Surgical Case Reports最新文献

{"title":"Sebaceous Carcinoma of the Breast in a Japanese Male with a <i>BRCA2</i> Pathogenic Variant: Report of an Exceedingly Rare Case and Review of the Literature.","authors":"Mamika Kuribayashi, Tadahiro Isono, Yuichi Satake, Yuta Yokochi, Tomoki Kawamura, Ryosuke Kishi, Ryohei Koreyasu, Konomi Sakyo, Takahiro Watanabe, Takeshi Ueda, Masashi Nozawa, Mitsuhiro Tachibana, Kei Tsukamoto, Kazuyasu Kamimura, Hidetoshi Wada","doi":"10.70352/scrj.cr.24-00543","DOIUrl":"10.70352/scrj.cr.24-00543","url":null,"abstract":"<p><strong>Introduction: </strong>Sebaceous carcinoma (SC) is a malignant neoplasm differentiated from the mature sebocyte and occurs mainly in the periorbital area. However, SC of the breast is extremely rare. We report a case of sebaceous breast carcinoma in a Japanese man with a <i>BRCA2</i> pathogenic variant.</p><p><strong>Case presentation: </strong>A 77-year-old Japanese man had been aware of a mass in his right breast for about a year and had visited his previous physician for a follow-up. Over the next year, the mass grew, and the last doctor he visited referred him to our hospital for further examination and treatment. Physical examination revealed a palpable 3-cm-large mass of the right breast. There was no skin invasion, and core needle biopsy revealed invasive ductal carcinoma cT2N1M0 cStage IIB, estrogen receptor (+)/progesterone receptor (+)/HER2/<i>neu</i> (-)/Ki-67 labeling index: 27.8%. His daughter had a history of breast cancer, and he had a <i>BRCA2</i> pathogenic variant. The patient underwent a total right mastectomy and axillary lymph node dissection. Pathological diagnosis was primary SC of the breast, pT2N0M0, pStage IIA. His postoperative clinical course was good. Postoperatively, the patient received endocrine therapy and S-1 for 1 year and is currently receiving endocrine therapy alone. One year and 5 months have passed since the operation, with no recurrence or metastasis noted.</p><p><strong>Conclusions: </strong>The prognosis of SC of the breast has not been elucidated. As cases of SC with a <i>BRCA2</i> pathogenic variant are exceedingly rare, it will be necessary to continue accumulating cases in the future to understand this disease further. This research is essential to elucidating SC.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"11 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11842163/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468928","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":"Improvement of Oral Intake after Treatment Using Enteral Feeding Tube for Large Advanced Gastric Cancer Invading Proximal Stomach: A Case Series of 20 Patients.","authors":"Koichi Hayano, Yoshihiro Kurata, Yasunori Matsumoto, Ryota Otsuka, Nobufumi Sekino, Takeshi Toyozumi, Akira Nakano, Tadashi Shiraishi, Masaya Uesato, Gaku Ohira, Hisahiro Matsubara","doi":"10.70352/scrj.cr.24-0143","DOIUrl":"10.70352/scrj.cr.24-0143","url":null,"abstract":"<p><strong>Introduction: </strong>Patients with large Stage IV gastric cancer (GC) invading the proximal stomach find it difficult to receive not only bypass surgery but also S-1-based chemotherapy. This study aimed to show our treatment results for those GC patients using elementary diet (ED) tubes, which enabled S-1-based chemotherapy and nutrition support.</p><p><strong>Case presentation: </strong>We evaluated 20 patients (13 men and 7 women; median age 70 years) with large Stage IV GCs (8.7-21.9 cm) invading the proximal stomach, who were admitted due to inability to eat, treated with S-1-based chemotherapy using an ED tube. The duration from the initiation of the chemotherapy to the improvement of oral intake, changes in nutritional status, and disease-specific survival (DSS) were retrospectively investigated. Two of the 20 patients failed to complete even one cycle of chemotherapy due to severe nausea or diarrhea. The other 18 patients improved oral liquid intake after 47.5 ± 18.8 days, and 17 patients improved oral solid food intake after 54.5 ± 19.6 days from the start of chemotherapy. In addition, three patients (16.7%) could receive conversion surgery after improvement of oral intake. The median DSS of those 18 patients was 13.1 months. Serum albumin level and prognostic nutritional index (PNI) were significantly improved after about 1 month of the treatment (both <i>P</i> <0.0001). Improvement of serum albumin level and PNI during the first 1 month of the treatment significantly correlated with better DSS (<i>P</i> = 0.006, 0.01, respectively).</p><p><strong>Conclusions: </strong>Given a high oral intake success rate, S-1-based chemotherapy using an ED tube can be a promising treatment option for large Stage IV GC with poor oral intake.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"11 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11842876/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484034","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 Pleomorphic Adenoma and Ductal Carcinoma In Situ in the Same Mammary Gland.","authors":"Shiho Nagasawa, Koshi Matsui, Misato Araki, Emi Kanaya, Kohji Takagi, Ryo Muranushi, Yoshihiro Shirai, Toru Watanabe, Takeshi Miwa, Katsuhisa Hirano, Shinichi Sekine, Kazuto Shibuya, Isaya Hashimoto, Isaku Yoshioka, Kenichi Hirabayashi, Tsutomu Fujii","doi":"10.70352/scrj.cr.24-0100","DOIUrl":"10.70352/scrj.cr.24-0100","url":null,"abstract":"<p><strong>Introduction: </strong>Pleomorphic adenoma is a benign tumor that frequently occurs in the salivary glands; however, it occurs in the breast rarely. There have been few reports of breast cancer complicated by pleomorphic adenoma of the mammary gland.</p><p><strong>Case presentation: </strong>A 70-year-old woman was found to have a mass lesion in her left breast during a medical examination. A needle biopsy was performed, and a diagnosis of pleomorphic adenoma was made. We performed a partial mastectomy with a margin of several millimeters from the tumor. Pathological examination revealed a diagnosis of pleomorphic adenoma with ductal carcinoma in situ. The resection margin was sufficient, and the patient was followed up.</p><p><strong>Conclusions: </strong>Pleomorphic adenoma arising in the mammary gland is difficult to differentiate from adenomyoepithelioma, mucocele-like tumor, and metaplastic carcinoma. Since the tumor can become malignant, resection with a narrow margin is recommended, along with special efforts not to damage the capsule at diagnosis.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"11 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11851019/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143504256","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":"Successful Conversion Surgery Following S-1 Plus Oxaliplatin Combined with Nivolumab Therapy for a Preoperatively Diagnosed Gastric Adenocarcinoma with Enteroblastic Differentiation: A Case Report.","authors":"Mizuki Fukuda, Naoto Takahashi, Yoshitaka Ishikawa, Naoki Toya, Kosuke Sasuga, Shoko Handa, Syun Sato, Fumiaki Yano, Ken Eto","doi":"10.70352/scrj.cr.24-0134","DOIUrl":"https://doi.org/10.70352/scrj.cr.24-0134","url":null,"abstract":"<p><strong>Introduction: </strong>Gastric adenocarcinoma with enteroblastic differentiation (GAED) is a rare subtype of gastric cancer known for its aggressive nature compared to conventional gastric adenocarcinoma. Due to its rarity and high malignancy, reports of successful medication therapy for Stage IV GAED are scarce. In this case, we report a GAED patient with peritoneal dissemination who responded well to combination chemotherapy with nivolumab, leading to the possibility of conversion surgery.</p><p><strong>Case presentation: </strong>A 74-year-old man presented with anemia and was diagnosed with GAED involving pancreatic infiltration and peritoneal dissemination. As first-line treatment, he underwent 9 cycles of S-1 and oxaliplatin chemotherapy combined with nivolumab. The tumor showed remarkable shrinkage. Staging laparoscopy revealed the disappearance of peritoneal nodules, and negative peritoneal cytology was confirmed intraoperatively. Consequently, conversion surgery was performed, involving laparoscopic distal gastrectomy with D2 lymph node dissection and Roux-en-Y reconstruction. Pathological examination showed ypT2N0M0, ypStage IB, with a chemotherapy response graded at 2a. Although peritoneal dissemination recurred 4 months after surgery, restarting nivolumab monotherapy significantly reduced ascites, and the patient maintained a partial response.</p><p><strong>Conclusions: </strong>Stage IV GAED is associated with a poor prognosis; however, the advent of immune checkpoint inhibitors has expanded treatment options for these patients. In this case, we propose a personalized treatment strategy for GAED with peritoneal metastases that may improve clinical outcomes.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"11 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11994458/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144018526","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":"Post-Esophagectomy Chylothorax with Thoracic Duct Anomaly Successfully Treated with Lymphangiography: A Case Report.","authors":"Akihiro Kuroda, Sho Yajima, Masayuki Urabe, Shuntaro Yoshimura, Motonari Ri, Koichi Yagi, Yasuyuki Seto","doi":"10.70352/scrj.cr.24-0129","DOIUrl":"https://doi.org/10.70352/scrj.cr.24-0129","url":null,"abstract":"<p><strong>Introduction: </strong>Chylothorax following esophagectomy is a relatively rare but significant complication, with incidences ranging from 1.1% to 3.8%. It typically arises from damage to the thoracic duct or associated lymphatic vessels during extensive lymph node dissection and thoracic surgery. Initial management usually relies on conservative approaches such as dietary modifications, drainage, and pharmacotherapy. If these methods are ineffective, surgical intervention becomes necessary. However, standardized guidelines for the optimal management of thoracic duct injuries are as yet lacking, with decisions made on a case-by-case basis. We describe a case of chylothorax following esophagectomy where lymphangiography played a crucial role in guiding the surgical approach.</p><p><strong>Case presentation: </strong>We report the clinical course of a 72-year-old male who developed chylothorax following esophagectomy for recurrent esophageal cancer. Despite initial conservative management, including octreotide and total parenteral nutrition, the patient's condition required further intervention. Lymphangiography performed on postoperative day (POD)14 revealed a rare anatomical variation of the thoracic duct, leading to successful surgical ligation through a right cervical approach. The patient's postoperative course was complicated by mediastinal fluid accumulation and resultant cardiac tamponade, necessitating emergency mediastinal drainage. Following the targeted surgical intervention, the drainage volume decreased, and the patient gradually resumed oral intake after swallowing function training. He was discharged on POD118.</p><p><strong>Conclusions: </strong>Thoracic duct injury after esophagectomy is challenging, especially with anatomical variations. Lymphangiography enables precise localization, guides surgery, and improves outcomes in chylothorax patients. The literature confirms that its early use reduces hospital stays and complications. Tumor invasion or inflammation at or beyond T3 may increase surgical complexity and injury risk. Given its diagnostic and therapeutic benefits, lymphangiography should be integrated into the standard protocols for chylothorax, especially in cases in where conservative treatment fails or anatomical variations are suspected.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"11 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12041436/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144047252","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":"Collision Tumor of Gallbladder Carcinosarcoma and Intrahepatic Cholangiocarcinoma: A Rare Case Report.","authors":"Zen Naito, Takehiro Noji, Kimitaka Tanaka, Yoshitsugu Nakanishi, Masahito Nakajima, Tomoko Mitsuhashi, Satoshi Hirano","doi":"10.70352/scrj.cr.24-0160","DOIUrl":"https://doi.org/10.70352/scrj.cr.24-0160","url":null,"abstract":"<p><strong>Introduction: </strong>Gallbladder carcinosarcoma is extremely rare, with fewer than 100 cases reported from its first description in 1907 until 2022. Collision carcinoma is a type of synchronous carcinoma in which 2 independently arising tumors come into contact or partially invade each other.</p><p><strong>Case presentation: </strong>A man in his 80s was referred to our hospital with the primary complaints of weight loss and decreased appetite. Contrast-enhanced computed tomography revealed a large lobular tumor with heterogeneous enhancement, measuring 66 mm in maximum diameter, located in the fundus of the gallbladder. The mass showed clear signs of liver invasion, raising immediate concerns of malignancy. Magnetic resonance imaging provided additional crucial details. The lesion exhibited low signal intensity on T1-weighted images and high signal intensity on T2-weighted images. Notably, diffusion-weighted imaging demonstrated restricted diffusion, a characteristic often associated with malignant processes. These findings strongly suggested gallbladder cancer with liver invasion. The patient underwent cholecystectomy and hepatectomy involving segments 4, 5, and 8 of the liver. A subsequent pathological examination revealed a complex and unusual tumor composition. The hepatic lesion showed nests of varying sizes with a medullary growth pattern, which is characteristic of intrahepatic cholangiocarcinoma. In contrast, the gallbladder lesion displayed features of adenosquamous carcinoma with a partial sarcomatoid morphology, indicative of gallbladder carcinosarcoma. Intriguingly, the interface between these 2 distinct tumor types exhibited unique characteristics. In some areas, normal hepatocytes were interspersed between the 2 types of tumor cells. Other regions demonstrated an invasive tendency of tumor cells towards each other. This unusual pattern led to the diagnosis of a collision tumor, a rare occurrence in which 2 independent primary malignancies coexist in the same organ or site.</p><p><strong>Conclusions: </strong>This was an extremely rare case of collision carcinoma involving both intrahepatic cholangiocarcinoma and gallbladder carcinosarcoma. The unique pathological findings and rarity of this tumor combination make this case particularly noteworthy. We present this case to contribute to the limited literature on such rare tumors, aiming to facilitate a better understanding and management of similar cases in the future.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"11 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12066210/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144038447","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":"Laparoscopic Distal Pancreatectomy for Lymph Node Metastasis around Splenic Artery from Hepatocellular Carcinoma in a Patient with Portal Annular Pancreas.","authors":"Kyosuke Habu, Shintaro Akamoto, Shin Imura, Yuta Fujiwara, Yusuke Konishi, Tetsuji Fukuhara, Kazuhiko Nakagawa, Keiichi Okano","doi":"10.70352/scrj.cr.24-0130","DOIUrl":"https://doi.org/10.70352/scrj.cr.24-0130","url":null,"abstract":"<p><strong>Introduction: </strong>Lymph node metastases after hepatocellular carcinoma (HCC) resection exist, although they are not common. However, solitary metastasis to the splenic artery lymph node with suspected pancreatic invasion after HCC resection is rare. In certain cases, surgical resection is performed to improve patient outcomes. We report a case of lymph node metastasis resected by laparoscopic distal pancreatectomy (LDP) in a patient with a unique anatomical anomaly known as portal annular pancreas (PAP).</p><p><strong>Case presentation: </strong>A 79-year-old Japanese man underwent laparoscopic left lateral segmentectomy for HCC. Two months after the surgery, alpha-fetoprotein levels remained elevated. Plain computed tomography revealed a swollen lymph node along the splenic artery involving the pancreas and the PAP. We suspected a solitary metastasis to the lymph node around splenic artery with pancreatic invasion. LDP was performed for complete resection of lymph node metastasis. Although the patient developed a grade B postoperative pancreatic fistula, he was discharged on postoperative day 33 under conservative treatment of antibiotics. He has remained recurrence-free for 4 years and 3 months after surgery.</p><p><strong>Conclusions: </strong>LDP was successfully performed for lymph node metastasis around the splenic artery in an HCC patient and resulted in long-term survival. Surgeons should be aware of the unique anatomical characteristics of PAP during LDP.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"11 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12012305/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144038451","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":"Partial Thymectomy during Tracheostomy for Superior Herniation of Normal Mediastinal Thymus in a Patient with Larsen Syndrome: A Case Report.","authors":"Atsushi Yoshiyama, Kaori Morita, Shinya Takazawa, Motoki Ebihara, Mitsuharu Yahiro, Tomo Kakihara, Mariko Yoshida, Jun Fujishiro","doi":"10.70352/scrj.cr.24-0158","DOIUrl":"https://doi.org/10.70352/scrj.cr.24-0158","url":null,"abstract":"<p><strong>Introduction: </strong>Superior herniation of the mediastinal thymus is a rare cause of neck mass, characterized by intermittent migration of normal thymic tissue into the suprasternal region due to increased intrathoracic pressure. Generally, thymus resection is discouraged to avoid inducing athymia and subsequent immunodeficiency in the child. To date, no prior cases of tracheostomy combined with partial thymectomy have been reported. We present a case in which partial resection of the thymus was necessary to facilitate a tracheostomy.</p><p><strong>Case presentation: </strong>A 3-month-old female infant diagnosed with Larsen syndrome, a rare congenital connective tissue disorder, presented with respiratory failure necessitating mechanical ventilation at birth. Despite successful extubation and subsequent management with noninvasive positive pressure ventilation, she experienced recurrent episodes of apnea and oxygen desaturation. Examination revealed an anterior midline neck swelling, synchronized with respiratory movements, originating from the suprasternal notch. Ultrasound, computed tomography, and magnetic resonance imaging of the neck confirmed the presence of a normal mediastinal thymus extending into the suprasternal region. Given the risk of upper airway stenosis after the otolaryngological evaluation, an early tracheostomy under general anesthesia was planned. Upon incising the thickened cervical fascia, the thymus was visualized on the anterior surface of the trachea. The thymus and its surrounding adhesions were separated, with resection of the upper pole, followed by closure of the hernia orifice. The tracheostomy was then performed as planned. The postoperative course was uneventful, marked by gradual respiratory improvement and resolution of the intermittently visible swelling during inspiration. Cannula exchanges were completed without complications, and the patient was discharged home with a heat moisture exchanger 3 months after surgery.</p><p><strong>Conclusions: </strong>We encountered a case of superior herniation of the normal mediastinal thymus in a patient with Larsen syndrome. While speculative, connective tissue abnormalities may contribute to this condition. In cases requiring tracheostomy, partial thymectomy and closure of the hernia orifice may be necessary to maintain fistula patency postoperatively.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"11 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12066831/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144039204","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":"Successful Laparoscopic-Assisted Pancreaticoduodenectomy for a Neuroendocrine Tumor of the Papilla of Vater in Type 1 Portal Annular Pancreas.","authors":"Hideki Izumi, Hisamichi Yoshii, Rika Fujino, Kou Mikkaichi, Masaya Mukai, Junichi Kaneko, Hiroyasu Makuuchi","doi":"10.70352/scrj.cr.25-0085","DOIUrl":"10.70352/scrj.cr.25-0085","url":null,"abstract":"<p><strong>Introduction: </strong>Portal annular pancreas (PAP) is a rare anomaly of pancreatic embryology that is classified into three types according to the position of the main pancreatic duct. PAP type 1, in which the main pancreatic duct runs dorsal to the pancreas, is extremely rare. Herein, we describe a case of successful laparoscopic-assisted pancreaticoduodenectomy in a patient with type 1 PAP.</p><p><strong>Case presentation: </strong>A 72-year-old Japanese woman with neck swelling was referred to our hospital. CT at admission showed dilation of the main pancreatic duct. After a thorough examination, a preoperative diagnosis of carcinoma of the papilla of Vater was made. Neck swelling was attributed to a lymphoma for which chemotherapy was administered. Upon remission, CT imaging indicated PAP type 1, and a laparoscopic-assisted pancreaticoduodenectomy was performed. The retroportal pancreas was dissected just below the portal vein, but anastomosis was difficult; therefore, the pancreas was moved to the anterior surface of the portal vein, and anastomosis was performed. Postoperative pancreatic leakage occurred but was relieved by drainage, and the patient was discharged 26 days postoperatively. The postoperative diagnosis was neuroendocrine tumor of the papilla of Vater.</p><p><strong>Conclusions: </strong>Only one case of open pancreaticoduodenectomy for PAP type 1 has been reported previously. We successfully removed a neuroendocrine tumor from the papilla of Vater in a patient with PAP type 1 through laparoscopic-assisted pancreaticoduodenectomy and detailed the operative procedures for optimal outcomes in future cases.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"11 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12142215/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144249677","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":"Male Occult Primary Breast Cancer Diagnosed with Small Bowel Metastases: A Case Report.","authors":"Suguru Ogata, Uhi Toh, Kunihiro Ozaki, Yutaro Mihara, Nanae Ogata, Yuko Takao, Shuko Saku, Rie Sugihara, Fumihiko Fujita","doi":"10.70352/scrj.cr.24-0089","DOIUrl":"10.70352/scrj.cr.24-0089","url":null,"abstract":"<p><strong>Introduction: </strong>Male occult breast cancers are extremely rare and often difficult to diagnose. With only few cases reported, no established treatment is available. And metastatic spread to the small intestine from a tumor originating outside the peritoneal cavity is rare. However, there is a higher tendency for metastasis to the peritoneal cavity, including the small bowel, in the case of lobular carcinoma of the breast.</p><p><strong>Case presentation: </strong>A 72-year-old man who initially presented with complaints of abdominal distention. Computed tomography revealed small bowel stenosis. Post-endoscopic stenosis dilatation, an emergency small bowel resection was performed for small bowel perforation. Postoperative histopathology revealed small bowel metastasis due to mammary gland lobular carcinoma with human epidermal growth factor receptor 2 (3+), estrogen receptor-negative, and progesterone receptor-negative status; the patient was then referred to our hospital. Imaging examinations revealed multiple lymph node metastases in the cervical region, right supraclavicular area, mediastinum, hilar region, and splenic portal. However, no obvious breast lesions or axillary lymph node metastases were identified, leading to a diagnosis of metastatic occult breast cancer. Complete response was achieved with trastuzumab plus pertuzumab plus docetaxel therapy; 30 months after chemotherapy initiation, multiple brain metastases were detected. Thus, 30 Gy whole-brain radiotherapy was performed followed by second-line treatment with trastuzumab emtansine. The patient died 4 years and 8 months after the disease onset, due to the progression of the disease with the new brain metastases.</p><p><strong>Conclusions: </strong>For male occult breast cancer, it is important to understand the potential metastatic patterns and genetic factors, as well as to utilize comprehensive diagnostic methods for early diagnosis and disease management.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"11 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12105989/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144162317","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}