Hisato Kobayashi

Autoimmune pancreatitis detected as a mass in the tail of the pancreas

A mass in the tail of the pancreas was detected in a 62‐year‐old male patient who had hypergammaglobulinaemia, and was positive for antinuclear antigen and anti‐SS‐A antibody. Endoscopic retrograde pancreatography revealed focal irregular narrowing of the main pancreatic duct in the tail of the pancreas. Dynamic computed tomography showed swelling of the pancreatic tail, which was enhanced on delayed phase. Autoimmune pancreatitis was suspected and corticosteroid therapy was commenced. This led to significant resolution of the pancreatic stricture. It is important to recognize this clinical entity as corticosteroid therapy may avoid unnecessary surgery.

Autoimmune pancreatitis detected as a mass in the head of the pancreas without hypergammaglobulinemia, which relapsed after surgery: case report and review of the literature.

Autoimmune pancreatitis is a recently proposed clinical entity characterized by diffuse swelling of the pancreas, irregular narrowing of the main pancreatic duct on endoscopic retrograde pancreatography, hypergammaglobulinemia, and the presence of autoantibodies, together with responsiveness to corticosteroid therapy (1, 2). There are some reports of cases with focal swelling, which simulates pancreatic cancer or lymphoma (3–6), as well as cases that begin with focal swelling and progress to diffuse swelling (7–10 ). Here, we report a case of autoimmune pancreatitis that presented with obstructive jaundice and a mass in the head of the pancreas, which progressed to diffuse swelling 4 months after surgery. We also review the clinical features of reported cases of autoimmune pancreatitis.

CASE REPORT: Autoimmune Pancreatitis Detected as a Mass in the Head of the Pancreas with Contiguous Fibrosis Around the Superior Mesenteric Artery

Several cases of chronic pancreatitis associated with autoimmunity have been reported (1–3), and the concept of autoimmune pancreatitis was recently proposed (4, 5). This clinical entity is characterized by diffuse or focal swelling of the pancreas, irregular narrowing of the main pancreatic duct on endoscopic retrograde pancreatography (ERP), hypergammaglobulinemia, and the presence of autoantibodies, together with remarkable responsiveness to corticosteroid therapy. Some cases showing focal swelling or multiple focal masses that simulate pancreatic cancer or lymphoma have been reported by us and others (3, 6–10). Here, we report a case of autoimmune pancreatitis, detected as a mass in the head of the pancreas with a contiguous mass around the superior mesenteric artery, that was treated successfully with corticosteroid.

Ovarian Mucinous Cystadenoma of Borderline Malignancy in a Premenarchal Girl

Ovarian mucinous cystadenomas are benign epithelial neoplasms that occur most often in the third to sixth decade of life. Ovarian mucinous cystadenoma can be classified into 3 categories (benign, borderline malignancy, malignancy) based on histopathologic evaluation. Premenarchal cases of ovarian mucinous cystadenoma of borderline malignancy are exceedingly rare. To the best of our knowledge, there have been only 4 reported cases of borderline ovarian mucinous cystadenoma prior to 2009. Here we report a 13-year-old premenarchal girl with a giant mass occupying almost the whole of the abdomino-pelvic cavity.

A case of ectopic hepatocellular carcinoma in the jejunum.

We describe the case of a 72 year-old man with a huge tumor in his lower abdomen and extremely high serum α-fetoprotein levels (99 100 ng/ml). The patient had no risk factors for hepatocellular carcinoma (HCC) or liver disease. Computed tomography, magnetic resonance imaging, and hepatic angiography detected no tumors in the liver before surgery. The arteries feeding the tumor arose from the superior mesenteric artery, but were not recognized on celiac angiography. Histologically, the tumor cells had features of HCC. Immunohistochemical staining revealed that the tumor cells were positive for AFP and the hepatocyte paraffin 1 monoclonal antibody. Furthermore, the tumor cells were strongly positive for cytokeratin 8 and cytokeratin 18, which are usually expressed on hepatocytes in HCC, and negative for both cytokeratin 7 and cytokeratin 20, which are not usually expressed in HCC. Hence, the tumor was diagnosed as an ectopic HCC that possibly developed from ectopic liver tissue in the jejunum. Approximately 2 months after the operation, transarterial chemoembolization was performed for liver metastasis from this tumor. One year after the transarterial chemoembolization procedure, the patient remains well with no evidence of a recurrent tumor or serum AFP elevation.

Umbilical cyst containing ectopic gastric mucosa originating from an omphalomesenteric duct remnant.

An umbilical cyst originating from an omphalomesenteric duct remnant is extremely rare, and to the best of our knowledge, it has scarcely been reported in medical literature. We present ultrasonographic manifestations and computed tomographic findings of an umbilical cyst originating from an omphalomesenteric duct remnant in a 6-year-old girl. In cases of umbilical cyst, radiographic evaluation alone may not differentiate an omphalomesenteric duct remnant with heterotopic gastric mucosa from a urachal remnant, and surgical intervention is required.

Mesenteric leiomyosarcoma in a 13-year-old boy

Mesenteric leiomyosarcoma occurs most commonly in middle-aged individuals. Primary tumors of the mesentery are uncommon in pediatric and adolescent patients, and primary mesenteric leiomyosarcoma is particularly rare. Accurate preoperative diagnosis of mesenteric soft tumor is generally difficult. We describe a case of leiomyosarcoma arising from the ileal mesentery in a 13-year-old boy. The diagnosis was based on histopathologic evaluation using immunohistochemical staining and gene analysis.

Pyloric duplication cyst in an infant

Correspondence: Minoru Iwasaki, MD, PhD, Department of Pediatric Surgery, 1-1-35 Nagara, Otsu-shi, Shiga, 520-8511, Japan. Email: iwasaki@otsu.jrc.or.jp Received 28 September 2006; revised 20 February 2007; accepted 25 April 2007. doi: 10.1111/j.1442-200X.2008.02777.x Duplication of the alimentary tract may occur in any site, from the mouth to the anus, and in recent years such anomalies have received wide notice. We restrict the term ‘duplication’ to enteric formations, either spherical or tubular, which lie in contiguity with the normal alimentary tract and which share with it a common blood supply and usually a common muscle layer. Gastric duplications comprise approximately 3.8% of gastrointestinal duplications. 1,2 True pyloric duplication cyst is extremely rare and can be confused with antral gastric duplication. Both may simulate pyloric stenosis. 2 – 4 Pyloric duplication cysts are extremely rare, and only 17 have been reported up to October 2006 ( Table 1 ). This article will review additional ones. It also includes the fi rst case report in Japan describing a pyloric duplication cyst associated with hypertrophic pyloric stenosis in a 10-month-old girl.

Feedback on baseline use of staging images is important to improve image overuse with newly diagnosed prostate cancer patients.

BACKGROUND The objective of this study was to evaluate baseline use and positive rates of staging images (bone scan, CT) in newly diagnosed patients with prostate cancer (PCa) and to improve staging image overuse. MATERIALS AND METHODS This retrospective study covered a consecutive series of patients with PCa who underwent stage imaging at our institution between 2006 and 2011. Various clinical and pathological variables (age, PSA, biopsy Gleason score, clinical T stage, positive biopsy core rate) were evaluated by multivariate logistic regression analysis for their ability to predict a positive staging image. All patients were stratified according to the NCCN risk stratification and positive rates were compared in each risk group. RESULTS 410 patients (100%) underwent a bone scan and 315 patients (76.8%) underwent a CT scan. Some 51 patients (12.4%) had a positive bone scan, clinical T3 and T4 being significant independent predictors. Positive bone scan rates for low-, intermediate-, high-, and very high-risk groups were 0%, 0%, 8.25%, and 56.6%. Some 59 (18.7%) patients had a positive CT scan, with elevated PSA and clinical T3, T4 as significant independent predictors. Low-, intermediate-, high- and very high-risk group rates were 0%, 0%, 13.8% and 80.0%. CONCLUSIONS The incidences of positive staging image in low- and intermediate- risk group were reasonably low. Following feedback on these results, staging in low- and intermediate- risk groups could be omitted.

Conservative follow-up of fractured percutaneously inserted central venous catheter

The use of percutaneously inserted central venous catheters (PICC) is common in neonatal intensive care units (NICU). One of the most important complications of PICC use is catheter fracture in the vein. To our knowledge, however, there are no reports on management of fractured PICC. In all of the past reports, fractured PICC were retrieved surgically. We report the case of a male infant with fractured PICC retained in his body who was followed up conservatively without removal of the segment for 1 year.