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Alsarraj OM, Alqahtani A, Alswayyed M, Almayouf M, Billa S. Primary Adrenal Angiosarcoma and its Management: A Case Report. Cureus 2023; 15:e48762. [PMID: 38098906 PMCID: PMC10719075 DOI: 10.7759/cureus.48762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2023] [Indexed: 12/17/2023] Open
Abstract
Primary adrenal angiosarcoma is a very rare malignancy. This is a case report of a 54-year-old female, who presented with right-sided abdominal pain. Magnetic resonance imaging of the abdomen and pelvis showed a right adrenal mass with a maximum dimension of 5.7 cm. The patient went for a laparoscopic right adrenalectomy. The postoperative period was uneventful, and she was discharged on postoperative day 2. The patient was free from complaints at outpatient follow-up visits. Pathology confirmed the diagnosis of adrenal angiosarcoma and the metastasis workup was negative. A multidisciplinary approach through the expertise of medical oncology, surgical oncology, and histopathology is essential for the diagnosis and management of such rare diseases.
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Affiliation(s)
- Omar M Alsarraj
- Department of Surgery, Dr. Sulaiman Al-Habib Hospital, Al Takhasussi, SAU
| | | | - Mohammed Alswayyed
- Department of Pathology and Laboratory Medicine, King Saud University, Riyadh, SAU
| | - Mohammad Almayouf
- Department of Surgery, Prince Sattam bin Abdulaziz University, Alkharj, SAU
| | - Srikar Billa
- Department of Surgery, Dr. Sulaiman Al-Habib Hospital, Al Takhasussi, SAU
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Pairon C, Dili A, Bertrand C, D'Hondt L, Fervaille C, Donckier JE. Effective multimodal management of a giant adrenocortical carcinoma. Acta Chir Belg 2023; 123:444-447. [PMID: 35137673 DOI: 10.1080/00015458.2022.2040109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 02/05/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Adrenocortical carcinoma is a rare and aggressive tumour. The only curative treatment is surgery with negative margins. In most series, the average lesion size ranges from 5.5 to 15 cm. METHODS We report the case of a 27-year-old female with hyperandrogenism and Cushing syndrome due to a right adrenocortical carcinoma of 19.7 cm. RESULTS The tumour abutting on liver and vena cava and the presence two nodules in liver required extensive surgery including a right posterior sectionectomy and an en bloc resection of the adrenal mass together with the right kidney and the gallbladder. The vena cava was also resected with a reconstruction using a pericardial patch since it was invaded on its border. Pathological examination confirmed an adrenocortical carcinoma, with tumour invasion of vessels, tumour capsule, vena cava and two metastases in the liver (pT4N0M1). All margins were negative. Three months after surgery, two lung nodules, cardio-phrenic and internal mammary adenomegalies were noticed on a PET/CT scan, justifying the initiation of chemotherapy, alongside with mitotane. After a 10-month follow-up, CT scan was stable excepted for a lung nodule growing from 4 to 7 mm. Targeted stereotaxic radiotherapy was then administered. Twenty-two months after surgery, the patient has improved considerably and all signs of hyperandrogenism and Cushing syndrome have resolved. CONCLUSION This case of adrenocortical carcinoma illustrates one of the largest tumours among those reported. It demonstrates the feasibility and effectiveness of a multimodal approach in its treatment even if it is giant and at high risk.
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Affiliation(s)
- Camille Pairon
- Department of Endocrinology, Université Catholique de Louvain, CHU UCL Namur (Site Godinne), Yvoir, Belgium
| | - Alexandra Dili
- Unit of Digestive, Endocrine and General Surgery, Department of Surgery, Université Catholique de Louvain, CHU UCL Namur (Site Godinne), Yvoir, Belgium
| | - Claude Bertrand
- Unit of Digestive, Endocrine and General Surgery, Department of Surgery, Université Catholique de Louvain, CHU UCL Namur (Site Godinne), Yvoir, Belgium
| | - Lionel D'Hondt
- Department of Oncology, Université Catholique de Louvain, CHU UCL Namur (Site Godinne), Yvoir, Belgium
| | - Caroline Fervaille
- Department of Pathology, Université Catholique de Louvain, CHU UCL Namur (Site Godinne), Yvoir, Belgium
| | - Julian E Donckier
- Department of Endocrinology, Université Catholique de Louvain, CHU UCL Namur (Site Godinne), Yvoir, Belgium
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Han YG, Lim KM, Song T. Comparison of surgical outcomes between 3-dimensional and 2-dimensional laparoscopy of ovarian cyst (LOOC): a randomised controlled trial. J OBSTET GYNAECOL 2021; 42:1437-1442. [PMID: 34927539 DOI: 10.1080/01443615.2021.1990231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The purpose of this study was to compare the surgical outcomes and efficacy of 3-dimensional (3D) versus 2-dimensional (2D) imaging systems for the treatment of ovarian cyst. A total of 46 patients undergoing a laparoscopic ovarian cystectomy were randomly assigned to either the 3D or 2D laparoscopy group. The primary outcome measure was the operative blood loss. The secondary outcome measure was visually induced motion sickness (VIMS), task efficacy during laparoscopy, and postoperative complication. There were no differences in baseline demographics between the two groups. The operative blood loss was significantly smaller in the 3D groups (28.7 ± 11.6 mL) than in the 2D groups (46.5 ± 24.4 mL) (p = .012). VIMS score was significantly higher in the 3D groups than the 2D groups (p < .001). 3D laparoscopy was superior to 2D in terms of the task efficacy of ovarian cyst enucleation (p < .001), adhesiolysis or dissection (p < .001), and ovarian suturing (p = .008). None of the patients in both groups developed operative complications. In conclusion, a 3D imaging system showed a more favourable surgical outcome and improved task efficacy than 2D in laparoscopic ovarian cystectomy. However, 3D laparoscopy tends to cause more frequent VIMS in surgeons.Impact statementWhat is already known on this subject? Several studies examining the possible benefits and drawbacks of a 3D imaging system versus 2D in laparoscopic surgery have brought about conflicting results. However, there have been few studies comparing the surgical outcomes of 3D and 2D laparoscopic ovarian cystectomy.What do the results of this study add? 3D laparoscopy showed favourable surgical outcomes and improved task efficacy than 2D laparoscopy in ovarian cystectomy.What are the implications of these findings for clinical practice and/or further research? More complex procedures, such as suturing and adhesiolysis, might be easier to perform with 3D laparoscopy than with 2D laparoscopy. Therefore, further large studies of 3D gynaecologic laparoscopy with different complexities and for surgeons with different surgical skills are needed.
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Affiliation(s)
- Young Gi Han
- Department of Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyung Min Lim
- Department of Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Taejong Song
- Department of Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Mantzoros I, Bitsianis S, Loutzidou L, Ntampakis G, Chatzakis C, Christidis P, Gkiouliava A, Koraki E, Aggelopoulos S. Giant Adrenocortical Carcinoma: A Case Report and Review of the Relevant Literature. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e928875. [PMID: 33813589 PMCID: PMC8033218 DOI: 10.12659/ajcr.928875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 02/24/2021] [Accepted: 02/02/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Adrenocortical carcinomas are rare and aggressive tumors often diagnosed as incidentalomas. The malignancy can present with abnormal hormone secretion or the tumor may be non-functioning and present as a palpable mass causing discomfort. Here, we present a case of an adrenal cortical carcinoma originally identified as an incidentaloma. CASE REPORT A 63-year-old woman presented with abdominal pain and discomfort. A large abdominal mass, occupying the left upper and lower quadrant, was palpated. Imaging revealed a mass occupying the left abdomen between the stomach and the spleen, applying pressure on the pylorus, duodenum, splenic vessels, and pancreas. The mass size was 21.2×13×14.6 cm. Hormonal investigations were normal. Surgical exploration was performed, and the tumor was excised. Pathological analysis revealed an adrenocortical carcinoma and the patient underwent adjuvant chemotherapy. Twelve months later, the carcinoma recurred. The patient underwent a second operation in which the recurrent mass was excised along with the tail of the pancreas and a small part of the left lobe of the liver. The postoperative period was uneventful, and the patient was discharged home on the 7th postoperative day. No further adjuvant therapy was applied. The patient remains disease-free 18 months after the reoperation. CONCLUSIONS Giant adrenocortical carcinomas, although rare, pose a challenge to the surgical team both diagnostically and therapeutically. Surgical excision with the appropriate oncologic support can guarantee excellent outcomes.
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Affiliation(s)
- Ioannis Mantzoros
- 4 Academic Department of General Surgery, General Hospital of Thessaloniki “G. Papanikolaou”, Aristotle University of Thessaloniki, Exochi, Thessaloniki, Greece
| | - Stefanos Bitsianis
- 4 Academic Department of General Surgery, General Hospital of Thessaloniki “G. Papanikolaou”, Aristotle University of Thessaloniki, Exochi, Thessaloniki, Greece
| | - Lydia Loutzidou
- 4 Academic Department of General Surgery, General Hospital of Thessaloniki “G. Papanikolaou”, Aristotle University of Thessaloniki, Exochi, Thessaloniki, Greece
| | - Georgios Ntampakis
- 4 Academic Department of General Surgery, General Hospital of Thessaloniki “G. Papanikolaou”, Aristotle University of Thessaloniki, Exochi, Thessaloniki, Greece
| | - Christos Chatzakis
- 4 Academic Department of General Surgery, General Hospital of Thessaloniki “G. Papanikolaou”, Aristotle University of Thessaloniki, Exochi, Thessaloniki, Greece
| | - Panagiotis Christidis
- 4 Academic Department of General Surgery, General Hospital of Thessaloniki “G. Papanikolaou”, Aristotle University of Thessaloniki, Exochi, Thessaloniki, Greece
| | - Anna Gkiouliava
- Department of Anesthesiology, General Hospital of Thessaloniki “G. Papanikolaou”, Exochi, Thessaloniki, Greece
| | - Eleni Koraki
- Department of Anesthesiology, General Hospital of Thessaloniki “G. Papanikolaou”, Exochi, Thessaloniki, Greece
| | - Stamatios Aggelopoulos
- 4 Academic Department of General Surgery, General Hospital of Thessaloniki “G. Papanikolaou”, Aristotle University of Thessaloniki, Exochi, Thessaloniki, Greece
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Ahmed AA, Thomas AJ, Ganeshan DM, Blair KJ, Lall C, Lee JT, Morshid AI, Habra MA, Elsayes KM. Adrenal cortical carcinoma: pathology, genomics, prognosis, imaging features, and mimics with impact on management. Abdom Radiol (NY) 2020; 45:945-963. [PMID: 31894378 DOI: 10.1007/s00261-019-02371-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Adrenocortical carcinoma (ACC) is a rare tumor with a poor prognosis. Most tumors are either metastatic or locally invasive at the time of diagnosis. Differentiation between ACC and other adrenal masses depends on clinical, biochemical, and imaging factors. This review will discuss the genetics, pathological, and imaging feature of ACC.
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Affiliation(s)
- Ayahallah A Ahmed
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA
| | - Aaron J Thomas
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Dhakshina Moorthy Ganeshan
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA
| | - Katherine J Blair
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA
| | - Chandana Lall
- Department of Radiology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - James T Lee
- Department of Radiology, University of Kentucky, Lexington, Kentucky, USA
| | - Ali I Morshid
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA
| | - Mouhammed A Habra
- Departments of Endocrine Neoplasia and Hormonal Disorders, University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Khaled M Elsayes
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA.
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Li XM, Yang H, Reng J, Zhou P, Cheng ZZ, Li Z, Xu GH. A case report of primary adrenal angiosarcoma as depicted on magnetic resonance imaging. Medicine (Baltimore) 2017; 96:e8551. [PMID: 29137070 PMCID: PMC5690763 DOI: 10.1097/md.0000000000008551] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
RATIONALE Angiosarcoma is an extremely rare malignant tumor of endothelial origin. The majority of studies reporting angiosarcoma have been concerned with the clinical and pathological aspects, with limited reporting of their imaging findings. To our knowledge, angiosarcoma of the adrenal gland is very rare. Herein we firstly report a primary adrenal angiosarcoma depicted on magnetic resonance imaging (MRI). PATIENT CONCERNS A 59-year-old man was referred to our hospital for 1 year left-flank pain that exacerbated in recent 4 months. DIAGNOSIS A regular mass with clear boundary was revealed on MRI in the region of left adrenal gland. Its signal intensity was inhomogeneous. It mainly showed isointensity with patchy slight hyperintensity on T1-weighted images and marked hyperintensity with patchy hypointensity on T2-weighted images. On contrast-enhanced images, it demonstrated significantly heterogeneous enhancement, and the peripheral solid component showed delayed enhancement. Bulky blood vessels and hemorrhage were identified in the tumor. INTERVENTIONS The mass was surgically excised under a left laparoscopic adrenalectomy. OUTCOMES Left adrenal angiosarcoma was confirmed by pathological and immunohistochemical examinations. No evidence of recurrence was found 6 months after operation. LESSONS In conclusion, primary adrenal angiosarcoma has some MRI features corresponding to its pathological nature. It should be included in the differential diagnosis when a mass was detected in the adrenal gland.
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Affiliation(s)
- Xue-Ming Li
- Department of Radiology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China
| | - Hong Yang
- Department of Pathology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China
| | - Jing Reng
- Department of Radiology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China
| | - Peng Zhou
- Department of Radiology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China
| | - Zhu-Zhong Cheng
- Department of Radiology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China
| | - Zhen Li
- Department of Urology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan China
| | - Guo-Hui Xu
- Department of Radiology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China
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Aprea G, Aloia S, Quarto G, Furino E, Amato M, Bianco T, Di Domenico L, Rocca A, Maurea S, Sivero L. Uncommon primary hydatid cyst occupying the adrenal gland space, treated with laparoscopic surgical approach in an old patient. Open Med (Wars) 2017; 11:413-417. [PMID: 28352829 PMCID: PMC5329862 DOI: 10.1515/med-2016-0075] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 09/02/2016] [Indexed: 12/15/2022] Open
Abstract
Hydatid disease (HD) is caused by Echinococcus Granulosus (EG), which is a larva endemic in many undeveloped areas. The most common target is the liver (59%–75%). The retroperitoneal space is considered as a rare localization. We report an uncommon case of HD located in the adrenal gland space. Presentation of case. This is a 78-year-old Moroccan woman, with right flank pain for eight months previously. She denied contact with dogs or sheep. Her physical examination was normal. There was no pathological alteration of laboratory exams. CT scan measuring 5 cm without clear signs for a sure diagnosis found a round lesion in the right adrenal gland. An abdominal MRI showed a round mass of 34 x 27 mm with fluid component without a clear plane of dissection from kidney and liver. A laparoscopic procedure was performed to obtain a histological diagnosis. We reached a conclusive diagnosis of Hydatid cyst of right adrenal gland space. Hydatid cysts often develop in the liver. The location in the adrenal bed is rare without clinical signs related to alteration of the gland’s secretion. Hydatid cyst identification in the adrenal gland space is based on ultrasonography, CT or MRI scans. The differential diagnosis includes various benign and malignant lesions. Laparoscopic procedure is the best approach available to obtain a histological diagnosis and a curative treatment. The best treatment for HD is the pericystectomy. Laparoscopic surgery can guarantee a radical resection of these lesions when it performed by an expert surgeon.
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Affiliation(s)
- Giovanni Aprea
- Department of General and Minivasive Surgery, University Federico II of Naples, Via Pansini Nr. 5 Postal Code 8010, Napoli, Italy
| | - Sergio Aloia
- Department of General and Minivasive Surgery, University Federico II of Naples, Via Pansini Nr. 5 Postal Code 8010, Napoli, Italy
| | - Gennaro Quarto
- Department of General and Minivasive Surgery, University Federico II of Naples, Via Pansini Nr. 5 Postal Code 8010, Napoli, Italy
| | - Ermenegildo Furino
- Department of General and Minivasive Surgery, University Federico II of Naples, Via Pansini Nr. 5 Postal Code 8010, Napoli, Italy
| | - Maurizio Amato
- Department of General and Minivasive Surgery, University Federico II of Naples, Via Pansini Nr. 5 Postal Code 8010, Napoli, Italy
| | - Tommaso Bianco
- Department of General and Minivasive Surgery, University Federico II of Naples, Via Pansini Nr. 5 Postal Code 8010, Napoli, Italy
| | - Lorenza Di Domenico
- Department of General and Minivasive Surgery, University Federico II of Naples, Via Pansini Nr. 5 Postal Code 8010, Napoli, Italy
| | - Aldo Rocca
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy. Via Sergio Pansini, 80131 Naples, Italy
| | - Simone Maurea
- Department of Advanced Biomedical Sciences, University Federico II of Naples, Via Pansini Nr. 5 Postal Code 80100, Napoli, Italy
| | - Luigi Sivero
- Department of General and Minivasive Surgery, University Federico II of Naples, Via Pansini Nr. 5 Postal Code 8010, Napoli, Italy
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Sivero L, Telesca DA, Ruggiero S, Russo T, Amato M, Bianco T, Amato B, Formisano C, Avellino M, Napolitano V. Endoscopic diagnosis and treatment of neuroendocrine tumors of the digestive system. Open Med (Wars) 2017; 11:369-373. [PMID: 28352822 PMCID: PMC5329854 DOI: 10.1515/med-2016-0067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 09/06/2016] [Indexed: 12/31/2022] Open
Abstract
The authors evaluated the role of endoscopic techniques in the diagnosis and in the potential treatment of neuroendocrine tumors (NET) localized in the gastro-entero-pancreatic system, on the basis of their experience and of the international literature. NET are rare tumors that arise from neuroendocrine cells of the gastrointestinal tract and pancreas. It is a possibility that both the digestive endoscopy and EUS play an important role in the diagnosis, staging and surveillance of this disease. In some cases, especially in the early stages, surgical endoscopy allows the treatment of such tumors.
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Affiliation(s)
- Luigi Sivero
- Department of Gastroenterology, Endocrinology, Surgery. University Federico II of Naples. School of Medicine, Naples, Italy . Via Sergio Pansini 5, 80131, Napoli
| | - Donato Alessandro Telesca
- Department of Clinical Medicine and Surgery. University of Naples Federico II School of Medicine. Naples, Italy
| | - Simona Ruggiero
- Department of Clinical Medicine and Surgery. University of Naples Federico II School of Medicine. Naples, Italy
| | - Teresa Russo
- Department of Clinical Medicine and Surgery. University of Naples Federico II School of Medicine. Naples, Italy
| | - Maurizio Amato
- Department of Clinical Medicine and Surgery. University of Naples Federico II School of Medicine. Naples, Italy
| | - Tommaso Bianco
- Department of Clinical Medicine and Surgery. University of Naples Federico II School of Medicine. Naples, Italy
| | - Bruno Amato
- Department of Clinical Medicine and Surgery. University of Naples Federico II School of Medicine. Naples, Italy
| | - Cesare Formisano
- Department of Clinical Medicine and Surgery. University of Naples Federico II School of Medicine. Naples, Italy
| | - Manuela Avellino
- Department of General and Specialized Surgery, Second University of Naples. School of Medicine, Naples, Italy
| | - Vincenzo Napolitano
- Department of General and Specialized Surgery, Second University of Naples. School of Medicine, Naples, Italy
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Pancreatic stump closure after pancreatoduodenectomy in elderly patients: a retrospective clinical study. Aging Clin Exp Res 2017; 29:35-40. [PMID: 27837458 PMCID: PMC5334406 DOI: 10.1007/s40520-016-0657-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 10/12/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND Pancreatic fistula (PF) after pancreatoduodenectomy (PD) represents the major source of morbidity. Derivative procedures are preferred by pancreatic surgeons, but the optimal management of remnant pancreatic stump remains controversial. AIMS The purpose of this retrospective study is to evaluate the efficacy and safety of pancreatic stump closure in selected elderly patients (>65 years). METHODS Clinical data of 44 PD undergone mechanical closure of the pancreatic stump performed between 2001 and 2014 in two department of general and oncologic surgery were retrospectively collected. Considering the age, patients were divided into two groups: 21 patients of less than 65 years (Group A) and 23 patients of more than 65 years (Group B). RESULTS A soft pancreatic parenchyma with a not-dilated duct (diameter <3 mm) was reported in all the 44 patients. A grade-A PF, which did not required further treatments, developed in 20 cases (45.4%; 13 in group A and 7 in group B; p < 0.05), grade-B in 5 patients (11.4%; 3 in group A and 2 in group B; statistically not significant) and a grade-C PF was observed only in one patient (2.2%; 1 in group A and 0 in group B). DISCUSSION In selected "high risk" elderly patients (>65 years) with soft pancreatic texture, the closure of the pancreatic stump can be a useful tool in the surgical armamentarium with the aim to reduce the incidence of age-related complications. CONCLUSIONS Prospective randomized controlled trial to better evaluate PF risk factors is needed.
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Agrusa A, di Buono G, Chianetta D, Sorce V, Citarrella R, Galia M, Vernuccio L, Romano G, Gulotta G. Three-dimensional (3D) versus two-dimensional (2D) laparoscopic adrenalectomy: A case-control study. Int J Surg 2015; 28 Suppl 1:S114-7. [PMID: 26708842 DOI: 10.1016/j.ijsu.2015.12.055] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 05/04/2015] [Accepted: 05/20/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Laparoscopic adrenalectomy is today considered the gold standard of treatment for adrenal tumors. The development of high definition cameras does not eliminate the major limitation of two-dimensional (2D) laparoscopy: lack of depth perception and loss of spatial orientation. Tree-dimensional (3D) HD laparoscopy was developed as an alternative to conventional 2D laparoscopy. METHODS We report our experience with use of 3D vision system for laparoscopic adrenalectomy. Between January 2009 and March 2015 we performed a total of 52 laparoscopic adrenalectomies. In this case-control study we considered 13 laparoscopic adrenalectomies performed with three-dimensional (3D) vision system as case group. The last 26 procedures made with two-dimensional (2D) HD laparoscopic system represented the control group. We considered primary end-points: operative time, intraoperative complications and conversion rate. We evaluated also quality of depth perception and surgical strain. RESULTS Although the operative time for the entire surgical procedure was shorter in 3D group, there were no significant differences. The surgeon experienced better depth perception with 3D system and subjectively reported less strain using 3D vision system. Residents and medical students confirmed these data on surgical outcome. CONCLUSION 3D system vision does not seem to influence the operative time of laparoscopic adrenalectomy performed by experienced surgeon because the surgical technique request simple tasks. We obtain the better visualization in depth perception with effect on surgical precision. Comparative studies are necessary to verify if 3D can reduce perioperative complication with similar operative time.
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Affiliation(s)
- Antonino Agrusa
- Department of General Surgery, Urgency and Organ Transplantation, University of Palermo, Italy.
| | - Giuseppe di Buono
- Department of General Surgery, Urgency and Organ Transplantation, University of Palermo, Italy.
| | - Daniela Chianetta
- Department of General Surgery, Urgency and Organ Transplantation, University of Palermo, Italy.
| | - Vincenzo Sorce
- Department of General Surgery, Urgency and Organ Transplantation, University of Palermo, Italy.
| | - Roberto Citarrella
- Department of Experimental Biomedicine and Clinical Neurosciences, University of Palermo, Italy.
| | - Massimo Galia
- Section of Radiology - Di.Bi.Me.F., University of Palermo, Italy.
| | - Laura Vernuccio
- Department of Clinical Medicine and Emerging Disease, University of Palermo, Italy.
| | - Giorgio Romano
- Department of General Surgery, Urgency and Organ Transplantation, University of Palermo, Italy.
| | - Gaspare Gulotta
- Department of General Surgery, Urgency and Organ Transplantation, University of Palermo, Italy.
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Agrusa A, Romano G, Salamone G, Orlando E, Di Buono G, Chianetta D, Sorce V, Gulotta L, Galia M, Gulotta G. Large cavernous hemangioma of the adrenal gland: Laparoscopic treatment. Report of a case. Int J Surg Case Rep 2015; 16:150-3. [PMID: 26468756 PMCID: PMC4643478 DOI: 10.1016/j.ijscr.2015.09.040] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 09/29/2015] [Accepted: 09/29/2015] [Indexed: 11/06/2022] Open
Abstract
Identify the preoperative radiologic features of adrenal hemangioma. We examine the better surgical approach for adrenal tumors and adrenal hemangioma. Controindication to laparoscopic adrenalectomy.
Introduction Cavernous hemangioma of the adrenal gland is a rare benign tumor. The diagnosis is often postoperative on histological exam with the presence of blood-filled, dilated vascular spaces. Presentation of case We report the clinical case of a 49 years-old woman who came to our observation with aspecific abdominal pain. A computed tomography (CT) abdominal scan revealed a 11 cm right adrenal mass. This lesion was well circumscribed, round, encapsulated. After iodinated-contrast we observed a progressive, inhomogeneous enhancement without evidence of active bleeding and with pre-operative diagnosis of adrenal hemangioma. Laparoscopic adrenalectomy was performed by a transperitoneal flank approach. Pathological examination revealed a 11 cm adrenal mass with extensive central necrotic areas mixed to sinusoidal dilation and fibrotic septa. Postoperative diagnosis was adrenal hemangioma. Discussion Adrenal hemangiomas occur infrequently. Generally these adrenal masses are non-functioning and there is no specific symptoms. Recent records demonstrate that laparoscopic adrenalectomy is technically safe and feasible for large adrenal tumors, but controversy exists in cases of suspected malignancy. We choose laparoscopic approach to adrenal gland on the basis of preoperative CT abdominal scan that excludes radiological signs of adrenocortical carcinoma (ACC) such as peri-adrenal infiltration and vascular invasion. Conclusion Laparoscopic adrenalectomy is considered the standard treatment in case of diagnosis of benign lesions. In this case report we discussed a large adrenal cavernous hemangioma treated with laparoscopic approach. Fundamental is the study of preoperative endocrine disorders and radiologic findings to exclude signs of malignancy.
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Affiliation(s)
- A Agrusa
- Department of General Surgery, Urgency and Organ Transplantation, University of Palermo, Italy.
| | - G Romano
- Department of General Surgery, Urgency and Organ Transplantation, University of Palermo, Italy.
| | - G Salamone
- Department of General Surgery, Urgency and Organ Transplantation, University of Palermo, Italy.
| | - E Orlando
- Department of Human Pathology, Section of Anatomic Pathology, University of Palermo, Italy
| | - G Di Buono
- Department of General Surgery, Urgency and Organ Transplantation, University of Palermo, Italy.
| | - D Chianetta
- Department of General Surgery, Urgency and Organ Transplantation, University of Palermo, Italy.
| | - V Sorce
- Department of General Surgery, Urgency and Organ Transplantation, University of Palermo, Italy.
| | - L Gulotta
- Department of General Surgery, Urgency and Organ Transplantation, University of Palermo, Italy
| | - M Galia
- Section of Radiology-Di.Bi.Me.F., University of Palermo, Italy.
| | - G Gulotta
- Department of General Surgery, Urgency and Organ Transplantation, University of Palermo, Italy.
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Almarzouq A, Asfar S, Hussain S, Al-Hunayan A, Aldousari S. Giant nonfunctioning adrenocortical carcinoma: a case report and review of the literature. BMC Res Notes 2014; 7:769. [PMID: 25361816 PMCID: PMC4223740 DOI: 10.1186/1756-0500-7-769] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 10/18/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adrenocortical carcinoma is a rare and aggressive malignancy. Patients usually present early with manifestation of abnormal hormone secretion. However, adrenocortical carcinoma can also be nonfunctioning, and such patients present late with a mass effect or distant metastases. CASE PRESENTATION We herein report a case of a 30-year-old Sri-Lankan woman who presented with a 3-month history of left flank pain associated with nausea, vomiting, and weight loss. Imaging revealed a large left upper quadrant mass with a 1.8-cm left lung nodule. The differential diagnoses included a left adrenal mass, left upper pole renal mass, and retroperitoneal sarcoma. A functional adrenal work-up revealed no abnormal findings. Surgical excision of the mass was uneventful with no postoperative complications. Pathological analysis revealed a nonfunctioning adrenocortical carcinoma measuring 16 × 14 × 10 cm. To our knowledge, a mass of this size is among the largest nonfunctioning adrenocortical carcinomas reported in the published literature. The investigations and approach to treatment were consistent with those in the published literature. CONCLUSION Large nonfunctioning adrenocortical carcinomas pose a diagnostic and therapeutic challenge, and most are diagnosed at a late stage. Appropriate imaging and functional work-up of the mass are vital before treatment. Surgical excision is safe, even for large adrenocortical carcinomas; excision in patients with advanced disease has been shown to have the best outcomes.
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Affiliation(s)
| | | | | | | | - Saad Aldousari
- Urology Unit, Department of Surgery, Faculty of Medicine, Kuwait University, PO Box 24923, Safat 13110, Kuwait.
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