Pancreas-preserving duodenectomy for treatment of a duodenal papillary tumor:A case report

BACKGROUND Duodenal papillary tumor is a rare tumor of the digestive tract,accounting for about 0.2%of gastrointestinal tumors and 7%of periampullary tumors.The clinical manifestations of biliary obstruction are most common.Some benign tumors or small malignant tumors are often not easily found because they have no obvious symptoms in the early stage.Surgical resection is the only treatment for duodenal papillary tumors.At present,the methods of operation for duodenal papillary tumors include pancreatoduodenectomy,duodenectomy,ampullectomy,and endoscopic resection.CASE SUMMARY A 47-year-old man was admitted to because of a duodenal mass that had been discovered 2 mo previously.Electronic gastroscopy at another hospital revealed a duodenal papillary mass that had been considered to be a high-grade intraepithelial neoplasia.Therefore,we conducted a multidisciplinary group discussion and decided to perform a pancreas-preserving duodenectomy and a R0 resection was successfully performed.After surgery,the patient underwent a follow-up period of 5 yr.No recurrence or metastasis occurred.CONCLUSION According to our experience with a duodenal papillary tumor,compared with pancreaticoduodenectomy,the use of pancreas-preserving duodenectomy can preserve pancreatic function,maintain gastrointestinal structure and function,reduce tissue damage and complications,and render the postoperative recovery faster.Pancreas-preserving duodenectomy for treatment of a duodenal papillary tumor is feasible under strict control of surgical indications.

Endolymphatic sac papillary tumor： a case report

Endolymphatic sac papillary tumor （ELST） is an extremely rare and aggressive tumor characterized by hearing loss and temporal bone destruction. A case with clinical, imaging, pathologic and treatment data is reported and relevant literature is reviewed. A 25-year-old woman, with ELST underwent craniotomy for tumor subtotal resection, and the diagnosis was confirmed by pathologic examination. Postoperative radiotherapy consisted of 50.4 Gy/28 f was given accordingly. The patient is currently alive with no signs of tumor recurrence locally and no radiation side-effects observed after one year follow-up. Complete resection is impossible in most cases, local resection, adjuvant radiotherapy may provide favored local control. A long-term follow-up is highly advocated in consideration of its slow development course.

Malignant transformation of pulmonary bronchiolar adenoma into mucinous adenocarcinoma:A case report

BACKGROUND Bronchiolar adenoma(BA)and ciliated muconodular papillary tumor are rare tumors that have bilayered cell proliferation and continuous expression of p40 and CK5/6 in the basal cell layer.Diagnosis is difficult because of the limited knowledge of these tumors and their morphological similarities to malignant tumors,including invasive mucinous adenocarcinoma,especially based on the histopathology of intraoperative frozen sections.These tumors are now considered to be benign neoplasms,with malignant transformation reported in only a few cases.CASE SUMMARY A 57-year-old woman presented with a 17.0 mm×7.0 mm nodule in the lower lobe of the left lung.Hematoxylin-eosin staining and immunohistochemistry of a surgical specimen were performed.The tumor consisted of a BA area and a mucinous adenocarcinoma(MA)area.In the BA area,the tumor had a bilayered structure of luminal cells and basal cells.The basal cells were positive for CK5/6 and p40,but the MA area was negative for these biomarkers.The Ki-67 proliferation index was low(1%-2%).The patient was diagnosed with BA accompanied by MA,and had a favorable outcome.CONCLUSION The present study indicated that BA may be carcinogenic,and suggests that clinicians should be aware of its potential for malignant transformation.

Endoscopic pancreaticobiliary drainage with overlength stents to prevent delayed perforation after endoscopic papillectomy:A pilot study

BACKGROUND Endoscopic papillectomy(EP)is rapidly replacing traditional surgical resection and is a less invasive procedure for the treatment of duodenal papillary tumors in selected patients.With the expansion of indications,concerns regarding EP include not only technical difficulties,but also the risk of complications,especially delayed duodenal perforation.Delayed perforation after EP is a rare but fatal complication.Exposure of the artificial ulcer to bile and pancreatic juice is considered to be one of the causes of delayed perforation after EP.Draining bile and pancreatic juice away from the wound may help to prevent delayed perforation.AIM To evaluate the feasibility and safety of placing overlength biliary and pancreatic stents after EP.METHODS This is a single-center,retrospective study.Five patients with exposure or injury of the muscularis propria after EP were included.A 7-Fr overlength biliary stent and a 7-Fr overlength pancreatic stent,modified by an endoscopic nasobiliary drainage tube,were placed in the common bile duct and pancreatic duct,respectively,and the bile and pancreatic juice were drained to the proximal jejunum.RESULTS EP and overlength stents placement were technically feasible in all five patients(63±12 years),with an average operative time of 63.0±5.6 min.Of the five lesions(median size 20 mm,range 15-35 mm),four achieved en bloc excision and curative resection.The final histopathological diagnoses of the endoscopic specimen were one tubular adenoma with high-grade dysplasia(HGD),one tubulovillous adenoma with low-grade dysplasia,one hamartomatous polyp with HGD,one poorly differentiated adenocarcinoma and one atypical juvenile polyposis with tubulovillous adenoma,HGD and field cancerization invading the muscularis mucosae and submucosa.There were no stent-related complications,but one papillectomy-related complication(mild acute pancreatitis)occurred without any episodes of bleeding,perforation,cholangitis or late-onset duct stenosis.CONCLUSION For patients with exposure or injury of the muscularis propria after EP,the placement of overlength biliary and pancreatic stents is a feasible and useful technique to prevent delayed perforation.

Bronchiolar adenoma with unusual presentation:Two case reports

BACKGROUND The clinicopathological features,immunohistochemical characteristics,and genetic mutation profile of two unusual cases of distal bronchiolar adenoma are retrospectively analyzed and the relevant literature is reviewed.CASE SUMMARY Case 1 was a 63-year-old female patient who had a mixed ground-glass nodule,with mild cells in morphology,visible cilia,and bilayer structures in focal areas.Immunohistochemical staining for P63 and cytokeratin(CK)5/6 revealed the lack of a continuous bilayer structure in most areas,and no mutations were found in epidermal growth factor receptor,anaplastic lymphoma kinase,ROS1,Kirsten rat sarcoma,PIK3CA,BRAF,human epidermal growth factor receptor-2(HER2),RET,and neuroblastoma RAS genes.Case 2 was a 58-year-old female patient who presented with a solid nodule,in which most cells were observed to be medium sized,the nuclear chromatin was pale and homogeneous,local cells had atypia,and cilia were found locally.Immunohistochemical staining for P63 and CK5/6 showed no expression of these proteins in mild cell morphology whereas the heteromorphic cells showed a bilayer structure.The same nine genes as above were analyzed,and HER2 gene mutation was identified.CONCLUSION Some unresolved questions remain to be answered to determine whether the lesion is a benign adenoma or a part of the process of malignant transformation from benign adenoma of the bronchial epithelium.Furthermore,whether lesions with atypical bilayer structures are similar to atypical hyperplastic lesions of the breast remains to be elucidated.Moreover,clarity on whether these lesions can be called atypical bronchiolar adenoma and whether they are invasive precursor lesions is needed.Future studies should examine the diagnostic significance of HER2 gene mutation as a prognostic indicator.