1
|
Gamble D, Frankel WL, Yearsley MM, Chen W. Ampulla of Vater biopsies: A retrospective 10-year, single-institution study. Ann Diagn Pathol 2023; 67:152189. [PMID: 37595391 DOI: 10.1016/j.anndiagpath.2023.152189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/06/2023] [Accepted: 08/06/2023] [Indexed: 08/20/2023]
Abstract
Endoscopic biopsies from the ampulla of Vater are challenging due to specimen sampling limitation, small size, interventional artifacts, and the nature of local complex anatomy. We retrospectively reviewed 318 in-house ampulla of Vater biopsy specimens from 252 patients over a 10-year period. The biopsy findings were compared to those in subsequent biopsy and/or resection specimens. Of the 318 biopsy cases, 104 (32.7 %) cases were diagnosed as adenoma (96 with low-grade dysplasia; 8 with high-grade dysplasia), 19 (6.0 %) adenocarcinomas (ampullary-12, distal bile duct-6, pancreatic-1), 5 (1.6 %) other carcinomas/tumors, and the rest were benign findings (unremarkable, ulcer and acute inflammation, reactive changes, and rare atypical cells/gland). Of the 90 cases with follow-up specimens, 55 cases (61.1 %) had concordant results and 35 (38.9 %) were discordant. Eight (22.9 %) of the 35 discordant cases had major discrepancies (benign biopsy diagnosis with malignant resection diagnosis); 27 (77.1 %) cases had minor discrepancies (normal, reactive, atypical, and dysplastic). We found that vast majority of the false negative biopsy results were due to sampling limitations. Combined biopsy and cytology specimens may help decrease the false negative rate. Careful correlation with endoscopic/cytology/clinical findings and acknowledging the limitation of the biopsy material in the pathology report are important, when malignancy is suspected but cannot be established in a small ampullary biopsy.
Collapse
Affiliation(s)
- Denise Gamble
- The Ohio State University Wexner Medical Center, Department of Pathology, Columbus, OH 43210, United States
| | - Wendy L Frankel
- The Ohio State University Wexner Medical Center, Department of Pathology, Columbus, OH 43210, United States
| | - Martha M Yearsley
- The Ohio State University Wexner Medical Center, Department of Pathology, Columbus, OH 43210, United States
| | - Wei Chen
- The Ohio State University Wexner Medical Center, Department of Pathology, Columbus, OH 43210, United States.
| |
Collapse
|
2
|
Svatoň R, Procházka V, Hanslianová M, Kala Z. Influence of bacteriobilia on postoperative complications in patients with periampullary tumors. Asian J Surg 2023; 46:1193-1198. [PMID: 36057492 DOI: 10.1016/j.asjsur.2022.08.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/21/2021] [Accepted: 08/17/2022] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Periampullary tumours (PAT) may cause obstruction of distal choledochus. The bile stasis is a risk factor for microbial colonisation of bile (bacteriobilia), cholangitis, hepatic insufficiency and coagulopathy. PAT obstruction can be managed surgically or non-operatively - by inserting a biliary drain or stent (BDS). Although BDS allows for adequate bile drainage, liver function restitution and coagulopathy, increased bacteriobilia has been reported and this is associated with an increased incidence of postoperative complications. METHODS A monocentric, prospective, comparative study including 100 patients operated with PAT. The effects of bacteriobilia and the presence of a drain in the biliary tract on the development of postoperative complications were evaluated. RESULTS Positive microbial findings in bile were found in 67% of patients. It was 98% in the biliary drain group vs. 36% in non-drained patients (p = 0.0001). In 68% 2 or more different bacterial strains were simultaneously present (p = 0.0001). Patients with a positive microbial finding in bile had more frequent incidence of infectious complications 40.2% (27) vs. 9.1% (3); p = 0.0011. The most frequent infectious complication was wound infection 29.8% (20) vs. 3.03% (1); p = 0.0014. Similarly, a higher incidence of postoperative infectious complications occurred in patients with BDS - 36% (18) vs. 24% (12); p = 0.2752. CONCLUSION The presence of a drain or stent in the biliary tract significantly increases the microbial colonisation of bile. It is associated with a significant increase in infectious complications, especially infections in the wound.
Collapse
Affiliation(s)
- Roman Svatoň
- Department of Surgery, University Hospital Brno Faculty of Medicine, Masaryk University, Brno, Czech Republic.
| | - Vladimír Procházka
- Department of Surgery, University Hospital Brno Faculty of Medicine, Masaryk University, Brno, Czech Republic.
| | - Markéta Hanslianová
- Department of Microbiology, University Hospital Brno Faculty of Medicine, Masaryk University, Brno, Czech Republic.
| | - Zdeněk Kala
- Department of Surgery, University Hospital Brno Faculty of Medicine, Masaryk University, Brno, Czech Republic.
| |
Collapse
|
3
|
Kim JS, Choi M, Kim SH, Choi SH, Kang CM. Safety and feasibility of laparoscopic pancreaticoduodenectomy in octogenarians. Asian J Surg 2021; 45:837-843. [PMID: 34649792 DOI: 10.1016/j.asjsur.2021.09.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 09/27/2021] [Accepted: 09/30/2021] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION With continued technical advances in surgical instruments and growing surgical expertise, many laparoscopic pancreaticoduodenectomies (LPDs) have been safely performed with favorable outcomes, and this approach is being used more frequently. With an increase in the life expectancy, interest in treatments for elderly patients has increased. In this study, we investigated the safety and feasibility of LPD in octogenarians. METHODS From September 2005 to February 2020, resectable/borderline resectable periampullary tumors (PATs) were diagnosed in 71 octogenarians at Sincheon Severance Hospital and CHA Bundang Medical Center. Patients were divided into two groups: those who underwent surgery (PD, N = 38) and those who did not (NPD, N = 33). The group that underwent surgery was further divided into two groups: those who underwent open PD (OPD, N = 19), and those who underwent LPD (LPD, N = 19). Perioperative outcomes, including long-term survival, were retrospectively compared between these groups. RESULTS There was no significant difference in age, sex, comorbidities, diagnosis, and chemo-radiotherapy between the surgery and non-surgery groups. The PD group had a better survival rate than the NPD group (p < 0.05). The baseline characteristics and postoperative outcomes were not significantly different between the OPD and LPD groups. Only three and two patients in the OPD and LPD groups had a biochemical leak (p > 0.999). There was no significant difference in overall survival and disease-free survival between the OPD and LPD groups (p = 0.816, p = 0.446, respectively). CONCLUSIONS LPD is a good alternative for octogenarians with PAT requiring PD.
Collapse
Affiliation(s)
- Ji Su Kim
- Department of Hepatobiliary and Pancreatic Surgery, Yonsei University College of Medicine, Seoul, South Korea; Pancreatobiliary Cancer Center, Yonsei Cancer Center, Severance Hospital, Seoul, South Korea
| | - Munseok Choi
- Department of Surgery, Yongin Severance Hospital, Yongin-si, Gyeonggi-do, South Korea
| | - Sung Hyun Kim
- Department of Hepatobiliary and Pancreatic Surgery, Yonsei University College of Medicine, Seoul, South Korea; Pancreatobiliary Cancer Center, Yonsei Cancer Center, Severance Hospital, Seoul, South Korea
| | - Sung Hoon Choi
- Department of Hepatobiliary and Pancreatic Surgery, CHA Bundang Medical Center, CHA University, Seongnam, South Korea.
| | - Chang Moo Kang
- Department of Hepatobiliary and Pancreatic Surgery, Yonsei University College of Medicine, Seoul, South Korea; Pancreatobiliary Cancer Center, Yonsei Cancer Center, Severance Hospital, Seoul, South Korea.
| |
Collapse
|
4
|
Balkaya T, Babayev A, Aydın I, Gür EÖ, Dilek ON. Coexistence of ampulla Vater tumor and Castleman's disease: a rare case report. Acta Gastroenterol Belg 2019; 82:546-547. [PMID: 31950815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- T Balkaya
- Izmir Katip Çelebi University, Atatürk Training and Research Hospital, General Surgery Clinics, Izmir, Turkey
| | - A Babayev
- Izmir Katip Çelebi University, Atatürk Training and Research Hospital, General Surgery Clinics, Izmir, Turkey
| | - I Aydın
- Izmir Katip Çelebi University, Atatürk Training and Research Hospital, Pathology Clinics, Izmir, Turkey
| | - E Ö Gür
- Izmir Katip Çelebi University, Atatürk Training and Research Hospital, General Surgery Clinics, Izmir, Turkey
| | - O N Dilek
- Izmir Katip Çelebi University, Atatürk Training and Research Hospital, General Surgery Clinics, Izmir, Turkey
| |
Collapse
|
5
|
El Nakeeb A, ElGawalby A, A Ali M, Shehta A, Hamed H, El Refea M, Moneer A, Abd El Rafee A. Efficacy of octreotide in the prevention of complications after pancreaticoduodenectomy in patients with soft pancreas and non-dilated pancreatic duct: A prospective randomized trial. Hepatobiliary Pancreat Dis Int 2018; 17:59-63. [PMID: 29428106 DOI: 10.1016/j.hbpd.2018.01.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 11/02/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND The efficacy of octreotide to prevent postoperative pancreatic fistula (POPF) of pancreaticoduodenectomy (PD) is still controversial. This study aimed to evaluate the effect of postoperative use of octreotide on the outcomes after PD. METHODS This is a prospective randomized controlled trial for postoperative use of octreotide in patients undergoing PD. Patients with soft pancreas and pancreatic duct < 3 mm were randomized to 2 groups. Group I did not receive postoperative octreotide. Group II received postoperative octreotide. The primary end of the study is to compare the rate of POPF. RESULTS A total of 104 patients were included in the study and were divided into two randomized groups. There were no significant difference in overall complications and its severity. POPF occurred in 11 patients (21.2%) in group I and 10 (19.2%) in group II, without statistical significance (P = 0.807). Also, there was no significant differences between both groups regarding the incidence of biliary leakage (P = 0.083), delayed gastric emptying (P = 0.472), and early postoperative mortality (P = 0.727). CONCLUSIONS Octreotide did not reduce postoperative morbidities, reoperation and mortality rate. Also, it did not affect the incidence of POPF and its clinically relevant variants.
Collapse
Affiliation(s)
- Ayman El Nakeeb
- Gastroenterology Surgical Center, Mansoura University, Mansoura 35516, Egypt.
| | - Ahmed ElGawalby
- Gastroenterology Surgical Center, Mansoura University, Mansoura 35516, Egypt
| | - Mahmoud A Ali
- Gastroenterology Surgical Center, Mansoura University, Mansoura 35516, Egypt
| | - Ahmed Shehta
- Gastroenterology Surgical Center, Mansoura University, Mansoura 35516, Egypt
| | - Hosam Hamed
- Gastroenterology Surgical Center, Mansoura University, Mansoura 35516, Egypt
| | - Mohamed El Refea
- Gastroenterology Surgical Center, Mansoura University, Mansoura 35516, Egypt
| | - Ahmed Moneer
- Gastroenterology Surgical Center, Mansoura University, Mansoura 35516, Egypt
| | - Ahmed Abd El Rafee
- Gastroenterology Surgical Center, Mansoura University, Mansoura 35516, Egypt
| |
Collapse
|
6
|
El Nakeeb A, Askar W, Atef E, Hanafy EE, Sultan AM, Salah T, shehta A, Sorogy ME, Hamdy E, Hemly ME, El-Geidi AA, Kandil T, Shobari ME, Allah TA, Fouad A, Zeid MA, Eneen AAE, El-Hak NG, Ebidy GE, Fathy O, Sultan A, Wahab MA. Trends and outcomes of pancreaticoduodenectomy for periampullary tumors: A 25-year single-center study of 1000 consecutive cases. World J Gastroenterol 2017; 23:7025-7036. [PMID: 29097875 PMCID: PMC5658320 DOI: 10.3748/wjg.v23.i38.7025] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 06/28/2017] [Accepted: 08/02/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the evolution, trends in surgical approaches and reconstruction techniques, and important lessons learned from performing 1000 consecutive pancreaticoduodenectomies (PDs) for periampullary tumors.
METHODS This is a retrospective review of the data of all patients who underwent PD for periampullary tumor during the period from January 1993 to April 2017. The data were categorized into three periods, including early period (1993-2002), middle period (2003-2012), and late period (2013-2017).
RESULTS The frequency showed PD was increasingly performed after the year 2000. With time, elderly, cirrhotic and obese patients, as well as patients with uncinate process carcinoma and borderline tumor were increasingly selected for PD. The median operative time and postoperative hospital stay decreased significantly over the periods. Hospital mortality declined significantly, from 6.6% to 3.1%. Postoperative complications significantly decreased, from 40% to 27.9%. There was significant decrease in postoperative pancreatic fistula in the second 10 years, from 15% to 12.7%. There was a significant improvement in median survival and overall survival among the periods.
CONCLUSION Surgical results of PD significantly improved, with mortality rate nearly reaching 3%. Pancreatic reconstruction following PD is still debatable. The survival rate was also improved but the rate of recurrence is still high, at 36.9%.
Collapse
Affiliation(s)
- Ayman El Nakeeb
- Gastroenterology surgical center, Mansoura University, Mansoura 35516, Egypt
| | - Waleed Askar
- Gastroenterology surgical center, Mansoura University, Mansoura 35516, Egypt
| | - Ehab Atef
- Gastroenterology surgical center, Mansoura University, Mansoura 35516, Egypt
| | - Ehab El Hanafy
- Gastroenterology surgical center, Mansoura University, Mansoura 35516, Egypt
| | - Ahmad M Sultan
- Gastroenterology surgical center, Mansoura University, Mansoura 35516, Egypt
| | - Tarek Salah
- Gastroenterology surgical center, Mansoura University, Mansoura 35516, Egypt
| | - Ahmed shehta
- Gastroenterology surgical center, Mansoura University, Mansoura 35516, Egypt
| | - Mohamed El Sorogy
- Gastroenterology surgical center, Mansoura University, Mansoura 35516, Egypt
| | - Emad Hamdy
- Gastroenterology surgical center, Mansoura University, Mansoura 35516, Egypt
| | - Mohamed El Hemly
- Gastroenterology surgical center, Mansoura University, Mansoura 35516, Egypt
| | - Ahmed A El-Geidi
- Gastroenterology surgical center, Mansoura University, Mansoura 35516, Egypt
| | - Tharwat Kandil
- Gastroenterology surgical center, Mansoura University, Mansoura 35516, Egypt
| | - Mohamed El Shobari
- Gastroenterology surgical center, Mansoura University, Mansoura 35516, Egypt
| | - Talaat Abd Allah
- Gastroenterology surgical center, Mansoura University, Mansoura 35516, Egypt
| | - Amgad Fouad
- Gastroenterology surgical center, Mansoura University, Mansoura 35516, Egypt
| | - Mostafa Abu Zeid
- Gastroenterology surgical center, Mansoura University, Mansoura 35516, Egypt
| | - Ahmed Abu El Eneen
- Gastroenterology surgical center, Mansoura University, Mansoura 35516, Egypt
| | - Nabil Gad El-Hak
- Gastroenterology surgical center, Mansoura University, Mansoura 35516, Egypt
| | - Gamal El Ebidy
- Gastroenterology surgical center, Mansoura University, Mansoura 35516, Egypt
| | - Omar Fathy
- Gastroenterology surgical center, Mansoura University, Mansoura 35516, Egypt
| | - Ahmed Sultan
- Gastroenterology surgical center, Mansoura University, Mansoura 35516, Egypt
| | - Mohamed Abdel Wahab
- Gastroenterology surgical center, Mansoura University, Mansoura 35516, Egypt
| |
Collapse
|
7
|
Lin RG, Huang HG, Chen YC, Lu FC, Lin XC, Yang YY, Fang HZ, Wang CF. [Choices of methods in dividing the neck of pancreas in laparoscopic pancreaticoduodenectomy]. Zhonghua Wai Ke Za Zhi 2017; 55:667-670. [PMID: 28870051 DOI: 10.3760/cma.j.issn.0529-5815.2017.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To discuss the methods, skills and experiences of dividing the neck of pancreas in laparoscopic pancreaticoduodenectomy(LPD). Methods: The clinical data of 58 patients with periampullary tumors who received LPD at the Union Hospital of Fujian Medical University from December 2014 to January 2017 were retrospectively analyzed.There were 26 males and 32 females, ranged from 18 to 65 years, with a mean age of (46±12)years. Results: All of the 58 patients underwent operation smoothly.Three cases underwent open anastomosis via an auxiliary incision after the total resection of specimen laparoscopically, due to the early learning curve of LPD.Two cases transformed into open operation as a result of tumor vascular invasion to portal vein(PV) or superior mesenteric vein(SMV). Fifty-three cases underwent laparoscopic or laparoscopic combined with robotic pancreaticoduodenectomy completely.Forty-two cases ligated gastroduodenal artery(GDA), fully penetrated the interspace between rear of pancreatic neck and SMV, suspended the pancreas and then divided the neck of pancreas from inferior to superior. Thirteen cases fully dissected the interspace between rear of pancreatic neck and SMV, divided the neck of pancreas from inferior to superior and then ligated GDA.Three cases ligated GDA, dissected PV and SMV at the superior and inferior margin of the neck of pancreas separately, and then divided pancreas from anterior to posterior.Mean time of dividing pancreas was (34.9±9.7)minutes, mean volume of blood loss while dividing pancreas was (30.1±8.2)ml.The main postoperative complications included pancreatic fistula(7 cases, Biochemical leak 2 cases, B grade 3 cases, C grade 2 cases), biliary fistula(3 cases), gastric fistula(1 case), delayed gastric emptying(1 case, C grade), abdominal infection(5 cases), hepatic failure (1 case), intra-abdominal hemorrhage(2 cases), reoperation(2 cases). One case died at the perioperative period while others recovered.The mean duration of postoperative stay was (14.2±5.1)days. Conclusions: Dividing the neck of pancreas is one of the most important steps in LPD, which deserved sufficient attention.At the meantime, a suitable method of dividing the neck of pancreas should be chosen according to intraoperative exploration and preoperative imageological examinations.
Collapse
Affiliation(s)
- R G Lin
- Department of General Surgery, Union Hospital, Fujian Medical University, Fuzhou 350001, China
| | | | | | | | | | | | | | | |
Collapse
|
8
|
Abstract
Backgrounds/Aims Surgical resection, such as pancreaticoduodenectomy (PD), is used for treatment of benign periampullary tumors, but high morbidity and mortality resulting from PD can be a huddle. The aim of this study is to suggest a safe and less invasive procedure for treatment of benign periampullary tumors. Methods From January 2001 to September 2016, 31 patients with ampulla of Vater (AOV) tumors were reviewed retrospectively. Patients who were confirmed with malignancy through biopsy were excluded, except for one patient with malignancy and multiple underlying diseases. To investigate the safety and availability of transduodenal ampullectomy (TDA), TDA and endoscopic papillectomy (EP) were compared. Results There was no significant difference in the occurrence of complications between the TDA group and EP group (p=0.145), and the resection margins were negative in both groups. There was no recurrence in patients who had TDA, while one patient had a recurrence after EP. Conclusions This study suggests that TDA is as safe as EP for treating benign periampullary tumors.
Collapse
Affiliation(s)
- Alvin Lyle Kim
- Department of Surgery, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
| | - Young Il Choi
- Department of Surgery, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
| |
Collapse
|
9
|
Buanes TA. Updated therapeutic outcome for patients with periampullary and pancreatic cancer related to recent translational research. World J Gastroenterol 2016; 22:10502-10511. [PMID: 28082802 PMCID: PMC5192261 DOI: 10.3748/wjg.v22.i48.10502] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 10/14/2016] [Accepted: 11/28/2016] [Indexed: 02/06/2023] Open
Abstract
Chemotherapy with improved effect in patients with metastatic pancreatic cancer has recently been established, launching a new era for patients with this very aggressive disease. FOLFIRINOX and gemcitabine plus nab-paclitaxel are different regimens, both capable of stabilizing the disease, thus increasing the number of patients who can reach second line and even third line of treatment. Concurrently, new windows of opportunity open for nutritional support and other therapeutic interventions, improving quality of life. Also pancreatic surgery has changed significantly during the latest years. Extended operations, including vascular/multivisceral resections are frequently performed in specialized centers, pushing borders of resectability. Potentially curative treatment including neoadjuvant and adjuvant chemotherapy is offered new patient groups. Translational research is the basis for the essential understanding of the ongoing development. Even thou biomarkers for clinical management of patients with periampullary tumors have almost been lacking, biomarker driven trials are now in progress. New insight is constantly made available for clinicians; one recent example is selection of patients for gemcitabine treatment based on the expression level of the human equilibrium nucleoside transporter 1. An example of new diagnostic tools is identification of early pancreatic cancer patients by a three-biomarker panel in urine: The proteins lymphatic vessel endothelial hyaluronan receptor 1, regenerating gene 1 alpha and translation elongation factor 1 alpha. Requirement of treatment guideline revisions is intensifying, as combined chemotherapy regimens result in unexpected advantages. The European Study Group for Pancreatic Cancer 4 trial outcome is an illustration: Addition of capecitabine in the adjuvant setting improved overall survival more than expected from the effect in advanced disease. Rapid implementation of new treatment options is mandatory when progress finally extends to patients with this serious disease.
Collapse
|
10
|
Mistry JH, Yadav A, Nundy S. Ampullary carcinoma in a patient with agenesis of the dorsal pancreas: a case report. Indian J Surg 2014; 77:32-4. [PMID: 25972636 DOI: 10.1007/s12262-014-1082-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 04/23/2014] [Indexed: 11/24/2022] Open
Abstract
The most common congenital anomaly of the pancreas is pancreatic divisum (Tadokoro et al. in Anat Res Int 2011:1-7, 2011). Agenesis of the dorsal pancreas is extremely rare (Schnedl et al. in World J Gastroenterol 15(3):376-377, 2009). We are reporting a case of agenesis of dorsal pancreas presented with ampullary carcinoma.
Collapse
Affiliation(s)
- Jitendra H Mistry
- Kaizen Hospital, Institute of Gastroenterology and Research Centre, Ahmedabad, 380052 India
| | | | | |
Collapse
|
11
|
Zhang RC, Xu XW, Wu D, Zhou YC, Ajoodhea H, Chen K, Mou YP. Laparoscopic transduodenal local resection of periampullary neuroendocrine tumor: A case report. World J Gastroenterol 2013; 19:6693-6698. [PMID: 24151401 PMCID: PMC3801388 DOI: 10.3748/wjg.v19.i39.6693] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 08/30/2013] [Accepted: 09/05/2013] [Indexed: 02/06/2023] Open
Abstract
Studies on laparoscopic transduodenal local resection have not been readily available. Only three cases have been reported in the English-language literature. We describe herein a case of 25-year-old woman with periampullary neuroendocrine tumor (NET). Endoscopic ultrasonography revealed a duodenal papilla mass originated from the submucosa and close to the ampulla. The periampullary tumor was successfully managed with laparoscopic transduodenal local resection without any procedure-related complications. Pathological examination showed a NET (Grade 2) with negative margin. The patient was followed up for six months without signs of recurrence. This case suggests that laparoscopic transduodenal local resection is a feasible procedure in selected patients with periampullary tumor.
Collapse
|
12
|
Sathyamurthy A, Choudhary A, Ng D, Okponobi S, Diaz-Arias A, Grewal A, Hammoud GM. Obstructive jaundice due to a rare periampullary tumor. World J Gastrointest Oncol 2013; 5:195-197. [PMID: 24137522 PMCID: PMC3796670 DOI: 10.4251/wjgo.v5.i10.195] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 08/06/2013] [Accepted: 09/04/2013] [Indexed: 02/05/2023] Open
Abstract
Gangliocytic paraganglioma is a rare neuroendocrine tumor predominantly arising in the second part of the duodenum with rare local recurrence or metastasis to regional lymph nodes. A 92-year-old female presented with obstructive jaundice. On exam she had pale conjunctiva and icteric sclera. Abdominal examination revealed tenderness in the upper abdomen. Laboratory data was consistent with obstructive jaundice. Computed tomography of the abdomen revealed a dilated gall bladder and a common bile duct (CBD) with no evidence of liver lesions or pancreatic head mass. Endoscopic ultrasonography revealed a 1 cm isoechoic submucosal nodule at the periampullary area, dilated CBD (9 mm), a prominent pancreatic duct (4.1 mm) and a hydropic gall bladder with no stones. Endoscopic retrograde cholangiopancreaticography was performed to relieve obstruction and showed a 1 cm periampullary mass which underwent an en-bloc snare resection. Histopathology analyses with immunohistochemical stains were positive for cytokeratin, synaptophysin, S-100 protein, neuron specific enolase and negative for actin and desmin consistent with periampullary gangliocytic paraganglioma. Periampullary gangliocytic paraganglioma is a rare benign tumor of the small bowel. Common presentation includes abdominal pain and obstructive jaundice which should be included in differential diagnosis of obstructive jaundice. Endoscopic resection is a curative therapy in the absence of local invasion or distant metastasis.
Collapse
|