Indocyanine green fluorescence to ensure perfusion in middle segment-preserving pancreatectomy: a case report

Abstract Background Middle segment-preserving pancreatectomy (MSPP) is an alternative to total pancreatectomy that allows for the preservation of the endocrine and exocrine functions of the pancreas. However, maintaining perfusion to the pancreatic remnant is of critical importance. We describe the first case to our knowledge in which indocyanine green (ICG) fluorescence was used to confirm perfusion to the pancreatic remnant during MSPP. Case presentation A 79-year-old man with diabetes mellitus was referred to our hospital for treatment of a pancreatic tumor. Computed tomography revealed a hypovascular mass in the uncus of the pancreas and dilatation of the main pancreatic duct, measuring 13 mm in the tail of the pancreas. He was diagnosed with cancer of the pancreatic uncus via endoscopic ultrasound and fine-needle aspiration revealed a mixed-type intraductal papillary mucinous neoplasm (IPMN), along with high-risk stigmata in the tail of the pancreas. We performed MSPP and the length of the pancreatic remnant was 4.6 cm. The dorsal pancreatic artery was preserved and perfusion to the pancreatic remnant was confirmed by ICG fluorescence. Histopathological examination showed a pancreatic ductal adenocarcinoma in the uncus (pT1cN1M0, pStage 2B) and IPMN in the tail of the pancreas. The postoperative course was complicated by a grade B pancreatic fistula, but this was successfully treated with conservative management. The patient was transferred to a hospital 33 days after surgery. Insulin administration was necessary, but C-peptide was detectable and blood glucose was relatively well-controlled. He did not exhibit any exocrine dysfunction when pancreatic enzyme supplementation was administered. Conclusion ICG fluorescence can be used to evaluate perfusion to the pancreatic remnant during MSPP.

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Indocyanine green fluorescence image-guided total laparoscopic living donor right hepatectomy: The first case report from Mainland China

International Journal of Surgery Case Reports ◽

10.1016/j.ijscr.2018.11.033 ◽

2018 ◽

Vol 53 ◽

pp. 406-409 ◽

Cited By ~ 3

Author(s):

Xiangfei Meng ◽

Hongguang Wang ◽

Yinzhe Xu ◽

Mingyi Chen ◽

Weidong Duan ◽

...

Keyword(s):

Case Report ◽

Indocyanine Green ◽

Living Donor ◽

Mainland China ◽

Right Hepatectomy ◽

Green Fluorescence ◽

Fluorescence Image ◽

Indocyanine Green Fluorescence ◽

Image Guided ◽

First Case

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Indocyanine green fluorescence angiography in colorrectal surgery. First case series in Mexico

Revista de Gastroenterología de México (English Edition) ◽

10.1016/j.rgmxen.2021.10.001 ◽

2021 ◽

Author(s):

J.I. Ortiz de Elguea-Lizárraga ◽

A. Riojas-Garza ◽

A.F. Chapa-Lobo ◽

H.A. Rangel-Ríos ◽

A.L. García-García ◽

...

Keyword(s):

Indocyanine Green ◽

Case Series ◽

Fluorescence Angiography ◽

Green Fluorescence ◽

Indocyanine Green Fluorescence ◽

First Case ◽

Surgery First ◽

Indocyanine Green Fluorescence Angiography

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Adenosquamous and squamous cell carcinoma of the pancreas: two histopathological variants of ductal adenocarcinoma

Acta Marisiensis - Seria Medica ◽

10.2478/amma-2021-0025 ◽

2021 ◽

Vol 67 (3) ◽

pp. 173-176

Author(s):

Tiberiu-Bogdan Szekely ◽

Cornelia Toganel ◽

Zoltan Kadar ◽

Alexandra Daniela Sava ◽

Tivadar Bara ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Squamous Cell ◽

Adenosquamous Carcinoma ◽

Histopathological Examination ◽

Pancreatic Head ◽

Ductal Adenocarcinoma ◽

Mesenchymal Transition ◽

Carcinoma Of The Pancreas ◽

First Case

Abstract Introduction: Primary squamous cell carcinoma (SCC) and adenosquamous carcinoma of the pancreas are rare malignancies for which diagnostic and treatment strategy are challenging. In this paper we present a literature review of these tumors based on two case reports. Case presentation: In the first case, a 55-year-old male presented with an inoperable pancreatic head/body junction tumor. Endoscopic ultrasound-guided fine needle aspiration was practiced, and histopathological examination revealed a squamous cell carcinoma of the pancreas. After exclusion of any another tumor, the diagnosis of cT4N0M0-staged primary pancreatic SCC was made. The patient is under treatment with gemcitabine and oxaliplatin. The second case is represented by a 73-year-old patient in which imagistic examinations highlighted a cystic mass of the pancreatic body. Following coporeo-caudal splenic-pancreatectomy and histopathological-proved diagnosis of adenosquamous carcinoma, the patient started chemotherapy but died at 11 months after surgery. Both tumor components displayed positivity for markers which prove ductal (cytokeratin19, maspin) and squamous differentiation (p63, cytokeratin5/6) same as vimentin, as indicator of epithelial mesenchymal transition (EMT). Conclusions: SCC and adenosquamous carcinoma of the pancreas are aggressive malignancies which prognosis remains highly reserved. These tumors might be variants of ductal adenocarcinomas which are dedifferentiated through EMT phenomenon.

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Identifying Cystic Vein Perfusion Area Employing Indocyanine Green Fluorescence Imaging during Laparoscopic Extended Cholecystectomy for Clinical T2 Gallbladder Cancer

Case Reports in Gastroenterology ◽

10.1159/000506361 ◽

2020 ◽

Vol 14 (1) ◽

pp. 110-115

Author(s):

Akira Umemura ◽

Hiroyuki Nitta ◽

Takeshi Takahara ◽

Yasushi Hasegawa ◽

Hirokatsu Katagiri ◽

...

Keyword(s):

Indocyanine Green ◽

Gallbladder Cancer ◽

Fluorescence Imaging ◽

Histopathological Examination ◽

Surgical Margin ◽

Ventral Side ◽

Hepatic Parenchyma ◽

Indocyanine Green Fluorescence ◽

Anterior Branch ◽

Extended Cholecystectomy

We present an original surgical technique for identifying the perfusion area of the cystic vein with indocyanine green (ICG) fluorescence imaging and laparoscopic extended cholecystectomy with lymphadenectomy for a 56-year-old woman with diagnosis of clinical T2 gallbladder cancer (GBC). First, we encircled Calot’s triangle using the Glissonean approach from the ventral side of the gallbladder plate and then taped the hilar Glissonean pedicles; these were temporally clamped, and ICG was injected into the vein. The perfusion area of the cystic vein was scrutinized, specifically the stained area of the hepatic parenchyma was marked, and extended cholecystectomy was performed along the resection line. Subsequently, we performed lymphadenectomy of the hepatoduodenal ligament to complete the operation. A postoperative histopathological examination revealed moderately differentiated adenocarcinoma with pathological T1bN0M0. Although extended cholecystectomy is currently recommended for clinical T2 GBC, there is no consensus on the definition of the gallbladder bed, and the ideal extent of hepatic resection has, therefore, not yet been determined. In addition, gallbladder bed resection with 2–3 cm of surgical margin is an empirical procedure that lacks scientific verification. Regarding anatomical features, the cystic vein sometimes drains directly into the anterior branch of the portal vein, penetrating the gallbladder plate and Laennec’s capsule of the anterior Glissonean pedicle. To address this background, we have developed a technique to identify the perfusion area of the cystic vein to determine the extent of hepatic parenchyma that should be resected during laparoscopic extended cholecystectomy for clinical T2 GBC.

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Middle segment-preserving pancreatectomy for multifocal pancreatic ductal adenocarcinoma located in the head and tail of the pancreas: a case report

Journal of Surgical Case Reports ◽

10.1093/jscr/rjaa383 ◽

2020 ◽

Vol 2020 (10) ◽

Author(s):

Nobuhito Nitta ◽

Yusuke Yamamoto ◽

Teiichi Sugiura ◽

Yukiyasu Okamura ◽

Takaaki Ito ◽

...

Keyword(s):

Pancreatic Enzyme ◽

Pancreatic Head ◽

Ductal Adenocarcinoma ◽

Pancreatic Tumors ◽

Middle Segment ◽

Pancreatic Tail ◽

Hypoglycemic Drug ◽

The Right

Abstract A 77-year-old woman with a solitary existence was referred to our hospital for the treatment of pancreatic tumors. Computed tomography revealed an 18-mm mass in the pancreatic head that had invaded the right side of the superior mesenteric vein (SMV) and a 32-mm mass in the pancreatic tail. We performed middle segment-preserving pancreatectomy (MSPP) with SMV resection and reconstruction. The TNM classifications were T2, N1, M0, stage IIB in the pancreatic head, and T2, N0, M0, stage IB in the pancreatic tail, respectively. Postoperatively, the blood glucose was well controlled using only hypoglycemic drug, and insulin preparation was not necessary. No fatty diarrhea was found using a pancreatic enzyme supplement. After 9 months of follow-up, no recurrence was found. MSPP for pancreatic head and tail carcinomas seemed acceptable for both preserving the postoperative quality of life and ensuring curative resection especially in elderly patient with a solitary existence.

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Laparoscopic Resection of a Hepatic Epithelioid Angiomyolipoma Revealed by Indocyanine Green Fluorescence Imaging

The American Surgeon ◽

10.1177/00031348211023456 ◽

2021 ◽

pp. 000313482110234

Author(s):

Kiyotaka Mochizuki ◽

Takeshi Aoki ◽

Tomokazu Kusano ◽

Kodai Tomioka ◽

Yoshihiko Tashiro ◽

...

Keyword(s):

Indocyanine Green ◽

Fluorescence Imaging ◽

Laparoscopic Resection ◽

Liver Tumors ◽

Laparoscopic Hepatectomy ◽

Surgical Margin ◽

Green Fluorescence ◽

Indocyanine Green Fluorescence ◽

First Case ◽

Indocyanine Green Fluorescence Imaging

Indocyanine green fluorescence imaging (ICG-FI)—a sensitive tool for detecting tumor localization in laparoscopic surgery—produces false positive results for benign liver tumors. This report is the first case of hepatic angiomyolipoma (HAML) treated laparoscopically with ICG-FI. We present the case of a 31-year-old woman with a liver tumor that was a 13-mm mass in the anterior superior segment. Though a benign tumor was suspected, malignant potential could not be ruled out. Therefore, minimally invasive laparoscopic resection using ICG-FI was planned. ICG, intravenously injected preoperatively, revealed the tumor’s existence. Pure laparoscopic hepatectomy with ICG-FI was performed for excisional biopsy, during which the tumor was resected with adequate surgical margins, followed by histological confirmation of HAML. In conclusion, it is suggested that laparoscopic resection with ICG-FI is an effective minimal invasive surgery for tumors that are difficult to detect, such as HAML, leading to a safe surgical margin.

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F.N.A.C. AS DIAGNOSTIC TOOL OF PAROTID TUMORS AND ASSOCIATED PITFALLS IN CORRELATION WITH HISTOPATHOLOGY

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v4i1.1153 ◽

2020 ◽

Vol 4 (1) ◽

Author(s):

Bhawana Pant ◽

Sanjay Gaur ◽

Prabhat Pant

Keyword(s):

Preoperative Diagnosis ◽

Histopathological Examination ◽

Clinical Information ◽

Final Diagnosis ◽

Needle Aspiration ◽

Histopathological Diagnosis ◽

Cytological Diagnosis ◽

Tertiary Referral Centre ◽

Clear Cut ◽

Parotid Tumors

F.NA.C has been used for ages as a safe and economical tool for fast preoperative diagnosis of parotid tumors. It has certain pitfall which sometimes leads to misdiagnosis and consequently it may have affect on treatment of the tumors. Keeping in view of the diverse classification of parotid tumors’ information from cytology should be combined with radiology as well as clinical diagnosis. Aim: To discuss some cases where there was discrepancy between cytological diagnosis and histopathological result and also suggest measures to improve the efficacy of F.N.A.C. Material and methods: The study includes 50 cases of parotid tumours who presented to the department of ENT at Government medical college Haldwani which is a tertiary referral centre during 2009 to 2016. Only adult patients were included and inflammatory swelling were excluded from the study. All patients evaluated Contrast enhanced computerized tomography(CECT) and Magnetic resonance imaging (MRI) followed by Fine needle aspiration cytology .Preoperative diagnosis was made upon the findings of the above investigations and different types of parotid surgeries were done. . Final diagnosis was made on histopathological examination. Result :The most common tumour came out to be pleomorphic adenoma (23 cases-46%) followed by mucoepidermoid carcinoma(12cases-24%). In ten cases there was no clear cut association between cytological diagnosis and final histopathological diagnosis. Conclusion: FNAC is highly sensitive and specific technique for diagnosis of many salivary gland swellings. FNAC can be used preoperatively to avoid unnecessary surgery and biopsy. Details of clinical information and radiologic features may help the pathologist to arrive at the appropriate diagnosis and reduce false interpretation. Pitfalls may also occur with improper technique of FNAC which can be overcome by proper caution.

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Intestinal Heterotopic Pancreas Involved by Simultaneous PanIN-2 Lesion and Endocrine Microadenoma: a Unique Case

Journal of Gastrointestinal and Liver Diseases ◽

10.15403/jgld.2014.1121.262.pan ◽

2017 ◽

Vol 26 (2) ◽

pp. 199-202

Author(s):

Remus Cornea ◽

Sorina Taban ◽

Cristian Suciu ◽

Codruta Lazureanu ◽

Alis Dema

Keyword(s):

Histopathological Examination ◽

Intraepithelial Neoplasia ◽

Heterotopic Pancreas ◽

Pancreatic Intraepithelial Neoplasia ◽

Unique Case ◽

Intraductal Papillary Mucinous Neoplasms ◽

Pancreatic Endocrine Neoplasm ◽

First Case ◽

Mucinous Neoplasms

We hereby present the case of a 58-year-old male who underwent a total gastrectomy for gastric neoplasm. During the surgery, a tumor mass in the jejunum was identified, considered as metastasis, and resected. The histopathological examination of the jejunal lesion showed ectopic pancreas. In this area, two pathological distinct lesions were identified, one histologically compatible with pancreatic intraepithelial neoplasia (PanIN) type 2 lesion and the other with morphologic criteria for endocrine microadenoma. To our knowledge, this is the first case that evidences the presence of a concomitant premalignant exocrine lesion and benign endocrine lesion in a heterotopic pancreas (HP).Abbreviations: HP: heterotopic pancreas; IPMN: Intraductal Papillary Mucinous Neoplasms; PanIN: Pancreatic Intraepithelial Neoplasia; PEN: pancreatic endocrine neoplasm.

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