Retropancreatic Retroperitoneal Tumors: A 30-year Experience with 38 Cases

2013 ◽  
Vol 79 (5) ◽  
pp. 470-475
Author(s):  
Tao-Tao Zhang ◽  
Ke-Jian Guo ◽  
Gang Ma ◽  
Shao-Wei Song
Keyword(s):  
Magnetic Resonance ◽  
Surgical Management ◽  
Malignant Tumors ◽  
Pancreatic Head ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Uncinate Process ◽  
The Body ◽  
Number Of Patients ◽  
Retroperitoneal Tumors

Retropancreatic retroperitoneal tumors (RRTs) are seldom encountered in clinical practice. The lack of characteristics on clinical presentation and imaging make preoperative diagnosis difficult and surgical management remains a challenge. This retrospective report surveys the presenting diagnosis and surgical management of 38 patients with RRTs presenting at our center between August 1981 and May 2012. Six patients were misdiagnosed on the basis of computerized tomography and one each by magnetic resonance imaging and magnetic resonance cholangiopancreatography. Tumors were localized posterior to the pancreatic head and uncinate process (n = 18); posterior to the neck and body of the pancreas (n = 9); or posterior to the body and tail of the pancreas (n = 11). Thirty-three patients underwent surgical resections. Operative approaches were chosen on the basis of tumor size and localization. The tumors were mostly commonly originating from neurogenic tissue (n = 16). There were 25 benign neoplasms (65.8%), 10 malignant tumors (26.3%), and three undefined tumors. The morbidity of postsurgical complications was 21 per cent (eight of 38). The number of patients who underwent follow-up was 21, and the mean follow-up time was 35 months (range, 2 to 90 months). Three patients died during follow-up. The morbility of local recurrence was 10.5 per cent (four of 38). Definitive diagnosis of RRTs is made at laparotomy. Complete resection remains the fundamental objective of disease management. Different operative approaches should be used according to tumor localization and size.

EXPERIENCE OF EVALUATION OF PATIENTS OF OBSTRUCTIVE JAUNDICE BY SONOGRAPHY AND MAGNETIC RESONANCE CHOLANGIOPANCREATOGRAPHY AT A TERTIARY CARE CENTRE IN EASTERN INDIA

2021 ◽  
pp. 61-64
Author(s):  
Santosh Kumar Prasad ◽  
Nupur Nupur ◽  
Akshit Pathak ◽  
Indra Shekhar Thakur ◽  
Vijay Shankar Prasad
Keyword(s):  
Magnetic Resonance ◽  
Obstructive Jaundice ◽  
Hepatic Duct ◽  
Tertiary Care ◽  
Pancreatic Head ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Stricture Formation ◽  
Tertiary Care Centre ◽  
Left Hepatic Duct ◽  
Cross Sectional

INTRODUCTION: Jaundice means yellow due to the yellowish discolouration of skin, sclera, and mucous membrane seen in jaundice caused by bilirubin pigment. It is divided in to two forms obstructive(surgical) and non- obstructive (non-surgical). AIM AND OBJECTIVE: To evaluate patients of obstructive jaundice by sonography and magnetic resonance cholangiopancreatography and compare the reporting and ndings by both the modalities. MATERIALS AND METHODS: Cross sectional observational study done from November 2018 to October 2020 and consists of 32 patients who had clinical jaundice and consented to being subjected to both ultrasound and MRCP. OBSERVATIONS:Both USG and MRCP were able to detect extrahepatic CBD dilatation equally in 25 patients. In 5(15.6%) patients USG and MRI both demonstrated intrahepatic mass causing obstruction at the level of conuence of right and left hepatic duct or CHD. Ultrasonography was able to detect the intrinsic mass of the extrahepatic common bile duct in 2(6.2%) patients out of 32 patients in our study population. MRCP could detect the same in 6(18.7%) patients. In our study narrowing of CBD with stricture formation and upstream dilatation of biliary tree was identied in 10(31.2%) patients on MRCP. Ultrasound could diagnose the same in one patient. Both USG and MRCP were able to detect pancreatic head mass as well as pseudocyst. CONCLUSION: The accuracy of MRCP was found to be comparable to that of ERCP for diagnosis of etiology for obstructive jaundice. MRCP allows better lesion characterization and assessment. However, the patchy availability of MR machines become the main achilles heel for the surgeons as well as the radiologists. Hence the valuable role of the omnipresent ultrasonography become immense.

scholarly journals Insulinoma and Chronic Kidney Disease: An Uncommon Conundrum Not to Be Overlooked

2017 ◽  
Vol 10 ◽  
pp. 117955141774262 ◽  
Author(s):  
Luca Foppiani ◽  
Serena Panarello ◽  
Marco Filauro ◽  
Maria Concetta Scirocco ◽  
Stefano Cappato ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Pancreatic Head ◽  
Small Region ◽  
Uncinate Process ◽  
Positron Emission ◽  
Long Term Follow Up ◽  
Histology And Immunohistochemistry

A hypertensive man with chronic kidney disease (CKD) secondary to polycystic disease was hospitalized for symptoms related to hypoglycemia. Fasting test elicited symptomatic hypoglycemia after 12 hours, which was associated with inappropriately unsuppressed normal insulin and C-peptide levels. Neither ultrasonography (US) nor magnetic resonance imaging detected any pancreatic tumor. Endoscopic ultrasonography (EUS) showed a small isoechogenic nodule suspect for neuroendocrine tumor in the pancreatic head. 68Gallium-DOTA-Tyr3-octreotide positron emission tomography/computed tomography revealed intense uptake by a small region in the pancreatic head. Surgical exploration together with intraoperative US confirmed the nodule in the pancreatic head and evidenced another hypoechogenic one in the uncinate process. Both nodules were enucleated, but only the latter, which had not been previously detected by EUS, proved compatible with insulinoma on combined histology and immunohistochemistry. After nodule enucleation, hypoglycemia resolved and did not relapse. Insulinoma, as a major cause of unexplained hypoglycemia, requires careful hormonal and instrumental workup. In patients with CKD, the interpretation of biochemical criteria for the diagnosis of insulinoma can be challenging. Localization techniques may display pitfalls. Surgery is curative in most patients but long-term follow-up is required.

Mirizzi Syndrome: Experience in Diagnosis and Treatment of 25 Cases

2012 ◽  
Vol 78 (1) ◽  
pp. 61-65 ◽  
Author(s):  
Hua Zhong ◽  
Jian-Ping Gong
Keyword(s):  
Magnetic Resonance ◽  
Preoperative Diagnosis ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Mirizzi Syndrome ◽  
Diagnosis And Treatment ◽  
Type I ◽  
Tube Insertion ◽  
Operative Strategy ◽  
T Tube

The objective of this study is to summarize the experience in diagnosis and treatment of Mirizzi syndrome (MS) and reduce the incidence of operative complications. Twenty-five cases of Mirizzi syndrome from January 2005 to January 2010 were retrospectively analyzed. There were 11 male patients and 14 female patients, ranging in ages from 26 to 80 years with a median age of 51.3. Preoperative radiological diagnosis was achieved in 10 patients: ultrasonography (n = 5) and magnetic resonance cholangiopancreatography (n = 10). The others were diagnosed intra-operatively. Fifteen patients had Type I MS. Two were treated with laparoscopic cholecystectomy successfully. The laparoscopic procedure had to be converted to open procedure in one patient. Seven patients had open complete cholecystectomy, three had subtotal cholecystectomy, and two had removal of stones from the gall bladder and choledochostomy after cholecystotomy was performed, with secondary cholecystectomy 3 months later. Six patients had Type II MS. Five underwent cholecystectomy, common bile duct (CBD) repair, and T-tube insertion. One was managed with transection of CBD and Roux-en-Y hepaticojejunostomy. Two patients with Type III MS underwent cholecystectomy, CBD repair, and T-tube insertion. Cholecystectomy and Roux-en-Y hepaticojejunostomy was performed in the two patients with Type IV MS. All the patients recovered from the operation. The follow-up period ranged from 5 years to 5 months. One patient developed obstructive jaundice more than 2 years after the operation, and recovered after the secondary operation. The follow-up of others were uneventful. Preoperative diagnosis of MS is very difficult. Magnetic resonance cholangiopancreatography is very helpful in preoperative diagnosis, and a high index of clinical suspicion is required to make a preoperative or intra-operative diagnosis, which can lead to correct operative strategy to manage Mirizzi syndrome.

Neuroma (schwannoma). A rare pancreatic tumor

2019 ◽  
Vol 91 (3) ◽  
pp. 1-4
Author(s):  
Grzegorz Witkowski ◽  
Małgorzata Kołos ◽  
Anna Nasierowska-Guttmejer ◽  
Marek Durlik
Keyword(s):  
Surgical Treatment ◽  
Histopathological Examination ◽  
English Literature ◽  
Pancreatic Head ◽  
Whipple Procedure ◽  
Uncinate Process ◽  
The Body ◽  
Ct Guided ◽  
Pancreatic Head Cancer ◽  
Common Location

Neuroma (Schwannoma in Latin) is an encapsulated, mesenchymal tumor arising from Schwann cells surrounded by nerves. Hence it can be located in any area in the body with passing peripheral nerves. The most common location is the head, neck, and extremities. The tumor arising from Schwannoma cells was first described by Stout and Carson in 1935. Pancreatic schwannomas are extremely rare tumors. Until 2017, in English literature 68 cases have been described. Surgical treatment is the most common way of treating pancreatic schwannomas, and postoperative prognoses are good. A 63-year-old patient was admitted to the Clinical Department of Gastroenterological Surgery and Transplantation of the Central Clinical Hospital at the Ministry of Interior and Administration in Warsaw due to pancreatic head cancer. Needle biopsy–both ultrasound-guided and CT-guided as well as open biopsy for lesions in the pancreas did not show tumor cells in any of the collected samples. Abdominal CT in a projection of the uncinate process of the pancreas revealed an oval lesion highly suspected of neoplastic process. Next, diagnostics was extended by abdominal MRI which revealed a retroperitoneal tumorous thick-walled cystic mass filled with fluid. The patient was qualified for surgical treatment. Pancreaticoduodenectomy (Whipple Procedure) was done on August 22, 2017. Material sent for histopathological examination revealed Schwannoma capitis pancreatis. In surgical practice, pancreatic schwannoma occurs extremely rare, but in centers which conduct large numbers of surgical procedures in the pancreas, a case like this may occur.

scholarly journals Multifocal Mass Lesions in Autoimmune Pancreatitis

2017 ◽  
Vol 11 (3) ◽  
pp. 686-693 ◽  
Author(s):  
Kazuhiro Suzumura ◽  
Etsuro Hatano ◽  
Naoki Uyama ◽  
Toshihiro Okada ◽  
Yasukane Asano ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Autoimmune Pancreatitis ◽  
Malignant Tumors ◽  
Histopathological Examination ◽  
Elevated Serum ◽  
Pancreatic Head ◽  
Pancreatic Ducts ◽  
Diffuse Infiltration ◽  
Serum Igg4 ◽  
Mass Lesions

A 59-year-old male patient with jaundice was referred to our hospital because of mass lesions in the pancreatic head and tail. An immunological examination revealed an elevated serum IgG4 level. Computed tomography showed two clear boundary mass lesions in the pancreatic head and tail. Magnetic resonance imaging showed that the mass lesions exhibited low intensity on T1-weighted images and iso-intensity on T2-weighted images. Magnetic resonance cholangiopancreatography showed an obstruction of the main pancreatic duct in the pancreatic head and tail. The possibility of malignant tumors could not be ruled out; therefore, we performed total pancreatectomy. A histopathological examination of the nodular lesions revealed severe lymphoplasmacytic infiltration and inflammatory change around the pancreatic ducts. Immunohistochemistry revealed diffuse infiltration of IgG4-positive plasma cells in the nodules. According to these pathological findings, we diagnosed the patient with IgG4-related multifocal mass lesions of autoimmune pancreatitis (AIP). It is difficult to distinguish between focal type AIP and pancreatic cancer. We herein report a rare case of multifocal mass lesions in AIP and include bibliographical comments.

The Usefulness of Gadolinium-Enhanced Images on a Follow-up Magnetic Resonance Image in Suspected Multiple Sclerosis

2013 ◽  
Vol 64 (4) ◽  
pp. 358-362 ◽  
Author(s):  
Fraser G.A. Moore ◽  
Mark Levental
Keyword(s):  
Multiple Sclerosis ◽  
Magnetic Resonance ◽  
Primary Outcome ◽  
Brain Mri ◽  
Brain Magnetic Resonance Imaging ◽  
Clinically Isolated Syndrome ◽  
Space And Time ◽  
Scan Time ◽  
Number Of Patients

Purpose Multiple sclerosis diagnostic criteria include the presence of gadolinium-enhancing lesions when determining dissemination in space and time. Gadolinium is expensive, increases scan time and patient discomfort, and can, rarely, cause serious adverse effects. Our objective was to determine the usefulness of including gadolinium-enhanced images as part of a follow-up brain magnetic resonance imaging (MRI) in patients with a clinically isolated syndrome. Methods Consecutive patients seen between 2008 and 2010 with a clinically isolated syndrome suggestive of multiple sclerosis were prospectively enrolled, had a non–gadolinium-enhanced brain MRI, and consented to a follow-up gadolinium-enhanced brain MRI. The primary outcome was a comparison of the number of patients diagnosed with multiple sclerosis compared with the number who would have been diagnosed without the gadolinium-enhanced images. Results Twenty-one patients enrolled, and 2 withdrew. Follow-up MRIs were performed a median of 241 days after the initial MRI. Eleven patients met the primary outcome and were diagnosed with multiple sclerosis: 6 as a result of a second clinical attack and 5 by using imaging criteria for dissemination in space and time. If the gadolinium-enhanced images had not been obtained, then there would have been no change in the primary outcome. Conclusions In Canadian centers with similar MRI waiting times to those in our study, the routine use of gadolinium as part of a follow-up MRI in patients with suspected multiple sclerosis may not be clinically useful. Gadolinium-enhanced images could still be obtained on an as-needed basis for specific clinical indications.

THE PRESENCE OF MULTIPLE MICROBLEEDS AS A PREDICTOR OF SUBSEQUENT CEREBRAL HEMORRHAGE IN PATIENTS WITH MOYAMOYA DISEASE

Neurosurgery ◽  
2008 ◽  
Vol 62 (1) ◽  
pp. 104-112 ◽  
Author(s):  
Ken-ichiro Kikuta ◽  
Yasushi Takagi ◽  
Kazuhiko Nozaki ◽  
Nobukatsu Sawamoto ◽  
Hidenao Fukuyama ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Moyamoya Disease ◽  
Magnetic Resonance Study ◽  
Cox Proportional Hazard ◽  
Kaplan Meier ◽  
Number Of Patients ◽  
Group A ◽  
A Prospective Study ◽  
The Relationship

Abstract OBJECTIVE To examine the relationship between asymptomatic microbleeds (MBs) and the occurrence of subsequent stroke in patients with moyamoya disease. METHODS Beginning in October 2003, 50 consecutive patients with moyamoya disease were enrolled in a prospective study using 3-T magnetic resonance imaging. These patients were followed from the date of the initial magnetic resonance study until the date of the first subsequent stroke or final magnetic resonance study. The median follow-up period was 15 months. The patients were comprised of 13 men and 37 women ranging in age from 9 to 68 years (mean age, 40.5 ± 16.2 yr). RESULTS Although no MBs were found in 27 patients in the initial magnetic resonance study, a total of 66 MBs were found in the remaining 23 patients. Eleven patients had a single MB and 12 had multiple MBs. The patients were divided into three groups according to the number of MBs: a non-MB group, a single-MB group, and a multi-MB group. Kaplan-Meier curves of the three groups showed a significantly higher likelihood of subsequent hemorrhage in the multi-MB group than in either the non-MB or single-MB groups (P = 0.0380). No significant differences among the three groups were seen in terms of their subsequent infarction-free ratios. Age-adjusted analysis performed with the Cox proportional hazard model also showed the presence of multiple MBs as an independent risk factor (hazard ratio, 2.89; 95% confidence interval, 1.001–13.24). CONCLUSION The presence of multiple MBs might be a predictor of subsequent hemorrhage in patients with moyamoya disease. Confirmation of these results will require a study with a larger number of patients and a longer follow-up period.

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