Cholangiocarcinoma is the most common biliary malignancy and the second most common hepatic malignancy following hepatocellular carcinoma. It can be classified anatomically as intrahepatic cholangiocarcinoma (iCCA), perihilar CCA, or distal CCA. The treatment of choice for iCCA is surgical resection, but only those with potentially resectable tumors can undergo surgery. The standard regimen for advanced stage iCCA is gemcitabine and cisplatin. We encountered two unusual cases of iCCA patients who were initially diagnosed as unresectable cases and underwent systemic chemotherapy, which showed great response and therefore enabled radical operation. The patients show that even though iCCA is a challenging disease, patients with good response to chemotherapy may have a chance to undergo radical surgery.
Carcinoma, Hepatocellular ; Cholangiocarcinoma ; Cisplatin ; Drug Therapy ; Humans

A 34-year-old woman presented with sudden breast enlargement that had occurred within 6 months. She also had an accessory breast mass on the left axilla. Clinical impression was phyllodes tumor. Needle biopsy revealed fibroepithelial tumor, a mixture of fibrous stroma and pseudoangiomatous stromal hyperplasia. The final pathologic report was hamartoma associated with focal pseudoangiomatous stromal hyperplasia and macromastia. This is the first reported case of bilateral breast hamartoma with hamartoma in ectopic breast tissue. The masses on the right and left breasts weighed 1,980 g and 1,233 g, respectively, while the mass on the left axilla weighed 36 g.
Adult ; Axilla ; Biopsy, Needle ; Breast* ; Female ; Hamartoma* ; Humans ; Hyperplasia* ; Phyllodes Tumor

Purpose: To determine the safety and feasibility of totally laparoscopic distal gastrectomy (TLDG) with modified delta-shaped anastomosis, we compared the short-term outcomes of TLDG to those of laparoscopy-assisted distal gastrectomy (LADG) with Billroth I anastomosis. Methods: We analyzed the characteristics of 85 patients with gastric cancer who underwent laparoscopic distal gastrectomy with Billroth I anastomosis between January 2013 and December 2018. After propensity score matching, each group had 35 patients. Results: Of these 85 patients, 44 underwent TLDG and 41 underwent LADG. Propensity score matching was performed with three covariates (age, underlying disease, and hypertension), and 35 patients from each group were matched 1:1. After matching, the TLDG group was older than the LADG group (64.5 ± 10.6 years vs. 56.3 ± 11.2 years, p = 0.003) and had more patients with hypertension (57.1% vs. 22.9%,p = 0.003).Tumors were larger in the TLDG group than in the LADG group (23.4 ± 16.2 mm vs. 16.0 ± 7.9 mm, p = 0.018). A greater proportion of patients had fever in the TLDG group than the LADG group (42.9% vs.20.0%, p = 0.039), and C-reactive protein from postoperative days 3 to 6 was greater in the TLDG group (11.4 ± 5.7 mg/dL vs. 7.0 ± 5.0 mg/dL, p = 0.001). Conclusion Although our data represent only our early experience performing TLDG with modified deltashaped anastomosis, this procedure is relatively safe and feasible. Nevertheless, compared to LADG, which is the conventional method, the operative time for TLDG was longer. Surgeons must also watch out for anastomotic complications

Plexiform neurofibroma (PN) is an uncommon benign tumor, usually associated with neurofibromatosis type 1. As most PNs involve the craniomaxillofacial region, PN of the colon is very rare. Here we present a case of PN involving the sigmoid colon. A 43-year-old male patient presented to the outpatient clinic for the evaluation of an incidentally discovered sigmoid colon mass. A colonoscopic biopsy was performed for the mass, and the result revealed neuronal proliferation. The patient visited the outpatient clinic a year later with symptoms of abdominal pain and stool caliber change. Biopsy was repeated for the sigmoid colon mass, and the results showed mucosal Schwann cell proliferation and S-100 immunostaining positivity. Computed tomography and magnetic resonance imaging were performed for further evaluation, and neurofibroma or schwannoma was suspected based on the imaging studies. For an accurate diagnosis, the patient underwent surgery to remove the sigmoid colon mass. The final diagnosis of the mass was confirmed as PN. We hereby report a rare case of PN involving the sigmoid colon that could not be diagnosed before surgery.

PURPOSE: Peritoneal carcinomatosis (PC) has been considered a terminal condition and cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIEPC) is regarded as an alternative therapeutic option. This study aimed to evaluate the 30-day clinical outcomes of CRS/HIPEC and the feasibility of the surgery by investigating the morbidity and mortality in Inje University Hospital.METHODS: Data were retrospectively collected from 19 patients with PC who underwent CRS/HIPEC at Inje University Hospital in 2018. We evaluated pre-, intra-operative parameters and postoperative clinical outcomes and early complications.RESULTS: The mean operating time was 506.95 minutes and the mean blood loss was 837.11 mL. Six cases (31.58%) had morbidity of grade III or above. A longer operating time (≥560 minutes, P=0.038) and large blood loss (≥700 mL, P=0.060) were positively correlated with grade III or worse postoperative complications.CONCLUSION: Our early experience with CRS/HIPEC resulted in a 31.58% morbidity rate of grade III and above, with risk factors being longer operating time and greater intraoperative blood loss. As the surgical team's skills improve, a shorter operating time with less intraoperative blood loss could result in better short-term outcomes of CRS/HIPEC.
Carcinoma ; Drug Therapy ; Humans ; Korea ; Mortality ; Postoperative Complications ; Retrospective Studies ; Risk Factors