Gastrointestinal: Unusual cause of painless jaundice after cholecystectomy

Carcinomas of the ampulla of Vater are uncommon tumors but have a better prognosis than typical pancreatic cancers. They tend to be well or moderately differentiated while the poorly differentiated variants are still quite aggressive. Signet ring features associated with poor differentiation traditionally confer a dismal prognosis in other gastrointestinal malignancies, particularly gastric cancer. Signet cell ring morphology has only been described in a few ampullary carcinomas with all cases reporting short follow-up. We describe a 58-year-old woman who presented with painless jaundice and a prominent ampulla of Vater by endoscopy. She underwent pancreaticoduodenectomy and was found to have a 1.0 x 0.8 cm poorly differentiated carcinoma with prominent signet ring cell features arising from the ampulla of Vater and invading into the periampullary duodenum but sparing the pancreatic parenchyma. No distant or nodal metastases were seen (pT2N0M0). No adjuvant therapy was given, and the patient remains free of disease with 134 months of follow-up.

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Biliary Obstruction: Endoscopic Approaches

Seminars in Interventional Radiology ◽

10.1055/s-0037-1608828 ◽

2017 ◽

Vol 34 (04) ◽

pp. 369-375 ◽

Cited By ~ 6

Author(s):

Tomas DaVee ◽

Jeffrey Lee

Keyword(s):

Pancreatic Cancer ◽

Biliary Obstruction ◽

Epigastric Pain ◽

Surgical Techniques ◽

Malignant Biliary Obstruction ◽

Metal Stents ◽

Biliary Stents ◽

Term Survival ◽

Painless Jaundice

AbstractPainless jaundice is a harbinger of malignant biliary obstruction, with the majority of cases due to pancreatic adenocarcinoma. Despite advances in treatment, including improved surgical techniques and neoadjuvant (preoperative) chemotherapy, long-term survival from pancreatic cancer is rare. This lack of significant improvement in outcomes is believed to be due to multiple reasons, including the advanced stage at diagnosis and lack of an adequate biomarker for screening and early detection, prior to the onset of jaundice or epigastric pain. Close attention is required to select appropriate patients for preoperative biliary decompression, and to prevent morbid complications from biliary drainage procedures, such as pancreatitis and cholangitis. Use of small caliber plastic biliary stents during endoscopic retrograde cholangiopancreatography should be minimized, as metal stents have increased area for improved bile flow and a reduced risk of adverse events during neoadjuvant therapy. Efforts are underway by translational scientists, radiologists, oncologists, surgeons, and gastroenterologists to augment lifespan for our patients and to more readily treat this deadly disease. In this review, the authors discuss the rationale and techniques of endoscopic biliary intervention, mainly focusing on malignant biliary obstruction by pancreatic cancer.

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Painless jaundice with serial multi-organ dysfunction

The Lancet ◽

10.1016/s0140-6736(09)60615-2 ◽

2009 ◽

Vol 373 (9673) ◽

pp. 1494 ◽

Cited By ~ 27

Author(s):

Arezou Khosroshahi ◽

James R Stone ◽

Daniel S Pratt ◽

Vikram Deshpande ◽

John H Stone

Keyword(s):

Organ Dysfunction ◽

Painless Jaundice

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Painless Jaundice Caused by Clonorchis sinensis Infection: A Case Report

The Korean Journal of Parasitology ◽

10.3347/kjp.2016.54.3.323 ◽

2016 ◽

Vol 54 (3) ◽

pp. 323-327 ◽

Cited By ~ 3

Author(s):

Yuhua Hao ◽

Wanguo Bao ◽

Meishan Jin ◽

Yuxiang Li ◽

Feng Wang

Keyword(s):

Case Report ◽

Clonorchis Sinensis ◽

Painless Jaundice

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Carcinosarcoma of the Pancreas Arising in a Mucinous Cystic Neoplasm

The American Surgeon ◽

10.1177/000313480607200416 ◽

2006 ◽

Vol 72 (4) ◽

pp. 351-355 ◽

Cited By ~ 13

Author(s):

Mark Bloomston ◽

Jose Chanona-Vilchis ◽

E. Christopher Ellison ◽

Nilsa C. Ramirez ◽

Wendy L. Frankel

Keyword(s):

Mucinous Cystic Neoplasm ◽

Nodal Metastasis ◽

Uneventful Recovery ◽

Cystic Neoplasm ◽

Painless Jaundice ◽

Head Of The Pancreas ◽

Poorly Differentiated ◽

Well Differentiated ◽

Immunohistochemical Studies ◽

Work Up

We report a carcinosarcoma of the pancreas in a 67-year-old woman who presented with nausea, vomiting, and painless jaundice. A work-up demonstrated a well-circumscribed mass in the head of the pancreas. After pylorus-preserving pancreaticoduodenectomy, the tumor was found to be grossly yellow, and it compressed the common bile duct and pancreatic duct. Histological examination of the neoplasm showed a 4.0 x 4.0 x 3.0-cm mucinous cystadenocarcinoma with invasive poorly differentiated carcinoma, well-differentiated squamous cell carcinoma, and sarcomatous stroma invading into the duodenum. There was no evidence of nodal metastasis (pT3N0M0). Immunohistochemical studies showed that the epithelial cells stained positive for cytokeratin 7, cytokeratin AE1/3, cytokeratin monoclonal antibody 5.2, epithelial membrane antigen, M-carcinoembryonic antigen, and low-molecular-weight kininogen, and the sarcomatous component was immunoreactive with vimentin. The patient had an uneventful recovery, but died 4 months later of rapidly progressive metastatic disease to the liver and peritoneum. To the best of our knowledge, this is the second case of carcinosarcoma with invasive epithelial and sarcomatous areas in the background of a mucinous cystic neoplasm of the pancreas.

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Methimazole induced hepatotoxicity: A rare adverse reaction

Case Reports in Internal Medicine ◽

10.5430/crim.v6n3p1 ◽

2019 ◽

Vol 6 (3) ◽

pp. 1

Author(s):

Kevin C. Kohm ◽

Lauren Pioppo ◽

Jack Xu ◽

Preston Keiffer ◽

Eric Pagan ◽

...

Keyword(s):

Liver Injury ◽

Liver Function ◽

Side Effect ◽

Hepatic Injury ◽

Total Bilirubin ◽

Liver Function Tests ◽

Side Effect Profile ◽

Function Tests ◽

Painless Jaundice ◽

Graves Orbitopathy

Methimazole (MMI) is a commonly used medication in the treatment of hyperthyroidism. The side effect profile is extensive and includes the rare but serious side effect of drug associated liver injury. We report the case of a 51-year-old female who presented with painless jaundice several weeks after initiating MMI therapy for treatment of hyperthyroidism complicated by Graves’ orbitopathy. Liver function tests on presentation showed alanine aminotransferase (ALT) 1366 IU/L, aspartate aminotransferase (AST) 853 IU/L, total bilirubin 26.2 mg/dl, alkaline phosphatase 954 IU/L. Workup of structural, infectious, and autoimmune causes of hepatic injury was negative. The patient was therefore found to have MMI associated liver injury. MMI was discontinued and the patient was started on ursodiol, resulting in resolution of her jaundice and improvement of her liver function tests.

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Obstructive Jaundice due to Pancreatic Involvement as an Initial Presentation of Adult Acute Lymphoblastic Leukemia

Case Reports in Hematology ◽

10.1155/2018/9175360 ◽

2018 ◽

Vol 2018 ◽

pp. 1-3

Author(s):

Oreoluwa Oladiran ◽

Ifeanyi Nwosu

Keyword(s):

Bone Marrow ◽

Acute Lymphoblastic Leukemia ◽

Lymphoblastic Leukemia ◽

Lymph Node Biopsy ◽

Lymphoid Cells ◽

Peripheral Blood Flow ◽

Pancreatic Involvement ◽

Treatment Centre ◽

Painless Jaundice ◽

Bone Marrow Blood

Acute lymphoblastic leukemia (ALL) is a heterogeneous group of lymphoid disorders characterized by monoclonal proliferation and expansion of immature lymphoid cells in the bone marrow, blood, and other organs. It commonly presents with nonspecific symptoms such as lethargy, easy bruising, and weight loss. In this article, we present the case of a 48-year-old male who presented to the hospital with painless jaundice resulting from pancreatic infiltration, initially thought to be due to pancreatic or hepatobiliary malignancy. He was later diagnosed with ALL by lymph node biopsy and peripheral blood flow cytometry immunophenotyping and was transferred to a cancer treatment centre for unilateral bone marrow biopsy and further management. Our case highlights the rare occurrence of pancreatic infiltration in ALL.

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