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| 1 | Cystic lymphangioma of the pancreas显示文摘Lymphangioma of the pancreas is an extremely rare benign tumour of lymphatic origin,with fewer than 60 published cases. Histologically,it is polycystic,with the cysts separated by thin septa and lined with endothelial cells. Though congenital,it can affect all age groups,and occurs more frequently in females. Patients usually present with epigastric pain and an associated palpable mass. Complete excision is curative,even though,depending on the tumour location,surgery may be simple or involve extensive pancreatic resection and anastomoses. The authors present a 49-year-old woman in whom a polycystic septated mass,35 mm x 35 mm in size,was discovered by ultrasonography (US) in the body of the pancreas during investigations for epigastric pain and nausea. At surgery,a well circumscribed polycystic tumor was completely excised,with preservation of the pancreatic duct. The postoperative recovery was uneventful. Histology confirmed a microcystic lymphangioma of the pancreas. Immunohistochemistry showed cystic endothelial cells reactivity to factor Ⅷ -RA (++),CD31 (+++) and CD34 (-). Postoperatively,abdominal pain disappeared and the patient remained symptomfree for 12 mo until now. Although extremely rare,lymphangioma of the pancreas should be taken into consideration as a differential diagnosis of a pancreatic cystic lesion,especially in women. | Radoje B Colovic Nikica M Grubor Marjan T Micev Henry Dushan E Atkinson Vitomir I Rankovic Mihajlo M Jagodic | 2008 | World Journal of Gastroenterology2008，14，44： | 6 |
| 2 | Isolated segmental,sectoral and right hepatic bile duct injuries显示文摘The treatment of isolated segmental,sectoral and right hepatic bile duct injuries is controversial.Nineteen patients were treated over a 26-year period.Group one was comprised of 4 patients in whom the injury was primarily repaired during the original surgery;3 over a T-tube,1 with a Roux-en-Y.These patients had an uneventful recovery.The second group consisted of 5 patients in whom the duct was ligated;4 developed infection,3 of which required drainage and biliary repair.Two patients had good long-term outcomes;the third developed a late anastomotic stricture requiring further surgery.The fourth patient developed a small bile leak and pain which resolved spontaneously.The fifth patient developed complications from which he died.The third group was comprised of 4 patients referred with biliary peritonitis;all underwent drainage and lavage,and developed biliary fistulae,3 of which resolved spontaneously,1 required Roux-en-Y repair,with favorable outcomes.The fourth group consisted of 6 patients with biliary fistulae.Two patients,both with an 8-wk history of a fistula,underwent Roux-en-Y repair.Two others also underwent a Roux-en-Y repair,as their fistulae showed no signs of closure.The remaining 2 patients had spontaneous closure of their biliary fistulae.A primary repair is a reasonable alternative to ligature ofinjured duct.Patients with ligated ducts may develop complications.Infected ducts require further surgery.Patients with biliary peritonitis must be treated with drainage and lavage.There is a 50% chance that a biliary fistula will close spontaneously.In cases where the biliary fistula does not close within 6 to 8 wk,a Roux-en-Y anastomosis should be considered. | Radoje B Colovic | 2009 | World Journal of Gastroenterology2009，15，12： | 5 |
| 3 | Perigastric extraskeletal Ewing's sarcoma: A case report显示文摘Ewing's sarcoma (ES) is a neoplasm of undifferentiated small round cells, which occurs in the bones and deep soft tissues of children and adolescents. We present a rare case of a 44-year-old woman with gastric ES presenting with epigastric pain and weight loss. Ultrasound and computed tomography scans indicated a solid/cystic mass in the pancreatic tail. At laparotomy, the tumor was found attached to the posterior surface of the stomach, completely free from the pancreas, with no lymphadenopathy or local metastases. The polynodal, partly pseudocystic, dark-red soft tumor was excised. Histopathology revealed an anaplastic small-round-cell tumor with strong membranous CD99 immunoexpression. Additionally, there was patchy immunostaining for S-100 protein, vimentin, protein gene product (PGP) 9.5 and neuron-specifi c enolase, and weak focal CD117 cytoplasmic immunoreactivity. The patient had no adjuvant chemotherapy; her postoperative recovery was uneventful, and she remains symptom-free, and without any sign of recurrence at 20 mo. To the best of our knowledge, this is only the third ever case of gastric ES. | Radoje B Colovic Nikica M Grubor Marjan T Micev Slavko V Matic Henry Dushan Edward Atkinson Stojan M Latincic | 2009 | World Journal of Gastroenterology2009，15，2： | 2 |
| 4 | Metastatic melanoma to the common bile duct causing obstructive jaundice:A case report显示文摘Metastatic melanoma to the common bile duct is very rare with only 18 cases reported so far. We report a 46 year old women who, 18 mo after excision of a skin melanoma, developped a painless progressive obstructive jaundice. At operation a melanoma within the distal third of the common bile duct was found. There were no other secondaries within the abdomen. The common bile duct, including the tumor, was resected and anastomosed with Roux-en-Y jejunal limb. The patient survived 31 mo without any sign of local recurrence and was submitted to three other operations for axillar and brain secondaries, from which she finally died. Radical resection of metastatic melanoma to the common bile duct may result in lifelong relief of obstructive jaundice. It is safe and relatively easy to perform. In other cases, a less aggressive approach, stenting or bypass procedures, should be adopted. | Radoje B Colovic Nikica M Grubor Miodrag D Jovanovic Marjan T Micev Natasa R Colovic | 2007 | World Journal of Gastroenterology2007，13，5： | 1 |
| 5 | Tuberculous lymphadenitis as a cause of obstructive jaundice:A case report and literature review显示文摘Obstructive jaundice secondary to tuberculosis (TB) is extremely rare. It can be caused by TB enlargement of the head of the pancreas, TB lymphadenitis, TB stricture of the biliary tree, or a TB mass of the retroperitoneum. A 29-year-old man with no previous history of TB presented with abdominal pain, obstructive jaundice, malaise and weight loss. Ultrasonography (US), computer tomography (CT) scan and endoscopic retrograde cholangiopancreatography (ERCP) were suggestive of a stenosis of the distal common bile duct (CBD) caused by a mass in the posterior head of the pancreas. Tumor markers, CEA and CA19-9 were within normal limits. At operation, an enlarged, centrally caseous lymph node of the posterior head of the pancreas was found, causing inflammatory stenosis and a fistula with the distal CBD. The lymph node was removed and the bile duct resected and anastomosed with the Roux-en Y jejunal limb. Histology and PCR based-assay confirmed tuberculous lymphadenitis. After an uneventful postoperative recovery, the patient was treated with anti-tuberculous medication and remained well 2.5 years later. Though obstructive jaundice secondary to tuberculous lymphadenitis is rare, abdominal TB should be considered as a differential diagnosis in immunocompromised patients and in TB endemic areas. Any stenosis or fistulation into the CBD should also be taken into consideration, and biliary bypass surgery be performed to both relieve jaundice and prevent further stricture. | Radoje Colovic Nikica Grubor Rada Jesic Marjan Micev Tanja Jovanovic Natasa Colovic Henry Dushan Atkinson | 2008 | World Journal of Gastroenterology2008，14，19： | 1 |
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