Signet-Ring Cell Carcinoma of the Ampulla of Vater

Signet-ring cell carcinoma (SRCC) of the ampulla of Vater is a very rare case and only 28 cases have beed reported in the English literature. Herein, we report a 59-year-old woman with SRCC of the ampulla of Vater. She developed symptoms of obstructive jaundice at early stage of disease and underwent pylorus-preserving Whipple procedure as definitive treatment. Histopathology examination showed numerous tumor cells with intracytoplasmic mucin and eccentric nuclei. Her tumor has already invaded the serosa of duodenum, but no infiltration to the stomach, pancreas, and lymphovascular structure. Her surgical margins and regional lymph nodes were free of tumor. She was diagnosed with T2N0M0 SRCC of the ampulla of Vater. No adjuvant treatment was given and she has been doing well for five months after surgery

Drug-Induced Liver Injury – Tantangan dalam Diagnosis

Jejas hati imbas obat (drug-induced liver injury, DILI), atau hepatotoksisitas imbas obat, merupakan jejas hati yang disebabkan oleh pajanan terhadap obat atau agen non-infeksius. Jejas yang ditimbulkan oleh obat bervariasi, mulai dari tidak bergejala, ringan, hingga gagal hati akut yang mengancam nyawa. Insidens hepatotoksisitas imbas obat terbilang rendah, yaitu antara 1 dari 10.000 sampai 1 dari 100.000 pasien, tampaknya karena sulitnya diagnosis dan angka pelaporan yang masih rendah. Kunci penting diagnosis DILI adalah pajanan obat harus terjadi sebelum onset jejas hati dan penyakit lain yang dapat menyebabkan jejas hati harus disingkirkan. Selain itu, jejas hati akan membaik bila penggunaan obat tertentu dihentikan dan jejas hati dapat terjadi lebih cepat dan lebih berat pada pajanan berikutnya, khususnya bila jejas hati tersebut terjadi akibat proses imunologis.Drug-induced liver injury or drug-related hepatotoxicity is injury to the liver caused by exposure to a drug or another noninfectious agent. The clinical signs could vary from very mild condition without any clinical symptoms to severe and life-threatening acute liver failure. Drug-related hepatotoxicity has a low reported incidence, ranging from 1 in 10.000 and 1 in 100.000 patients, but its true incidence may be higher because of difficulties in detection or diagnosis and underreporting. Key elements in assessing cause in the diagnosis of drug-related hepatotoxicity were : Exposure to a drug must precede the onset of liver injury. Other disease should be ruled out. Condition may improve when the drug is stopped and may recur more rapidly and severely on repeated exposure, especially if immunological process is involved