While extended cholecystectomy is recommended for T2 gallbladder cancer (GBC), the role of hepatic resection for T2 GBC is unclear. This study aimed to identify the necessity of hepatic resection in patients with T2 GBC. Data of 81 patients with histopathologically proven T2 GBC who underwent surgical resection between January 1999 and December 2017 were enrolled from a retrospective database. Of these, 36 patients had peritoneal-side (T2a) tumors and 45 had hepatic-side (T2b) tumors. To identify the optimal surgical management method, T2 GBC patients were classified into the hepatic resection group (n = 44, T2a/T2b = 20/24) and non-hepatic resection group (n = 37, T2a/T2b = 16/21). The recurrence pattern and role of hepatic resection for T2 GBC were then investigated. Mean age of the patients was 69 (range 36–88) years, and the male-to-female ratio was 42:39 (male, 51.9%; female, 48.1%). Hepatic-side GBC had a higher rate of recurrence than peritoneal-side GBC (44.4% vs. 8.3%, p = 0.006). The most common type of recurrence in T2a GBC was para-aortic lymph node recurrence (n = 2, 5.6%); the most common types of recurrence in T2b GBC were para-aortic lymph node recurrence (n = 7, 15.6%) and intrahepatic metastasis (n = 6, 13.3%). Hepatic-side GBC patients had worse survival outcomes than peritoneal-side GBC patients (76.0% vs. 96.6%, p = 0.041). Hepatic resection had no significant treatment effect in T2 GBC patients (p = 0.272). Multivariate analysis showed that lymph node metastasis was the only significant prognostic factor (p = 0.002). Hepatic resection is not essential for curative treatment in T2 GBC, and more systemic treatments are needed for GBC patients, particularly for those with T2b GBC.
Purpose: Pancreatic surgery is challenging and associated with high morbidity. Therefore, it is important to detect it early before it becomes clinically apparent. The white blood cell (WBC) count useful as a predictive marker of postoperative pancreatic fistula. The aim of this study was to evaluate the diagnostic accuracy of WBC in predicting pancreatic fistula. Methods: Between September 2003 and December 2013, 405 patients underwent elective pancreaticoduodenectomy or pylorus preserving pancreaticoduodenectomy for periampullary malignancy. Among them, 372 patients with no preoperative leukocytosis were enrolled in this study. The serum WBC count was monitored daily until postoperative day 8. The clinic and pathological data of these patients were analyzed by reviewing medical records retrospectively. Results: Thirty patients (8%) developed pancreatic fistula grade B and C. The WBC count, measured every other day, was significantly higher every other day during the first 7 postoperative days in patients who developed pancreatic fistula grade B and C, compared with those patients who did not develop pancreatic fistula. The WBC count cutoff value of 13.07Ã109/L, 10.37Ã109/L on postoperative day 1,7 yielded a sensitivity of 57%, 70%, specificity of 53%, 67% for the detection of pancreatic fistula. Conclusion: Patients with postoperative fistula grades B and C showed WBC counts that did not decrease on subsequent measurements during the early postoperative period. The measurement of WBC counts after pancreaticoduodenectomy can play a clinically important role in the early detection of pancreatic fistula development even from postoperative one day. Keywords: Leukocytosis, White blood cell, Pancreatic fistula, Pancreaticoduodenectomy, Postoperative complications
Background: Adult pancreatoblastoma is very rare and preoperative diagnosis is difficult due to its heterogenous, variable cellular differentiation and atypical clinical features.Methods: We describe here our recent adult case in a 78-year-old man, who underwent surgical biopsy and was diagnosed as pancreatoblastoma.Results: A 78-year-old man, who underwent right radical nephrectomy due to renal cell carcinoma 2 years ago, was found on follow up abdominal computed tomography scan to have a pancreatic body mass with superior mesenteric vein invasion.For differential diagnosis between metastatic renal cell carcinoma and primary pancreatic malignancy, endoscopic biopsy was attempted for pathologic confimation, but failed.Finally, tissue was obtained by laparoscopy.As a final biopsy result with immunohistochemical stain, pancreatoblastoma was reported and chemotherapy was planned.Conclusions: Adult pancreatoblastoma is very rare and preoperative diagnosis is difficult due to its heterogenous, variable cellular differentiation and atypical clinical features.Despite the rarity, awareness of pancreatoblasoma is necessary for specific cases, like our patient.Similar to other pancreatic malignancies, in patients with pancreatoblastoma, early detection and curative resection is the only way to achieve good long-term survival.
Adenosquamous carcinoma arising in congenital choledochal cyst is very rare and herein we report a case thereof. A 37-year-old woman was referred for further evaluation of pancreas head mass and a hepatic nodule on CT. She had been diagnosed with congenital choledochal cyst at 22-years-old and received Roux-en-Y choledochojejunostomy at that time. Endoscopic ultrasonography-guided biopsy proved the pancreas head mass as a squamous cell carcinoma and liver biopsy also proved the liver mass as a metastatic squamous cell carcinoma. We performed pancreaticoduodenectomy and tumorectomy of metastatic liver nodule. Grossly, the primary lesion was located at intrapancreatic portion of choledochal cyst. Histologically, the primary lesion and hepatic nodule was metastatic adenosquamous carcinoma. So far, there have been only three cases of adenosquamous carcinoma arising in congenital choledochal cyst reported in English-language literature. This is another case and the first case reported in Korea.
Abstract Background Islet allotransplantation is a promising way to treat some type 1 diabetic (T1D) patients with frequent hypoglycemic unawareness, and islet xenotransplantation is emerging to overcome the problem of donor organ shortage. Our recent study showing reproducible long‐term survival of porcine islets in non‐human primates ( NHP s) allows us to examine whether autologous regulatory T‐cell (Treg) infusion at peri‐transplantation period would induce transplantation tolerance in xenotransplantation setting. Methods Two diabetic rhesus monkeys were transplanted with porcine islets from wild‐type adult Seoul National University ( SNU ) miniature pigs with immunosuppression by anti‐thymoglobulin ( ATG ), cobra venom factor, anti‐ CD 154 monoclonal antibody ( mA b), and sirolimus. CD 4 + CD 25 high CD 127 low autologous regulatory T cells from the recipients were isolated, ex vivo expanded, and infused at the peri‐transplantation period. Blood glucose and porcine C‐peptide from the recipients were measured up to 1000 days. Maintenance immunosuppressants including a CD 40‐ CD 154 blockade were deliberately discontinued to confirm whether transplantation tolerance was induced by adoptively transferred Tregs. Results After pig islet transplantation via portal vein, blood glucose levels of diabetic recipients became normalized and maintained over 6 months while in immunosuppressive maintenance with a CD 40‐ CD 154 blockade and sirolimus. However, the engrafted pig islets in the long‐term period were fully rejected by activated immune cells, particularly T cells, when immunosuppressants were stopped, showing a failure of transplantation tolerance induction by autologous Tregs. Conclusions Taken together, autologous Tregs infused at the peri‐transplantation period failed to induce transplantation tolerance in pig‐to‐ NHP islet xenotransplantation setting.
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