Spectrum of mucin-producing neoplastic conditions of the abdomen and pelvis:Cross-sectional imaging evaluation

Various mucin-producing neoplasms originate in different abdominal and pelvic organs.Mucinous neoplasms differ from non-mucinous neoplasms because of the differences in clinical outcome and imaging appearance.Mucinous carcinoma,in which at least 50%of the tumor is composed of large pools of extracellular mucin and columns of malignant cells,is associated with a worse prognosis.Signet ring cell carcinoma is characterized by large intracytoplasmic mucin vacuoles that expand in the malignant cells with the nucleus displaced to the periphery.Its prognosis is also generally poor.In contrast,intraductal papillary mucinous neoplasm of the bile duct and pancreas,which is characterized by proliferation of ductal epithelium and variable mucin production,has a better prognosis than other malignancies in the pancreaticobiliary tree.Imaging modalities play a critical role in differentiating mucinous from non-mucinous neoplasms.Due to high water content,mucin has a similar appearance to water on ultrasound(US) ,computed tomography(CT) ,and magnetic resonance imaging,except when thick and proteinaceous,and then it tends to be hypoechoic with fine internal echoes or have complex echogenicity on US,hyperdense on CT,and hyperintense on T1and hypointense on T2-weighted images,compared to water.Therefore,knowledge of characteristic mucin imaging features is helpful to diagnose various mucinproducing neoplastic conditions and to facilitate appropriate treatment.

Intracorporeal esophagojejunostomy using the double stapling technique after laparoscopic total gastrectomy:A retrospective case-series study

AIM:To introduce a simple and safe anvil insertion technique to esophagus during laparoscopic total gastrectomy(LTG).METHODS:Between July 2010 and December 2012,58 consecutive patients with early gastric cancer underwent LTG were enrolled.We performed a simple and safe Roux-en-Y esophagojejunostomy using the double stapling technique to all patients.Then patients’characteristics,perioperative outcome and histopathologic data were analyzed retrospectively.RESULTS:The mean age and body mass index were59.3±9.7 years and 22.7±2.6 kg/m2.The mean operation,reconstruction and anvil insertion times(from gastric incision to linear stapling)were 251.8±57.0,43.1±2.8 and 4.2±1.9 min,respectively.Intraoperative blood loss was 204.6±156.3 m L and there was no open conversion.The postoperative complications were in 8 cases(delayed gastric emptying in 4 cases,pulmonary complication in 2cases,pancreatitis in 1 case,anastomotic stricture in 1case).Anastomotic stricture occurred after discharge and was recovered by endoscopic intervention.The patients were discharged at a mean of 9.6±2.0 d after surgery.Neither leakage nor bleeding from the esophagojejunostomy occurred postoperatively.The mean proximal margin of specimen was 2.7±2.8 cm CONCLUSION:Roux-en Y esophagojejunostomy usingthe double stapling technique is simple and rapid,and it may offer a solid,alternative reconstruction method for LTG or proximal gastrectomy.

Solitary Peutz-Jeghers-type appendiceal hamartomatous polyp growing into the terminal ileum

Solitary Peutz-Jeghers type hamartomatous polyp is rare.It is considered to be related to a variant PeutzJeghers syndrome(PJS)and may be a separate disease entity.A 50-year-old man was referred to our hospital with a diagnosis of intussusception in the terminal ileum and underwent segmental ileal resection with appendectomy.We identified a 3.5-cm diameter polyp arising from the appendix with ingrowth into the terminal ileum.The polyp was confirmed to be a hamartomatous polyp of Peutz-Jeghers-type,histologically.However,the patient had no characteristic manifestations of PJS such as mucocutaneous pigmentation and family history.There are few reports of appendiceal hamartomatous polyp in PJS patients and solitary appendiceal hamartomatous polyp is even rarer.Also,rather than telescoping,ours is the first reported intussuscepted lesion,to the best of our knowledge.

Polysplenia syndrome with preduodenal portal vein detected in adults

Polysplenia syndrome, defined as the presence of multiple spleens of almost equal volume, is a rare condition involving congenital anomalies in multiple organ systems. We report this anomaly in a 41-year-old female who underwent a left lateral sectionectomy due to recurrent cholangitis and impacted left lateral duct stones. Polysplenia syndrome with preduodenal vein was diagnosed preoperatively by computed to-mography (CT) and surgery was done safely. Although the polysplenia syndrome with preduodenal portal vein (PDPV) in adult is rarely encountered, surgeons need to understand the course of the portal vein and exercise caution in approaching the biliary tract.