Neuroma of the biliary tract is a rare condition thought to be caused by trauma secondary to cholecystectomy. More rare is the occurrence that causes symptomatic biliary obstruction. A 65-year-old woman was hospitalized because of abdominal pain, nausea, vomiting, and general malaise of 1 to 2 months duration. Cholecystectomy had been performed 40 years before. Ultrasound revealed hepatomegaly and dilated intrahepatic ducts. CT showed intra- and extrahepatic ductal dilatation with questionable intraductal mass. Endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangiography demonstrated stricture of the hepatic duct bifurcation. The biliary bifurcation was resected, and hepaticojejunostomy was performed. The patient's postoperative course was unremarkable. Histological examination of the surgical specimen revealed positive staining for the S-100 antigen of the obstructing luminal stricture (without evidence of cholangiocarcinoma), which was consistent with a biliary neuroma. Positive staining was also found for acidic (and not basic) fibroblast growth factor (FGF) and two of its high affinity receptors (FGFR-1 and FGFR-4). This study supports the apparent association between biliary neuromas and cholecystectomy as well as the potential role of an established angiogenic and neurogenic growth factor in the formation of this tumor. Finally, this case is also unique in that it represents the longest interval between cholecystectomy and presentation of a biliary neuroma, 40 years after surgery.

Very few case reports of pure squamous cell carcinoma (SCC) of stomach are available in the world literature. The exact pathology of this uncommon carcinoma in stomach remains unknown. This is an additional case report of SCC in an elderly female arising in the gastric antrum. She underwent distal gastrectomy, gastrojejunostomy and jejunojejunostomy. The histopathology was reported as SCC of stomach without any adenocarcinomatous component. She had no other source of extra gastric primary SCC. After surgery, the patient was advised adjuvant chemotherapy. This is an additional case of primary SCC of stomach.

abdominal mass in (28.6%) cases. All 35 patients had curative resection including pancreaticoduodenectomy, central pancreatectomy and distal pancreatectomy. POPF developed in 4 cases (8.6%), biliary leakage occurred in 8 cases (22.9%). The recurrence rate was (12%) after 3 years postoperatively. No hospital mortality, all patients except 2 patients (5.7%) were alive at follow up period. The estimated 1, 3, and 5 year survival rate was 95%, 95%, and 88%. Conclusion: SPT are increasing in last years in our locality. It is presented more in young females. The tumour was located in the head in majority of cases. Aggressive surgical resection is needed even in presence of local invasion, and also for recurrence as patients had a good long term survival.

used EUSE to assess pancreatic texture at the resection margin and its relation to pancreatic fibrosis and POPF. Methods: Between June 2012 and December 2013 all patients who underwent EUS for diagnosis/assessment of resectability had an EUSE done. An area (A) in the neck/body (intended resection site) and another area (B) in the peripancreatic soft tissue were analysed. The strain ratio (B/A) was used to assess pancreatic texture. The main pancreatic duct (MPD) size was measured and the degree of fibrosis at the resected pancreatic margin was assessed histologically. Results: Thirty-four patients were studied. A strain ratio of 2.75 defined normal/soft and >2.75 as firm/very firm pancreas. Nine had clinically relevant POPF (26.5%; ISGPF grades B: 6 and C: 3). A higher proportion of patients with strain ratio 2.75 developed POPF (34.7% vs. 9.1%; p = 0.21) and had a sensitivity and negative predictive value of 88.9% and 91%, respectively Patients with no/minimal fibrosis had a higher rate of POPF(32% vs. 11.1%; p = 0.39). Strain ratio correlated well with pancreatic texture, fibrosis grade and MPD size (p < 0.001). POPF occurred more frequently in those with a higher mean BMI (22.5 AE 3.6 vs. 20.1 AE 2.7; P = 0.04). Strain ratio had an accuracy, sensitivity, specificity, PPV and NPV of 88.2%, 89%, 88%, 72.7% and 95%, respectively for assessment of fibrosis. Conclusions: EUSE of the pancreas did not predict POPF but correlated well with pancreatic texture, degree of pancreatic fibrosis and MPD size.

Background: Liver hydatidosis is a common health problem in endemic areas. Cysto biliary communication is the most common complication of liver hydatid. Methods: All cases of liver hydatid operated during the period 2000 to 2015 were retrospectively assessed. Demographic characteristics, laboratory investigations were noted. Computed tomographic (CT) findings, intra-operative findings, postoperative outcomes and any intervention if done were noted. Results: 71 patients with liver hydatid underwent surgical intervention. There were 32 male and 39 female patients. Mean age was 42years. Most common presenting symptom was pain (67/71), history of jaundice was present in 5(7%) patients.Bilirubin was elevated in 3(4.2%) patients, alkaline phosphatase was elevated in 16(22.5%) patients. Total counts were elevated in 11(15.5%) patients. Radiologically, majority (84%) were solitary, mean size was 9.8 cm, 66% (47/71) were present in right lobe, 19.7% (14/ 71) involved left lobe, rest involved both lobes.Cystobiliary communication was detected in a total of 14patients. Two were identified preoperatively, they underwent preoperative ERCP, 5 were identified intra-operatively, the communication was sutured, and 7 were identified postoperatively. Size (p = 0.0192), central location (p = 0.0011) were significant predictors of cystobiliary communication. Marsupialization was done in 66 patients, Cystopericystectomy in 4 patients and one patient underwent right hepatectomy. There were 10 recurrences in the follow up period. Conclusion: Liver hydatid cysts present most commonly with pain abdomen, more common inn right lobe.Cystobiliary communication is more common with large cyst size, location in the central segments of liver close to biliary confluence. Timely diagnosis and appropriate management decreases the morbidity and mortality.