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Collision tumor of the ampulla of Vater - Coexistence of neuroendocrine carcinoma and adenocarcinoma: report of a case.

Hee Joon KIM ; Byung Gwan CHOI ; Choong Young KIM ; Chol Kyoon CHO ; Jin Woong KIM ; Jae Hyuk LEE ; Young Hoe HUR

Korean Journal of Hepato-Biliary-Pancreatic Surgery.2013;17(4):186-190. doi:10.14701/kjhbps.2013.17.4.186

Herein, we present a case of coexisting neuroendocrine carcinoma and conventional adenocarcinoma (collision tumor) in the ampulla of Vater, which has seldom been reported in the literature. A 51-year-old man presented with a month history of jaundice. MRCP disclosed about 1.9x1.8 cm sized heterogeneously enhancing mass in ampulla of Vater, causing obstructions of distal common bile duct. He underwent pylorus-preserving pancreaticoduodenectomy under the diagnosis on ampulla of Vater cancer. Pathologically, sections on the ampulla of Vater showed conventional ductal adenocarcinoma extended and collided with poorly differentiated neuroendocrine carcinoma. In conclusion, we hereby presented a case of coexisting neuroendocrine carcinoma and conventional adenocarcinoma in the ampulla of Vater.
Adenocarcinoma* ; Ampulla of Vater* ; Carcinoma, Neuroendocrine* ; Common Bile Duct ; Diagnosis ; Humans ; Jaundice ; Middle Aged ; Pancreaticoduodenectomy

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Collision Tumor of the Liver (Hepatocellular Carcinoma and Undifferentiated Sarcoma).

Hyung Il SEO

Korean Journal of Hepato-Biliary-Pancreatic Surgery.2009;13(2):120-123.

Collision tumors represent the coexistence of two adjacent but histologically distinct tumors in an organ. Collision tumors have been identified in various organs, but they are rare in liver. We present a rare case of a 57-year-old man, who was hospitalized for the removal of a liver mass (S5/6 segmentectomy), that was probably a hepatocellular carcinoma. The eventual pathology examination revealed a collision tumor composed of a hepatocellular carcinoma and an undifferentiated sarcoma. Because the tumor recurred 2 months after the operation, reoperation (right hemicolectomy and tumorectomy) was performed. In the 2nd month following the second operation we found multiple liver metastases, chest metastasis and abdominal cavity metastasis. To our knowledge this is the first case of a hepatic collision tumor that was composed of a hepatocellular carcinoma and an undifferentiated sarcoma. Herein, we report the case of a hepatic collision tumor and briefly review the literature.
Abdominal Cavity ; Carcinoma, Hepatocellular ; Humans ; Liver ; Middle Aged ; Neoplasm Metastasis ; Reoperation ; Sarcoma ; Thorax

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Composite Large Cell Neuroendocrine Carcinoma and Adenocarcinoma of the Ampulla of Vater.

Bo Sung SOHN ; Yu Hee NAM ; Jin A LEE ; Il Young PARK ; Nam Ik HAN ; Hee Jeong LEE

Korean Journal of Hepato-Biliary-Pancreatic Surgery.2009;13(2):114-119.

Large Cell Neuroendocrine Tumors (LCNEC) in the ampulla of Vater are extremely rare. This report addresses a case of concurrent LCNEC and adenocarcinoma in the ampulla of Vater. A 60-year-old male patient experienced fever, body chills and jaundice. He had a periampullary ulcerative lesion and underwent radical pancreaticoduodenectomy. Histopathologically, the tumor consisted of an LCNEC component and an adenocarcinoma component. Simultaneous LCNEC and adenocarcinoma has been reported in a few cases. Our patient had a coexisting LCNEC and an adenocarcinoma of the ampulla of Vater. We also present a review of the literature
Adenocarcinoma ; Ampulla of Vater ; Carcinoma, Neuroendocrine ; Chills ; Fever ; Humans ; Jaundice ; Male ; Middle Aged ; Neuroendocrine Tumors ; Pancreaticoduodenectomy ; Ulcer

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Renal Carcinoma Cell Metastasis into Pancreas : A Single Center Experience.

Jang Ho CHA ; Joon Seong PARK ; Ho Kyung HWANG ; Jae Keun KIM ; Dong Sup YOON ; Woo Jung LEE ; Hoon Sang CHI

Korean Journal of Hepato-Biliary-Pancreatic Surgery.2009;13(2):109-113.

INTRODUCTION: Renal cell carcinoma (RCC) is a relative rare tumor, accounting for approximately 3% of adult malignancies. Renal cell carcinoma has a high metastatic potential and is renowned for its ability to spread to almost any organ of the body. Pancreas is a rare site for metastasis from other primary cancers. Moreover, pancreatic metastasis is difficult to differentiate and may be misdiagnosed as a primary pancreatic cancer. The aim of this study was to review our cases of renal cell carcinoma that had metastasized to the pancreas after radical nephrectomy. METHODS: We did a retrospective review of the records of 4 patients with pathologically confirmed RCC that had metastasized to the pancreas after radical nephrectomy. RESULTS: Our group of 4 patients consisted of 2 men and 2 women. Their average age was 58.7 years (+/- 10.51 years). The locations within the pancreas were the head, in 2 (50.0%) and the body/tail in 2 (50.0%) patients. The pancreatic metastases were treated by pancreaticoduodenectomy in 2 patients, and by distal pancreatectomy in 2 patients. Median survival duration was 109.0 (+/- 67.3 months) "Median" is associated with an interquartile range (25% to 75%). The number 67.3 appears to be a standard deviation which is associated with the "mean". CONCLUSIONS: RCC is an unpredictable tumor that may result in a late metastasis even from an early stage. Aggressive surgical management of pancreatic lesions offers a chance of long-term survival.
Accounting ; Adult ; Carcinoma, Renal Cell ; Female ; Head ; Humans ; Male ; Neoplasm Metastasis ; Nephrectomy ; Pancreas ; Pancreatectomy ; Pancreatic Neoplasms ; Pancreaticoduodenectomy ; Retrospective Studies

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Effect of Pre-operative Biliary Drainage on Surgical Outcomes after Pancreaticoduodenectomy in Patients with Common Bile Duct Cancer.

Jae Myeong LEE ; Young Joo LEE ; Chan Wook KIM ; Ki Miung MOON ; Myung Wook KIM

Korean Journal of Hepato-Biliary-Pancreatic Surgery.2009;13(2):103-108.

INTRODUCTION: Biliary drainage is tried before surgery because it is thought that obstructive jaundice is associated with post-operative mortality and morbidity. However, there are no confirmed criteria about the optimal operation time after drainage. We attempted to determine the appropriate pre-operative bilirubin level after drainage which should be achieved before pancreaticoduodenectomy is done for extrahepatic bile duct cancer. METHODS: We reviewed 100 patients (69 males and 31 females with a mean age of 61.3 +/- 9.4 years) who underwent pancreaticoduodenectomy after a pre-operative biliary drainage procedure for distal common bile duct cancer by one surgeon at the Asan Medical Center in Seoul Korea between 1994 and 2005. RESULTS: We compared the group with pre-operative bilirubin levels < 5.0 mg/dl (N = 14) with the group with a bilirubin levels > or = 5.0 mg/dl (N = 86). In the bilirubin <5.0 group, the preoperative hemoglobin level was lower (p = 0.001), the pre-operative creatinine level was higher (p = 0.000), pre-operative cholangitis was more frequent (p = 0.034), and the bilirubin level at the time of admission was also higher (p = 0.000). The bilirubin < 5.0 group showed no postoperative morbidity, while there was a 25.6% morbidity rate in the bilirubin > or = 5.0 group (p = 0.032). CONCLUSION: The pre-operative bilirubin < 5.0 and > or = 5.0 groups had a clear difference in postoperative morbidity. Therefore, we suggest waiting until the pre-operative bilirubin level decreases to <5.0 mg/dl after biliary drainage.
Bile Ducts, Extrahepatic ; Bilirubin ; Cholangitis ; Common Bile Duct ; Creatinine ; Drainage ; Female ; Hemoglobins ; Humans ; Jaundice, Obstructive ; Korea ; Male ; Pancreaticoduodenectomy

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Clinical Experience of Mesenchymal Hamartoma of Liver.

Yun Seok KIM ; Dae Yun KIM ; So Hyun NAM ; Seong Chul KIM ; In Gu KIM

Korean Journal of Hepato-Biliary-Pancreatic Surgery.2009;13(2):97-102.

Purpose: Mesenchymal hamartoma of the liver (MHL) is an uncommon benign disease of childhood, yet its biology and pathogenesis are still unknown. It is difficult to diagnose from other hepatic tumors, and malignant transformation can occur. It has caused a debate regarding choice of the proper management of each neoplasm of liver in childhood. Methods: We analyzed histologically confirmed MHLs from 1998 to 2008. Results: Six patients presented at a median age of 21months, with a painless abdominal mass. Gastrointestinal symptoms were present in two patients. Abdominal ultrasonography and CT scans revealed a cystic, septated mass within the liver in all patients. Three patients underwent major hepatic resections, one had a simple excision of the tumor, and two were observed after biopsy. The median follow up period was 46months (range 6-115months), and there were neither recurrences of tumors nor complications, in patients who underwent surgical treatment. Conclusion: Resectable mesenchymal hamartoma of the liver in childhood with normal liver function studies can be cured by complete excision without complications and without recurrence.
Biology ; Biopsy ; Follow-Up Studies ; Hamartoma ; Humans ; Liver ; Recurrence

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Clinical Importance of Vimentin and MMP 2 Expression in Hepatocellular Carcinoma.

Eun Sin LEE ; Seong Woo HONG ; Yun Kyung KANG ; Woo Yong LEE ; Yeo Goo CHANG ; In Wook PAIK ; Hyucksang LEE

Korean Journal of Hepato-Biliary-Pancreatic Surgery.2009;13(2):89-96.

BACKGROUND / PURPOSE: Hepatocellular carcinoma (HCC) is a common cancer with a poor prognosis. A better understanding of the molecular mechanisms underlying the genesis of HCC, as well as the progression of HCC, allow for improved prediction of the prognosis of patients with HCC and more effective treatment. In this study, we determined the expression of vimentin and matrix metalloproteinase 2 (MMP 2) and evaluated the clinical significance in (HCC). METHODS: Immunohistochemical staining was performed for vimentin and MMP 2 in 98 surgically resected HCC specimens using the tissue microarray method. The clinicopathologic data and the outcomes were reviewed, and the levels of expression of vimentin and MMP 2 were compared. RESULTS: Positive expression of vimentin and MMP 2 was observed in 7.1% and 41.8% of specimens, respectively. The overexpression of vimentin and MMP 2 had a positive correlation with tumor cell proliferative activity, as measured by the Ki-67 labeling index (p<0.001 and p=0.043, respectively), but was not correlated with the TUNEL labeling index. Other clinicopathological factors, such as platelet count, serosal invasion, Edomondson grade, capsule infiltration, TNM stage(UICC, 6th edition) and extrahepatic metastases in patients with recurrences had a significant correlation with vimentin. The presence of portal vein thrombosis approached statistical significance with MMP 2 expression. In the survival analysis, overexpression of vimentin and MMP 2 was correlated with a poor overall survival rate based on univariate analysis (p=0.002 and, p=0.047, respectively), but not based on multivariate analysis. CONCLUSION: In HCC, vimentin and MMP 2 may have a role in cancer progression with more aggressive potential, thus suggesting their use as a prognostic markers in HCC.
Carcinoma, Hepatocellular ; Humans ; Immunohistochemistry ; In Situ Nick-End Labeling ; Matrix Metalloproteinase 2 ; Multivariate Analysis ; Neoplasm Metastasis ; Platelet Count ; Portal Vein ; Prognosis ; Recurrence ; Survival Analysis ; Survival Rate ; Thrombosis ; Vimentin

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Extent of Surgical Resection in Gallbladder Cancer.

Sang Jae PARK

Korean Journal of Hepato-Biliary-Pancreatic Surgery.2009;13(2):84-88.

Gallbladder (GB) cancer is a fatal disease for which the only chance for cure is surgical resection. The primary goal of surgery in GB cancer is to achieve zero residual tumor microscopically (R0 resection) and to be safe. However, there are still debates about the extent of surgery in GB cancer. For determining the extent of liver resection, tumor factors such as T-stage, tumor growth pattern and location as well as patients factors such as age, presence of liver cirrhosis and co-morbidity should be considered together. The extent of lymph node (LN) dissection in GB cancer is still inconclusive, and dissection of LN group 12, 13a and 8 can be regarded as the standard LN dissection. There is little evidence that extended lymph node dissection enhances survival. Acceptable indications for combined resection of the bile duct are direct invasion of the bile duct or cystic duct stump, and presence of LN metastasis in LN group 12. Routine pancreatoduodenectomy for extended LN dissection in GB cancer is not recommended.
Bile Ducts ; Cystic Duct ; Gallbladder ; Gallbladder Neoplasms ; Humans ; Liver ; Liver Cirrhosis ; Lymph Node Excision ; Lymph Nodes ; Neoplasm Metastasis ; Neoplasm, Residual ; Pancreaticoduodenectomy

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What is your initial surgical procedure for suspicious T2 gallbladder cancer? - Minimally invasive surgery..

Woo Jung LEE

Korean Journal of Hepato-Biliary-Pancreatic Surgery.2009;13(2):76-83.

There is controversy regarding surgical treatment of gallbladder carcinomas. Generally, simple cholecystectomy alone (including laparoscopic cholecystectomy) is an adequate treatment for pathologic stage T1a gallbladder carcinoma. T1b tumors are associated with good long-term survival even after simple cholecystectomy, but are associated with a slightly elevated locoregional recurrence rate. Therefore, a definitive curative treatment with liver resection and lymph node dissection should be performed. According to anecdotal experiences at our institution, simple, minimally invasive, laparoscopic cholecystectomy in certain patients (T1a) is likely to provide an acceptable surgical outcome compared to radical surgery in treating gallbladder carcinoma. And as evidence for minimally invasive surgical treatment for gallbladder carcinoma with T1b and T2 gallbladder carcinomas has increased and technical improvements have occurred in laparoscopic lymph node dissection, we have extended the indication of minimally invasive laparoscopic surgery (including da Vinci Robotic surgery) to T2 gallbladder carcinoma. Even though we cannot draw firm conclusions because the sample size was small and study duration was short, preliminary results are intriguing. a) Among 15 patients with T1a gallbladder carcinomas who were treated with minimally invasive surgery, there has been no recurrence to date. b) Among 7 patients with T1b lesions, one patient had liver metastasis 2 years after surgery. c) Among 15 patients with T2 lesions, two patients had disease recurrence in the para-aortic lymph node area 1 and 5 months, respectively, after surgery (laparoscopic simple cholecystectomy). d) After doing regional lymph node dissection (sometimes aortocaval lymph nodes as well) in 2006, 2 of 10 patients (20%) had positive regional lymph nodes after surgery but no recurrence has occurred to date. For suspected T1 and T2 gallbladder carcinomas without regional and systemic metastasis, after a preoperative study (using EUS and PET) for the main lesion and metastasis, we found that we can treat them with minimally invasive laparoscopic (or da Vinci Robotic) cholecystectomy and lymph node dissection (if needed, including aortocaval para-aortic lymph nodes).
Cholecystectomy ; Cholecystectomy, Laparoscopic ; Gallbladder ; Humans ; Laparoscopy ; Liver ; Lymph Node Excision ; Lymph Nodes ; Neoplasm Metastasis ; Recurrence ; Sample Size

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The Surgical Strategy for Treating T1 Gallbladder Cancer.

Seung Eun LEE ; Jin Young JANG ; Sun Whe KIM

Korean Journal of Hepato-Biliary-Pancreatic Surgery.2009;13(2):69-75.

Because T1 Gallbladder cancer (GB) has shown a better prognosis than advanced GB cancer, some authors have considered it proper to perform only cholecystectomy. Yet there has been controversy regarding the optimum management owing to the lack of evidence. Thus, retrospectively evaluating the therapeutic effect of each of these surgical procedure is essential to establish the appropriate surgical procedures for treating T1a & T1b GB cancer. In this study, we systematically reviewed 33 articles on T1a & T1b GB cancer. In most of the series, the treatment of choice for patients with T1a was a simple cholecystectomy with a 5-year survival of 100%. For T1b GB cancer, there was no definite evidence to support the superiority of extended cholecystectomy as opposed to simple cholecystectomy. However, considering the low recurrence rate after extended cholecystectomy, it is recommendable for patients who have a low preoperative risk to undergo extended cholecystectomy. Since lymph node metastasis occurs in about 8% of patients with T1b GB cancer, lymph node dissection is needed for the purposes of treatment and staging.
Cholecystectomy ; Gallbladder ; Gallbladder Neoplasms ; Humans ; Lymph Node Excision ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Retrospective Studies

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