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The American Journal of Case Reports May 2024BACKGROUND Schwannomas are tumors that arise from Schwann cells that surround and support nerve cells. Most common sites for presentations are head, neck, and... (Review)
Review
BACKGROUND Schwannomas are tumors that arise from Schwann cells that surround and support nerve cells. Most common sites for presentations are head, neck, and extremities. Schwannomas of gastrointestinal tract are rare, slow-growing tumors, usually benign, arising from gastrointestinal tract's neural plexus. They are histologically distinguishable from conventional schwannomas that arise in soft tissue or the central nervous system. Preoperative diagnosis of gastrointestinal schwannoma is challenging, requiring immunohistological confirmation of the nature of the tumor. Here, we report a case of 57-year-old woman with an incidental finding of an asymptomatic submucosal jejunal schwannoma. CASE REPORT A 57-year-old woman with a medical history of hematological disorder underwent a contrast abdominal computed tomography as part of medical follow-up. The imaging revealed the presence of a jejunal mass. The patient underwent laparoscopic surgical resection of the lesion, followed by side-to-side jejuno-jejunal anastomosis with 4-cm clear surgical margins. The final pathologic study revealed the presence of jejunal schwannoma, as tested positive for S-100 protein. The patient was discharged home on the fourth postoperative day, having an uneventful recovery. CONCLUSIONS Jejunal schwannoma are usually benign and asymptomatic, and they are often discovered incidentally during diagnostic tests for other conditions; therefore, it should be included in the differential diagnosis of gastrointestinal tumors. Surgical treatment appears to be necessary to achieve a definitive diagnosis through a biopsy of the tumor tissue. Benign jejunal schwannomas have a good prognosis.
Topics: Humans; Neurilemmoma; Incidental Findings; Female; Middle Aged; Jejunal Neoplasms; Asymptomatic Diseases; Tomography, X-Ray Computed
PubMed: 38745406
DOI: 10.12659/AJCR.942881 -
Acta Medica Okayama Dec 2021The long-term changes in tissues implanted in the oral cavity and pharynx after head and neck reconstruction have not been fully evaluated. This study aimed to clarify...
Morphological Changes and Durability of Skin and Mucosal Flaps in Intraoral and Pharyngeal Reconstructions: Long-term Follow-up and Literature Review for Potential Second Carcinomas.
The long-term changes in tissues implanted in the oral cavity and pharynx after head and neck reconstruction have not been fully evaluated. This study aimed to clarify the morphological changes, long-term durability, and potential for secondary carcinogenesis in such tissues. In our single-center study, the rough morphological changes in 54 cases of intraoral and pharyngeal skin and mucosal flaps were evaluated more than 10 years after flap transfer. In addition, the literature on the development of second carcinomas from skin flaps was reviewed. The mean follow-up period for transferred flaps was 148 months. The reconstruction areas and the probability of morphological changes were significantly correlated (p=0.006), especially in cases with tongue, lower gingiva, and buccal mucosal reconstruction. Free jejunal flap surfaces were well maintained, whereas tubed skin flaps showed severe morphological changes in cases with pharyngeal reconstruction. None of the flaps in our series developed second primary carcinomas. Skin flaps generally had good durability for > 10 years in intraoral environments, while mucosal flaps had better durability for pharyngeal reconstruction. Second squamous carcinomas arising from skin flaps are extremely rare; however, surgeons should take this possibility into consideration and conduct meticulous and long-term follow-up.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Carcinoma, Squamous Cell; Female; Follow-Up Studies; Free Tissue Flaps; Humans; Male; Middle Aged; Neoplasms, Second Primary; Pharynx; Plastic Surgery Procedures; Retrospective Studies; Young Adult
PubMed: 34955541
DOI: 10.18926/AMO/62813 -
Cureus Dec 2020Gastrointestinal stromal tumours (GISTs) are considered the most common mesenchymal neoplasms of the alimentary tract, yet they account for only 0.2% of all...
Gastrointestinal stromal tumours (GISTs) are considered the most common mesenchymal neoplasms of the alimentary tract, yet they account for only 0.2% of all gastrointestinal neoplasms. We are presenting a case of a 68-year-old gentleman who was diagnosed with a 250 mm jejunal GIST only when he presented with abdominal pain and fullness in the upper abdomen. We believe that detailed medical history, followed by prompt investigations, will help in early diagnosis of small GISTs with less malignant potential, which in turn will lead to better outcomes.
PubMed: 33415061
DOI: 10.7759/cureus.11913 -
Chirurgia (Bucharest, Romania : 1990) 2018Neoplastic invasion of the structures of the cervical region originating from a malignant tumour developed in one of the viscera of the throat may benefit from cervical...
UNLABELLED
Neoplastic invasion of the structures of the cervical region originating from a malignant tumour developed in one of the viscera of the throat may benefit from cervical exenteration. Defined as resection of the hypopharynx, cervical oesophagus, larynx and cervical trachea, exenteration has limited indications and is mandatorily accompanied by digestive tube reconstruction. The aim of this article is to highlight the indication, surgical strategy and important surgical stages illustrated by images from personal professional experience.
MATERIALS AND METHOD
Pharyngo-laryngo-oesophageal en bloc resection and radical cervical lymphadenectomy were followed by reconstruction via free jejunal transfer or colic pedicle grafting. Between 2000 and 2018 we have performed cervical exenteration in 25 patients with tumours originating in the pharynx, larynx or cervical oesophagus. In the cases of 5 patients in whom we did not obtain the oncological safety margin for oesophageal cancer we performed transhiatal pharyngo-laryngo-oesophagectomy. In these patients, we performed reconstruction of the oesophagus with colonic graft. In 20 cases we performed jejunal autotransplant. We recorded 4 perioperative deaths, due to major arterial vessel haemorrhage (1 case), after jejunal necrosis (2 cases), and mediastinitis after oesophageal striping and colonic graft necrosis (1 case). One patient presented tumour recurrence at the level of the tracheal stump. Survival rate varied between 6 months and 4 years for the group of patients who presented for postoperative follow-ups. Cervical exenteration remains an option for tumour recurrence after radiochemotherapy or for obstructive airway or digestive tract tumours. It can be burdened by complications difficult to treat. The surgical team has to adapt its initial surgical strategy to the reality of the surgical field, both in terms of exeresis and in terms of types of pharyngo-oesophageal reconstruction.
Topics: Carcinoma, Squamous Cell; Colon; Esophageal Neoplasms; Esophagectomy; Esophagoplasty; Humans; Hypopharynx; Jejunum; Laryngectomy; Lymph Node Excision; Neck Dissection; Plastic Surgery Procedures; Retrospective Studies; Romania; Survival Rate; Treatment Outcome; Universities
PubMed: 29509539
DOI: 10.21614/chirurgia.113.1.123 -
Annals of the Royal College of Surgeons... Nov 2016Although sporadic lipomas are not uncommon in the upper gastrointestinal tract, diffuse gastroduodenal lipomatosis is a rare clinical entity. Medical literature reveals...
Although sporadic lipomas are not uncommon in the upper gastrointestinal tract, diffuse gastroduodenal lipomatosis is a rare clinical entity. Medical literature reveals a limited number of such cases presenting with upper gastrointestinal obstruction or bleeding. We present the management experience of a 43-year-old woman who presented with intussusception causing high small-bowel obstruction secondary to jejunal lipomatosis. Computed tomography showed diffuse fatty thickening of the gastric wall in addition to multiple lipomas in stomach, duodenum and in the jejunum with jejunal intussusception. As complete resection of the affected segment was not possible, a side-to-side jejunal bypass was made. The patient remains well on review after 18 months.
Topics: Adult; Duodenal Neoplasms; Female; Humans; Intussusception; Lipoma; Stomach Diseases; Stomach Neoplasms; Tomography, X-Ray Computed
PubMed: 27551904
DOI: 10.1308/rcsann.2016.0243 -
International Journal of Surgery... Jun 2015Reconstruction following total pharyngolaryngo-oesophagectomy (PLE) still challenges surgeons because of the extreme length of removed tissue. Gastric pull-up...
INTRODUCTION
Reconstruction following total pharyngolaryngo-oesophagectomy (PLE) still challenges surgeons because of the extreme length of removed tissue. Gastric pull-up reconstruction, one of the most common reconstructive methods after PLE, has many complications such as anastomotic fistula and gastric necrosis caused by the high anastomotic tension. However, modifications of gastric pull-up reconstruction aiming to reducing the high anastomotic tension have been less reported compared with other aspects with this technique. Here we report a modified gastric pull-up reconstruction combined with free jejunal transfer (FTJ) to reduce the anastomosis tension, and thus to reduce the risk of complications after PLE.
METHODS
Patients underwent a standard surgical procedure including total pharyngolaryngo-oesophagectomy and bilateral internal jugular lymph nodal clearance. A free jejunal graft about 10 cm was harvested and placed in the appropriate position between mobilized stomach and oropharynx. The anastomosis between the free jejunal graft and the gastric tube was created through a stapler. Vascular anastomosis was made between the jejunal artery and the transverse cervical artery, and between the jejunal vein and the internal jugular vein. Hand suturing technique was used in the anastomosis between jejunum and pharynx.
RESULTS
None of the patients suffered from any complications such as anastomotic fistula. Both patients resumed early postoperative oral intake. So far, they remain free of tumor recurrence and are in good health for 46 and 18 months, respectively.
CONCLUSION
Considering the tumor status and the patient condition, the gastric pull-up reconstruction combined with FJT after PLE could be a reliable choice.
Topics: Adult; Esophageal Neoplasms; Esophagectomy; Esophagoplasty; Female; Humans; Jejunum; Laryngeal Neoplasms; Laryngectomy; Male; Middle Aged; Pharyngeal Neoplasms; Pharyngectomy; Retrospective Studies; Stomach
PubMed: 25865081
DOI: 10.1016/j.ijsu.2015.03.025 -
Surgical Case Reports Jun 2023Pancreatic head resection following proximal gastrectomy jeopardizes the blood flow of the remnant stomach owing to right gastroepiploic conduit sacrifice, thereby...
Total pancreatectomy with remnant stomach preservation in a patient with a history of proximal gastrectomy and interposed jejunal reconstruction with right gastroepiploic conduit preservation: a case report.
BACKGROUND
Pancreatic head resection following proximal gastrectomy jeopardizes the blood flow of the remnant stomach owing to right gastroepiploic conduit sacrifice, thereby necessitating total gastrectomy. However, owing to its high invasiveness, concomitant remnant total gastrectomy with pancreatectomy should be avoided as much as possible. Herein, we describe our experience of total pancreatectomy with right gastroepiploic conduit preservation in a patient with a history of proximal gastrectomy and reconstruction by jejunum interposition.
CASE PRESENTATION
A 78-year-old woman with a history of gastric cancer was followed up at our institute for multiple intraductal papillary mucinous neoplasm, and main pancreatic duct stricture in the pancreatic head was newly detected. The cystic lesion was extended to the pancreatic body. Proximal gastrectomy and reconstruction by jejunal interposition were previously performed, and the mesenteric stalk of the interposed jejunum was approached through the retrocolic route. We planned total pancreatectomy with right gastroepiploic conduit preservation. Following adhesiolysis, the interposed jejunum and its mesentery lying in front of the pancreas were isolated. The arterial arcade from the common hepatic artery to the right gastroepiploic artery was detached from the pancreas. Furthermore, the right gastroepiploic vein was isolated from the pancreas. The pancreatic body and tail were pulled up in front of the remnant stomach, and the splenic artery and vein were resected. The pancreatic body and tail were pulled out to the right side, and the pancreatic head was divided from the pancreatic nerve plexus to the portal vein. The jejunal limb for entero-biliary anastomosis was passed through the hole behind the superior mesenteric artery and vein, and gastrointestinal anastomosis using the antecolic route and Braun anastomosis were performed.
CONCLUSIONS
To avoid remnant total gastrectomy, right gastroepiploic conduit preservation is an optional procedure for pancreatic head resection in patients who have undergone proximal gastrectomy with reconstruction by jejunal interposition.
PubMed: 37356046
DOI: 10.1186/s40792-023-01700-0 -
The American Journal of Case Reports Jan 2021BACKGROUND Neurofibromatosis type 1 (NF1) is a multi-tumor syndrome in which affected patients develop malignancies that are rare in the overall population, such as... (Review)
Review
Pancreatic Gastrinoma, Gastrointestinal Stromal Tumor (GIST), Pheochromocytoma, and Hürthle Cell Neoplasm in a Patient with Neurofibromatosis Type 1: A Case Report and Literature Review.
BACKGROUND Neurofibromatosis type 1 (NF1) is a multi-tumor syndrome in which affected patients develop malignancies that are rare in the overall population, such as tumors of neural or endocrine origin. CASE REPORT A 67-year-old woman with a clinical diagnosis of NF1 presented with abdominal pain and pneumoperitoneum. She underwent small-bowel resections for a perforated jejunal lesion and a second lesion in the ileum; pathology showed a neurofibroma at the site of the perforation and a 1-cm low-grade GIST, respectively. Additional staging with cross-sectional imaging identified a 3.7-cm pancreatic head mass and a 1.7-cm left adrenal mass; biochemical studies revealed elevated serum gastrin and urinary free metanephrines and catecholamines consistent with pheochromocytoma. Initial surgical management was a left posterior retroperitoneoscopic adrenalectomy. Postoperatively, gallium-68-DOTATOC PET/CT showed uptake in the pancreatic head and a 28-mm left thyroid nodule. Months later, she had an open pancreaticoduodenectomy. Pathology showed pheochromocytoma and a low-grade (G1) gastrinoma involving 2/8 peripancreatic lymph nodes (pT3pN1M0), respectively. Fine-needle aspiration biopsy of the thyroid nodule showed features consistent with a Hürthle cell neoplasm. Genetic testing identified a pathogenic mutation in NF1 and no mutations in BRCA1/2, CDC72, MEN1, or PALB2. The patient continues surveillance, with no evidence of recurrent disease. CONCLUSIONS We report the fifth case of gastrinoma associated with NF1 and the first to arise from the pancreas. This case of a pancreatic neuroendocrine tumor was associated with multiple additional neoplasms. Neuroendocrine tumors found in NF1 should raise suspicion of other malignancies.
Topics: Adenoma, Oxyphilic; Aged; Endocrine Gland Neoplasms; Female; Gastrinoma; Gastrointestinal Neoplasms; Gastrointestinal Stromal Tumors; Humans; Neurofibromatosis 1; Pheochromocytoma
PubMed: 33452231
DOI: 10.12659/AJCR.927761 -
Pleura and Peritoneum Sep 2017Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) has changed treatment for selected patients with peritoneal metastases (PM) arising...
BACKGROUND
Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) has changed treatment for selected patients with peritoneal metastases (PM) arising from appendiceal, colorectal, epithelial ovarian, primary peritoneal and gastric cancers. However, the results of CRS with HIPEC remain unclear in PM from other tumor histologies.
METHODS
We report a series of 10 patients who underwent CRS and HIPEC between 2006 and 2015, for PM arising from uncommon tumor origins.
RESULTS
Ten patients with PM from uncommon tumor origins underwent CRS and HIPEC. Median age was 46.5 years. Two patients had ovarian Sertoli-Leydig cell tumors (SLCT) and two had small bowel adenocarcinomas. The other histologies included: ovarian transitional cell carcinoma, ovarian granulosa cell tumor, endometroid adenocarcinoma, endocervical adenocarcinoma, synovial sarcoma, and ovarian leiomyosarcoma. Median peritoneal cancer index was 9 (2-18) and complete cytoreduction was achieved for all patients. Median follow-up was 14 months (2-100), and median time to recurrence from CRS and HIPEC was 16.0 months by Kaplan-Meier estimate. Four patients remain alive and disease-free, five are alive with disease, and one had died with disease. Median survival was not reached.
CONCLUSIONS
Eight of ten patients with peritoneal metastases in the above rare indications survived 10 months or more after CRS and HIPEC. These encouraging results are a rationale for prospective clinical trials in these tumor histologies.
PubMed: 30911642
DOI: 10.1515/pp-2017-0017 -
Medicine Sep 2022A jejunal gastrointestinal stromal tumor (GIST) is a rare neoplasm of the gastrointestinal (GI) tract. Massive bleeding due to a jejunal GIST is a diagnostic and...
BACKGROUND
A jejunal gastrointestinal stromal tumor (GIST) is a rare neoplasm of the gastrointestinal (GI) tract. Massive bleeding due to a jejunal GIST is a diagnostic and therapeutic challenge. It may be a life-threatening GIST complication that requires urgent intervention. Acute GI bleeding, which requires urgent surgical intervention, is a very rare clinical manifestation of GIST. A jejunal GIST with massive hemorrhage with coronavirus disease 2019 in a male patient in older age with many comorbidities has been not reported in the worldwide literature.
METHODS
In this case report, we present an 80-year-old man who was admitted to surgery due to abdominal pain, melena, and hematochezia for several hours. An upper endoscopy and colonoscopy were inconclusive. A multidetector contrast-enhanced computed tomography (CT) of the abdominal and pelvic cavity showed concentric irregular thickening in the distal jejunum.The histopathological finding showed a GIST measuring 6 cm with a mitotic index 2/50 high power fields. The patient's hemodynamic condition deteriorated despite initial conservative treatment including a blood transfusion. Therefore, patient underwent the emergency surgery 24 hours after admission: partial jejunal resection with the tumor followed by primary end-to-end anastomosis.
RESULTS
The mass was removed completely. There were no surgical complications in the postoperative course. On the first postoperative day, a severe acute respiratory syndrome coronavirus 2 polymerase chain reaction test was performed due to a persistent dry cough, which yielded a positive result. After 14 days, the patient died due to pneumonia and circulatory failure.
CONCLUSIONS
This case indicates that jejunal GIST can present as massive lower gastrointestinal bleeding and urgent surgery can successfully stop bleeding and save the patient's life. The CT scan was the most effective investigation to find the source of GI bleeding in this case. Therefore, we suggest performing CT in patients with acute massive lower gastrointestinal bleeding when the source of bleeding is not visible on endoscopy, and urgent surgical jejunal resection to stop life-threatening bleeding caused by a jejunal GIST.
Topics: Aged, 80 and over; COVID-19; Endoscopy, Gastrointestinal; Gastrointestinal Hemorrhage; Gastrointestinal Stromal Tumors; Humans; Jejunum; Male
PubMed: 36107510
DOI: 10.1097/MD.0000000000030098