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Pancreatic angiosarcoma: A case report

Supandi FN, Singh B, Thamutaram H, Lim KF, Yusoff AR

Ann Hepatobiliary Pancreat Surg, 2021 Jun 30;25(Suppl 1):S388.
PMID: 34230285 DOI: 10.14701/ahbps.EP-189

Introduction: Pancreatic cancer has a relative 5-year survival of less than 10%. The most common neoplasm of the pancreas is ductal adenocarcinoma, which comprises 85% of all malignant pancreatic tumours. Primary pancreatic sarcomas are extremely rare which account for less than 0.1% of all pancreatic malignancies and pancreatic angiosarcomas attribute to 1% of all tissue sarcomas. Sarcomas of the pancreas are more aggressive and have a dismal prognosis.
Methods: A 69-year-old lady presented with obstructive jaundice, abdominal discomfort and associated constitutional symptoms. She was investigated and found to have obstructive jaundice with normal tumor marker assays. An endoscopic ultrasound was done followed by a needle biopsy which confirmed a pancreatic head angiosarcoma followed by an ERCP and a stent placement. A CT abdomen done revealed a pancreatic head and uncinate tumor with a stent in the common bile duct.
Results: Patient underwent a pylorus preserving pancreaticoduodenectomy with an uneventful post-operative recovery. She defaulted her oncology appointments and was followed up with serial imaging. She developed a local recurrence 18 months after surgery and succumbed to her disease after 3 years.
Conclusions: Pancreatic angiosarcoma is an aggressive tumor compared to other pancreatic malignancies. For a definite diagnosis of angiosarcoma, histopathologic and immunohistochemical analysis are necessary. Surgical resection offers the only possible cure, while oncological treatment has variable outcome. Currently, there are no treatment protocols available due to the small number of cases present in literature.
Caudate lobe abscess: Challenging site with less invasive option of treatment: A case series

Supandi FN, Singh B, Roslan R, Husin I, Lee TS

Ann Hepatobiliary Pancreat Surg, 2021 Jun 30;25(Suppl 1):S240.
PMID: 34230345 DOI: 10.14701/ahbps.EP-39

Introduction: The rarity of caudate lobe abscess has made it difficult to outline a treatment algorithm for this pathology due to its anatomically challenging site. Caudate lobe abscesses also poses a risk of rupture, making its management more complicated. However, advances in imaging have made it possible for early detection and paradigm shift in its management from open surgery to non-operative intervention.
Methods: All patients with isolated caudate lobe abscess were selected retrospectively and diagnosis was confirmed by imaging. Patient in this case series underwent either percutaneous or endoscopic drainage and empirical antibiotic therapy alone.
Results: There are 5 patients in this case series, 3 of them underwent percutaneous drainage, 1 of them treated with antibiotic alone and another underwent endoscopic ultrasound (EUS)-guided drainage. All patients showed complete resolution of caudate lobe abscess without procedural complications.
Conclusions: The caudate lobe, which lies posterior to the hepatoduodenal ligament and anterior to the inferior vena cava exposes the patient to possible life-threatening complications when subjected to drainage via a percutaneous approach. EUS allows not only identification of intervening vessels which is the major reason for technical difficulty in percutaneous drainage, but excellent visualization of abscess cavities and the surrounding landmarks. In conclusion, non-surgical approach is our treatment of choice in management of caudate lobe liver abscess.
Primary pleomorphic liver liposarcoma: A case series and literature review

Sen CJ, Yng SJ, Choon SK, Zamri FI

Ann Hepatobiliary Pancreat Surg, 2021 Aug 31;25(3):395-400.
PMID: 34402442 DOI: 10.14701/ahbps.2021.25.3.395

Primary hepatic liposarcoma is an extremely rare mesenchymal tumor that accounts for only 0.1% to 2% of primary malignant liver tumors. Due to its rarity, there is a lack of knowledge about its clinical course, management, and prognosis. Only 15 cases of primary liposarcoma of the liver have been reported since 1973. Among these 15 cases, only two involved primary liver liposarcoma with a pleomorphic subtype. Here we report the third and fourth cases of primary pleomorphic liver liposarcoma. A 57-year-old female presented with abdominal discomfort and progressive abdominal distension for two weeks. Computed tomography (CT) of her abdomen revealed a large well-defined solid nodule mass with an area of necrosis and hemorrhage occupying segment IV-B of the liver. Wide local excision was performed. She had an uneventful recovery and remained well at six months post-treatment. A 65-year-old male presented with an abdominal mass for two-month. CT demonstrated a mass in the left lobe of the liver with mixed soft tissues and fat attenuation. He underwent wide local excision. He was discharged on day three postoperatively. Histological analysis for both cases revealed liposarcoma of the liver with a pleomorphic subtype.
Hemorrhagic extrahepatic recurrence of hepatocellular carcinoma: A case report

Yeow GPV, Yeow DGE, Sankaran P, Maiyauen T, Sharif MS

Ann Hepatobiliary Pancreat Surg, 2019 Feb;23(1):77-79.
PMID: 30863813 DOI: 10.14701/ahbps.2019.23.1.77

The recurrence of hepatocellular carcinoma (HCC) can mainly be divided into two phases or types: the intrahepatic recurrence (IHR) and the extrahepatic recurrence (EHR). Generally speaking, the EHR is usually referenced as being the less common of the two types or categories. In a post-hemihepatectomy patient with routine surveillance at 6 months, it was noted that the patient appeared to have an elevated alpha-fetoprotein, and also complained of vague lower abdominal pain. The accompanying computed tomography scan revealed a 6 cm-sized heterogeneous mass located at the pelvis region. Next, during a laparotomy for resection, the tumor was found to be bleeding from the omental deposition. In conclusion, a high index of suspicion and early surgical intervention can help in detecting possible bleeding extrahepatic recurrence in the background of a patient with history of HCC.
Fulltext Case series of gallstone ileus with one- or two-stage surgery

Chuah JS, Tan JH, Khairudin KB, Ling LLL, Mat TNBT

Ann Hepatobiliary Pancreat Surg, 2022 May 31;26(2):199-203.
PMID: 35272270 DOI: 10.14701/ahbps.21-139

Gallstone ileus is an uncommon cause of intestinal obstruction. It may present with typical symptoms of intestinal obstruction with or without biliary sepsis. Its management strategies vary depending on the patient and operative factors. Enterotomy and stone removal alone versus synchronous cholecystectomy and fistula disconnection at the same stage, often pose a debate among surgeons. The decision for operative strategies largely depends on the surgeon's experience, patient's physiology, and operative difficulties. As literature on gall stone ileus remains insufficient at a regional level, we report four cases of gallstone ileus managed with different approaches. Three patients were managed in a staged-manner, whereas one patient received a definitive procedure performed at index surgery. Clinical challenges and associated operative strategies are discussed. Findings of the current study were compared to those of the literature. The need for a definitive fistula disconnection and repair or cholecystectomy following stone removal in these patients was subsequently discussed.