1/8. Gingival metastasis from gallbladder cancer.gallbladder cancer is generally diagnosed at an advanced stage. The liver is the most commonly invaded organ by direct extension and/or metastasis, followed by regional lymph nodes. Oral soft tissue metastasis is extremely unusual. This report describes the case of a 62-year-old woman diagnosed with advanced metastatic gallbladder cancer, who initially presented with abdominal pain. diagnosis of gallbladder cancer was made about 3 months after her symptoms developed, when a laparoscopic cholecystectomy was performed because of the suspicion of gallstones. liver metastasis was also discovered during surgery. A postoperative investigation revealed additional lung and bone metastases. A visible left gingival tumor was found on physical examination and was confirmed as gallbladder cancer metastasis by compatible histopathology 1 month after surgery. The patient responded poorly to chemotherapy and unfortunately died 5 months after the diagnosis. The clinical presentation of gallbladder cancer was relatively typical, apart from the unusual gingival metastasis. The medical literature contains quite a few examples of metastatic lesions located strictly in the oral soft tissue, however no case of gallbladder cancer metastasizing to the oral soft tissue has been previously reported.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/8. Covered expandable metallic stent placement for hemostasis of colonic bleeding caused by invasion of gallbladder carcinoma.A 72-year-old Japanese man was admitted to our hospital complaining of right upper-quadrant abdominal pain, blood in his stool, and symptoms of anemia. On physical examination a hard mass, about 6 cm in diameter, was palpable in the right upper quadrant of the abdomen. Computed tomography revealed a gallbladder carcinoma which had invaded the transverse colon, with liver metastasis. We diagnosed gallbladder carcinoma, stage IVB. colonoscopy was performed for persistent blood in the stools. This revealed an elevated lesion which appeared to be an invasion of gallbladder carcinoma, with diffuse bleeding from the right-side of the transverse colon. It proved difficult to stop this bleeding by ordinary therapeutic endoscopy. In order to achieve hemostasis we therefore inserted a covered Ultraflex metallic stent to compress the tumor. After stent placement, blood was no longer seen in the patient's stools, he became able to eat soft food and was discharged. This treatment was uninvasive and effective. Covered stent placement appears to be a new and useful method in the management of bleeding from malignant gastrointestinal tumors.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
3/8. Abnormal arrangement of the pancreato-biliary ductal system associated with advanced gallbladder cancer diagnosed 3 years after follow-up ultrasonography.We herein report a case of abnormal arrangement of the pancreato-biliary ductal system (AAPB) followed by advanced gallbladder cancer 9 years after the initial endoscopic retrograde cholangiopancreatography (ERCP) diagnosis and almost 3 years after follow-up ultrasonography (US). A 65-year-old woman was referred to our department from a private clinic because of difficulty in controlling her diabetes mellitus. The patient had no complaints, and physical examination revealed no jaundice in her skin or conjunctiva. ERCP demonstrated the presence of AAPB (bile duct-main type) without congenital dilatation of the bile duct or irregularity in the gallbladder wall. She did not wish to undergo cholecystectomy. Follow-up transabdominal US revealed no change in the gallbladder. Two years and 9 months after this US examination, she developed advanced gallbladder cancer involving the liver and bile duct, with paraaortic lymph node metastases confirmed by US, computed tomography, and ERCP. This case re-emphasizes the necessity for patients with AAPB to undergo intensive follow-up examinations or cholecystectomy when the diagnosis of AAPB has been established.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
4/8. Metastatic carcinoma of the gallbladder mimicking an advanced cervical carcinoma.BACKGROUND: Metastasis to the uterine cervix from a non-gynecologic neoplasm is extremely rare. To our knowledge, only three cases of primary carcinoma of the gallbladder with metastasis to the cervix have been previously reported. We report a case of metastatic gallbladder carcinoma mimicking a stage IIIB cervical carcinoma. CASE: A 74 year-old woman presented with pain in her left lumbar area radiating to her left flank. On physical examination, a 6 cm cervical tumor involving the left parametrium was noted. A computed tomography (CT) scan of the pelvis showed left-sided hydronephrosis and hydroureter with distal ureteral obstruction. A Pap smear revealed adenocarcinoma, and a biopsy of the endocervical canal was consistent with poorly differentiated adenocarcinoma. The patient was referred to a tertiary care center. On review of the biopsy after referral, the carcinoma was felt to be unusual for an endocervical primary and immunohistochemical stains were ordered. The carcinoma was positive for cytokeratin 7, had only focal cytoplasmic staining for p16, and was negative for carcinoembryonic antigen and cytokeratin 20. Upon presentation, the patient complained of new onset of shortness of breath and cough. A chest CT revealed multiple lesions in both lungs suggestive of metastatic disease, and an abdominal CT revealed a gallbladder tumor with extension into the liver. The patient underwent a CT-guided biopsy of one of the lung lesions and the pathologic findings were consistent with metastatic adenocarcinoma. The patient was diagnosed with stage IVB primary gallbladder adenocarcinoma and was treated with capecitabine, but her condition deteriorated rapidly and she died 5 months later. CONCLUSION: In patients with an atypical presentation for cervical adenocarcinoma, it is important to consider a metastatic tumor in the differential diagnosis and to perform a thorough work-up for metastatic disease before initiating therapy.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
5/8. Hepatobiliary cystadenoma: a case report and a review of the literature.BACKGROUND: Hepatic cystic lesions are rare; however, their management and treatment is dependent on early recognition and diagnosis. methods: In this report, the authors discuss a 72-year-old woman who presented to their clinic for treatment of a hepatocystadenoma. RESULTS: The history, physical examination, and diagnostic modalities lead to surgical intervention despite an unclear diagnosis. CONCLUSIONS: This case illustrates an unusual hepatic lesion in which the diagnosis was not known until the time of laparotomy. However, diagnostic modalities were important in establishing the need for surgical intervention. The authors offer a pertinent review of the literature and discuss current treatment modalities.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
6/8. carcinosarcoma of the gallbladder.The case of a 60-year-old woman with a five-year history of abdominal pain, jaundice, and weight loss is presented. On physical examination a hard mass on her right flank was evident. She died under unknown circumstances while she was waiting to be examined. At post-mortem examination the gallbladder was replaced by a neoplasm and there were gallstones within its lumen. Histologically, the tumour was constituted by a mixture of adenocarcinoma, squamous cell carcinoma and undifferentiated sarcoma. The diagnosis of carcinosarcoma of the gallbladder was established. A review of previously reported cases is presented too.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
7/8. Indications for surgical resection of metastatic ocular melanoma. A case report and review of the literature.CONCLUSIONS: Ocular melanoma can metastasize to the gallbladder and porta hepatic nodes and mimic pancreatic carcinoma. If one suspects metastatic disease, a complete metastatic work-up must be done prior to surgery to prevent unnecessary surgery. If no distant disease is present or the patient is symptomatic, metastatic disease should be resected. PURPOSE: To review the literature pertaining to the spread of ocular melanoma and to determine if distant disease should be resected. patients AND methods: A 44-yr-old Egyptian male presented to an outside institution with mid-epigastric and right upper quadrant abdominal pain. His past medical history was significant for a left orbital enucleation for uveal melanoma in 1982. On physical examination, there was no supraclavicular adenopathy and no skin lesions were noted. There was a mass in the right upper quadrant. The total bilirubin was 4.8 mg/dL. A computed tomography showed a mass in the head of the pancreas and portal vein involvement could not be determined. RESULTS: The patient was taken to the operating room and a pancreatico-duodenectomy was performed for a cystic mass in the head of the pancreas. Final pathology revealed metastatic melanoma in the gallbladder and an enlarged, cystic lymph node growing into the head of the pancreas replaced with metastatic melanoma. The patient did well post-operatively and was discharged home on the eighth post-operative day.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
8/8. A large inflammatory polyp of the gallbladder masquerading as gallbladder carcinoma.An inflammatory polyp of the gallbladder is a rare variant of benign gallbladder polyp. Differentiation between an inflammatory polyp and polypoid gallbladder carcinoma is difficult when the polyp is more than 1 cm in diameter. We report a rare case of a large inflammatory polyp of the gallbladder masquerading as gallbladder carcinoma in a 37-year-old Japanese woman who was incidentally diagnosed with a large gallbladder polyp, measuring 1 cm in diameter, by ultrasonography. She was asymptomatic and physical examination was unremarkable. Abdominal ultrasonography and endoscopic ultrasonography revealed three polypoid lesions in the gallbladder. One lesion was an isoechoic polyp, measuring 15 x 8 mm, showing a nodular surface and located in the fundus of the gallbladder. The other two lesions were hyperechoic polyps, measuring 5 x 5 mm, in the body of the gallbladder. Computed tomography and magnetic resonance imaging revealed marked enhancement of the largest polypoid lesion by dynamic study, and no lymph node enlargement was noted. Endoscopic retrograde cholangiography revealed a 12 x 8 mm polyp with an irregular surface in the fundus of the gallbladder. Superselective angiography of the cystic artery revealed neovascularity and a tumor stain in the fundus of the gallbladder. cholecystectomy with lymph node dissection was performed. Intraoperative frozen section diagnosis of the largest polyp was an inflammatory polyp of the gallbladder. The other two polyps were cholesterol polyps. Inflammatory polyp should be considered as a differential diagnosis of hypervascular gallbladder polyps that measure more than 1 cm in diameter.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |