BACKGROUNDIgG4-related disease can manifest diversely, including autoimmune pancreatitis and IgG4-related cholangiopathy. We are reporting a very unusual cause of pancreatic cancer triggered in a previously unknown IgG4-related disease.CASE SUMMARYA 75-year-old man was diagnosed with a 43 mm × 33 mm pancreatic head tumor after consulting for abdominal pain and jaundice. A pancreaticoduodenectomy was carried out uneventfully, and the histopathology report showed an early stage of acinar-cell pancreatic cancer. The patient reconsulted on the 30th postoperative day with fever, jaundice and asthenia. Magnetic resonance cholangiopancreatography evidenced an extense bile duct stricture. A percutaneous biliary drainage proved to be ineffective, even after exchanging it with larger bore drainage. Reviewing the surgical specimen, features compatible with IgG4-related disease were observed. Consequently, empiric treatment with steroids was initiated achieving excellent results.CONCLUSIONIgG4-related disease may cause chronic inflammation of the pancreas and can condition pancreatic malignancies.

Intrahepatic cholangiocarcinoma (iCCA) is a rare tumor that arises from second order or smaller bile ducts. Its incidence has been growing in the last couple of decades, in parallel with its mortality rates, both in America and Europe. The currently accepted gold treatment for iCCA is liver resection (LR). However, results are still poor, with 5-year survival rates ranging between 25% and 40%. In addition, more than half of the patients undergoing LR will relapse, particularly those who present with multifocal iCCA. Given the aggressiveness of this tumor, and the modest results seen with adjuvant and neoadjuvant therapies, the sights have been set on liver transplantation (LT) for this disease. Retrospective studies have shown encouraging results in select patients, especially those with very early-staged iCCA (< 2 cm) who underwent LT. The aim of this review is to analyze the current information regarding LT for iCCA, as well as future perspectives.

Colorectal cancer is the third most common cancer worldwide, and up to 50% of all patients diagnosed will develop metastatic disease. Management of colorectal liver metastases (CRLM) has been constantly improving, aided by newer and more effective chemotherapy agents and the use of multidisciplinary teams. However, the only curative treatment remains surgical resection of the CRLM. Although survival for surgically resected patients has shown modest improvement, this is mostly because of the fact that what is constantly evolving is the indication for resection. Surgeons are constantly pushing the limits of what is considered resectable or not, thus enhancing and enlarging the pool of patients who can be potentially benefited and even cured with aggressive surgical procedures. There are a variety of procedures that have been developed, which range from procedures to stimulate hepatic growth, such as portal vein embolization, two-staged hepatectomy, or the association of both, to technically challenging procedures such as simultaneous approaches for synchronous metastasis, ex-vivo or in-situ perfusion with total vascular exclusion, or even liver transplant. This article reviewed the major breakthroughs in liver surgery for CRLM, showing how much has changed and what has been achieved in the field of CRLM.

Purpose: To evaluate the effectiveness of percutaneous transhepatic direct simultaneous puncture of portal vein and inferior vena cava in Budd-Chiari syndrome and the clinical outcomes. Material and Methods: From January 2006 to January 2022, we performed TIPS in 65 consecutive patients (mean age, 33 years) with BCS (8 patients with acute BCS and 57 patients with subacute and chronic BCS). Doppler US was performed first day, one week, one month and then 3 months apart. Portography and pressure measurements were performed every year if no shunt dysfunction was detected before. Mean follow-up of 52 months (range, 6 months -119 months). Results: TIPS procedure was technically successful in all patients. In all patients, bare stents were used. Patients were anticoagulated with warfarin after TIPS procedure. Early thrombosis (in one week) was diagnosed in 13 (20%) patients and TIPS revision was required. One year primary patency was 65.2%. Clinical success was achieved in 60 patients. 5 patients required liver transplantation because of liver function deterioration but only 3 of them had liver transplantation(7months, 1.5 year and 2 year later from TIPS) other 2 patients died while in the waiting list. Conclusion: Percutaneous direct puncture of portal vein and inferior vena cava is safe and effective in patients with Budd-Chiari syndrome. This procedure may provide an effective alternative for the management of Budd-Chiari patients that necessitates TIPS. Close follow-up and second intervention is necessary to get good clinical outcome.

BACKGROUND: Image-guided percutaneous transthoracic lung biopsy has become a widely used and less invasive diagnostic method. Pneumothorax is the most frequent complication after lung biopsy. The aim of the present study is to describe the experience with expectant management of asymptomatic small post-biopsy pneumothorax in order to reduce unnecessary hospital admissions. METHODS: A retrospective review was performed analyzing the results of subjects who underwent expectant and conservative treatment after presenting pneumothorax following  percutaneous lung biopsy, in a period of 6 years (January 2013 - December 2019) RESULTS: 160 subjects who underwent diagnostic percutaneous lung biopsy of lung nodules were evaluated. Of these, 46 subjects (29%) presented pneumothorax, of which 36 were small. This group of subjects was managed expectantly, with a therapeutic success of 81% (7 subjects had to undergo percutaneous pleural drainage).  CONCLUSION: Expectant management in subjects with pneumothorax following percutaneous lung biopsy is a useful tool and should be applied by surgeons in order to avoid hospitalizations and / or unnecessary  and expensive procedures.