Introduction: Overexpression of epidermal growth factor receptor (EGFR) in tumor cells has been associated with a poor prognosis, but also offers the therapeutic option of pharmacologically targeting these receptors. The role of EGFR in hepatic malignancies is not clearly understood. The aim of this study was to analyze the expression of the EGFR in gallbladder cancer and cholangiocarcinomas. Methods: Paraffin-embedded samples from 60 patients with carcinomas of the biliary tract were studied. Clinicopathologic features were assessed. The immunohistochemical for EGFR were performed and scored independently by two pathologists. Results: The age of patients was 59 years (range, 28e83). From the 60 patients examined 22 (36.6%) had gallbladder cancer (GB) and 38 (63.3%) cholangiocarcinoma, 9 (23.7%) had intrahepatic, 22 (57.9) perihilar, and 7(18.4%) distal cholangiocarcinomas. Intraductal growth type was identified in 14 (36.8%) cases of cholangiocarcinomas. EFGR was positive in 44% of the GB cancer, and 50% of the cholangiocarcinomas. Conclusions: EGFR was positive in about half of the biliary tract cancer.
Background
The median arcuate ligament syndrome (MALS) is a disease in which the celiac artery is compressed by the arcuate ligament and causes stenosis. If abdominal pain or an aneurysm is observed in the head of the pancreas, it is necessary to release the arcuate ligament, and recently laparoscopic surgery has been reported. However, the indication for treatment in asymptomatic cases is unknown. The treatment for asymptomatic MALS in patients with gastric cancer who are indicated for surgery is also novel.
Case presentation
A 70-year-old female was found with early gastric cancer in the middle body of the stomach. An enhanced CT scan showed no metastasis, but a gallstone and stenosis of the celiac artery due to the MALS were found. The patient underwent releasing median arcuate ligament after lymph node dissection. A median arcuate ligament was located on the ventral side of the left gastric artery stump, and the celiac artery was exposed when cutting it off. The operation time was 4 h and 59 min, and the bleeding was 6 ml. It took about 5 min to dissect the medial arcuate ligament. The postoperative course was satisfactory, and the patient was discharged 7 days after the operation. CT scan and 3-D CT angiography were performed about 2 months after the operation, and the findings revealed that the celiac artery's stenosis resolved.
Conclusion
The patient underwent laparoscopic gastrectomy and simultaneously the median arcuate ligament release under an excellent visual field. Therefore, median arcuate ligament release may be considered if MALS is found in a gastrectomy case.
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