scholarly journals Metastasis of Hepatocellular Carcinoma to the Esophagus: Case Report and Review

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Jun-ichiro Harada ◽  
Takeshi Matsutani ◽  
Nobutoshi Hagiwara ◽  
Yoichi Kawano ◽  
Akihisa Matsuda ◽  
...  
Keyword(s):  
Middle Part ◽  
Endoscopic Biopsy ◽  
Resected Specimen ◽  
Esophageal Tumor ◽  
Thoracic Esophagus ◽  
Polypoid Mass ◽  
Right Thoracotomy ◽  
Old Japanese ◽  
Left Lateral Segmentectomy

A follow-up endoscopy in a 71-year-old Japanese man who had undergone a left lateral segmentectomy for HCC two years ago revealed an approximately 2 cm in diameter pedunculated polypoid mass in the middle part of the thoracic esophagus. Immunohistochemical staining of the endoscopic biopsy revealed a metastatic HCC esophageal tumor. As the patient’s disease could be radically removed by preoperative examinations, we resected the metastatic esophageal tumor via right thoracotomy and esophagogastrostomy reconstruction. Histological examination of the resected specimen revealed that the esophageal tumor was compatible with a HCC metastasis. This is an extremely rare case of a solitary metastasis to the esophagus from HCC in the literature.

Evaluation of pre- and postoperative chemotherapy for resectable adenocarcinoma of the esophagus or gastroesophageal junction.

1990 ◽  
Vol 8 (7) ◽  
pp. 1231-1238 ◽  
Author(s):  
J A Ajani ◽  
J A Roth ◽  
B Ryan ◽  
M McMurtrey ◽  
T A Rich ◽  
...  
Keyword(s):  
Curative Resection ◽  
Postoperative Radiotherapy ◽  
Gastroesophageal Junction ◽  
Endoscopic Biopsy ◽  
Pathologic Response ◽  
Postoperative Chemotherapy ◽  
Resection Margins ◽  
Resected Specimen ◽  
Adenocarcinoma Of The Esophagus

Thirty-five consecutive patients with resectable adenocarcinoma of the esophagus or gastroesophageal junction were treated with two preoperative and three or four postoperative chemotherapy courses consisting of etoposide, fluorouracil, and cisplatin (EFP) to evaluate the rate of curative resection, clinical and pathologic response, toxic effects, and survival. One hundred thirty-seven courses with a median number of five courses (range, one to six) were administered. Preoperative EFP resulted in 17 (49%) major responses, including six patients who did not have carcinoma cells in the repeat endoscopic biopsy specimens and cytologic brushings. Among 32 patients who had surgery, 25 (78%) had curative resection, one patient had a complete pathologic response, and one had microscopic carcinoma in the resected specimen. Six patients had microscopic carcinoma at the resection margins and received postoperative radiotherapy. At a median follow-up of 20 months, the projected survival of 35 patients is 23 months (range, 6 to 33+). Fifteen patients died of their carcinomas, and 15 patients were alive (median follow-up, 20+ months; range, 15+ to 33+ months) with no evidence of relapse. There were no deaths related to chemotherapy, surgery, or radiotherapy. EFP-induced toxic reactions were moderate. Our data suggest that multiple courses of EFP are feasible. Future strategies for this disease should consider prolonged chemotherapy with regimens that result frequently in pathologic complete responses.

scholarly journals Mixed adenoneuroendocrine carcinoma with loss of HER2 positivity after trastuzumab-based chemotherapy for HER2-positive gastric cancer: a case report

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Hiromi Nagata ◽  
Hironori Tsujimoto ◽  
Yoshihisa Yaguchi ◽  
Keita Kouzu ◽  
Yujiro Itazaki ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Rare Case ◽  
Metastatic Tumor ◽  
Endoscopic Biopsy ◽  
Her2 Status ◽  
Resected Specimen ◽  
Her2 Positive ◽  
Standard Regimen ◽  
Mixed Adenoneuroendocrine Carcinoma ◽  
Her2 Positivity

Abstract Background Trastuzumab (T-mab)-based chemotherapy is a standard regimen for human epithelial growth factor 2 (HER2)-positive gastric cancer. However, some patients have demonstrated a change in HER2 status after T-mab-based treatment of breast cancer. We report a rare case of mixed adenoneuroendocrine carcinoma with loss of HER2 positivity after T-mab-based chemotherapy for HER2-positive gastric cancer. Case presentation A 60-year-old man presented with a mass of the upper abdomen, which was diagnosed as adenocarcinoma with a HER2 score of 3+ by endoscopic biopsy. He received seven cycles of combination chemotherapy with capecitabine, cisplatin, and T-mab. Subsequently, he underwent open total gastrectomy, distal pancreatosplenectomy, and extended left hepatic lobectomy as a conversion surgery. The surgically resected specimen demonstrated both adenocarcinoma and neuroendocrine components; therefore, it was diagnosed as HER2-negative mixed adenoneuroendocrine carcinoma. Although the patient received additional chemotherapy, multiple liver metastases appeared at 3 months postoperatively and he died at 6 months postoperatively because of the rapidly progressing metastatic tumor. Conclusions We encountered a rare case of rapidly progressive mixed adenoneuroendocrine carcinoma that was negative for HER2 expression after T-mab treatment combined with chemotherapy.

scholarly journals Salvage therapy of bleeding esophageal tumor by fully covered self-expandable metallic stent: A case report

2021 ◽  
Vol 9 ◽  
pp. 2050313X2199719
Author(s):  
Sundus Bilal ◽  
Saad Muhammad Saeed ◽  
Muhammad Zeeshan Siddique ◽  
Muhammad Saqib ◽  
Shafqat Mehmood ◽  
...  
Keyword(s):  
Case Reports ◽  
Esophageal Tumor ◽  
Metallic Stent ◽  
Diverse Group ◽  
Expandable Metallic Stent ◽  
Lost To Follow Up ◽  
Expandable Metallic Stents ◽  
Tamponade Effect

The role of self-expandable metallic stents is gradually evolving for a diverse group of benign and malignant gastrointestinal tract problems, with luminal obstruction being by far the most common. Although its role in refractory variceal bleeding is well established, it has rarely been tried for tumor-related bleeding, with only a few case reports in this regard. We share our experience of successfully controlling esophageal tumor–related bleeding with the use of a fully covered self-expandable metallic stent. A 58-year-old woman with irresectable distal esophageal cancer, presented with hematemesis. Esophago-gastro-duodenoscopy revealed an obstructing esophageal tumor with diffuse oozing of blood. This was unamenable to local injection of adrenaline and hemospray; therefore, a temporary self-expandable metallic stent was parked to create a tamponade effect. This successfully stopped bleeding and the patient remained asymptomatic till discharge. However, she was lost to follow-up, and therefore, the stent was removed after a period of 5 months instead of 2 weeks.

scholarly journals Impact of 5-Year Endoscopic Surveillance Intervals with Biopsy following Endoscopic Papillectomy for Ampullary Adenoma

2022 ◽  
Vol 12 (1) ◽  
pp. 51
Author(s):  
Hoonsub So ◽  
Sung Woo Ko ◽  
Seung Hwan Shin ◽  
Eun Ha Kim ◽  
Do Hyun Park
Keyword(s):  
Patient Adherence ◽  
Diagnostic Yield ◽  
Endoscopic Biopsy ◽  
Endoscopic Surveillance ◽  
Adherence Rate ◽  
Low Grade ◽  
Ampullary Adenoma ◽  
Endoscopic Papillectomy ◽  
Routine Biopsy

Background: Endoscopic snare papillectomy (ESP) has been established as a safe and effective treatment for ampullary adenomas. However, little is known about the optimal post-procedure follow-up period and the role of routine endoscopic surveillance biopsy following ESP. We aimed to evaluate patient adherence to a 5-year endoscopic surveillance and routine biopsy protocol after ESP of ampullary adenoma. Methods: We reviewed our prospectively collected database (n = 98), all members of which underwent ESP for ampullary lesions from January 2011 to December 2016, for the evaluation of long-term outcomes. The primary outcome was the rate of patient adherence to 5-year endoscopic surveillance following ESP. The secondary outcomes were the diagnostic yield of routine endoscopic biopsy, recurrence rate, and adverse events after endoscopic surveillance in the 5-year follow-up (3-month, 6-month, and every 1 year). Results: A total of 19 patients (19.4%) experienced recurrence during follow-up, all of these patients experienced recurrence within 3 years of the procedure (median 217 days, range 69–1083). The adherence rate for patients with sporadic ampullary adenoma were 100%, 93.5%, and 33.6% at 1, 3, and 5 years after ESP, respectively. The diagnostic yield of routine endoscopic biopsy without macroscopic abnormality was 0.54%. Pancreatitis occurred in four patients (4%, 3 mild, 1 moderate) after surveillance endoscopic biopsy without macroscopic abnormality. Conclusions: Given the low 5-year adherence rate and diagnostic yield of routine endoscopic biopsy with risk of pancreatitis, optimal surveillance intervals according to risk stratification (low grade vs. high grade adenoma/intramucosal adenocarcinoma) may be required to improve patient adherence, and routine biopsy without macroscopic abnormality may not be recommended.

DOZ047.77: Extraluminal airway stabilization for localized tracheomalacia: a case report

2019 ◽  
Vol 32 (Supplement_1) ◽  
Author(s):  
A Laín ◽  
F Pumarola ◽  
C Giné ◽  
L García ◽  
P Barila ◽  
...  
Keyword(s):  
Case Report ◽  
Respiratory Infections ◽  
Neurological Status ◽  
Middle Part ◽  
Transcervical Approach ◽  
Endoscopic Control ◽  
Effective Option ◽  
Cervical Trachea ◽  
Genetic Anomaly

Abstract Aim In the last years several treatments for tracheomalacia have been reported. However, management of this entity is still a complex matter. This study presents a case diagnosed of severe proximal tracheomalacia managed by external tracheal resorbable plates. Case Report A seven-year-old child was tracheostomized in the neonatal period in relation to severe generalized tracheomalacia in association with swallowing incoordination and recurrent respiratory infections. Data to point out of his personal history were prematurity, a mosaic type genetic anomaly, cognitive and development impairment, and bilateral hypoacusia. After improvement of the neurological status and his feeding and swallow problems he was evaluated by the Airway Unit of our centre. Dynamic transnasal flexible laryngotracheobronchoscopy showed severe tracheomalacia. The collapse was 100% in the proximal airway (from the subglotis to the middle part of the trachea) and decannulation was not possible. Given the extent, localization, and proximity of the tracheomalacia to the vocal cords a surgical approach with external bioresorbable plates was indicated. By a transcervical approach, dissection of the larynx and cervical trachea was carried out. Two 2.5 cm multiperforated plates of ‘poly [L-lactide-co-glycolide] copolymer’ were modeled and fixed to the anteromedial laryngotracheal surface. Direct intraoperative endoscopy defined the proper location to fix the plates and showed significant improvement of the collapse thanks to the rigidification of the airway. Three weeks after the procedure endoscopic control was realized and the patient was successfully decannulated. He remains asymptomatic with a 6 months follow-up. No complications were reported. Conclusion Extraluminal stabilization with resorbable plates can be a safe and effective option for selected patients with localized tracheomalacias. It represents a valid alternative for the management of this complex entity.

scholarly journals Long-Term Follow-Up after Conservative Surgical Treatment of Odontogenic Myxoma: A Case Report and Literature Review

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Hitoshi Sato ◽  
Yuji Kurihara ◽  
Sunao Shiogama ◽  
Kotaro Saka ◽  
Yuya Kurasawa ◽  
...  
Keyword(s):  
Surgical Margin ◽  
Radical Resection ◽  
Conservative Surgery ◽  
Odontogenic Myxoma ◽  
Recurrence Rates ◽  
Jaw Bones ◽  
Old Japanese ◽  
Long Term Follow Up

Odontogenic myxoma (OM) is a relatively rare, benign odontogenic tumor with locally aggressive behavior, but it is a nonmetastasizing neoplasm of the jaw bones. Although radical resection with an appropriate surgical margin is recommended, emerging evidence has suggested that a more conservative approach will result in acceptable recurrence rates with less morbidity if careful long-term follow-up is provided. A 56-year-old Japanese man with odontogenic myxoma of the left mandible was conservatively treated by surgical enucleation and curettage because he desired functional and cosmetic preservation. During a follow-up period of 100 months, the patient has remained clinically and radiologically free of recurrence. As far as we can ascertain, 20 reports published after 1990 described 37 patients with mandibular OM that had been treated by conservative surgery. Tumors recurred during a mean follow-up of 49.2±42.8 months in 7 (18.9%) patients, and only one of five patients who were followed up for over 100 months developed recurrence. The rate of recurrence decreased from 24.0% to 8.3% when follow-up exceeded 60 months. Although enucleation and curettage have proven effective, the risk of recurrence remains considerable and long-term follow-up is indispensable. More evidence of long-term outcomes after conservative surgery for OM is needed.

scholarly journals Complete laparoscopic pancreaticoduodenectomy: our experience of the first case

2019 ◽  
Vol 22 (1) ◽  
pp. 26-30
Author(s):  
Mukund Raj Joshi ◽  
Sujan Regmee ◽  
Tanka Prasad Bohara ◽  
Rupesh Chakradhar ◽  
Mandesh Shrestha
Keyword(s):  
Blood Loss ◽  
Point Of View ◽  
Resected Specimen ◽  
Laparoscopic Pancreaticoduodenectomy ◽  
Technical Aspects ◽  
Technical Point ◽  
Operative Outcomes ◽  
Post Operative Period ◽  
First Case

Laparoscopic pancreaticoduodenectomy was described in 1994. It is considered the most challenging abdominal surgery. Although the procedure was found to be feasible in initial reports, the benefits were not considered favorable. In recent days, with the increasing experience of surgeons, acceptable outcomes are being observed and have been found to be technically beneficial and oncologically safe in selective cases in experienced hands. We performed the procedure in a 42-year-old gentleman with good operative and post-operative outcomes. The patient’s follow-up for six post-operative months seems satisfactory. The operation took 840 minutes with minimal blood loss. The resected specimen was adequate and satisfactory from an oncological and technical point of view. The patient developed some inherent complications of the procedure in the post-operative period. He recovered well. Details of the case and technical aspects are being discussed.  

Lumpectomy and radiation therapy for the treatment of intraductal breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-17.

1998 ◽  
Vol 16 (2) ◽  
pp. 441-452 ◽  
Author(s):  
B Fisher ◽  
J Dignam ◽  
N Wolmark ◽  
E Mamounas ◽  
J Costantino ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Breast Cancer Incidence ◽  
Resected Specimen ◽  
Cumulative Probability ◽  
Event Free Survival ◽  
Free Survival ◽  
National Surgical Adjuvant Breast ◽  
Bowel Project

PURPOSE In 1993, findings from a National Surgical Adjuvant Breast and Bowel Project (NSABP) trial to evaluate the worth of radiation therapy after lumpectomy concluded that the combination was more beneficial than lumpectomy alone for localized intraductal carcinoma-in-situ (DCIS). This report extends those findings. PATIENTS AND METHODS Women (N = 818) with localized DCIS were randomly assigned to lumpectomy or lumpectomy plus radiation (50 Gy). Tissue was removed so that resected specimen margins were histologically tumor-free. Mean follow-up time was 90 months (range, 67 to 130). Size and method of tumor detection were determined by central clinical, mammographic, and pathologic assessment. Life-table estimates of event-free survival and survival, average annual rates of occurrence for specific events, relative risks for event-specific end points, and cumulative probability of specific events comprising event-free survival are presented. RESULTS The benefit of lumpectomy plus radiation was virtually unchanged between 5 and 8 years of follow-up and was due to a reduction in invasive and noninvasive ipsilateral breast tumors (IBTs). Incidence of locoregional and distant events remained similar in both treatment groups; deaths were only infrequently related to breast cancer. Incidence of noninvasive IBT was reduced from 13.4% to 8.2% (P = .007), and of invasive IBT, from 13.4% to 3.9% (P < .0001). All cohorts benefited from radiation regardless of clinical or mammographic tumor characteristics. CONCLUSION Through 8 years of follow-up, our findings continue to indicate that lumpectomy plus radiation is more beneficial than lumpectomy alone for women with localized, mammographically detected DCIS. When evaluated according to the mammographic characteristics of their DCIS, all groups benefited from radiation.

Prospective Evaluation of Intrahepatic Microscopic Occult Tumor Foci in Patients with Numerous Colorectal Liver Metastases

2018 ◽  
Vol 36 (4) ◽  
pp. 340-347 ◽  
Author(s):  
Luca Vigano ◽  
Luca Di Tommaso ◽  
Antonio Mimmo ◽  
Mauro Sollai ◽  
Matteo Cimino ◽  
...  
Keyword(s):  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Intraoperative Imaging ◽  
Median Number ◽  
Early Recurrence ◽  
Resected Specimen ◽  
Lesion Analysis ◽  
Healthy Liver ◽  
Disease Free

Background: Patients with numerous colorectal liver metastases (CLM) have high risk of early recurrence after liver resection (LR). The presence of intrahepatic occult microscopic metastases missed by imaging has been hypothesized, but it has never been assessed by pathology analyses. Methods: All patients with > 10 CLM who underwent LR between September 2015 and September 2016 were considered. A large sample of liver without evidence of disease (“healthy liver”) was taken from the resected specimen and sent to the pathologist. One mm-thick sections were analyzed. Any metastasis, undetected by preoperative and intraoperative imaging, but identified by the pathologist was classified as occult microscopic metastasis. Results: Ten patients were prospectively enrolled (median number of CLM n = 15). In a per-lesion analysis, the sensitivity of computed tomography and magnetic resonance imaging was 91 and 98% respectively. The pathology examination confirmed all the CLM. All patients had an adequate sample of “healthy liver” (median number of examined blocks per sample n = 14 [5–33]). No occult microscopic metastases were detected. After a median follow-up of 15 months, 5 patients were disease-free. Recurrence was hepatic and bilobar in all patients. Conclusions: Clinically relevant occult microscopic disease in patients with numerous CLM is excluded. These results support the indication to resection in such patients and exclude the need for de principe major hepatectomy to increase the completeness of surgery.

PS01.110: ACUTE NECROTIZING ESOPHAGITIS WITH ESOPHAGUS PERFORATION, TREATED BY THORACOSCOPIC ESOPHAGECTOMY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 81-81
Author(s):  
Ryujiro Akaishi ◽  
Yusuke Taniyama ◽  
Tadashi Sakurai ◽  
Takahiro Heishi ◽  
Hiroshi Okamoto ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Conflicts Of Interest ◽  
Esophageal Resection ◽  
Endoscopic Examination ◽  
Resected Specimen ◽  
Thoracic Esophagus ◽  
Esophageal Mucosa ◽  
Acute Necrotizing ◽  
Esophagus Perforation ◽  
Black Pigmentation

Abstract Background Acute necrotizing esophagus is defined as the diffuse black pigmentation of the esophagus due to the necrosis of the esophageal mucosa, and so called ‘black esophagus’ from its endoscopic findings. The prevalence is only 0.001∼0.2%, although the mortality rate is up to 32%. Methods 67 years old female with medical history of diabetes mellitus, transported to the emergency room with hematemesis and conscious disorder. She had suffered from nausea and epigastralgia for two days. Her general status was in shock vitals and didn’t respond to rehydration. After intubation, emergency endoscopic examination revealed black pigmentation of the esophageal mucosa and diagnosed as acute necrotizing esophagitis. Antibiotics and blood absorption therapy had been started and the patient gradually stabilized. 1 week after the admission, esophagus perforation was suspected from the significant increase of the right pleural effusion and free air at the esophagus wall and the mediastinum on CT scan. Emergency thoracoscopy was performed and found that the esophagus was edematous and adventitia was colored into black. The esophagectomy with esophagostomy and enterostomy was performed. Results On resected specimen, mucosal necrosis was found only on squamous epithelium with three perforating areas in the middle to lower thoracic esophagus. No signs of inflammation nor ischemia was found on the gastric mucosa of the esophagogastric junction. After the operation, patient recovered generally well, except the severe stenosis of the cervical esophagus had developed. Although endoscopic dilation had been constantly performed, the reconstruction remains unsolved issue. Conclusion In acute necrotizing esophagitis, stabilization of the patient's condition by treating comorbid diseases is extremely important. Improving the nutritional status in addition to the administration of antacids and antibiotics is also required. Surgical intervention should be performed when perforating mediastinitis or abscess formation occurs. Primary closure shouldn’t be attempted, and esophageal resection with delayed reconstruction should be considered in addition to drainage. In this case, we could successfully rescued the patient with necrotic esophagitis by performing surgical intervention promptly. It is important to detect the esophagus perforation and mediastinitis early, not to miss the chance of surgical intervention for curative treatment. Disclosure All authors have declared no conflicts of interest.

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