Background Solitary fibrous tumor (SFT), a mesenchymal fibroblastic tumor with a hypervascular nature, rarely develops in the pelvis. Resection of a giant SFT occupying the pelvic cavity poses an increased risk of developing massive hemorrhage during resection, although surgical resection is the most effective treatment method for this tumor to achieve a potential cure. SFT rarely develops with Doege–Potter syndrome, which is known as a paraneoplastic syndrome characterized by non-islet cell tumor hypoglycemia (NICTH) secondary to SFT that secretes insulin-like growth factor-II (IGF-II). We present a case of a giant pelvic SFT with Doege–Potter syndrome, which was successfully treated with transcatheter arterial embolization (TAE) followed by surgical resection. Case presentation A 46-year-old woman presented with a disorder of consciousness due to refractory hypoglycemia. Images of the pelvis showed a giant and heterogeneously hypervascular mass displacing and compressing the rectum. Endocrinological evaluation revealed low serum levels of insulin and C-peptide consistent with NICTH. Angiography identified both the inferior mesenteric artery and the bilateral internal iliac artery as the main feeders of the tumor. To avoid intraoperative massive bleeding, super-selective TAE was performed for the tumor 2 days prior to surgery. Hypoglycemia disappeared after TAE. The tumor was resected completely, with no massive hemorrhage during resection. Histologically, it was diagnosed as IGF-II-secreting SFT. Partial necrosis of the rectum in the specimen was observed due to TAE. The patient was followed up for 2 years and no evidence of disease has been reported. Conclusions Preoperative angiography followed by TAE is an exceedingly helpful method to reduce intraoperative hemorrhage when planning to resect SFT occupying the pelvic cavity. Complications related to ischemia should be kept in mind after TAE, which needs to be planned within 1 or 2 days before surgery. TAE for tumors may be an option in addition to medical and surgical treatment for persistent hypoglycemia in Doege–Potter syndrome.

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Introduction: This study aimed to elucidate indications and limitations of pancreaticoduodenectomy (PD) for gallbladder carcinoma (GBC). Methods: This study retrospectively analyzed the longterm outcomes of 37 patients undergoing PD for GBC. PD was indicated for tumors with evident peripancreatic nodal metastasis and/or massive invasion of the pancreas/duodenum/bile duct. Primary end point was overall survival (OS). The median follow-up time was 264 months. Results: Morbidity ( Clavien-Dindo IIIB) and in-hospital mortality were 19% (n = 7) and 8% (n = 3), respectively. For all 37patients, OS following resection was 31% at 5 years and 25% at 10 years (median survival time, 20 months). Multivariate analysis identified residual tumor status (P = 0.009) and the extent of disease (P = 0.025) as independent prognostic factors. The 5-year OS in patients with and without residual tumor was 43% and 0%, respectively (P < 0.001). The 5-year OS in patients with peripancreatic nodal disease (n = 12), organ involvement other than the liver (n = 12), and the both (n = 13) was 52%, 37%, and 8%, respectively (P = 0.001). There were 10 5-year survivors; all the patients underwent R0 resection. Of the 10 patients, 6 had peripancreatic nodal disease; 3 had 3 positive nodes. Conclusions: PD provides survival benefit for some patients with advanced GBC only if R0 resection is feasible. Patients with both peripancreatic nodal disease and organ involvement other than the liver are not good candidates for PD. PD may be beneficial in selected patients with peripancreatic nodal disease.