An Extremely Rare Case of Primary Anterior Mediastinal Tumor

Background: There were very few reports of atypical carcinoid in anterior mediastinum. Atypical carcinoids originating in the mediastinum belong to a neuroendocrine tumor (NET), which is also a very rare clinically aggressive mediastinal tumor. Case presentation: We herein reported a rare case of NET of mediastinal origin and a review of several cases concerning the clinical and pathological features of this disease, which is often misdiagnosed as atypical carcinoid tumor in mediastinum. The tumor was removed by mid-sternal thoracotomy with superior vena cava formation, left common carotid artery resection and artificial blood vessel replacement, left upper lobe wedge resection, left phrenic nerve resection, left vagus nerve resection and partial pericardectomy.Conclusions: To the best of our knowledge, this is the sixth atypical carcinoid occurring in mediastinum with proof via histology and IHC. Our findings suggest the difficulty of making a diagnosis before surgery and more cases will need to be reported in order to facilitate the preoperative diagnosis of such a rare tumor.

Vascular Involvements in Cholangiocarcinoma: Tips and Tricks

Cholangiocarcinoma (CCA) is an aggressive malignancy of the biliary tract. To date, surgical treatment remains the only hope for definitive cure of CCA patients. Involvement of major vascular structures was traditionally considered a contraindication for resection. Nowadays, selected cases of CCA with vascular involvement can be successfully approached. Intrahepatic CCA often involves the major hepatic veins or the inferior vena cava and might necessitate complete vascular exclusion, in situ hypothermic perfusion, ex situ surgery and reconstruction with autologous, heterologous or synthetic grafts. Hilar CCA more frequently involves the portal vein and hepatic artery. Resection and reconstruction of the portal vein is now considered a relatively safe and beneficial technique, and it is accepted as a standard option either with direct anastomosis or jump grafts. However, hepatic artery resection remains controversial; despite accumulating positive reports, the procedure remains technically challenging with increased rates of morbidity. When arterial reconstruction is not possible, arterio-portal shunting may offer salvage, while sometimes an efficient collateral system could bypass the need for arterial reconstructions. Keys to achieve success are represented by accurate selection of patients in high-volume referral centres, adequate technical skills and eclectic knowledge of the various possibilities for vascular reconstruction.

Effect of nerve growth factor dimeric mimetic GK-2 on microcirculation in skeletal muscle on the hind limb ischemia model in rats

The purpose of the study. In experiments on a hind limb ischemia model in rats, the effect of the TrkA-receptor agonist of the NGF 4th loop dimeric dipeptide mimetic compound GK-2 has been studied on microcirculation in ischemic skeletal muscle.Methods. the Hind limb ischemia was caused in white male mongrel rats by the femoral artery resection. The compound GK-2 was administered intravenously (1 mg/kg/day during 14 days). Microcirculation parameters were recorded using a computer laser analyzer "LAKK-OP2". Registration was carried out simultaneously in the intact and operated limb before the operation, 1 and 14 days after it.Results. In the conditions of the hind limb ischemia model, it was shown that the compound GK-2 almost completely restored the perfusion index and its variation coefficient in the ischemic muscle to the intact contralateral limb level by the 14th day after surgery.Conclusion. It can be assumed that the anti-ischemic effect of the compound GK-2 is associated with the restoration of microcirculation as a result of increased neoangiogenesis.

Eight-Year Survival Following Left Hepatic Trisectionectomy With Combined Hepatic Artery And Portal Vein Resection For Advanced Perihilar Cholangiocarcinoma

We report the case of a patient with exceptional survival over 8 years after left trisectionectomy combined with portal vein and hepatic artery resection and reconstruction for advanced perihilar cholangiocarcinoma. Such extended hepatectomy with vascular resection is the only way to obtain free tumor margin. It can be performed with acceptable morbidity and mortality and it is the only hope to prolong survival.