We are reporting the first documented case of an abdominal desmoid tumor presenting primarily after liver transplantation. This tumor, well described in the literature as occurring both in conjunction with familial ad...We are reporting the first documented case of an abdominal desmoid tumor presenting primarily after liver transplantation. This tumor, well described in the literature as occurring both in conjunction with familial adenomatous polyposis as well as in the postsurgical patient, has never been noted after solid organ transplantation and was therefore not included in our differential upon presentation. Definitive diagnosis required the patient to undergo surgical excision and immunochemical staining of the mass for confirmation. A review of the literature showed no primary tumors after transplantation. In a population of patients who received a small bowel transplant after they developedshort gut post radical resection of aggressive fibromatosis, only rare recurrences were seen. No connection of tumor development with immunosuppression or need to decrease immunosuppressant treatment has been demonstrated in these patients. Our case and the literature show the risk of this tumor presenting in the post-transplantation patient and the need for a high index of suspicion in patients who present with a complex mass after transplantation to prevent progression of the disease beyond a resectable lesion. Results of a thorough search of the literature are detailed and the medical and surgical management of both resectable and unresectable lesions is reviewed.展开更多
BACKGROUND There are several case reports of acute cholecystitis as the initial presentation of lymphoma of the gallbladder;all reports describe non-Hodgkin lymphoma or its subtypes on histopathology of the gallbladde...BACKGROUND There are several case reports of acute cholecystitis as the initial presentation of lymphoma of the gallbladder;all reports describe non-Hodgkin lymphoma or its subtypes on histopathology of the gallbladder tissue itself.Interestingly,there is no description in the literature of Hodgkin lymphoma causing hilar lymphadenopathy,inevitably presenting as ruptured cholecystitis with imaging mimicking gallbladder adenocarcinoma.CASE SUMMARY A 48-year-old man with a past medical history of diabetes mellitus presented with progressive abdominal pain,jaundice,night sweats,weakness,and unintended weight loss for one month.Work-up revealed a mass in the region of the porta hepatis causing obstructions of the cystic and common hepatic ducts,gallbladder rupture,as well as retroperitoneal lymphadenopathy.The clinical picture and imaging findings were suspicious for locally advanced gallbladder adenocarcinoma causing ruptured cholecystitis and cholangitis,with metastases to retroperitoneal lymph nodes.Minimally invasive techniques,including endoscopic duct brushings and percutaneous lymph node biopsy,were inadequate for tissue diagnosis.Therefore,this case required exploratory laparo-tomy,open cholecystectomy,and periaortic lymph node dissection for histopathological assessment and definitive diagnosis.Hodgkin lymphoma was present in the lymph nodes while the gallbladder specimen had no evidence of malignancy.CONCLUSION This clinical scenario highlights the importance of histopathological assessment in diagnosing gallbladder malignancy in a patient with gallbladder perforation and a grossly positive positron emission tomography/computed tomography scan.For both gallbladder adenocarcinoma and Hodgkin lymphoma,medical and surgical therapies must be tailored to the specific disease entity in order to achieve optimal long-term survival rates.展开更多
文摘We are reporting the first documented case of an abdominal desmoid tumor presenting primarily after liver transplantation. This tumor, well described in the literature as occurring both in conjunction with familial adenomatous polyposis as well as in the postsurgical patient, has never been noted after solid organ transplantation and was therefore not included in our differential upon presentation. Definitive diagnosis required the patient to undergo surgical excision and immunochemical staining of the mass for confirmation. A review of the literature showed no primary tumors after transplantation. In a population of patients who received a small bowel transplant after they developedshort gut post radical resection of aggressive fibromatosis, only rare recurrences were seen. No connection of tumor development with immunosuppression or need to decrease immunosuppressant treatment has been demonstrated in these patients. Our case and the literature show the risk of this tumor presenting in the post-transplantation patient and the need for a high index of suspicion in patients who present with a complex mass after transplantation to prevent progression of the disease beyond a resectable lesion. Results of a thorough search of the literature are detailed and the medical and surgical management of both resectable and unresectable lesions is reviewed.
文摘BACKGROUND There are several case reports of acute cholecystitis as the initial presentation of lymphoma of the gallbladder;all reports describe non-Hodgkin lymphoma or its subtypes on histopathology of the gallbladder tissue itself.Interestingly,there is no description in the literature of Hodgkin lymphoma causing hilar lymphadenopathy,inevitably presenting as ruptured cholecystitis with imaging mimicking gallbladder adenocarcinoma.CASE SUMMARY A 48-year-old man with a past medical history of diabetes mellitus presented with progressive abdominal pain,jaundice,night sweats,weakness,and unintended weight loss for one month.Work-up revealed a mass in the region of the porta hepatis causing obstructions of the cystic and common hepatic ducts,gallbladder rupture,as well as retroperitoneal lymphadenopathy.The clinical picture and imaging findings were suspicious for locally advanced gallbladder adenocarcinoma causing ruptured cholecystitis and cholangitis,with metastases to retroperitoneal lymph nodes.Minimally invasive techniques,including endoscopic duct brushings and percutaneous lymph node biopsy,were inadequate for tissue diagnosis.Therefore,this case required exploratory laparo-tomy,open cholecystectomy,and periaortic lymph node dissection for histopathological assessment and definitive diagnosis.Hodgkin lymphoma was present in the lymph nodes while the gallbladder specimen had no evidence of malignancy.CONCLUSION This clinical scenario highlights the importance of histopathological assessment in diagnosing gallbladder malignancy in a patient with gallbladder perforation and a grossly positive positron emission tomography/computed tomography scan.For both gallbladder adenocarcinoma and Hodgkin lymphoma,medical and surgical therapies must be tailored to the specific disease entity in order to achieve optimal long-term survival rates.
