1.Primary Hepatic Choriocarcinoma with Pregnancy: A Diagnostic and Therapeutic Challenge
Amith Kumar PAKKALA ; Phani Kumar NEKARAKANTI ; Bheerappa NAGARI ; Ashish Kumar BANSAL ; Gourang SHROFF ; Megha S UPPIN
The Korean Journal of Gastroenterology 2023;81(2):91-94
Choriocarcinoma occurs mainly in the gonads, but an extragonadal origin has been reported, albeit infrequently. Primary hepatic choriocarcinoma (PHC) is a rare malignancy, with only 11 cases reported. Most cases reported were in males, with none reported in pregnant females. A 23-year-old primigravida presented with a large liver lesion involving the right lobe of the liver at 28 weeks of pregnancy. Preoperative imaging was suggestive of hepatocellular carcinoma. She underwent a non-anatomical resection of the liver lesion. Surprisingly, her postoperative histopathology revealed a diagnosis of PHC. Her blood workup showed elevated beta human chorionic gonadotrophin. She underwent a termination of her pregnancy at 32 weeks. Before initiating adjuvant chemotherapy four weeks after surgery, a whole-body PET scan revealed multiple bi-lobar liver and pelvic deposits. After a multidisciplinary team discussion, she was started on adjuvant chemotherapy. She is currently under regular follow-up, seven months post-surgery. PHC, one of the vascular lesions of the liver, poses a diagnostic and therapeutic challenge, warranting a multidisciplinary approach.
2.Solitary Fibrous Tumors of the Mesocolon: A Report of Two Cases and Review of Literature
Madhur M PARDASANI ; Phani Kumar NEKARAKANTI ; Bheerappa NAGARI ; Surya Ramachandra Varma GUNTURI ; Ashish Kumar BANSAL ; Shantiveer G UPPIN
The Korean Journal of Gastroenterology 2023;82(2):96-101
Solitary fibrous tumors (SFTs) are an uncommon group of neoplasms. The visceral pleura is the most common site of origin of these tumors. The colonic mesentery is an unusual site of origin of SFTs. A pre-operative diagnosis of SFT is challenging as there are no pathognomonic clinical or radiological signs. Most patients reported thus far were diagnosed post-operatively with the aid of immunohistochemical markers. Complete surgical excision is the treatment of choice for SFTs. Recurrences are uncommon. However, they can occasionally show aggressive behavior. In this report, we describe two cases of rare colonic mesentery SFTs.
3.Role of adjuvant therapy in resected periampullary adenocarcinoma:A propensity matched case-control study
Anurita SRIVASTAVA ; Phani Kumar NEKARAKANTI ; Sudheer KANCHODU ; Siddharth SRIVASTAVA ; Pramod Kumar MISHRA ; Sundeep Singh SALUJA
Annals of Hepato-Biliary-Pancreatic Surgery 2024;28(3):371-380
Background:
s/Aims: The published data had contradictory information on the role of adjuvant therapy on resected periampullary carcinomas (PACA). The study was performed to evaluate the survival benefit of adjuvant treatment.
Methods:
This was a propensity score matched case-control study from a prospectively maintained database from 2004–2019. The study included patients with nonpancreatic PACA who underwent curative resection. The patients (cases) who received adjuvant chemotherapy were compared with patients (controls) who were observed alone after surgery.
Results:
Of 510 patients with PACA, 230 patients (cases = 107, controls = 123) formed the unmatched study cohort. After propensity score matching, 140 patients (cases = 70, controls = 70) formed the matched study cohort. The median overall survival (OS) was similar in cases than controls in the unmatched population but doubled non-significantly in cases after matching (unmatched population, 54 months vs. 54 months, p -value = 0.624; matched population, 71 months vs. 36 months, p -value = 0.087). However, the median recurrence-free survival (RFS) was non significantly higher in the control group (unmatched population, 59 months vs. 38 months, p-value = 0.195; matched population, 53 months vs. 40 months, p-value = 0.797). In cox regression analysis, age < 60 years, advanced T stage, and presence of perineural invasion were independent factors for worse RFS, while tumor recurrence was an independent factor for poor OS.
Conclusions
Patients with nonpancreatic PACA may have an OS benefit from adjuvant chemotherapy, and this needs to be validated with large prospective randomized studies.
4.Post-living donor liver transplant biliary strictures: prevalence, predictors, and long-term outcomes in a retrospective study
Shekhar Singh JADAUN ; Phani Kumar NEKARAKANTI ; Sushant BHATIA ; Mukesh KUMAR ; Pankaj SINGH ; Vikas SINGLA ; Shweta A. SINGH ; Shaleen AGARWAL ; Sanjiv SAIGAL ; Subhash GUPTA
Clinical Transplantation and Research 2025;39(1):55-65
Background:
Post-liver transplant biliary strictures are a common cause of morbidity among patients who have undergone living donor liver transplantation (LDLT). Limited data are available concerning the response rates to various treatment modalities and the long-term outcomes for these individuals.
Methods:
This study was a retrospective analysis of a prospectively collected database, including adult patients aged 18 years or older who underwent LDLT between 2006 and 2022.
Results:
Between 2006 and 2022, a total of 3,550 patients underwent liver transplantation. After applying exclusion criteria, 2,956 patients were included in the analysis.During the study period, 344 patients (11.6%) developed biliary strictures. Of these, 77.0% underwent endoscopic retrograde cholangiopancreatography as the primary treatment for biliary strictures, while the remainder received percutaneous transhepatic biliary drainage. Identified risk factors for post-liver transplant biliary strictures included the presence of multiple biliary anastomoses, bile leak, and older donor and recipient ages. The overall graft and patient survival rates were comparable between patients with and without biliary strictures, at both 1 year (93.0% vs. 96.3%) and 5 years (82.3% vs. 79.2%).
Conclusions
Biliary strictures are observed in approximately 11% of recipients following LDLT. While the presence of biliary strictures is associated with increased morbidity, it does not significantly impact patient survival.
5.Post-living donor liver transplant biliary strictures: prevalence, predictors, and long-term outcomes in a retrospective study
Shekhar Singh JADAUN ; Phani Kumar NEKARAKANTI ; Sushant BHATIA ; Mukesh KUMAR ; Pankaj SINGH ; Vikas SINGLA ; Shweta A. SINGH ; Shaleen AGARWAL ; Sanjiv SAIGAL ; Subhash GUPTA
Clinical Transplantation and Research 2025;39(1):55-65
Background:
Post-liver transplant biliary strictures are a common cause of morbidity among patients who have undergone living donor liver transplantation (LDLT). Limited data are available concerning the response rates to various treatment modalities and the long-term outcomes for these individuals.
Methods:
This study was a retrospective analysis of a prospectively collected database, including adult patients aged 18 years or older who underwent LDLT between 2006 and 2022.
Results:
Between 2006 and 2022, a total of 3,550 patients underwent liver transplantation. After applying exclusion criteria, 2,956 patients were included in the analysis.During the study period, 344 patients (11.6%) developed biliary strictures. Of these, 77.0% underwent endoscopic retrograde cholangiopancreatography as the primary treatment for biliary strictures, while the remainder received percutaneous transhepatic biliary drainage. Identified risk factors for post-liver transplant biliary strictures included the presence of multiple biliary anastomoses, bile leak, and older donor and recipient ages. The overall graft and patient survival rates were comparable between patients with and without biliary strictures, at both 1 year (93.0% vs. 96.3%) and 5 years (82.3% vs. 79.2%).
Conclusions
Biliary strictures are observed in approximately 11% of recipients following LDLT. While the presence of biliary strictures is associated with increased morbidity, it does not significantly impact patient survival.
6.Post-living donor liver transplant biliary strictures: prevalence, predictors, and long-term outcomes in a retrospective study
Shekhar Singh JADAUN ; Phani Kumar NEKARAKANTI ; Sushant BHATIA ; Mukesh KUMAR ; Pankaj SINGH ; Vikas SINGLA ; Shweta A. SINGH ; Shaleen AGARWAL ; Sanjiv SAIGAL ; Subhash GUPTA
Clinical Transplantation and Research 2025;39(1):55-65
Background:
Post-liver transplant biliary strictures are a common cause of morbidity among patients who have undergone living donor liver transplantation (LDLT). Limited data are available concerning the response rates to various treatment modalities and the long-term outcomes for these individuals.
Methods:
This study was a retrospective analysis of a prospectively collected database, including adult patients aged 18 years or older who underwent LDLT between 2006 and 2022.
Results:
Between 2006 and 2022, a total of 3,550 patients underwent liver transplantation. After applying exclusion criteria, 2,956 patients were included in the analysis.During the study period, 344 patients (11.6%) developed biliary strictures. Of these, 77.0% underwent endoscopic retrograde cholangiopancreatography as the primary treatment for biliary strictures, while the remainder received percutaneous transhepatic biliary drainage. Identified risk factors for post-liver transplant biliary strictures included the presence of multiple biliary anastomoses, bile leak, and older donor and recipient ages. The overall graft and patient survival rates were comparable between patients with and without biliary strictures, at both 1 year (93.0% vs. 96.3%) and 5 years (82.3% vs. 79.2%).
Conclusions
Biliary strictures are observed in approximately 11% of recipients following LDLT. While the presence of biliary strictures is associated with increased morbidity, it does not significantly impact patient survival.
7.Post-living donor liver transplant biliary strictures: prevalence, predictors, and long-term outcomes in a retrospective study
Shekhar Singh JADAUN ; Phani Kumar NEKARAKANTI ; Sushant BHATIA ; Mukesh KUMAR ; Pankaj SINGH ; Vikas SINGLA ; Shweta A. SINGH ; Shaleen AGARWAL ; Sanjiv SAIGAL ; Subhash GUPTA
Clinical Transplantation and Research 2025;39(1):55-65
Background:
Post-liver transplant biliary strictures are a common cause of morbidity among patients who have undergone living donor liver transplantation (LDLT). Limited data are available concerning the response rates to various treatment modalities and the long-term outcomes for these individuals.
Methods:
This study was a retrospective analysis of a prospectively collected database, including adult patients aged 18 years or older who underwent LDLT between 2006 and 2022.
Results:
Between 2006 and 2022, a total of 3,550 patients underwent liver transplantation. After applying exclusion criteria, 2,956 patients were included in the analysis.During the study period, 344 patients (11.6%) developed biliary strictures. Of these, 77.0% underwent endoscopic retrograde cholangiopancreatography as the primary treatment for biliary strictures, while the remainder received percutaneous transhepatic biliary drainage. Identified risk factors for post-liver transplant biliary strictures included the presence of multiple biliary anastomoses, bile leak, and older donor and recipient ages. The overall graft and patient survival rates were comparable between patients with and without biliary strictures, at both 1 year (93.0% vs. 96.3%) and 5 years (82.3% vs. 79.2%).
Conclusions
Biliary strictures are observed in approximately 11% of recipients following LDLT. While the presence of biliary strictures is associated with increased morbidity, it does not significantly impact patient survival.