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Peribiliary Gland Hyperplasia That Required Differentiation from Extrahepatic Bile Duct Cancer: A Case Report. 需要与肝外胆管癌鉴别的胆管周围腺体增生:病例报告。
IF 0.5 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-05-23 eCollection Date: 2024-01-01 DOI: 10.1159/000538491
Kazuhiro Takami, Kuniharu Yamamoto, Hiroto Sakurai, Yoshihiro Sato, Noriko Kondo, Toru Nakano, Shingo Tsujinaka, Akinobu Koiwai, Morihisa Hirota, Keigo Murakami, Kazuhiro Murakami, Chikashi Shibata, Yu Katayose

Introduction: The peribiliary gland is an accessory bile duct gland. Hyperplasia of these tissues may lead to elevation of the mucosa in the bile ducts and bile duct stenosis. We herein report a case of peribiliary gland hyperplasia that required preoperative differentiation from bile duct cancer, with a discussion of the literature.

Case presentation: The patient had an adenomatous lesion in the ascending colon that was difficult to treat endoscopically; therefore, surgery was planned. Preoperative abdominal ultrasonography revealed a bile duct tumor, and endoscopic ultrasonography revealed a mass lesion around the confluence of the cystic duct. Computed tomography revealed localized wall thickening in the middle bile duct, and the upstream bile ducts were slightly dilated. In addition, continuous thickening of the bile duct wall from the gallbladder to the confluence of the cystic duct was observed. No distant metastases, such as liver metastases, or nearby enlarged lymph nodes were observed. Endoscopic retrograde cholangiopancreatography and magnetic resonance cholangiopancreatography revealed a papillary-like elevated lesion in the bile duct near the confluence of the cystic duct, and a biopsy and bile cytology from the same area showed no malignant findings. As a result, the possibility that the patient had gallbladder or bile duct cancer could not be ruled out; therefore, a policy of surgery together with the ascending colon tumor was decided after receiving sufficient informed consent. During surgery, the patient underwent extrahepatic bile duct resection, reconstruction of the biliary tract using the Roux-en-Y method, and right hemicolectomy. Both duodenal and hilar bile duct transects were subjected to a fast frozen section analysis during surgery, and the results were negative for cancer. A histopathological examination of the resected specimen revealed no malignant findings in the bile duct lesions, and a diagnosis of peribiliary gland hyperplasia with chronic inflammatory cell infiltration and fibrosis of the extrahepatic bile duct wall was made.

Conclusions: We encountered a case of peribiliary gland hyperplasia that was difficult to distinguish from bile duct cancer.

导言:胆管周围腺体是胆管的附属腺体。这些组织的增生可能导致胆管粘膜隆起和胆管狭窄。我们在此报告一例胆管周围腺增生病例,该病例需要在术前与胆管癌进行鉴别,并对文献进行了讨论:患者升结肠有一处腺瘤性病变,难以通过内镜治疗,因此计划进行手术。术前腹部超声波检查发现了胆管肿瘤,内镜超声波检查发现了胆囊管汇合处的肿块病变。计算机断层扫描显示中胆管局部管壁增厚,上游胆管轻度扩张。此外,还观察到从胆囊到胆囊管汇合处的胆管壁持续增厚。未发现远处转移(如肝转移)或附近淋巴结肿大。内镜逆行胰胆管造影和磁共振胰胆管造影显示,胆囊管汇合处附近的胆管内有乳头状隆起病变,同一部位的活检和胆汁细胞学检查未发现恶性病变。因此,不能排除患者患有胆囊癌或胆管癌的可能性,所以在征得患者充分知情同意后,决定对其进行升结肠肿瘤一并手术治疗。手术期间,患者接受了肝外胆管切除术,采用 Roux-en-Y 方法重建胆道,并进行了右半结肠切除术。手术期间对十二指肠和肝门胆管横断面进行了快速冰冻切片分析,结果显示癌症阴性。切除标本的组织病理学检查显示胆管病变无恶性发现,诊断为胆管周围腺体增生伴慢性炎症细胞浸润和肝外胆管壁纤维化:结论:我们遇到了一例胆管周围腺体增生症与胆管癌难以区分的病例。
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引用次数: 0
Side Effects of Stem Cell Transplant Mimicking Symptoms of Known Amyloidosis. 模仿已知淀粉样变性症状的干细胞移植副作用。
IF 0.6 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-05-21 eCollection Date: 2024-01-01 DOI: 10.1159/000538947
Gabriel Heering, Zilan Lin, Michael Rosman, Nao Hara, Fouzia Shakil, Dimitrios Georgostathis

Introduction: AL amyloidosis can involve the gastrointestinal (GI) tract in a sporadic manner, affecting certain anatomical areas while sparing others.

Case presentation: Our patient with AL amyloidosis and confirmed colonic involvement was found to have new odynophagia, GI bleeding, and imaging findings that might suggest AL amyloidosis. However, negative pathology results from esophageal biopsies suggested the patient's new ulcerations were more likely a side effect of her autologous stem cell transplant (SCT) and chemotherapy meant to target amyloidosis, as opposed to an effect of amyloid infiltration itself.

Conclusion: GI involvement of amyloidosis requires a high degree of clinical suspicion and should be considered in patients with systemic diseases affecting the kidney, heart, and GI tract; however, when satisfactory biopsies obtained from endoscopy results are negative, other causes should be considered.

导言:AL淀粉样变性可能以散发性方式累及胃肠道(GI),影响某些解剖区域,而其他区域则不受影响:我们的患者患有 AL 淀粉样变性并确诊为结肠受累,但发现新的吞咽困难、消化道出血和影像学检查结果可能提示 AL 淀粉样变性。然而,食管活检的阴性病理结果表明,患者的新溃疡更可能是自体干细胞移植(SCT)和针对淀粉样变性的化疗的副作用,而非淀粉样变性浸润本身的影响:结论:临床上需要高度怀疑淀粉样变性的消化道受累,如果患者患有影响肾脏、心脏和消化道的全身性疾病,则应考虑淀粉样变性的消化道受累。
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引用次数: 0
Oesophageal Lichen Planus Successfully Treated with Budesonide Orodispersible Tablets: A Case Report. 用布地奈德口腔分散片成功治疗食道扁平苔藓:病例报告。
IF 0.6 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-05-15 eCollection Date: 2024-01-01 DOI: 10.1159/000538894
Harald Bagger-Jörgensen, Mohammed Abdulrasak, Kevin Sandeman, Mohammed Binsalman, Klas Sjöberg

Introduction: Lichen planus is a relatively common inflammatory condition of the nails, skin, and mucosal surfaces. Oesophageal involvement of lichen planus is thought to be very rare, mainly described in case reports, but is associated with a high risk of oesophageal stenosis as well as squamous cell carcinoma. No evidence-based treatment recommendations exist, with the majority of described treatment regimens involving systemic immunosuppression.

Case report: In this case report, we describe a novel approach in treating oesophageal lichen planus in a patient with budesonide orodispersible tablets, a treatment normally reserved for eosinophilic oesophagitis. The patient achieved complete relief of dysphagia, with a follow-up oesophagogastroduodenoscopy 2 months after treatment commencement being macroscopically and microscopically free of inflammatory activity. This case report is to our knowledge the first to report this treatment regimen in oesophageal lichen planus.

Conclusion: We consider a trial of budesonide orodispersible tablets a reasonable initial management as it's a local therapy specific to the oesophagus with a more benign side effect profile than systemic immunosuppression, but further studies need to be undertaken to corroborate our findings. Also, based on the severity and malignant potential of oesophageal lichen planus, we suggest that physicians be liberal in ordering oesophagogastroduodenoscopy with biopsy taking as part of the workup of dysphagia in a patient with known lichen planus.

简介扁平苔藓是一种比较常见的指甲、皮肤和粘膜表面炎症。扁平苔藓累及食道被认为非常罕见,主要见于病例报告,但与食道狭窄和鳞状细胞癌的高风险相关。目前尚无循证治疗建议,大多数描述的治疗方案都涉及全身免疫抑制:在本病例报告中,我们介绍了一种使用布地奈德口崩片剂治疗食管扁平苔藓患者的新方法,布地奈德口崩片剂通常用于治疗嗜酸性粒细胞性食管炎。该患者的吞咽困难得到了完全缓解,治疗开始 2 个月后进行的食道胃十二指肠镜随访检查显示,其宏观和微观均无炎症活动。据我们所知,本病例报告是首次报道食道扁平苔藓的这种治疗方案:我们认为试用布地奈德口服分散片是一种合理的初始治疗方法,因为它是一种针对食道的局部治疗方法,与全身性免疫抑制相比副作用更小。此外,鉴于食道扁平苔藓的严重性和恶变可能性,我们建议医生在对已知扁平苔藓患者进行吞咽困难检查时,应谨慎要求患者接受食道胃十二指肠镜检查并进行活检。
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引用次数: 0
Biliary Cast Syndrome and Secondary Sclerosing Cholangitis in Critically Ill Patient after Long-Term Treatment in the Intensive Care Unit. 重症监护室长期治疗后重症患者的胆道铸型综合征和继发性硬化性胆管炎
IF 0.6 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-05-10 eCollection Date: 2024-01-01 DOI: 10.1159/000537957
Adnan Alkurdi, Johannes Herrmann, Damir Bikmukhametov, Rebecca Tschöpe

Introduction: Secondary sclerosing cholangitis in critically ill patients (SSC-CIP) is a rare but underdiagnosed entity that occurs after life-threatening events and treatment in the intensive care unit (ICU). The etiology of SSC-CIP is not fully understood but may be caused by ischemic bile duct injury. SSC-CIP is a cholestatic liver disease that rapidly progresses to liver cirrhosis, with a high mortality rate in the first year of 50%. Endoscopic retrograde cholangiopancreatography (ERCP), which is the gold standard for diagnosing SSC-CIP, shows primary SC-like changes, usually in the intrahepatic bile ducts. Biliary cast formation is pathognomonic for SSC-CIP. No proven effective conservative treatment is available for SSC-CIP, and liver transplantation is the only curative therapy when liver cirrhosis or recurrent cholangitis occurs.

Case presentation: We report the case of a 47-year-old male patient who developed cholestasis after a long treatment in the ICU for severe pneumonia. ERCP showed characteristic findings with rarefication and multiple segmental stenosis in the intrahepatic bile ducts. We removed multiple biliary casts from the bile ducts.

Conclusion: SSC-CIP should be considered for ICU patients with unclear cholestasis, especially when the cholestasis persists after recovery from the underlying disease. Early diagnosis is important to achieve better outcomes; without liver transplantation, the prognosis is generally poor.

简介:重症患者继发性硬化性胆管炎(SSC-CIP)是一种罕见但诊断不足的疾病,多发生在危及生命的事件和重症监护室(ICU)的治疗之后。SSC-CIP 的病因尚不完全清楚,但可能是由缺血性胆管损伤引起的。SSC-CIP 是一种胆汁淤积性肝病,会迅速发展为肝硬化,第一年的死亡率高达 50%。内镜逆行胰胆管造影术(ERCP)是诊断 SSC-CIP 的金标准,可显示原发性 SC 样改变,通常发生在肝内胆管。胆管铸型形成是 SSC-CIP 的病理标志。SSC-CIP 目前尚无行之有效的保守治疗方法,当出现肝硬化或复发性胆管炎时,肝移植是唯一可治愈的治疗方法:我们报告了一例 47 岁男性患者的病例,他因重症肺炎在重症监护室接受长期治疗后出现胆汁淤积。ERCP 显示肝内胆管稀疏化和多节段狭窄。我们从胆管中取出了多个胆汁栓:结论:对于胆汁淤积不清的 ICU 患者,尤其是胆汁淤积在基础疾病康复后仍持续存在时,应考虑使用 SSC-CIP。早期诊断对取得更好的治疗效果非常重要;如果不进行肝移植,预后一般较差。
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引用次数: 0
A Fatal Outcome after Cessation of Nucleotide Analogue Therapy in a Patient with Chronic Hepatitis B: A Case Report. 一名慢性乙型肝炎患者在停止核苷酸类似物治疗后死亡:病例报告。
IF 0.6 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-04-26 eCollection Date: 2024-01-01 DOI: 10.1159/000538342
Sylvia M Brakenhoff, Heng Chi, Pieter Friederich, Michail Doukas, Caroline den Hoed, Hajo J Flink, Robert J de Knegt, Robert A de Man

Introduction: Emerging evidence suggests that long-term nucleos(t)ide analogue (NA) therapy can be ceased in a selective group of chronic hepatitis B (CHB). This is being gradually implemented in clinical practice.

Case presentation: A 68-year-old man known with a chronic hepatitis B e antigen-positive hepatitis B infection without signs of advanced liver fibrosis or cirrhosis was admitted with acute liver failure. Two months prior to his admission, he ceased his NA therapy. During the admission, NA therapy was restarted, but the liver function worsened. The patient was put on the high-urgency liver transplantation waiting list, and the next day, he was successfully transplanted. However, the patient died 17 days later due to hemorrhagic shock that resulted from intra-abdominal bleeding and acute pancreatitis.

Conclusion: Current guidelines suggest that NA therapy can be discontinued in a selective group of CHB patients. However, these guidelines suggest different stopping and follow-up criteria. This case illustrates that NA withdrawal is not without risks and that these differences in recommendations may lead to inadequate management and eventually a fatal outcome.

导言:新的证据表明,对于部分慢性乙型肝炎(CHB)患者,可以停止长期核苷酸类似物(NA)治疗。病例介绍:一名已知患有慢性乙型肝炎 e 抗原阳性、无晚期肝纤维化或肝硬化症状的 68 岁男性因急性肝衰竭入院。入院前两个月,他停止了 NA 治疗。入院期间,他重新开始接受 NA 治疗,但肝功能恶化。患者被列入肝移植高危候诊名单,并于第二天成功接受了肝移植。然而,17天后,患者因腹腔内出血和急性胰腺炎导致失血性休克而死亡:结论:现行指南建议,有选择性地对部分慢性阻塞性肺病患者停止NA治疗。然而,这些指南提出了不同的停药和随访标准。本病例说明,停用NA并非没有风险,这些不同的建议可能会导致处理不当,最终造成致命后果。
{"title":"A Fatal Outcome after Cessation of Nucleotide Analogue Therapy in a Patient with Chronic Hepatitis B: A Case Report.","authors":"Sylvia M Brakenhoff, Heng Chi, Pieter Friederich, Michail Doukas, Caroline den Hoed, Hajo J Flink, Robert J de Knegt, Robert A de Man","doi":"10.1159/000538342","DOIUrl":"https://doi.org/10.1159/000538342","url":null,"abstract":"<p><strong>Introduction: </strong>Emerging evidence suggests that long-term nucleos(t)ide analogue (NA) therapy can be ceased in a selective group of chronic hepatitis B (CHB). This is being gradually implemented in clinical practice.</p><p><strong>Case presentation: </strong>A 68-year-old man known with a chronic hepatitis B e antigen-positive hepatitis B infection without signs of advanced liver fibrosis or cirrhosis was admitted with acute liver failure. Two months prior to his admission, he ceased his NA therapy. During the admission, NA therapy was restarted, but the liver function worsened. The patient was put on the high-urgency liver transplantation waiting list, and the next day, he was successfully transplanted. However, the patient died 17 days later due to hemorrhagic shock that resulted from intra-abdominal bleeding and acute pancreatitis.</p><p><strong>Conclusion: </strong>Current guidelines suggest that NA therapy can be discontinued in a selective group of CHB patients. However, these guidelines suggest different stopping and follow-up criteria. This case illustrates that NA withdrawal is not without risks and that these differences in recommendations may lead to inadequate management and eventually a fatal outcome.</p>","PeriodicalId":9614,"journal":{"name":"Case Reports in Gastroenterology","volume":"18 1","pages":"252-259"},"PeriodicalIF":0.6,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11052559/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140849401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Primary Malignant Melanoma of the Esophagus Treated with Surgical Resection at an Early Stage. 食道原发性恶性黑色素瘤早期通过手术切除治疗。
IF 0.6 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-03-28 eCollection Date: 2024-01-01 DOI: 10.1159/000538161
Akira Yoneda, Ryosuke Ogata, Shintaro Ryu, Kyohei Yoshino, Saeko Fukui, Takahiro Ikeda, Amane Kitasato, Nozomu Sugiyama, Hiroaki Takeshita, Shigeki Minami, Masahiro Ito, Tamotsu Kuroki

Introduction: Primary malignant melanoma of the esophagus is a very rare disease with a poor prognosis. We herein report a patient with primary malignant melanoma of the esophagus who underwent surgical resection.

Case presentation: A 73-year-old female underwent an upper gastrointestinal endoscopy during follow-up for colonic diverticulitis. An endoscopic examination and constructed radiography revealed a slightly elevated black pigmented lesion in the upper esophagus and a black pigmented area in the esophagogastric junction. Through a preoperative endoscopic biopsy, she was diagnosed with malignant melanoma of the esophagus. We performed thoracoscopy-assisted and laparoscopy-assisted subtotal esophagectomy with lymphadenectomy. The surgical specimens were subjected to immunohistochemical analysis, resulting in a diagnosis of malignant melanoma. The tumor cells were positive for Melan-A and HMB-45 diffusely, supporting that diagnosis. We performed surgical resection in a case of primary malignant melanoma of the esophagus, and the patient has remained disease free for 2 years since the surgery.

Conclusion: Early diagnosis and radical resection may be essential for long-term survival in patients with malignant melanoma of the esophagus.

简介食管原发性恶性黑色素瘤是一种非常罕见的疾病,预后较差。我们在此报告一名接受手术切除的食管原发性恶性黑色素瘤患者:一名 73 岁的女性在结肠憩室炎随访期间接受了上消化道内镜检查。内镜检查和造影显示食管上段有一个略微隆起的黑色色素病变,食管与胃交界处有一个黑色色素区。通过术前内镜活检,她被诊断为食管恶性黑色素瘤。我们为她实施了胸腔镜辅助和腹腔镜辅助的食管次全切除术,并进行了淋巴结切除。手术标本经过免疫组化分析,最终确诊为恶性黑色素瘤。肿瘤细胞弥漫性呈 Melan-A 和 HMB-45 阳性,支持这一诊断。我们为一例食管原发性恶性黑色素瘤患者实施了手术切除,患者术后 2 年一直保持无病状态:结论:早期诊断和根治性切除可能是食管恶性黑色素瘤患者长期生存的关键。
{"title":"Primary Malignant Melanoma of the Esophagus Treated with Surgical Resection at an Early Stage.","authors":"Akira Yoneda, Ryosuke Ogata, Shintaro Ryu, Kyohei Yoshino, Saeko Fukui, Takahiro Ikeda, Amane Kitasato, Nozomu Sugiyama, Hiroaki Takeshita, Shigeki Minami, Masahiro Ito, Tamotsu Kuroki","doi":"10.1159/000538161","DOIUrl":"10.1159/000538161","url":null,"abstract":"<p><strong>Introduction: </strong>Primary malignant melanoma of the esophagus is a very rare disease with a poor prognosis. We herein report a patient with primary malignant melanoma of the esophagus who underwent surgical resection.</p><p><strong>Case presentation: </strong>A 73-year-old female underwent an upper gastrointestinal endoscopy during follow-up for colonic diverticulitis. An endoscopic examination and constructed radiography revealed a slightly elevated black pigmented lesion in the upper esophagus and a black pigmented area in the esophagogastric junction. Through a preoperative endoscopic biopsy, she was diagnosed with malignant melanoma of the esophagus. We performed thoracoscopy-assisted and laparoscopy-assisted subtotal esophagectomy with lymphadenectomy. The surgical specimens were subjected to immunohistochemical analysis, resulting in a diagnosis of malignant melanoma. The tumor cells were positive for Melan-A and HMB-45 diffusely, supporting that diagnosis. We performed surgical resection in a case of primary malignant melanoma of the esophagus, and the patient has remained disease free for 2 years since the surgery.</p><p><strong>Conclusion: </strong>Early diagnosis and radical resection may be essential for long-term survival in patients with malignant melanoma of the esophagus.</p>","PeriodicalId":9614,"journal":{"name":"Case Reports in Gastroenterology","volume":"18 1","pages":"189-194"},"PeriodicalIF":0.6,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10978042/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140317796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A Case Report of Pulmonary Edema Secondary to Large Volume Bowel Preparation in a High-Risk Patient with Multiple Cardiopulmonary Co-Morbidities. 一位合并多种心肺疾病的高危患者因大容量肠道准备术而继发肺水肿的病例报告。
IF 0.6 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-03-27 eCollection Date: 2024-01-01 DOI: 10.1159/000538158
Kush Fansiwala, Preeti Prakash, Christopher L Coe, Guy A Weiss

Introduction: Polyethylene glycol 3,350 and electrolytes is a commonly prescribed bowel regimen for colonoscopy preparation with an overall excellent safety profile, though prior reports have demonstrated risk of volume overload.

Case presentation: A 55-year-old man with significant cardiopulmonary co-morbidities was admitted for acute hypoxic respiratory failure and subsequent evaluation for lung transplant. As part of his pretransplant evaluation, colon cancer screening was advised. Despite multiple days of bowel preparation, his stools contained sediment. Unfortunately, he developed pulmonary edema due to prolonged bowel preparation.

Conclusion: While bowel preparation is considered generally safe, our case report highlights the importance of judicious use with monitoring in high-risk individuals.

简介:聚乙二醇 3,350 和电解质是用于结肠镜检查准备的常用处方肠道疗法,总体安全性极佳,但之前的报告显示存在容量超负荷的风险:一名 55 岁的男性因急性缺氧性呼吸衰竭入院,患有严重的心肺并发症,随后接受了肺移植评估。作为移植前评估的一部分,他被建议进行结肠癌筛查。尽管进行了多天的肠道准备,他的粪便中仍含有沉淀物。不幸的是,由于长时间的肠道准备,他出现了肺水肿:虽然肠道准备被认为总体上是安全的,但我们的病例报告强调了在高危人群中谨慎使用并进行监测的重要性。
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引用次数: 0
Pancreatic Ductal Adenocarcinoma Encapsulated by a Tumor-Forming Type 1 Autoimmune Pancreatitis Located at the Pancreatic Tail: A Case Report. 位于胰尾的肿瘤形成型自身免疫性胰腺炎包裹的胰腺导管腺癌:病例报告。
IF 0.6 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-03-27 eCollection Date: 2024-01-01 DOI: 10.1159/000536008
Taro Ando, Hiroyuki Nitta, Akira Umemura, Hirokatsu Katagiri, Shoji Kanno, Daiki Takeda, Masao Nishiya, Noriyuki Uesugi, Tamotsu Sugai, Akira Sasaki

Introduction: Autoimmune pancreatitis (AIP) is recognized as a disease with a good prognosis that responds well to steroids, but the complication of pancreatic ductal adenocarcinoma (PDAC) in AIP is a rare condition. We report a case of PDAC encapsulated by tumor-forming type 1 AIP.

Case presentation: The patient, a 65-year-old female, was found to have high CA19-9 levels and a pancreatic mass with a diameter of 30 mm on abdominal ultrasonography. Contrast-enhanced computed tomography revealed a 40-mm mass in the tail of the pancreas that had a 27-mm oligemic mass inside it. From these work-up examinations, this tumor was diagnosed as PDAC, with evidence of colonic invasion. As curative resection for PDAC, a distal pancreatectomy with splenectomy and combined colon resection were performed. Histopathological examination showed invasive PDAC surrounded by IgG4-positive plasma cell infiltration. Based on these findings, a diagnosis was made of PDAC located in the pancreatic tail capsulized by type 1 AIP. The postoperative course was uneventful, and the patient was discharged on postoperative day 15. She underwent postoperative adjuvant chemotherapy with S-1 for 6 months, and no recurrence was noted for 2 years after operation.

Conclusion: Currently, there are two hypothetical mechanisms of PDAC induction by AIP: (1) carcinogenic stimulation due to chronic inflammation and (2) paraneoplastic syndrome caused by AIP. Further study of the relationship between AIP and pancreatic cancer is needed, and follow-up should be conducted while keeping in mind the possibility of complications.

简介自身免疫性胰腺炎(AIP)被认为是一种预后良好的疾病,对类固醇类药物反应良好,但AIP并发胰腺导管腺癌(PDAC)是一种罕见病。我们报告了一例形成肿瘤的1型AIP包裹PDAC的病例:患者是一名 65 岁的女性,腹部超声检查发现其 CA19-9 水平较高,胰腺肿块直径达 30 毫米。对比增强计算机断层扫描显示,胰腺尾部有一个 40 毫米的肿块,肿块内有一个 27 毫米的少血块。根据这些检查结果,该肿瘤被诊断为 PDAC,并有结肠侵犯的证据。作为 PDAC 的根治性切除术,患者接受了胰腺远端切除术和脾脏切除术,并联合结肠切除术。组织病理学检查显示,浸润性 PDAC 周围有 IgG4 阳性浆细胞浸润。根据这些结果,诊断为位于胰腺尾部、由 1 型 AIP 包囊的 PDAC。术后过程顺利,患者于术后第 15 天出院。她术后接受了为期 6 个月的 S-1 辅助化疗,术后 2 年未见复发:目前,AIP诱导PDAC有两种假设机制:(1)慢性炎症导致的致癌刺激;(2)AIP导致的副肿瘤综合征。需要进一步研究 AIP 与胰腺癌之间的关系,并在考虑并发症可能性的同时进行随访。
{"title":"Pancreatic Ductal Adenocarcinoma Encapsulated by a Tumor-Forming Type 1 Autoimmune Pancreatitis Located at the Pancreatic Tail: A Case Report.","authors":"Taro Ando, Hiroyuki Nitta, Akira Umemura, Hirokatsu Katagiri, Shoji Kanno, Daiki Takeda, Masao Nishiya, Noriyuki Uesugi, Tamotsu Sugai, Akira Sasaki","doi":"10.1159/000536008","DOIUrl":"10.1159/000536008","url":null,"abstract":"<p><strong>Introduction: </strong>Autoimmune pancreatitis (AIP) is recognized as a disease with a good prognosis that responds well to steroids, but the complication of pancreatic ductal adenocarcinoma (PDAC) in AIP is a rare condition. We report a case of PDAC encapsulated by tumor-forming type 1 AIP.</p><p><strong>Case presentation: </strong>The patient, a 65-year-old female, was found to have high CA19-9 levels and a pancreatic mass with a diameter of 30 mm on abdominal ultrasonography. Contrast-enhanced computed tomography revealed a 40-mm mass in the tail of the pancreas that had a 27-mm oligemic mass inside it. From these work-up examinations, this tumor was diagnosed as PDAC, with evidence of colonic invasion. As curative resection for PDAC, a distal pancreatectomy with splenectomy and combined colon resection were performed. Histopathological examination showed invasive PDAC surrounded by IgG4-positive plasma cell infiltration. Based on these findings, a diagnosis was made of PDAC located in the pancreatic tail capsulized by type 1 AIP. The postoperative course was uneventful, and the patient was discharged on postoperative day 15. She underwent postoperative adjuvant chemotherapy with S-1 for 6 months, and no recurrence was noted for 2 years after operation.</p><p><strong>Conclusion: </strong>Currently, there are two hypothetical mechanisms of PDAC induction by AIP: (1) carcinogenic stimulation due to chronic inflammation and (2) paraneoplastic syndrome caused by AIP. Further study of the relationship between AIP and pancreatic cancer is needed, and follow-up should be conducted while keeping in mind the possibility of complications.</p>","PeriodicalId":9614,"journal":{"name":"Case Reports in Gastroenterology","volume":"18 1","pages":"181-188"},"PeriodicalIF":0.6,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10972576/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140305003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Migration of a Common Bile Duct Stone into the Main Pancreatic Duct due to Catheter Manipulation during Endoscopic Retrograde Cholangiopancreatography. 内镜逆行胰胆管造影术中导管操作导致胆总管结石移入主胰管。
IF 0.6 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-03-26 eCollection Date: 2024-01-01 DOI: 10.1159/000538009
Toji Murabayashi, Haruka Nakamura, Shinya Sugimoto

Introduction: We report the first case of a choledocholithiasis migrating into the main pancreatic duct (MPD) due to catheter manipulation during endoscopic retrograde cholangiopancreatography (ERCP).

Case presentation: A 57-year-old woman complaining of vomiting was diagnosed with acute cholangitis and pancreatitis due to choledocholithiasis. During ERCP, the stone migrated from the papilla into the MPD due to the pushing motion of the catheter. However, the ERCP session was completed after biliary sphincterotomy without intervention in the MPD because the migration was not noticed. The migrated stone became apparent on computed tomography the following day. The second ERCP revealed the stone measuring 5 mm in the MPD. After pancreatic sphincterotomy, a pancreatic stent was placed, which improved the obstructive pancreatitis.

Conclusion: Endoscopists performing ERCP should be aware of this rare but serious complication.

导言:我们报告了首例在内镜逆行胰胆管造影术(ERCP)中因导管操作导致胆总管结石移入主胰管(MPD)的病例:一名57岁的妇女主诉呕吐,被诊断为胆总管结石引起的急性胆管炎和胰腺炎。在ERCP过程中,由于导管的推送动作,结石从乳头移入MPD。然而,ERCP手术在胆道括约肌切开术后完成,没有对MPD进行干预,因为没有发现结石移位。第二天的计算机断层扫描显示结石移位。第二次ERCP检查发现,结石在MPD中的大小为5毫米。胰腺括约肌切开术后,放置了胰腺支架,改善了梗阻性胰腺炎:结论:实施ERCP的内镜医师应注意这种罕见但严重的并发症。
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引用次数: 0
Coexisting Primary Sclerosing Cholangitis and Autoimmune Hepatitis: Overlapping Challenges in Diagnosis and Treatment. 原发性硬化性胆管炎和自身免疫性肝炎并存:诊断和治疗中的重叠难题。
IF 0.6 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-03-26 eCollection Date: 2024-01-01 DOI: 10.1159/000537798
Hannah W Fiske, Firrah Saeed, Christopher Ward, Boris Sinayuk, Veronica Ulici, Michael Curry, Edward Feller, Samir A Shah

Introduction: Hepatobiliary overlap syndromes describe the coinciding presentation of more than one immune-mediated biliary and liver disease in a single patient and present complex challenges in diagnosis and treatment. We report a case of ulcerative colitis with primary sclerosing cholangitis and autoimmune hepatitis overlap syndrome responsive to vancomycin.

Case presentation: The patient is a 30-year-old female with known ulcerative pancolitis and autoimmune hepatitis. She presented to the emergency department with a constellation of gastrointestinal symptoms, including diffuse lower abdominal pain, bloody diarrhea, and nausea with bilious vomiting. Subsequent imaging revealed the additional diagnosis of primary sclerosing cholangitis, and she was diagnosed with overlap syndrome. Multiple treatment regimens were trialed with minimal improvement. She eventually achieved normalization of both clinical status and biochemical markers after the addition of vancomycin.

Conclusion: Vancomycin is an underutilized therapy; its potential role in primary sclerosing cholangitis and autoimmune hepatitis overlap syndrome has not been previously reported.

导言:肝胆重叠综合征是指一名患者同时患有一种以上免疫介导的胆道和肝脏疾病,给诊断和治疗带来了复杂的挑战。我们报告了一例对万古霉素有反应的溃疡性结肠炎合并原发性硬化性胆管炎和自身免疫性肝炎重叠综合征病例:患者是一名 30 岁的女性,已知患有溃疡性胰腺炎和自身免疫性肝炎。她到急诊科就诊时出现了一系列胃肠道症状,包括弥漫性下腹痛、血性腹泻、恶心伴胆汁淤积性呕吐。随后的影像学检查发现,她又被诊断为原发性硬化性胆管炎,并被确诊为重叠综合征。她尝试了多种治疗方案,但效果甚微。在使用万古霉素后,她的临床状态和生化指标最终恢复正常:结论:万古霉素是一种未得到充分利用的疗法;它在原发性硬化性胆管炎和自身免疫性肝炎重叠综合征中的潜在作用此前尚未见报道。
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引用次数: 0
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Case Reports in Gastroenterology
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