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Lymphangiomatosis of spleen – a rare case report
Electronic Poster Abstracts
EP03F-045 DOUBLE GALLBLADDER, A RARE ANATOMICAL ANOMALY OF HEPATOBILIARY TREE R. Torresquevedo Hepatobiliary and Pancreas Surgery, Hospital Regional Concepcion, Chile In congenital anomalies of the biliary tract is double gallbladder (DGB), which is a rare anomaly, with a frequency of 1 in 3000 e 4000 cases. DGB two types may exist as cystic duct, which can continue separately (“H”) or pre join reach choledocus (inverted “Y”). Objective is to present a clinical case of DGB, with preoperative diagnosis by ultrasonography. Female patient 22, which presents symptoms of acute cholecystitis. On admission the abdominal ultrasound and magnetic colangioresonancia who reported “vesicular duplex”. Subsequently, a laparoscopic cholecystectomy was performed with intraoperative finding of DGB type “H”. The histopathological study reported presence of two gall bladders, each with separate cystic duct, and one of them with signs of acute cholecystitis, and the other normal.
EP03F-046 LYMPHANGIOMATOSIS OF SPLEEN e A RARE CASE REPORT Y. Satish Reddy, V. Venkatarami Reddy, G. Sivaramakrishna, C. Chandramaliteeswaran, M. Brahmeswara Rao and D. Varun Surgical Gastroenterology, Srivenkateswara Institute of Medical Sciences, India Introduction: Generalized lymphangiomatosis is a rare condition which constitutes multifocal lymphatic proliferation involving multiple organs including the lung, liver, spleen, bone, and skin. It may occur with cystic hygroma of the neck. We present a case report of generalized lymphangiomatosis with cystic hygroma in a 21-year-old female. Case report: 21-year-old female presented with left upper quadrant abdominal pain, early satiety, and weakness of 2 months duration. On examination, there was no generalized lymphadenopathy. Abdominal examination showed a tender, nodular massive spleen extending into the pelvis. No hepatomegaly. Hemogram and platelet count were within normal limits. Ultrasound, CT and whole body MRI showed splenomegaly with multiple cysts. In addition, there were multiple well defined hypodense lytic lesions with sclerotic rim seen in lower thoracic and lumbar vertebral bodies, bilateral iliac, ischial and pubic bones and sacrum. Additionally, a 5 6 cm multiloculated cystic lesion noted in left supraclavicular region. A diagnosis of generalized lymphangiomatosis was established. In view of massive symptomatic splenomegaly, splenectomy was performed. Diagnosis of lymphangiomatosis was confirmed by histopathology. Conclusion: Generalised lymphangiomatosis with splenic involvement is a rare condition reported less frequently. 65% Of lesions are found in paediatric patients and is seen equally in both genders. Many patients are asymptomatic. The clinical features depend on the site and the extent of the involved organ. There is no specific treatment for
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generalized lymphangiomatosis. Treatment is usually conservative. Surgical intervention is indicated when complications, such as pathological fractures and symptomatic deformity, are encountered.
EP03F-047 GALLBLADDER METASTASIS OF LOBULAR BREAST CARCINOMA R. Torresquevedo and J. M. Grajeda Hepatobiliary and Pancreas Surgery, Hospital Regional Concepcion, Chile Gallbladder metastases are uncommon in clinical practice. In Chile there is no statistical reports published about this disease. Metastases from mammary gland lobular carcinoma rarely affect the gallbladder. However, when analyzing the digestive tract metastases described in the literature generally from lobular carcinoma. The aim is to present a case of metastatic gallbladder lobular breast carcinoma. 73-year-old female patient with a history of arterial hypertension, diabetes mellitus type 2 and partial gastrectomy for gastric cancer. She had biliary colic and ultrasound reports cholelithiasis, laparoscopic cholecystectomy is done later. Histopathology reported that muscle and vesicular subserosa is infiltrated by cells of lobular breast carcinoma and breast origin immunohistochemistry supported with positive estrogen receptors. Discussion: Compared to what is uncommon metastatic lesions of melanoma and renal cell carcinoma, gallbladder metastasis of breast cancer is even more unusual. An analysis of 1000 autopsies, with cases confirmed by biopsy revealed an incidence of metastasis to the gallbladder 5.8%. When comparing the incidence of metastasis to the most common organs (abdominal lymphadenopathy 49.5%, liver 49.4%, lung 46.5%) it is evident that metastases to the gallbladder are relatively rare. Metastases reach the gallbladder via the blood from tumors of the lung, pancreas, liver, colon, ovary, breast, kidney and melanoma, but it is also possible for tumor infiltration.
EP03F-048 A CASE OF BILE DUCT ADENOMA DEVELOPED IN HEPATIC HILAR PORTION MIMICKING KLATSKIN’S TUMOR H. J. Kim1 and E. K. Park2 1 Department of Surgery, Division of HBP, Chonnam National University Medical School, and 2Department of Surgery, Division of HBP, Chonnam National University Hospital, Republic of Korea Aims: Adenoma of bile duct is a relatively rare benign tumor. It can be found mostly in the ampulla or in close proximity to the Vaterian system, intrahepatic duct and the common bile duct (CBD), and the bile duct adenoma developed in hepatic hilar portion has never been reported in English literature to our knowledge. So it can be misdiagnosed preoperatively. Methods: A 75-year-old man who presented epigastric pain and indigestion for 6 months was referred to our hospital. On physical examination, there was tenderness on
EP03F-045 DOUBLE GALLBLADDER, A RARE ANATOMICAL ANOMALY OF HEPATOBILIARY TREE R. Torresquevedo Hepatobiliary and Pancreas Surgery, Hospital Regional Concepcion, Chile In congenital anomalies of the biliary tract is double gallbladder (DGB), which is a rare anomaly, with a frequency of 1 in 3000 e 4000 cases. DGB two types may exist as cystic duct, which can continue separately (“H”) or pre join reach choledocus (inverted “Y”). Objective is to present a clinical case of DGB, with preoperative diagnosis by ultrasonography. Female patient 22, which presents symptoms of acute cholecystitis. On admission the abdominal ultrasound and magnetic colangioresonancia who reported “vesicular duplex”. Subsequently, a laparoscopic cholecystectomy was performed with intraoperative finding of DGB type “H”. The histopathological study reported presence of two gall bladders, each with separate cystic duct, and one of them with signs of acute cholecystitis, and the other normal.
EP03F-046 LYMPHANGIOMATOSIS OF SPLEEN e A RARE CASE REPORT Y. Satish Reddy, V. Venkatarami Reddy, G. Sivaramakrishna, C. Chandramaliteeswaran, M. Brahmeswara Rao and D. Varun Surgical Gastroenterology, Srivenkateswara Institute of Medical Sciences, India Introduction: Generalized lymphangiomatosis is a rare condition which constitutes multifocal lymphatic proliferation involving multiple organs including the lung, liver, spleen, bone, and skin. It may occur with cystic hygroma of the neck. We present a case report of generalized lymphangiomatosis with cystic hygroma in a 21-year-old female. Case report: 21-year-old female presented with left upper quadrant abdominal pain, early satiety, and weakness of 2 months duration. On examination, there was no generalized lymphadenopathy. Abdominal examination showed a tender, nodular massive spleen extending into the pelvis. No hepatomegaly. Hemogram and platelet count were within normal limits. Ultrasound, CT and whole body MRI showed splenomegaly with multiple cysts. In addition, there were multiple well defined hypodense lytic lesions with sclerotic rim seen in lower thoracic and lumbar vertebral bodies, bilateral iliac, ischial and pubic bones and sacrum. Additionally, a 5 6 cm multiloculated cystic lesion noted in left supraclavicular region. A diagnosis of generalized lymphangiomatosis was established. In view of massive symptomatic splenomegaly, splenectomy was performed. Diagnosis of lymphangiomatosis was confirmed by histopathology. Conclusion: Generalised lymphangiomatosis with splenic involvement is a rare condition reported less frequently. 65% Of lesions are found in paediatric patients and is seen equally in both genders. Many patients are asymptomatic. The clinical features depend on the site and the extent of the involved organ. There is no specific treatment for
HPB 2016, 18 (S1), e385ee601
e527
generalized lymphangiomatosis. Treatment is usually conservative. Surgical intervention is indicated when complications, such as pathological fractures and symptomatic deformity, are encountered.
EP03F-047 GALLBLADDER METASTASIS OF LOBULAR BREAST CARCINOMA R. Torresquevedo and J. M. Grajeda Hepatobiliary and Pancreas Surgery, Hospital Regional Concepcion, Chile Gallbladder metastases are uncommon in clinical practice. In Chile there is no statistical reports published about this disease. Metastases from mammary gland lobular carcinoma rarely affect the gallbladder. However, when analyzing the digestive tract metastases described in the literature generally from lobular carcinoma. The aim is to present a case of metastatic gallbladder lobular breast carcinoma. 73-year-old female patient with a history of arterial hypertension, diabetes mellitus type 2 and partial gastrectomy for gastric cancer. She had biliary colic and ultrasound reports cholelithiasis, laparoscopic cholecystectomy is done later. Histopathology reported that muscle and vesicular subserosa is infiltrated by cells of lobular breast carcinoma and breast origin immunohistochemistry supported with positive estrogen receptors. Discussion: Compared to what is uncommon metastatic lesions of melanoma and renal cell carcinoma, gallbladder metastasis of breast cancer is even more unusual. An analysis of 1000 autopsies, with cases confirmed by biopsy revealed an incidence of metastasis to the gallbladder 5.8%. When comparing the incidence of metastasis to the most common organs (abdominal lymphadenopathy 49.5%, liver 49.4%, lung 46.5%) it is evident that metastases to the gallbladder are relatively rare. Metastases reach the gallbladder via the blood from tumors of the lung, pancreas, liver, colon, ovary, breast, kidney and melanoma, but it is also possible for tumor infiltration.
EP03F-048 A CASE OF BILE DUCT ADENOMA DEVELOPED IN HEPATIC HILAR PORTION MIMICKING KLATSKIN’S TUMOR H. J. Kim1 and E. K. Park2 1 Department of Surgery, Division of HBP, Chonnam National University Medical School, and 2Department of Surgery, Division of HBP, Chonnam National University Hospital, Republic of Korea Aims: Adenoma of bile duct is a relatively rare benign tumor. It can be found mostly in the ampulla or in close proximity to the Vaterian system, intrahepatic duct and the common bile duct (CBD), and the bile duct adenoma developed in hepatic hilar portion has never been reported in English literature to our knowledge. So it can be misdiagnosed preoperatively. Methods: A 75-year-old man who presented epigastric pain and indigestion for 6 months was referred to our hospital. On physical examination, there was tenderness on