BACKGROUND An ectopic hepatocellular carcinoma(EHCC)arises from the ectopic liver which is defined as a hepatic organ or tissue not connected to surrounding tissues.EHCC is a rare disease and it is difficult to diagno...BACKGROUND An ectopic hepatocellular carcinoma(EHCC)arises from the ectopic liver which is defined as a hepatic organ or tissue not connected to surrounding tissues.EHCC is a rare disease and it is difficult to diagnose preoperatively.Furthermore,the clinical features are not fully elucidated.CASE SUMMARY A retroperitoneal tumor(6 cm)was located at the dorsal side of the pancreas head on abdominal ultrasonography in an 81-year old woman positive for hepatitis C virus antibody.Contrast enhanced-computed tomography and gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging showed viable HCC patterns with early enhancement and delayed washout.The tumor markers-serum alphafetoprotein and alpha-fetoprotein-L3%-were increased to 30.1 ng/m L and83.1%,respectively.Protein induced by vitamin K absence or antagonist-Ⅱwas within normal levels(17 m AU/m L).Positron emission tomography-computed tomography showed strong accumulation into the tumor(Standardized Uptake Value max:13.8),and the tumor cytology following endoscopic ultrasoundguided fine needle aspiration showed poorly differentiated carcinoma.Tumor extirpation was performed,and operative findings showed that the retroperitoneal tumor was disconnected from the pancreas and the liver.Swollen lymph nodes near the tumor were histologically normal.On histological examination,the tumor was finally diagnosed as EHCC with Arginase-1 positive expression.CONCLUSION We report our experience of a rare EHCC which was difficult to diagnose,and we present a review of the literature.展开更多
BACKGROUND Although PNENs generally have a better prognosis than pancreatic cancers,some PNENs display malignant behavior including lymph node(LN)metastasis.Complete tumor resection can be the only potentially curativ...BACKGROUND Although PNENs generally have a better prognosis than pancreatic cancers,some PNENs display malignant behavior including lymph node(LN)metastasis.Complete tumor resection can be the only potentially curative treatment for patients with resectable PNENs.However,the indications for LN dissection are still controversial.Over the last decade,minimally invasive surgery such as laparoscopic pancreatic surgery(LPS)has been increasingly performed for pancreatic tumors including PNENs.AIM To investigate the risk factors for LN metastasis in PNENs and to select appropriate patients for limited surgery by LPS.METHODS From April 2001 to December 2019,92 patients underwent pancreatic resection for PNENs at Kumamoto University Hospital.Finally,82 patients were enrolled in this study.Using perioperative factors,we examined the predictive factors for LN metastasis in PNENs.RESULTS Among the 82 patients,the percentage of LN metastasis according to the pathological findings was 12%(10/82 cases).The median tumor size was 12 mm(range:5-90 mm).The median tumor size in the LN-positive group(37 mm)was significantly larger than that in the LN-negative group(12 mm)(P=0.0001).Multivariate analyses revealed that larger tumor size(≥20 mm)was an independent risk factor for LN metastasis(odds ratio 16.8,P=0.0062).In patients with small tumors(≤10 mm),LN metastasis was not found.CONCLUSION Larger tumor size(≥20 mm)is an independent risk factor for LN metastasis in PNENs.In smaller PNENs(≤10 mm),we may be able to choose limited surgery without LN dissection.展开更多
文摘BACKGROUND An ectopic hepatocellular carcinoma(EHCC)arises from the ectopic liver which is defined as a hepatic organ or tissue not connected to surrounding tissues.EHCC is a rare disease and it is difficult to diagnose preoperatively.Furthermore,the clinical features are not fully elucidated.CASE SUMMARY A retroperitoneal tumor(6 cm)was located at the dorsal side of the pancreas head on abdominal ultrasonography in an 81-year old woman positive for hepatitis C virus antibody.Contrast enhanced-computed tomography and gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging showed viable HCC patterns with early enhancement and delayed washout.The tumor markers-serum alphafetoprotein and alpha-fetoprotein-L3%-were increased to 30.1 ng/m L and83.1%,respectively.Protein induced by vitamin K absence or antagonist-Ⅱwas within normal levels(17 m AU/m L).Positron emission tomography-computed tomography showed strong accumulation into the tumor(Standardized Uptake Value max:13.8),and the tumor cytology following endoscopic ultrasoundguided fine needle aspiration showed poorly differentiated carcinoma.Tumor extirpation was performed,and operative findings showed that the retroperitoneal tumor was disconnected from the pancreas and the liver.Swollen lymph nodes near the tumor were histologically normal.On histological examination,the tumor was finally diagnosed as EHCC with Arginase-1 positive expression.CONCLUSION We report our experience of a rare EHCC which was difficult to diagnose,and we present a review of the literature.
文摘BACKGROUND Although PNENs generally have a better prognosis than pancreatic cancers,some PNENs display malignant behavior including lymph node(LN)metastasis.Complete tumor resection can be the only potentially curative treatment for patients with resectable PNENs.However,the indications for LN dissection are still controversial.Over the last decade,minimally invasive surgery such as laparoscopic pancreatic surgery(LPS)has been increasingly performed for pancreatic tumors including PNENs.AIM To investigate the risk factors for LN metastasis in PNENs and to select appropriate patients for limited surgery by LPS.METHODS From April 2001 to December 2019,92 patients underwent pancreatic resection for PNENs at Kumamoto University Hospital.Finally,82 patients were enrolled in this study.Using perioperative factors,we examined the predictive factors for LN metastasis in PNENs.RESULTS Among the 82 patients,the percentage of LN metastasis according to the pathological findings was 12%(10/82 cases).The median tumor size was 12 mm(range:5-90 mm).The median tumor size in the LN-positive group(37 mm)was significantly larger than that in the LN-negative group(12 mm)(P=0.0001).Multivariate analyses revealed that larger tumor size(≥20 mm)was an independent risk factor for LN metastasis(odds ratio 16.8,P=0.0062).In patients with small tumors(≤10 mm),LN metastasis was not found.CONCLUSION Larger tumor size(≥20 mm)is an independent risk factor for LN metastasis in PNENs.In smaller PNENs(≤10 mm),we may be able to choose limited surgery without LN dissection.
