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Pheochromocytoma with pancreatic islet cell tumor: a case report.

Young Tae JU ; Eun Jung JUNG ; Sun Hoo PARK ; Soon Chan HONG

Korean Journal of Hepato-Biliary-Pancreatic Surgery.2000;4(1):191-195.

A 17-years old woman with a combination of unilateral pheochromocytoma and an asymptomatic islet cell tumor of the pancreas is presented. The unusual coincidence of pheochromocytoma and pancreatic islet cell tumor in the patient is of interest as a possible crossover between MEN I and MEN II. It has been suggested that MEN I represents an abnormality of the APUD(amine precursor uptake and decarboxylation) cells of ectodermal origin. However, the possibility of a common progenitor cell in the neural crest for all APUD cells has been suggested by Pearse and Polak(1971). Recent clinical reports suggest that overlap between the two syndroms may occur. The overlapping of elements of the classical endocrine neoplasia should alert clinicians to the possibility of such associations in any particular patients. Since islet cell tumors may occur in association with pheochromocytomas and may be clinically silent, exploration of the pancreas during surgery for pheochromocytomas would seem to be useful.
Adenoma, Islet Cell ; Adolescent ; APUD Cells ; Ectoderm ; Female ; Humans ; Islets of Langerhans* ; Male ; Multiple Endocrine Neoplasia Type 1 ; Multiple Endocrine Neoplasia Type 2a ; Neural Crest ; Pancreas ; Pheochromocytoma* ; Pyrus ; Stem Cells

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Modified Appleby's operation in distal pancreatic cancer: A case report.

Jeong Eon LEE ; Sang Jae PARK ; Sun Whe KIM ; Yong Hyun PARK

Korean Journal of Hepato-Biliary-Pancreatic Surgery.2000;4(1):185-189.

The prognosis of distal pancreatic cancer is even poorer than that of pancreatic head cancer because of its late symptom onset and tendency of aggressive retroperitoneal invasion at diagnosis. Since the first Appleby's operation in 1952, it has been performed in stomach cancer by several surgeons. But the survival benefit is still controversial. Appleby's operation includes total gastrectomy, splenectomy, distal pancreatectomy, celiac trunk division with ligation of common hepatic artery(CHA) and retroperitoneal lymph node dissection. In 1976, Nimura first adopted this method for distal pancreatic cancer. We report a case of modified Appleby's operation for distal pancreatic cancer. The patient was 44- year old female. Her chief complaint was epigastric pain for 2 weeks. Preoperative liver function test was within normal range and CA19-9 was elevated to 200 U/ml. Preoperative CT angiography showed 4.5x3cm sized, pancreatic mass in body and tail area invading splenic artery and celiac trunk from its left side. In operation, splenectomy and distal pancreatectomy was initially performed. After ligation of CHA, we confirmed intact proper hepatic artery(PHA) flow by doppler and then divided CHA. After confirmation of intact gastric blood flow, left gastric artery(LGA) was divided. Celiac axis(CA) was divided near its origin. Then we dissected retroperitoneal lymph nodes. There was minor pancreatic leakage controlled by conservative management. CA19-9 was normalized to 33 U/ml on the 16th postoperative day. She was discharged on the 28th postoperative day and underwent adjuvant chemotherapy and radiotherapy. There is no evidence of recurrence for 15 months of follow-up. We suggest that modified Appleby's operation should be considered for radical resection of distal pancreatic cancer which is invading CA or major CA branch but not involving PHA and superior mesenteric artery(SMA), if the CA root is resectable and PHA flow is intact from SMA after ligation of CHA.
Angiography ; Chemotherapy, Adjuvant ; Diagnosis ; Female ; Follow-Up Studies ; Gastrectomy ; Head and Neck Neoplasms ; Humans ; Ligation ; Liver Function Tests ; Lymph Node Excision ; Lymph Nodes ; Pancreatectomy ; Pancreatic Neoplasms* ; Prognosis ; Radiotherapy ; Recurrence ; Reference Values ; Splenectomy ; Splenic Artery ; Stomach Neoplasms

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Gallbladder neck cancer and perihilar cholangiocarcinoma - siblings, cousins or look alikes?.

Vinay Kumar KAPOOR

Korean Journal of Hepato-Biliary-Pancreatic Surgery.2015;19(2):86-88. doi:10.14701/kjhbps.2015.19.2.86

The gallbladder neck cancer and perihilar cholangiocarcinoma present as painless progressive surgical obstructive jaundice. Sometimes it becomes difficult to differentiate between them even on cross-sectional imaging studies including computed tomography and magnetic resonance imaging. Staging laparoscopy and positron emission tomography may be useful in detecting metastases in gallbladder neck cancer, but are not recommended in perihilar cholangiocarcinoma. Most patients with gallbladder neck cancer and perihilar cholangiocarcinoma require preoperative biliary drainage. The differentiation is, however, important because their behavior and prognosis are totally different. Gallbladder neck cancer is biologically aggressive, thus long-term surviver are rare even after major resection. On the other hand, perihilar cholangiocarcinoma is often less aggressive and major proceduresresections are justified. Gallbladder neck cancer and perihilar cholangiocarcinoma, though not siblings, they tend to look alike sometimes.
Cholangiocarcinoma* ; Drainage ; Gallbladder* ; Hand ; Head and Neck Neoplasms* ; Humans ; Jaundice, Obstructive ; Laparoscopy ; Magnetic Resonance Imaging ; Neoplasm Metastasis ; Positron-Emission Tomography ; Prognosis ; Siblings*

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A rare case of gallbladder torsion along the axis of body: a case report.

Hyung Jun KWON ; Sang Geol KIM

Korean Journal of Hepato-Biliary-Pancreatic Surgery.2015;19(2):82-85. doi:10.14701/kjhbps.2015.19.2.82

Abnormal attachment of the gallbladder to the liver is the main cause for gallbladder torsion. However, the present study reports a rare case of gallbladder torsion in which a portion of fundus is rotated along the axis of body. So far, very few similar cases have been reported. An 87-year-old woman complaining right upper quadrant abdominal pain for 4 days was admitted. Her body temperature was 38.5degrees C with moderate dehydration. A large tender mass was palpated on the right abdomen extending to the right iliac fossa. Computed tomography of abdomen showed a large cavity with a diameter of 15 cm containing a big stone and a small normal looking gallbladder. Ultrasonographic scan showed a twisted portion of the gallbladder torsion. During emergency laparotomy, the middle portion of the gallbladder was found to be twisted counterclockwise with huge gangrenous gallbladder distal. The proximal body of the gallbladder was spared and attached firmly to the liver. Cholecystectomy was performed and the patient was discharged 2 weeks later without postoperative complications. Histological findings of specimen were consistent with operative findings. The current study reports on a rare case of gallbladder torsion by reviewing previous studies.
Abdomen ; Abdominal Pain ; Aged, 80 and over ; Axis, Cervical Vertebra ; Body Temperature ; Cholecystectomy ; Dehydration ; Emergencies ; Female ; Gallbladder* ; Gallstones ; Humans ; Laparotomy ; Liver ; Postoperative Complications

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A Composite Tumor of the Ampulla of Vater: Signet-ring Cell and Neuroendocrine Carcinoma: A Case Report.

Kun Moo CHOI ; Dae Woon EOM

Korean Journal of Hepato-Biliary-Pancreatic Surgery.2007;11(4):85-88.

Most tumors affecting Vater's ampulla are adenocarcinomas. Other histological variants or mixed forms are less frequent, even rare. We treated a rare case of composite signet-ring cell carcinoma and well differentiated neuroendocrine carcinoma of the ampulla of Vater in a 72-year-old Korean man with abdominal discomfort and jaundice for two weeks. Computed tomography (CT) and endoscopic retrograde cholangiopancreatography (ERCP) revealed a 2 cm protruding mass with an abrupt narrowing of the distal common bile duct. Pancreaticoduodenectomy was performed. An ill-defined nodular 2 cm mass in the ampulla of Vater invaded the entire duodenal wall and pancreatic parenchyma with duct dilatation of the remaining common bile duct and pancreatic duct. Two out of twenty regional lymph nodes were positive for metastases. Histopathologically, the tumor was composed of mucinous adenocarcinoma with predominant signet-ring cell components (80%) and well-differentiated neuroendocrine carcinoma (20%). There were intermingled and transitional areas between both elements as well as amphicrine tumor cells with dual differentiation. By Immunohistochemistry, the adenocarcinoma with signet-ring cells was positive for CK7 and CEA and the neuroendocrine carcinoma was diffusely positive for CK7, synaptophysin and chromogranin but negative for insulin and CEA. Of the two metastatic peripancreatic lymph nodes, one was a neuroendocrine carcinoma and the other was an adenocarcinoma. The postoperative course was uneventful. The patient refused adjuvant chemotherapy and was discharged to home 13 days later. The patient died of multiple liver metastases and carcinomatosis 11 months after surgery.
Adenocarcinoma ; Adenocarcinoma, Mucinous ; Aged ; Ampulla of Vater* ; Carcinoma ; Carcinoma, Neuroendocrine* ; Cellular Structures ; Chemotherapy, Adjuvant ; Cholangiopancreatography, Endoscopic Retrograde ; Common Bile Duct ; Dilatation ; Humans ; Immunohistochemistry ; Insulin ; Jaundice ; Liver ; Lymph Nodes ; Neoplasm Metastasis ; Pancreatic Ducts ; Pancreaticoduodenectomy ; Synaptophysin

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Comparison of Laparoscopy and Exploration in the Distal Pancreatectomy.

Ji Woong HWANG ; Song Cheol KIM ; Kwan Tae PARK ; Haeng Chul SHIN ; Duck Jong HAN

Korean Journal of Hepato-Biliary-Pancreatic Surgery.2007;11(4):77-84.

BACKGROUND: To determine the benefits of laparoscopic surgery compared with exploration, the clinical outcomes of open and laparoscopic distal pancreatectomy were compared. METHOD: From March 2005 to June2007, we studied 95 patients at Asan Medical Center. These patients had benign pancreatic disease in the distal pancreas, e.g. a cystic neoplasm. These patients underwent a distal pancreatectomy with or without spleen-preservation using laparoscopic or exploration surgery. We divided these patients into two groups i.e. laparoscopy (n=60) and exploration (n=35), and compared the outcomes of the two groups retrospectively. RESULT: There was no difference in demographic features between the two groups. Laparoscopic resection required a median time of 208 mins, compared with 190 mins for the open resection. (p>0.05) The laparoscopic patients started a liquiddiet on postoperative day three, and required a median hospital stay of 11 days, compared with 4.5 days and 16 days for the open resection surgery, respectively. (p<0.001) The overall postoperative complication rate was 28.3% for the laparoscopic group compared with 22.9% for the open group. (p>0.05) The pancreatic fistula rate was lower in the laparoscopic patient group than in the open group. (8.3% vs. 14.3%) (p>0.05) The rate of spleen-preservation was higher in the laparoscopy group than the open group. (25% vs. 5.7%), (p>0.05) CONCLUSION: The results of this study showed that the laparoscopic distal pancreatectomy had a similar surgical time, an early start of the diet, a shorter hospital stay, and a higher spleensaving rate, compared to exploration surgery. Therefore, considering the benefits of laparoscopic surgery, it appears to be the preferred approach, with or without spleen-preservation, for treating benign distal pancreatic disease.
Chungcheongnam-do ; Diet ; Humans ; Laparoscopy* ; Length of Stay ; Operative Time ; Pancreas ; Pancreatectomy* ; Pancreatic Diseases ; Pancreatic Fistula ; Postoperative Complications ; Retrospective Studies

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Management of a Bleeding Pseudoaneurysm after Pancreaticoduodenectomy: 27 cases experience in single-center.

Young Nam ROH ; Hyung Geun LEE ; Dong Do RYU ; Kwang Yeol PAIK ; Jin Seok HEO ; Seong Ho CHOI ; Dong Wook CHOI

Korean Journal of Hepato-Biliary-Pancreatic Surgery.2007;11(4):69-76.

PURPOSE: Delayed massive hemorrhages from pseudoaneurysm rupture of the peripancreatic large arteries, after pancreaticoduodenectomy, are fatal. We reviewed the clinical course and outcome of bleeding pseudoaneurysms after pancreaticoduodenectomy. METHOD: The medical records of 905 consecutive patients who underwent pancreaticoduodenectomies between October 1994 and February 2007 were reviewed retrospectively. In 27 cases with hemorrhagic complications, pseudoaneurysms were diagnosed as the main cause of bleeding. The clinical characteristics, course, management, and outcomes were reviewed. RESULT: In 27 cases (3.0%) of the 905, the bleeding pseudoaneurysms were diagnosed by angiography, during surgery or clinically. In 11 cases, the hemorrhage was from the pseudoaneurysm on the ligated gastroduodenal artery-stump, in five it was from the right hepatic artery, in four from the proper hepatic artery or common hepatic artery, and two from the right gastric artery. Twelve cases had pancreatic leakage. Sentinel bleedings were observed in 21 cases, there were 11 cases of bleeding from the surgical drains, eight cases from the GI tract, and in two cases from both. In 23 cases, arterial embolization was attempted and 18 cases were successful. Four cases had secondary pseudoaneurysmal bleeding. After embolization at the common or proper hepatic artery, six cases had liver abscess or infarction and there was one case of hepatic failure. CONCLUSION: Delayed massive hemorrhage after pancreaticoduodenectomy should be ruled out to determine whether it is associated with an arterial pseudoaneurysm rupture. Transcatheter arterial embolization is an effective modality for control of the bleeding from an arterial pseudoaneurysm.
Aneurysm, False* ; Angiography ; Arteries ; Gastrointestinal Tract ; Hemorrhage* ; Hepatic Artery ; Humans ; Infarction ; Liver Abscess ; Liver Failure ; Medical Records ; Pancreaticoduodenectomy* ; Retrospective Studies ; Rupture

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Analysis of Outcomes after Curative Resection of Ampullary Carcinoid Tumor.

Sea Hyun KWON ; Shin HWANG ; Sung Gyu LEE ; Young Joo LEE ; Duck Jong HAN ; Kwang Min PARK ; Song Cheol KIM ; Je Ho RYU ; Jeong Ik PARK ; Hyo Jun LEE

Korean Journal of Hepato-Biliary-Pancreatic Surgery.2007;11(4):64-68.

PURPOSE: Ampullary carcinoid tumors are rare and therefore the clinicopathologic characteristics and prognosis after radical surgery have yet to be clarified. The goal of this study was to analyze the outcome of ampullary carcinoid tumors in patients who underwent radical curative resection. METHODS: From January 1998 to December 2005, 10 patients (3.4%) were diagnosed with an ampullary carcinoid tumor among 294 patients who underwent pancreatoduodenectomy for various ampullary neoplasms. The clinical findings from these 10 patients were retrospectively analyzed. RESULTS: The mean patient age was 58.0 +/- 13.4 years and seven were male. A standard pancreatoduodenectomy was performed in three patients and pylorus-preserving pancreatoduodenectomy in seven. An R0 resection was achieved in all 10 patients. The mean tumor size was 2.1 +/- 1.3 cm. Synaptophysin staining was positive in 10 and chromogranin staining was positive in eight patients. The overall and disease-free survival rates were 90% and 80% at 1 year and 64% and 56% at 3 years, respectively. Univariate analyses revealed that a maximum tumor diameter > or = 2 cm and tumor invasion beyond the ampulla were significant risk factors for tumor recurrence. CONCLUSIONS: The results of this study showed that performing a radical resection is the treatment of choice, with the intention of total tumor removal and the possibility of cure.
Carcinoid Tumor* ; Carcinoma, Neuroendocrine ; Disease-Free Survival ; Humans ; Intention ; Male ; Pancreaticoduodenectomy ; Prognosis ; Recurrence ; Retrospective Studies ; Risk Factors ; Synaptophysin

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Clinical Predictive Factors for Acute Gangrenous Cholecystitis.

Jong Tae JEE ; Kwang Sik CHUN ; In Sang SONG

Korean Journal of Hepato-Biliary-Pancreatic Surgery.2007;11(4):58-63.

PURPOSE: The postoperative morbidity and mortality for acute gangrenous cholecystitis (AGC) are higher than for acute nongangrenous cholecystitis (ANGC). However, preoperative predictive factors for the outcome of gangrenous cholecystitis have not been identified. The goal of this study was to determine the preoperative clinical predictive factors for the outcome of surgical treatment for acute gangrenous cholecystitis. METHODS: From January 2005 to December 2006, the medical records of 173 patients who underwent laparoscopic cholecystectomy for acute cholecystitis were reviewed and analyzed retrospectively. RESULTS: Among 173 patients with acute cholecystits, 57 (32.9%) had pathologically confirmed gangrenous cholecystits. Six variables were found to be associated with gangrenous cholecystits by univariate analysis: an age > or = 55 years, the presence of associated diseases, hypertension, fever (> or =37 degrees), an increased white blood cell count (> or = 15,450/mm3) and glucose. Four variables were identified that were associated with gangrenous cholecystits by multivariate analysis: an age > or = 55 years, the presence of associated diseases, hypertension, and an increased white blood cell count (> or =15450/mm3). CONCLUSION: The results of this study suggest that patients with an age > or = 55 years, the presence of associated diseases, hypertension, and an increased white blood cell count (> or =15450/mm3) have an increased risk of gangrenous cholecystitis and require immediate surgery.
Cholecystectomy, Laparoscopic ; Cholecystitis* ; Cholecystitis, Acute ; Fever ; Glucose ; Humans ; Hypertension ; Leukocyte Count ; Medical Records ; Mortality ; Multivariate Analysis ; Retrospective Studies

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Analysis of Survival After Portal Vein Resection (PVR) In Combination With Hepatectomy For Hilar Cholangiocarcinoma: An Audit of 51 Cases.

Gi Won SONG ; Sung Gyu LEE ; Young Joo LEE ; Kwang Min PARK ; Shin HWANG ; Ki Hun KIM ; Chul Soo AHN ; Deok Bog MOON ; Tae Yong HA ; Je Ho RYU ; Jeong Ikk PARK ; Hyo Jun LEE ; Chan Wook KIM

Korean Journal of Hepato-Biliary-Pancreatic Surgery.2007;11(4):47-57.

PURPOSE: Although a portal vein resection (PVR) can increase the chance for a successful curative resection, there is debate concerning the balance between the risk of the procedure and the effect on survival in patients with hilar cholangiocarcinoma. Therefore, we performed a retrospective study to determine the safety and survival after PVR for hilar cholangiocarcinoma. METHODS: We analyzed the cumulative survival rate and the associated clinical factors in 301 patients undergoing surgical intervention between June 1989 and June 2005. We divided 259 patients undergoing resection into two groups (51 PVR+ and 208 PVR-) and compared the survival and clinicopathological data. RESULTS: The 1-, 3- and 5-year survival rate of 186 patients undergoing curative resection was 83.3, 42.0 and 29.3%, respectively. The Bismuth-Corlette type IV, the infiltrative type, presence of perineural invasion, lymphovascular tumor emboli and lymph node metastases were more frequent in the PVR+ group. The survival rate was significantly lower in the PVR+ group but seven patients have survived for more than 5 years. Five (9.8%) operative mortalities occurred. However, the mortality directly related to the PVR was present in only one case. The morbidity and postoperative liver function were not different in comparisons between the two groups. In the PVR+ group, tumor invasion into the portal vein was observed in 28 of 51 patients. The tumor invasion on pathological examination did not affect survival in the PVR+ group. CONCLUSION: The results of this study showed that PVR in combination with hepatectomy, for hilar cholangiocarcinoma, could be performed with acceptable safety. Although the PVR has a negative impact on survival, a hepatectomy combined with a PVR can offer long-term survival to a few patients with advanced hilar cholangiocarcinoma.
Cholangiocarcinoma* ; Hepatectomy* ; Humans ; Klatskin's Tumor ; Liver ; Lymph Nodes ; Mortality ; Neoplasm Metastasis ; Portal Vein* ; Retrospective Studies ; Survival Rate

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