Surgical Case Reports最新文献

{"title":"Epidermoid Cysts in an Intrapancreatic Accessory Spleen Mimicking Pancreatic Neoplasms: Two Case Reports and a Literature Review of Japanese Cases.","authors":"Xiufeng Li, Qingjiang Hu, Yu Takashi, Koto Kawata, Shohei Shibuta, Yuki Ando, Hajime Otsu, Yusuke Yonemura, Taro Tobo, Koshi Mimori","doi":"10.70352/scrj.cr.26-0039","DOIUrl":"10.70352/scrj.cr.26-0039","url":null,"abstract":"<p><strong>Introduction: </strong>Epidermoid cyst(s) arising in an intrapancreatic accessory spleen (ECIPAS) are rare benign lesions that often mimic pancreatic cystic neoplasms on imaging studies. Owing to their rarity and nonspecific radiological features, ECIPAS are frequently misdiagnosed preoperatively, leading to unnecessary pancreatic resections.</p><p><strong>Case presentation: </strong>We report 2 asymptomatic middle-aged women who were incidentally found to have cystic lesions in the tail of the pancreas during routine imaging examinations. Contrast-enhanced CT and MRI demonstrated well-demarcated cystic lesions with low signal intensity on T1-weighted images and high signal intensity on T2-weighted images. In both cases, mucinous cystic neoplasms or intraductal papillary mucinous neoplasms were suspected, prompting distal pancreatectomies, with a concomitant splenectomy in 1 patient. Histopathological examination revealed cysts lined predominantly by stratified squamous epithelium and surrounded by normal splenic tissue, confirming the diagnosis of ECIPAS. In addition, a review of the Japanese literature identified 52 reported cases of ECIPAS; most patients were asymptomatic, with lesions predominantly located in the pancreatic tail and frequently associated with elevated serum carbohydrate antigen 19-9 levels, although normal levels are also common.</p><p><strong>Conclusions: </strong>Recognizing ECIPAS may support more cautious clinical decision-making and help surgeons consider less invasive management strategies, including spleen-preserving distal pancreatectomy when appropriate.</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/PMC13215772/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148139003","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":"Primary Chest Wall Glomus Tumor Resected by Video-Assisted Thoracoscopic Surgery: A Case Report with 10-Year Follow-up.","authors":"Noritake Kikunishi, Tetsukan Woo, Daisuke Noma, Atsuko Osawa, Takashi Nakayama, Aya Saito","doi":"10.70352/scrj.cr.26-0226","DOIUrl":"10.70352/scrj.cr.26-0226","url":null,"abstract":"<p><strong>Introduction: </strong>Glomus tumors are rare perivascular neoplasms that typically occur in the distal extremities. Their occurrence in the chest wall is extremely rare, with only 13 cases previously reported in the English literature. Herein, we report a unique case of a primary chest wall glomus tumor in a patient who presented with severe, rapidly worsening back pain, underwent ¹⁸F-fluorodeoxyglucose-PET/CT (FDG-PET/CT) evaluation, and experienced complete pain resolution following thoracoscopic resection.</p><p><strong>Case presentation: </strong>A 65-year-old man presented to our emergency department with a 1-month history of progressively worsening right posterior back pain. Contrast-enhanced CT revealed a 20 × 13-mm well-enhanced oval mass in the right posterior chest wall at the level of the ninth rib. MRI demonstrated heterogeneous intensity on T2-weighted images. FDG-PET/CT showed low tumor uptake with a maximum standardized uptake value (SUVmax) of 2.2. This finding was considered adjunctive metabolic information that did not strongly suggest a highly aggressive malignancy; however, it was insufficient to exclude malignancy or establish a definitive diagnosis. To achieve a definitive diagnosis and alleviate the severe pain, surgical resection was performed via 4-port video-assisted thoracoscopic surgery (VATS). The tumor was completely excised with clear margins. Histopathological and immunohistochemical analyses confirmed the diagnosis of a benign glomus tumor, with diffuse positivity for smooth muscle actin (SMA) and a Ki-67 labeling index of less than 1%. The patient's severe back pain completely resolved immediately after surgery, and he remained completely asymptomatic with no evidence of recurrence at the 10-year follow-up.</p><p><strong>Conclusions: </strong>Although exceedingly rare, glomus tumors should be included in the differential diagnosis of painful chest wall tumors. FDG-PET/CT may provide adjunctive information regarding metabolic activity during preoperative assessment; however, its findings should be interpreted cautiously and cannot replace histopathological evaluation. To the best of our knowledge, this is the first reported case of a chest wall glomus tumor evaluated with FDG-PET/CT. Complete surgical resection remains essential for definitive diagnosis and symptom relief, and minimally invasive resection via VATS may be an effective approach when complete resection is feasible.</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/PMC13402036/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148593203","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":"Utility of Narrow-Band Imaging during Intraoperative Colonoscopy for Colon Tumor Localization: A Report of Two Cases.","authors":"Mitsuki Nakazawa, Kaori Watanabe, Hiroyuki Asai, Shuhei Uehara, Akira Kato, Takuya Suzuki, Hajime Ushigome, Yushi Yamakawa, Hiroki Takahashi, Hiroyuki Sagawa, Takafumi Sato, Yoichi Matsuo, Akira Mitsui, Shuji Takiguchi","doi":"10.70352/scrj.cr.26-0091","DOIUrl":"10.70352/scrj.cr.26-0091","url":null,"abstract":"<p><strong>Introduction: </strong>Accurate intraoperative localization of colonic tumors is essential to ensure appropriate resection margins, particularly in laparoscopic surgery where tactile feedback is limited. Intraoperative colonoscopy combined with narrow-band imaging (NBI) may facilitate precise delineation of tumor borders, but its clinical utility remains underreported.</p><p><strong>Case presentation: </strong>We report 2 cases of cecal tumors in which intraoperative colonoscopy with NBI was employed to identify tumor margins and guide resection. The first case was a 79-year-old man with a positive fecal occult blood test, in whom colonoscopy revealed a 25-mm laterally spreading tumor (LST) in the cecum. During laparoscopic surgery, intraoperative colonoscopy with NBI clearly visualized the lesion, enabling cecal resection with negative histopathological margins. The second case was a 75-year-old woman referred for surgery following the detection of a 30-mm LST involving the appendiceal orifice. Intraoperative colonoscopy with NBI enabled accurate margin assessment, and the tumor was resected without residual disease. Histopathology confirmed tubulovillous adenoma with negative resection margins.</p><p><strong>Conclusions: </strong>Intraoperative colonoscopy with NBI was effective for identifying tumor borders and ensuring adequate resection margins in both cases. This approach may be a valuable adjunct in selected patients undergoing laparoscopic colorectal surgery, particularly for tumors located in anatomically complex regions such as the cecum or appendiceal orifice.</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/PMC13195446/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148017394","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":"Pulmonary <i>Mycobacterium shigaense</i> Infection with Hemoptysis: Two Surgically Resected Case Reports.","authors":"Naoko Ose, Kaoru Fukuyama, Yusuke Sugiura, Eiichi Morii, Yasushi Shintani","doi":"10.70352/scrj.cr.26-0092","DOIUrl":"10.70352/scrj.cr.26-0092","url":null,"abstract":"<p><strong>Introduction: </strong><i>Mycobacterium shigaense (M. shigaense)</i> is a rare nontuberculous mycobacterium (NTM) first reported in Japan in 2012. Only a few cases of pulmonary infection have been described, all treated medically. No surgically resected cases or cases presenting with hemoptysis have been reported to date.</p><p><strong>Case presentation: </strong>We report 2 immunocompetent patients with pulmonary <i>M. shigaense</i> infection presenting with persistent hemoptysis who were successfully treated surgically. Case 1 was a 67-year-old woman with daily hemoptysis caused by a nodular lesion in the right middle lobe. Despite long-term antimicrobial therapy, hemoptysis worsened, and a robot-assisted right middle lobectomy was performed. Hemoptysis resolved immediately after surgery, and no recurrence was observed during 1 year of follow-up. Case 2 was a 68-year-old man with repeated moderate hemoptysis caused by a cavitary lesion in the left upper lobe. Robot-assisted surgery was attempted but converted to thoracotomy due to severe adhesions, and left upper division segmentectomy was performed. Hemoptysis was resolved completely after surgery. In both cases, <i>M. shigaense</i> was identified by culture and genomic analysis, and histopathology showed epithelioid granulomas with caseous necrosis.</p><p><strong>Conclusions: </strong>Pulmonary <i>M. shigaense</i> infection can cause clinically significant hemoptysis. Surgical resection combined with antimicrobial therapy was effective for symptom control in both cases. Surgery should be considered for localized disease refractory to medical treatment.</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/PMC13233110/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148164464","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":"Surgical Management of Left Atrial Myxoma through Right Mini-Thoracotomy in a Patient with Retrosternal Gastric Tube.","authors":"Masayuki Nishiyama, Takayuki Okada, Tadaaki Koyama","doi":"10.70352/scrj.cr.26-0293","DOIUrl":"10.70352/scrj.cr.26-0293","url":null,"abstract":"<p><strong>Introduction: </strong>Open-heart surgery in patients with a retrosternal gastric tube after esophagectomy presents a significant surgical challenge owing to the risk of conduit injury during median sternotomy. In such cases, a minimally invasive cardiac surgery (MICS) strategy to avoid sternotomy is of paramount importance and must be tailored according to individual anatomy.</p><p><strong>Case presentation: </strong>A 71-year-old man with a history of robot-assisted subtotal esophagectomy and retrosternal gastric tube reconstruction was found to have a mobile left atrial mass attached to the interatrial septum. Preoperative CT showed that the gastric conduit was located immediately beneath the sternum, indicating a high risk of injury during median sternotomy. Therefore, a MICS approach via right mini-thoracotomy was selected to avoid sternotomy. The procedure was performed through a right inframammary incision via the fourth intercostal space. Cardiopulmonary bypass was established via femoral arterial cannulation and direct bicaval venous cannulation. The tumor was successfully resected through a transseptal approach, and the atrial septum was reconstructed using an autologous pericardial patch. A transesophageal echocardiography probe was inserted carefully without resistance or complications, even despite the presence of a reconstructed gastric conduit. Intraoperative findings confirmed that the gastric tube was intact. The postoperative course was uneventful. Histopathological examination confirmed the diagnosis of cardiac myxoma and its complete resection.</p><p><strong>Conclusions: </strong>A sternotomy-avoiding MICS strategy via right mini-thoracotomy is a safe and effective approach for left atrial tumor resection in patients with a retrosternal gastric tube. Careful preoperative imaging and strategic surgical planning are essential to prevent catastrophic complications and optimize outcomes.</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/PMC13311320/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148353648","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":"Early Distant Metastasis in Synchronous Bilateral Breast Cancer including a Small Low-Grade Carcinoma with Osteoclast-Like Giant Cells: A Case Report.","authors":"Mayuko Hirata, Tamami Morisaki, Yuki Asaka, Hanae Matsuda, Saeko Henmi, Yuko Kikukawa, Asuka Kochi, Chika Watanabe, Koji Takada, Yukie Tauchi, Kana Ogisawa, Haruhito Kinoshita, Kenichi Kohashi, Shinichiro Kashiwagi","doi":"10.70352/scrj.cr.26-0409","DOIUrl":"10.70352/scrj.cr.26-0409","url":null,"abstract":"<p><strong>Introduction: </strong>Breast carcinoma with osteoclast-like giant cells (OGCs) is an uncommon morphological finding, and its clinical significance remains unclear. We report a case of synchronous bilateral hormone receptor-positive breast cancer including a small, low-grade carcinoma with OGCs, followed by early distant recurrence after surgery.</p><p><strong>Case presentation: </strong>A 47-year-old woman presented with a palpable mass in the left breast. Imaging revealed synchronous bilateral breast tumors without evidence of nodal or distant metastasis. She underwent bilateral mastectomy and bilateral sentinel lymph node biopsy. The right breast tumor was a carcinoma with OGCs measuring 6 mm in diameter; it was estrogen receptor (ER)-positive, progesterone receptor (PgR)-positive, human epidermal growth factor receptor 2 (HER2)-negative, had a Ki-67 labeling index of 10%, was nuclear grade 1/histological grade 1, and showed no lymphovascular invasion or nodal metastasis. The left breast tumor was an invasive ductal carcinoma (so-called scirrhous type), measuring 25 mm in diameter; it was ER-positive, PgR-positive, HER2-negative, had a Ki-67 labeling index of 10%, was nuclear grade 2/histological grade 2, showed lymphatic invasion, and had an Oncotype DX recurrence score of 16. Tamoxifen was initiated. CT performed 6 months after surgery as postoperative imaging follow-up for this patient revealed multiple pulmonary nodules, and PET-CT showed pulmonary and lumbar vertebral lesions. Pathological confirmation was not performed; therefore, the precise origin could not be determined. Fulvestrant plus abemaciclib was started for clinically suspected recurrent breast cancer.</p><p><strong>Conclusions: </strong>This case illustrates that early distant recurrence can occur in synchronous bilateral hormone receptor-positive breast cancer even when available clinicopathological and genomic findings appear relatively favorable. However, because the left conventional invasive ductal carcinoma had more plausible recurrence-risk features than the small right-sided carcinoma with OGCs, and because the metastatic lesions were not pathologically confirmed, this case should not be interpreted as evidence that the OGC-containing carcinoma caused the recurrence. Rather, it highlights the diagnostic and risk-assessment complexity of synchronous bilateral breast cancer that includes a rare stromal-rich morphological pattern.</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/PMC13453401/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148702073","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 Acquired Hemophilia A Following Robot-Assisted Minimally Invasive Esophagectomy.","authors":"Shota Eguchi, Yoshio Nagahisa, Kenji Yamaguchi, Yukio Inamura, Michio Okabe, Toshihiko Masui","doi":"10.70352/scrj.cr.25-0797","DOIUrl":"10.70352/scrj.cr.25-0797","url":null,"abstract":"<p><strong>Introduction: </strong>Acquired hemophilia A (AHA) is a rare but potentially fatal bleeding disorder that arises suddenly in individuals without a prior history of bleeding tendency. It is often associated with malignant disease and can present with severe hemorrhagic complications. Reports of AHA occurring in the postoperative course of esophageal cancer surgery are extremely limited, and the safety of immune checkpoint inhibitors (ICIs) in patients with a history of AHA remains uncertain. This case highlights both the diagnostic and therapeutic challenges of AHA and provides novel insight into the safe administration of ICIs in a patient with recurrent esophageal cancer following remission of AHA.</p><p><strong>Case presentation: </strong>We describe a 77-year-old man with clinical stage II esophageal cancer who received neoadjuvant chemotherapy with docetaxel, cisplatin, and fluorouracil, followed by robot-assisted thoracoscopic and laparoscopic subtotal esophagectomy. Postoperatively, he developed an anastomotic stricture requiring re-anastomosis via median sternotomy. After the second surgery, he experienced uncontrollable wound bleeding, and laboratory testing revealed a markedly prolonged activated partial thromboplastin time. Further evaluation confirmed the diagnosis of AHA, for which medical therapy was initiated, resulting in remission. Subsequently, the patient developed recurrent esophageal cancer and is currently receiving fluorouracil plus cisplatin in combination with pembrolizumab. Notably, no relapse of AHA has been observed during immunotherapy.</p><p><strong>Conclusions: </strong>This case illustrates that AHA can complicate the postoperative course of esophageal cancer surgery, leading to significant bleeding difficulties. It also suggests that ICIs may be administered relatively safely in patients with recurrent esophageal cancer who have previously developed AHA. Clinicians should remain vigilant for this rare but serious condition when encountering unexplained bleeding in cancer patients, and the findings may provide reassurance regarding the use of immunotherapy in similar clinical contexts.</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/PMC12962788/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147378537","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 Paget's Disease of the Breast without a Nipple Lesion.","authors":"Yukari Koga, Kyoko Eto, Masumi Tanaka, Yoshiko Masuda, Yasuteru Yoshinaga, Toshihiko Sato, Mikiko Aoki","doi":"10.70352/scrj.cr.25-0730","DOIUrl":"10.70352/scrj.cr.25-0730","url":null,"abstract":"<p><strong>Introduction: </strong>Paget's disease of the breast is generally associated with breast cancer involving the epithelium of the nipple and frequently extends into the areola or surrounding epidermis. Although it classically presents as a nipple lesion, recent diagnostic frameworks recognize that Paget's disease may rarely occur without overt nipple involvement. We report a rare case of Paget's disease of the breast without a nipple lesion.</p><p><strong>Case presentation: </strong>The patient was a 73-year-old woman who was referred to the dermatology department at our hospital for investigation of a ring-shaped area of erythema on her right areola that had been treated with topical steroids for a month at a local dermatology clinic with no improvement. A skin biopsy led to a diagnosis of Paget's disease of the breast, and she was referred to our department. Mammography and ultrasonography did not show any intramammary lesions, while MRI suggested possible limited ductal involvement near the nipple. However, the exact extent of the disease could not be reliably delineated preoperatively. A right mastectomy was performed. Postoperative pathology confirmed Paget cells in the erythematous area and ductal carcinoma in situ within the breast, without demonstrable histological continuity between the two lesions.</p><p><strong>Conclusions: </strong>When a patient presents with a refractory lesion in the areolar region, even in the absence of nipple involvement, the possibility of Paget's disease of the breast should be considered, and a skin biopsy should be performed for appropriate diagnosis.</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/PMC13071901/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147692253","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":"Stomal Outlet Obstruction Caused by Torsion of the Stomal Limb Associated with Fecal Loading after End Colostomy: A Case Report.","authors":"Sho Nambara, Koji Ando, Tetsuro Kawazoe, Shotaro Korehisa, Yasuo Tsuda, Tomonori Nakanoko, Eiji Oki, Tomoharu Yoshizumi","doi":"10.70352/scrj.cr.26-0337","DOIUrl":"https://doi.org/10.70352/scrj.cr.26-0337","url":null,"abstract":"<p><strong>Introduction: </strong>Stoma-related complications after colostomy include obstruction, prolapse, and parastomal hernia. However, torsion of the stomal limb associated with fecal loading in the proximal colon has rarely been reported.</p><p><strong>Case presentation: </strong>A 55-year-old woman with a history of rectal cancer underwent multiple surgeries, including pelvic exenteration with a permanent end colostomy via an intraperitoneal route. Nine days after discharge following hepatectomy and inguinal lymph node dissection, she presented with abdominal pain and cessation of stool output. CT revealed obstruction at the stomal outlet. Decompression through the stoma using a drainage tube was attempted but failed. Emergency surgery was performed. Intraoperatively, no significant adhesions were observed. The proximal colon was markedly dilated and filled with feces. An elongated transverse colon and a mobilized splenic flexure had descended into the pelvis, and the fecal loading may have contributed to torsion of the stomal limb at the outlet. Reduction of the colon from the pelvis resolved the torsion. Fecal contents were evacuated via the stoma, and no bowel resection was required. The postoperative course was uneventful, and the patient was discharged on the 5th day after surgery. No recurrence was observed during the short-term follow-up.</p><p><strong>Conclusions: </strong>Torsion of a mobile stomal limb associated with fecal loading should be considered as a rare cause of stomal outlet obstruction, particularly when conservative decompression is ineffective. In patients with an elongated and mobile colon, appropriate bowel management may be important to prevent fecal retention and recurrence.</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/PMC13485458/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148798072","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 Neuroendocrine Tumor with Acinar Pattern Mimicking Pancreatic Ductal Adenocarcinoma: A Case Report.","authors":"Yasunori Shirakawa, Kei Yamane, Kazuyuki Nagai, Shinya Otsuki, Masakazu Fujimoto, Kentaro Tsuji, Tomoaki Yoh, Shinya Okumura, Hirofumi Hirao, Satoshi Ogiso, Takayuki Anazawa, Atsuko Kasajima, Günter Klöppel, Hironori Haga, Etsuro Hatano","doi":"10.70352/scrj.cr.26-0184","DOIUrl":"10.70352/scrj.cr.26-0184","url":null,"abstract":"<p><strong>Introduction: </strong>Pancreatic neuroendocrine tumors (PanNETs) are rare, but their incidence has been increasing. PanNETs are usually diagnosed based on typical radiological and pathological findings. However, some exhibit unusual findings; therefore, we need to consider these and make a diagnosis through multidisciplinary evaluation. In this report, we present a case of PanNET that was challenging to diagnose preoperatively.</p><p><strong>Case presentation: </strong>A man in his 70s with a prior diagnosis of intrahepatic cholangiocarcinoma (iCCA) was referred to our hospital (Kyoto University Hospital) for suspected recurrence of multiple intrahepatic metastases. MRI showed space-occupying lesions in the liver and a 2.7-cm hyperintense mass in the uncinate process of the pancreas. Adenocarcinoma was diagnosed by endoscopic US-guided tissue acquisition (EUS-TA) of the pancreatic lesion. Accordingly, the patient underwent neoadjuvant chemotherapy followed by pancreatoduodenectomy. However, postoperative histological and immunohistochemical evaluations of the surgically resected specimen revealed G2 PanNET with an unusual acinar structure that was not considered preoperatively.</p><p><strong>Conclusions: </strong>This case highlights the diagnostic challenge of unusual PanNETs that presented radiologically and pathologically with unusual features. A multidisciplinary evaluation and awareness of PanNETs with unusual features are essential for accurate diagnosis.</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/PMC13521685/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148841299","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}