BACKGROUND Undifferentiated pleomorphic sarcoma(UPS)is a rare malignant mesenchymal tumor with a poor prognosis.It mainly occurs in the extremities,trunk,head and neck,and retroperitoneum regions.Owing to the lack of ...BACKGROUND Undifferentiated pleomorphic sarcoma(UPS)is a rare malignant mesenchymal tumor with a poor prognosis.It mainly occurs in the extremities,trunk,head and neck,and retroperitoneum regions.Owing to the lack of specific clinical manifestations and imaging features,UPS diagnosis mainly depends on pathological and immunohistochemical examinations for exclusive diagnosis.Here we report an extremely rare case of high-grade UPS in the common bile duct(CBD).There are limited available data on such cases.CASE SUMMARY A 70-year-old woman was admitted to our department with yellow eyes and urine accompanied by upper abdominal distending pain for 2 wk.Her laboratory data suggested significantly elevated hepatorenal function levels.The imaging data revealed calculous cholecystitis,intrahepatic and extrahepatic bile duct dilation with extrahepatic bile duct calculi,and a space-occupying lesion at the distal CBD.After endoscopic biliary stenting and symptomatic support therapy,CBD exploration and biopsy were performed.The frozen section indicated malignant spindle cell tumor of the CBD mass,and further radical pancreaticoduodenectomy was performed.Finally,the neoplasm was diagnosed as a high-grade UPS combined with the light-microscopic morphology and immunohistochemical results.CONCLUSION This extremely rare case highlighted the need for increasing physicians'vigilance,reducing the odds of misdiagnosis,and providing appropriate treatment strategies.展开更多
BACKGROUND This is the first report of an ROS1-CENPW fusion gene in pancreatic malignancies.CASE SUMMARY A 77-year-old woman with a pancreatic tumor and multiple liver metastases was admitted to our hospital.Genetic t...BACKGROUND This is the first report of an ROS1-CENPW fusion gene in pancreatic malignancies.CASE SUMMARY A 77-year-old woman with a pancreatic tumor and multiple liver metastases was admitted to our hospital.Genetic testing revealed the presence of the ROS1-CENPW fusion gene,a rare fusion gene that has not been previously reported in the field of pancreatic cancer.The patient received crizotinib plus AG(albumin paclitaxel plus gemcitabine)chemotherapy.After treatment,the patient’s condition stabilized,and her prognosis was good.CONCLUSION The ROS1-CENPW gene treatment regimen used in this case is an excellent treatment option that provides new hope for patients with advanced pancreatic cancer and similar genetic mutations.To date,owing to the rarity of the ROS1-CENPW fusion gene,our team has encountered only a single case.Therefore,the efficacy of crizotinib plus AG chemotherapy in patients with pancreatic acinar cell carcinoma harboring the ROS1-CENPW fusion gene requires further validation.展开更多
BACKGROUND Anastomosing hemangioma(AH)is a rare subtype of benign hemangioma that is most commonly found in the genitourinary tract.Due to the lack of specific clinical and radiologic manifestations,it is easily misdi...BACKGROUND Anastomosing hemangioma(AH)is a rare subtype of benign hemangioma that is most commonly found in the genitourinary tract.Due to the lack of specific clinical and radiologic manifestations,it is easily misdiagnosed preoperatively.Here,we report a case of AH arising from the left renal vein that was discovered incidentally and confirmed pathologically,and then describe its imaging characteristics from a radiologic point of view and review its clinicopathologic features and treatment.CASE SUMMARY A 74-year-old woman was admitted to our department for a left retroperitoneal neoplasm measuring 2.6 cm×2.0 cm.Her laboratory data showed no significant abnormalities.A non-contrast-enhanced computed tomography(CT)scan showed a heterogeneous density in the neoplasm.Non-contrast-enhanced magnetic resonance imaging(MRI)revealed a heterogeneous hypointensity on T1-weighed images and a heterogeneous hyperintensity on T2-weighed images.On contrastenhanced CT and MRI scans,the neoplasm presented marked septal enhancement in the arterial phase and persistent enhancement in the portal phase,and its boundary with the left renal vein was ill-defined.Based on these clinical and radiological manifestations,the neoplasm was initially considered to be a neurogenic neoplasm in the left retroperitoneum.Finally,the neoplasm was completely resected and pathologically diagnosed as AH.CONCLUSION AH is an uncommon benign hemangioma.Preoperative misdiagnoses are common not only because of a lack of specific clinical and radiologic manifestations but also because clinicians lack vigilance and diagnostic experience in identifying AH.AH is not exclusive to the urogenital parenchyma.We report the first case of this neoplasm in the left renal vein.Recognition of this entity in the left renal vein can be helpful in its diagnosis and distinction from other neoplasms.展开更多
BACKGROUND Duplication of the appendix is an infrequent congenital malformation with a complex classification.The horseshoe appendix is a subtype of the duplex appendix and is rarely reported in the literature.Endomet...BACKGROUND Duplication of the appendix is an infrequent congenital malformation with a complex classification.The horseshoe appendix is a subtype of the duplex appendix and is rarely reported in the literature.Endometriosis is a common gynecological disease that rarely occurs in the appendix.Moreover,horseshoe appendix combined with endometriosis has not been previously reported.CASE SUMMARY Here,we describe a 44-year-old woman who was admitted with a 1-d history of migratory lower right quadrant pain.Physical examination was consistent with the signs of acute appendicitis.The patient underwent an emergency exploratory laparotomy.The distal tip of the appendix was in contact with the cecum by another base,or“horseshoe appendix”.In addition,a small intestinal mass and an ovarian mass were identified.Subsequently,appendectomy,partial resection of the small intestine,and right oophorectomy were successively performed.The histopathology confirmed the diagnosis of acute inflammation of the duplex appendix with endometriosis,small intestine endometriosis,and ovarian endometriosis.CONCLUSION Surgeons need to be aware of the possibility of the duplex appendix when performing an appendectomy,and this study emphasizes the importance of exploring the entire abdomen.展开更多
BACKGROUND Spontaneous bladder rupture is relatively rare,and common causes of spontaneous bladder rupture include bladder diverticulum,neurogenic bladder dysfunction,gonorrhea infection,pelvic radiotherapy,etc.Urinar...BACKGROUND Spontaneous bladder rupture is relatively rare,and common causes of spontaneous bladder rupture include bladder diverticulum,neurogenic bladder dysfunction,gonorrhea infection,pelvic radiotherapy,etc.Urinary bladder perforation caused by urinary catheterization mostly occurs during the intubation process.CASE SUMMARY Here,we describe an 83-year-old male who was admitted with 26 h of middle and upper abdominal pain and a history of long-term catheterization.Physical examination and computed tomography of the abdomen supported the diagnosis of diffuse peritonitis,most likely from a perforated digestive tract organ.Laparoscopic exploration revealed a possible digestive tract perforation.Finally,a perforation of approximately 5 mm in diameter was found in the bladder wall during laparotomy.After reviewing the patient's previous medical records,we found that 1 year prior the patient underwent an ultrasound examination showing that the end of the catheter was embedded into the mucosal layer of the bladder.Therefore,the bladder perforation in this patient may have been caused by the chronic compression of the urinary catheter against the bladder wall.CONCLUSION For patients with long-term indwelling catheters,there is a possibility of bladder perforation,which needs to be dealt with quickly.展开更多
BACKGROUND Hepatocellular adenoma(HCA)is very rare and has a high misdiagnosis rate through clinical and imaging examinations.We report a case of giant HCA of the left liver in a young woman that was diagnosed by medi...BACKGROUND Hepatocellular adenoma(HCA)is very rare and has a high misdiagnosis rate through clinical and imaging examinations.We report a case of giant HCA of the left liver in a young woman that was diagnosed by medical imaging and pathology.CASE SUMMARY A 21-year-old woman was admitted to our department for a giant hepatic tumor measuring 22 cm×20 cm×10 cm that completely replaced the left hepatic lobe.Her laboratory data only suggested mildly elevated liver function parameters and C-reactive protein levels.A computed tomography(CT)scan showed mixed density in the tumor.Magnetic resonance imaging(MRI)of the tumor revealed a heterogeneous hypointensity on T1-weighed MR images and heterogeneous hyperintensity on T2-weighed MR images.On dynamic contrast CT and MRI scans,the tumor presented marked enhancement and the subcapsular feeding arteries were clearly visible in the arterial phase,with persistent enhancement in the portal and delayed phases.Moreover,the tumor capsule was especially prominent on T1-weighted MR images and showed marked enhancement in the delayed phase.Based on these imaging manifestations,the tumor was initially considered to be an HCA.Subsequently,the tumor was completely resected and pathologically diagnosed as an HCA.CONCLUSION HCA is an extremely rare hepatic tumor.Preoperative misdiagnoses were common not only due to the absence of special clinical manifestations and laboratory examination findings,but also due to the clinicians’lack of practical diagnostic experience and vigilance in identifying HCA on medical images.Our case highlights the importance of the combination of contrast-enhanced CT and MRI in the preoperative diagnosis of HCA.展开更多
BACKGROUND Synchronous primary cancers(SPCs) have become increasingly frequent over the past decade.However,the coexistence of duodenal papillary and gallbladder cancers is rare,and such cases have not been previously...BACKGROUND Synchronous primary cancers(SPCs) have become increasingly frequent over the past decade.However,the coexistence of duodenal papillary and gallbladder cancers is rare,and such cases have not been previously reported in the English literature.Here,we describe an SPC case with duodenal papilla and gallbladder cancers and its diagnosis and successful management.CASE SUMMARY A 68-year-old Chinese man was admitted to our hospital with the chief complaint of dyspepsia for the past month.Contrast-enhanced computed tomography of the abdomen performed at the local hospital revealed dilatation of the bile and pancreatic ducts and a space-occupying lesion in the duodenal papilla.Endoscopy revealed a tumor protruding from the duodenal papilla.Pathological findings for the biopsied tissue revealed tubular villous growth with moderate heterogeneous hyperplasia.Surgical treatment was selected.Macroscopic examination of this surgical specimen revealed a 2-cm papillary tumor and another tumor protruding by 0.5 cm in the gallbladder neck duct.Intraoperative rapid pathology identified adenocarcinoma in the gallbladder neck duct and tubular villous adenoma with high-grade intraepithelial neoplasia and local canceration in the duodenal papilla.After an uneventful postoperative recovery,the patient was discharged without complications.CONCLUSION It is essential for clinicians and pathologists to maintain a high degree of suspicion while evaluating such synchronous cancers.展开更多
基金Supported by the People’s Livelihood Science and Technology Innovation Project of the Bureau of Science and Technology of Jiaxing City,No.2021AD30091.
文摘BACKGROUND Undifferentiated pleomorphic sarcoma(UPS)is a rare malignant mesenchymal tumor with a poor prognosis.It mainly occurs in the extremities,trunk,head and neck,and retroperitoneum regions.Owing to the lack of specific clinical manifestations and imaging features,UPS diagnosis mainly depends on pathological and immunohistochemical examinations for exclusive diagnosis.Here we report an extremely rare case of high-grade UPS in the common bile duct(CBD).There are limited available data on such cases.CASE SUMMARY A 70-year-old woman was admitted to our department with yellow eyes and urine accompanied by upper abdominal distending pain for 2 wk.Her laboratory data suggested significantly elevated hepatorenal function levels.The imaging data revealed calculous cholecystitis,intrahepatic and extrahepatic bile duct dilation with extrahepatic bile duct calculi,and a space-occupying lesion at the distal CBD.After endoscopic biliary stenting and symptomatic support therapy,CBD exploration and biopsy were performed.The frozen section indicated malignant spindle cell tumor of the CBD mass,and further radical pancreaticoduodenectomy was performed.Finally,the neoplasm was diagnosed as a high-grade UPS combined with the light-microscopic morphology and immunohistochemical results.CONCLUSION This extremely rare case highlighted the need for increasing physicians'vigilance,reducing the odds of misdiagnosis,and providing appropriate treatment strategies.
文摘BACKGROUND This is the first report of an ROS1-CENPW fusion gene in pancreatic malignancies.CASE SUMMARY A 77-year-old woman with a pancreatic tumor and multiple liver metastases was admitted to our hospital.Genetic testing revealed the presence of the ROS1-CENPW fusion gene,a rare fusion gene that has not been previously reported in the field of pancreatic cancer.The patient received crizotinib plus AG(albumin paclitaxel plus gemcitabine)chemotherapy.After treatment,the patient’s condition stabilized,and her prognosis was good.CONCLUSION The ROS1-CENPW gene treatment regimen used in this case is an excellent treatment option that provides new hope for patients with advanced pancreatic cancer and similar genetic mutations.To date,owing to the rarity of the ROS1-CENPW fusion gene,our team has encountered only a single case.Therefore,the efficacy of crizotinib plus AG chemotherapy in patients with pancreatic acinar cell carcinoma harboring the ROS1-CENPW fusion gene requires further validation.
基金the People’s Livelihood Science and Technology Innovation Project of the Bureau of Science and Technology of Jiaxing City,No.2019AD32201。
文摘BACKGROUND Anastomosing hemangioma(AH)is a rare subtype of benign hemangioma that is most commonly found in the genitourinary tract.Due to the lack of specific clinical and radiologic manifestations,it is easily misdiagnosed preoperatively.Here,we report a case of AH arising from the left renal vein that was discovered incidentally and confirmed pathologically,and then describe its imaging characteristics from a radiologic point of view and review its clinicopathologic features and treatment.CASE SUMMARY A 74-year-old woman was admitted to our department for a left retroperitoneal neoplasm measuring 2.6 cm×2.0 cm.Her laboratory data showed no significant abnormalities.A non-contrast-enhanced computed tomography(CT)scan showed a heterogeneous density in the neoplasm.Non-contrast-enhanced magnetic resonance imaging(MRI)revealed a heterogeneous hypointensity on T1-weighed images and a heterogeneous hyperintensity on T2-weighed images.On contrastenhanced CT and MRI scans,the neoplasm presented marked septal enhancement in the arterial phase and persistent enhancement in the portal phase,and its boundary with the left renal vein was ill-defined.Based on these clinical and radiological manifestations,the neoplasm was initially considered to be a neurogenic neoplasm in the left retroperitoneum.Finally,the neoplasm was completely resected and pathologically diagnosed as AH.CONCLUSION AH is an uncommon benign hemangioma.Preoperative misdiagnoses are common not only because of a lack of specific clinical and radiologic manifestations but also because clinicians lack vigilance and diagnostic experience in identifying AH.AH is not exclusive to the urogenital parenchyma.We report the first case of this neoplasm in the left renal vein.Recognition of this entity in the left renal vein can be helpful in its diagnosis and distinction from other neoplasms.
基金Supported by Department of Science and Technology of Jiaxing,No.2017AY33037
文摘BACKGROUND Duplication of the appendix is an infrequent congenital malformation with a complex classification.The horseshoe appendix is a subtype of the duplex appendix and is rarely reported in the literature.Endometriosis is a common gynecological disease that rarely occurs in the appendix.Moreover,horseshoe appendix combined with endometriosis has not been previously reported.CASE SUMMARY Here,we describe a 44-year-old woman who was admitted with a 1-d history of migratory lower right quadrant pain.Physical examination was consistent with the signs of acute appendicitis.The patient underwent an emergency exploratory laparotomy.The distal tip of the appendix was in contact with the cecum by another base,or“horseshoe appendix”.In addition,a small intestinal mass and an ovarian mass were identified.Subsequently,appendectomy,partial resection of the small intestine,and right oophorectomy were successively performed.The histopathology confirmed the diagnosis of acute inflammation of the duplex appendix with endometriosis,small intestine endometriosis,and ovarian endometriosis.CONCLUSION Surgeons need to be aware of the possibility of the duplex appendix when performing an appendectomy,and this study emphasizes the importance of exploring the entire abdomen.
文摘BACKGROUND Spontaneous bladder rupture is relatively rare,and common causes of spontaneous bladder rupture include bladder diverticulum,neurogenic bladder dysfunction,gonorrhea infection,pelvic radiotherapy,etc.Urinary bladder perforation caused by urinary catheterization mostly occurs during the intubation process.CASE SUMMARY Here,we describe an 83-year-old male who was admitted with 26 h of middle and upper abdominal pain and a history of long-term catheterization.Physical examination and computed tomography of the abdomen supported the diagnosis of diffuse peritonitis,most likely from a perforated digestive tract organ.Laparoscopic exploration revealed a possible digestive tract perforation.Finally,a perforation of approximately 5 mm in diameter was found in the bladder wall during laparotomy.After reviewing the patient's previous medical records,we found that 1 year prior the patient underwent an ultrasound examination showing that the end of the catheter was embedded into the mucosal layer of the bladder.Therefore,the bladder perforation in this patient may have been caused by the chronic compression of the urinary catheter against the bladder wall.CONCLUSION For patients with long-term indwelling catheters,there is a possibility of bladder perforation,which needs to be dealt with quickly.
文摘BACKGROUND Hepatocellular adenoma(HCA)is very rare and has a high misdiagnosis rate through clinical and imaging examinations.We report a case of giant HCA of the left liver in a young woman that was diagnosed by medical imaging and pathology.CASE SUMMARY A 21-year-old woman was admitted to our department for a giant hepatic tumor measuring 22 cm×20 cm×10 cm that completely replaced the left hepatic lobe.Her laboratory data only suggested mildly elevated liver function parameters and C-reactive protein levels.A computed tomography(CT)scan showed mixed density in the tumor.Magnetic resonance imaging(MRI)of the tumor revealed a heterogeneous hypointensity on T1-weighed MR images and heterogeneous hyperintensity on T2-weighed MR images.On dynamic contrast CT and MRI scans,the tumor presented marked enhancement and the subcapsular feeding arteries were clearly visible in the arterial phase,with persistent enhancement in the portal and delayed phases.Moreover,the tumor capsule was especially prominent on T1-weighted MR images and showed marked enhancement in the delayed phase.Based on these imaging manifestations,the tumor was initially considered to be an HCA.Subsequently,the tumor was completely resected and pathologically diagnosed as an HCA.CONCLUSION HCA is an extremely rare hepatic tumor.Preoperative misdiagnoses were common not only due to the absence of special clinical manifestations and laboratory examination findings,but also due to the clinicians’lack of practical diagnostic experience and vigilance in identifying HCA on medical images.Our case highlights the importance of the combination of contrast-enhanced CT and MRI in the preoperative diagnosis of HCA.
基金Supported by the Jiaxing Science and Technology Plan Project (Civil Science and Technology Innovation Project),No. 2019AY32028。
文摘BACKGROUND Synchronous primary cancers(SPCs) have become increasingly frequent over the past decade.However,the coexistence of duodenal papillary and gallbladder cancers is rare,and such cases have not been previously reported in the English literature.Here,we describe an SPC case with duodenal papilla and gallbladder cancers and its diagnosis and successful management.CASE SUMMARY A 68-year-old Chinese man was admitted to our hospital with the chief complaint of dyspepsia for the past month.Contrast-enhanced computed tomography of the abdomen performed at the local hospital revealed dilatation of the bile and pancreatic ducts and a space-occupying lesion in the duodenal papilla.Endoscopy revealed a tumor protruding from the duodenal papilla.Pathological findings for the biopsied tissue revealed tubular villous growth with moderate heterogeneous hyperplasia.Surgical treatment was selected.Macroscopic examination of this surgical specimen revealed a 2-cm papillary tumor and another tumor protruding by 0.5 cm in the gallbladder neck duct.Intraoperative rapid pathology identified adenocarcinoma in the gallbladder neck duct and tubular villous adenoma with high-grade intraepithelial neoplasia and local canceration in the duodenal papilla.After an uneventful postoperative recovery,the patient was discharged without complications.CONCLUSION It is essential for clinicians and pathologists to maintain a high degree of suspicion while evaluating such synchronous cancers.
