Jiunn-Chang Lin

Goblet Cell Carcinoid of Appendix

Carcinoid tumors are rare and slow-growing malignancies which occur most frequently in the appendix as its primary malignancy. Goblet cell carcinoid belongs to a subgroup of carcinoids and occurs in exclusively the appendix. Goblet cell carcinoid of the appendix is usually discovered incidentally after appendectomy. We report a 44-year-old woman, who underwent laparoscopic appendectomy for acute appendicitis. The final pathological diagnosis was goblet cell carcinoid. After a series of gastrointestinal examination, no evidence of local or distant lesions was found. The patient decided to be closely followed -up. There have been no signs of progression of the disease more than 1 year.

Refractory gastric variceal bleeding secondary to splenic vein occlusion associated with abdominal lymphadenopathy

Splenic vein occlusion caused by abdominal lymphadenopathy is rare. We herein present the case of a 80‐year‐old man with refractory isolated gastric variceal bleeding in the absence of pancreatic or liver disease. Left‐sided portal hypertension was confirmed by angiography, and para‐aortic lymphadenopathy compressing the splenic vein was identified by serial abdominal computed tomography. Endoscopic sclerosing therapy failed to treat the recurring gastric variceal hemorrhage. Therefore, splenectomy was suggested and the patient was successfully treated. The patient had been variceal bleeding free for 12 months since the surgery. In patients with isolated gastric varices but without advanced liver disease, a variety of diagnostic techniques should be attempted to elucidate the nature of portal hypertension, and left‐sided portal hypertension should be suspected. For those cases in which endoscopic treatment failed to treat refractory gastric variceal bleeding, splenectomy can be an effective option.

Monopolar Radiofrequency Ablation for Medium-sized Hepatocellular Carcinoma: Preliminary Experience with Single-Electrode Overlapping Ablation and Multiple-Electrode Switching System

Background: Radiofrequency ablation (RFA) has been regarded as an effective treatment for early and small hepatocellular carcinoma (HCC). In vivo porcine studies showed a multipleelectrode switching system could create larger necrotic areas than single-electrode or clusterelectrode ablations. Some recent studies demonstrated a multiple-electrode RFA system could achieve local control of medium-sized HCCs. This study aimed to evaluate the treatment results of monopolar RFA with either single-electrode overlapping ablations or a multipleelectrode switching system in treating medium-sized (3-5 cm) HCC. Methods: A total of 20 patients with medium-sized hepatocellular carcinomas were included in this study. Nine patients (6 males and 3 females) were treated with single-electrode monopolar RFA. Eleven patients (4 males and 7 females) were treated with multiple- electrode switching monopolar RFA. Twelve patients (60%) included in this study had multi- nodular HCCs at the time of treatment. The tumor size was slightly larger in the multiple- electrode group (4.6±0.3 cm) compared to that in the single-electrode group (3.6±0.6 cm). CT or MR imaging studies were performed at 1 month after RFA to evaluate treatment effectiveness. Thereafter, local tumor progression, treatment effectiveness and survival after RFA were evaluated. Results: Overall, 18 of 20 patients (90%) showed satisfactory ablation of HCCs 1 month after their RFA procedures. Treatment effectiveness was achieved in 8 patients (88.9%) with singleelectrode overlapping ablation and 10 (90.9%) patients with multiple-electrode switching system. The mean follow-up periods were 14.9 (range, 2-26) months in the single-electrode group, and 20.2 (range 4-41) months in the multiple-electrode group. Among the 18 patients who achieved primary tumor control, 2 patients (1 in the single-electrode group and 1 in the multiple-electrode group) had local progression noted during follow-up examinations. Conclusions: Medium-sized hepatocellular carcinoma can be effectively ablated with monopolar radiofrequency ablation by either single-electrode overlapping ablation or a multiple electrode switching system. Regarding mid-term treatment responses, both RFA approaches can achieve similar treatment effectiveness, local tumor progression rate, and survival probabilities. Multiple-electrode switching RFA can treat larger medium-sized HCC with comparable mid-term efficacy as smaller medium-sized HCC treated with single-electrode overlapping RFA.

Pleural Effusion after Percutaneous Radiofrequency Ablation for Hepatic Malignancies

Background and Aims: Radiofrequency ablation (RFA) can play an important role in the treatment of primary or metastatic liver tumors. Currently, percutaneous RFA is generally regarded as a safe, effective, and minimally invasive procedure. This study aimed to evaluate the presence and course of pleural effusion after monopolar RFA. Methods: From October 2008 to July 2013, a total of 54 patients (28 male and 26 female, mean age 65.2) treated with monopolar RFA were included in our study. 47 patients were diagnosed with hepatocellular carcinoma, 4 patients with hepatic metastasis, and 3 patients had other diagnoses. There were a total of 115 sessions of treatment and 199 liver tumors to be treated (1.73±1.02 tumors treated per session). The tumor size ranged from 0.8 cm to 5.0 cm (mean 2.31 cm, standard deviation 1.04 cm). Thereafter, a follow-up ultrasound was performed within 24 hours subsequent to ablation to evaluate the presence of pleural effusion. The degree of pleural effusion was assessed by chest X-ray. Results: Fifteen (13.0%) treatment sessions in 14 patients showed right-sided pleural effusion after ablations. One patient had a large amount of effusion, while other patients manifested a minimal to small amount of effusion. There were 5 patients that experienced delayed resolution of pleural effusion; one patient (0.87%) had a minimal amount of pleural effusion even after one month. Overall, there was no pneumothorax, or periprocedural morality. Age, gender, tumor numbers, tumor sizes, and complete ablation of target tumors were similar among groups presenting with or without pleural effusion. Tumor locations associated with S78 segments abutting the diaphragm or right lobe of the liver were not associated with development of pleural effusion. Only the duration of ablation time had a marginal trend toward significance (p=0.051). Conclusions: The transient appearance of right-sided pleural effusion after percutaneous RFA for hepatic malignancies was not infrequent. However, refractory pleural effusion was rare.

Hepatic Angiomyolipoma-A Rare Presentation with Recurrence and Intrahepatic Metastases

Angiomyolipoma is a histologically benign tumor composed of adipose tissue, smooth muscle and blood vessels. It is usually seen in the kidney associated with tuberous sclerosis. Hepatic angiomyolipoma (HAML) is thought to be a rare benign liver tumor. Although HAML has benign pathologic features, it is still possible for it to manifest malignant behavior, such as recurrence. We report on a 38-year-old patient with HAML recurrence 4 years after surgical resection of the initial tumor.

Double Cancer of the Liver and Lung: A Report of Three Cases

Hepatocellular carcinoma is one of the most common malignancies and, because of the high prevalence of chronic hepatitis B and C, it is the leading cause of death in Taiwan. Lung cancer coexisting with hepatocellular carcinoma has rarely been reported in the medical literature. It might have been misdiagnosed as lung metastasis in many cases. We report three cases of double cancer of the liver and lung. All of the diagnoses were confirmed by pathology. One of the three cases was diagnosed early enough to be treated with surgical resection of both liver and lung tumors. Computed tomography may be helpful in differentiating primary from metastatic lung cancer. Thus, in patients with hepatocellular carcinoma and lung lesions, the possibility of double cancer of the liver and lung rather than lung metastasis should be kept in mind.

Carcinoid Tumors of the Appendix-Experience in a Teaching Hospital

Carcinoid tumor is distinct from other malignancies because of its indolent behavior, so usually it has better survival. The appendix was considered to be the most common site of carcinoid tumor. We retrospectively reviewed 8,961 appendectomies in our hospital from 1995 to 2005, and 12 patients with appendiceal carcinoid tumors were identified. The incidence of appendiceal carcinoids in our hospital (0.13%) is lower than the reported incidence (0.3-0.9%) from western literatures. In the same period, 93 patients with carcinoid tumors in different organ system were also reviewed. The rectum (60.2%), rather than the appendix (12.9%), is the most common site of carcinoid tumors. All twelve patients with appendiceal carcinoid tumor received simple appendectomy because the size of tumors was smaller than 2cm. No recurrence was found during a mean follow up of 5.6 years. Notably, four patients (33%) were diagnosed with second neoplasm synchronously or metachronously, including rectal cancer, renal angiomyolipoma, appendiceal leiomyoma, and uterine leiomyoma. The possibility of a second neoplasm should be considered during follow up of patients with appendiceal carcinoid tumors.

Vomiting and a target sign on abdominal CT

An 88-year-old woman was admitted with postprandial vomiting and fever for 2 days. She had had a subtotal gastrectomy with Billroth-II anastomosis for a gastric ulcer 30 years previously. For several months she …

Papillary Cystic Tumor(Frantz Tumor)of the Pancreas:Report of 3 Cases and Review of the Literature

We saw 3 female patients in the past 16 years with papillary cystic tumor of the pancreas. It is an uncommon tumor (0.17-2.7% of non-endocrine pancreatic tumors) and is most commonly found in young women. The most common symptoms and signs of this low-grade malignancy are epigastric pain and an abdominal mass. Ultrasound (US) and computed topography (CT) show a circumscribed, solid heterogeneous mass with cystic areas, which must be differentiated from several cystic-type tumors and pseudocysts of the pancreas. Prognosis after complete resection is usually excellent. Several cases have been reported in which the tumors were misdiagnosed as pancreatic pseudocysts so that the appropriate surgical treatment was delayed. Because of its low-grade malignancy, it is important to consider papillary cystic tumor of the pancreas in patients with cystic tumors of the pancreas. From June 1984 to August 2002 there were 3 female patients (age range, 13-42 years) who proved to have papillary cystic tumor of the pancreas in our hospital. The clinical courses, overall outcomes, and the literature are reviewed and discussed.

The Sonographic Findings of Mondor's Disease in the Breast

Mondors disease, superficial thrombophlebitis of the anterolateral chest wall, is a rare cause of breast pain. This disease often presents as a cordlike lesion with tenderness in the lateral breast. It is usually a benign and self-limiting process and only symptomatic control is needed. However, a small proportion of cases (2.4% to 12%) are associated with breast cancer. Breast sonography is a useful tool in the diagnosis of this disease, with the advantages of convenience and good resolution in young Asian females. We present a 24-year-old postpartum woman with a painful cord-like structure in the left lateral breast. This lesion resolved in 2 weeks after conservative treatment. The sonographic features of Mondors disease in this patient are illustrated and the association with breast cancer is emphasized.