Surgical Case Reports最新文献

{"title":"Synchronous Multifocal Intraductal Tubulopapillary Neoplasm of the Pancreas Treated with Total Pancreatectomy: A Case Report.","authors":"Kohei Suto, Mariko Tsukagoshi, Ayako Yamazaki, Emi Saito, Ryosuke Fukushima, Ryo Muranushi, Kouki Hoshino, Norihiro Ishii, Takamichi Igarashi, Norio Kubo, Kenichiro Araki, Ken Shirabe","doi":"10.70352/scrj.cr.26-0492","DOIUrl":"10.70352/scrj.cr.26-0492","url":null,"abstract":"<p><strong>Introduction: </strong>An intraductal tubulopapillary neoplasm (ITPN) is a rare pancreatic tumor characterized by scant mucin production. Even when associated with an invasive carcinoma component, its prognosis is generally considered more favorable than that of conventional pancreatic ductal adenocarcinoma. However, its pathogenesis and optimal treatment strategy remain unclear. Herein, we report a case of a synchronous multifocal ITPN treated with total pancreatectomy.</p><p><strong>Case presentation: </strong>A man in his 50s was referred to Gunma University Hospital for evaluation of pancreatic duct abnormalities after CT revealed a caliber change in the main pancreatic duct in the pancreatic body and distal pancreatic atrophy. Further evaluation demonstrated lesions associated with main pancreatic duct strictures in the pancreatic body and tail. A diagnosis of resectable pancreatic body and tail cancers was therefore established, and the patient received 2 courses of neoadjuvant chemotherapy (NAC) with gemcitabine plus S-1. Imaging after NAC revealed a new lesion in the pancreatic head. Endoscopic ultrasonography-guided fine-needle aspiration confirmed adenocarcinoma, and the patient was diagnosed with synchronous multifocal pancreatic cancers involving the pancreatic head, body, and tail. Total pancreatectomy was performed. Histopathological examination demonstrated 3 noncontiguous synchronous multifocal ITPNs, each with an independent invasive carcinoma component, in the pancreatic head, body, and tail. The postoperative course was uneventful, and the patient was discharged on POD 15. The patient required no adjuvant therapy and remained recurrence-free at 11 months postoperatively.</p><p><strong>Conclusions: </strong>We describe an extremely rare case of a synchronous multifocal ITPN. The noncontiguous distribution observed in this case raises the possibility of multicentric development, although alternative mechanisms cannot be excluded. Further case accumulations and molecular analyses are required to clarify the pathogenesis of this disease and establish optimal treatment strategies.</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/PMC13557851/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148921054","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":"Schwannoma Likely Arising from the Pancreatic Head Nerve Plexus That Mimicked a Mucinous Cystic Neoplasm and Was Treated by Pancreaticoduodenectomy: A Case Report.","authors":"Shingo Kozono, Hirokuni Hazama, Yasuna Manabe, Chiaki Nakahara, Norimasa Abe, Atsushi Fujii, Keisuke Hirahata, Yuzo Shimokawa, Masayuki Hijioka, Hirotaka Kuga, Masato Sakamoto, Sadafumi Tamiya, Toru Nakano","doi":"10.70352/scrj.cr.26-0488","DOIUrl":"10.70352/scrj.cr.26-0488","url":null,"abstract":"<p><strong>Introduction: </strong>Pancreatic and peripancreatic schwannomas are exceptionally rare benign peripheral nerve sheath tumors. Cystic and hemorrhagic degeneration may produce imaging findings resembling pancreatic cystic neoplasms, while an extrapancreatic neural origin can be difficult to recognize preoperatively. Lesions located in the pancreatic head nerve plexus region pose additional surgical challenges because of their close relationship with periarterial nerve plexuses and major vessels.</p><p><strong>Case presentation: </strong>A 48-year-old woman was referred for a 5-cm multilocular cystic lesion adjacent to the pancreatic head. CT, MRI, and endoscopic ultrasonography showed a thick-walled multilocular cystic mass with enhancing septa and solid components, hemorrhagic change, no communication with the main pancreatic duct, and marked displacement of peripancreatic vessels. An MCN-like cystic neoplasm with malignant potential was suspected. Endoscopic US-guided tissue acquisition was not performed because puncture-related dissemination was a concern. Pancreaticoduodenectomy was selected because malignancy could not be excluded and safe local excision was considered technically difficult. Intraoperatively, the tumor was well demarcated from the pancreatic parenchyma but firmly adherent to the periarterial nerve plexus around the common hepatic artery, celiac axis, splenic artery, and superior mesenteric artery. A replaced right hepatic artery was in broad contact with the tumor and was resected en bloc with the tumor and reconstructed. The tumor was removed without capsular rupture. Histopathological examination showed a spindle cell neoplasm with cystic and hemorrhagic degeneration located in the pancreatic head nerve plexus region, with the surrounding nerve plexus tissue around the tumor and no epithelial lining. Immunohistochemistry showed diffuse positivity for S-100 protein and SRY-box transcription factor 10 (SOX10) and negativity for c-kit, discovered on gastrointestinal stromal tumor 1 (DOG1) CD34, α-SMA, desmin, and pan-cytokeratin AE1/AE3 (AE1/AE3), supporting the diagnosis of schwannoma likely arising from the pancreatic head nerve plexus. The postoperative course was uneventful.</p><p><strong>Conclusions: </strong>A schwannoma located in the pancreatic head nerve plexus region may mimic an MCN-like cystic neoplasm and make periarterial dissection technically demanding. When clinically appropriate and safely feasible, EUS-guided tissue acquisition may be considered because a preoperative diagnosis may permit observation or organ-preserving surgery. Pancreaticoduodenectomy may be selected when malignancy cannot be excluded and safe local excision is not feasible because of firm periarterial adhesion.</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/PMC13554833/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148921056","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":"Spontaneous Regression of Metastatic Colorectal Cancer Following Discontinuation of an Interleukin-6 Receptor Inhibitor: A Case Report.","authors":"Eiki Miyake, Fumitaka Taniguchi, Mikoto Nosaka, Kengo Mouri, Maho Sato, Hiroki Kajioka, Toshihiro Ogawa, Megumi Watanabe, Koh Katsuda, Akiko Iseki, Yumiko Sato, Kohji Tanakaya, Hideki Aoki","doi":"10.70352/scrj.cr.25-0710","DOIUrl":"10.70352/scrj.cr.25-0710","url":null,"abstract":"<p><strong>Introduction: </strong>Spontaneous cancer regression is exceptionally rare, particularly in colorectal cancer. Tumor regression has been reported in some patients with autoimmune diseases or organ transplants, after cessation of immunosuppressive therapy; however, its underlying mechanisms remain unclear. We report a rare case of Stage IVA transverse colon cancer with synchronous liver metastasis that showed complete pathological regression in both sites after discontinuation of tocilizumab, an interleukin-6 receptor inhibitor.</p><p><strong>Case presentation: </strong>A 79-year-old woman with a history of rheumatoid arthritis and interstitial pneumonia was treated with iguratimod, methotrexate, prednisolone, and tocilizumab. PET-CT images revealed an accumulation of fluorodeoxyglucose in the transverse colon and liver. Colonoscopy and biopsy findings confirmed a poorly differentiated adenocarcinoma in the transverse colon; liver biopsy findings confirmed metastatic disease. In preparation for surgery, and because the rheumatoid arthritis activity was stable, tocilizumab was discontinued. Three months after tocilizumab discontinuation, laparoscopic partial colectomy with lymph node dissection was performed. Histopathologic examination of the resected colon showed no viable tumor cells. Subsequently, laparoscopic partial hepatectomy of segments 2 and 3 revealed no viable tumor cells as well. The patient remained recurrence-free at the 2-year follow-up.</p><p><strong>Conclusions: </strong>The findings of this case suggest that tocilizumab discontinuation may have reactivated antitumor immune responses, resulting in spontaneous regression of both the primary colorectal cancer and liver metastasis. Notably, prior to regression, both masses were histologically confirmed as malignant lesions. This observation provides valuable clinical insight into the relationship between interleukin-6 receptor blockade, immune modulation, and tumor dynamics.</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/PMC12999363/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147500039","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":"Chronic Expanding Hematoma in the Liver Presenting with Intraperitoneal Hemorrhage: A Case Report and Literature Review.","authors":"Kosuke Funaki, Renta Kawaguchi, Takao Hara, Takashi Masuda, Yu Takeuchi, Akio Morimoto, Tsutomu Daa, Masafumi Inomata","doi":"10.70352/scrj.cr.26-0261","DOIUrl":"10.70352/scrj.cr.26-0261","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic expanding hematoma (CEH) is a rare condition in which a hematoma gradually enlarges over time after trauma or surgery. Hepatic CEH is extremely rare, and its preoperative differentiation from malignant tumors is difficult. Here, we report a case of CEH complicated by intraperitoneal hemorrhage.</p><p><strong>Case presentation: </strong>A man in his 60s presented with epigastric pain. Contrast-enhanced CT revealed a 32-mm mass lesion in segment 2 of the liver and intraperitoneal hemorrhage with contrast extravasation adjacent to the lesion. Ruptured hepatocellular carcinoma was initially suspected, and emergency transcatheter arterial embolization achieved hemostasis. Follow-up CT demonstrated enlargement of the encapsulated hematoma near the embolized lesion. Left lateral sectionectomy was performed 33 days after embolization. Intraoperatively, a 10-cm cystic lesion with dense adhesions was identified in the left lateral section. Histopathological examination revealed a fibrous cyst wall with capillary proliferation and aggregates of histiocytes without malignant cells, leading to the diagnosis of hepatic CEH. The postoperative course was uneventful, and the patient was discharged on POD 8.</p><p><strong>Conclusions: </strong>CEH in the liver is rare, and its differentiation from malignant tumors is challenging; therefore, further accumulation of cases is required to establish optimal diagnostic and therapeutic strategies. If CEH in the liver is complicated by intraperitoneal hemorrhage, as in this case, surgical resection may need to be considered proactively.</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/PMC13306181/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148346329","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":"Ectopic Pancreatic Adenocarcinoma Arising in the Mesentery of the Jejunum: A Case Report.","authors":"Izuru Furusho, Teijiro Hirashita, Wataru Miyoshino, Hiroomi Takayama, Yoko Kawano, Yuiko Nagasawa, Shun Nakamura, Masahiro Kawamura, Takashi Masuda, Yuichi Endo, Tsutomu Daa, Masafumi Inomata","doi":"10.70352/scrj.cr.26-0120","DOIUrl":"10.70352/scrj.cr.26-0120","url":null,"abstract":"<p><strong>Introduction: </strong>Ectopic pancreas is defined as pancreatic tissue lacking anatomical and vascular continuity with the main pancreas. Malignant transformation within ectopic pancreatic tissue is extremely rare, and cases arising in the mesentery are exceptionally uncommon. We report a rare case of adenocarcinoma arising from ectopic pancreatic tissue in the proximal jejunal mesentery.</p><p><strong>Case presentation: </strong>An 80-year-old man presented with abdominal pain. Contrast-enhanced CT showed a 3-cm mass adjacent to the proximal jejunum, initially suspected to be a jejunal submucosal tumor, such as gastrointestinal stromal tumor. Laparoscopy identified a firm mesenteric tumor closely associated with the superior mesenteric artery and jejunal branches, necessitating conversion to open surgery. The tumor was completely excised while preserving the small intestine. Histopathological examination demonstrated well-differentiated adenocarcinoma arising within ectopic pancreatic tissue containing acinar, ductal, and islet of Langerhans. Immunohistochemistry showed positive staining for carbohydrate antigen 19-9, p16, p53, and S100A4, supporting the diagnosis of pancreatic ductal adenocarcinoma. The postoperative course was uneventful except for transient paralytic ileus. The patient was discharged on POD 19 and has remained recurrence-free for 9 months.</p><p><strong>Conclusions: </strong>Adenocarcinoma arising from ectopic pancreatic tissue in the mesentery is exceedingly rare and difficult to diagnose preoperatively. Complete surgical excision is essential for definitive diagnosis and curative treatment. Further case accumulation is required to better define its clinical characteristics and optimal treatment strategies.</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/PMC13384810/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148550559","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":"Strangulated Small Bowel Obstruction Caused by a Hernia-Related Adhesive Band after Successful Reduction of an Incarcerated Inguinal Hernia.","authors":"Kazuya Takabatake, Keigo Hanya, Ryo Ishida, Yudai Nakabayashi, Tomoki Konishi, Toru Mizutani, Yoshitaka Nakamura, Susumu Nakashima, Manabu Takemura, Hiroshi Koike, Fumihiro Taniguchi, Atsushi Shiozaki","doi":"10.70352/scrj.cr.26-0559","DOIUrl":"10.70352/scrj.cr.26-0559","url":null,"abstract":"<p><strong>Introduction: </strong>Incarcerated inguinal hernia is a common surgical emergency. Persistent bowel obstruction after successful reduction is typically attributed to reduction en masse, whereas other mechanisms of ongoing strangulation are rarely reported. We describe a rare case in which bowel strangulation persisted despite successful reduction of an incarcerated inguinal hernia due to a hernia-related adhesive band.</p><p><strong>Case presentation: </strong>A 92-year-old man presented with an incarcerated left inguinal hernia. Manual reduction was successfully performed, and contrast-enhanced CT confirmed reduction of the herniated bowel into the abdominal cavity without obvious signs of ischemia or persistent incarceration. However, abdominal pain and small bowel obstruction persisted. Because ongoing strangulation could not be excluded, emergency laparoscopic exploration was undertaken. Intraoperatively, the incarcerated bowel had been completely reduced into the abdominal cavity, and no evidence of reduction en masse was identified. Instead, a fibrous band extending from the sigmoid colon to the retroperitoneum formed a constricting ring that entrapped a segment of small bowel, resulting in strangulated obstruction. Laparoscopic division of the band immediately relieved the strangulation, and bowel resection was avoided. Retrospective review of the post-reduction CT revealed subtle findings consistent with a closed-loop obstruction.</p><p><strong>Conclusions: </strong>This case highlights that successful reduction of an incarcerated inguinal hernia does not necessarily indicate resolution of strangulation. Persistent symptoms after reduction should prompt consideration of ongoing bowel strangulation even when CT findings appear reassuring.</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/PMC13572207/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148971463","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":"Axillary Accessory Breast Cancer Performed Reconstruction Using a Local Flap: A Case Report.","authors":"Sawaka Yukishige, Norihiro Hokimoto, Keisuke Kashiwagi, Kenji Yorita, Miho Tsutsui, Hiroaki Inoue, Hiromitsu Takizawa","doi":"10.70352/scrj.cr.26-0078","DOIUrl":"10.70352/scrj.cr.26-0078","url":null,"abstract":"<p><strong>Introduction: </strong>Accessory breast cancer is rare, with approximately two-thirds of cases arising in the axillary region. Wide local excision is commonly performed; however, large axillary defects can lead to postoperative scar contractures and limited range of motion in the ipsilateral upper limb.</p><p><strong>Case presentation: </strong>A 67-year-old woman presented with a palpable mass and erythema in the left axilla. Physical examination revealed a 2-cm indurated lesion with erythema in the left axilla. Ultrasonography revealed an irregular 14-mm hypoechoic mass with suspected dermal invasion. Skin punch biopsy suggested the presence of invasive carcinoma in the dermis, suggestive of invasive lobular carcinoma on immunohistochemistry. Contrast-enhanced breast MRI revealed no abnormal breast enhancement. Systemic evaluation revealed no evidence of distant metastases. The patient underwent a wide local excision of the left axillary lesion with axillary lymph node dissection, followed by local skin flap reconstruction of the axillary defect. Histopathological examination revealed an invasive lobular carcinoma of pleomorphic type (pT1cN1aM0, pStage IIA, triple-negative subtype), associated with heterotopic breast tissue and lobular carcinoma <i>in situ</i>. Postoperative adjuvant chemotherapy was administered. The patient experienced no limitations in left upper limb range of motion and survived without recurrence.</p><p><strong>Conclusions: </strong>During the surgical treatment of axillary accessory breast cancer, reconstructive procedures should be considered based on the size of the skin defect to prevent postoperative scar contracture.</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/PMC13103485/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147781654","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":"Medullary Carcinoma of the Ascending Colon in an Older Woman: A Case Report.","authors":"Ayana Kishimoto, Tetsu Yamamoto, Takahito Taniura, Kazunari Ishitobi, Keisuke Inoue, Shunsuke Kaji, Takayuki Tanaka, Takeshi Matsubara, Masaaki Hidaka","doi":"10.70352/scrj.cr.26-0022","DOIUrl":"10.70352/scrj.cr.26-0022","url":null,"abstract":"<p><strong>Introduction: </strong>Medullary carcinoma of the colon is a rare histological subtype of poorly differentiated or undifferentiated adenocarcinoma, with a reported incidence of 0.05%-0.08%. It typically affects older women, is more frequently located in the right colon, and is characterized by a high prevalence of mismatch repair deficiency, particularly microsatellite instability (MSI). In comparison to other poorly differentiated adenocarcinomas, medullary carcinoma generally exhibits a lower rate of lymph node or distant metastasis and carries a relatively favorable prognosis. Due to its recent classification and rarity, reported cases remain limited. We herein describe a case of surgically resected medullary carcinoma of the ascending colon in an older woman, along with a brief review of the relevant literature.</p><p><strong>Case presentation: </strong>An 88-year-old woman presented with unintentional weight loss of 4 kg over 3 months. Colonoscopy revealed a type 2 tumor in the ascending colon, and biopsy demonstrated poorly differentiated adenocarcinoma. Imaging showed asymmetric wall thickening without lymph node or distant metastasis, and the clinical diagnosis was ascending colon cancer, cT3N0M0, Stage IIA. She underwent an elective laparoscopic right hemicolectomy with D3 lymphadenectomy. The postoperative course was uneventful. A histopathological examination showed sheets of atypical cells with enlarged nucleoli, expansive growth, a Crohn's-like lymphoid reaction, and focal signet-ring-like features. Immunohistochemistry demonstrated positivity for MUC5AC, partial positivity for MUC2, focal positivity for CK20 and CDX-2, retained expression of MSH2 and MSH6, and loss of MLH1 and PMS2 expression, indicating deficient mismatch repair (dMMR), which supports the diagnosis of medullary carcinoma. The final pathological staging was pT3N0M0, Stage IIA. Given the absence of lymph node metastasis and the patient's advanced age, adjuvant chemotherapy was not administered. She has remained recurrence-free for 4 years under active surveillance.</p><p><strong>Conclusions: </strong>Colonic medullary carcinoma is a rare tumor that predominantly occurs in older patients and generally demonstrates a more favorable prognosis than other poorly differentiated adenocarcinomas. Treatment decisions should be based primarily on tumor stage. Although preoperative diagnosis is often difficult, awareness of its characteristic features may help avoid excessive therapeutic de-escalation.</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/PMC13561586/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148945749","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":"Torsion and Rupture of a Wandering Pelvic Accessory Spleen Associated with Essential Thrombocythemia: A Case Report.","authors":"Aoi Suzuki, Taku Sato, Fumi Hasegawa, Megumu Enjoji","doi":"10.70352/scrj.cr.26-0232","DOIUrl":"10.70352/scrj.cr.26-0232","url":null,"abstract":"<p><strong>Introduction: </strong>The pelvic accessory spleen is a rare anomaly, and its diagnosis is challenging. Essential thrombocythemia (ET) is a myeloproliferative neoplasm that can cause secondary myelofibrosis and splenomegaly. We report a case of torsion and rupture of a large wandering pelvic accessory spleen associated with ET.</p><p><strong>Case presentation: </strong>A 62-year-old man with a history of ET presented with acute abdominal pain. Contrast-enhanced CT revealed a 9-cm pelvic mass with surrounding high-density fluid consistent with a hematoma, indicating its rupture. He was diagnosed with ET 8 years earlier, and disease control had gradually worsened. Splenomegaly and an 8-cm pelvic mass were detected 2 months before onset using CT and MRI. The signal-intensity pattern of the pelvic mass and the spleen on MRI was identical. Therefore, the mass was considered an accessory spleen rather than a tumor. Emergency laparotomy was performed. The pelvic mass was a wandering accessory spleen. There was no supportive tissue, except for a cord-like vascular pedicle. The mass was easily resected by ligating the pedicle. Splenomegaly was observed in the left lateral abdomen. In this case, both the native and pelvic accessory spleens were enlarged because of the progression of ET. The patient was discharged on POD 16.</p><p><strong>Conclusions: </strong>Awareness of pelvic accessory spleen and its torsion is important in the differential diagnosis of pelvic masses and acute abdominal pain. When a large pelvic accessory spleen is identified, elective resection should be considered to prevent torsion or rupture. Although secondary enlargement of an accessory spleen after splenectomy has been reported, simultaneous enlargement of both the native and accessory spleens is exceptionally rare. To our knowledge, this is the first report describing the pathophysiology of simultaneous enlargement of the native and accessory spleens in association with a hematological disease.</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/PMC13503049/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148813904","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":"Pancreatic Cancer after Living-Donor Liver Transplantation: A Case Report of Long-Term Recurrence-Free Survival after Pancreaticoduodenectomy Followed by Adjuvant Chemotherapy.","authors":"Naoki Matsuya, Yoshinori Takeda, Shoichi Irie, Takaaki Kato, Ryuji Yoshioka, Yoshihito Kotera, Yoshihiro Mise, Yuki Fukumura, Akio Saiura","doi":"10.70352/scrj.cr.26-0464","DOIUrl":"https://doi.org/10.70352/scrj.cr.26-0464","url":null,"abstract":"<p><strong>Introduction: </strong>Malignancies are a major cause of late mortality after liver transplantation (LT), with an incidence significantly higher than that in the general population. Pancreatic cancer (PC) occurring after LT carries a dismal prognosis; however, the feasibility and outcome of surgery and perioperative chemotherapy remain unclear.</p><p><strong>Case presentation: </strong>A 73-year-old Japanese woman who had undergone living-donor LT 16 years earlier for hepatitis C virus-related cirrhosis was diagnosed with PC during routine CT surveillance in outpatient follow-up. A 23-mm hypovascular tumor in the pancreatic head was found to abut the portal vein (PV), without nodal or distant metastasis. After initiation of neoadjuvant gemcitabine plus S-1, treatment was discontinued during the first cycle because of S-1-induced enteritis requiring hospitalization and intravenous hydration. After recovery of her general condition, she underwent subtotal stomach-preserving pancreaticoduodenectomy with PV resection and reconstruction. During the operation, the pre-existing hepaticojejunostomy was preserved, and pancreaticojejunostomy was created using the blind end of the preserved afferent Roux limb. She was discharged on POD 25 without major complications. Pathological examination revealed well-differentiated pancreatic ductal adenocarcinoma, ypT2N0M0, Stage IB (UICC 9th edition). She subsequently completed 6 months of adjuvant gemcitabine without severe adverse events. No recurrence has been detected during 3 years of postoperative follow-up.</p><p><strong>Conclusions: </strong>Early detection and curative-intent surgery followed by adjuvant chemotherapy may contribute to long-term recurrence-free survival in selected LT recipients with localized PC. Careful multidisciplinary management may support safe oncologic treatment in these medically complex 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/PMC13624390/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115172","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}