Adarsh Vijay

Retroperitoneal liposarcoma: a comprehensive review.

Retroperitoneal liposarcomas are rare mesenchymal tumors of the retroperitoneum that typically present with advanced disease and often carry a poor prognosis. Because of their rarity and anatomic location, these malignant tumors can cause a diagnostic dilemma and present several therapeutic challenges. They are usually associated with a high rate of recurrence despite grossly complete resection, thus requiring long-term and often indefinite follow-up. Relevant data on this topic was procured and synthesized with the aid of a comprehensive Medline search in addition to oncologic, pathologic, urologic, radiologic, and surgical literature review on retroperitoneal sarcomas. This article provides an in-depth review into the natural history, pathology, clinical manifestations, and prognostic features of retroperitoneal liposarcomas. It also discusses the reliability of diagnostic procedures and novel curative approaches that are currently being evaluated for the disease.

Early laparoscopic approach to pancreatic injury following blunt abdominal trauma

The incidence of pancreatic injury following blunt abdominal trauma is rare. A timely accurate diagnosis of such injury is difficult and also the management remains controversial. Here, we reported the successful use of laparoscopy to diagnose, characterize and treat blunt pancreatic trauma in a 28-year-old male patient involved in a motor vehicle crash. An abdominal computed tomography scan showed peripancreatic fat stranding suggestive of pancreatic injury. With persistent clinical signs of peritonitis and laboratory investigations suggestive of pancreatitis, the patient underwent laparoscopic drainage of the lesser sac. The patient had an uneventful postoperative course. The management of patients with blunt pancreatic injuries should be tailored to individual situations. Our experience suggests that a timely laparoscopic management of traumatic pancreatic injury is safe approach in selected cases.

Hepatocellular adenoma: An update

Hepatocellular adenomas (HCA) are rare benign liver tumors. Recent technological advancements have helped in the early identification of such lesions. However, precise diagnosis of hepatocellular incidentalomas remains challenging. Studies at the molecular level have provided new insights into the genetics and pathophysiology of these lesions. These in turn have raised questions over their existing management modalities. However, the rarity of the tumor still restricts the quality of evidence available for current recommendations and guidelines. This article provides a comprehensive review on the etiology, molecular biology, patho-physiology, clinical manifestations, and complications associated with HCA. It also elaborates on the genetic advancements, existing diagnostic tools and current guidelines for management for such lesions.

Solid pseudopapillary tumor of the pancreas in a patient with cervical cancer: relation of E-cadherin/β-catenin adhesion complex in their carcinogenesis

Solid pseudopapillary tumor (SPT) of the pancreas is one of the most uncommon histotypes of all exocrine pancreatic neoplasms. Disorganization of E-cadherin and β-catenin mutations, two key components of the Wnt signal transduction pathway, has been implicated in the development of SPT, but not other pancreatic tumors. Loss of E-cadherin/β-catenin proteins and tyrosine phosphorylation of E-cadherin/β-catenin have been postulated in cervical carcinogenesis and cancer invasion. A 38-year-old married woman, who had undergone brachytherapy, radiotherapy and chemotherapy for cervical cancer in Philippines in 2011, was admitted to our hospital after follow-up CT scan of abdomen in 2012 revealed a lesion in the tail of pancreas. The patient underwent distal pancreatectomy and splenectomy. The pathological diagnosis was SPT of pancreas. We suspect that the concurrent SPT pancreas and cervical cancer in this woman were triggered by a primary insult, a process in which E-cadherin/β-catenin/Wnt-signaling pathway played important roles.

Invasive duct carcinoma of the forearm: a rare case of distant, isolated ‘carcinoma en cuirasse’

Cutaneous metastasis (carcinoma en cuirasse) is a condition that results from a tumor spreading via lymphatic or vascular embolization, direct implant during surgery or skin involvement by contiguity. Contralateral distant cutaneous breast cancer has never been reported before and hence, the nature and management of such rare cases remains challenging. We aim to present a case of left-sided ‘distant’ cutaneous metastatic invasive duct carcinoma affecting the distal upper extremity (contralateral side) two and half years (disease-free) following treatment for right breast cancer (right mastectomy + chemoradiation). A complete metastatic work-up excluded the presence of any underlying disease. Clinical examination revealed a fungating, irregular ulcer that bled easily on touch involving the left forearm. The ulcer was excised totally and the raw area reconstructed using a split thickness graft. The patient had uneventful postoperative course and now remains disease-free for almost 1 year with no evidence of local recurrence.

Pancreatico-enteric fistula post pancreatic duct ligation for delayed haemorrhage complicating pancreaticoduodenectomy

Highlights • Delayed post-pancreatectomy haemorrhage in association with pancreatic fistula is a grave complication.• Pancreatic duct occlusion may be considered in hemodynamically unstable patients.• Spontaneous development of a pancreatico-enteric fistula despite ligation of the pancreatic duct has never been reported to date.

Echinococcal cyst of the pancreas with Cystopancreatic duct fistula successfully treated by partial cystectomy and Cystogastrostomy

The primary pancreatic hydatid (echinococcal) cyst is extremely rare with a reported incidence of <1%. Owing to its rareness and a considerable overlap of imaging features, a preoperative diagnosis is usually difficult. The dilemma in confirming this benign diagnosis has often questioned the extent of radical pancreatic resection. The involvement of pancreatic duct (cystopancreatic duct fistula) further complicates the management of such cystic lesions. In this report, we present a case of isolated hydatid cyst of the pancreatic body and tail communicating with the pancreatic duct. Cystogastrostomy preceded by partial cystectomy in the same setting has never been reported to date. The patient had an uneventful postoperative course and follow-up showed no evidence of cyst recurrence or dissemination. We consider this a safe surgical option in longstanding large cysts, especially if a cystopancreatic fistula is detected beforehand. The success of such a procedure however may rely on the size and thickness of the cyst wall to support this anastomosis.