Background
Formation of a liver abscess due to gastrointestinal perforation by a foreign body is rare. In addition, there are few case reports on laparoscopic surgical treatment of a liver abscess caused by perforation of the gastrointestinal tract by a foreign body.
Case presentation
A 51-year-old man visited our hospital because of fever and anorexia. There were no physical findings except for fever. He had no comorbidities or surgical history. Laboratory tests showed increased inflammatory marker and liver enzyme levels. Abdominal ultrasonography showed a hypoechoic lesion in the left lobe of the liver. Abdominal contrast-enhanced computed tomography revealed an air-containing abscess in the left side of the liver and a high-density linear object. We diagnosed a liver abscess secondary to stomach perforation by a foreign body. Emergency laparoscopic surgery identified a fish bone in the abscess that formed between the stomach and liver. We succeeded in removing the fish bone laparoscopically.
The patient was discharged without any postoperative complications on day 11.
Conclusions
A liver abscess secondary to perforation of the gastrointestinal tract by a foreign body usually requires surgical treatment. Foreign body removal is important to prevent recurrence of liver abscess. In cases with the foreign body located at the liver margin, a laparoscopic approach to the abscess is very useful.
HighlightsAccurate preoperative diagnosis of gallbladder torsion is challenging because of the absence of clinical characteristics associated with it.Careful attention to symptoms during clinical presentation, including acute severe pain in the right quadrant and gallbladder deviation observed during radiological investigation, is required for accurate diagnosis of the condition.Upon confirmation of diagnosis, laparoscopic cholecystectomy would be the gold-standard treatment option rather than open cholecystectomy.
Background: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. The tumor size and mitotic count, typical risk category factors, are difficult to determine preoperatively. This study aimed to evaluate the usefulness of preoperative 18F-fluoro-2-deoxyglucose positron-emission tomography/computed tomography (18FDG-PET/CT) for predicting the malignant potential of GISTs by analyzing the correlation between the maximum standardized uptake value (SUVmax) and postoperative factors. Methods: Thirty consecutive patients underwent surgery after preoperative 18FDG-PET/CT and were diagnosed with pathologically confirmed GIST. The tumor size, mitotic count, MIB-1 index and National Institutes of Health (NIH) risk category were compared with SUVmax. Results: Significant correlations between SUVmax and tumor size and NIH risk category were determined. The sensitivity and specificity of SUVmax for predicting the risk of malignancy were 85.7 and 62.5%, respectively. The optimal cut-off value for SUVmax was 3.0 between patients classified into low-risk and high-risk malignancy groups. There was no significant correlation between SUVmax and mitotic count or MIB-1 index. Multivariate analysis indicated that SUVmax was the only predictive risk factor in the high-risk malignancy group. Conclusions: 18FDG-PET/CT is useful for assessing the malignant potential and bioactivity of GISTs. When SUVmax is >3.0, the tumor must be resected even if it measures <2 cm, because of its high malignant potential.
CD24 is a heavily glycosylated cell surface protein that is expressed in putative stem cells and is overexpressed in various human malignancies, yet the significant roles of CD24 in gastric cancer development are still elusive. We investigated the involvement of CD24 in gastric cancer aggressiveness, which is attributed to its heterogeneity. Cultured gastric cancer cells showed diverse expression patterns in CD24, whereas other defined cell surface markers, such as CD44 and CD133, were homogenous. Purely sorted CD24-negative gastric cancer cells showed strong alteration into the CD24-positive cell type in an autochthonous manner, and reached to steady expression levels. Our clinicopathological study revealed that CD24 positivity was an independent prognostic factor in both intestinal and diffuse types of gastric cancer. CD24 expression was correlated with the advanced stages, invasiveness, and lymph node metastasis of gastric cancer. Silencing of CD24 in cultured cells significantly decreased cell migration and invasion. Hypoxic treatment upregulated CD24 expression, and simultaneously induced cell motility and invasion of gastric cancer cells. Hypoxic treatment-induced CD24 expression was significantly attenuated by knockdown of hypoxia-inducible transcription factors. These data suggest that CD24-negative cells are capable of gaining cell motility and invasiveness through the induction of CD24, which is mediated by hypoxia. CD24 would be an attractive marker to define not only the heterogeneity but also the aggressiveness of gastric cancer cells. The mechanisms by which hypoxia induces CD24 expression would also be a potential therapeutic target for gastric cancer.
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