ObjectiveTo summarize the diagnosis and treatment process of a patient who underwent laparoscopic local excision of duodenal papillary tumor, and to explore the safety and feasibility of this surgery. MethodThe clinicopathologic characteristics and surgical procedure of the patient with duodenal papillary neuroendocrine tumor admitted to the West China Hospital of Sichuan University in June 2021 were retrospectively analyzed. ResultsThe patient underwent the laparoscopic local excision of duodenal papillary tumor + in situ cholangiojejunostomy and pancreaticojejunostomy. The operation lasted about 3 hours, the blood loss was about 20 mL, and the patient exhausted on the 3rd day after the operation. On the 7th postoperative day, the gastric tube was pulled out and oral feeding was started. On the 8th day, the plasma drainage tube was pulled out and the patient was discharged smoothly. There was no duodenal fistula, bleeding, wound infection, and other complications. After 6 months of follow-up, the general condition of this patient was good, and no tumor recurrence or metastasis was found. ConclusionLaparoscopic local excision is an appropriate option for benign or low-grade malignancies involving the duodenal papillary tumor.
Thymic neuroendocrine tumors (TNETs) are a series of rare diseases with aggressive biology and poor prognosis. Clinical manifestations of TNETs are atypical, and ectopic secretion of adrenocorticotropic hormone can be found in some cases, resulting in associated endocrine symptoms. Due to the low morbidity and strong heterogeneity, it’s difficult to diagnose, treat and obtain new treatment regimen. Early complete surgical resection is an effective treatment. For advanced cancer, clinical trials of new drugs are expected to improve the survival of patients.
Objective To discuss the CT appearances and clinicopathologic features of gastrointestinal neuroendocrine neoplasms (GI-NENs). Method The clinical and CT materials of 33 cases of GI-NENs who treated in our hospital from Jan. 2013 to Dec. 2015 were retrospectively analyzed. Results Of the 33 cases, 25 males and 8 females were enrolled. The median age was 62-year old (27–78 years), and the age at diagnosis mainly focused in the 50–70 years period. GI-NENs situation: 12 cases in the stomach, 11 cases in the rectum, 3 cases in the esophagus and colon respectively, 2 cases in the duodenum and appendix respectively. The main clinical symptoms included: abdominal pain in 13 cases, dysphagia and obstruction in 9 cases, hematemesis and hematochezia in 8 cases, abdominal distention in 5 cases, stool and bowel habits change in 5 cases, subxyphoid pain in 3 cases, belching in 2 cases, diarrhea in 1 case, protrusion of the neoplasm when defecation in 1 case, obstructive jaundice in 1 case. Seven cases of G1 grade, 6 cases of G2 grade, 15 cases of G3 grade, and 5 cases of mixed adenoneuroendocrine carcinomas were found according to pathologic grading. The immunohistochemical marker: synaptophsin was positive in 31 cases, cytokeratin A was positive in 23 cases, and cytokeratin was positive in 9 cases. The CT appearances of GI-NENs were mainly thickening of the walls and formation of nodules or masses in local area. Moderately homogeneous enhancement (in 20 cases) and irregularly heterogeneous enhancement (in 13 cases) were both commonly seen. In addition, 13 cases of lymphadenophathy, 6 cases of liver metastasis, and 3 cases of lung metastasis were also detected by CT. Conclusions GI-NENs have a preference for elderly male. The most common site of onset is the stomach. Its clinical symptoms and CT appearances are nonspecific, however, the enhancement pattern of the tumors has a certain characteristic.
Objective To explore CT features that can be used to identify nonhypervascular pancreatic neuroendocrine neoplasm (pNEN) and pancreatic ductal adenocarcinoma (PDAC). Methods The patients with pathologically confirmed the pNEN and PDAC were retrospectively included from May 2010 to May 2017. The CT features were analyzed. The CT features were extracted by the multivariate logistic regression, and their diagnostic performances were calculated. Results Forty patients with the nonhypervascular pNEN (33 unfunctional, 7 functional) and 80 patients with the PDAC were included in this study. The features of significant differences between the nonhypervascular pNEN and the PDAC included: the location, long diameter, margin, uniform lesions, calcification, and vascular shadows of the lesion (P<0.05). The margin ［OR=14.63, 95% CI (2.82, 75.99)］, calcification ［OR=4.00, 95% CI (1.03, 15.59)］, and location ［OR=3.09, 95% CI(1.19, 7.99)］ of the lesion could independently identify the nonhypervascular pNEN. The multivariate logistic regression model of the differential diagnosis of the nonhypervascular pNEN and PDAC was obtained through the CT features of significant differences. The diagnostic sensitivity was 70.00%, 95% CI (53.5,83.4); specificity was 83.54%, 95% CI (73.5, 90.9); and area under the receiver operating curve was 0.824, 95% CI (0.743, 0.887). Conclusions Multivariate logistic regression model of CT features is helpful for differential diagnosis of nonhypervascular pNEN and PDAC. Features of margin and calcification of lesion are more valuable in differential diagnosis of nonhypervascular pNEN and PDAC.
ObjectiveTo investigate the value of laparoscopic liver venous deprivation (LLVD) in promoting the growth of contralateral future liver remnant (FLR) during two-step hepatectomy. MethodThe clinicopathologic data of a 45-year-old female patient with pancreatic neuroendocrine tumor with multiple liver metastases (grade G2) treated by two-step hepatectomy based on LLVD in January 2022 in the Sichuan Provincial People’s Hospital were analyzed retrospectively. ResultsThe liver function returned to normal within 10 d after LLVD, and the relative increase ratio of FLR reached to 98.35% on postoperative day 10. The laparoscopic right hemi-hepatectomy and distal pancreatectomy plus splenectomy was performed without any postoperative complications, and the patient was discharged from hospital on postoperative day 8. No tumor recurrence or metastasis occurred during the follow-up period. ConclusionsFrom the analysis results of this case, the LLVD could promote the growth of FLR safely and effectively. LLVD provides an alternative surgical method of two-step hepatectomy for treatment of benign and malignant liver tumors.