[Show abstract][Hide abstract] ABSTRACT: Concomitant primary sarcomatoid hepatocellular carcinoma (SHC) with gallbladder carcinoma is a rare type of hepatobillary disease. To the best of our knowledge, this coexistence has rarely been reported. An 80-year-old male presented with right-sided epigastric pain and a low fever. Computed tomography (CT) imaging revealed a hypodense lesion in the right lobe of the liver and a regular intraluminal polypoid mass in the gallbladder. The patient underwent a partial hepatectomy of the right lobe of the liver and a cholecystectomy. Following pathological examination, the patient was diagnosed with SHC combined with gallbladder adenocarcinoma. The patient and his family refused post-operative adjuvant chemotherapy and radiation therapy. The patient succumbed to intrahepatic and lung metastases at six months post-surgery. In conclusion, concomitant gallbladder carcinoma and SHC may occur. Surgery-based multimodal treatment is the preferred strategy for compound tumors. Adjuvant chemotherapy or radiotherapy may be necessary for the high risk hepatobiliary malignancies.
[Show abstract][Hide abstract] ABSTRACT: Livin is a new member of the inhibitor of apoptosis proteins family of proteins that interacts with downstream caspases, such as caspase-3, caspase-7, and caspase-9, however, its role in human ampullary carcinoma has not been clearly defined. Immunohistochemistry was used to evaluate tissue samples from patients with ampullary carcinomas (n=71) using antibodies against livin, Ki-67 (a proliferation marker), and caspase-3. Livin was detected in 33/71 cases (in the cytoplasm of all and in the nucleus of only 2 cases). High livin expression correlated with cell differentiation, tumor-node-metastasis stage, and lymph node metastasis (P=0.001, P<0.001, and P=0.028, respectively). Caspase-3 and Ki-67 expression were significantly associated with differentiation (P<0.001, P=0.008, respectively). There was a significant negative correlation between livin and caspase-3 (r=-0.575, P<0.001), and a positive correlation between livin and Ki-67 (r=0.308, P=0.009). Survival of patients with high livin expression was shorter compared with that of patients with low livin expression (P=0.001). Expression of caspase-3 was not associated with overall survival in this cohort (P=0.335). Livin expression was an independent prognostic factor (hazard ratio 2.693, P=0.017), as was lymph node metastasis (hazard ratio 4.959; P<0.001). In this study livin expression significantly correlated with the proliferation marker Ki-67, but was negatively correlated with caspase-3 expression. These data suggest that livin may be a valuable prognostic factor for human ampullary carcinoma.
Applied immunohistochemistry & molecular morphology: AIMM / official publication of the Society for Applied Immunohistochemistry 01/2013; 21(6). DOI:10.1097/PAI.0b013e31827da412 · 2.01 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: L'obstruction membraneuse de la veine cave inférieure est une cause fréquente de syndrome de Budd-Chiari en Extrême-Orient. L'étude rapporte le cas d'un jeune homme présentant un syndrome de Budd-Chiari provoqué par une obstruction membraneuse multiple extrêmement rare de la veine cave inférieure. Une angioplastie transluminale percutanée avec stent a été faite avec succès, avec la résolution satisfaisante des symptômes et des signes cliniques. La reconstruction était perméable 2 ans après.
Annales de Chirurgie Vasculaire 11/2011; 25(8):1213.e5–1213.e7. DOI:10.1016/j.acvfr.2013.02.001
[Show abstract][Hide abstract] ABSTRACT: Solitary fibrous tumors of the thyroid gland (T-SFT) are rarely described, with only 21 cases being reported in the English literatures, all showing benign clinical characteristics. We herein present a 76-year-old woman presenting with a 3-month history of rapidly enlarging neck masses and the CT showed masses with partial calcification in the right thyroid lobe. We performed right hemithyroidectomy and isthmectomy with negative margin under general anesthesia. Histologically, the masses consisted of pleomorphic spindle cells with high mitoses and collagen bands. Immunohistochemically, the tumor cells showed positive reactions for CD34, vimentin and bcl-2, then a diagnosis of malignant solitary fibrous tumor of the right thyroid was made. Six months postoperatively, the CT showed the recurrence of the thyroid tumor and the presence of many nodules of varying sizes throughout bilateral pulmonary lobes. To our knowledge, this is the first case of malignant solitary fibrous tumor of the thyroid gland (T-SFT) with local recurrence and pulmonary metastasis and T-SFT must be considered in the differential diagnosis of spindle cells lesions in the thyroid gland. Correct diagnosis of the malignant T-SFT plays an important role in choosing appropriate therapeutic strategies and long-term follow-up is also extremely essential for these patients.
[Show abstract][Hide abstract] ABSTRACT: Membranous obstruction of the inferior vena cava is a frequent cause of Budd--Chiari syndrome in Eastern countries. The study reports the case of a young male patient with Budd--Chiari syndrome caused by extremely rare multiple membranous obstruction of inferior vena cava. A percutaneous transluminal angioplasty with stent placement was performed successfully, accompanied with satisfactory resolution of clinical symptoms and signs. The graft was reported to be patent 2 years postoperatively.
Annals of Vascular Surgery 08/2011; 25(8):1139.e5-7. DOI:10.1016/j.avsg.2011.06.004 · 1.17 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To investigate therapeutic effects of meso-atrial shunts (MASs) and meso-cavo-atrial shunt (MCASs) in combined Budd-Chiari syndrome (BCS).
We retrospectively gathered 29 cases of combined BCS with all or bilateral hepatic vein occlusion and long range occlusion or obstruction of inferior vena cava (IVC). Of them, 12 were treated with a MAS and 17 with a MCAS. We analyzed pre- and postoperative clinical symptoms, IVC, and portal venous (PV) pressure, occurrence rate of postoperative complications, patency rate of artificial vessels, and survival rate.
One patient in the MAS group died in the preoperative period. During the follow-up period from 3 d to 60 mo, 96.6% were included. The effective rates were 54% in MAS and 90.8% in MCAS. The occurrence rates of postoperative complications were 12.5% and 1.8%, respectively. The average decreases in IVC and PV pressure were 15.5 mm saline and 62.4 mm saline for MAS, and 12.3 mm saline and 184.7 mm saline for MCAS. The survival rates at 1, 3, and 5 y were 41.7%, 41.7%, and 16.7% for MAS, and 94.1%, 88.2%, and 82.4% for MCAS. The 5-y patency rates were 41.7% and 94.1%. Comparing these two groups, all of the studied factors, with the exception of PV pressure, were significantly different (P<0.05). Thus, the therapeutic effects of MCASs were better than those of MASs.
MCAS can simultaneously relieve high IVC and PV pressure in combined BCS. Compared with MASs, MCASs showed a decreased postoperative complication rate, a higher 5-y survival and artificial vessel patency rate.
Journal of Surgical Research 06/2011; 168(1):162-6. DOI:10.1016/j.jss.2009.07.024 · 1.94 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Liver involvement in patients with hereditary hemorrhagic telangiectasia (HHT) has not been fully characterized in China. The clinical manifestations, imaging studies, results of treatment in six patients and symptomatic liver involvement were analyzed. Patients included three women and three men with age from 35 to 62 years old. Two patients presented with shortness of breath, one patient with anemia and splenomegaly, and one with chronic gastrointestinal bleeding; the remaining two were asymptomatic. CT and CT angiography (CTA) showed arterioportal and arteriovenous shunting in liver. CTA showed at least one enlarged hepatic artery in all patients. One patient received ligation of the enlarged arteries with subsequent disappearance of symptoms at 56-month follow-up. The patient with gastrointestinal bleeding received interventional embolotherapy and resolved; interventional therapy to embolize the enlarged hepatic arteries was unsuccessful in another patient and the patient died of heart failure and liver dysfunction 38 months later. The patient with splenomegaly received a splenectomy and bandage of an enlarged hepatic artery. One of the two patients with no symptoms died of liver dysfunction 41 months after diagnosis. The other showed abnormal liver function and ascites, and traditional Chinese medicinal herb was used with no effect 21 months later. The symptoms disappeared after systemic medical treatment. Individualized and active therapy is advantageous and proper for patients with HHT.
The American surgeon 03/2011; 77(3):281-5. · 0.82 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: For the surgical treatment of Bismuth Type IV hilar cholangiocarcinoma, it is difficult to achieve curative resection (R0 resection) with restrictive excision (local resection and parenchyma-preserving liver resection) as a result of the complexity and difficulty in biliary reconstruction. Extended hepatectomy with vessel resection can improve the rate of curative resection, but it can also give rise to postoperative complications and mortality. We proposed a high hilar resection and portal parenchyma-enterostomy method to improve the surgical procedure. Eleven patients with Bismuth IV hilar cholangiocarcinoma underwent high hilar resection (resection for tumors in bile ducts and 1 cm above the tumors including segments IVb, V, and part of the caudate liver lobe) and the biliary tract was reconstructed through a portal parenchyma-enterostomy. Biliary radicles were not ligated but were drained into the "bile lake." No cases of perioperative death were observed. Four weeks after surgery, patients' serum aspartate aminotransferase, alanine aminotransferase, and total bilirubin were decreased evidently. The average survival was 25.3 months. In conclusion, the portal parenchyma-enterostomy procedure can be performed with increased curative rate and reduced parenchyma resection, extending the survival time of patients and improving patients' quality of life.
The American surgeon 02/2010; 76(2):182-7. · 0.82 Impact Factor