Angiomyolipoma is a benign renal tumor composed of thick- walled blood vessels, smooth muscle cells, and adipose tissue. Despite the aggressive biological and histological features associated with angiomyolipoma, the lack of distant metastasis led us to conclude that angiomyolipoma is a benign neoplasm. Epithelioid angiomyolipoma is a recently described variant type of angiomyolipoma of the kidney. Diagnosis is usually made by histological method and immunohistochemical staining with HMB-45. Several reports suggested the presence of malignant epithelioid angiomyolipomas showing multiple metastases and local aggressiveness. We report a case of epithelioid angiomyolipoma with multiple metastases. Local recurrence and liver, bone and lung metastases developed 11 months after radical nephrectomy. Right hepatectomy and wedge resection of left lobe of the liver with radiation therapy were done.
Adipose Tissue ; Angiomyolipoma* ; Blood Vessels ; Diagnosis ; Hepatectomy ; Kidney ; Liver ; Lung ; Myocytes, Smooth Muscle ; Neoplasm Metastasis* ; Nephrectomy ; Recurrence

A case of primary carcinoid tumor of the liver with striking central fibrous scar in a 61-year-old male is reported. Tumor cells contained electron dense secretory granules with an average diameter 150~200 nm which demonstrated positive immunohistochemical reaction for neuron-specific enolase, synaptophysin and chromogranin. The stellate central scar was observed in various hepatic tumors including focal nodular hyperplasia, fibrolamellar carcinoma, or sclerosing hepatocellular carcinoma, but have not been reported in carcinoid tumor.
Carcinoid Tumor* ; Carcinoma, Hepatocellular ; Cicatrix ; Focal Nodular Hyperplasia ; Humans ; Liver ; Male ; Middle Aged ; Phosphopyruvate Hydratase ; Secretory Vesicles ; Strikes, Employee ; Synaptophysin

BACKGROUND/AIMS: Since 1980 a group of pancreatic tumors have been termed intraductal papillary mucinous tumors (IPMT). Controversy about the term and clinico pathologic entity still exist. This study compared the clinicopathlogic features, imaging, prognostic differences between mucinous cystic tumors (MCT) and intraductal papillary mucinous tumors (IPMT) of pancreas. METHODS: We reviewed 7 operated patients between January of 1997 to December of 2000, retrospectively by clinical record. 4 patients with mucinous cystic tumors and 3 patients with intraductal papillary mucinous tumors. RESULTS: Gender, age, symptoms, signs, tumor location and size, the presence or abscece of communication with the pancreatic duct differed between two types. Mucinous cystic tumors showed single cyst, located in pancreatic tail. Intraductal papillary mucinous tumor showed pancreatic duct dilatation & mucin plug, located in pancreatic head & body. 4 patients of mucinous cystic tumor were received distal pacreatectomy. 2 patients of intraductal papillary mucinous tumor received pancreaticoduodenectomy. 1 patient of intraductal papillary mucinous tumor received distal pancreatectomy. CONCLUSIONS: Mucinous cystic tumors and Intraductal papillary mucinous tumors were different clinicopathologic entities. Complete resection should be attempted for these mucin producing tumors.
Dilatation ; Head ; Humans ; Mucins* ; Pancreas ; Pancreatectomy ; Pancreatic Ducts ; Pancreaticoduodenectomy ; Retrospective Studies

BACKGROUND/AIMS: Mirizzi syndrome is a rare complication of longstanding gallstone disease which resulting in obstructive Jaundice. It is benign stricture of common hepatic duct because of stone impacted with in the cystic duct or Hartmann pouch of the gallbladder. The aim of this study is to evaluate our experience of Mirizzi syndrome and consider its surgical treatment. METHODS: During the years 1994 to 2001 at Asan medical center, 23 cases of Mirizzi syndrome were diagnosed on the basis of preoperative and postoperative findings and they were retrospectively reviewed. RESULTS: There were 12 patients with Csendes type I, 6 patients with type II, and 5 patients with Type III. Average age was 61 years (range: 31 to 83 years) For preoperative evaluation Endoscopic retrograde cholangiopancreatography (ERCP) and Ultrasonography were performed in all cases. Laparoscopic cholecystectomy was tried in 7 type I cases. 5 were successfully treated and 2 conversions were reported, all because of unclear anatomy. In 6 type II cases open cholecystrctomy, CHD repair and T tube insertion were performed. 5 patients with type III were required hepaticojejunostomy. CONCLUSIONS: High index of suspicion is required for diagnosis of Mirizzi syndrome and laparoscopic approach is permissible in specialized center especially in the case of suspected Mirizzi type I, under the recognition of biliary anatomy through preoperative imaging studies. If there is fistula or unclear anatomy, we recommend open operative techniques for the safety and the efficiency.
Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy, Laparoscopic ; Chungcheongnam-do ; Constriction, Pathologic ; Cystic Duct ; Diagnosis ; Fistula ; Gallbladder ; Gallstones ; Hepatic Duct, Common ; Humans ; Jaundice, Obstructive ; Mirizzi Syndrome* ; Retrospective Studies ; Ultrasonography

BACKGROUND/AIMS: The objectives of this study were to analyze actual long-term survivors' characteristics and investigate what affect long-term survival after resection for extrahepatic bile duct cancer. METHODS: 151 patients of the total 282 patients with extrahepatic bile duct cancer underwent surgical resection between 1986 and 1996. During study period, 23 cases of hepatobiliary resection (HBR), 25 bile duct resection (BDR), and 103 pancreatoduodenectomy were performed respectively. We analyzed survival results and prognostic factors after surgical resection. We also investigated clinico-pathological features of actual long-term survivors. RESULTS: The 1-,3-,and 5-year survival rates were 72.9%, 41.1%,and 32.5% in the resection group, and the 1-, 3-year survival rates were 35.4% and 1.6% in the non-resection group (p<0.001). The differences of survival rates according to the types of resection were not significant (p=0.083). After surgical resection, tumor histology and lymph node metastasis were the independent prognostic factors in multivariate analysis. CONCLUSION: The prognosis of the extrahepatic bile duct cancer depends on the curative resection. Regardless of the types of resection and tumor location, if tumor histology might be favorable and no lymph node metastasis exist, long-term survival could be expected.
Bile Ducts ; Bile Ducts, Extrahepatic* ; Humans ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Pancreaticoduodenectomy ; Prognosis ; Survival Rate ; Survivors

BACKGROUND/AIMS: Laparoscopic cholecystectomy has become popular. Occasionally, unsuspected gallbladder carcinoma is diagnosed after the operation by pathologic examination, incidentally. And even when the gallbladder carcinoma is suspected preoperatively, it is determined whether or not the additional radical operation will proceed, according to the pathologic diagnosis after laparoscopic cholecystectomy. Multiple staging systems have been described, including the modified Nevin classification (Donohue et al 1990, Nevin et al 1976), the AJCC TNM staging system, and there are controversies in the surgical management of gallbladder carcinoma for each stage. The purpose of this study was to evaluate the role and the meaning of the laparoscopic cholecystectomy in the surgical management of the gallbladder carcinoma. METHODS: A retrospective analysis was made of 24 patients with gallbladder carcinoma that was confirmed by pathologic diagnosis after laparoscopic cholecystectomy in Severance Hospital between January 1993 and Feburary 2002. RESULTS: Gallbladder carcinoma was found in 1.1% of the 2141 cholecystectomy specimens. Gallbladder carcinoma was suspected preoperatively in 11 patients (45.8%). The location of the lesions was the serosal side in 16 patients (66.7%), the liver bed side in 1 patient, and undetermined in 7 patients. The histologic type was adenocarcinoma in all patient, and well differentiated in 16 patients (66.7%), moderate and poorly differentiated in 8 patients (33.3%). According to the AJCC TNM staging system, there were 13 stage I (54%), 5 stage II (20.8%), 2 stage III (8.3%), 4 stage IV (16.7%). The lymph node metastasis was observed in 4 patients (16.7%). In 18 patients (75%), only laparoscopic cholecystectomies were performed, and additional radical cholecystectomies were performed in 4 patients (16.7%). The patients with stage I and II tumor were alive without recurrence except 1 follow-up loss, and there was not any port site recurrence. CONCLUSION: Laparoscopic cholecystectomy is sufficient with stage I gallbladder carcinoma. It may be considered that the patient with stage II gallbladder carcinoma is closely followed without additional radical cholecystectomy after laparoscopic cholecystectomy, if properly selected. The use of vinyl bag for retrieval of specimen is recommended to avoid the port site recurrence. For advanced gallbladder carcinoma (stage III and IV), the additional radical cholecystectomy is recommended. When gallbladder cancer is suspected, an open operation should be performed with sufficient preoperative staging work-up.
Adenocarcinoma ; Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Classification ; Diagnosis ; Follow-Up Studies ; Gallbladder Neoplasms ; Gallbladder* ; Humans ; Liver ; Lymph Nodes ; Neoplasm Metastasis ; Neoplasm Staging ; Recurrence ; Retrospective Studies

BACKGROUND/AIMS: The gallbladder cancer shows highly malignant potential and very poor prognosis. Most of patients who have gallbladder cancer are asymptomatic and have far advanced stage when it was diagnosed. Recently early detection rate of gallbladder disease was increased by common use of screening ultrasonography. For the patients with early staged cancer, we can achieve cure of the disease even with laparoscopic cholecystectomy. Instead, for the patients with advanced stage of gallbladder cancer, extended surgery is required for increased survival rate. METHODS: The authors analyzed the clinical manifestation, diagnosis, therapeutic modality and survival rate for the patients of gallbladder cancer who were treated with surgical resection. From 1993 to 2001, we analysed 55 patients who had gallbladder cancer that was proven pathologically. RESULTS: The mean age of 55 patients was 62.6 years old. The clinical manifestations were RUQ abdominal pain (50.9%), jaundice (12.7%), anorexia (10.9%), epigastric discomfort, palpable mass, ascites and so on. Seven (12.7%) of the patients were asymptomatic. For diagnostic modalities, untrasonography was used for all of the patients, abdominal CT, MRI and ERCP were used selectively. Among 55 patients, 18 patients were diagnosed as benign lesion preoperatively. The sensitivity rate of detecting malignancy was 67.3%. The operative procedure included laparoscopic cholecystectomy, open cholecystectomy, cholecystectomy with regional lymph node dissection, cholecystectomy with combined hepatectomy and hepatopancreatoduodenectomy (HPD). Pathologic findings showed infiltrating type in 27 patients (49.1%) and fungating type in 28 patients (50.1%). Three and five year survival rate of each type were 39.8%, 14.2% and 62.1%, 48.3%. Three and five year survival rates of patients who had negative lymph nodes metastasis were 60.7% and 23.2%, instead positive lymph nodes metastasis were 18.3% and 0%. CONCLUSION: In order to get better survival rate of the patients with gallbladder cancer, early detection and appropriate operative procedures are important, so that minimal invasive surgery for early cancer and extended surgery for advanced stages.
Abdominal Pain ; Anorexia ; Ascites ; Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy ; Cholecystectomy, Laparoscopic ; Diagnosis ; Gallbladder Diseases ; Gallbladder Neoplasms* ; Gallbladder* ; Hepatectomy ; Humans ; Jaundice ; Lymph Node Excision ; Lymph Nodes ; Magnetic Resonance Imaging ; Mass Screening ; Neoplasm Metastasis ; Prognosis ; Surgical Procedures, Operative ; Survival Analysis* ; Survival Rate ; Tomography, X-Ray Computed ; Ultrasonography

BACKGROUND/AIMS: There has been a lot of controversy about the treatment methods in the management of residual & recurrent biliary stones. So we performed the study to clarify the important factors in choosing the treatment modality of the residual & recurrent biliary stones. METHODS: 154 patients who were diagnosed as residual or recurrent biliary stone between January 1995 and August 2000 were divided into 4 groups according to their first re- treatment methods (surgery, stone removal via T-tube, PTBD*, ESTP**) and analyzed the results of these treatments to determine what is the significant factor affecting the prognoses. RESULTS: The necessity of the second re-treatment for residual & recurrent stones was affected by the complete- ness of stone removal only, and no other factors affected it in view of multivariate analysis. The rate of residual & recurrent stones among the patients who have had the first operation in our department was 6.7%. Furthermore the clearance rate of residual & recurrent stones was relatively high value (82.2%), as a result of multidisciplinary treatments. CONCLUSION: Thus, as long as the residual stones can be removed completely, any treatment modality can be applied to these patients. We don't have to insist on surgery.
Humans ; Multivariate Analysis ; Prognosis

BACKGROUND/AIMS: The size and number of gallbladder polyps are used to differentiate between benign and malignant lesions before surgery. The objective of this study was to determine which polyps of the gallbladder should be operated upon and whether laparoscopic cholecystectomy is a safe and feasible method for gallbladder polypoid lesions of the gallbladder. METHODS: Data from 68 patients with polypoid lesions of the gallbladder treated by laparoscopic cholecystectomy at the Department of surgery, Pusan National University Hospital were reviewed retrospectively. the gallbladders were classified into four histologic groups. Clinical features, maximal diameter, and the number of lesions were compared among the groups. RESULTS: The mean maximal diameter of neoplasms was significantly larger than that of lesions in the nonneoplasm group. All four malignant lesions that were detected measured at least 1.5 cm. Univariate analysis showed that polypoid lesions of the gallbladder with neoplastic lesion correlated significantly with age, sex, and number of the lesions. Univariate analysis also showed that malignancy in polypoid lesions of the gallbladder correlated significantly with age, size, and number of the lesions. Multivariate logistic regression analysis showed that the age of the patient and the size of the lesion (> or =1.0 cm) are two independent factors in predicting neoplastic lesions in polypoid lesions of the gallbladder. The size of the lesion (> or =1.5 cm) is the only independent factor in predicting malignancy in the polypoid lesions of the gallbladder as shown by multivariate logistic regression analysis. CONCLUSION: Laparoscopic cholecystectomy is a safe and feasible method for gallbladder polypoid lesions. Neoplastic change in polypoid lesions of the gallbladder should be considered when a patient older than 50 years of age has a polypoid lesion larger than 1.0 cm. Cancer should be suspected when a polypoid lesion of the gallbladder is larger than 1.5 cm.
Busan ; Cholecystectomy, Laparoscopic* ; Gallbladder* ; Humans ; Logistic Models ; Polyps ; Retrospective Studies

BACKGROUND/AIMS: Blood loss and blood transfusion are extremely important determinants of morbidity and mortality following hepatic resection. This is attributed to increased risks of coagulopathy, acute respiratory distress syndrome and multiorgan failure. The hypothesis is that a low pressure in the central veins would be accompanied by a low pressure in the hepatic veins and sinusoids, thereby decreasing blood loss during hepatic resection. This study evaluates the effectiveness of continuing low central venous pressure comparing with high central venous pressure during major hepatic resection. METHODS: 20 consecutive major hepatic resections between March 2000 and August 2000 were studied prospectively concerning central venous pressure which was analysed for 10 cases with a central venous pressure less than 10 mmHg, and greater than or equal to 10 mmHg. The central venous pressure was monitored continuously using a Narkomed Anaesthetic Component Monitoring System (Drager Inc., USA). RESULTS: Low central venous pressure allowed a smaller intraoperative blood loss (<10 mmHg: 1010+/-465.3 ml vs. > or =10 mmHg: 1770+/-916.5 ml, p<0.05), a smaller perioperative transfusion (<10 mmHg: 139+/-276.2 ml vs. > or =10 mmHg: 807+/-799.2 ml, p<0.05), a lower postoperative peak AST (<10 mmHg: 167.4+/-53.2 IU/L vs. > or =10 mmHg: 293.0+/-123.2 IU/L, p<0.05), a lower postoperative peak ALT (<10 mmHg: 96.1+/-55.3 IU/L vs. > or =10 mmHg: 193.2+/-103.5 IU/L, p<0.05), and a earlier resumption of a normal hepatic enzyme (<10 mmHg: 6.4+/-0.9 days vs. > or =10 mmHg: 8.7+/-1.6 days, p<0.05) in comparison to high central venous pressure. There was no postoperative mortality in both group. CONCLUSIONS: Maintaining a low central venous pressure throughout major hepatic resection reduced blood loss, blood transfusion requirements and enzyme recovery periods. Lowering the central venous pressure is a simple and effective way during hepatic resection.
Blood Transfusion ; Central Venous Pressure* ; Hepatic Veins ; Mortality ; Prospective Studies ; Respiratory Distress Syndrome, Adult ; Veins