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Neung Hwa Park - One of the best experts on this subject based on the ideXlab platform.
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a gastrointestinal stromal Tumor of the duodenum masquerading as a pancreatic Head Tumor
World Journal of Gastroenterology, 2007Co-Authors: Sung Ho Kwon, Seok Won Jung, Jae Serk Park, In Du Jeong, Sung Jo Bang, Jung Woo Shin, Neung Hwa ParkAbstract:Gastrointestinal stromal Tumor (GIST) represents the most common kind of mesenchymal Tumor that arises from the alimentary tract. GIST is currently defined as a gastrointestinal tract mesenchymal Tumor showing CD117 (c-kit protein) positivity at immunohistochemistry. Throughout the whole length of the gastrointestinal tract, GIST arises most commonly from the stomach followed by the small intestine, the colorectum, and the esophagus. Only 3%-5% of GISTs occur in the duodenum, and especially, if GIST arises from the C loop of the duodenum, it can be difficult to differentiate from the pancreas Head mass because of its anatomical proximity. Here, we report a case of duodenal GIST, which was assessed as a pancreatic Head Tumor preoperatively.
Yasuhiro Matsugu - One of the best experts on this subject based on the ideXlab platform.
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celiac axis stenosis due to median arcuate ligament compression in a patient who underwent pancreatoduodenectomy intraoperative assessment of hepatic arterial flow using doppler ultrasonography a case report
Journal of Medical Case Reports, 2018Co-Authors: Masateru Yamamoto, Toshiyuki Itamoto, Akihiko Oshita, Yasuhiro MatsuguAbstract:Celiac axis stenosis due to compression by the median arcuate ligament has been reported in patients undergoing pancreaticoduodenectomy; it leads to the development of major collateral pathways that feed the hepatic artery. Dividing these important collaterals during pancreaticoduodenectomy can cause ischemic complications which may lead to a high mortality rate. To prevent these complications, it is necessary to assess intrahepatic arterial flow. A 71-year-old Japanese man with anorexia was referred to us for the treatment of alcoholic chronic pancreatitis. Computed tomography revealed a pancreatic Head Tumor with a calculus, associated with the dilatation of the main pancreatic duct and intrahepatic bile duct. Three-dimensional imaging demonstrated focal narrowing in the proximal celiac axis due to median arcuate ligament compression and a prominent gastroduodenal artery that fed the common hepatic artery. The preoperative diagnosis was alcoholic chronic pancreatitis with common bile duct obstruction and celiac axis stenosis due to median arcuate ligament compression. Pancreaticoduodenectomy with median arcuate ligament release was scheduled. Before the division of the median arcuate ligament, the peak flow velocity and resistive index of his intrahepatic artery measured with Doppler ultrasonography decreased from 37.7 cm/second and 0.510, respectively, to 20.6 cm/second and 0.508 respectively, when his gastroduodenal artery was clamped. However, these values returned to baseline levels after the division of the median arcuate ligament. These findings suggested that pancreaticoduodenectomy could be performed safely. Our patient was discharged on postoperative day 17 without significant complications. The intraoperative quantitative evaluation of intrahepatic arterial blood flow using Doppler ultrasonography was useful in a patient who underwent pancreaticoduodenectomy, who had celiac axis stenosis due to compression by the median arcuate ligament.
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Celiac axis stenosis due to median arcuate ligament compression in a patient who underwent pancreatoduodenectomy; intraoperative assessment of hepatic arterial flow using Doppler ultrasonography: a case report
BMC, 2018Co-Authors: Masateru Yamamoto, Toshiyuki Itamoto, Akihiko Oshita, Yasuhiro MatsuguAbstract:Abstract Background Celiac axis stenosis due to compression by the median arcuate ligament has been reported in patients undergoing pancreaticoduodenectomy; it leads to the development of major collateral pathways that feed the hepatic artery. Dividing these important collaterals during pancreaticoduodenectomy can cause ischemic complications which may lead to a high mortality rate. To prevent these complications, it is necessary to assess intrahepatic arterial flow. Case presentation A 71-year-old Japanese man with anorexia was referred to us for the treatment of alcoholic chronic pancreatitis. Computed tomography revealed a pancreatic Head Tumor with a calculus, associated with the dilatation of the main pancreatic duct and intrahepatic bile duct. Three-dimensional imaging demonstrated focal narrowing in the proximal celiac axis due to median arcuate ligament compression and a prominent gastroduodenal artery that fed the common hepatic artery. The preoperative diagnosis was alcoholic chronic pancreatitis with common bile duct obstruction and celiac axis stenosis due to median arcuate ligament compression. Pancreaticoduodenectomy with median arcuate ligament release was scheduled. Before the division of the median arcuate ligament, the peak flow velocity and resistive index of his intrahepatic artery measured with Doppler ultrasonography decreased from 37.7 cm/second and 0.510, respectively, to 20.6 cm/second and 0.508 respectively, when his gastroduodenal artery was clamped. However, these values returned to baseline levels after the division of the median arcuate ligament. These findings suggested that pancreaticoduodenectomy could be performed safely. Our patient was discharged on postoperative day 17 without significant complications. Conclusion The intraoperative quantitative evaluation of intrahepatic arterial blood flow using Doppler ultrasonography was useful in a patient who underwent pancreaticoduodenectomy, who had celiac axis stenosis due to compression by the median arcuate ligament
Seigo Kitano - One of the best experts on this subject based on the ideXlab platform.
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an extramural gastrointestinal stromal Tumor of the duodenum mimicking a pancreatic Head Tumor
Journal of Hepato-biliary-pancreatic Surgery, 2005Co-Authors: Hiroki Uchida, Atsushi Sasaki, Kentaro Iwaki, Masayuki Tominaga, Kazuhiro Yada, Yukio Iwashita, Kohei Shibata, Toshifumi Matsumoto, Masayuki Ohta, Seigo KitanoAbstract:We report the case of a 53-year-old woman with a gastrointestinal stromal Tumor (GIST) of the duodenum that showed only extramural growth, mimicking a pancreatic Tumor. Preoperatively, computed tomography (CT) and angiography revealed a hypervascular mass, 3.0 cm in diameter, in the pancreatic Head. Hypotonic duodenography showed compression of the second and third portions of the duodenum by the pancreatic lesion. Endoscopic examination showed no specific mucosal abnormalities in the duodenal lumen. The pancreatic Head Tumor was diagnosed preoperatively as a nonfunctioning islet cell Tumor of the pancreas, and the patient underwent pylorus-preserving pancreaticoduodenectomy. A hard mass was palpated intraoperatively in the pancreatic Head region, and neither peritoneal dissemination nor metastasis was detected. Histologically, the Tumor was composed of spindle-shaped cells with a fascicular growth pattern, and only a few mitotic features were seen. Immunohistochemically, most of the Tumor cells were positive for c-kit oncoprotein and CD34, but negative for alpha-smooth muscle actin and S-100 protein. Therefore, this neoplasm was finally diagnosed as a duodenal GIST of the uncommitted type. This is a rare case of a duodenal GIST with exclusively extramural growth mimicking a pancreatic Head Tumor.
Sung Ho Kwon - One of the best experts on this subject based on the ideXlab platform.
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a gastrointestinal stromal Tumor of the duodenum masquerading as a pancreatic Head Tumor
World Journal of Gastroenterology, 2007Co-Authors: Sung Ho Kwon, Seok Won Jung, Jae Serk Park, In Du Jeong, Sung Jo Bang, Jung Woo Shin, Neung Hwa ParkAbstract:Gastrointestinal stromal Tumor (GIST) represents the most common kind of mesenchymal Tumor that arises from the alimentary tract. GIST is currently defined as a gastrointestinal tract mesenchymal Tumor showing CD117 (c-kit protein) positivity at immunohistochemistry. Throughout the whole length of the gastrointestinal tract, GIST arises most commonly from the stomach followed by the small intestine, the colorectum, and the esophagus. Only 3%-5% of GISTs occur in the duodenum, and especially, if GIST arises from the C loop of the duodenum, it can be difficult to differentiate from the pancreas Head mass because of its anatomical proximity. Here, we report a case of duodenal GIST, which was assessed as a pancreatic Head Tumor preoperatively.
Bruno Meduri - One of the best experts on this subject based on the ideXlab platform.
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unusual presentation of a gastrointestinal stromal Tumor of the duodenum mimicking an inflammatory enlargement of a peripancreatic lymph node
Annals of Gastroenterology, 2014Co-Authors: Gianfranco Donatelli, Bertrand Marie Vergeau, Gilles Roseau, Bruno MeduriAbstract:Gastrointestinal stromal Tumors (GISTs) are low-grade malignant mesenchymal Tumors of GI tract and are believed to originate from malignant transformation of the interstitial cells of Cajal from their precursors [1]. Duodenal GISTs are usually exophytic and appear as submucosal swellings [2]; however, in the absence of specific mucosal changes or anatomical variations of the duodenal lumen, it may be difficult to differentiate a duodenal GIST from a malignant lymphoma, duplication cyst, retroperitoneal Tumor, or pancreatic Head Tumor [1]. We present a case of a 40-year-old woman referred for endoscopic ultrasound (EUS), after she was submitted to a contrast-enhanced spiral computed tomography scan for diffuse abdominal pain, which showed a mass of 2 cm at the level of the internal part of pancreas suggesting a neuroendocrine Tumor. Biochemistry and Tumor markers were within normal limits. At the level of the second part of the duodenum, a hypoechogenic pericholedochal mass was visualized, between the pancreatic Head and the duodenal wall, well-delineated, multilobular, seemingly not deriving either from the duodenal wall or from the pancreatic parenchyma, suggesting an inflammatory enlargement of a lymph node given its appearance, i.e. triangular, homogeneous, and grayish (Fig. 1A). However, because of its abnormal size, we decided to proceed to EUS fine needle aspiration (FNA) biopsy (Fig. 1B). Surprisingly, histology confirmed a GIST charecterized by spindled cells (Fig. 2), strongly reactive to the antibody DOG1, with a proliferation index counted by Ki67 antibody to less than 5%. Figure 1 (A) Hypoechoic, triangular, homogeneous, grayish mass evoking an inflammatory enlargement of lymph node mass between the pancreas and the duodenal wall. (B) Endoscopic ultrasound fine needle aspiration biopsy of the lesion Figure 2 Gastrointestinal stromal Tumor charecterized by spindled cells In conclusion, EUS presentation of the GIST might mimic various pathologies, and, in order to avoid misdiagnosis of an apparently unusual lesion during EUS, a well-detailed wall layer study is necessary to guide diagnosis, and EUS-FNA is mandatory for histological confirmation.
