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Query: UMLS:C0000737 (abdominal pain)
 31,184 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We experienced an unusual case of duodenal adenocarcinoma associated with Peutz-Jeghers syndrome (PJS). A 34-year-old woman was admitted to our hospital with abdominal pain. She had been diagnosed as having PJS at 21 years of age, based on the presence of mucocutaneous pigmentation of the lip and fingertips, and colonic hamartomatous polyps. Abdominal computed tomography revealed a tumor in the third portion of the duodenum extending into the pancreas head. As the tumor was pathologically determined to be adenocarcinoma at the time of surgery, pylorus-preserving pancreaticoduodenectomy was performed. We carried out molecular analyses of this patient to examine the pathway of carcinogenesis in PJS. The tumor did not show somatic mutation of the APC and K-ras genes, which is a critical step for the adenoma-carcinoma sequence in colon cancer. Importantly, a germline mutation of the STK11 gene was detected at codon 281 delC in exon 6. Moreover, the tumor showed loss of heterozygosity of the 19p marker near STK11 and somatic mutation of the p53 gene. These findings suggest that STK11 is a tumor suppressor gene regulating the development of hamartomas, and that somatic mutation of p53 subsequently promotes gastrointestinal cancer at a later stage in PJS.
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PMID:Duodenal cancer in a patient with Peutz-Jeghers syndrome: molecular analysis. 1205 37

At least 50 proven cases of liver tumors following use of oral contraceptives have been reported. The authors reports 12 in his practice but thinks may have gone unrecognized elsewhere. The 11 cases reported to the surgical meeting in Miami Beach were solitary primary tumors in nonalcoholic and otherwise healthy women with an average of 32 years. Of these 6 had been taking oral contraceptives for 5 or more years, 3 for 2 years or less, and 2 for 1 year or less. Several had catastrophic hemorrhage, abdominal pain, and shock. Hemoperitoneum was found at laparotomy. In 2 cases the tumors were malignant. In 5 cases the tumors had not bled but were found incidentally at laparotomy. No particular type of contraceptive was correlated. sometimes the patient had detected a lump in the right upper part of the abdomen. All tumors were hepatocellular. The tumors were hamartoma, focal nodular hyperplasia, and adenoma or hepatocellular carcinoma.
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PMID:A few women taking the pill found to have benign liver tumors. 1233 50

A recent case-control study by a team of University of Southern California investigators follows published observations on a total of 107 liver tumors among young women. Most of them were, or had been, oral contraceptive users. The importance of duration of use in the etiology of these tumors was shown by data on 58 women reported at the 1976 annual meeting of the American College of Obstetricians and Gynecologists. Of the 58 women who developed these tumors, 85% had used the pill continuously for more than 4 years. An increasing number of such reports has induced the National Cancer Institute to undertake an investigation regarding these tumors. Almost all of the reported tumors have been benign and described as adenomas, hamartomas, or focal nodular hyperplasia. Some have been without symptoms. Others have been associated with severe abdominal pain or sudden bleeding. A case-control study of 34 young women diagnosed as having benign liver tumors in 1955-1976 was made with appropriate controls. Of the 34 tumor cases, 29 had used oral contraceptives but 26 of the controls had done so also. The tumor patients had taken the pills for significantly longer periods than the controls. The risk of developing liver tumors increased with duration of use and was 2.5 times greater than after 3-5 years than for 1 year or less of use. After 5 years of use, the risk increased sharply to 25 times greater after 9 or more years of pill use. A palpable mass was present in 34% of the cases and severe abdominal pain in 29% of 1 series. Pills containing mestranol seemed more likely to cause liver tumors than those containing ethinyl estradiol. Another report was of 44 case histories published within the past 5 years and 27 new cases reported to the Registry for Liver Tumors Associated with Oral Contraceptives. This Registry was established in 1975. Duration and type of pill use was recorded for 58 of them. Of these, 85% had taken the pill for over 4 years. Mestranol-containing pills had been mostly used. Norethindrone was often used. Of these tumors, 18 ruptured resulting in the death of 8 of the 71 women. In Louisville, 9 cases of benign liver tumors were diagnosed between 1968 and 1974 in women who had used oral contraceptives. No similar tumors had been observed in a comparable age group of women in the previous 13 years. In 1 case, a patient had the tumor removed and resumed the pills. After 6 years a 2nd similar tumor developed. It was not removed but regressed somewhat in 5 months when the oral contraceptive was omitted. In Britain and the U.S., 3 prospective studies of pill users are being conducted. The different types of liver tumors involved seem to have different etiologies. Focal nodular hyperplasia is sometimes found in men but liver-cell adenoma is almost exlusively found in women, many of whom have used oral contraceptives. The Central Registry may resolve some questions.
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PMID:Case control study finds long-term pill use is associated with higher risk of benign liver tumors. 1233 49

Adenomatous polyps of the jejunum/ileum in patients with familial adenomatous polyposis (FAP) are usually small (<5 mm) and are considered to be of little clinical importance. Genetic alterations in these polyps have not previously been analyzed. We herein report an extremely rare case of FAP presenting with intussusception caused by jejunal adenomas. Both somatic and germline mutations of the APC gene were detected in one of the polyps. A 40-year-old man with FAP was admitted for closure of an ileostomy that had been created because of an anastomotic leak after subtotal proctocolectomy with ileo-anal-canal anastomosis. During the follow-up after that surgery, he had occasionally complained of colicky abdominal pain, but it had quickly subsided. At the second laparotomy, for closure of the ileostomy, jejuno-jejunal intussusception was incidentally found, and segmental resection of the jejunum, including the leading point of the intussusception, was performed. There were five polyps clustered in the resected jejunum. Histologically, the polyps, ranging from 5 to 26 mm in diameter, were adenomas with moderate to severe atypia. Genetic examinations of one of the largest polyps, using polymerase chain reaction single-strand conformation polymorphism (PCR-SSCP) and direct sequencing methods, revealed somatic (T insertion at codon 1557) and germline mutations (4 base-pair deletion at codons 181-182) of the APC gene. This is the first evidence that the coexistence of somatic and germline alterations in the APC gene is involved in the development of a jejunal adenoma causing small-bowel intussusception.
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PMID:APC gene mutations in a jejunal adenoma causing intussusception in a patient with familial adenomatous polyposis. 1252 39

We report a case of distal common bile duct adenoma presenting with acute cholangitis. A 47-year-old woman suffered from right upper abdominal pain with persistent fever for 4 days. Abdominal ultrasonography showed mild dilatation of common bile duct and bilateral intrahepatic ducts. Endoscopic retrograde cholangiopancreatography disclosed a fixed filling defect in the distal common bile duct. Transpapillary biopsy and brush cytology was performed after sphincterotomy. The biopsy specimen showed adenomatous change with dysplasia and negative stain for p53. No significant regional lymph node enlargement was found on computed tomography. The patient subsequently received exploratory laparotomy and sphincteroplasty with excision of the distal common bile duct tumor. Finally, the tumor was diagnosed as common bile duct tubular adenoma with moderate nuclear dysplasia. Postoperatively, the patient had an uneventful course and has been well at follow-up for 8 months. We encountered a rare case of common bile duct adenoma in which malignant change was hard to rule out. We propose that sphincterotomy with biopsy is crucial before operation and p53 immunohistochemical staining is valuable for determining whether or not malignant change occurs in this borderline tumor.
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PMID:Acute cholangitis secondary to a common bile duct adenoma. 1284 56

The March COM. A 41-year-old woman presented in 1997 with diffuse abdominal pain, meteorism and intermittent diarrhea. Imaging studies revealed a focal rounded lesion in the liver. Although there was no history of progesterone or estrogen therapy, the radiographic appearance was considered to be suggestive of adenoma. The lesion was monitored by ultrasound until October 2000 when a resection was performed because of the presumed risk of a malignant transformation. H&E stained sections revealed an ectopic ependymoma that was strongly positive for GFAP. The surrounding hepatic tissue was negative for GFAP. An extensive search for a CNS manifestation or any other extraspinal localization was unrevealing. We believe we have encountered the first case of an ectopic ependymoma presenting as a solitary hepatic lesion in the absence of CNS disease. Ependymomas generally arise in the CNS in relation to the ventricular system. Extraneural metastasis from ependymomas may occasionally occur even years after detection and treatment of the primary lesion and have been the subject of several reports. In contrast, there are only anecdotal reports of primary extraneural "ectopic" ependymomas. So far those rare cases have only been found in close vicinity to the neural axis, eg, in the sacrococcygeal region, the posterior mediastinum or the ovaries and are there thought to originate from embryonic remnant cells around the neural tube. Distant metastases of ependymomas invading or arising within the extraneural lumbosacral soft tissue may occur in this situation. Here, we report what appears to be the first case of a primary ectopic ependymoma originating in the liver, with no signs of CNS or other systemic involvement.
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PMID:March 2003: a 41 -year-old female with a solitary lesion in the liver. 1294 33

Polypoid lesions of the gallbladder (PLG) are rare in childhood. The authors describe 2 additional cases. A 12 year-old-girl was found to have a 5-mm gallbladder polyp during an ultrasound examination for nonspecific abdominal pain. Investigation showed no other biliary tract abnormality. During the next 5 years, she was reviewed periodically with ultrasound scans and underwent cholecystectomy when the diameter of the polyp increased to 1 cm. Histology results showed a benign cholesterol polyp. A 12-year-old-boy was found to have an incidental gallbladder polyp, which 2 years later remained static in size for 10 months. The polyp had disappeared spontaneously. The authors suggest that PLGs in children may be either primary or secondary. Only 11 primary PLGs have been reported, and their histology is variable (adenoma, gastric heterotopia, and epithelial hyperplasia). Secondary PLGs may be found in association with metachromatic leukodystrophy, Peutz-Jeghers syndrome, or pancreato-biliary malunion. The pathologic spectrum of PLGs in children appears to be different from that in adults. For primary PLGs, cholecystectomy is advisable if there are biliary symptoms or if the polyp is > or =1 cm in size. Asymptomatic cases should be maintained under ultrasound surveillance.
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PMID:Gallbladder polyps in children--classification and management. 1461 26

Metanephric adenoma of the kidney is rare. We report 2 cases of metanephric adenoma with massive hemorrhage and necrosis. Case 1, a 42-year-old Japanese woman, complained of abdominal pain. Case 2, a 41-year-old Japanese woman, complained of fever and lumbago. They underwent nephrectomy. The cut surface was solid and yellow with massive hemorrhage and necrosis. These tumors showed packed tubular and glomeruloid patterns. The tumor cells were uniform and small, with uniform, oval, and hyperchromatic nuclei and scant cytoplasm, and showed reactivity for cytokeratin, vimentin, and CD 57. The MIB-1 indexes were up to 0.63%. The DNA ploidy pattern was diploid. The tumor cells formed small tubular structures with lumina and microvilli. These features suggested that metanephric adenoma is a benign tumor of an immature epithelial nature.
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PMID:Metanephric adenoma of the kidney with massive hemorrhage and necrosis: immunohistochemical, ultrastructural, and flow cytometric studies. 1461 36

We reported the outcomes of computed tomography (CT)-guided percutaneous acetic acid injection therapy for functioning adrenocortical adenomas. With the patient in a prone position, the puncture needle was inserted vertically downward into the adenoma with frequent CT scanning. After confirmation by pilot injection with contrast medium, a small aliquot of 40-50% acetic acid was injected and repeated. Between 1997 and 2002, 18 sessions of CT-guided injection therapy, including one session of ethanol injection, were performed on 10 patients (five patients with primary aldosteronism and five patients with Cushing's or subclinical Cushing's syndrome) without any complications except transient upper abdominal pain during the acetic acid injection. The follow-up period ranged from 5-69 months. The treatment resulted in almost an extirpation of the adrenocortical hyperfunction in seven patients after one or two sessions. CT-guided percutaneous acetic acid injection might be a simple, cost-effective, and far less invasive treatment for small functioning adrenocortical adenomas.
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PMID:Computed tomography-guided percutaneous acetic acid injection therapy for functioning adrenocortical adenoma. 1467 Nov 74

Adenoma is the most frequent type of gall-bladder (GB) neoplasm; however, GB neoplasms are unusual and unsuspected diagnoses in childhood. The average patient age is 50 +/- 16.3 years. We present a case of tubulopapillary adenoma of the gallbladder in a 3-year-old girl. She was admitted to the hospital with a 6-month history of abdominal pain and nausea and vomiting. Ultrasonography (USG) revealed an echogenic soft tissue lesion in the lumen of the GB. She underwent cholecystectomy. A tubulopapillary adenoma and adenomatous hyperplasia of the GB were diagnosed histologically. According to the literature, this is the youngest patient found to have gallbladder adenoma.
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PMID:A tubulopapillary adenoma of the gallbladder in a child of 3 years. 1501 77


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