CASE: CA RECTUM WITH lower GI massive bleed with left Ca ovary^-www.drkeyurbhatt.in*

65 yrs female with known HTN, presented at 11 pm  with massive Lower GI BLEED, hypotension , shock

P/A: reveled a huge mass in left flank arising from pelvis
P/R : Growth in upper rectum with ulceration and bleeding.

after resuscitation was taken up fro CT angio: which suggested a pseudoanurismal bleed from superior rectal artery crushed between ca rectum and left ca ovary.

PLAN: Emergency angiography and agioembolization of vessel. if unsuccessful --> surgery.

angiography failed to located bleeder..but vessel went in spasm and bleeding decreased..was taken up for rescue surgery next day early..

LOW anterior resection with left ovarian mass removal and descending colostomy, with high ligation of IMA.

Pt discharged on POD 9.

HPE: S/O well differentiated ca rectum and well diff. ca ovary with internal hemorrhagic necrosis.
T3,N1, IHC awaited..

pt subjected to adjuvant chemoradiation..

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CASE: CA RECTUM WITH OBSTRUCTION^-www.drkeyurbhatt.in*

Middle aged male with pain in abdomen , distension, obstipation for 4 days
known case of DM / HTN on Rx.

Tachycardia, hypo tension at the time of presentation , CT DONE after resuscitation
S/o large bowel obstruction ? ca rectum, with colonic diameter more than 11 cm

Emergency colonoscopy done s/o tight growth in upper rectum, scope not negotiable, tube not passed

SURGERY: Emergency surgery : (T M E) Anterior resection with Hartmann's procedure, closing of distal stump, proximal diverting colostomy.
discharged on POD 8.

HPE: moderately diff. adeno ca rectum with 22/22 nodes positive, T3, N2. M0., All resection margins are free with distal being 7 cm away.

patient now subjected to adjuvant chemo radio..

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Rev Med Chil. 2009 Mar;137(3):394-400. Epub 2009 Jun 15.

[Fibrolamellar liver carcinoma: report of two cases and review of the literature].

[Article in Spanish]

Butte JM, Waugh E, Meneses M, Pruzzo R, Carvallo C, Redondo F, Suárez C, Parada H, Amaral H, de La Fuente H.

Source

Instituto Oncológico Fundación Arturo López Pérez, Santiago,Chile.

Abstract

Fibrolamellar hepatocellular carcinoma (FLC) is a rare histologic variant of hepatocellular carcinoma that appears most commonly in teenagers and young adults. The diagnosis is often made incidentally and surgical resection is the only curative treatment. Here we report two cases of incidental FLC involving a 19 year-old male, initially diagnosed with screening abdominal ultrasound, and a 14 year-old female that presented with abdominal pain. Diagnostic workup consisted of abdominal PET/CT and MR1 Imaging studies and tissue diagnosis was confirmed with percutaneous liver biopsy. Both patients were treated with radical liver resection/tumor excision. However, tumor recurrence was observed in both during short-term follow-up. The male patient was treated successfully with surgical treatment however the female patient succumbed top regression of disease.

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Radiographics. 1999 Mar-Apr;19(2):453-71.

Fibrolamellar carcinoma of the liver: radiologic-pathologic correlation.

McLarney JK, Rucker PT, Bender GN, Goodman ZD, Kashitani N, Ros PR.

Source

Department of Radiologic Pathology, Armed Forces Institute of Pathology, Washington DC 20306, USA.

Abstract

Fibrolamellar carcinoma is a malignant hepatocellular tumor with distinct clinical and pathologic differences from hepatocellular carcinoma. It differs from hepatocellular carcinoma in demographics, condition of the affected liver, tumor markers, and prognosis. Fibrolamellar carcinoma characteristically manifests as a large hepatic mass in adolescents or young adults (without gender predominance). Cirrhosis; elevated alpha-fetoprotein levels; and typical risk factors for hepatocellular carcinoma such as viral hepatitis, alcohol abuse, and metabolic disease are typically absent. Fibrolamellar carcinoma is characterized pathologically by cords of tumor cells surrounded by abundant collagenous fibrous tissue arranged in a parallel or lamellar distribution. Fibrotic lamellae often coalesce to form a central scar. Fibrolamellar carcinoma characteristically appears on radiologic images as a lobulated heterogeneous mass with a central scar in an otherwise normal liver. Radiologic evidence of cirrhosis, vascular invasion, or multifocal disease--findings typical of hepatocellular carcinoma--is uncommon in fibrolamellar carcinoma. Imaging features of fibrolamellar carcinoma overlap with those of other scar-producing lesions including focal nodular hyperplasia (FNH), hepatocellular adenoma and carcinoma, hemangioma, metastases, and cholangiocarcinoma. FNH, in particular, may simulate fibrolamellar carcinoma, since both have similar demographic and clinical characteristics. Because some believe that radiologic diagnosis of FNH is possible, it is important to understand the imaging appearance of fibrolamellar carcinoma to avoid misdiagnosing this malignant tumor as a FNH.

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CASE: HEPATOBLASTOMA in adolescence female- left hepatectomy^-www.drkeyurbhatt.in*

15 yrs female with vague pain in epigastric region
O/E : large 15 x 12 cm mass palpable arising from liver left lobe, hard, nontender.
NO Anorexia, No wt loss.
AFP, CEA,CA 19.9, CA 125 Were normal

CT / MR Abdomen angio:
s/o malignant liver mass from segment 3, hanging in nature with doubtful lesion in seg 4b as well.

SURGERY: Left hepatectomy with excision of seg 4b lesion, DURATION: 4.5 hrs. No blood transfusion required..and pt was shifted to ward post operatively..

was discharged on POD 5, With normal diet, and without any undue complication..

HPE : IHC S/o Hepatoblastoma, node negative, resection margins free of tumor..
pt subjected to adjuvent chemotherapy to totally eradicate the disease..

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