1/11. Endoscopic comparison of two cases: distal resection of reconstructed gastric tube.Recently, with the improvement of the prognosis of esophageal cancer, subsequent gastric cancer has increased. However, the standard surgical treatment for such patients has not been established as of yet. Since the patient's physical condition is relatively poor after Ivor-Lewis esophagectomy, it is important that surgical strategies must be decided according to both physical and cancerous conditions. Hence, various surgical procedures have been reported to date. The authors experienced two cases with cancer occurring in the reconstructed gastric tube after Ivor-Lewis esophagectomy. One was subsequent primary gastric cancer, and the other was metastatic gastric cancer. Distal resection of the gastric tube including the dissection of the right gastroepiploic vessels was carried out in both cases. Vascular reconstruction by utilizing microsurgery technique was attempted for each case, but failed in one case. After surgery, four sessions of endoscopic examinations were carried out. In the early period, we could identify mucosal ischemic change in the remnant gastric tube in the case without successful vascular reconstruction. On the contrary, no ischemic change was revealed in the other with successful vascular reconstruction. Hence, we came to the conclusion that vascular reconstruction must be added to the cases, which undergo distal resection of the reconstructed gastric tube with regional vascular dissection.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/11. Angiotropic lymphoma occurring in a lacrimal sac oncocytoma.This report describes a case of angiotropic variant of diffuse large B cell lymphoma within a benign oncocytoma of the lacrimal sac. The occurrence of this rare lymphoma within a benign neoplasm has not been documented previously. An 87 year old woman presented with a swelling over the area of the left lacrimal sac, which histological examination revealed to be an oncocytoma. Many small blood vessels within the tumour were filled with large cytologically atypical cells, which stained positively for leucocyte common antigen and a B cell antigen, CD20, confirming the presence of a large B cell non-Hodgkin's lymphoma of angiotropic type. Angiotropic lymphoma is a very rare and usually highly aggressive variant of non-Hodgkin's lymphoma, which classically involves the central nervous system and skin, but has been described within most organs. Its occurrence within a benign neoplasm is probably coincidental, although a close association between oncocytic epithelium and normal lymphoid cells is recognised in Warthin's tumour of salivary and lacrimal glands.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/11. Intravascular lymphomatosis of the skin as a manifestation of recurrent B-cell lymphoma.Intravascular lymphomatosis (IVL) is a rare type of lymphoma with a poor prognosis. Its distinctive clinical and histopathologic features are generated by the proliferation of neoplastic mononuclear cells within blood vessels. We describe a patient with IVL of the skin as a manifestation of a recurrent diffuse large B-cell lymphoma of ureteral origin. lymphoma cells were located both within the vessels and the parenchyma in an early cutaneous lesion. After recurrence in the skin, lymphoma cells gradually located only in the vascular lumina. This transition suggests that cells localized within the vessels were selected as a consequence of chemotherapy. Immunohistochemical examination revealed that the expression of surface adhesion molecules of lymphoma cells did not significantly change. The results of polymerase chain reaction revealed that the ureteral and cutaneous tumors were identical in clonality. Our findings suggest that conventional diffuse large B-cell lymphoma can change into IVL.- - - - - - - - - - ranking = 3keywords = vessel (Clic here for more details about this article) |
4/11. Metastatic breast cancer delayed brachial plexopathy. A brief case report.Metastatic involvement of brachial plexopathy is a rare condition that is often associated with advanced systemic breast cancer and the role of surgeon appears to be restricted because radio-chemotherapy is better recommended in this setting. We report a case of a 64-year-old woman that presented a very delayed breast cancer metastatic lower trunks lesions without associated radiation injury, treated by surgery. MRI of plexus and CT of chest and axilla are methods of choice in preoperative radiological evaluation. Neurosurgeon effort is restricted to provide pathologic diagnosis (confirm of metastasis), adequate pain control and improvement of neurological function. So that surgical exploration and neurolysis should be performed as soon as possible after appearance of neurological deficits before denervation signs occurs. General surgeon presence should be warranted for more radical removal of remain lymph nodes and metastatic nodal infiltration of adjacent anatomical structures (vessels and so on) when detected by preoperative radiological work-up.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/11. Trigeminal neurinoma presenting with intratumoral hemorrhage: report of two cases.We report 2 cases of trigeminal neurinoma presenting with spontaneous intratumoral hemorrhage. There are only 2 similar cases reported in the literature. Presenting symptoms were headache, diplopia, disturbed consciousness and trigeminal disturbance with sudden onset. CT scan showed a typical fluid-fluid level within low-density mass in the cerebellopontine angle in one case. On MRI, one case showed a typical fluid-fluid level on T2-weighted image and another one had mixed signal intensities including hyper- and hypointensities on both T1- and T2-weighted images. Histologically, increased vascularity, consisting of dilated and thin-walled vessels presenting telangiectatic or cavernous angiomatous appearances were observed in the specimens in both cases. The size of these tumors was about 3 cm each in diameter. risk factors for hemorrhage appear to be large tumor size and increased vascularity.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/11. Pleomorphic xanthoastrocytoma as a component of a cerebellar ganglioglioma: case report.A 27-year old male patient underwent surgery for a cerebellar ganglioglioma in which a pleomorphic xanthoastrocytoma constituted the gliomatous element. Neither radiation nor chemotherapy was administered. The patient was well for 12 years and then he suffered a recurrence and underwent a gross total resection. Histological examination revealed a ganglioglioma with thrombosed blood vessels, areas of tumor necrosis, and scattered mitoses. These anaplastic changes, which were restricted to the glial component of the tumor, may herald a more aggressive clinical course. However, 11 months after the second operation, there have been no signs of tumor recurrence.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/11. Gastric tube-preserving pancreatoduodenectomy after esophagectomy and reconstruction using the gastric tube: report of a case.We herein present the case of an intraductal papillary mucinous tumor of the pancreas resected by a gastric tube-preserving pancreatoduodenectomy in a patient who underwent an esophagectomy and reconstruction using the gastric tube. To preserve the gastric tube, the gastroduodenal artery and right gastroepiploic vein must be successfully skeletonized and preserved. In the present case, the vascular anatomy was clarified not only two-dimensionally with the use of selective abdominal angiography, but also three-dimensionally with the use of helical computed tomography. After precisely identifying the location of the tumor in relation of the blood vessels, it was confirmed that a gastric tube-preserving pancreatoduodenectomy was feasible. A detailed analysis of the vascular anatomy should be carried out by helical computed tomography preoperatively. When the radicality of tumor resection is not compromised, a gastric tube-preserving pancreatoduodenectomy can be recommended, due to the fact that it is considered to be less invasive.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
8/11. Malignant astrocytoma six years after the resection of a cerebral metastatic cardiac myxoma: case report.We describe a woman who had a total resection of a cardiac myxoma followed 8 months later by a hemorrhage in the right frontal lobe secondary to extravascular metastasis of the myxoma. Six years later, after an asymptomatic follow-up, she developed a recurrence of left-sided seizures and an enhancing mass in the same location as the previous tumor. At operation, a malignant astrocytoma was demonstrated. Cardiac myxoma is a true neoplasm with benign histology, which may be associated with heart failure, systemic illness, or peripheral embolization. The neurological manifestations of embolization may include no symptoms, acute or delayed infarction, and intravascular proliferation with aneurysmal dilatation and potential for hemorrhage. The development of extravascular metastatic tumor deposits has been reported previously in only three histologically verified cases. Once the integrity of the blood vessel wall is destroyed by the tumor, a portal of entry is established for tumor cell proliferation in the brain parenchyma. There is no known association between a metastatic cardiac myxoma and a malignant glioma in the literature. Several possibilities for the occurrence of these two neoplasms are discussed.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
9/11. Inflammatory sarcomatoid carcinoma: a case report and discussion of a malignant tumor with benign appearance.Inflammatory sarcomatoid carcinoma is an aggressive tumor with an unusually benign appearance. We report the case of a 65-year-old man with a history of inoperable poorly differentiated carcinoma of the right lung, for which he had received chemoradiotherapy. A new solitary mass was discovered 4 years later in the left lung on surveillance computed tomography. The patient underwent thoracotomy with a wedge biopsy on which frozen section was performed. The nodule was vaguely granulomatous and associated with a mixed inflammatory infiltrate and a deceptively bland spindle cell proliferation. Results of immunoperoxidase studies, however, showed that the nodule contained neoplastic cells with an epithelial phenotype that were invading the pulmonary vessels. These are features of the rare inflammatory sarcomatoid carcinoma. In contrast to sarcomatoid carcinomas, this case highlights the deceptively benign appearance of inflammatory sarcomatoid carcinoma. This leads us to concur with the recommendation to exercise caution when attempting the diagnosis of apparently benign lesions on intraoperative frozen section in patients with high clinical suspicion of malignancy.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
10/11. Intracranial large vessel vasculopathy and anaplastic meningioma 19 years after cranial irradiation for acute lymphoblastic leukaemia.A child was diagnosed in 1969 as having acute lymphoblastic leukaemia (ALL) and received chemotherapy. On bone marrow relapse in 1973, he was treated with cranial irradiation (20 Gy) in addition to chemotherapy. He continues in complete remission 19 years after his relapse. At age 25 years, he presented with headaches and left hemiparesis. Computerised tomograph demonstrated a large, enhancing right-sided intracranial tumour. angiography was performed and showed the right internal carotid artery was occluded. Most of the right hemisphere was supplied from the external carotid via the middle meningeal artery. The left posterior cerebral artery and the left anterior cerebral artery were absent presumably as a result of radiation-induced arteritis. A resection of an anaplastic meningioma arising from the right sphenoidal ridge was achieved. There was a rapid improvement in function and he returned to work. Vasculopathy of the large intracranial arteries has been described after high dose radiation. It may occur as in this case after moderate dose radiation. There is a correlation with meningioma. There is a possibility that large artery vasculopathy will be present in a proportion of patients irradiated for ALL. The long lag time between irradiation and the development of meningioma may mean that, as survivors of childhood ALL enter their third decade since cure, this tumour may be seen increasingly.- - - - - - - - - - ranking = 4keywords = vessel (Clic here for more details about this article) |
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