Small cell cancer commonly occurs in the lungs, but it is rarely found in other organs. Small cell cancer that occurs in the pancreas is rare and its progress very rapid, and most patoents' tumor has already spread by metastasis when it is discovered. Although this cancer has a poor prognosis, we report here on treating case with combined curative resection and chemotherapy and showed a good prognosis.
Carcinoma, Small Cell* ; Drug Therapy ; Lung ; Neoplasm Metastasis ; Pancreas* ; Pancrelipase* ; Prognosis

The ampullary carcinoid tumor is a rare lesion accounting for less than 0.3% of all carcinoid tumors of the gastrointestinal tract. We recently experienced a case of an ampullary carcinoid tumor at our institution. A 70-year-old man was admitted to our hospital on January 2006 for right upper quadrant pain with jaundice. He underwent a pyloruspreserving pancreaticoduodenectomy for an ampullary carcinoid tumor. Abdominal computed tomography showed an oval shaped mass at the ampulla of Vater with abrupt obstruction of the distal end of the common bile duct. The patient underwent a percutaneous transhepatic bile drainage for a cholangiogram, in which was noted a filling defect with a smooth margin at the ampullary portion. During surgery, a firm, grayish-pink, and fairly well circumscribed tumor measuring 2.5 cm was found in the ampulla of Vater. Histopathologically, the tumor with invasion to the muscular layers consisted of cells with an eosinophillic cytoplasm and uniform, oval hyperchromatic nuclei. Immunohistochemical staining of the tumor was positive for chromogranin, synaptophysin and neuron-specific enolase. The patient had an unremarkable hospital course. Carcinoids of the ampulla of Vater are very rare. Only 105 cases have been reported in the literature, most as single case reports. We report here a case of an ampullary carcinoid tumor with a discussion based on the literature.
Aged ; Ampulla of Vater ; Bile ; Carcinoid Tumor* ; Common Bile Duct ; Cytoplasm ; Drainage ; Eosinophils ; Gastrointestinal Tract ; Humans ; Jaundice ; Pancreaticoduodenectomy ; Phosphopyruvate Hydratase ; Synaptophysin

A 64 year-old male, with a history of alcoholism, presented at our hospital with dyspnea. He had a history of admission to hospital for treatment of chronic pancreatitis 4 month ago. Chest radiography showed a marked amount of right pleural effusion. Thoracentesis revealed an exudate of amylase-rich fluid. After conservative management he was discharged, but 1 month later increased right pleural effusion was detected. A pancreaticopleural fistula was detected on ERCP and abdomen CT. After 2 months of conservative management, there had been no improvement of the fistula; therefore, the authors decided to operate. The pancreas was hard and atrophic, with severe adhesion to adjacent tissues. Several pancreatic duct stones were found intraoperatively, with a pseudocyst was also found at the body portion. A suspicious fistula tract was observed at the posterior aspect of the body, which was subsequently ligated. A distal pancreatectomy, with a lateral pancreaticojejunostomy, and an additional side-to-side choledochojejunostomy were performed. A small amount of right pleural effusion was detected, with thoracentesis performed on the 8th postoperative day. The pleural effusion did not show a pancreatic juice nature, with amylase and protein levels of 9 U/L and 2,127 mg/L, respectively. No further increase in the amount of pleural effusion was observed, and the patient was discharged on the 16th postoperative day, without any complications. There was no evidence of recurrence at the 6 month follow up.
Abdomen ; Alcoholism ; Amylases ; Cholangiopancreatography, Endoscopic Retrograde ; Choledochostomy ; Dyspnea ; Exudates and Transudates ; Fistula* ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Pancreas ; Pancreatectomy ; Pancreatic Ducts ; Pancreatic Fistula ; Pancreatic Juice ; Pancreaticojejunostomy ; Pancreatitis, Chronic* ; Pleural Effusion ; Radiography ; Recurrence ; Thorax

Gastric neuroendocrine tumor is an uncommon entity, and it constitutes less than 1% of all neuroendocrine tumors and less than 2% of all gastric neoplasms. Regardless of its origin, approximately 75% of the patients with neuroendocrine tumors will develop liver metastasis. We report here on two cases of primary neuroendocrine tumor with hepatic metastasis. A 37-year-old-man presented with chronic and intermittent abdominal pain in the epigastric area. He was diagnosed with gastric neuroendocrine tumor together with hepatic metastasis, based on the imaging studies and the octreotide scan. Subtotal gastrectomy and right hemihepatectomy was done and the patient was discharged on the postoperative 15th day without any complication. Another 41-year-old man presented with abdominal discomfort and a RUQ palpable mass. He was diagnosed with hepatocellular carcinoma based on the abdominal computerized tomography (CT). However, we incidentally found a gastric mass in the operating field and subtotal gastrectomy was then done. The pathologic report was large cell neuroendocrine carcinoma. The patient was discharged on the postoperative 19th day without any complication.
Abdominal Pain ; Adult ; Carcinoid Tumor ; Carcinoma, Hepatocellular ; Carcinoma, Neuroendocrine ; Gastrectomy ; Humans ; Liver ; Neoplasm Metastasis* ; Neuroendocrine Tumors* ; Octreotide ; Stomach Neoplasms

A 52-year-old woman with a meningioma was transferred to our hospital due to abdominal mass and hypoglycemic symptoms. Abdominal computed tomography confirmed thickening of the gallbladder wall, with a 10 x 7 cm mass occupying the right inferior and medial segment of the liver. Her fasting glucose was low on hypoglycemic attack, with a serum insulin level of 173 mIU/ml (normal; 5~20 mIU/ml). Other radiologic tests, including portal venous sampling, did not localize the insulin producing lesion in the pancreas. The preoperative diagnosis was one of a malignant gallbladder tumor infiltrating the liver, with the possibility of nesidioblastosis; therefore, extended cholecystectomy and distal pancreatectomy were performed as the frozen biopsy of the pancreas confirmed an increase of cells in the islet of Langerhans. In permanent specimens, the pancreas showed normal histology and the gallbladder lesion showed a neuroendocrine carcinoma combined with an adenocarcinoma, with positive immunostaining for CD56, chromogranin A and synaptophysin. The special immunostaining for insulin was positive. The patient was in a glucose intolerant state with administration of small dose of oral hypoglycemic agents after operation. Metastases of the lesion to the skull and spine were observed two months after surgery. We report non-islet cell insulin releasing neuroendocrine carcinoma, combined with an adenocarcinoma of the gallbladder, presenting with hypoglycemic symptoms
Adenocarcinoma ; Biopsy ; Carcinoma, Neuroendocrine* ; Cholecystectomy ; Chromogranin A ; Diagnosis ; Fasting ; Female ; Gallbladder* ; Glucose ; Humans ; Hypoglycemia ; Hypoglycemic Agents ; Insulin ; Liver ; Meningioma ; Middle Aged ; Neoplasm Metastasis ; Nesidioblastosis ; Pancreas ; Pancreatectomy ; Skull ; Spine ; Synaptophysin

PURPOSE: The expressions of epidermal growth factor receptor (EGFR) and c-erbB-2 have been considered to be implicated in the genesis and progression of cholangiocarcinomas. However, their clinical roles and pathological characteristics remain uninvestigated. The purpose of this study was to assess the expressions of EGFR and c-erbB-2, and to identify their clinical and pathological significances in biliary tract cancers. METHODS: One hundred and fourteen samples were obtained from surgically resected biliary tract cancers (72 extrahepatic bile duct cancers, 33 gallbladder cancers, and 9 intrahepatic bile duct cancers). Expressions of EGFR and c-erbB-2 were examined by immunohistochemical staining. Expression rates were analyzed according to the location of the tumor, histologic differentiation, depth of invasion, lymph node metastasis, lymphovascular invasion, recurrence, and survival rate. RESULTS: The expression rate of EGFR was 10.7% in biliary tract cancers. EGFR expression was more often observed in moderately- or poorly-differentiated carcinomas than in well-differentiated carcinomas (p=0.0252). No correlations were observed with age, gender, location of tumor, depth of invasion, lymph node metastasis, lymphovascular invasion, recurrence rate, or survival rate. c-erbB-2 was expressed in 4.5% of biliary tract cancers. c-erbB-2 expression had no significant relationships with clinical and pathological prognostic factors. CONCLUSION: EGFR expression can be used restrictively as a prognostic indicator of biliary tract cancers. c-erbB-2 expression in biliary tract cancers is very low, and does not show any prognostic significance.
Bile Ducts, Extrahepatic ; Bile Ducts, Intrahepatic ; Biliary Tract Neoplasms* ; Biliary Tract* ; Cholangiocarcinoma ; Epidermal Growth Factor* ; Gallbladder Neoplasms ; Lymph Nodes ; Neoplasm Metastasis ; Receptor, Epidermal Growth Factor* ; Receptor, erbB-2 ; Recurrence ; Survival Rate

PURPOSE: The development of MDCT and associated software has enabled us to obtain clear biliary images. This study aimed to investigate the preliminary experience and use of MDCT cholangiography using MinIP and MPR for preoperative planning. METHODS: We reviewed MDCT cholangiographies of 11 patients who underwent surgery due to a biliary obstruction in our hospital between May 2004 and July 2005. The CT scan used 16 channels. The axial images were routinely reconstructed at 5 mm intervals. If the bile ducts were dilated as seen on the axial images, portal phase raw data (with a collimation of 0.75 mm) were reconstructed at 0.5 mm intervals for MDCT cholangiography using MinIP and MPR. We analyzed the images and compared them with the surgical findings. RESULTS: Of 11 patients, 8 patients underwent a pylorus preserving pancreaticoduodenctomy, one patient underwent a hepatopancreaticoduodenectomy, one patient had a segmental resection of the bile duct, and one patient received a pancreatic head resection and segmental duodenectomy. MDCT cholangiographies showed an enhancement of wall thickening in the lesion of the bile duct, especially with extrahepatic bile duct cancer. The MDCT cholangiographies were able to provide the correct level and range of the biliary obstruction and were useful for preoperative planning. CONCLUSION: MDCT cholangiography using thin-slab MinIP and MPRprovided useful information for the diagnosis of patients with malignant biliary obstruction and was well correlated with other cholangiographies. With technical advances in MDCT and three dimensional projection techniques, CT cholangiography may supplant other procedures such as diagnostic endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic cholangiography (PTC) and magnetic resonance cholangiopancreatography (MRCP) because of its superior resolution and ability to provide pertinent information for the evaluation of the biliary tract and the surrounding structures.
Bile Ducts ; Bile Ducts, Extrahepatic ; Biliary Tract ; Cholangiography* ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangiopancreatography, Magnetic Resonance ; Diagnosis ; Head ; Humans ; Pylorus ; Tomography, X-Ray Computed

Superior mesenteric vein (SMV) thrombosis caused by acute appendicitis is a very rare entity nowadays. We report a successfully treated case of a 21-year-old man with SMV thrombosis associated with severe acute appendicitis. Intravenous heparin was administered, and it was later substituted with warfarin. Systemic antibiotic therapy was continued for 1 week, and it was substituted with oral antibiotics, which were administered for 3 weeks. On the 45th postoperative day, follow-up computed tomography scan demonstrated dissolution of SMV thrombosis. Anticoagulation therapy was maintained for 3 months. He was discharged without any complications. SMV thrombosis can be treated successfully with emergency appendectomy, broad-spectrum antibiotics, and anticoagulation therapy.
Anti-Bacterial Agents ; Appendectomy ; Appendicitis* ; Emergencies ; Follow-Up Studies ; Heparin ; Humans ; Mesenteric Veins* ; Thrombosis* ; Warfarin ; Young Adult

Inferior vena cava (IVC) thrombosis after traumatic liver injury is an extremely rare condition, and only 12 cases have been reported in the English literature since 1911. We report a case of a 26-year-old man who presented with IVC thrombosis after blunt liver injury. IVC thrombosis was incidentally detected by computed tomography 15 days after conservative management of blunt liver injury. The patient denied any symptoms of thrombophlebitis and did not have any evidence of hypercoagulable state. We placed an IVC filter via the right jugular vein and started the anticoagulation treatment. The patient recovered successfully without operative treatment and IVC thrombosis disappeared completely two months later. We suggest that that the possibility of IVC thrombosis should be considered in patients with a large hematoma of the liver, which may cause compression of the IVC.
Adult ; Hematoma ; Humans ; Jugular Veins ; Liver* ; Thrombophlebitis ; Thrombosis* ; Vena Cava, Inferior*

Emergent abdominal surgery in cirrhotic patients with ascites can result in dismal postoperative outcomes such as sepsis and hepatic failure. In the present case, small bowel resection followed by anastomosis by the hand-sewn method was performed for small bowel strangulation caused by an umbilical hernia; deceased donor liver transplantation was performed one week after the bowel resection because of deterioration of hepatic function. To the best of our knowledge, this is the first case of liver transplantation performed at only one week after small bowel resection; and although we obtained a good result, the optimal time to perform liver transplantation in this situation requires further evaluation.
Ascites ; Hernia, Umbilical* ; Humans ; Liver Failure ; Liver Transplantation* ; Sepsis ; Tissue Donors*