119 research outputs found
Mucobilia in Association With a Biliary Cystadenocarcinoma of the Caudate Duct: A Rare Cause of Malignant Biliary Obstruction
Mucobilia is a rare condition characterized by the
accumulation of abundant mucus within the intra- or
extrahepatic biliary tree. A variety of hepatobiliary
and pancreatic neoplasms are mucin producing
and have been associated with the development of
mucobilia including biliary mucinosis, biliary papillomatosis,
mucin-producing cholangiocarcinoma
(MPCC), or cystic neoplasms of the pancreas or
biliary tree (cystadenoma or cystadenocarcinoma).
We report the case of 46 year-old male with a biliary
cystadenocarcinoma of the caudate lobe which resulted
in chronic biliary obstruction and relapsing
cholangitis. A review of the literature for both mucobilia
and biliary cystadenocarcinoma is provided
along with a discussion addressing the clinical presentation,
diagnosis, treatment, and prognosis for
this rare entity
Adult Mesenchymal Hamartoma of the Liver: Case Report and Literature Review
Mesenchymal hamartoma of the liver (MHL) is a rare benign lesion occurring primarily in the pediatric population. While the precise pathogenesis of the tumor is not certain, the most common theory relates to aberrant mesenchyme development in the portal tract likely related to the bile ducts. A 53-year-old female was evaluated for an incidental liver mass. Initial CT scan showed a cystic lesion in the right lobe of the liver and follow-up imaging revealed an increase in size and the percent solid component within the mass. In view of these changes, a nondiagnostic biopsy was obtained followed by extirpation of the lesion. Gross pathological review of the lesion identified a 9 × 9 × 7.5 cm, pink-yellow-tan, gelatinous mass, with a >1 cm clear surgical margin. Histologically, the mass consisted of benign dilated bile ducts, as well as myxoid stroma with spindle cells showing smooth muscle differentiation. The patient was discharged home on postoperative day five. A review of the literature for MHL in adults reports 30 previous cases, predominantly published as individual case reports describing the size, lobe(s) of the liver affected, and the cystic/solid nature of the tumor. MHL in adults may represent a potentially premalignant lesion, as the emerging literature supports a potential relationship between MHL and malignant undifferentiated embryonal sarcoma in regards to cytogenetic analysis. Aggressive surgical management of MHL in adults is mandated when feasible
Right Ventricular Pneumocardia Secondary to Hepatic Abscesses
Gas-filled abscesses and gas gangrenes are extremely rare causes of intrahepatic gas. Even rarer, however, is the occurrence of gas within the non-portal hepatic veins. Most often seen in diabetic patients, dissemination and hepatic seeding of bacteria has been linked to procedures such as femoral catheters as well as liver lacerations and pyelonephritis. We report the case of a 69-year-old relatively healthy male who presented to our emergency department with abdominal pain and a fever of 103.3°F (39.6°C). A contrast-enhanced computed tomography scan of the abdomen revealed multiple hepatic abscesses and gas within the hepatic venous system as well as pneumocardia. In conclusion, gas within the non-portal hepatic veins is usually an indication of a serious underlying condition and its immediate identification is essential for treatment as hematogenous dissemination has already begun
Laparoscopic Cholecystectomy Conversion Rates Two Decades Later
Male patients greater than 50 years of age and cases performed by low-volume surgeons were found to have a higher rate of conversion to open procedures
The Mercury System: Exploiting Truly Fast Hardware in Data Mining
In many data mining applications, the size of the database is not only extremely large, it is also growing rapidly. Even for relatively simple searches, the time required to move the data off magnetic media, cross the system bus into main memory, copy into processor cache, and then execute code to perform a search is prohibitive. We are building a system in which a significant portion of the data mining task (i.e., the portion that examines the bulk of the raw data) is implemented in fast hardware, close to the magnetic media on which it is stored. Furthermore, this hardware can be replicated allowing mining tasks to be performed in parallel, thus providing further speedup for the overall mining application. In this paper, we describe a general framework under which this can be accomplished and provide initial performance results for a set of applications
Exploiting Truly Fast Hardware in Data Mining
In many data mining applications, the size of the database is not only extremely large, it is also growing rapidly. Even for relatively simple searches, the time required to move the data off magnetic media, cross the system bus into main memory, copy into processor cache, and then execute code to perform a search is prohibitive. We are proposing that a significant portion of the data mining task (i.e., the portion that examines the bulk of the raw data) be implemented in fast hardware, close to the magnetic media on which it is stored. Furthermore, this hardware can be replicated allowing mining tasks to be performed in parallel, thus providing further speed up for the overall mining application. In this paper, we describe a general framework under which this can be accomplished, and identify a number of important research questions that must be addressed for it to be practical
Giant Gastrointestinal Stromal Tumor Presenting as a Palpable Abdominal Mass: An Unusual Presentation
Gastrointestinal stromal tumors (GIST-) account for the majority of mesenchymal tumors arising within the gastrointestinal tract. GIST presenting as a palpable abdominal mass is extremely rare. We report four additional cases of a GIST presenting as an abdominal mass along with a pertinent review of the literature. Twenty five cases of GISTs presenting with an abdominal mass, including 4 cases discussed here, have been reported in the world literature since 2001. The mean duration of symptoms was 152.7 days. Twenty one of 25 (84%) patients received surgical resection. The mean tumor size was 17.2 cm, with an average mitotic index of 7.6 per 50 high power fields. Thirteen of 14 (92.9%) patients had a high-risk tumor. Five patients were disease-free at a mean followup of 11 months, 2 patients had stable disease and 2 patients had progressive disease, and one patient had a partial response. In conclusion, symptomatic patents have an increased incidence of high-risk tumors and metastases at presentation. Adjuvant therapy with imatinib improves disease-free survival in patients with large abdominal GIST tumors, but no change in overall survival was noted. Finally, GISTs should be considered in the differential diagnosis of an abdominal mass in an elderly patient
Intraabdominal Intravascular Papillary Endothelial Hyperplasia (Masson's Tumor): A Rare and Novel Cause of Gastrointestinal Bleeding
Intravascular papillary endothelial hyperplasia (IPEH), or Masson's tumor, a rare benign vascular lesion, occurs mainly in the head, neck, and hands in the human population. Aberrant tumor locations have been rarely reported. We present a case of a patient with chronic abdominal pain and melena of variable severity due to a Masson's tumor, with no apparent Masson's tumor-associated comorbidities, along with a comprehensive review of the literature. Using PubMed, a search engine provided by the U.S. National Library of Medicine and the National Institutes of Health, we searched for all reports of Masson's tumor limited within the abdominal cavity. Furthermore, keywords such as ‘intravascular papillary endothelial hyperplasia’, ‘renal’, ‘gastrointestinal’, ‘hepatic’ and ‘intraabdominal’ were used to facilitate the search. We thus found fourteen cases of intraabdominal Masson's tumors published. Six (42.9%) of these were located in the renal vein, 4 (28.6%) were reported in the gastrointestinal tract, 1 (7.1%) in the adrenal gland, 1 (7.1%) in the liver, and 1 (7.1%) instance with multiple lesion sites including the renal hilum and retroperitoneum. Among these patients, 9 (64.3%) were female and 5 (35.7%) male, with a mean age of 38.9 years (7–69). IPEH is a reactive process, having three subtypes, all involving the proliferation of epithelial cells around a thrombus in the setting of venous stasis. In its pure form, the organized thrombus is solely localized within the vascular lumen. Mixed-form IPEH is formed in preexisting vascular lesions (such as arteriovenous malformation, hemangioma, pyogenic granuloma, etc.). The rarest form is the extravascular variety, which arises in hematomas often from recent trauma to the area. In its pure form, IPEH has a zero recurrence rate when an R0 resection is performed; all mixed and extravascular forms show the highest recurrence rates. The exact histogenesis of these epithelial cells remains a mystery and multiple theories have been offered. Although difficult to distinguish from malignant angiosarcomas solely on presentation and radiologic work-up, Masson's tumors occur more frequently in women, demonstrate no local invasion, do not metastasize, are commonly located intravascularly, and are associated with a significantly more favorable prognosis than angiosarcomas. Only four Masson's tumors have been reported in the gastrointestinal tract, two of these cases were related to microvascular thrombosis secondary to paroxysmal nocturnal hemoglobinuria and two were formed secondary to arteriovenous malformations. Our case lacked solitary evidence of either of these comorbidities. An incidental finding of an enlarged ovary, which was removed during our exploratory laparoscopy, plus strong demographic statistics that suggest women have an increased prevalence of this lesion may help support a hormonal theory of pathogenesis
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