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A Case of Carcinoid Tumor of the Common Bile Duct.

Ki Su HAN ; Byung Hun YIM ; Ki Hyun KIM ; Do Hyoung KIM ; Yong Sung WON ; Ji Han JUNG

Korean Journal of Hepato-Biliary-Pancreatic Surgery.2007;11(3):72-75.

Carcinoid tumors arising in the extrahepatic bile duct are very rare, accounting for only 0.2%~2% of all gastrointestinal carcinoid tumord. We experienced one case of a carcinoid tumor in the common bile duct. A 43-years-old man was unexpectedly found to have a carcinoid tumor of the common bile duct. This patient had no obstructive jaundice, yet we thought that this tumor was a clinically malignant tumor, so we performed pylorus preserving pancreatoduodenectomy. Pathologically, an ill-demarcated mass that measured 1.5x1.5cm in size had invaded into the pancreas. Immunohistochemically, the mass was founded to be chromogranin, synaptophysin and CD56 positive. The patient who underwent curative resection is alive and disease-free at time of this publication. This report also reviews the relevant literature on carcinoid tumors in the common bile duct.
Bile Ducts, Extrahepatic ; Carcinoid Tumor* ; Common Bile Duct* ; Humans ; Jaundice, Obstructive ; Pancreas ; Pancreaticoduodenectomy ; Publications ; Pylorus ; Synaptophysin

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A case of Combined Resection for Synchronous Primary Carcinoma of Gallbladder and Duodenum.

Young Hoi HUR ; Soon Ju JEONG ; Yang Seouk KOH ; Jung Chul KIM ; Chol Kyoon CHO ; Hyun Jong KIM ; Young Eun JOO ; Chang Hwan PARK ; Wan Sik LEE ; Sung Kyu CHOI ; Jong Sun REW ; Se Jong KIM ; Sang Su SHIN ; Yong Yeon JEONG ; Jae Hyuk LEE

Korean Journal of Hepato-Biliary-Pancreatic Surgery.2007;11(3):68-71.

PURPOSE: The incidence of multiple primary malignant tumor has ranged from 0.7% to 11% in the medical literature. Various organs in the digestive system are the sites of multiple primary cancer (MPC). MPC may be synchronous or metachronous depending on the interval between their diagnosis. To the best of our knowledge, there are only rare reports of resected cases of synchronous primary carcinomas that developed in the GB and duodenum. METHODS: We present here a patient who underwent an operation for synchronous primary carcinomas of the GB and duodenum. A 51-year-old female was admitted for postprandial abdominal discomfort. CT scan and MRI of the abdomen showed a 3 x 2 cm sized heterogenously enhancing mass in the GB and a 3.7 x 2.7 cm sized hetrogenously enhancing mass in the 2nd portion of the duodeum. The laboratory findings, including the tumor markers, were non-specific. An elective operation was done under the impression of combined GB cancer and cancer in the 2nd portion of the deuodenum. On the operative findings, there was a 3 x 2.5 cm sized mass in the GB and a 5 x 4 cm sized duodenal mass with near complete luminal obstruction 3 cm distal from the pyloric ring. Radical cholecystectomy with wedge resection of the liver bed and Whipple's operation was performed. RESULTS: On microscopic examination, the GB mass was well differentiated adenocarcinoma and the duodenal mass was moderately differentiated adenocarcinoma, and one lymph node (a lymph node along the common hepatic artery) among the 18 dissected lymph nodes was invaded by tumor cells. The microscopic findings showed that the GB mass and duodenal mass were synchronous primary carcinomas. The patient recovered uneventfully and is alive and doing well without evidence of recurrence at 21-months of follow up evaluation. CONCLUSIONS: We report here on a case of combined curative resection for synchronous primary carcinomas of the gallbladder and duodenum.
Abdomen ; Adenocarcinoma ; Cholecystectomy ; Diagnosis ; Digestive System ; Duodenum* ; Female ; Follow-Up Studies ; Gallbladder* ; Humans ; Incidence ; Liver ; Lymph Nodes ; Magnetic Resonance Imaging ; Middle Aged ; Phenobarbital ; Recurrence ; Tomography, X-Ray Computed ; Biomarkers, Tumor

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Surgical Outcomes and Prognostic Factors of Primary Gallbladder Carcinoma.

Mi Ran JUNG ; Young Hoe HUR ; Yang Seok KOH ; Jung Chul KIM ; Chol Kyoon CHO ; Hyun Jong KIM

Korean Journal of Hepato-Biliary-Pancreatic Surgery.2007;11(3):60-67.

PURPOSE: Even with recent advances of diagnostic tools and therapeutic strategies, the prognosis of gallbladder cancers remains poor. The clinical outcome has not improved much over the past couple of decades. This study analyzed our surgical results to evaluate the prognostic factors associated with survival after surgery in patients with gallbladder malignancies. METHODS: Retrospective review of 69 patients with gallbladder carcinomas operated on at our surgical department over a period of 9 years from May 1995 to April 2004. RESULTS: The overall 5-year survival rate was 45.9%, 3-year survival rate 52.8% and 1-year survival rate 72.4%. The 5-year survival rates according to the AJCC stage were 0 100%, Ia 100%, Ib 71.0%, IIa 41.7%, IIb 23.8%, III 50.0%, and IV 11.0% for each. The 5-year survival rates according to the depth of invasion were Tis 100%, T1a 100%, T1b 66.6%, T2 57.1%, T3 36.8%, and T4 22.7%. A univariate analysis of clinicopathologic factors showed that the T stage, N stage, M stage, radical surgery, tumor location, surgical procedure and histological grade were significant prognostic factors. Multivariate Cox-regression analysis of these eight important factors demonstrated that lymph node metastases and the degree of radical surgery were independent variables associated with prognosis. CONCLUSION: The results of this study showed that lymph node metastases and degree of radical surgery were associated with patient prognosis. Therefore, long-term survival may be achieved by an early diagnosis with curative radical tumor resection.
Early Diagnosis ; Gallbladder Neoplasms ; Gallbladder* ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis ; Retrospective Studies ; Survival Rate

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Gallbladder Carcinomas found after a Laparoscopic Cholecystectomy.

Hye Yeon JEONG ; Su Kurn CHANG ; Jong Yeol KIM ; Sang Geol KIM ; Yun Jin HWANG ; Young Kook YUN

Korean Journal of Hepato-Biliary-Pancreatic Surgery.2007;11(3):54-59.

PURPOSE: An laparoscopic cholecystectomy (LC) is being increasingly performed for benign gallbladder disease. Accordingly, gallbladder carcinomas have been increasingly reported in patients after undergoing an LC. This study aims to reveal the clinicopathological features and prognosis of gallbladder carcinomas found after an LC. METHODS: Between April 1994 and March 2007, 2714 patients underwent an LC and 1.5% of the patients were diagnosed histologically as having a gallbladder carcinoma. We retrospectively evaluated the clinicopathological features and long-term survival of the patients. RESULTS: There were 19 male patients and 21 female patients, with a mean age of 60.7 degrees+/-12.3 years. The indications for LC included acute calculous cholecystitis, chronic calculous cholecystitis and polypoid lesions of the gallbladder (PLGs). An LC only was performed in 26 patients (13 pT1a, 7 pT1b and 6 pT2 cases) while additional surgery including gallbladder bed resection and lymph node dissection was performed in 14 patients (2 pT1a, 2 pT1b, 8 pT2 and 2 pT3 cases). The patients with a carcinoma associated with PLGs were younger, had more incidence of pT1a and had well differentiated carcinomas and a better 5-year survival rate as compared to patients with a non-polypoid carcinoma. Whereas no recurrences or deaths occurred for the 24 pT1 patients, two of the 14 pT2 patients had a recurrence. Both pT3 patients had a recurrence despite additional surgery. In patients with pT2 or more, additional surgery did not improve survival (p = 0.82). CONCLUSION: The polypoid morphology of gallbladder carcinoma, but not additional surgery, favorably affects survival of gallbladder carcinoma patients following an LC. However, a further multi-institutional study may be needed to determine the benefit of additional surgery.
Cholecystectomy, Laparoscopic* ; Cholecystitis ; Female ; Gallbladder Diseases ; Gallbladder* ; Humans ; Incidence ; Lymph Node Excision ; Male ; Prognosis ; Recurrence ; Retrospective Studies ; Survival Rate

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Small cell carcinoma of pancrease.

Ha Guen LEE ; Kyeong Geun LEE ; Chan Kum PARK ; Kwang Soo LEE

Korean Journal of Hepato-Biliary-Pancreatic Surgery.2006;10(4):38-40.

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

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Ampullary Carcinoid Tumor.

Dong Sun SHIN ; Dae Young KANG ; In Sang SONG

Korean Journal of Hepato-Biliary-Pancreatic Surgery.2006;10(4):34-37.

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

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Pancreaticopleural Fistula : Complication of Chronic Pancreatitis.

Sun Yong PARK ; Jin Young JANG ; Seung Eun LEE ; Sung hoon YANG ; Sun Whe KIM

Korean Journal of Hepato-Biliary-Pancreatic Surgery.2006;10(4):29-33.

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

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Primary Gastric Neuroendocrine Tumor with Hepatic Metastasis.

Taek Soo KWON ; Ho Yuon KIM ; Jae Young CHOI ; Sang Mok LEE ; Sung Wha HONG

Korean Journal of Hepato-Biliary-Pancreatic Surgery.2006;10(4):24-28.

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

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Insulin-releasing Neuroendocrine Carcinoma of the Gallbladder Presenting with Hypoglycemic Symptoms.

Jeong Man NAMGOONG ; Song Cheol KIM ; Duck Jong HAN ; Kwan Tae PARK ; Young Joo LEE ; Kyu Lae KIM

Korean Journal of Hepato-Biliary-Pancreatic Surgery.2006;10(4):19-23.

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

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Epidermal Growth Factor Receptor and c-erbB-2 Expressions in Biliary Tract Cancers.

Jin Soo KIM ; Woo Seok AHN ; Kwang Hee KIM ; Chang Soo CHOI ; Hye Kyoung YOON ; Young Kil CHOI

Korean Journal of Hepato-Biliary-Pancreatic Surgery.2006;10(4):13-18.

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

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