Patient: Female, 71-year-old Final Diagnosis: Hepatic epithelioid angiomyolipoma Symptoms: Abdominal pain Medication:— Clinical Procedure: — Specialty: Pathology • Surgery Objective: Rare disease Background: The World Health Organization classification of premalignant gallbladder lesions includes adenomas, intraductal papillary neoplasms, biliary intraepithelial neoplasia, and intracystic papillary neoplasms. Noninvasive neo-plastic lesions >1 cm that originate from the pancreatobiliary system are defined as intraductal papillary neoplasia when they occur in the biliary ducts. The clinical and pathological features of preinvasive lesions arising in the gallbladder are not yet well defined. However, the most widely accepted classification is that of intracholecystic papillary neoplasm (ICPN). Case Report: We present the case of a 71-year-old woman referred to a General Surgery outpatient clinic for suspicious findings on imaging of the gallbladder, namely irregular infundibular parietal thickening. The patient underwent a laparoscopic cholecystectomy and histological examination revealed a thickened gallbladder with mucosa partially surrounded by ICPN with an intestinal pattern and some foci of low-grade dysplasia but no foci of high-grade dysplasia or invasive neoplasia. At follow-up at 30 months, the patient remains clinically well, with no changes visible on computed tomography scan. Conclusions: ICPN of the gallbladder appears to be part of a spectrum of alterations encompassing bile duct or pancreatic lesions. Although it is uncommon, more than half of the lesions are known to have foci of invasive neoplasia at the time of diagnosis. Despite that, the prognosis for these neoplasms is more favorable than for gallbladder neoplasia that originates from another type of lesion. Pathological study of ICPN is essential to define the main characteristics that impact prognosis and survival in these patients.

Endometrial carcinoma is one of the most common gynaecologic malignancies in the western society. Treatment of recurrent disease became more refined, with the study of molecular and hormonal receptors playing a central role. A 76-year-old caucasian woman presented to the emergency department with growing tiredness, and melaena. Past medical history included an endometrioid adenocarcinoma. The patient had undergone a hysterectomy with bilateral salpingo-oophorectomy with pelvic and paraaortic lymphadenectomy and was disease-free for 2 years. The endoscopy revealed an ulcerated lesion involving the second and third portions of the duodenum. Histopathologic examination confirmed a poorly differentiated adenocarcinoma of endometrial origin. She started palliative chemotherapy, remaining with adequate symptomatic control. Endometrial cancer recurrence typically occurs locally. The liver is the intra-abdominal organ most commonly involved. There are scarce reports of duodenal metastasis of malignancies originated in distant organs. The duodenum remains an uncommon metastization site and is rarely associated with endometrial cancer.

the Hannover classification. The pre-operative MELD score was obtained and correlated with the following: patient characteristics, perioperative variables and postoperative outcomes, including mortality rates. Results: Out of 25 patients, 13 (52%) had open and 12 (48%) had laparoscopic cholecystectomy. 17 patients (68%) were referred to our center within 6 weeks from the time of injury. 14 (56%) were managed by endoscopic stenting, while 7 (28%) had definitive surgical reconstruction. There were no mortalities for patients with MELD score < 20. However, for those patients with MELD scores of 20-29 and 30, the mortality rate was 50% and 100%, respectively. Conclusion: MELD score is a potential prognostic tool for patients with iatrogenic bile duct injury sustained during cholecystectomy.

difference in the baseline demographics, type of primary tumour, level of obstruction and pre-procedural laboratory data between the two groups. Comparison between EPTBD and IEPTBD showed no significant difference in effectiveness of biliary drainage and post-procedural cholangitis and sepsis. However, IEPTBD has significantly higher post-procedural complications at 39% compared to EPTBD at 17% (p value = 0.02). Conclusions: EPTBD is recommended as the preferred intervention for patients with malignant pancreaticobiliary obstruction requiring percutaneous intervention. EPTBD may be less deleterious to certain high risk group, namely, the elderly, patients with proximal obstruction and those with pre-procedural cholangitis and sepsis. However, selected palliative cases may benefit from the more physiological drainage of IEPTBD.

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