Usual sources of subphrenic abscess with intestinal fistula are previous abdominal operation, inflammatory bowel disease and malignancy. Reported cases of intestinal fistula caused by adenocarcinoma were complicated by direct invasion. In this report, a 70-year-old male had a subphrenic abscess with intestinal fistula and the cause was a metastatic adenocarcinoma of unknown origin. As far as we know, this has not been reported previously in the literatures. The abscess went on chronic course for six months because intermittent administration of antibiotics modified its clinical presentation. The fistulous tract between the abscess and ileum was demonstrated by tubogram via the drainage catheter in abscess. The patient underwent surgical treatment because the cause of fistula was obscure. Invasion of the ileum by metastatic adenocarcinoma was diagnosed by the histologic examination of surgical specimen. Therefore, when a fistula develops without any apparent cause, there is a possibility of malignancy, and surgical approach must be considered. An early surgical approach will prevent the delay in treatment and reduce the mortality.
Adenocarcinoma/complications/diagnosis/*secondary ; Aged ; English Abstract ; Humans ; Ileal Diseases/diagnosis/*etiology ; Ileal Neoplasms/complications/diagnosis/*secondary ; Intestinal Fistula/diagnosis/*etiology ; Male ; *Neoplasms, Unknown Primary ; Subphrenic Abscess/diagnosis/*etiology

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

No abstract available.
Adenocarcinoma/*complications/*diagnosis/pathology ; Aged, 80 and over ; Colonoscopy ; Ethanol/therapeutic use ; Female ; Gallbladder Neoplasms/*complications/*diagnosis/pathology ; Humans ; Intestinal Obstruction/*etiology ; Liver Neoplasms/complications/drug therapy/secondary ; Tomography, X-Ray Computed

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