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Shibuya H, Sato K, Yamauchi Y, Tamura Y, Takahashi K, Asari Y. Lesser omental hernia through a defect in the posterior layer of the lesser omentum. Surg Case Rep 2023; 9:70. [PMID: 37140713 PMCID: PMC10160332 DOI: 10.1186/s40792-023-01651-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 04/25/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND In previously reported cases of lesser omental hernia, a rare clinical presentation, the herniated intestinal tract was passing through both peritoneal layers of the lesser omentum to herniate into the peritoneal cavity or bursa omentalis. Here we present a very rare case of lesser omentum hernia, where the transverse colon entered through only the posterior layer of the lesser omentum to form a hernia between the anterior and posterior layers. CASE PRESENTATION A 43-year-old man was admitted to the emergency department with acute abdominal pain. Plain abdominal computed tomography (CT) revealed a change in the caliber of the transverse colon between the stomach and pancreas, forming a closed loop on the cephaloventral side of the stomach. On contrast-enhanced CT images, vessels were observed in the contrast-enhanced lesser omentum surrounding the herniated intestine. The patient was diagnosed with a lesser omental hernia and underwent laparoscopic surgery. Intraoperatively, the transverse colon was covered by the anterior layer of the lesser omentum, and a defect was found in the posterior layer of the lesser omentum on the dorsal side of the stomach. A 2-cm incision was made in the posterior layer of the lesser omentum to widen the small defect. The herniated intestinal section was removed from the hernia sac, and the transverse colon was retained unresected. The postoperative course was uneventful. CONCLUSIONS As illustrated in this first case of a lesser omental hernia forming between the anterior and posterior layers, characteristic CT findings may play an active role in the diagnosis of this rare presentation.
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Affiliation(s)
- Hirotaka Shibuya
- Department of Surgery, Japanese Red Cross Ise Hospital, 1-471-2 Funae, Ise, Mie, 516-8512, Japan.
- Department of Emergency and Critical Care Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.
| | - Keita Sato
- Department of Surgery, Japanese Red Cross Ise Hospital, 1-471-2 Funae, Ise, Mie, 516-8512, Japan
| | - Yosuke Yamauchi
- Department of Surgery, Japanese Red Cross Ise Hospital, 1-471-2 Funae, Ise, Mie, 516-8512, Japan
| | - Yoshihisa Tamura
- Department of Surgery, Japanese Red Cross Ise Hospital, 1-471-2 Funae, Ise, Mie, 516-8512, Japan
| | - Koji Takahashi
- Department of Surgery, Japanese Red Cross Ise Hospital, 1-471-2 Funae, Ise, Mie, 516-8512, Japan
| | - Yasushi Asari
- Department of Emergency and Critical Care Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
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Okamoto T, Yoshimoto T, Ohike N, Fujikawa A, Kanie T, Fukuda K. Spontaneous regression of gastric gastrinoma after resection of metastases to the lesser omentum: A case report and review of literature. World J Gastroenterol 2021; 27:129-142. [PMID: 33505155 PMCID: PMC7789063 DOI: 10.3748/wjg.v27.i1.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 11/28/2020] [Accepted: 12/16/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Gastric gastrinoma and spontaneous tumor regression are both very rarely encountered. We report the first case of spontaneous regression of gastric gastrinoma. CASE SUMMARY A 37-year-old man with a 9-year history of chronic abdominal pain was referred for evaluation of an 8 cm mass in the lesser omentum discovered incidentally on abdominal computed tomography. The tumor was diagnosed as grade 2 neuroendocrine neoplasm (NEN) on endoscopic ultrasound-guided fine-needle aspiration. Screening esophagogastroduodenoscopy revealed a 7 mm red polypoid lesion with central depression in the gastric antrum, also confirmed to be a grade 2 NEN. Laparoscopic removal of the abdominal mass confirmed it to be a metastatic gastrinoma lesion. The gastric lesion was subsequently diagnosed as primary gastric gastrinoma. Three months later, the gastric lesion had disappeared without treatment. The patient remains symptom-free with normal fasting serum gastrin and no recurrence of gastrinoma during 36 mo of follow-up. CONCLUSION Gastric gastrinoma may arise as a polypoid lesion in the gastric antrum. Spontaneous regression can rarely occur after biopsy.
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Affiliation(s)
- Takeshi Okamoto
- Department of Gastroenterology, St. Luke's International Hospital, Tokyo 104-8560, Japan
| | - Takaaki Yoshimoto
- Department of Gastroenterology, St. Luke's International Hospital, Tokyo 104-8560, Japan
| | - Nobuyuki Ohike
- Department of Pathology, Shizuoka Cancer Center, Shizuoka 411-8777, Japan
| | - Aoi Fujikawa
- Department of Surgery, St. Luke’s International Hospital, Tokyo 104-8560, Japan
| | - Takayoshi Kanie
- Department of Cardiology, St. Luke’s International Hospital, Tokyo 104-8560, Japan
| | - Katsuyuki Fukuda
- Department of Gastroenterology, St. Luke's International Hospital, Tokyo 104-8560, Japan
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Bulky peritoneal carcinosarcoma with tiny high-grade serous carcinoma of the fallopian tube: a case report. Int Cancer Conf J 2020; 10:72-77. [PMID: 33489706 DOI: 10.1007/s13691-020-00451-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 09/27/2020] [Indexed: 10/23/2022] Open
Abstract
Peritoneal carcinosarcoma is a highly aggressive and uncommon neoplasm that has carcinomatous and sarcomatous components; the malignancy rarely localizes to the omentum. We report a case of a bulky peritoneal carcinosarcoma with tiny high-grade serous carcinoma of the fallopian tube. A 60-year-old female with a huge pelvic mass (12 cm in diameter) underwent a total abdominal hysterectomy, bilateral salpingo-oophorectomy, and omentectomy for tumor debulking. Pathological findings showed minimally invasive high-grade serous carcinoma of the left fallopian tube and carcinosarcoma of the omentum. Similar p53 diffuse immunostaining in the omental carcinosarcoma and the tubal carcinoma provides evidence for a clonal relationship between the two neoplasias. This case suggests a small serous carcinoma, originating in the tubal mucosa, subsequently became implanted in the omentum and grew preferentially, converting to a carcinosarcoma at a remote site.
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A Case of Significant Response to Olaparib in a Patient with Primary Peritoneal Carcinosarcoma Diagnosed by Laparoscopic Surgery. Case Rep Obstet Gynecol 2020; 2020:9106390. [PMID: 32850164 PMCID: PMC7436359 DOI: 10.1155/2020/9106390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 07/17/2020] [Accepted: 07/29/2020] [Indexed: 12/02/2022] Open
Abstract
Primary peritoneal carcinosarcomas which arise from extragenital locations are extremely rare. Carinosarcomas contain both carcinomatous and sarcomatous elements and can be mainly detected in the female genital tract. We herein report a case of primary peritoneal carcinosarcoma diagnosed by laparoscopic surgery and treated with olaparib. A 62-year-old woman referred to our hospital due to abdominal distension. From imaging findings, we suspected advanced primary peritoneal carcinoma, and laparoscopic surgery was thereafter performed. The pathological diagnosis was carcinosarcoma, and the patient received chemotherapy with docetaxel and carboplatin. After three cycles of chemotherapy, the interval debulking surgery was attempted but resulted in suboptimal results. Because the bilateral ovaries were observed with a normal size and normal findings, we considered that the most likely diagnosis was primary peritoneal carcinosarcoma. After the additional chemotherapy and a 6-month observation period, the tumor relapsed. The patient received chemotherapy again, and the peritoneal carcinosarcoma was judged to be a platinum-sensitive tumor. Oral administration of olaparib was thus initiated. Although a dose reduction was needed due to anemia, olaparib was effective, and the patient could continue the drug for another 7 months. This is the first report of primary peritoneal carcinosarcoma treated with olaparib and shows that it could be a treatment option for platinum-sensitive tumors.
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Abstract
Mesenchymal Stem Cells (MSCs) are a heterogeneous population of fibroblast-like cells which maintain self-renewability and pluripotency to differentiate into mesodermal cell lineages. The use of MSCs in clinical settings began with high enthusiasm and the number of MSC-based clinical trials has been rising ever since. However; the very unique characteristics of MSCs that made them suitable to for therapeutic use, might give rise to unwanted outcomes, including tumor formation and progression. In this paper, we present a model of carcinogenesis initiated by MSCs, which chains together the tissue organization field theory, the stem cell theory, and the inflammation-cancer chain. We believe that some tissue resident stem cells could be leaked cells from bone marrow MSC pool to various injured tissue, which consequently transform and integrate in the host tissue. If the injury persists or chronic inflammation develops, as a consequence of recurring exposure to growth factors, cytokines, etc. the newly formed tissue from MSCs, which still has conserved their mesenchymal and stemness features, go through rapid population expansion, and nullify their tumor suppressor genes, and hence give rise to neoplastic cell (carcinomas, sarcomas, and carcino-sarcomas). Considering the probability of this hypothesis being true, the clinical and therapeutic use of MSCs should be with caution, and the recipients' long term follow-up seems to be insightful.
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Koyanagi T, To Y, Ando M, Matsuoka S, Nakamura S, Goto M, Kondo H, Eguchi F, Tsujioka H. Primary peritoneal carcinosarcoma arising from the Douglas pouch: A case report. Mol Clin Oncol 2018; 9:485-488. [PMID: 30345041 PMCID: PMC6174426 DOI: 10.3892/mco.2018.1711] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 08/17/2018] [Indexed: 11/09/2022] Open
Abstract
Primary peritoneal carcinosarcoma is extremely rare and only few cases have been reported in the literature to date. We herein present a case of carcinosarcoma of the Douglas pouch in a 73-year-old Japanese woman. The patient complained of fever and lower abdominal pain, and a large pelvic mass (>10 cm in diameter) was detected, with rectal invasion. Laparotomy was performed and revealed a left ovarian abscess and a Douglas pouch mass; however, there was no obvious tumor involvement of the bilateral ovaries or uterus. The patient underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy and tumor debulking, with a reduction rate of ~30%. Sigmoid colostomy was also performed due to the deep and wide rectal invasion. Histologically, the tumor was composed of a mixture of ovarian high-grade serous carcinoma and spindle-cell sarcoma mimicking leiomyosarcoma. Immunohistochemically, the serous carcinoma component was positive for cytokeratin (CK)7, Wilms' tumor-1 and p53 (null type), while CDX-2 and CK20 were negative. The spindle-cell sarcoma component was positive for vimentin and α-smooth muscle actin. The present case was diagnosed as carcinosarcoma of the homologous type derived from the peritoneum in the Douglas pouch. The patient received several courses of combination chemotherapy with paclitaxel, carboplatin and bevacizumab, and achieved complete remission. The principal treatment for such cases is surgery, and several chemotherapeutic regimens, including paclitaxel and carboplatin, or cisplatin and ifosfamide, have been reported. The accumulation of more clinical cases is crucial for understanding the clinicopathological characteristics of these rare tumors and establishing effective therapeutic strategies.
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Affiliation(s)
- Takahiro Koyanagi
- Department of Obstetrics and Gynecology, ASO Iizuka Hospital, Iizuka, Fukuoka 820-8505, Japan.,Department of Obstetrics and Gynecology, School of Medicine, Jichi Medical University, Shimotsuke, Tochigi 329-0498, Japan
| | - Yoko To
- Department of Obstetrics and Gynecology, ASO Iizuka Hospital, Iizuka, Fukuoka 820-8505, Japan
| | - Miho Ando
- Department of Obstetrics and Gynecology, ASO Iizuka Hospital, Iizuka, Fukuoka 820-8505, Japan
| | - Sakiko Matsuoka
- Department of Obstetrics and Gynecology, ASO Iizuka Hospital, Iizuka, Fukuoka 820-8505, Japan
| | - Sumie Nakamura
- Department of Obstetrics and Gynecology, ASO Iizuka Hospital, Iizuka, Fukuoka 820-8505, Japan
| | - Maki Goto
- Department of Obstetrics and Gynecology, ASO Iizuka Hospital, Iizuka, Fukuoka 820-8505, Japan
| | - Haruhiko Kondo
- Department of Obstetrics and Gynecology, ASO Iizuka Hospital, Iizuka, Fukuoka 820-8505, Japan
| | - Fuyuki Eguchi
- Department of Obstetrics and Gynecology, ASO Iizuka Hospital, Iizuka, Fukuoka 820-8505, Japan
| | - Hiroshi Tsujioka
- Department of Obstetrics and Gynecology, ASO Iizuka Hospital, Iizuka, Fukuoka 820-8505, Japan
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