1/11. cholecystitis caused by hemocholecyst from underlying malignancy.Massive hemobilia is a well recognized clinical entity, particularly when it presents with jaundice, GI bleeding, and biliary pain. However, occult hemobilia is more difficult to diagnose and has seldom been reported because of its clinically silent nature. In fact, this is usually overlooked until complications arise. Hemocholecyst or clot within the gallbladder may rarely occur in this setting, leading to cystic duct obstruction and cholecystitis. Most previous reports describe cholecystitis resulting from hemocholecyst after iatrogenic trauma. We describe two cases in which hemocholecyst occurred from underlying malignancies, both resulting in cholecystitis (acute or chronic).- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/11. Carcinoid of the ampulla of vater: presentation of a new case.The appendix is the most common location for carcinoid tumors within the gastrointestinal tract. Carcinoid tumors of the ampulla of vater is an extremely rare entity; only 71 cases of carcinoid of the ampulla of vater have been reported in the literature to date. The clinical picture is non-specific, and endoscopy is the main diagnostic procedure; but large and deep biopsies are often needed to verify the histological nature of the tumor. Surgery is the treatment of choice. We report a new case of this rare tumor, and a review of the literature concerning the clinical findings, diagnosis, therapeutic challenge and results.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/11. granular cell tumor of the common bile duct: a case report.Granular cell tumors (GCTs) are uncommon soft tissue tumors, usually presenting in the skin and subcutaneous tissue tongue and oral cavity. We present a case report of granular cell tumor of the common bile duct involving both extra- and intrapancreatic portions. The histogenesis appears to be related to schwann cells, similar to granular cell tumors of other sites, as evidenced by histologic and immunohistochemical findings. review of the English literature concerning biliary tract GCTs revealed a high occurrence in African-American females in their third decade. By-pass operation to correct the biliary tract obstruction may be appropriate, if the nature of the tumor can be obtained from intraoperative diagnosis by frozen section.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/11. adenomyoma and adenomyomatous hyperplasia of the Vaterian system: clinical, pathological, and new immunohistochemical features of 13 cases.adenomyoma and adenomyomatous hyperplasia of the Vaterian system are consistently benign lesions. Clinically, adenomyoma mimics frequently ampullary adenoma or carcinoma, and biopsy analysis is often difficult. The histogenesis of ampullary adenomyoma and adenomyomatous hyperplasia is still subject to debate. We present a retrospective study of clinicopathological features of 13 cases of surgically resected ampullary adenomyoma. The age of our patients was between 38 and 78 years (mean: 63 y). The preoperative diagnosis was ampullary tumor or tumor of the head of the pancreas. On macroscopy, a white, firm lesion of the ampullary wall was observed; its size ranged between 10 and 30 mm. Histologically the lesion consisted of multiple glandular structures surrounded by a fibroblastic/myofibroblastic proliferation, resulting in a "pseudo-hypertrophy" of the Vaterian system. The immunophenotype of the epithelial component was cytokeratin 7 /cytokeratin 20-, similar to that of the normal biliary and pancreatic duct system. The epithelial cells exhibited low proliferative activity. The hyperplastic myofibroblastic cells expressed smooth muscle actin. A complete pancreatic heterotopy contiguous with the adenomyoma was noted in three cases. adenomyoma and adenomyomatous hyperplasia of the Vaterian system are benign lesions frequently treated by extensive surgery because of long-term biliary obstruction. The clinicopathological characteristics suggest either a reactive and/or a malformative, nonneoplastic nature for this lesion, which could, in some cases, develop from heterotopic pancreas. The immunophenotype of epithelial cells may be a useful tool for differentiating it from ampullary adenoma on biopsy specimens.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/11. Disseminated metastasis following periampullary cancer resection masquerading as uveitis.The uveitis Masquerade Syndromes (UMS) are a group of ocular diseases that mimic intraocular inflammation, but are in fact neoplastic in nature. We report a patient with disseminated malignancy who presented with uveitis 5 years after an apparently successful resection of periampullary adenocarcinoma. The Masquerade syndrome was detected by cytological examination of the vitreous.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/11. Malignant carcinoid tumor of the common bile duct: report of a case.Carcinoid tumors of the extrahepatic bile duct are exceedingly rare and account for between 0.1% and 2% of all gastrointestinal carcinoid tumors, with most reported cases arising from the gallbladder. We herein present what we believe is only the 47th reported case of a primary carcinoid tumor occurring in the extrahepatic bile ducts. A 67-year-old woman sought treatment for obstructive jaundice accompanied by epigastric pain. Laboratory and imaging studies gave results that were consistent with a malignant obstruction in the common bile duct. We performed a pylorus-preserving pancreaticoduodenectomy. Pathologically, an ill-demarcated mass was noted in the common bile duct measuring 1.6 x 1.5 x 0.5 cm in size. The tumor had invaded the adjacent pancreatic tissues. Immunohistochemically, the mass demonstrated chromogranin, synaptophysin, and CD56 positivity. The final pathologic diagnosis was well-differentiated carcinoid tumor of a malignant nature. The patient, who underwent a curative surgical resection, was alive and disease-free at the time of writing.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/11. Paneth-like cells in an adenoma and adenocarcinoma in the ampulla of vater.A case of adenocarcinoma with significant Paneth cell differentiation arising in a villoglandular polyp at the ampulla of vater is presented. Paneth-like cells, containing distinct fuchsinophilic granules, were a prominent component of the nonglandular invasive adenocarcinoma and were also seen in the associated adenomatous polyp. Lysozyme, trichrome, and periodic acid-Schiff digest stains, and electron microscopy confirmed that the granules were lysosomal in nature. This case confirms that cells with Paneth-like features can be a significant component in invasive neoplasms and can occur at unusual sites such as the ampulla of vater.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/11. Abrupt termination of the common bile duct: a sign of malignancy identified by high-resolution real-time sonography.Although contrast cholangiography has a greater accuracy than sonography in determining the precise nature of extrahepatic biliary obstruction, it is not without risk. High-resolution real-time sonography is frequently adequate to evaluate the extrahepatic biliary system in multiple planes without known risk to the patient. In a one-year period the authors prospectively observed eight instances of distal biliary obstruction with abrupt termination of the common bile duct, and all were associated with malignant obstruction. There was no instance of abrupt ductal termination secondary to benign disease in this series. Malignancy should be suspected when careful sonograms along the longitudinal axis of an obstructed distal common bile duct reveal an abrupt termination.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
9/11. Psammomatous carcinoid tumor of the duodenum.We report a case of psammomatous calcification in a carcinoid tumor of the ampulla of vater. Although the tumor was glandular, its neuroendocrine nature was proved using chromogranin immunostain.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
10/11. Granular cell myoblastoma involving multiple organs.We have described a rare case of multifocal granular cell myoblastoma affecting respiratory and hepatobiliary tracts in a young woman. The patient had successful tracheal resection and biliary stent placement to alleviate symptoms. Long-term follow-up will clarify the true nature of the disease.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
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