Surgical Case Reports最新文献

{"title":"An Adult Case of Bochdalek Hernia with Incarcerated Transverse Colon Successfully Treated by Hand-Assisted Laparoscopic Surgery.","authors":"Erica Nishimura, Momoka Oosawa, Kazuhiro Matsuo, Nozomi Watanobe, Risa Ohtani, Koshiro Matsunami, Takako Muroi, Asuka Hara, Keita Hayashi, Yuki Tajima, Yasushi Kaneko, Hiroto Fujisaki, Kumiko Hongo, Kikuo Yo, Kimiyasu Yoneyama, Kiminori Takano, Motohito Nakagawa","doi":"10.70352/scrj.cr.25-0124","DOIUrl":"10.70352/scrj.cr.25-0124","url":null,"abstract":"<p><strong>Introduction: </strong>Bochdalek hernia (BH) is a congenital diaphragmatic hernia that is rare among adults. It is difficult to treat especially with an incarcerated abdominal organ. Although surgery via laparotomy or thoracotomy to repair the hernia with or without mesh reinforcement is the gold standard of treatment for BH, conversion to open surgery is performed to obtain a good surgical view and sufficient working space. Herein, we describe a rare case of BH with incarcerated distal transverse colon treated by hand-assisted laparoscopic surgery (HALS).</p><p><strong>Case presentation: </strong>A 74-year-old man visited the outpatient clinic with the chief complaints of anorexia and abdominal distension. Contrast-enhanced computed tomography scan showed incarcerated left diaphragmatic hernia, with the distal transverse colon trapped in the left hemithorax with ischemic change. The patient was diagnosed with large bowel obstruction because of BH. Thus, emergency laparoscopic surgery was performed. However, it was converted to HALS because the colon could not be easily pulled back to the abdominal cavity. The transverse colon was carefully removed without perforation. The surgical course was uneventful, and the patient was discharged 1 week after surgery.</p><p><strong>Conclusions: </strong>HALS can be used when laparoscopic surgery is difficult.</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/PMC12159293/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144286534","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":"Incarceration of the Afferent Loop into the Sutured Closed Mesenteric Defect after Gastrectomy Followed by Billroth-II Reconstruction for Gastric Cancer: Two Case Reports.","authors":"Kiyotomi Maruyama, Tadaaki Shimizu, Kou Shimada, Arano Makino, Natsuhiro Morita, Tasuku Kawaguchi, Takahiro Amano, Tomoki Shirota, Kuniyuki Gomi, Motohiro Mihara","doi":"10.70352/scrj.cr.25-0167","DOIUrl":"10.70352/scrj.cr.25-0167","url":null,"abstract":"<p><strong>Introduction: </strong>Internal hernia is a critical complication after laparoscopic gastrectomy with Roux-en-Y, Billroth-II or double tract reconstruction. It is recommended that mesenteric defects should be closed to prevent internal hernias. We reported two patients who developed internal hernias, in which the afferent loop of Billroth-II reconstruction became incarcerated into the closed mesenteric defects.</p><p><strong>Case presentation: </strong>A man in his late 40s had undergone laparoscopic distal gastrectomy 3 months prior for gastric cancer followed by Billroth-II reconstruction, in which mesenteric defect was sutured closed. The patient visited our hospital complaining of sudden severe upper abdominal pain and was diagnosed with afferent loop obstruction due to an incarcerated internal hernia complicated by acute pancreatitis. Emergency surgery, in which intestinal incarceration was relieved and intestinal ischemia was not found, was performed on the same day as admission. However, postoperative duodenal microperforation occurred, making treatment difficult. A woman in her late 70s had undergone laparoscopic distal gastrectomy 7 days prior for gastric cancer followed by Billroth-II reconstruction, in which mesenteric defect was sutured closed. The patient complained of nausea without abdominal pain and was diagnosed with afferent loop obstruction due to an incarcerated internal hernia. Emergency surgery, in which intestinal incarceration was relieved and intestinal ischemia was not found, was performed on the same day. The patient was discharged uneventfully. In both cases, a hernia orifice formed in the Treiz ligament area, and the afferent loop was incarcerated into the closed mesenteric defect.</p><p><strong>Conclusions: </strong>Incarcerated internal hernias should be treated as soon as possible. Although closure of the mesenteric defects after Billroth-II reconstruction is necessary to prevent internal hernias, mesenteric defects should be closed on the left side as far away from the Treiz ligament as possible.</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/PMC12129561/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144209563","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":"Inflammatory Response during Neoadjuvant Chemotherapy with Immune Checkpoint Inhibitors in a Patient with T3N1 Triple-Negative Breast Cancer: A Case Report.","authors":"Kyoko Goda, Toshinari Yamashita, Mio Yasukawa, Takashi Yamanaka, Saori Fujiwara, Akari Takahashi, Emi Yoshioka, Yayoi Yamamoto","doi":"10.70352/scrj.cr.25-0172","DOIUrl":"10.70352/scrj.cr.25-0172","url":null,"abstract":"<p><strong>Introduction: </strong>Preoperative chemotherapy, including immune checkpoint inhibitors (ICIs), is widely accepted as the most likely treatment regimen to obtain a pathological complete response (pCR) in triple-negative breast cancer (TNBC). This case report presents a rare instance of a pCR in a patient with cT3N1M0 TNBC who underwent neoadjuvant chemotherapy (NAC) with ICIs.</p><p><strong>Case presentation: </strong>We present the case of a 44-year-old woman diagnosed with stage cT3N1M0 TNBC. The patient experienced a gradual enlargement of a left breast mass, axillary lymphadenopathy, and pain. Despite initial NAC with pembrolizumab, paclitaxel, and carboplatin, in addition to pembrolizumab, doxorubicin, and cyclophosphamide, tumor enlargement with an inflammatory response prompted surgical intervention. The patient underwent a left mastectomy with axillary lymph node dissection, resulting in a pCR with no viable tumor cells in the breast or lymph nodes. Postoperative radiotherapy and continued pembrolizumab therapy were administered. After 21 months of follow-up, the patient remains disease-free, with no evidence of recurrence or metastases.</p><p><strong>Conclusions: </strong>The patient's inflammatory and cystic tumor response is an unreported variant of the NAC response, suggesting the potential for further exploration into the mechanisms driving such responses and their implications for treatment strategies.</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/PMC12206563/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529588","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":"Hybrid Extended Totally Extraperitoneal Transversus Abdominis Release for Ruptured Incisional Hernia Etiologically Very Similar to Flood Syndrome: A Case Report.","authors":"Mariko Sambommatsu, Taketo Matsubara, Gen Shimada, Toshimi Kaido","doi":"10.70352/scrj.cr.24-00447","DOIUrl":"10.70352/scrj.cr.24-00447","url":null,"abstract":"<p><strong>Introduction: </strong>The rupture of an umbilical hernia, which is known as Flood syndrome, is a rare and life-threatening complication of liver cirrhosis. Herein, we report the successful repair of a ruptured incisional hernia accompanied by liver cirrhosis.</p><p><strong>Case presentation: </strong>A female in her 40s with a history of alcoholic cirrhosis and ruptured acute umbilical hernia treated by primary closure 6 months earlier presented with ascites leakage from abdominal skin. She was diagnosed with a ruptured incisional hernia accompanied by massive ascites. We started preoperative management with topical corticosteroids and oral diuretics. Nine months after the first visit, hybrid herniorrhaphy, extended totally extraperitoneal transversus abdominis release (eTEP-TAR) was performed. The patient has since been well without any sign of recurrence for 2 years.</p><p><strong>Conclusions: </strong>We experienced a successful treatment of a ruptured incisional hernia accompanied by liver cirrhosis. Preoperative management and surgical strategies are important for the treatment of ruptured incisional hernia and Flood syndrome.</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/PMC11836010/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143459095","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":"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}