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Li X, Ren J, Ke J, Jiang P, Guo L, Zhang L, Han W, Liu Y, Ji B. Solid pseudopapillary neoplasm of the pancreas with hepatic metastases: problems and strategies. Front Oncol 2024; 14:1410888. [PMID: 39099687 PMCID: PMC11294175 DOI: 10.3389/fonc.2024.1410888] [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] [Received: 04/02/2024] [Accepted: 07/05/2024] [Indexed: 08/06/2024] Open
Abstract
Background Solid pseudopapillary neoplasms of the pancreas with hepatic metastases are infrequent and difficult to diagnose, and treatment is uncertain. Methods A retrospective analysis of clinical data from patients with pancreatic solid pseudopapillary neoplasm (SPN) hepatic metastases who underwent surgery at the First Hospital of Jilin University from January 2005 to December 2021 was conducted. A total of 287 patients with SPN were included in the study, of which 8 (3%) developed liver metastases, all of whom were treated surgically and recovered well after surgery. The clinical presentation, imaging features, surgical treatment, histopathological examination, and postoperative follow-up data (mean 70 months; range 28-138 months) of the patients were recorded and analyzed. Clinical response strategies can be derived by reviewing previous studies on hepatic metastases of SPNs. Results For resectable hepatic metastases from pancreatic solid pseudopapillary neoplasms, early surgery with total resection of the primary tumor and metastasis has shown great efficiency and is associated with patient good prognosis. In patients presenting unresectable hepatic metastases, aggressive tumor reduction surgery resulted in the alleviation of clinical symptoms and reduction of tumor burden while potentially achieving long-term survival. Conclusion For hepatic metastases of SPNs, a preoperative liver tissue biopsy is beneficial for a definitive diagnosis. Surgery demonstrates excellent therapeutic efficacy and is considered the preferred curative treatment approach. This paper presents clinical experiences with SPN-related hepatic metastases at the Affiliated Hospital of Jilin University, which can be used to guide patient counseling in clinical practice.
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Affiliation(s)
- Xiaocheng Li
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, the First Hospital of Jilin University, Changchun, China
| | - Jiaxin Ren
- Department of Neurology, the First Hospital of Jilin University, Changchun, China
| | - Jianji Ke
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, the First Hospital of Jilin University, Changchun, China
| | - Peng Jiang
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, the First Hospital of Jilin University, Changchun, China
| | - Liang Guo
- Department of Pathology, the First Hospital of Jilin University, Changchun, China
| | - Li Zhang
- Department of Radiology, the First Hospital of Jilin University, Changchun, China
| | - Wei Han
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, the First Hospital of Jilin University, Changchun, China
| | - Yahui Liu
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, the First Hospital of Jilin University, Changchun, China
| | - Bai Ji
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, the First Hospital of Jilin University, Changchun, China
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Yamane K, Tsukano K, Umino Y, Nagami T, Tarumoto K, Hattori K, Maemoto R, Iwasaki J, Kanazawa A. Successful curative treatment for a ruptured pancreatic acinar cell carcinoma by radical resection following modified FOLFIRINOX: a case report and literature review. Int Cancer Conf J 2024; 13:281-288. [PMID: 38962046 PMCID: PMC11217244 DOI: 10.1007/s13691-024-00679-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 03/28/2024] [Indexed: 07/05/2024] Open
Abstract
Pancreatic acinar cell carcinoma (PACC) is a rare pancreatic tumor type, and ruptured pancreatic tumors are rarer. Computed tomography (CT) in a 48-year-old man incidentally revealed a raptured pancreatic tail tumor. The patient was treated conservatively because he was asymptomatic, and his general condition was stable. After a detailed examination, the pancreatic tumor was diagnosed as raptured PACC. Considering the potential infiltration of tumor cells into the hematoma within the omental sac, our decision is to initiate chemotherapy as the primary course of action. A liquid biopsy was performed, and comprehensive genomic profiling of circulating tumor DNA showed a tumor BRCA2 mutation. Chemotherapy with modified FOLFIRINOX (mFFX) was selected as the first treatment. After seven courses of mFFX, the primary tumor diminished remarkably. At this time, the radical resection was performed via distal pancreatectomy with simultaneous resection of the gastric wall and colon, which had adhered strongly to the tumor. Histopathological examination revealed that the tumor had shrunk to less than 5% of its original size due to chemotherapy (Grade 3 of Evans Classification). Devising treatment strategies for ruptured pancreatic malignant tumors is challenging due to the worsening general condition caused by severe abdominal symptoms and intra-abdominal bleeding. In this context, this case-report documents a rare instance of raptured PACC with a tumor BRCA2 mutation that underwent radical resection following mFFX treatment.
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Affiliation(s)
- Kei Yamane
- Department of Surgery, Shimane Prefectural Central Hospital, Izumo-Shi, Shimane, 693-8555 Japan
| | - Kosuke Tsukano
- Department of Gastroenterology, Shimane Prefectural Central Hospital, Izumo-Shi, Shimane, 693-8555 Japan
| | - Yosuke Umino
- Department of Surgery, Shimane Prefectural Central Hospital, Izumo-Shi, Shimane, 693-8555 Japan
| | - Tadashi Nagami
- Department of Surgery, Shimane Prefectural Central Hospital, Izumo-Shi, Shimane, 693-8555 Japan
| | - Koji Tarumoto
- Department of Surgery, Shimane Prefectural Central Hospital, Izumo-Shi, Shimane, 693-8555 Japan
| | - Kuniaki Hattori
- Department of Surgery, Shimane Prefectural Central Hospital, Izumo-Shi, Shimane, 693-8555 Japan
| | - Ryo Maemoto
- Department of Surgery, Shimane Prefectural Central Hospital, Izumo-Shi, Shimane, 693-8555 Japan
| | - Junji Iwasaki
- Department of Surgery, Shimane Prefectural Central Hospital, Izumo-Shi, Shimane, 693-8555 Japan
| | - Akiyoshi Kanazawa
- Department of Surgery, Shimane Prefectural Central Hospital, Izumo-Shi, Shimane, 693-8555 Japan
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Baskaran S, Lodha M, Kumar RR, Elhence P. Spontaneous rupture of solid pseudopapillary epithelial neoplasm of pancreas with intraperitoneal haemorrhage. BMJ Case Rep 2023; 16:e257398. [PMID: 38081741 PMCID: PMC10728932 DOI: 10.1136/bcr-2023-257398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Affiliation(s)
- Suruthi Baskaran
- General Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Mahendra Lodha
- General Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Ravi Ranjan Kumar
- General Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Poonam Elhence
- Pathology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Ricardo VD, Marchetti G, de Almeida AF, Lopes CV, Reis JDS, Bonin EA, de Araújo WC, Machado MA, Romanini SG, Ardengh JC. Multicenter Study on the Performance of Imaging Tests Compared to Endosonography-Guided Fine-Needle Aspiration in the Diagnosis of Solid Pseudopapillary Neoplasms of the Pancreas. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2023; 30:375-383. [PMID: 37868635 PMCID: PMC10586220 DOI: 10.1159/000525994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 03/07/2022] [Indexed: 10/24/2023]
Abstract
Introduction Imaging diagnosis of pancreatic solid-pseudopapillary neoplasms (SPNs) is difficult. Preoperative diagnosis by endosonography-guided fine-needle aspiration (EUS-FNA) is possible and has been reported in the literature in pancreatic tumors. However, its usefulness is still controversial. The aim of this study was to determine the accuracy of the EUS-FNA in the diagnosis of patients with SPN and describe the findings in computerized tomography (CT), magnetic resonance cholangiopancreatography imaging (MRI/MRCP), and EUS therefore comparing the imaging methods alone to the findings of microhistology (McH) obtained by EUS-FNA. Materials and Methods We retrospectively reviewed the medical records of patients undergoing EUS-FNA with suspected SPN in imaging studies in 5 Brazilian high-volume hospitals (two university hospitals and three private hospitals). The demographic data; findings in CT, MRI/MRCP, and EUS; and McH results obtained by EUS-FNA were noted prospectively. The final diagnosis was obtained after the anatomopathological examination of the surgical specimen in all patients (gold standard), and we compared the results of CT, MRI/MRCP, EUS, and the McH with the gold standard. Results Fifty-four patients were included in the study, of which 49 (90.7%) were women with an average age of 33.4 (range 11-78) years. The most common symptom presented was abdominal pain, present in 35.2% patients. SPN was detected incidentally in 32 (59%) patients. The average size of the tumors was 3.8 cm (SD: 2.26). The most common finding at EUS was a solid, solid/cystic, and cystic lesion in 52.9%, 41.1%, and 7.8% patients, respectively. The final diagnosis was 51 patients with SPN and 3 with nonfunctioning pancreatic neuroendocrine tumors (NF-NET). The correct diagnosis was made by CT, MRI/MRCP, EUS isolated, and EUS-FNA in 21.9%, 28.88%, 64.71%, and 88.24%, respectively. EUS-FNA associated with CT and MRI increased diagnostic performance from 22.72% to 94.11% and from 29.16% to 94.11%, respectively. Conclusions SPN are rare, incidentally identified in most cases, and affect young women. Differential diagnosis between SPN, NF-NET, and other types of tumors with imaging tests can be difficult. EUS-FNA increases preoperative diagnosis in case of diagnostic doubt and should be used whenever necessary to rule out NF-NET or other type of solid/cystic nodular lesion of the pancreas.
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Affiliation(s)
| | - Giulia Marchetti
- Santa Casa de São Paulo Medical School (FCMSCSP), São Paulo, Brazil
| | | | - César Vivian Lopes
- Endoscopy Service of Santa Casa do Rio Grande do Sul, Rio Grande, Brazil
| | - Jerusa dos Santos Reis
- Endoscopy Section of the Presidente Dutra Hospital, Federal University of Maranhão, São Luís, Brazil
| | | | | | | | | | - José Celso Ardengh
- Endoscopy Department of Hospital Moriah, São Paulo, Brazil
- Digestive Endoscopy Section of Hospital das Clínicas de Ribeirão Preto Medical School, University of São Paulo (HCFMRP-USP), São Paulo, Brazil
- Department of Diagnostic Imaging of the Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
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Revoredo F, Kometter F, Núñez J, León J, Luna J, Valdes J. Spontaneous rupture and upper gastrointestinal bleeding of solid pseudopapillary neoplasm of the pancreas. J Surg Case Rep 2022; 2022:rjac462. [PMID: 36226134 PMCID: PMC9550352 DOI: 10.1093/jscr/rjac462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 09/14/2022] [Indexed: 11/12/2022] Open
Abstract
The solid pseudopapillary neoplasm (SPN) of the pancreas is an uncommon, low-grade malignant tumour, mostly seen in young women. We report a rare case of a 44-year-old female who presented with spontaneous rupture and upper gastrointestinal bleeding. The emergency endoscopy revealed a 2 cm bleeding ulcer on the duodenal bulb. A computer tomography scan (CT scan) showed a 6.7 cm mass, with solid and cystic components arising in the head of the pancreas. After achieving haemostasis, she was discharged. Two months later, a new CT scan showed a persistent 6 cm mass in the head of the pancreas, now containing air and communicating with the duodenal lumen. The patient was successfully treated by pancreatoduodenectomy. Histopathological examination showed a T3N0M0 SPN with immunohistochemical expression of β-catenin, synaptophysin, vimentin and progesterone receptor, and negativity for chromogranin. The labelling index of Ki 67 was 2%. No recurrence was present after 2 years of follow-up.
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Affiliation(s)
- Fernando Revoredo
- Correspondence address. Department of General Surgery, Clínica Internacional, Avenida Guardia Civil 385, San Borja, Lima 15036, Perú. Tel: 051 (1) 6196161; E-mail:
| | - Fritz Kometter
- Department of General Surgery, Clínica Internacional, Lima, Perú
| | - Juan Núñez
- Department of General Surgery, Clínica Internacional, Lima, Perú
| | - Julio León
- Department of Gastroenterology, Clínica Internacional, Lima, Perú
| | - Juan Luna
- Department of General Surgery, Clínica Internacional, Lima, Perú
| | - Jorge Valdes
- Division of Pathology, Clínica Internacional - Instituto de Patología y Biología Molecular Arias Stella, Lima, Perú
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El Abbassi T, Elazhary A, Ouchane M, El Wassi A, Lefriyekh MR. Solid pseudopapillary tumors of the pancreas in young women: Case report. Int J Surg Case Rep 2021; 89:106592. [PMID: 34800803 PMCID: PMC8605423 DOI: 10.1016/j.ijscr.2021.106592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Solid pseudopapillary tumor of the pancreas (SPTP) is a rare tumor of the exocrine pancreas, with undetermined etiopathogeny, which most often affects young women. The clinical and physical signs are non-specific and despite the progress of complementary examinations, Confirmation is usually anatomopathological. Surgical resection is the only curative treatment. CASE PRESENTATION We report the case of a 17-year-old girl, consulted for a left hypochondrium mass which imaging concluded to be a corporal-caudal tumor mass of the pancreas for which a complete surgical excision was performed and whose anatomopathological study confirmed a pseudo-papillary and solid tumor of the pancreas. The positive diagnosis of SPTP remains difficult and is usually made on pathological analysis with immunohistochemical study. DISCUSSION Solid pseudopapillary tumor of the pancreas is a rare anatomic-clinical entity, first described by Frantz in 1959. The clinical manifestations of SPTP are not specific. Biologically, no signs are predictive of SPTP and imaging usually shows a well encapsulated mass with both solid and cystic components. The curative treatment of SPTP is exclusively surgical and consists of a complete removal of the tumor with its capsule because of its degenerative potential SPTP has a good prognosis with a recurrence rate of 10-15% and 95% survival at 5 years. CONCLUSION Solid pseudopapillary tumor of the pancreas is a rare tumor of the exocrine pancreas. Its evolution is slow. Preoperative diagnosis remains difficult despite the progress of complementary examinations. Surgical resection is the only curative treatment. Its prognosis remains excellent.
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Affiliation(s)
- Taoufik El Abbassi
- Department of General Surgery I, CHU Ibn Rochd, Casablanca, Morocco; Faculty of Medicine and Pharmacy of Casablanca, Hassan II University, Morocco
| | - Abdessamad Elazhary
- Department of General Surgery I, CHU Ibn Rochd, Casablanca, Morocco; Faculty of Medicine and Pharmacy of Casablanca, Hassan II University, Morocco.
| | - Mohamed Ouchane
- Department of General Surgery I, CHU Ibn Rochd, Casablanca, Morocco; Faculty of Medicine and Pharmacy of Casablanca, Hassan II University, Morocco
| | - Anas El Wassi
- Department of General Surgery I, CHU Ibn Rochd, Casablanca, Morocco; Faculty of Medicine and Pharmacy of Casablanca, Hassan II University, Morocco
| | - M Rachid Lefriyekh
- Department of General Surgery I, CHU Ibn Rochd, Casablanca, Morocco; Faculty of Medicine and Pharmacy of Casablanca, Hassan II University, Morocco
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AlQattan AS, Alshaqaq HM, Al Abdrabalnabi AA, Alnamlah M, Alanazi AA, Alqahtani MS. Huge solid pseudopapillary tumor of the pancreas 'Frantz tumor': a case report. J Gastrointest Oncol 2020; 11:1098-1104. [PMID: 33209501 DOI: 10.21037/jgo-20-180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Solid pseudopapillary neoplasms (SPN) of the pancreas are rare neoplasms accounting for 1-2% of all pancreatic tumors and have a general female predominance. We report a case and intraoperative videos of SPN involving the whole pancreatic tail. A 19-year-old female patient initially presented to another healthcare facility complaining of abdominal pain, which was started 6 years ago. A contrast-enhanced Computed Tomography (CT) scan of the abdomen showed a large mass measuring 15.6 cm × 11.6 cm × 11 cm, arising from the pancreas with an enhancing cystic component. The patient underwent exploratory laparotomy, which revealed a huge mass occupying most of the abdominal cavity. Thus, we proceeded with a distal pancreatectomy and splenectomy. Intraoperatively, the frozen section showed that the mass had features of a solid pseudopapillary tumor of the pancreas with negative resection margins. The SPN diagnosis was confirmed by histopathology and immunohistochemistry. The pathophysiology behind the development of SPN and its cellular origin is still a matter of debate with multiple proposed hypotheses. SPNs are asymptomatic in almost 70% of all cases and usually discovered incidentally. The pre-operative diagnosis of SPNs remains a clinical challenge despite all the current advances in the diagnostic modalities. Surgical management with negative resection margins is the mainstay of treatment, even with metastasis and vascular invasion, surgical excision should be performed whenever feasible. The recurrence rate after surgical resection has been reported to be 3-9%. The prognosis of SPN limited to the pancreas is generally excellent with over 95% cure rate following complete surgical resection. SPN is a rare entity of a controversial origin but is considered as a low-grade malignancy. Surgical resection to achieve complete excision constitutes the mainstay of treatment, which mostly results in an excellent prognosis.
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Affiliation(s)
- Abdullah Saleh AlQattan
- Hepatopancreaticobiliary Unit, Department of Surgery, King Fahad Specialist Hospital, Dammam, Kingdom of Saudi Arabia
| | - Hassan M Alshaqaq
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Alaa A Al Abdrabalnabi
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Muna Alnamlah
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Ahmed Abdulmajeed Alanazi
- Hepatopancreaticobiliary Unit, Department of Surgery, King Fahad Specialist Hospital, Dammam, Kingdom of Saudi Arabia
| | - Mohammed Saad Alqahtani
- Hepatopancreaticobiliary Unit, Department of Surgery, King Fahad Specialist Hospital, Dammam, Kingdom of Saudi Arabia
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Yokose T, Kitago M, Oshima G, Abe K, Masugi Y, Miura E, Shinoda M, Yagi H, Abe Y, Hori S, Matsusaka Y, Endo Y, Toyama K, Okuda S, Kitagawa Y. Urgent distal pancreatectomy for intraperitoneal hemorrhage due to the spontaneous rupture of a pancreatic metastatic tumor from synovial sarcoma: a case report. BMC Surg 2020; 20:175. [PMID: 32758199 PMCID: PMC7430812 DOI: 10.1186/s12893-020-00832-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 07/23/2020] [Indexed: 01/02/2023] Open
Abstract
Background Synovial sarcoma is a soft tissue malignancy that frequently affects the extremities, adjacent to the large joints. Synovial sarcoma has a high rate of distant metastasis; however, pancreatic metastasis is extremely rare, and to our knowledge, there has been no report of bleeding due to spontaneous tumor rupture. This study reports the case of a patient with synovial sarcoma pancreatic metastasis causing tumor rupture and bleeding, which was successfully managed with emergent distal pancreatectomy. Case presentation A 27-year-old woman underwent extensive resection of the primary tumor and partial lung resection after chemotherapy for left femoral synovial sarcoma and multiple lung metastases 4 years prior. During the follow-up, a 35-mm tumor was noted in the pancreatic tail on abdominal computed tomography (CT), and no other distant metastases were detected via positron emission tomography CT. Laparoscopic distal pancreatectomy was scheduled for pancreatic metastasis of synovial sarcoma. However, before the scheduled pancreatectomy could be conducted, the patient visited the emergency department because of abdominal pain that occurred after consuming a small amount of alcohol, and CT showed ascites with high CT values and leakage of contrast media. She was diagnosed with intra-abdominal hemorrhage due to a ruptured metastatic pancreatic tumor, and an emergency operation was performed. In total, 1500 mL of blood was evacuated from the abdomen, and the bleeding pancreatic tail tumor was resected. Histopathological findings revealed synovial sarcoma metastasis and a ruptured tumor capsule, and tumor cells were observed in the hematoma. After discharge on postoperative day 18, the patient was carefully monitored and confirmed to be in relapse-free survival, without chemotherapy, at 6 months post-surgery. Conclusions While the rate of tumor growth varies depending on the grade of the tumor, the possibility of rupture should be considered even in metastatic pancreatic tumors. In the case of pancreatic tumor rupture with stable circulation, radiological evaluation for oncology is necessary, and primary resection may be compatible with resectable cases.
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Affiliation(s)
- Takahiro Yokose
- Department of Surgery, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Minoru Kitago
- Department of Surgery, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Go Oshima
- Department of Surgery, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kodai Abe
- Department of Surgery, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Yohei Masugi
- Department of Pathology, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Eisuke Miura
- Department of Pathology, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Masahiro Shinoda
- Department of Surgery, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hiroshi Yagi
- Department of Surgery, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Yuta Abe
- Department of Surgery, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Shutaro Hori
- Department of Surgery, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Yohji Matsusaka
- Department of Radiology, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Yutaka Endo
- Department of Surgery, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kenji Toyama
- Department of Radiology, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Shigeo Okuda
- Department of Radiology, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, 160-8582, Japan
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