1/19. gallbladder carcinoma with choledochoduodenal fistula: a case report with surgical treatment.A 79 year-old man was admitted to our hospital because of upper abdominal pain and nausea. A mobile tumor was palpable in the right upper abdomen. Abdominal ultrasonography, computed tomography and celiac angiography revealed a gallbladder tumor. Endoscopic retrograde cholangiopancreatography revealed a fistula 1.5 cm oral to the orifice of the papilla of Vater, dilatation of the common bile duct, and a filling defect in the gallbladder. Pancreatoduodenectomy associated with reconstruction using Imanaga's method was performed under a pre-operative diagnosis of gallbladder carcinoma with choledochoduodenal fistula. The gallbladder contained a tumor and two bilirubin stones impacted in the orifice of the duodenal papilla. Histological studies confirmed that the gallbladder tumor was a mucinous adenocarcinoma and had not infiltrated the bile duct. We speculated that choledochoduodenal fistula stimulated the development of cancer due to chronic irritation from pancreatic juice reflux.- - - - - - - - - - ranking = 1keywords = abdomen (Clic here for more details about this article) |
2/19. leiomyosarcoma of the gallbladder: a case report.Primary sarcoma of the gallbladder is a rare disease. The tumor occurs more frequently in women. Usually gallstones are present. Symptoms resemble those of cholelithiasis or cholecystitis. The diagnosis is rarely made preoperatively. The patient was a 51-year-old woman with a 2-month history of right upper quadrant pain, nausea, vomiting, and a 10-pound weight loss. Ultrasound showed cholelithiasis and cholecystitis. Laparoscopic cholecystectomy was converted to open as a result of dense tissue in the middle to distal gallbladder. Exploration by a right subcostal incision revealed multiple implants on the surface of the liver and the peritoneum of the upper abdomen. The wall of the gallbladder was very thick and inflamed. cholecystectomy with liver biopsy was performed. pathology revealed poorly differentiated epithelioid leiomyosarcoma of the gallbladder with extension to the liver. The disease followed a very aggressive course and the patient died 3 weeks after the procedure. Recommended treatment is extensive surgical resection that can be followed by radiotherapy or chemotherapy. The tumor follows a very aggressive course, which often lasts a few weeks. prognosis is poor with rare reported 5-year survivals.- - - - - - - - - - ranking = 1keywords = abdomen (Clic here for more details about this article) |
3/19. Inflammatory malignant fibrous histiocytoma of the gallbladder: report of a case.We describe herein a case of inflammatory malignant fibrous histiocytoma (IMFH) of the gallbladder that subsequently metastasized to the ascending colon and later to the stomach. A 70-year-old Japanese man with a palpable mass in the right upper quadrant of the abdomen was referred to our hospital for investigation and treatment. Laboratory data showed severe leukocytosis and elevated serum granulocyte colony-stimulating factor (G-CSF) concentrations. A laparotomy was performed, and the tumor was excised en bloc with the gallbladder and part of the liver bed. Histopathologically, the tumor was composed of ordinary malignant fibrous histiocytoma (MFH) components characterized by pleomorphic tumor cells, bizarre giant cells, and conventional spindle cells in a storiform growth pattern, as well as a xanthogranulomatous component, including inflammatory cells, foamy histiocytes, and plasma cells. Immunohistochemical study revealed that the pleomorphic tumor cells and bizarre giant cells were positive for antibodies against alpha1-antitrypsin and alpha1-antichymotrypsin. The final pathologic diagnosis was IMFH. The tumor cells were diffusely positive for anti-G-CSF monoclonal antibody, and the inflammatory reaction subsided immediately after tumor resection, strongly suggesting that the primary tumor cells produced G-CSF. This patient is still alive with no signs of recurrence more than 3 years after his primary operation, which to our knowledge is the longest survival period ever reported. Therefore, visceral IMFH is manageable in some cases by resecting the primary and isolated metastatic lesions.- - - - - - - - - - ranking = 1keywords = abdomen (Clic here for more details about this article) |
4/19. Covered expandable metallic stent placement for hemostasis of colonic bleeding caused by invasion of gallbladder carcinoma.A 72-year-old Japanese man was admitted to our hospital complaining of right upper-quadrant abdominal pain, blood in his stool, and symptoms of anemia. On physical examination a hard mass, about 6 cm in diameter, was palpable in the right upper quadrant of the abdomen. Computed tomography revealed a gallbladder carcinoma which had invaded the transverse colon, with liver metastasis. We diagnosed gallbladder carcinoma, stage IVB. colonoscopy was performed for persistent blood in the stools. This revealed an elevated lesion which appeared to be an invasion of gallbladder carcinoma, with diffuse bleeding from the right-side of the transverse colon. It proved difficult to stop this bleeding by ordinary therapeutic endoscopy. In order to achieve hemostasis we therefore inserted a covered Ultraflex metallic stent to compress the tumor. After stent placement, blood was no longer seen in the patient's stools, he became able to eat soft food and was discharged. This treatment was uninvasive and effective. Covered stent placement appears to be a new and useful method in the management of bleeding from malignant gastrointestinal tumors.- - - - - - - - - - ranking = 1keywords = abdomen (Clic here for more details about this article) |
5/19. Elevated serum alpha-fetoprotein levels in primary gallbladder carcinoma without hepatic involvement.BACKGROUND. Elevated serum alpha-fetoprotein (AFP) levels, although frequently associated with hepatocellular carcinoma, have also been reported in cases of primary gallbladder carcinoma. methods. The case of a 56-year-old man with a markedly elevated serum AFP level and primary gallbladder carcinoma without detectable hepatic involvement is reported. RESULTS. The patient had right upper quadrant abdominal pain and a palpable right upper quadrant mass. Computerized tomography scan of the abdomen showed a large, subhepatic mass consistent with the gallbladder, and normal liver parenchyma. liver enzyme levels were normal. Management included cholecystectomy followed by postoperative radiation therapy to the gallbladder bed and portal areas and systemic chemotherapy. At the end of therapy, the AFP level had returned to normal. CONCLUSIONS. gallbladder carcinoma is rarely diagnosed before surgery, which sometimes inhibits operative planning. AFP may be a useful preoperative tumor marker in differentiating the patient with primary gallbladder carcinoma from the patient with gallbladder hydrops.- - - - - - - - - - ranking = 1keywords = abdomen (Clic here for more details about this article) |
6/19. The first case of intraperitoneal bronchogenic cyst in korea mimicking a gallbladder tumor.We present a case of an intraperitoneal bronchogenic cyst located at inferior surface of the liver, next to the gallbladder which clinically mimicked a gallbladder tumor. This is the first case reported in korea, and we offer reviews of the related literatures. A 48-yr-old woman was admitted to our hospital because of intermittent abdominal pain in right upper quadrant. Computed tomography showed a large mass along-side the gallbladder. During laparotomy, the mass showed an ovoid cystic nature, which was attached to the normal gallbladder and liver bed. Cyst excision with cholecystectomy was performed, and histopathological examination revealed a broncho-genic cyst. Most bronchogenic cysts have a benign nature, but malignant changes have also been reported. Therefore, if a cystic tumor in the abdomen is suspected during preoperative diagnosis, a bronchogenic cyst should be considered in the differential diagnosis.- - - - - - - - - - ranking = 1keywords = abdomen (Clic here for more details about this article) |
7/19. Intramural gallbladder hematoma mimicking gallbladder neoplasm in a 33-year-old male.We report a case of intramural gallbladder hematoma mimicking gallbladder neoplasm in a 33-year-old male; bleeding was confined to the gallbladder wall without rupture into the lumen. The patient presented with sudden onset of right upper quadrant pain, with no history of abdominal trauma. The abdomen was soft, with mild tenderness over the right upper quadrant, and a positive Murphy's sign. Abdominal sonography, computed tomography, and endoscopic retrograde cholangiopancreatography all revealed the presence of a mass lesion in the gallbladder wall. Thus, a gallbladder tumor was highly suspected. Laparoscopic cholecystectomy was performed, and intramural hematoma was found intraoperatively. The cause of intramural hemorrhage was obscure.- - - - - - - - - - ranking = 1keywords = abdomen (Clic here for more details about this article) |
8/19. Retrobulbar metastasis from gallbladder carcinoma after laparoscopic cholecystectomy. A case report.Extra-abdominal metastases from gallbladder cancer are very rare; the sites outside the abdomen most frequently affected are the skin, bone and central nervous system. In the literature, only one case of orbital metastasis from gallbladder cancer has been reported, in a patient previously treated by open cholecystectomy. We report the case of a 53-year-old woman who underwent a laparoscopic cholecystectomy for symptomatic gallbladder stones. Postoperative histological examination revealed an unsuspected gallbladder adenocarcinoma. One month later she came to our observation after having developed diplopia and ophthalmic pain due to an orbital metastasis. We decided not to perform a surgical second look because of the already rapid dissemination of the malignant tumor. The few cases of uncommon gallbladder cancer metastases after laparoscopic cholecystectomy described in the literature are discussed, as well as the possible role of laparoscopy in the dissemination and localized seeding of malignant cells.- - - - - - - - - - ranking = 1keywords = abdomen (Clic here for more details about this article) |
9/19. Malignant melanoma of the biliary tract: a case report.A 58-year-old man was seen with obstructive jaundice and discomfort in the upper abdomen. Computed tomographic and ultrasound examinations revealed a soft-tissue mass in the gallbladder. cholecystectomy and choledochotomy revealed a soft black mass in the gallbladder and a second one in the intrapancreatic portion of the common bile duct. Each was diagnosed as malignant melanoma. Subsequently, a Whipple resection of the pancreas, duodenum, and distal bile duct revealed a melanoma circumferentially invading and obstructing the distal common duct. No lymph node or distant metastasis was identified. Repetitive searches for another primary site have been negative. The tumor apparently originated in the biliary tract. The patient remains almost well 2 years after diagnosis.- - - - - - - - - - ranking = 1keywords = abdomen (Clic here for more details about this article) |
10/19. A case of a gallbladder cancer with marked hypercalcemia and leukocytosis.hypercalcemia and leukocytosis of malignancy have been highlighted over a decade. We report a case of a gallbladder cancer with marked hypercalcemia and leukocytosis. A 54-year-old woman was admitted to the hospital because of remittent fever and left hypochondric pain. The computed tomographic scan of the abdomen revealed the cancer of the gallbladder with liver metastases. The patient's medical condition deteriorated as the tumor was rapidly growing up. Her medical course was marked by hypercalcemia and an increase in mature neutrophils. Medical therapy with normal saline, furosemide, indomethacin, prednisolone, and calcitonin failed to ameliorate hypercalcemia. On the twenty-ninth hospital day the serum calcium was elevated to 17.6 mg/dl which responded to 1000 micrograms of mithramycin while leucocytosis continued. Despite the chemotherapy with doxorubicin and tegafur, the tumor continued to grow. leukocytosis was attributed to the elevated colony-stimulating factor activity which was two-fold of control. The parathyroid hormone and nephrogeneous cyclic amp levels were normal with low vitamin d levels. hypercalcemia was attributed to a parathyroid hormone-like substance because of a decrease in %TRP in the presence of normal renal function and the normal parathyroid hormone level. autopsy revealed an undifferentiated adenocarcinoma of the gallbladder with multiple liver metastases, and bone resorption in the vertebral column and sternum without evident bone metastasis.- - - - - - - - - - ranking = 1keywords = abdomen (Clic here for more details about this article) |
| | Next -> |