Surgical Case Reports最新文献

{"title":"Small-Intestinal Metastasis from Breast Cancer Presenting with Gastrointestinal Bleeding: A Case Report.","authors":"Ryo Hamaoka, Takahiko Kawate, Yoshiya Horimoto, Yoichi Koyama, Kayono Onishi, Kyoko Orimoto, Natsuki Uenaka, Hiroki Kusama, Yasuyuki Kagawa, Tomoya Tago, Yoshitaka Utsumi, Eiichi Sato, Hiroshi Kaise, Takashi Ishikawa","doi":"10.70352/scrj.cr.25-0814","DOIUrl":"10.70352/scrj.cr.25-0814","url":null,"abstract":"<p><strong>Introduction: </strong>Gastrointestinal metastases from breast cancer are rare, especially in the small intestine, and diagnosis is often difficult due to nonspecific symptoms and limited detectability with standard endoscopy. Intestinal bleeding, although uncommon, may become clinically significant. We report a case of recurrent triple-negative breast cancer in which persistent anemia during sacituzumab govitecan (SG) therapy was attributed to small-bowel metastasis, and small-bowel evaluation using capsule endoscopy and balloon-assisted enteroscopy led to the diagnosis after standard upper and lower endoscopy failed to identify the source of bleeding.</p><p><strong>Case presentation: </strong>A 50-year-old woman with recurrent triple-negative breast cancer underwent multiple systemic treatments before receiving sacituzumab govitecan. From treatment initiation, grade 3 anemia persisted despite transfusion support. Blood test findings indicated ongoing blood loss, including normocytic features with preserved marrow activity. Positive fecal occult blood prompted capsule endoscopy and balloon-assisted enteroscopy, which revealed a protruding jejunal lesion with active bleeding. Biopsy confirmed metastatic breast cancer. Because endoscopic hemostasis was difficult to achieve, laparoscopic partial small-bowel resection was subsequently performed. Histopathology of the resected specimen demonstrated multiple transmural lesions, many of which were suggestive of nodal metastases. Postoperatively, anemia resolved without transfusion, and SG therapy was successfully resumed after surgery.</p><p><strong>Conclusions: </strong>Small-intestinal metastasis causing bleeding is difficult to diagnose due to its nonspecific clinical presentation, and dedicated small-bowel evaluation is essential when standard endoscopy fails to identify the bleeding source.</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/PMC13078317/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147691970","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":"Rare Extrahepatic Metastasis of Hepatocellular Carcinoma to the Left Triangular Ligament: A Case Report.","authors":"Ayumi Tsuda, Takehiko Hanaki, Hiroshi Ishii, Kentaro Uehira, Jun Yoshida, Mikiya Kishino, Masaki Morimoto, Yuki Murakami, Naruo Tokuyasu, Teruhisa Sakamoto, Yoshiyuki Fujiwara","doi":"10.70352/scrj.cr.26-0217","DOIUrl":"10.70352/scrj.cr.26-0217","url":null,"abstract":"<p><strong>Introduction: </strong>The left triangular ligament is an uncommon site of heterotopic liver tissue, from which ectopic hepatocellular carcinoma (HCC) may arise. In contrast, extrahepatic metastasis from an intrahepatic primary HCC to the triangular ligament appears to be extremely rare. To the best of our knowledge, within the scope of our structured search of the English-language literature (PubMed and Web of Science), we did not identify a pathologically confirmed report of an isolated metastasis to the left triangular ligament from an orthotopic HCC. We report a case of isolated HCC metastasis to the left triangular ligament discovered incidentally during laparoscopic hepatectomy, which posed a differential diagnostic challenge between ectopic HCC and extrahepatic metastasis.</p><p><strong>Case presentation: </strong>A 62-year-old man was referred for evaluation of increasing serum alpha-fetoprotein (AFP) levels (27772 ng/mL). Dynamic contrast-enhanced CT revealed an approximately 25-mm hypervascular tumor in segment 2 with washout, consistent with HCC, and laparoscopic left lateral sectionectomy was planned. Intraoperatively, during mobilization of the left lateral section, an unexpected flat, white lesion was identified within the left triangular ligament, adjacent to but clearly separate from the primary tumor and liver parenchyma. Because malignancy could not be excluded, the triangular ligament was transected on the diaphragmatic side and resected en bloc with the planned specimen. Histopathological examination showed the segment 2 tumor to be well- to moderately differentiated HCC, whereas the triangular ligament lesion consisted of poorly differentiated HCC. The lesion was located entirely within the peritoneal fold, enclosed by peritoneal tissue, without intervening normal hepatic parenchyma or macroscopic/microscopic continuity with the primary tumor. These findings supported the diagnosis of isolated extrahepatic metastasis rather than ectopic HCC. The final pathological stage was pT2N0M1, pStage IVB (Union for International Cancer Control TNM, 8th edition). The postoperative course was uneventful, and the patient has remained recurrence-free with normalized AFP for 5 years.</p><p><strong>Conclusions: </strong>This case demonstrates an unusual pattern of HCC spread to the left triangular ligament, a site also known for ectopic HCC. Accurate diagnosis required integration of intraoperative findings and histopathological features. Careful inspection of the triangular ligament during left-sided mobilization should be considered to detect occult lesions and facilitate complete resection.</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/PMC13237782/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148199806","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":"Optimal Operative Strategies in Repair of Giant Coronary Artery Aneurysms: Case Presentation.","authors":"Takuma Fukunishi, Tomohide Higaki, Tomohisa Sakaue, Hirotsugu Kurobe, Takashi Nishimura, Hironori Izutani","doi":"10.70352/scrj.cr.26-0145","DOIUrl":"10.70352/scrj.cr.26-0145","url":null,"abstract":"<p><strong>Introduction: </strong>Surgical exclusion of giant coronary artery aneurysms (GCAAs) complicated by coronary-to-left ventricular (LV) fistulae requires a definitive strategy to obliterate the abnormal communication while maintaining myocardial integrity. We report 2 surgical cases focusing on internal orifice closure.</p><p><strong>Case presentation: </strong>In Case 1 (80-year-old male), a calcified left circumflex artery-GCAA was managed by direct internal closure of the aneurysm neck and LV fistula. The procedure focused on isolating the aneurysm from the coronary circulation, with an auxiliary left internal thoracic artery-obtuse marginal (LITA-OM) graft to ensure distal flow. In Case 2 (39-year-old male), the extensive GCAA required a Hemashield patch (GETINGE, Göteborg, Sweden) for internal closure of the left coronary ostium. Simultaneously, the LV fistula was closed from within the aneurysm. Although postoperative LV unloading via percutaneous cardiopulmonary support (PCPS) and Impella (Abiomed, Danvers, MA, USA) was required, the core surgical success was achieved through complete internal exclusion of both the fistula and the coronary inlet.</p><p><strong>Conclusions: </strong>For GCAAs with LV fistulae, the primary surgical objective should be the integrated internal closure of the fistula and the coronary ostium. This approach effectively excludes the aneurysm and prevents 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/PMC13294691/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148345633","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":"Cefmetazole-Induced Vitamin K-Dependent Coagulopathy Associated with Life-Threatening Gastrointestinal Bleeding in a Critically Ill Older Patient: A Case Report.","authors":"Takamichi Nishida, Daisuke Muroya, Hisaaki Shimokobe, Satoshi Taniwaki","doi":"10.70352/scrj.cr.26-0417","DOIUrl":"10.70352/scrj.cr.26-0417","url":null,"abstract":"<p><strong>Introduction: </strong>Cefmetazole (CMZ) is frequently used in abdominal surgery and critical care settings. Although cephalosporins containing an N-methyl-tetrazole-thiol (NMTT) side chain interfere with vitamin K metabolism, life-threatening clinically significant bleeding associated with CMZ-induced coagulopathy has rarely been reported.</p><p><strong>Case presentation: </strong>A 78-year-old woman with severe infections developed severe vitamin K-dependent coagulopathy during CMZ therapy. She subsequently experienced worsening upper gastrointestinal bleeding complicated by hemorrhagic shock in the setting of severe vitamin K-dependent coagulopathy despite preserved platelet counts and fibrinogen levels. Coagulation abnormalities rapidly improved following vitamin K administration, and no recurrence was observed after CMZ discontinuation.</p><p><strong>Conclusions: </strong>This case report highlights CMZ-induced vitamin K-dependent coagulopathy as a rare but life-threatening adverse event in critically ill older patients. Coagulation parameters should be carefully monitored during CMZ therapy, particularly in high-risk 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/PMC13370546/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148456711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single-Incision Laparoscopic Hartmann's Reversal Using the Stoma Site in a Patient with Perioperative Anaphylaxis.","authors":"Tsubasa Yanagihara, Ryohei Shoji, Yusuke Yoshida, Nobuhiko Kanaya, Yuki Matsumi, Kunitoshi Shigeyasu, Yoshitaka Kondo, Toshiyoshi Fujiwara","doi":"10.70352/scrj.cr.26-0206","DOIUrl":"10.70352/scrj.cr.26-0206","url":null,"abstract":"<p><strong>Introduction: </strong>Reversal of Hartmann's procedure is associated with substantial morbidity, and further reduction of surgical invasiveness may be beneficial in selected patients. Perioperative anaphylaxis caused by anesthetic agents or skin antiseptics poses a significant challenge to surgical management. We report a case of stoma-site single-incision laparoscopic Hartmann's reversal (HR) performed in a patient with severe perioperative allergies.</p><p><strong>Case presentation: </strong>A 73-year-old woman underwent an emergency open Hartmann's procedure with partial cystectomy for perforated sigmoid colon cancer with bladder invasion. After adjuvant chemotherapy, she developed a progressively enlarging giant parastomal hernia that significantly impaired daily activities. Two attempts at HR were aborted because of perioperative anaphylactic shock. Subsequent allergy evaluations suggested rocuronium and chlorhexidine as causative agents, and povidone-iodine was also avoided based on clinical history. Approximately 14 months after the initial surgery, single-incision laparoscopic HR using the stoma site was successfully performed under general anesthesia without neuromuscular blocking agents. Preoperative skin antisepsis was performed using benzalkonium chloride, avoiding both chlorhexidine and povidone-iodine. No additional abdominal incisions were required. The operative time was 2 h 56 min, with minimal blood loss. The postoperative course was uneventful and she was discharged on POD 9.</p><p><strong>Conclusions: </strong>Stoma-site single-incision laparoscopic HR may represent a useful surgical option for selected patients with severe perioperative allergies to anesthetic agents and skin antiseptics, in whom minimizing abdominal approach and wound-related risks is particularly important.</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/PMC13333322/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148438041","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":"Real-Time Full-Color Overlay Indocyanine Green Navigation for Laparoscopic Deroofing of Liver Cysts.","authors":"Koya Yoshida, Satoru Seo, Masaki Aida, Yasuhiro Kawanishi, Kazune Fujisawa, Masaya Munekage, Hiromichi Maeda, Hiroyuki Kitagawa, Tsutomu Namikawa","doi":"10.70352/scrj.cr.25-0711","DOIUrl":"10.70352/scrj.cr.25-0711","url":null,"abstract":"<p><strong>Introduction: </strong>Laparoscopic deroofing is the standard treatment for symptomatic liver cysts. Indocyanine green (ICG) fluorescence imaging has been effectively used to delineate the boundary between cysts and liver parenchyma; however, intermittent switching between fluorescence and normal light modes is time-consuming and requires memorizing the cutting lines along a curved surface, which can be burdensome during surgery.</p><p><strong>Case presentation: </strong>We report two cases of laparoscopic deroofing of liver cysts using the PINPOINT and 1788 systems, which enable full-color visualization of ICG signals and real-time surgical navigation. The full-color overlay mode clearly defines the cyst-liver boundary, allowing surgeons to determine optimal resection lines and perform procedures simultaneously. This enhances surgical precision, reduces intraoperative stress, and may improve outcomes. Both patients had uneventful recoveries and were discharged on POD 8.</p><p><strong>Conclusions: </strong>Laparoscopic deroofing with real-time ICG navigation is a safe and accurate surgical technique, performed in a minimally invasive setting that facilitates efficient and precise liver cyst resection.</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/PMC12967856/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147435698","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":"Multidisciplinary Treatment for Advanced Pancreatic Adenocarcinoma Arising from Esophageal Heterotopic Pancreas in a Young Adult: A Case Report.","authors":"Yohei Mizusawa, Kazuhiro Noma, Tomoyoshi Kunitomo, Yasushige Takeda, Hijiri Matsumoto, Masashi Hashimoto, Naoaki Maeda, Shunsuke Tanabe, Masaaki Akai, Shoji Takagi, Tomohiro Toji, Toshiyoshi Fujiwara","doi":"10.70352/scrj.cr.26-0088","DOIUrl":"10.70352/scrj.cr.26-0088","url":null,"abstract":"<p><strong>Introduction: </strong>Heterotopic pancreas (HP) is a congenital anomaly characterized by pancreatic tissue located outside its normal anatomical site, without anatomical or vascular continuity with the pancreas proper. HP typically occurs in the stomach or duodenum, whereas esophageal HP is extremely rare. Malignant transformation is even rarer, with only a limited number of reported cases. We report a case of adenocarcinoma arising from esophageal HP successfully managed by multidisciplinary treatment.</p><p><strong>Case presentation: </strong>A 32-year-old woman presented with persistent epigastric pain accompanied by severe right-sided posterior thoracic pain that was markedly positional, preventing her from resting in the supine position. Upper gastrointestinal endoscopy revealed ectopic gastric mucosa with a papillary elevation in the lower thoracic esophagus (Lt), and endoscopic US (EUS) demonstrated a homogeneous hypoechoic submucosal mass. Contrast-enhanced CT and esophagography identified a well-defined 30-mm lesion arising from the right wall of the Lt, without distant metastasis or lymphadenopathy. Although EUS-guided fine-needle aspiration (EUS-FNA) and referral for a second opinion were recommended, the patient declined both because of intractable pain and requested immediate surgical management. Thoracoscopic tumor resection was therefore performed for diagnostic and therapeutic purposes. Histopathology confirmed pancreatic-type adenocarcinoma arising from Heinrich type I HP, with lymphatic invasion and a positive resection margin. Accordingly, 3 cycles of adjuvant chemotherapy with gemcitabine (1000 mg/m²) and nab-paclitaxel (125 mg/m²) were administered over 3 months. Follow-up CT and PET-CT showed no recurrence or metastasis, and robot-assisted subtotal esophagectomy was performed 7 months after the initial surgery. Postoperative pathology demonstrated fibrotic scar tissue without residual malignancy. The patient declined further adjuvant therapy and remains free of recurrence 12 months after the second surgery.</p><p><strong>Conclusions: </strong>Esophageal HP carcinoma is exceedingly rare. Multidisciplinary treatment following pancreatic cancer protocols enabled curative resection and favorable outcomes. Given the malignant potential, meticulous preoperative evaluation and individualized therapeutic planning are essential.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"12 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13318428/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148362605","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":"Congenital Duodenal Stenosis Presenting with Bowel Obstruction Caused by Food Impaction in a Three-Year-Old Boy: A Case Report.","authors":"Koki Higashi, Yuhki Koike, Yuki Sato, Yuka Nagano, Tadanobu Shimura, Takahito Kitajima, Kohei Matsushita, Yoshinaga Okugawa, Yuji Toiyama","doi":"10.70352/scrj.cr.26-0165","DOIUrl":"10.70352/scrj.cr.26-0165","url":null,"abstract":"<p><strong>Introduction: </strong>Congenital duodenal stenosis (CDS) is often associated with trisomy 21 and is typically diagnosed in the neonatal period. However, some cases may present beyond infancy with episodes of acute gastroenteritis or foreign body impaction, which makes diagnosis challenging. This report describes a case in which a young child with trisomy 21 was diagnosed with CDS following an episode of acute bowel obstruction caused by an impacted mushroom.</p><p><strong>Case presentation: </strong>A male infant was born at term without abnormal prenatal findings, including polyhydramnios. Although he was diagnosed with trisomy 21 after birth, no obvious congenital anomalies were identified. He began complementary feeding at 6 months of age and transitioned to a regular toddler diet at 2 years of age. At 3 years of age, he presented with recurrent vomiting at a local hospital and was initially treated for acute gastroenteritis. An upper gastrointestinal contrast study and contrast-enhanced CT raised suspicion for impaired passage at the duodenum. Consequently, the patient was referred to our department for further evaluation and management. Careful review of the CT images obtained at the referring hospital revealed a mushroom-shaped foreign body in the descending portion of the duodenum. A repeat contrast study demonstrated not only the foreign body but also indicated an underlying duodenal stenosis at the same site. Upper gastrointestinal endoscopy confirmed the duodenal stenosis and revealed an impacted mushroom blocking the opening, which was successfully removed endoscopically. Laparotomy was performed via an inverted Y-shaped umbilical incision, and a membranous stenosis in the descending portion of the duodenum was identified. Membrane resection and duodenoplasty were performed. The patient's postoperative course was favorable, and no recurrence has been observed during follow-up.</p><p><strong>Conclusions: </strong>Late-onset CDS can be detected following food impaction. This case highlights the importance of comprehensive imaging in such cases, including a contrast study and CT, which facilitates both endoscopic removal of the impacted food and definitive surgical management of the duodenal stenosis. Clinicians should maintain a high index of suspicion for CDS in children presenting with sudden or recurrent vomiting at any age, particularly in those with trisomy 21.</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/PMC13283751/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148303159","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":"Thoracoscopic Resection of a Bronchial Artery Aneurysm Mimicking Mediastinal Lymph Node Metastasis after Surgery for Papillary Thyroid Cancer: A Case Report.","authors":"Yoshihiro Shimomura, Norihisa Uemura, Daisuke Hayashi, Koki Tabata, Tetsuo Tsukahara, Takaaki Ito, Takeshi Amemiya, Satomi Saeki, Toshiyuki Arai","doi":"10.70352/scrj.cr.26-0069","DOIUrl":"10.70352/scrj.cr.26-0069","url":null,"abstract":"<p><strong>Introduction: </strong>Mediastinal lymph node recurrence is frequently encountered during the follow-up after surgery for thyroid cancer. We report a rare case of a bronchial artery aneurysm (BAA) that was preoperatively suspected to be a mediastinal lymph node metastasis based on imaging findings and subsequently treated with thoracoscopic resection.</p><p><strong>Case presentation: </strong>A 68-year-old male underwent a total thyroidectomy and neck lymph node dissection for papillary thyroid carcinoma (pT1bN1bM0, UICC Stage II), followed by radioactive iodine ablation as adjuvant therapy. Surveillance CT performed 2 years postoperatively revealed a 30-mm mass in the subcarinal region of the mediastinum. The mass showed peripheral calcification with an internal low-density area. Serum thyroglobulin level was 0.18 ng/mL (within normal limits). PET revealed mild fluorodeoxyglucose uptake with a maximum standardized uptake value of 2.5. These findings were consistent with solitary mediastinal lymph node metastasis. No other findings suggestive of recurrence were identified, leading to the decision to perform thoracoscopic resection of the mediastinal tumor for both diagnostic confirmation and therapeutic intervention. The operative time was 67 min with minimal blood loss, and the patient was discharged on POD 3 without complications. Histopathological examination revealed that the mass was a 25-mm arterial aneurysm with atherosclerotic changes and no evidence of malignancy.</p><p><strong>Conclusions: </strong>When evaluating a subcarinal mediastinal mass following thyroid cancer surgery, it is important to include vascular lesions, such as BAAs, in the differential diagnosis, although these are rare. This case demonstrates that minimally invasive thoracoscopic resection provides both diagnostic confirmation and therapeutic benefits when preoperative diagnosis remains uncertain.</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/PMC13047288/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147623747","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":"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}