CASE: INCIDENTAL CA GB - COMPLETION RADICAL CHOLECYSTECTOMY^-www.drkeyurbhatt.in*

CA G.B: routinely detected GB malignancy, mostly by imaging.

Missed Ca GB: detected during surgery, and missed during prior work up or imaging.

Incidental CA GB: cholecystectomy done and histology shows GB mailgnancy, or pt presents later on with features of CA GB after cholecystectomy, complete/partial.

----------------------------------------------------------------------------------------------------------------

60 yrs male presented with pain in rt upper quadrant following cholecystectomy done 2 yrs back in Bihar.
histology report of GB: not available.
USG/ CECT: S/o mass in liver bed, in seg 4b and 5. likely incidental ca GB.

CA 19.9: NORAML.

Surgery: COMPLETION radical cholecystectomy with liver resection and lymphadinectomy, With duodenal sleeve resection and port site excision. no blood transfusion was given.

pt was discharged on POD 6.

HPE: S/O well differentiated adenocarcinoma of GB, all resection margins are free of tumor, and all lymph nodes are negative..port site nodule positive for malignancy...

pt is now subjected to adjuvant chemotherapy.


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CASE: Multiple polyposis coli with ca colon^-www.drkeyurbhatt.in*

Middle aged male with recurrent colicky  pain in abdomen for more than 1 year,DM, HTN.

CECT: S/o growth near splenic flexure with dilated proximal large bowel.  and an enlarged single node near splenic flexure, rest NAD.

COLONOSCOPY: S/o non negotiable growth in splenic flexure, with two polyps in descending colon, bx taken.

Plan : Lap assisted redical left hemicolectomy and intra op proximal colonoscopy  to look for polyps..sos total colectomy..

SURGERY: LAP Assisted radical left hemicolectomy done, intra op proximal colonoscopy done s/o 9 more polyps in proximal colon of variable size and type. frozen sent from two of them..s/o moderate to severe dysplasia in both.

TOTAL abdominal colectomy done with ileo rectal anastomosis and proximal diverting ileostomy. 

HPE: T3, N1, G1 adeno ca  of colon, (1/16 nodes positive), all  11 polyps showed moderate to severe dysplasia.., ALL resection margins are free of tumor. 

pt discharged on POD 10. 

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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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