Solid pseudopapillary tumor (SPT) is a low grade malignant tumor in the pancreas, and extrapancreatic SPT is extremely rare. We report a case of a 61-year-old woman who complained abdominal pain with diffuse tenderness. She was diagnosed with extrapancreatic SPT with extensive peritoneal dissemination and hepatic metastases. Although a few cases have reported imaging findings of extrapancreatic SPT, there have been no reports of extrapancreatic SPT with aggressive tumor behavior and dismal prognosis. Although imaging features closely resembled those of classical pancreatic SPTs, malignant transformation of extrapancreatic SPT should be considered when focal discontinuity of the tumor capsule with ill-defined margin and invasion of adjacent structures were identified.
Abdominal Pain ; Female ; Humans ; Middle Aged ; Neoplasm Metastasis ; Pancreas ; Prognosis ; Ultrasonography

PURPOSE: To determine normal postoperative CT findings and tumor recurrence in patients who have under-goneradical cystectomy and urinary diversion. MATERIALS AND METHODS: We retrospectively reviewed the postoperative CTscans of 51 patients who had un-dergone radical cystectomy with urinary diversion, and in analysis speciallyemphasised normal postoperative CT findings and recurrent cancer in the surgical bed. Among these 51 patients, 43had undergone incontinent urinary diversion(Bricker operation), while for six, diversion had been continent (Kockprocedure). Attempts were also made to characterise the CT findings of each procedure according to the location ofthe ileal pouch, the pattern of contrast collection within the pouch, and the morphology of the ileocutaneostomysite. RESULTS: Each urinary diversion procedure demonstrated characteristic postoperative CT appearances. TheBricker procedure revealed a contrast-filled ileal conduit in the right lower quadrant excreting into theileocu-taneostomy site, while the Kock procedure demonstrated layering of contrast and urine within the pouch aswell as artificially intussuscepted afferent and efferent ileal loops at the anastomotic sites. Thirty-three smallsoft tissue density lesions in the surgical bed were seen in 19 patients (37%). Thirty one were bilateral (n=28)or unilateral (n=3) triangular or oval shaped soft-tissue-density lesions and two were unilateral irregular shapedlesions. Follow-up CT scans showed that all triangular or oval-shaped lesions were smaller (n=8) or show no changein size (n=23) ; they were thought to represent postoperative fibrosis or granulation tissue. Two cases ofirregular-shaped soft-tissue-density lesions were seen on follow-up CT scans to be larger, and these wereconfirmed by percutaneous biopsy to be recurrent cancer. CONCLUSION: It is important for the radiologist to befamiliar with normal postoperative CT findings of various urinary diversion procedures as well as to recognize arelatively high incidence (37%) of small soft tissue den-sity lesions in a surgical bed. In our study, smalltriangular or oval-shaped soft-tissue-density lesions in the sur-gical bed (especially when these were bilateral)were thought to represent postoperative fibrosis or granulation tissue, and close follow-up by means of CTscanning rather than an invasive procedure is therefore warranted.
Biopsy ; Cystectomy ; Fibrosis ; Follow-Up Studies ; Granulation Tissue ; Humans ; Incidence ; Recurrence* ; Retrospective Studies ; Tomography, X-Ray Computed ; Urinary Diversion

BACKGROUND: Long-term treatment of immunosuppresant CsA causes interstitial inflammation and fibrosis in the kidney. Renin-angiotensin system (RAS) plays the most important role in the pathogenesis CsA-induced renal injury. Accordingly we evaluated the anti-inflammatory effect of angiotensin II blockades using losartan (LSRT) in a rat model of chronic CsA nephropathy. METHODS: Male Sprague-Dawley rats, initially weighing 225 to 250 g, were used. After 1 week of a low-salt diet (0.05% sodium), the rats were randomized into four groups and treated for 4 weeks. The Vehicle (VH) group was treated with olive oil. The VH+LSRT group was treated with olive oil and LSRT. The CsA group received CsA. The CsA+LSRT group was simultaneously treated with CsA and LSRT. The anti-inflammatory effect of LSRT was evaluated with C-reactive protein (CRP) expression, osteopontin (OPN) mRNA and protein expression, and ED-1 infiltration RESULTS: The CsA treatment caused an increase in serum creatinine and a decrease in creatinine clearance compared with that of the VH group. Intrarenal CRP positive cells were significantly decreased in the CsA+LSRT group compared with the CsA group (38.0 +/- 2.1 vs. 65.0 +/- 5.1, p<0.01). In the CsA group, the degree of OPN mRNA expression was increased compared with that of the VH group. But, OPN mRNA expression was decreased in the CsA+LSRT group (387.5 +/- 56.6% vs. 719.8 +/- 58.5%, p<0.05). In the degree of ED-1 infiltration, we had a similar results such as CRP and OPN mRNA expression (CsA group 30.5 +/- 8.0 vs. CsA+LSRT 86.0 +/- 11.0, p<0.01). CONCLUSION: We concluded that the anti-inflammatory effects of angiotensin II blockade has a potential protective effect against CsA-induced renal injury.
Angiotensin II* ; Angiotensins* ; Animals* ; C-Reactive Protein ; Creatinine ; Diet, Sodium-Restricted ; Fibrosis ; Humans ; Inflammation ; Kidney ; Losartan ; Male ; Models, Animal* ; Olea ; Osteopontin ; Rats ; Rats, Sprague-Dawley ; Renin-Angiotensin System ; RNA, Messenger ; Olive Oil

OBJECTIVE: The aims of this study were to compare the efficacy and morbidity of optimal debulking operation with those of suboptimal operation for patients with advanced gynecologic malignancies and to establish the precluding factors for performing the optimal cytoreductive surgery. METHODS: From January 1998 to December 2003, debulking operation for advanced gynecologic malignancy was performed in thirty-nine patients with ovarian cancer (32), tubal cancer (4), and primary peritoneal carcinoma (3) at the department of obstetrics and gynecology, Ghil Medical Center. Of them, 38 patients had FIGO Stage IIIC disease and only one patient had FIGO Stage IV disease. Most informations were obtained by hospital records and were analyzed retrospectively. RESULTS: The mean follow-up was 23 months (range, 1-62 months). The optimal debulking operation could be performed in 25 patients (64.1%). In multivariate analysis, the largest diameter of residual tumor was the most important prognostic factor. Two-year overall survival rate of optimally debulked patients was 86.5% and that of suboptimally debulked patients was 41.3% (p=0.015). Two-year disease free survival rates were 75.9% and 7.1%, respectively (p=0.0003). Complication rates associated with surgery were 40% in optimally debulked patients and 35.7% in suboptimally debulked patients (p=0.083). Major causes of suboptimal surgery were old age (>69 yrs), poor medical condition (cardiac problem, intraoperative unstable vital sign, bronchiectasis), no submission of permission, and involvement of the base of mesentery and small bowel. CONCLUSION: Optimal debulking operation is possible if there were no significant clinical problem and involvement of base of mesentery and small bowel. It appears acceptable surgical morbidity and better prognosis. Therefore, the surgeon should use every technique aimed at removing the tumor as much as possible.
Disease-Free Survival ; Follow-Up Studies ; Gynecology ; Hospital Records ; Humans ; Mesentery ; Multivariate Analysis ; Neoplasm, Residual ; Obstetrics ; Ovarian Neoplasms ; Prognosis ; Retrospective Studies ; Survival Rate ; Vital Signs