Pericardial effusion following pulmonary resection

Objective Postoperative pericardial effusion commonly occurs after open heart surgery. However, after general thoracotomy such as pulmonary resection, there have been few reports of pericardial effusion. The purpose of this study is to investigate patients with pericardial effusion following pulmonary resection.Methods: Among 2,385 patients with pulmonary resection for lung neoplasm in our institute, eight patients, whose pericardium had never been opened during the operation, developed pericardial effusion. The clinical characteristics of the eight patients were analyzed.Results: Pericardial effusion after pulmonary resection was divided into two subtypes: pericardial effusion in three patients with left thoracotomy occurring within 30 days postoperatively, and pericardial effusion in the remaining five patients with right thoracotomy occurring more than 30 days postoperatively. Pericardiotomy or pericardiocentesis was performed in three symptomatic patients, and the remaining five asymptomatic patients were treated with diuretics. Pericardial effusion disappeared in three of the five patients about 1–3 months after the conservative treatment, while, in the remaining patients, because pericardial effusion had increased gradually, pericardiocentesis was performed.Conclusion: From our experience, the treatment strategy of drainage for early pericardial effusion and diuretics for late pericardial effusion seems to be appropriate. (Jpn J Thorac Cardiovasc Surg 2006; 54:193-198)     

ASO Visual Abstract: Preoperative FDG Positive Lymph Nodes Predict the Postoperative Prognosis in Resectable Biliary Tract Cancers

Annals of Surgical Oncology -     

Intrahepatic cholangiocarcinoma in a worker at an offset color proof‐printing company: An autopsy case report

A 40‐year‐old Japanese man visited our hospital after test results indicated elevated hepatobiliary enzymes. He had worked at a printing plant for 8 years and been exposed to organic solvents, including 1,2‐dichloropropane (1,2‐DCP) and dichloromethane (DCM). Abdominal computed tomography (CT) showed an intrahepatic tumor with dilation of the intrahepatic bile duct. He was diagnosed with intrahepatic cholangiocarcinoma. He had no known risk factors for cholangiocarcinoma. Extended left hepatectomy with lymph node dissection was performed and the tumor was histologically diagnosed as well‐differentiated adenocarcinoma. A histological examination also showed biliary intraepithelial preneoplastic lesions in non‐cancerous liver areas. Two years after surgery, the patient developed jaundice, esophageal varices and ascites. A CT examination showed liver cirrhosis without recurrence of the cholangiocarcinoma. Although a liver transplantation was planned as a therapeutic option for his liver cirrhosis, his liver failure progressed rapidly and he died before transplantation could be performed. At autopsy, fibrosis was found in the whole liver, especially in the wall of the bile duct and periductal area suggesting chronic bile duct injury due to exposure to organic solvents. Taken together, the current case may suggest that exposure to organic solvents, including 1,2‐DCP and DCM, is a risk factor for cholangiocarcinoma. Identifying risk factors for cholangiocarcinoma will help identify the mechanism and help prevent development of the disease.     

A case of anal fistula cancer probably developing from intraluminal dissemination of rectal cancer

A 63-year-old man with a history of anal fistula was admitted to our hospital because the anal pain didn't disappear after the operation. On digital examination, a hard mass measuring 3.0 cm in diameter was found at the anal canal. Biopsy of the mass showed moderately differentiated adenocarcinoma. Colonoscopy revealed another rectal cancer at 15 cm from anal verge. Biopsy of the tumor also showed moderately differentiated adenocarcinoma, resembling the anal canal tumor. Because the histological findings of both tumors were nearly identical, we considered that cancer cells from the rectal cancer had been implanted and developed the metastatic tumor in the anal fistula. The patient underwent anterior resection for the rectal cancer, and a local resection for the anal canal cancer. Immunohistochemical staining for Ki-67, p53, Muc2, CD10, CK-7, and CK-20 revealed similar patterns in both tumors. Additionally, genetic analysis for p53, K-ras, and MSI revealed similar patterns in both tumors. We may suggest from these results that cancer cells from the rectal cancer had been implanted and developed the metastatic tumor in the anal canal.     

A case of phyllodes tumor of the breast with a lesion mimicking fibroadenoma

We report a case of phyllodes tumor (PT) with multiple lesions partly mimicking fibroadenoma (FA). A 43-year-old woman was referred to our institute because of a left breast mass which was diagnosed as FA clinically. During the follow-up, the mass gradually enlarged and excisional biopsy was performed to rule out malignant lesion. On histological examination, the tumor consisted of three different components; a lesion diagnosed as FA, another lesion as benign PT, and the other lesion as borderline PT. Finally, the tumor was diagnosed as borderline PT. Stromal cellularity may vary from area to area in any given PT. If there are some disagreements among the findings of imagings and cytology for the diagnosis of FA, as was seen in our case, the possibility of coexistence of PT should be considered.     

Intraductal papillary-mucinous carcinoma of the pancreas with tumor thrombus in the portal vein: a report of two cases

Intraductal papillary-mucinous carcinoma (IPMC) is a recently recognized pancreatic tumor and this is the first report to present two patients with IPMC complicating tumor thrombi in the portal vein. Two women, a 74- and a 55-year-old, each revealed a round, cystic and well-demarcated tumor of the pancreas in an abdominal computed tomography (CT). However, the inner lumen of the splenic and portal veins was insufficiently stained during iv-infusion of the contrast medium, suggesting the presence of tumor thrombi. Owing to this information, the presence of tumor thrombus was investigated and correctly identified during laparotomy, and it was completely removable together with the primary pancreatic tumor. The resected tumors showed expansive growth because mucin and tumor tissues rose up when they were cut. Microscopically, the tumor was diagnosed as adenocarcinoma without ovarian-like stroma, and the final diagnosis of branch type of IPMC was made for the two patients. However, within one postoperative year, both patients developed liver metastasis. Although IPMC is known as having a lower potential for metastasis or invasion, the tumor thrombi can form when it reveals an expansive growth suggesting a high inner pressure. In addition, a higher possibility for subsequent liver metastasis should be anticipated after the tumor forms a thrombus in the portal vein.     

Transcatheter arterial embolization for the continuous bleeding from duodenal carcinoma--a case report

We report a case of duodenal carcinoma with continuous bleeding that was successfully treated with transcatheter arterial embolization using gelatin sponge particles. The case was a woman in her 70's who had a curative surgical resection for sigmoid colon cancer with liver and lung metastases, hepatic arterial infusion chemotherapy and radiofrequency ablation for liver metastasis in the past. She was admitted to our hospital because of liver abscess and anemia. Upper gastrointestinal endoscopy revealed active bleeding from a duodenal tumor. The biopsy of the specimens was made and showed duodenal adenocarcinoma. The patient was considered to be inoperable because of the liver abscess and transcatheter arterial embolization of an anterior superior pancreaticoduodenal artery through an inferior pancreaticoduodenal artery was performed for the continuous bleeding from duodenal carcinoma not completely treated by endoscopic hemostasis or frequent transfusion. After the tumor embolization anemia was improved and partial response was obtained by systemic chemotherapy of mFOLFOX6. Transcatheter arterial embolization for a continuous bleeding from duodenal carcinoma is a feasible and effective method as a noninvasive therapy when it is unabled to be treated by surgical resection or endoscopic therapy.