Successful curative surgery for postoperative oesophageal recurrence of oesophagogastric junction cancer

A man in his 70s had undergone total gastrectomy for oesophagogastric junction cancer. Three years and 11 months later, he began to vomit after meals and was diagnosed with mediastinal recurrence of oesophagogastric junction cancer. A CT scan showed that the tumour was suspected of infiltrating the aorta and lung. He received two cycles of chemotherapy with S-1 plus cisplatin, resulting in tumour reduction. The patient underwent resection of the lower oesophagus, including the tumour, the left lower lobe of the lung and the pericardium through a left thoracoabdominal incision. This is the first report of a patient surgically resected for postoperative oesophageal recurrence of oesophagogastric junction cancer. Although most postoperative recurrences of oesophagogastric junction cancer are far advanced at the time of diagnosis and prognosis is poor, chemotherapy followed by surgery may improve the prognosis of patients with locoregional recurrence.

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Infections of the Aorta: Case Report and Review of Treatment

Vascular ◽

10.1258/rsmvasc.13.4.252 ◽

2005 ◽

Vol 13 (4) ◽

pp. 252-256 ◽

Cited By ~ 6

Author(s):

Shannon Lehner ◽

Catherine Wittgen

Keyword(s):

Back Pain ◽

Case Report ◽

Ct Scan ◽

Rapid Development ◽

Compression Fracture ◽

Lower Lobe ◽

Computed Tomographic ◽

Emergent Operation ◽

Surgical Options

Radiographic documentation of the rapid development of an aortic infection has not previously been reported. We report the case of a 68-year-old woman who presented with back pain. A computed tomographic(CT) scan documented a nondisplaced L1 compression fracture as well as an atherosclerotic but nonaneurysmal aorta. Two weeks after discharge, she developed left lower lobe pneumonia and was readmitted. A second CT scan was obtained because of continuous complaints of back pain. A contained rupture of the visceral aorta was now clearly visible. Emergent operation successfully repaired her aorta. The microorganisms responsible for aortic infection have changed since the widespread use of antibiotics. Patterns of aortic involvement have also evolved. The difficulty in making these diagnoses, the role of current antibiotic therapy, and the surgical options for these infections will be discussed.

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Pancreatic enzymatic mediastinitis followed by total gastrectomy with splenectomy: report of two cases

Surgical Case Reports ◽

10.1186/s40792-021-01240-5 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Yoko Zaitsu ◽

Takashi Nishizaki ◽

Takuma Izumi ◽

Daisuke Taniguchi ◽

Yuichiro Kajiwara ◽

...

Keyword(s):

Gastric Cancer ◽

Abdominal Surgery ◽

Ct Scan ◽

Pancreatic Fistula ◽

Medical History ◽

Advanced Gastric Cancer ◽

Total Gastrectomy ◽

Upper Body ◽

History Of ◽

Acute Mediastinitis

Abstract Background Acute mediastinitis is a rare disease that rapidly progresses with a high mortality rate. Its most common cause is direct injury of the mediastinum, including iatrogenic causes such as cardiac surgery or upper endoscopy. Enzymatic mediastinitis is a rare complication of a pancreatic fistula caused by the inflammatory digestion of the parietal peritoneum spreading to the mediastinum. Here, we present two cases of enzymatic mediastinitis caused by total gastrectomy with splenectomy. One of them was successfully treated and cured after early diagnosis and transabdominal drainage. Case presentation Case 1 was that of a 60-year-old man (body mass index [BMI] 27) with a medical history of diabetes and hypertension who was diagnosed with advanced gastric cancer in the upper body of the stomach. A total gastrectomy with splenectomy was performed. The patient experienced acute respiratory failure 24 h after surgery. Pulmonary embolism was suspected, so a computed tomography (CT) scan was performed; however, no relevant causes were found. Although he was immediately intubated and treated with catecholamine, he died in the intensive care unit (ICU) 40 h after surgery. Post-mortem findings revealed retroperitonitis caused by a pancreatic fistula spreading towards the mediastinum, causing severe mediastinitis; a review of the CT scan revealed pneumomediastinum. We concluded that the cause of death was enzymatic mediastinitis due to post-gastrectomy pancreatic fistula. Case 2 involved a 61-year-old man (BMI 25) with a medical history of appendicitis who was diagnosed with advanced gastric cancer at the gastric angle between the lesser curvature and the pylorus, spreading to the upper body of the stomach. A total gastrectomy with splenectomy was also performed. The patient had a high fever 3 days after the surgery, and a CT scan revealed pneumomediastinum, indicating mediastinitis. As the inflammation was below the bronchial bifurcation, we chose a transabdominal approach for drainage. The patient was successfully treated and discharged. Conclusion Acute mediastinitis caused by gastrectomy is rare. The acknowledgment of abdominal surgery as a cause of mediastinitis is important. In treating mediastinitis caused by abdominal surgery, transabdominal drainage may be a minimally invasive yet effective method if the inflammation is mainly located below the bifurcation of the trachea.

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Castleman's Disease: An Intrapulmonary Form with Intrafissural Development

The Scientific World JOURNAL ◽

10.1100/tsw.2009.110 ◽

2009 ◽

Vol 9 ◽

pp. 940-945 ◽

Cited By ~ 6

Author(s):

Hajer Racil ◽

Sana Cheikh Rouhou ◽

Olfa Ismail ◽

Saoussen Hantous-Zannad ◽

Nawel Chaouch ◽

...

Keyword(s):

Contrast Enhancement ◽

Castleman’S Disease ◽

Lower Lobe ◽

Unknown Etiology ◽

Castleman's Disease ◽

Curative Surgery ◽

Abnormal Shadow ◽

History Of ◽

Chest X Ray ◽

The Right

Castleman's disease (CD) is an uncommon, mainly benign, lymphoproliferative disorder of unknown etiology, mostly involving the mediastinum. Parenchymal lung involvement of the disease is exceedingly rare. We describe a case of CD in a 23-year-old woman with a 4-year history of recurring dyspnea and nonproductive cough, whose chest X-ray showed an abnormal shadow of the right hilum. Chest computed tomography confirmed the presence of a tissue-density mass of the right lower lobe, demonstrating poor contrast enhancement, associated with multiple laterotracheal and mediastinal lymphadenopathies. The patient underwent curative surgery, revealing a right hilar compressive mass, with an intrafissural development between the superior and middle lobes. Pneumonectomy was performed due to profuse bleeding. This case of CD is particular because of its unusual intrapulmonary location and its intrafissural development. Poor contrast enhancement is atypical in CD.

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Multiple Pulmonary Pleomorphic Adenomas of Unknown Primary

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqaa161.080 ◽

2020 ◽

Vol 154 (Supplement_1) ◽

pp. S38-S39

Author(s):

X Liu ◽

W Miller

Keyword(s):

Ct Scan ◽

Salivary Glands ◽

Lower Lobe ◽

Unknown Primary ◽

Benign Tumors ◽

Low Grade ◽

Eosinophilic Cytoplasm ◽

Pleomorphic Adenomas ◽

Multiple Primary ◽

History Of

Abstract Introduction/Objective The most common site of pleomorphic adenomas (PAs) is salivary glands, which behave as benign tumors and rarely metastasize. Primary PAs in lungs are exceedingly rare. We report a case of multiple PAs in lungs with an inconclusive origin. Methods A 65-year-old woman had a two-year history of numerous scattered bilateral well-circumscribed pulmonary nodules measuring up to 2.1 cm. She had no prior history of smoking, asbestos exposure and salivary gland diseases, and denied any symptoms. The latest chest computed tomography (CT) scan showed the two largest lower lobe nodules had mildly increased in size compared to two years before. The patient then underwent wedge resections. Results Grossly, the wedge resection specimens showed multiple well-circumscribed, pale tan, firm nodules. Microscopically, the nodules comprised cytologically bland nests of polygonal to plasmacytoid cells with eosinophilic cytoplasm, variably set in a myxoid matrix. Immunohistochemical stains demonstrated that the cells were positive for AE-1/AE-3, S-100, bcl-2 and SOX-10, and negative for chromogranin, smooth muscle actin, p63, calponin, PAX-8, CD34, CD31, HMB-45, melan-A, HHF-35, GATA-3, GFAP and RCC marker; TTF-1 highlighted entrapped pulmonary epithelium but the tumor cells were negative. These findings might suggest metastatic low grade PA from salivary glands. However, the patient’s follow-up examination by an otolaryngologist was normal; the CT scan of her chest and abdomen did not show any remarkable findings other than her lung nodules. Conclusion To our knowledge, this is the first reported case of multiple pulmonary PAs without a preceding primary. It has raised questions about the pathogenesis of multiple PAs in lungs. Could PA present as multiple primary nodules in lungs? Could one primary pulmonary PA generate multiple satellite nodules in lungs? Do multiple primary pulmonary PAs have a different IHC profile than that of a single primary pulmonary PA? More research is needed.

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Late term renal complications related to chemoradiotherapy in patients with gastric cancer

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.15033 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 15033-15033

Author(s):

A. Mayadagli ◽

O. O. Seseogullari ◽

C. Gemici ◽

A. Ozkan ◽

C. Parlak ◽

...

Keyword(s):

Gastric Cancer ◽

Total Gastrectomy ◽

Renal Damage ◽

Statistical Significance ◽

Combined Treatment ◽

Subtotal Gastrectomy ◽

Renal Scintigraphy ◽

Normal Range ◽

Curative Surgery ◽

Renal Complications

15033 Background: The aim of this study is to evaluate late term renal complications of the combined treatment with chemoradiotherapy, according to the scheme of McDonald et al, in patients diagnosed with gastric cancer, after radical curative surgery. Methods: Totally 44 patients who administered to our clinic between years 2003 and 2004, with the diagnosis of gastric cancer, and with the age-adjusted creatinine clearance test (CCT) results within normal range, were enrolled into the study. Surgical procedure was subtotal gastrectomy in 34 patients (63,6%), and total gastrectomy in 16 patients (36,4%). Total 4600 cGy radiotherapy was administered to all patients through parallel-opposed AP-PA fields in 23 fractions concomitant with chemotherapy according to the scheme of McDonald et al. One year after the completion of the treatment, a technetium 99-m renal scintigraphy (DMSA) and CCT were performed to all patients whose renal functions were within normal limits. Results: Median age in the study was 52 (22–78). 34 patients (77,3%) were male and 10 (22,7%) were female. TNM stages were stage II in 15 (34,1%), IIIA in 21 (47,7%), IIIB in 4 (9,1%), and IV in 4 cases (9,1%). CCT measured 1 year after the treatment was low in 13 patients (29,6%), and within normal range in 31 patients (70,4%). Renal scintigraphy revealed damage at one pole in 32 patients (72,7%), damage at bilateral renal poles in 8 patients (18,3%), and it was normal in 4 patients (9%). Renal damage was higher in left kidneys than right kidneys (89,9% vs. 15,4%). There was a correlation between CCT values and scintigraphical findings. Damage in bilateral renal poles was higher in cases with low CCT than in cases with normal values (85,7% vs. 15,4). In general, there were no statistically significant relationship between late term renal complications and sex, and grade III treatment-related gastrointestinal toxicity. However, the relationships with age, extent of surgery reached statistical significance (p=0.009, and =0.006). Renal damage was notably higher in older patients, and in patients who underwent total gastrectomy. Conclusions: Since postoperative chemoradiotherapy is a novel modality for the treatment of gastric cancer, more studies are required in order to evaluate chronic toxicities. No significant financial relationships to disclose.

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Ten-year follow-up results of a randomized clinical trial comparing left thoracoabdominal and abdominal transhiatal approaches to total gastrectomy for adenocarcinoma of the oesophagogastric junction or gastric cardia

British Journal of Surgery ◽

10.1002/bjs.9764 ◽

2015 ◽

Vol 102 (4) ◽

pp. 341-348 ◽

Cited By ~ 51

Author(s):

Y. Kurokawa ◽

M. Sasako ◽

T. Sano ◽

T. Yoshikawa ◽

Y. Iwasaki ◽

...

Keyword(s):

Clinical Trial ◽

Randomized Clinical Trial ◽

Total Gastrectomy ◽

Gastric Cardia ◽

Oesophagogastric Junction

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Neuroendocrine Tumour of the Lung: A Diagnostic Challenge

Journal of Clinical and Health Sciences ◽

10.24191/jchs.v4i2.7550 ◽

2019 ◽

Vol 4 (2) ◽

pp. 97

Author(s):

Nur Hidayah Bahrom ◽

Anis Safura Ramli ◽

Nor Suraya Samsudin ◽

Norliana Dalila Mohamad Ali ◽

Nor Salmah Bakar

Keyword(s):

Primary Care ◽

Tranexamic Acid ◽

Ct Scan ◽

Neuroendocrine Tumour ◽

Somatostatin Receptor ◽

Primary Care Clinic ◽

Lower Lobe ◽

Mediastinal Lymphadenopathy ◽

Care Clinic ◽

Persistent Symptoms

This is a case of a 62-year-old Indian man who was diagnosed with a rare type of lung neuroendocrine tumour (NET) of atypical carcinoid (AC) subtype which comprise only 0.1%–0.2% of pulmonary neoplasms. He initially presented to a private hospital in May 2018 with a 6-month history of chronic productive cough and haemoptysis. Chest X-Ray (CXR), CT scan, bronchoscopy, biopsy and broncho-alveolar lavage were conducted. At this stage, imaging and histopathological investigations were negative for malignancy. Diagnosis of bronchiectasis was made and he was treated with antibiotic and tranexamic acid. Due to financial difficulties, his care was transferred to a university respiratory clinic in June 2018. His condition was monitored with CXR at every visit and treatment with tranexamic acid was continued for 6 months. However, due to persistent haemoptysis, he presented to the university primary care clinic in Dec 2018. Investigations were repeated in January 2019 where his CXR showed increased opacity of the left retrocardiac region and CT scan revealed a left lower lobe endobronchial mass causing collapse with mediastinal lymphadenopathy suggestive of malignancy. Bronchoscopy, biopsy and histopathology confirmed the presence of NET. Although the Ki-67 index was low, the mitotic count, presence of necrosis and evidence of liver metastases favoured the diagnosis of AC. A positron emission tomography Ga-68 DONATOC scan showed evidence of somatostatin receptor avid known primary malignancy in the lungs with suspicions of liver metastasis. He was subsequently referred to the oncology team and chemotherapy was initiated. This case highlights the challenge in diagnosis and management of patients with AC. Physicians ought to be vigilant and have a high index of suspicion in patients who present with persistent symptoms on multiple visits. Early diagnosis of NET would prevent metastasis and provide better prognosis. Continuous follow-up shared care between primary care and secondary care physicians is also essential to provide ongoing psychosocial support for patients with NET, especially those with metastatic disease.

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Acute Ischaemic Enterocolitis Due to a Thrombotic Event in a COVID-19 Patient

Surgical Case Reports ◽

10.31487/j.scr.2021.01.14 ◽

2021 ◽

pp. 1-3

Author(s):

Montse Adell Trapé ◽

Anna Curell Garcia ◽

Xavier Guri Azogue ◽

Adriana Carolina Zucchiatti Llanos ◽

...

Keyword(s):

Ct Scan ◽

Thrombotic Event ◽

Vena Cava ◽

Lower Lobe ◽

Abdominal Distension ◽

Exploratory Laparotomy ◽

Endothelial Activation ◽

Pathological Examination ◽

Respiratory Impairment ◽

Aged Woman

We describe the case of a COVID-19 patient who developed an intestinal ischaemia with thrombotic origin, confirmed by anatomo-pathological examination. A middle-aged woman affected with COVID-19 was evaluated in March 2020. Reverse transcriptase-polymerase chain reaction (RT-PCR) to detect SARS-CoV2 was performed. On the 16th day of being hospitalized, she presented with hemodynamic and respiratory impairment. The physical examination revealed abdominal distension. An urgent abdominal CT scan reported signs of pneumatosis in the distal ileum and ascending colon suggestive of ischaemia (Figure 1D), with mural irregularity predominantly in the ileum. An urgent exploratory laparotomy was performed. Ischaemia of the right colon, as well as patched ischaemia of the distal and middle ileum, was found (Figures 2A & 2B). A right hemicolectomy and resection of the distal-middle ileum with a terminal ileostomy were performed. Pathological examination reported: severe ischaemic colitis, with areas of mucosal necrosis and the presence of abundant small-calibre thrombi in the submucosa and medium-caliber vessels of the mesocolon. Re-examination of the CT scan revealed findings consistent with right lower lobe segmental pulmonary embolism, as well as inferior vena cava filling defects consistent with thrombi. COVID-19 is associated with a large and misleading field of complications, including coagulopathy. The combination of viral injury, cytokine release, and damage-associated molecular patterns induce localized microvascular inflammation, which triggers endothelial activation, leading to vasodilation and prothrombotic conditions. We report this case to alert physicians that they should be vigilant for signs of abdominal thromboembolic complications in patients suffering from COVID-19

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Rasmussen's Aneurysm Associate With Pulmonary Artery Vascular Malformation Presented With Haemoptysis

KYAMC Journal ◽

10.3329/kyamcj.v10i3.44424 ◽

2019 ◽

Vol 10 (3) ◽

pp. 168-170

Author(s):

Khaleda Parvin Rekha ◽

Umme Iffat Siddiqua ◽

Md Mofazzal Sharif ◽

Md Musharraf Husain ◽

Mohammad Abdus Salam

Keyword(s):

Pulmonary Artery ◽

Ct Scan ◽

Vascular Malformation ◽

Left Lung ◽

Lower Lobe ◽

Low Grade ◽

Imaging Department ◽

Increased Risk ◽

Risk Of Rupture ◽

Contrast Ct

Rasmussen's aneurysm is an inflammatory pseudo-aneurysmal dilatation of a branch of pulmonary artery associated with a cavitary lung lesion. Like any aneurysm, a Rasmussen's aneurysm is at increased risk of rupture and bleeding into the lungs. A 52 years old male presented with low-grade fever and haemoptysis, chest x-ray revealed a well margined nodular shadow with calcifications in mid zone of left lung associated with ipsilateral upper zone fibrosis and bronchiectasis. The patient had past history of pulmonary tuberculosis eight years back. For characterization of left pulmonary nodule the patient was referred to radiology and Imaging department and contrast CT scan of chest was done. Contrast CT scan of chest with reformat MIP pulmonary angiogram revealed a small pulmonary artery vascular malformation in lateral basal segment of lower lobe of left lung associated with left upper lobar cavitating lesion with fibrosis, traction bronchiectasis and Rasmussen's aneurysm arising from upper lobar apical segmental pulmonary artery. Early surgical or angiographic interventions with endovascular embolization are recommended once it be clearly diagnosed. KYAMC Journal Vol. 10, No.-3, October 2019, Page 168-170

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