Most patients with duodenal carcinoids are asymptomatic or suffer from nonspecific symptoms. But the tumors in the periampullary region may be associated with symptoms of obstruction related to the size of the lesion. Two serial internal dranage procedures (cystogastrostomy and cystojejunostomy) were performed in a 46-year-old man because of recurred pancreatic pseudocyst at an interval of five months. Eight months after the first operation, an abdominal CT showed a remained pancreatic pseudocyst. And duodenoscopic findings showed a luminally protrusing mass, with preserved mucosa at the second portion of duodenum. Local resection of the mass was perfomed. Grossly, the mass had a 2 cm-sized, well circumscribed yellowish appearance. Microscopic findings showed well-defined intramucosal mass having almost glandular and nest of tumor cells showing uniform round nuclei, glandular and basophilic cytoplasm. And the nonspecific neuroendocrine markers chromogranin and NSE are positive. We report a case of Periampullary duodenal carcinoid tumor with complicated pancreatic pseudocyst.
Basophils ; Carcinoid Tumor* ; Cytoplasm ; Duodenum ; Humans ; Middle Aged ; Mucous Membrane ; Pancreatic Pseudocyst* ; Tomography, X-Ray Computed

Lymphangiomas are rare congenital benign tumors arising from the lymphatic system, and are mostly encountered in the neck and axillary regions of pediatric patients (95%). Lymphangioma of the pancreas is extremely rare accounting for less than 1% of these tumors. We report here on a case of pancreatic cystic lymphangioma. A 54-year-old woman presented with intermittent postprandial abdominal discomfort and radiating back pain. Abdominal computed tomography scan revealed 8 x 6.5 cm hypodense cystic mass arising from the tail of the pancreas without septa or solid component. The initial impression was a pancreatic pseudocyst. The patient underwent distal pancreatectomy with splenectomy. The histopathologic and immunohistochemical study helped make the diagnosis of a pancreatic cystic lymphangioma. Herein, we report a case of pancreatic cystic lymphangioma mimicking pancreatic pseudocyst and review the relevant medical literature.
Accounting ; Back Pain ; Female ; Humans ; Lymphangioma ; Lymphangioma, Cystic ; Lymphatic System ; Middle Aged ; Neck ; Pancreas ; Pancreatectomy ; Pancreatic Cyst ; Pancreatic Pseudocyst ; Splenectomy

No abstract available.
Humans ; Neoplasm Metastasis*

The CT findings of the adrenal disease in a total of 52 patients were analysed. 39 patients of them wereverified at operation and composed of 22 patients of Cushing's syndrome, 11 patients of pheochromocytoma, 6patients of aldosteronism. The remainder was finally diagnosed on the basis of compelling clinical and biochemical evidence. Aldosteronoma is very small (all under 3cm), round or oval mass with homogeneous low density, but pheochromocytoma is relatively large mass (all beyond 3cm) with heterogeneous or isodense comparing to pancreaticdensity. Size and density of Cushing's adenoma has transitional character between aldosteronoma andpheochromocytoma. Overall diagnostic accuracy, sensitivity and specificity of CT in adrenal tumor/adrenal diseaseare 96.2%/87%. 96.4%/78.9% and 95.7%/97.7% respectively. The relative low sensitivity of adrenal disease(78.9%) isdue to inclusion of normal sized bilateral hyperplasia. Of 28 adrenal tumors, 27 were correctly diagnosed by CT,and there were one false positive and one false negative diagnosis. CT is a highly accurate non-invasive method inlocalization of adrenal tumors and differentiation of the tumors from hyperplasia.
Adenoma ; Cushing Syndrome ; Diagnosis ; Humans ; Hyperaldosteronism ; Hyperplasia ; Methods ; Pheochromocytoma ; Sensitivity and Specificity

A-57-year-old male patient suddenly developed cramping pain in the left lower abdomen with a slight abdominal distension. He had undergone a laparoscopic nephrectomy for transitional cell carcinoma 7 days earlier. An abdominal CT scan revealed a dilated small bowel loop and an internal hernia was suspected. Surgery revealed a herniation of the jejunal loop through defects in the retroperitoneum, which was successfully reduced. We report a case of an internal hernia following a laparoscopic nephrectomy. To the best of our knowledge, this is the only reported case of an internal hernia as a complication of laparoscopic nephrectomy.
Abdomen ; Carcinoma, Transitional Cell ; Hernia* ; Humans ; Laparoscopy ; Male ; Muscle Cramp ; Nephrectomy* ; Tomography, X-Ray Computed

PURPOSE: Intraductal papillary mucinous tumor (IPMT) of the pancreas pathologically shows papillary proliferation and its tumor cells display a spectrum of changes ranging from adenoma to infiltrating carcinoma. Because of this variability, there have been many difficulties for making an accurate diagnosis and administering proper treatment. The aim of this study was to determine the treatment strategy and differential diagnosis of benign and malignant IPMT. METHODS: Between January 2000 and June 2007, 24 patients with IPMT of the pancreas underwent surgery. The relationships among the clinopathologic features and tumor locations and subtypes were retrospectively investigated. In addition, the type of surgical procedures and findings, the microscopic finding, the immunohistochemical staining and the clinopathological features were analyzed. RESULTS: There were 17 men and 7 women with a mean age of 65 (range: 45~81). Pathologically, 11 cases were benign, 9 were borderline and 4 were malignant. The tumor was located in the head of the pancreas in 17 patients. 16 cases received Whipple's procedure and pylorus preserving pancreaticoduodenectomy, and the others were received different kinds of operations. Regarding the subtypes of IPMT, 2 cases were the main duct type, 19 were the branched type and 3 were the combined type. There were no statistically significant differences in the clinical manifestations, radiologic findings and immnohistochemical staining between the patients with benign and malignant IPMT. Except two patients who were not followed up, all the patients had no recurrence and they survived. CONCLUSION: It is very difficult to exactly differentiate malignant IPMT from benign IPMT with using the current preoperative evaluations and immunohistochemical staining of the resected specimens. The patients who were operated on and followed in our hospital had no recurrence and they all survived. Therefore, if IPMT is suspected, we think the patients should be operated on and we should continue studying other specific antibodies for immunohistochemical staining.
Adenoma ; Antibodies ; Diagnosis, Differential ; Female ; Head ; Humans ; Male ; Mucins ; Pancreas ; Pancreaticoduodenectomy ; Pylorus ; Recurrence ; Retrospective Studies

An ectopic pancreas, also known as a heterotopic or aberrant pancreas, is defined as pancreas tissue lying outside its normal location and lacking anatomic or vascular connections with the pancreas. Most occurrences of an ectopic pancreas are located in the stomach, duodenum, or jejunum. However, an ectopic pancreas can sometimes be found in unusual sites such as the Meckel's diverticulum, gallbladder, umbilicus, mediastinum and fallopian tubes. An ectopic pancreas rarely produces clinical symptoms, but occasionally can result in varying symptoms according to its location, size and involvement of the overlying mucosa. Herein, a case of 41-year-old male with an ectopic pancreas in the duodenum, presenting as a duodenal obstructing mass, is reported.
Adult ; Deception ; Duodenum ; Fallopian Tubes ; Female ; Gallbladder ; Humans ; Jejunum ; Male ; Meckel Diverticulum ; Mediastinum ; Mucous Membrane ; Pancreas* ; Stomach ; Umbilicus

PURPOSE: Surgery remains the only curative option for patients with extrahepatic bile duct cancer (EHBD Ca). But, long-term survival is typically not good because of the advanced stage of disease at the time of diagnosis and frequent disease recurrence after surgical resection. The purpose of this study was to evaluate factors that influence survival and recurrence after surgical resection of EHBD Ca. METHODS: A retrospective analysis of 113 patients who had received surgical resection for EHBD Ca between 2004 and 2009 was done. We investigated histopathological features, and survival and recurrence rates, and evaluated prognostic factors affecting survival and disease recurrence after surgical resection. RESULTS: Overall survival rates for 1, 3 and 5 years were 73.2%, 42.8%, and 36.0% respectively. In univariate analysis, prognostic factors influencing survival were histologic differentiation, T stage, lymph node (LN) metastasis, TNM stage, perineural invasion (PNI), lymphovascular invasion (LVI) and resection margin state. Among them, LN metastasis, PNI and resection margin state were found to be independent prognostic factors for overall survival in multivariate analysis. Recurrence occurred in 44 patients (48.9%) and disease-free survival rates were 50.6% at 1 year and 38.3% at 3 year. Univariate analysis revealed that histologic differentiation, T stage, LN metastasis, TNM stage, PNI and LVI were significantly associated with recurrence. In multivariate analysis, only LN metastasis was found to be a significant independent predictor of recurrence. CONCLUSION: LN metastasis, PNI and positive resection margin were significant prognostic factors affecting survival. LN metastasis was found to be a significant independent predictor of recurrence in surgical resection of EHBD Ca.
Bile ; Bile Duct Neoplasms ; Bile Ducts ; Bile Ducts, Extrahepatic ; Disease-Free Survival ; Humans ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Recurrence ; Retrospective Studies ; Survival Rate

OBJECTIVE: To examine clinical characteristics and risk factors and to assess prognosis of peripartum cardiomyopathy (PPCM). METHODS: We retrospectively reviewed the medical records of 10 patients with confirmed PPCM by clinical symptoms and echocardiography, who delivered between January 1995 and December 2005 at our Hospital. Clinical and serial echocardiographic data of these patients were collected. RESULTS: Mean maternal age at the time of diagnosis was 28.8+/-3.2 years and the mean gestational age was 37(+3)+/-4 weeks. Common associated conditions were nulliparity (90%), cesarean delivery (70%), anemia (70%), preeclampsia (60%), transfusion before diagnosis (40%), twin pregnancy (30%). At the time of diagnosis, the mean left ventricular ejection fraction (EF) was 42.84+/-9.69%, fractional shortening (FS) was 23.41+/-5.49%, and left ventricular end diastolic dimension (LVEDD) was 5.58+/-0.55 cm/m2. Normalization of left ventricular function occurred in 8 patients (80%). After recovery of the left ventricular function, mean EF was 61.41+/-4.21%, FS was 34.08+/-3.26%, and LVEDD was 4.68+/-0.76 cm/m2. Incidence of PPCM was 1 in 2455 pregnancies, and maternal mortality was 12.5% in 10 months follow-up. CONCLUSION: The risk of PPCM may increase in puerperal women with rapid dramatic hemodynamic change. Echocardiography may provide significant prognostic information.
Anemia ; Cardiomyopathies* ; Diagnosis ; Echocardiography ; Female ; Follow-Up Studies ; Gestational Age ; Heart Failure ; Hemodynamics ; Humans ; Incidence ; Maternal Age ; Maternal Mortality ; Medical Records ; Parity ; Peripartum Period* ; Pre-Eclampsia ; Pregnancy ; Pregnancy, Twin ; Prognosis* ; Retrospective Studies ; Risk Factors ; Stroke Volume ; Ventricular Function, Left

A pancreatic hamartoma is a rare benign lesion that may be mistaken for malignancy. A pancreatic hamartoma can present with vague, non-specific symptoms, which can be difficult to diagnose despite modern diagnostic tools. We report here a pancreatic hamartoma diagnosed after surgical resection. A 52-year-old female presented with postprandial abdominal discomfort. Abdominal computed tomography and pancreatic magnetic resonance imaging revealed a 2.2 x 2.5-cm cystic mass in the pancreatic head. The patient underwent a pylorus-preserving pancreaticoduodenectomy. The histopathological and immunohistochemical studies helped make the diagnosis of pancreatic hamartoma. Here, we report a case of pancreatic hamartoma and review the relevant medical literature.
Female ; Hamartoma ; Head ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Pancreas ; Pancreaticoduodenectomy