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Medicine Oct 2023An overdistended gallbladder is usually observed in cases of distal bile obstruction due to malignancy. The gallbladder may also become enlarged and distended during...
RATIONALE
An overdistended gallbladder is usually observed in cases of distal bile obstruction due to malignancy. The gallbladder may also become enlarged and distended during cystic duct or gallbladder neck obstruction due to gallstones. However, a grossly distended gallbladder ( > 14 cm in length) without any pathology is rare. We present the case of a 46-year-old female patient who suffered from acute right lower quadrant pain for 4 days. Initially, a liver cyst and a choledochal cyst were diagnosed by the local hospital. Then, the diagnosis of giant gallbladder (measuring approximately 20.0 cm × 7.0 cm and containing more than 30 gallbladder stones) was made by magnetic resonance cholangiopancreatography at our hospital. Finally, we successfully performed a laparoscopic cholecystectomy and the patient had an uneventful recovery.
PATIENT CONCERNS
A 46-year-old female patient presented with acute right lower quadrant pain lasting 4 days. At first, the abdominal pain was severe and paroxysmal, and then it subsided spontaneously. Computed tomography of the abdomen at another hospital revealed a hepatic cyst and a choledochal cyst. Come to our hospital for surgical treatment.
DIAGNOSES
giant gallbladder with gallstones.
INTERVENTIONS
Laparoscopic cholecystectomy was successfully performed in this patient after decompressing the gallbladder.
OUTCOMES
On the third postoperative day, the patient recovered well, and the abdominal pain resolved following the operation. At the 3-year postoperative follow-up, the patient was symptom-free, with no obvious abnormalities seen in liver function and hepatobiliary color Doppler ultrasound.
LESSONS
The patient was successfully treated using laparoscopic cholecystectomy. This rare case may contribute to the development of mechanisms for treating giant gallbladders.
Topics: Female; Humans; Middle Aged; Gallbladder; Cholecystectomy, Laparoscopic; Gallstones; Choledochal Cyst; Abdomen; Gallbladder Diseases; Cholestasis; Abdominal Pain
PubMed: 37800759
DOI: 10.1097/MD.0000000000035429 -
World Journal of Clinical Cases Jul 2023Angiosarcoma (AS) is a rare and highly aggressive soft tissue disease that most commonly arises in deep soft tissues. There are only a few reported cases of AS involving...
BACKGROUND
Angiosarcoma (AS) is a rare and highly aggressive soft tissue disease that most commonly arises in deep soft tissues. There are only a few reported cases of AS involving the ovary and even fewer reports of the underlying molecular abnormalities. Here, we briefly review two cases of primary ovarian AS (oAS) with specific molecular events and immune checkpoints. The clinical features and prognosis of the disease, diagnosis, differential diagnosis, and new treatment approaches are discussed based on a literature review.
CASE SUMMARY
Case 1: A 51-year-old female patient was admitted with right lower limb pain for 5 mo, and lower abdominal pain with hematuria for 1 mo. Partial removal of rectus abdominis muscle and fascia, partial hysterectomy, bilateral salpingo-oophorectomy, and inguinal and pelvic lymphadenectomy were performed. Pathology revealed primary oAS. Fluorescence hybridization revealed gene amplification. MESNA + ADM + IFO + DTIC (MAID) regimen was administered, but stable disease was achieved. The patient died 1 mo later. Case 2: A 41-year-old female patient presented with fatigue, nausea, decreased appetite, and diffuse abdominal pain. On physical examination, the abdomen was distended and a complex cystic mass was palpable in the right pelvic cavity. Pathology revealed primary oAS. MAID chemotherapy was administered and programmed death ligand 1 (PD-L1) staining was performed on the tumor samples. The patient benefited from anti-PD-1 immunotherapy and is alive without any evidence of disease 27 mo off therapy in follow-up.
CONCLUSION
Long-term survival benefit for primary oAS can be achieved by alternative therapeutic strategies using pathological indicators to inform treatment.
PubMed: 37583851
DOI: 10.12998/wjcc.v11.i21.5122 -
Ear, Nose, & Throat Journal Jul 2023Woakes' syndrome, first reported by Edward Woakes in 1885, is an extremely rare, recurrent sinonasal polyposis leading to bone erosion of the sinus walls with consequent...
Woakes' syndrome, first reported by Edward Woakes in 1885, is an extremely rare, recurrent sinonasal polyposis leading to bone erosion of the sinus walls with consequent nasal pyramid deformity and facial disfigurement. We report a 66-year-old man who presented with severe nasal obstruction. His external nose was deformed and distended with complete obstruction of the bilateral nasal cavities by nasal polyps. The normal structure of the nose was disrupted. Thus, super-selective embolization was performed before surgery to minimize bleeding. The day after the embolization, polypectomy was performed with the navigation system. The progression was uneventful, and the patient was discharged on postoperative day 7. Pathological examination revealed inflammatory polyps with no eosinophil infiltration. Thus, we diagnosed it as Woakes' syndrome. Although there have been few reports of Woakes' syndrome in the past, these are the largest polyps reported to the best of our knowledge.
PubMed: 37431670
DOI: 10.1177/01455613231186473 -
Clinical and Translational Radiation... Nov 2023Distended rectums on pre-radiotherapy scans are historically associated with poorer outcomes in patients treated with two-dimensional IGRT. Subsequently, strict rectal...
INTRODUCTION
Distended rectums on pre-radiotherapy scans are historically associated with poorer outcomes in patients treated with two-dimensional IGRT. Subsequently, strict rectal tolerances and preparation regimes were implemented. Contemporary IGRT, daily online registration to the prostate, corrects interfraction motion but intrafraction motion remains. We re-examine the need for rectal management strategies when using contemporary IGRT by quantifying rectal volume and its effect on intrafraction motion.
MATERIALS AND METHODS
Pre and during radiotherapy rectal volumes and intrafraction motion were retrospectively calculated for 20 patients treated in 5-fractions and 20 treated in 20-fractions. Small (rectal volume at planning-CT ≤ median), and large (volume > median) subgroups were formed, and rectal volume between timepoints and subgroups compared. Rectal volume and intrafraction motion correlation was examined using Spearman's rho. Intrafraction motion difference between small and large subgroups and between fractions with rectal volume < or ≥ 90 cm were assessed.
RESULTS
Median rectal volume was 74 cm, 64 cm and 65 cm on diagnostic-MRI, planning-CT and treatment imaging respectively (ns). No significant correlation was found between patient's rectal volume at planning-CT and median intrafraction motion, nor treatment rectal volume and intrafraction motion for individual fractions. No significant difference in intrafraction motion between small and large subgroups presented and for fractions where rectal volume breached 90 cm, motion during that fraction was not significantly greater.
CONCLUSION
Larger rectal volumes before radiotherapy and during treatment did not cause greater intrafraction motion. Findings support the relaxation of strict rectal diameter tolerances and do not support the need for rectal preparation when delivering contemporary IGRT to the prostate.
PubMed: 37842073
DOI: 10.1016/j.ctro.2023.100685 -
Cureus Apr 2024Secondary tumors of the ampulla of Vater are exceedingly rare and associated with relatively poor prognosis. Tumors of the ampulla are classified into four distinct...
Secondary tumors of the ampulla of Vater are exceedingly rare and associated with relatively poor prognosis. Tumors of the ampulla are classified into four distinct subtypes based on the location and involvement of surrounding structures. Most reported cases are of renal cell or malignant skin melanoma primary with only five previously reported cases of breast primary found in a literature review. We present a 72-year-old woman with metastatic breast cancer to the ampulla of Vater as well as multiple bones. She had a history of breast cancer status post bilateral mastectomy and chemo 27 years prior. She presented to the hospital with altered mental status and was found to have an acute liver injury. Magnetic resonance cholangiopancreatography revealed a distended gallbladder and an indeterminate left retroperitoneal mass concerning for cystic or necrotic lymphadenopathy. Endoscopy then showed an edematous and erythematous periampullary region, which was biopsied and returned positive for carcinoma. Immunohistochemical staining of the retroperitoneal mass returned positive for keratin, estrogen receptor, GATA3, and MOC31 and negative for progesterone receptor, WT1, calretinin, and E-cadherin. The periampullary region's immunohistochemistry returned positive for pankeratin (AE1/AE3) and CD138 and negative for CD45 and S100, supporting a diagnosis of primary breast carcinoma. The average time from diagnosis of breast cancer to metastasis was found to be 2.5 years. Endoscopic visual presentation of metastatic cancer to the ampulla is indistinguishable from that of primary cancers. Thus, a biopsy with cytology and immunohistochemical analysis is necessary for diagnosis. Management of secondary ampullary tumors requires a multidisciplinary team, including gastroenterology, surgery, oncology, and often palliative care. Secondary tumors have been found to be treated by any combination of Whipple's resections, chemotherapy, drainage/stenting, and endoscopic ampullectomy.
PubMed: 38756323
DOI: 10.7759/cureus.58396 -
Open Veterinary Journal Mar 2024Urolithiasis in dogs is a disorder of the urinary tract caused by the development of crystals. These crystals are composed of minerals such as phosphates, oxalates,...
BACKGROUND
Urolithiasis in dogs is a disorder of the urinary tract caused by the development of crystals. These crystals are composed of minerals such as phosphates, oxalates, urates, cystine, carbonates, and silica. It can be fatal if the diagnosis and treatment are inaccurate. This report aims to report a case of urolithiasis in a Toy Poodle dog.
CASE DESCRIPTION
A 2-year-old male Toy Poodle dog weighing 4.2 kg with black hair, and having trouble urinating was presented to Prof. Soeparwi Animal Hospital, Universitas Gadjah Mada, Indonesia. The dog is examined physically and, in the laboratory, diagnosed and continued with operative therapy. The history and physical examination revealed that the dog had been experiencing hematuria, stranguria, and oliguria for 2 months, with the last few days accompanied by decreased appetite. The dog exhibited decreased skin turgor, a capillary refill time (CRT) of less than 2 seconds, signs of pain and distress during urination, and palpation of distended urinary vesicles. Ultrasound scans revealed uroliths in the urinary vesica, which were identified by an acoustic shadow. Blood tests indicated a decrease in hematocrit and erythrocytes along with an increase in leukocytes. Urolithiasis was diagnosed in the case dog based on anamnesis, physical examination, hematological examination, and ultrasonography. Subsequently, a cystotomy was performed, and uroliths located in urinary vesicles were removed. The dog received ceftriaxone injections at 15 mg/kg body weight and vitamin B-complex injections at a concentration of 10 mg/kg body weight for 5 days. Four days post-surgery, the case dog was able to successfully urinate and pass clean urine.
CONCLUSION
The Toy Poodle dog was diagnosed with silica urolithiasis in the urinary vesicles and the urolith is quite large. Cystotomy was performed to remove the urolith. Postoperative care were included the administration of antibiotics and vitamins to facilitate the healing process. The condition of the Poodle toy dog improved.
Topics: Animals; Dogs; Dog Diseases; Male; Urolithiasis; Indonesia
PubMed: 38682149
DOI: 10.5455/OVJ.2024.v14.i3.23 -
International Journal of Surgery Case... Mar 2024Intestinal atresia is a congenital anomaly commonly happening in the small bowel and rarely in the colon. Colonic atresia can manifest as intestinal obstruction with...
INTRODUCTION AND IMPORTANCE
Intestinal atresia is a congenital anomaly commonly happening in the small bowel and rarely in the colon. Colonic atresia can manifest as intestinal obstruction with abdominal distention and bilious vomiting.
CASE PRESENTATION
A 3-day-old male new-born who was referred from a rural hospital, full term, product of normal vaginal delivery, with a weight of 2400 g. The patient had a complaint of bilious vomiting, inability to pass meconium, and abdominal distension for three days. On clinical examination the patient had visible bowel loops and yellowish aspiration from the orogastric tube. An erect abdominal radiograph showed distended bowel loops and sharp air-fluid levels. Administration of contrast enema revealed resistance to pass the rectal tube and stopping of contrast pas the rectosigmoid region with contrast spillage from the anus.
CLINICAL DISCUSSION
Sigmoid atresia is a rare congenital anomaly that occurs in approximately 1 in 20,000 live births. The most common presentation is bilious vomiting and abdominal distension in the first 24 h of life. Diagnosis is confirmed with abdominal X-ray and contrast enema. Treatment is surgical, with primary repair being the most common approach. He underwent two stages of repair with an end colostomy and mucous fistula, then closure of the colostomy after four months of the first stage.
CONCLUSION
This presentation requires clinical suspicion with prompt care, as this condition can mimic Hirschsprung's disease. In our case, the patient has a classical presentation of sigmoid atresia that had an early diagnosis, which resulted in a better outcome.
PubMed: 38401322
DOI: 10.1016/j.ijscr.2024.109434 -
Frontiers in Surgery 2023Gorham-Stout disease is a rare condition of unknown prevalence and unknown exact cause. Its pathogenesis is based on enhanced osteoclastic activity leading to bone...
BACKGROUND
Gorham-Stout disease is a rare condition of unknown prevalence and unknown exact cause. Its pathogenesis is based on enhanced osteoclastic activity leading to bone resorption and bone replacement by distended lymphatic vessels. Because of its rarity and a various range of symptoms the disease may give, diagnosis is challenging and a strong index of suspicion is required. Although it is a benign condition, the prognosis may be unpredictable. The treatment options suggested so far are limited, and every case should be provided with the best individual approach. Herein, we present a case report of Gorham-Stout disease managed with a regular lump drainage with a good response and control of the patient symptoms over a period of 20 years.
CASE REPORT
A 23-year-old male was admitted to the Head and Neck Cancer Clinic with a 6-month history of a left-sided neck lump. Other symptoms reported were neck pain and general weakness. The basic laboratory tests were within normal limits. On physical examination, a large round lump on the left side of a patient's neck and left armpit were noticed. They were about several centimeters in diameter, soft on palpation, but firmly attached to the underlying tissue. CT scan revealed large lymphatic left-sided masses of the neck and axillary fossa and multiple osteolytic lesions in the patient's vertebrae. Together with the biopsy findings and imaging studies, a diagnosis of Gorham-Stout Syndrome was made. The patient was then scheduled for a regular cystic drainage with good control of a disease for over a period of 20 years.
CONCLUSION
Gorham-Stout disease is a rare challenging condition, and the available treatment options remain sparse. Although surgical approach is effective, it is not always possible. In addition, the risk of radiotherapy-induced malignancy shows that this therapy may eventually result in unfavorable response. Depending on symptoms and the disease location, this condition requires an individual treatment plan. The presented case illustrates that a minimally invasive approach may result in a good control of the Gorham-Stout syndrome and may stand as an alternative treatment option for some patients with this condition.
PubMed: 37744726
DOI: 10.3389/fsurg.2023.1225209 -
Current Problems in Diagnostic Radiology 2023Conditions that lead to small bowel mural thickening fall into a broad spectrum of diseases, including inflammatory, infectious, vascular or neoplastic. Computed... (Review)
Review
Conditions that lead to small bowel mural thickening fall into a broad spectrum of diseases, including inflammatory, infectious, vascular or neoplastic. Computed tomography (CT) and Magnetic Resonance Imaging (MRI), especially CT-enterography and MR-enterography, permit evaluation of both entire small bowel and extraluminal structures. In CT/MR-enterography, the main prerequisite for the correct evaluation of small bowel is to obtain optimal intestinal distension. In fact, most errors are related to poor intestinal distension of the bowel which can lead to interpret as pathological a small bowel segment that is not very distended (false positive), or not to recognize presence of pathology in a collapsed segment (false negative). Once the examination has been performed, the images are analyzed in order to identify the presence of small bowel pathology. Pathology of the small bowel can manifest as endoluminal alteration and/or intestinal wall thickening. Once bowel wall thickening has been identified, the radiologist's first objective is trying to define benign or malignant nature of the alteration, using also patient's history and clinical features. Once the suspicion of benign or malignant pathology has been raised, the radiologist must try to formulate a diagnosis of nature. In this pictorial review we describe how the radiologist must reason for a correct diagnosis by answering a pattern of sequential questions in a patient with suspected small bowel disease studied by CT or MRI.
Topics: Humans; Intestine, Small; Tomography, X-Ray Computed; Diagnosis, Differential; Magnetic Resonance Imaging; Radiologists
PubMed: 37137738
DOI: 10.1067/j.cpradiol.2023.03.006 -
Cell Stress & Chaperones Jul 2023Glucose-regulated protein 78 (GRP78) is frequently and highly expressed in various human malignancies and protects cancer cells against apoptosis induced by multifarious...
Glucose-regulated protein 78 (GRP78) is frequently and highly expressed in various human malignancies and protects cancer cells against apoptosis induced by multifarious stresses, particularly endoplasmic reticulum stress (ER stress). The inhibition of GRP78 expression or activity could enhance apoptosis induced by anti-tumor drugs or compounds. Herein, we will evaluate the efficacy of lysionotin in the treatment of human liver cancer as well as the molecular mechanism. Moreover, we will examine whether inhibition of GRP78 enhanced the sensitivity of hepatocellular carcinoma cells to lysionotin. We found that lysionotin significantly suppressed proliferation and induced apoptosis of liver cancer cells. TEM showed that lysionotin-treated liver cancer cells showed an extensively distended and dilated endoplasmic reticulum lumen. Meanwhile, the levels of the ER stress hallmark GRP78 and UPR hallmarks (e.g., IRE1α and CHOP) were significantly increased in response to lysionotin treatment in liver cancer cells. Moreover, the reactive oxygen species (ROS) scavenger NAC and caspase-3 inhibitor Ac-DEVD-CHO visibly attenuated the induction of GRP78 and attenuated the decrease in cell viability induced by lysionotin. More importantly, the knockdown of GRP78 expression by siRNAs or treatment with EGCG, both induced remarkable increase in lysionotin-induced PARP and pro-caspase-3 cleavage and JNK phosphorylation. In addition, knockdown of GRP78 expression by siRNA or suppression GRP78 activity by EGCG both significantly improved the effectiveness of lysionotin. These data indicated that pro-survival GRP78 induction may contribute to lysionotin resistance. The combination of EGCG and lysionotin is suggested to represent a novel approach in cancer chemo-prevention and therapeutics.
Topics: Humans; Endoplasmic Reticulum Chaperone BiP; Endoribonucleases; Heat-Shock Proteins; Protein Serine-Threonine Kinases; Endoplasmic Reticulum Stress; Apoptosis; Liver Neoplasms; RNA, Small Interfering; Cell Line, Tumor
PubMed: 37326827
DOI: 10.1007/s12192-023-01358-5