Surgical Case Reports最新文献

{"title":"Immune Thrombocytopenia Successfully Controlled by Dissection of an Enlarged Mediastinal Lymph Node Metastasis from Squamous Cell Carcinoma of Unknown Primary: A Case Report.","authors":"Yoshihito Iijima, Takaki Mizoguchi, Masahito Ishikawa, Shun Iwai, Nozomu Motono, Hidetaka Uramoto","doi":"10.70352/scrj.cr.25-0642","DOIUrl":"10.70352/scrj.cr.25-0642","url":null,"abstract":"<p><strong>Introduction: </strong>Immune thrombocytopenia (ITP) is an autoimmune hematologic disorder characterized by a reduced platelet count resulting from immune-mediated platelet destruction and/or impaired thrombopoiesis. This condition is often associated with malignant tumors, making perioperative management crucial to maintain hemostasis during and after surgery. Herein, we report a case of ITP successfully controlled following surgical dissection of a large mediastinal lymph node metastasis originating from squamous cell carcinoma of unknown primary.</p><p><strong>Case presentation: </strong>A 57-year-old man with poorly controlled ITP was found to have progressively enlarging mediastinal lymph nodes on chest CT over 4 months. The largest lymph node measured 72× 37× 31 mm. The patient received preoperative intravenous immunoglobulin therapy (0.4 g/kg/day) for 4 days, after which mediastinal lymph node dissection was safely performed without hemorrhagic complications. The platelet count improved transiently after surgery. Histopathology revealed metastatic poorly differentiated squamous cell carcinoma, but imaging failed to identify a primary lesion, leading to a diagnosis of squamous cell carcinoma of unknown primary.</p><p><strong>Conclusions: </strong>With appropriate preoperative management, the platelet count was effectively controlled, allowing safe removal of the large mediastinal lymph node. As the platelet level improved postoperatively, prednisolone tapering was initiated. Given that recurrent malignancy may precipitate a decline in platelet count, close follow-up is warranted.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"12 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12815691/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146019603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mesenteric Steal Syndrome Caused by Abdominal Aortic Stenosis due to Takayasu Arteritis.","authors":"Shoichiro Nagashima, Kentaro Inoue, Yusuke Fujioka, Kohei Ueno, Go Kinoshita, Shinichiro Yoshino, Koichi Morisaki, Tomoharu Yoshizumi","doi":"10.70352/scrj.cr.25-0631","DOIUrl":"10.70352/scrj.cr.25-0631","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic mesenteric ischemia (CMI) is usually caused by atherosclerotic stenosis of multiple mesenteric arteries. However, aortic stenosis secondary to Takayasu arteritis can rarely cause intestinal ischemia through hemodynamic steal from the mesenteric to lower limb circulation.</p><p><strong>Case presentation: </strong>A 67-year-old woman with a history of Takayasu arteritis presented with postprandial and exertional abdominal pain and a 3-kg weight loss over 2 weeks. CTA revealed isolated severe stenosis of the infrarenal aorta with development of the arc of Riolan, and Doppler ultrasonography demonstrated retrograde flow in the inferior mesenteric artery. Based on these findings, a diagnosis of mesenteric steal syndrome secondary to Takayasu arteritis was made. Endovascular stenting of the infrarenal aorta was performed, resulting in improved antegrade aortic flow and reduced collateral circulation. After treatment, the patient's abdominal pain resolved and her weight recovered.</p><p><strong>Conclusions: </strong>This rare case demonstrates that Takayasu arteritis can cause mesenteric steal syndrome without mesenteric arterial lesions and highlights that endovascular stenting can effectively restore physiological blood flow and relieve ischemic symptoms.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"12 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12883276/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146150764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Solid Pseudopapillary Neoplasm of the Pancreas Showing Spontaneous Regression Followed by Regrowth: A Case Report.","authors":"Yuji Ikeda, Daisuke Hashimoto, So Yamaki, Kazuki Matsumura, Hiroyuki Ishida, Satoshi Mii, Hidetaka Miyazaki, Yuki Matsui, Sang Thanh Nguyen, Sohei Satoi","doi":"10.70352/scrj.cr.26-0188","DOIUrl":"10.70352/scrj.cr.26-0188","url":null,"abstract":"<p><strong>Introduction: </strong>Solid pseudopapillary neoplasm (SPN) of the pancreas is a rare, low-grade malignant tumor. Although SPNs generally exhibit indolent behavior, spontaneous regression detected on CT imaging is exceedingly rare, and to the best of our knowledge, regrowth following regression has not been previously reported.</p><p><strong>Case presentation: </strong>A 33-year-old woman was referred to Kansai Medical University following the detection of liver dysfunction during a routine medical checkup. Imaging revealed a well-demarcated 20-mm mass in the pancreatic body, and an endoscopic US-guided biopsy confirmed SPN. Surgical resection was initially planned but postponed because of a COVID-19 infection in a fellow inpatient. During follow-up, the tumor showed spontaneous regression and became undetectable on imaging at 4 months. However, MRI at 16 months revealed tumor regrowth, which became clearly visible on T2-weighted imaging by 23 months, measuring 15 mm. At 24 months, a laparoscopic spleen-preserving distal pancreatectomy was performed. Histopathology confirmed SPN with intratumoral hemorrhage and characteristic pseudopapillary architecture. Complete resection was achieved, and the patient's postoperative course was uneventful.</p><p><strong>Conclusions: </strong>This case illustrates that SPN can regress spontaneously, yet subsequently regrow, underscoring the need for careful long-term imaging surveillance even after apparent tumor shrinkage.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"12 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13254556/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148253242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single-Incision Laparoscopic Cholecystectomy in a Patient with a Left Ventricular Assist Device.","authors":"Ayako Ishii, Shohei Takaichi, Kei Fukumori, Watsapol Juavi Jitjan, Yuka Iwami, Kyoko Kobayashi, Satoshi Ishikawa, Masakatsu Paku, Kazuya Iwamoto, Tomofumi Ohashi, Yujiro Nakahara, Kohei Murakami, Hidekazu Takahashi, Tadafumi Asaoka, Ichiro Takemasa, Takeshi Omori","doi":"10.70352/scrj.cr.25-0756","DOIUrl":"10.70352/scrj.cr.25-0756","url":null,"abstract":"<p><strong>Introduction: </strong>Laparoscopic cholecystectomy (LC) is the standard treatment for benign gallbladder diseases, including acute cholecystitis (AC). However, performing LC in patients with a left ventricular assist device (LVAD) presents specific technical and physiological challenges related to driveline preservation and hemodynamic stability. We report the first case of single-incision laparoscopic cholecystectomy (SILC) via the right lower abdomen in a patient with an LVAD after treatment for biliary tract infection, following prior surgery for strangulated ileus and umbilical wound infection.</p><p><strong>Case presentation: </strong>A 57-year-old male with dilated cardiomyopathy underwent LVAD implantation and later developed AC and cholangitis, managed with endoscopic retrograde biliary drainage. Three months later, he underwent laparoscopic adhesiolysis for a strangulated ileus via a midline incision, complicated by umbilical wound infection. After recovery, elective LC was planned. Preoperative fluoroscopy identified the driveline's subcutaneous course through the upper midline and right upper abdomen. To avoid the infected area and driveline injury, SILC was performed via the right lower abdomen. Dense midline adhesions were manageable on the right side, and the driveline was clearly preserved. Pneumoperitoneum was maintained at 8 mmHg to minimize hemodynamic disturbance. Heparin was resumed 3 hours postoperatively and warfarin on POD 1. The patient was discharged on POD 7 without complications.</p><p><strong>Conclusions: </strong>This case demonstrates the feasibility of SILC via the right lower abdomen in an LVAD patient with a complex surgical history. A tailored surgical approach and multidisciplinary perioperative planning were essential for achieving a safe and effective surgery.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"12 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12989747/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147475162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adult Primary Hepatic Sarcoma Presenting as a Chronic Expanding Hematoma.","authors":"Takako Yamada Fujii, Takuya Kimura, Shinichi Nakatsuka","doi":"10.70352/scrj.cr.25-0811","DOIUrl":"10.70352/scrj.cr.25-0811","url":null,"abstract":"<p><strong>Introduction: </strong>Primary hepatic sarcoma is extremely rare in adults and can be difficult to distinguish from benign hemorrhagic lesions on imaging. We report a rare case of undifferentiated sarcoma (US) that initially mimicked chronic expanding hematoma (CEH) and ruptured.</p><p><strong>Case presentation: </strong>A woman in her 50s presented with sudden-onset abdominal pain caused by rupture of a hepatic lesion diagnosed radiologically as CEH and underwent right hepatectomy. Preoperative imaging demonstrated a well-circumscribed hypodense mass with rich arterial vascularity and MRI findings suggestive of mixed old and recent hematoma. Nine months later, rapidly progressive peritoneal dissemination developed and was surgically evacuated. Histopathological examination of the disseminated lesions revealed US, and retrospective review of the initial specimen identified similar spindle-shaped tumor cells beneath the fibrous capsule.</p><p><strong>Conclusions: </strong>This case illustrates that hepatic lesions resembling CEH may represent or develop into US. Rupture and atypical clinical progression should raise suspicion for malignancy, and careful histopathological assessment of subcapsular tissue is essential.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"12 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12997172/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147487424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reversal of Obesity-Related Spinal Epidural Lipomatosis after Metabolic and Bariatric Surgery: A Case Suggesting the Role of Ectopic Fat Reduction.","authors":"Yota Tanahashi, Akira Sasaki, Akira Umemura, Yusuke Suto, Takafumi Iwasaki, Akiko Kawakami, Toma Kawashima, Hiroyuki Nitta","doi":"10.70352/scrj.cr.26-0178","DOIUrl":"10.70352/scrj.cr.26-0178","url":null,"abstract":"<p><strong>Introduction: </strong>Spinal epidural lipomatosis (SEL) is a disorder characterized by excessive accumulation of epidural adipose tissue, resulting in spinal canal stenosis and neurological symptoms. In recent years, obesity-related SEL has been increasingly recognized as a manifestation of ectopic fat deposition associated with metabolic dysfunction and has been re-evaluated as a potentially reversible condition following weight reduction. However, reports describing radiological and clinical improvement of SEL after metabolic and bariatric surgery (MBS) remain limited, and this disease concept and therapeutic strategy have not yet gained sufficient attention in Japan. Herein, we report a case of SEL that improved following MBS.</p><p><strong>Case presentation: </strong>A 49-year-old man with severe obesity (body weight 160 kg; BMI 48.3 kg/m²) presented with several obesity-related diseases. MRI revealed spinal canal stenosis due to SEL with accompanying neurological symptoms, which did not improve despite medical weight-loss therapy. Laparoscopic sleeve gastrectomy was performed as MBS. At 1 year postoperatively, body weight had decreased to 122.4 kg (BMI 36.9 kg/m²), corresponding to 23.5% total weight loss and 43.2% excess weight loss. The cross-sectional area of epidural fat (EF) decreased from 4.22 cm² preoperatively to 2.25 cm² postoperatively, while the dural sac (DS) area increased from 0.61 to 2.32 cm². Accordingly, the EF-to-DS (EF/DS) ratio decreased from 6.92 to 0.97, and the Borré classification improved from Grade III to Grade I. Neurological symptoms were alleviated, and no spinal decompression surgery was required.</p><p><strong>Conclusions: </strong>MBS led to meaningful improvement in patient-oriented outcomes accompanied by radiological resolution of SEL. Obesity-related SEL may represent a reversible condition driven by ectopic fat accumulation, and MBS may serve as a therapeutic option in carefully selected patients.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"12 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13271837/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148272987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiofrequency Identification Marker-Guided Right S7 Segmentectomy for a Deeply Located Pulmonary Nodule: A Case Report.","authors":"Taichi Matsubara, Fumihiko Kinoshita, Naoya Iwamoto, Kazuki Takada, Tomoyoshi Takenaka, Tomoharu Yoshizumi","doi":"10.70352/scrj.cr.26-0320","DOIUrl":"10.70352/scrj.cr.26-0320","url":null,"abstract":"<p><strong>Introduction: </strong>The right S7 segment is the smallest pulmonary segment. Securing an adequate surgical margin during S7 segmentectomy can be challenging, particularly when the tumor is located more centrally. Radiofrequency identification (RFID) marking systems provide substantial benefits in detecting small nodules as well as ensuring an adequate resection margin from the marking site.</p><p><strong>Case presentation: </strong>A 67-year-old man with a history of renal cell carcinoma was referred to Kyushu University Hospital with a 9-mm solid nodule located deep within the right S7 segment. Given its central and deep location, preoperative RFID marker placement was performed in a hybrid operating room under cone-beam CT guidance. Subsequently, thoracoscopic S7 segmentectomy was performed using a confronting upside-down video-assisted thoracoscopic surgery approach. The RFID probe enabled precise intraoperative localization of the tumor and continuous confirmation of its surgical margin from the intersegmental plane. Pathological examination revealed papillary adenocarcinoma and confirmed complete resection. The patient's postoperative course was uneventful.</p><p><strong>Conclusions: </strong>RFID represents a valuable adjunct for segmentectomy of deeply or centrally located pulmonary nodules.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"12 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13357009/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148430813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Apocrine Ductal Carcinoma <i>in situ</i> Ex Pleomorphic Adenoma of the Breast: A Rare Case Report.","authors":"Tadahiro Isono, Ryohei Koreyasu, Konomi Sakyo, Ryosuke Kishi, Takahiro Watanabe, Takeshi Ueda, Masashi Nozawa, Kazuyasu Kamimura, Mitsuhiro Tachibana, Hidetoshi Wada","doi":"10.70352/scrj.cr.25-0771","DOIUrl":"10.70352/scrj.cr.25-0771","url":null,"abstract":"<p><strong>Introduction: </strong>Pleomorphic adenoma (PA) of the breast is an extremely rare benign tumor, and malignant transformation within PA is exceptional. Only a few cases have been reported, and none have described apocrine ductal carcinoma <i>in situ</i> (DCIS) arising in PA. We report a case of apocrine-type DCIS considered to have developed from mammary PA.</p><p><strong>Case presentation: </strong>A 75-year-old woman presented with a 2.0-cm palpable mass in the left breast with nipple inversion. Mammography showed a well-circumscribed 24-mm mass and an adjacent 11-mm lesion with irregular margins near the nipple. MRI demonstrated a cystic lesion with an enhancing mass on the nipple side and nipple retraction toward the lesion. Cytology of cyst fluid revealed no malignant cells and was consistent with a benign hemorrhagic cyst. However, core needle biopsy of the adjacent lesion identified apocrine-type DCIS. Systemic evaluation showed no metastases, and the clinical diagnosis was cTisN0M0, cStage 0 breast cancer. Because nipple involvement could not be excluded, nipple-sparing surgery was not recommended, and the patient underwent mastectomy. Histopathology revealed a well-defined, encapsulated PA containing an intraductal apocrine carcinoma component. The carcinoma cells showed abundant eosinophilic cytoplasm, high nuclear grade, and occasional mitoses without stromal invasion. Immunohistochemically, tumor cells were androgen receptor and Forkhead box protein A1-positive and estrogen- and progesterone receptor-negative, with a Ki-67 index of approximately 30%. The lesion was diagnosed as apocrine-type DCIS ex PA, with ductal extension toward the nipple corresponding to the clinical nipple retraction.</p><p><strong>Conclusions: </strong>We describe the first reported case of apocrine-type DCIS arising in breast PA. Awareness of this rare entity is essential to avoid misdiagnosis and to clarify its clinicopathological characteristics.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"12 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13033405/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147582468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Intra-Abdominal Desmoid Tumor Mimicking Malignant Recurrence after Distal Pancreatectomy for Pancreatic Neuroendocrine Tumor: A Case Report.","authors":"Osamu Inamoto, Shuhei Sakamoto, Takashi Fujimoto, Kazuhiro Nishiyama, Ryotaro Ogawa, Atsushi Yoshizawa, Yoshiro Taki, Izumi Komoto, Ryuta Iwamoto","doi":"10.70352/scrj.cr.26-0162","DOIUrl":"10.70352/scrj.cr.26-0162","url":null,"abstract":"<p><strong>Introduction: </strong>Intra-abdominal desmoid tumors (DTs) are rare non-metastatic fibroblastic neoplasms that commonly develop at sites of prior surgical trauma or inflammation. Here, we report a diagnostically challenging case of a DT mimicking tumor recurrence or primary malignancy following laparoscopic distal pancreatectomy.</p><p><strong>Case presentation: </strong>A 69-year-old woman with a history of laparoscopic ileocecal resection for Stage I cecal cancer underwent laparoscopic distal pancreatectomy with splenectomy for suspected pancreatic cancer. Histopathology of the resected pancreas revealed low-grade pancreatic intraepithelial neoplasia (PanIN-1/2), which was considered responsible for the main pancreatic duct obstruction, with a minute neuroendocrine tumor (NET) (Grade 1, 1.9 mm) identified in the vicinity. The patient developed a Grade B postoperative pancreatic fistula (POPF) requiring prolonged drainage. Ten months later, follow-up CT revealed an 18-mm nodule in the transverse mesocolon. ¹⁸F-fluorodeoxyglucose PET/CT (FDG-PET/CT) demonstrated intense focal FDG accumulation (maximum standardized uptake value = 4.6), whereas somatostatin receptor scintigraphy was negative. The tumor grew rapidly to 31 mm over 4 months. Differential diagnoses included recurrence of the primary NET, peritoneal dissemination from occult pancreatic adenocarcinoma (given the PanIN background), or a primary mesenteric gastrointestinal stromal tumor. Due to a high suspicion of malignancy, laparoscopic diagnostic resection was performed. Intraoperatively, the tumor was found to have infiltrated the mesentery of the transverse colon and jejunum, requiring delicate dissection to preserve the middle colic artery and first jejunal vessels. Histopathological examination revealed a spindle cell neoplasm with nuclear accumulation of β-catenin, ruling out malignant recurrence and confirming a DT. Chronic chemical irritation resulting from the preceding POPF is considered a likely trigger.</p><p><strong>Conclusions: </strong>Intra-abdominal DTs can mimic malignant recurrence on FDG-PET/CT after pancreatic surgery. This case highlights that clinicians should include DTs in the differential diagnosis of mesenteric masses arising at the site of prior postoperative complications, such as a pancreatic fistula.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"12 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13384763/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148607128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Transient Spontaneous Regression of Intrahepatic Cholangiocarcinoma Clinically Mimicking Inflammatory Pseudotumor: A Diagnostic Dilemma.","authors":"Shoya Yamaguchi, Tatsunori Miyata, Yoshiyuki Tagayasu, Shota Uemura, Yuta Shiraishi, Daisuke Ogawa, Shotaro Kinoshita, Takanobu Yamao, Yuki Kitano, Hirohisa Okabe, Keita Kai, Hiromitsu Hayashi, Masaaki Iwatsuki","doi":"10.70352/scrj.cr.26-0248","DOIUrl":"10.70352/scrj.cr.26-0248","url":null,"abstract":"<p><strong>Introduction: </strong>Spontaneous regression of intrahepatic cholangiocarcinoma (iCCA) is extremely rare and may create diagnostic confusion when mimicking benign inflammatory lesions. We herein report a case of iCCA that demonstrated transient spontaneous regression, which led to difficulty in differentiating it from hepatic inflammatory pseudotumor (HIPT).</p><p><strong>Case presentation: </strong>A 70-year-old woman with alcoholic liver cirrhosis was found to have a 14-mm hepatic mass in segment 6 with peripheral ring-like enhancement on contrast-enhanced CT and high fluorodeoxyglucose (FDG) uptake (maximum standardized uptake value [SUVmax] 11.2). Carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) were mildly elevated. iCCA, hepatocellular carcinoma, and combined hepatocellular-cholangiocarcinoma were considered. Two months later, the lesion regressed spontaneously to 5 mm without treatment, and CEA and CA19-9 decreased, suggesting a diagnosis of HIPT. However, the lesion gradually increased in size over the following year. CEA and CA19-9 subsequently increased markedly, and FDG uptake intensified (SUVmax 14.3). Given the strong suspicion of malignancy, laparoscopic partial hepatectomy was performed. Histopathological examination revealed an invasive iCCA with glandular formation, mucin production, necrosis with neutrophilic infiltration, and portal vein invasion.</p><p><strong>Conclusions: </strong>This case highlights that spontaneous tumor regression does not exclude malignancy. Careful long-term surveillance and timely surgical intervention are crucial when imaging findings and tumor marker trends raise suspicion of malignancy despite temporary regression.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"12 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13310802/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148353594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}