were found to be positive from 0 to 21 in each patient with a mean of 8.3. Of the 36 patients: 31 had bilateral positive lymph nodes; 3 unilateral positive; 2 bilateral negative lymph nodes. The follow up period ranged from 1 to 13 years, Three patients died of distant metastasis, 1 died of cerebral vascular accident. 7 patients lost in follow-up. Totally, 25 patients are still alive, 3 patients had local relapse and were surgically treated again.

CONCLUSIONThe procedure of one-stage thyroidectomy and bilateral neck lymph node dissection for well-differentiated thyroid carcinoma is safe, as it is mandatory that at least one unilateral internal jugular vein should be preserved; one unilateral recurrent laryngeal nerves and accessory nerves should not be injured. Well-differentiated thyroid carcinoma patients whose bilateral cervical lymph nodes are clinically suspected to be positive (obviously enlarged, hard, purplish grapelike lymph node) or are confirmed pathologically to be positive are indications for one-stage thyroidectomy and bilateral neck lymph node dissection. Total or sub-total thyroidectomy should be undertaken with emphasis that at least one parathyroid with blood supply should be preserved. It is of utmost importance that not only the cancer be completely resected but the function of the organs be preserved.

Adenocarcinoma, Follicular ; secondary ; surgery ; Adult ; Carcinoma, Papillary ; secondary ; surgery ; Female ; Follow-Up Studies ; Humans ; Hypothyroidism ; etiology ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; Male ; Middle Aged ; Neck Dissection ; Neoplasm Recurrence, Local ; Postoperative Complications ; Retrospective Studies ; Survival Rate ; Thyroid Neoplasms ; pathology ; surgery ; Thyroidectomy ; methods