BACKGROUND: Gastrointestinal stromal tumors are the most common mesenchymal tumors of the gastrointestinal tract and occur rarely in the duodenum. Splenic angiosarcoma is an aggressive neoplasm with an extremely poor ...BACKGROUND: Gastrointestinal stromal tumors are the most common mesenchymal tumors of the gastrointestinal tract and occur rarely in the duodenum. Splenic angiosarcoma is an aggressive neoplasm with an extremely poor prognosis. METHODS: We report a case of a 70-year-old man hospitalized for abdominal pain in the upper quadrants, dyspepsia and nausea, previously treated for Hodgkin lymphoma 30 years ago. Abdominal CT showed a solid nodular lesion in the third portion of the duodenum, the presence of retropancreatic, aortic and caval lymph nodes, and four nodular splenic masses. 111 In-octreotide scintigraphy revealed pathological tissue accumulation in the duodenal region, and in the retropancreatic, retroduodenal, aortic and caval lymph nodes, suggesting a nonfunctioning neuroendocrine peripancreatic tumor. RESULTS: At exploratory laparotomy, an exophytic soft tumor was found originating from the third portion of the duodenum. Pancreas-preserving duodenectomy with duodenojejunostomy, splenectomy and lymphnodectomy of retropancreatic aortic and caval lymph nodes were performed. Pathological evaluation and immunohistochemical studies showed the presence of a duodenal gastrointestinal stromal tumor with low mitotic activity and a well-differentiated angiosarcoma localized to the spleen and invading lymph nodes.CONCLUSIONS: We speculated that the angiosarcoma and duodenal gastrointestinal stromal tumors of this patient were due to the treatment of Hodgkin lymphoma with radiotherapy 30 years ago. Pancreas-preserving segmental duodenectomy can be used to treat non-malignant neoplasms of the duodenum and avoid extensive surgery. Splenectomy is the treatment of choice for localized angiosarcomas but a strict follow-up is mandatory because of the possibility of recurrence.展开更多
BACKGROUND Endoscopic ultrasound-guided fine needle aspiration or biopsy(EUS-FNA or FNB)has become a popular method for diagnosing various lesions of the gastrointestinal tract and surrounding tissue due to the accura...BACKGROUND Endoscopic ultrasound-guided fine needle aspiration or biopsy(EUS-FNA or FNB)has become a popular method for diagnosing various lesions of the gastrointestinal tract and surrounding tissue due to the accuracy and safety.To the best of our knowledge,no case report of severe infection after EUS-FNB of a solid lesion in the spleen has been described.Herein,we report a rare case of septic shock after EUS-FNB of a splenic mass.CASE SUMMARY A 45-year-old male patient presented to the outpatient clinic due to an incidentally detected splenic mass.A definitive diagnosis could not be established based on the abdominal magnetic resonance imaging.EUS of the spleen showed a 6 cm-sized,relatively well-demarcated,heterogeneous mass,and EUS-FNB with a 22G needle was performed.Ten days after the procedure patient developed septic shock and a splenic abscess was identified.Blood culture revealed growth of Granulicatella adiacens.After the treatment with antibiotics the patient underwent surgical resection,and the pathological examination showed diffuse large B-cell lymphoma.The patient received chemotherapy and he is in complete remission.CONCLUSION Infection of a splenic mass after EUS-FNB is a rare complication and prophylactic antibiotics might be considered.展开更多
BACKGROUND Sclerosing angiomatoid nodular transformation(SANT)is a rare disease of the spleen.It has unique pathological features and mimics splenic tumor on radiological imaging.CASE SUMMARY A 47-year-old woman was i...BACKGROUND Sclerosing angiomatoid nodular transformation(SANT)is a rare disease of the spleen.It has unique pathological features and mimics splenic tumor on radiological imaging.CASE SUMMARY A 47-year-old woman was incidentally found to have a splenic mass on abdominal ultrasound.She had a 10-cm postoperative scar in the lower abdomen due to previous cesarean sections.The patient had a past history of anemia of unknown etiology for 20 years.The patient underwent laparoscopic splenectomy.The postoperative course was uneventful,with a hospital stay of 7 d.The histopathological examination of the spleen revealed SANT.At the 6-mo followup,the patient remained disease-free.CONCLUSION SANT is a rare benign disease mimicking a malignant tumor.A definitive diagnosis can be made only on histopathology.展开更多
BACKGROUND Hepatocellular carcinoma(HCC)with massive portal vein tumor thrombosis(PVTT)and distant metastasis is considered unresectable.However,due to recent developments in systemic chemotherapy,successful cases of ...BACKGROUND Hepatocellular carcinoma(HCC)with massive portal vein tumor thrombosis(PVTT)and distant metastasis is considered unresectable.However,due to recent developments in systemic chemotherapy,successful cases of conversion therapy for unresectable diseases have been reported.Herein,we report a successful multidisciplinary approach for treatment of multi-visceral recurrence with sequential multikinase inhibitor and laparoscopic surgery.CASE SUMMARY A 63-year-old woman with chronic hepatitis B virus infection was diagnosed with HCC.Subsequently,she underwent two rounds of laparoscopic partial hepatectomy,laparoscopic left adrenalectomy,and transcatheter arterial chemoembolization plus sorafenib for recurrence.Four years after initial hepatectomy,she presented with a 43-mm mass in the spleen and tumor thrombus involving the main portal vein trunk with ascites.Her liver function was Child-Pugh B(8),and protein induced by vitamin K absence or antagonist II(PIVKA II)levels were elevated up to 46.291 mAU/mL.Since initial treatment with regorafenib for three months was unsuccessful,the patient was administered lenvatinib.Ten months post-treatment,there was no contrast enhancement of PVTT or splenic metastasis.Chemotherapy was discontinued due to severe diarrhea.Afterward,splenic metastasis became viable,and PIVKA II increased.Therefore,hand-assisted laparoscopic splenectomy was performed.She experienced no clinical recurrence 14 mo after resection.CONCLUSION Conversion surgery after successful multikinase inhibitor treatment might be considered an effective treatment option for advanced HCC.展开更多
D2 gastric resection has been increasingly recognized as the optimal surgical treatment for advanced gastric cancer. Dissection of the station 10 splenic lymph nodes is required in the treatment of advanced proximal g...D2 gastric resection has been increasingly recognized as the optimal surgical treatment for advanced gastric cancer. Dissection of the station 10 splenic lymph nodes is required in the treatment of advanced proximal gastric cancer. Based on vascular anatomy and anatomical plane of fascial space, integrated with our experience in station 10 splenic lymph node dissection in open surgery and proven skills of laparoscopic operation, we have successfully mastered the surgical essentials and technical keypoints in laparoscopic-assisted station 10 lymph node dissection.展开更多
Splenic hamartoma is a benign malformation composed of an anomalous mixture of normal splenic elements.1 Approximately half of the patients with the tumor are asymptomatic and diagnosed accidentally by autopsy or sple...Splenic hamartoma is a benign malformation composed of an anomalous mixture of normal splenic elements.1 Approximately half of the patients with the tumor are asymptomatic and diagnosed accidentally by autopsy or splenectomy. The tumor-related renal hematological and dermatological abnormalities can be treated by removal of the tumor. Splenic hamartoma which is related to renal diseases including extramembranous glomerulonephritis, membranoproliferative glomerulonephritis and renal adenocarcinoma has been reported previously.展开更多
文摘BACKGROUND: Gastrointestinal stromal tumors are the most common mesenchymal tumors of the gastrointestinal tract and occur rarely in the duodenum. Splenic angiosarcoma is an aggressive neoplasm with an extremely poor prognosis. METHODS: We report a case of a 70-year-old man hospitalized for abdominal pain in the upper quadrants, dyspepsia and nausea, previously treated for Hodgkin lymphoma 30 years ago. Abdominal CT showed a solid nodular lesion in the third portion of the duodenum, the presence of retropancreatic, aortic and caval lymph nodes, and four nodular splenic masses. 111 In-octreotide scintigraphy revealed pathological tissue accumulation in the duodenal region, and in the retropancreatic, retroduodenal, aortic and caval lymph nodes, suggesting a nonfunctioning neuroendocrine peripancreatic tumor. RESULTS: At exploratory laparotomy, an exophytic soft tumor was found originating from the third portion of the duodenum. Pancreas-preserving duodenectomy with duodenojejunostomy, splenectomy and lymphnodectomy of retropancreatic aortic and caval lymph nodes were performed. Pathological evaluation and immunohistochemical studies showed the presence of a duodenal gastrointestinal stromal tumor with low mitotic activity and a well-differentiated angiosarcoma localized to the spleen and invading lymph nodes.CONCLUSIONS: We speculated that the angiosarcoma and duodenal gastrointestinal stromal tumors of this patient were due to the treatment of Hodgkin lymphoma with radiotherapy 30 years ago. Pancreas-preserving segmental duodenectomy can be used to treat non-malignant neoplasms of the duodenum and avoid extensive surgery. Splenectomy is the treatment of choice for localized angiosarcomas but a strict follow-up is mandatory because of the possibility of recurrence.
文摘BACKGROUND Endoscopic ultrasound-guided fine needle aspiration or biopsy(EUS-FNA or FNB)has become a popular method for diagnosing various lesions of the gastrointestinal tract and surrounding tissue due to the accuracy and safety.To the best of our knowledge,no case report of severe infection after EUS-FNB of a solid lesion in the spleen has been described.Herein,we report a rare case of septic shock after EUS-FNB of a splenic mass.CASE SUMMARY A 45-year-old male patient presented to the outpatient clinic due to an incidentally detected splenic mass.A definitive diagnosis could not be established based on the abdominal magnetic resonance imaging.EUS of the spleen showed a 6 cm-sized,relatively well-demarcated,heterogeneous mass,and EUS-FNB with a 22G needle was performed.Ten days after the procedure patient developed septic shock and a splenic abscess was identified.Blood culture revealed growth of Granulicatella adiacens.After the treatment with antibiotics the patient underwent surgical resection,and the pathological examination showed diffuse large B-cell lymphoma.The patient received chemotherapy and he is in complete remission.CONCLUSION Infection of a splenic mass after EUS-FNB is a rare complication and prophylactic antibiotics might be considered.
文摘BACKGROUND Sclerosing angiomatoid nodular transformation(SANT)is a rare disease of the spleen.It has unique pathological features and mimics splenic tumor on radiological imaging.CASE SUMMARY A 47-year-old woman was incidentally found to have a splenic mass on abdominal ultrasound.She had a 10-cm postoperative scar in the lower abdomen due to previous cesarean sections.The patient had a past history of anemia of unknown etiology for 20 years.The patient underwent laparoscopic splenectomy.The postoperative course was uneventful,with a hospital stay of 7 d.The histopathological examination of the spleen revealed SANT.At the 6-mo followup,the patient remained disease-free.CONCLUSION SANT is a rare benign disease mimicking a malignant tumor.A definitive diagnosis can be made only on histopathology.
文摘BACKGROUND Hepatocellular carcinoma(HCC)with massive portal vein tumor thrombosis(PVTT)and distant metastasis is considered unresectable.However,due to recent developments in systemic chemotherapy,successful cases of conversion therapy for unresectable diseases have been reported.Herein,we report a successful multidisciplinary approach for treatment of multi-visceral recurrence with sequential multikinase inhibitor and laparoscopic surgery.CASE SUMMARY A 63-year-old woman with chronic hepatitis B virus infection was diagnosed with HCC.Subsequently,she underwent two rounds of laparoscopic partial hepatectomy,laparoscopic left adrenalectomy,and transcatheter arterial chemoembolization plus sorafenib for recurrence.Four years after initial hepatectomy,she presented with a 43-mm mass in the spleen and tumor thrombus involving the main portal vein trunk with ascites.Her liver function was Child-Pugh B(8),and protein induced by vitamin K absence or antagonist II(PIVKA II)levels were elevated up to 46.291 mAU/mL.Since initial treatment with regorafenib for three months was unsuccessful,the patient was administered lenvatinib.Ten months post-treatment,there was no contrast enhancement of PVTT or splenic metastasis.Chemotherapy was discontinued due to severe diarrhea.Afterward,splenic metastasis became viable,and PIVKA II increased.Therefore,hand-assisted laparoscopic splenectomy was performed.She experienced no clinical recurrence 14 mo after resection.CONCLUSION Conversion surgery after successful multikinase inhibitor treatment might be considered an effective treatment option for advanced HCC.
文摘D2 gastric resection has been increasingly recognized as the optimal surgical treatment for advanced gastric cancer. Dissection of the station 10 splenic lymph nodes is required in the treatment of advanced proximal gastric cancer. Based on vascular anatomy and anatomical plane of fascial space, integrated with our experience in station 10 splenic lymph node dissection in open surgery and proven skills of laparoscopic operation, we have successfully mastered the surgical essentials and technical keypoints in laparoscopic-assisted station 10 lymph node dissection.
文摘Splenic hamartoma is a benign malformation composed of an anomalous mixture of normal splenic elements.1 Approximately half of the patients with the tumor are asymptomatic and diagnosed accidentally by autopsy or splenectomy. The tumor-related renal hematological and dermatological abnormalities can be treated by removal of the tumor. Splenic hamartoma which is related to renal diseases including extramembranous glomerulonephritis, membranoproliferative glomerulonephritis and renal adenocarcinoma has been reported previously.
