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1
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Pancreatic-pleural fistula presenting as epigastric pain

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Bąk M., Murawa D.
Polish Journal of Surgery
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2020
|
vol. 92(4)
54-57
EN
We are reporting a case of a pancreatic-pleural fistula causing epigastric pain. Chest radiograph revealed pleural effusion reaching the seventh rib. Thoracocentesis was performed and 1600 mL of brownish fluid was removed, which showed an elevated amylase level. Ultimately, the diagnosis was confirmed by computed tomography. Due to the failure of medical and endoscopic treatment, the decision was made to perform surgery. It resulted in total pancreatectomy.
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Przetoka trzustkowo-opłucnowa manifestująca się dolegliwościami bólowymi nadbrzusza

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Bąk M., Murawa D.
Polish Journal of Surgery
|
2020
|
vol. 92(4)
54-57
PL
Przedstawiamy przypadek przetoki trzustkowo-opłucnowej objawiającej się dolegliwościami bólowymi nadbrzusza. Na zdjęciach RTG klatki piersiowej uwidoczniono płyn w prawej jamie opłucnowej, sięgający do VII żebra. Po punkcji opłucnej uzyskano 1600 ml brunatnego płynu z wysokim poziomem diastaz. Ostateczne rozpoznanie postawiono na podstawie tomografii komputerowej. Ze względu na niepowodzenie metod zachowawczych i endoskopowych, zdecydowano się na zabieg operacyjny, który zakończył się totalną resekcją trzustki.
3
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Analysis of risk factors of positive peritoneal cytology in patients treated for gastric cancer – preliminary report

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Lisiecki R., Spychała A., Peter K., Murawa D.
Polish Journal of Surgery
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2015
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vol. 87(10)
506-512
EN
Presence of free gastric cancer cells in the peritoneal cavity of patients who underwent surgical treatment for gastric cancer is a negative prognostic factor and caused rapid disease recurrence, manifested as peritoneal metastases. Positive peritoneal cytology despite lack of visible peritoneal metastases was regarded as M1 class in the TNM classification (7th edition) in 2010. The aim of the study was to analyze factors associated with positive peritoneal cytology and identify groups of patients in whom diagnostic laparoscopy plus peritoneal lavage in the diagnostic process could affect therapeutic decisions. Material and methods. The study enrolled patients with gastric cancer who underwent surgical treatment at the Department of Surgery, Wielkopolskie Oncology Center in Poznań. During the laparotomy, after opening of the peritoneal cavity, 200 ml of physiological saline at 37°C was administered in the tumor region. After this fluid was mixed, 100 ml of lavage fluid was collected. This fluid was subsequently spun many times to obtain sediment for cytology and immunohistochemistry investigation using anti-BerEp-4, CK 7/20, and B72.3. Results of peritoneal cytology were analyzed jointly with clinical factors – patient’s age, sex and pathology factors – tumor invasion, involvement of lymph nodes, histological grade, histological type according to Lauren and localization of the cancer in the stomach. Results. Analysis of the peritoneal fluid for presence of free cancer cells was done in 51 patients. Positive peritoneal cytology was found in 12 (23.5%) patients. In the group of patients with positive cytology, all patients had T3/T4 tumors and all were found to have lymph node metastases, while G3 cancer was found in 83.3% of patients. In patients with positive cytology, diffuse gastric cancer according to Lauren predominated (9 of 12 patients, 75%), while in patients with negative cytology – intestinal type (20 of 39 patients, 51.2%). In the group of patients with positive histology, the whole stomach was involved by the cancer process in 7 of 12 patients (58.3%), while in the group with negative histology, in 29 of 39 patients the tumor was located in the gastric body and prepyloric part (74.4%). Conclusions. Based on this study we can conclude that determinants of positive peritoneal cytology include: tumor stage T3/T4, N+, G3, cancer located in the whole stomach, diffuse histological type according to Lauren.
4
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Comparison of lymphatic system staging classifications in patients with gastric cance

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Spychała A., Nowaczyk P., Murawa D.
|
EN
Despite an observed decrease in the incidence of gastric cancer, it still remains an important clinical problem. It is the fourth most common cancer in the world and the second cause of death in cancer patients. The quality of lymphadenectomy procedure and the number of analysed lymph nodes are both important factors influencing the treatment of the patient. The aim of the study was to compare the lymph node ratio staging system with the 6th and 7th edition of the TNM classification. Material and methods. A group consisting of 493 patients who underwent surgery in 1998–2010 due to gastric cancer was used to compare the staging systems. Following statistical analysis, the following cut-off points were adopted for the lymph node ratio for the purpose of comparison: 0, from 0.05 to 0.3, from 0.3 to 0.5 and over 0.5. Subsequently the homogeneity (using chi-square test for linear trend) and the predictive value of the different classifications (using Akaike information criterion) were assessed in order to compare the lymph node ratio staging system with the 6th and 7th edition of the TNM classification. Results. The lymph node ratio classification has a higher discriminatory value than the TNM classifications (higher linear trend result). What is more, the lymph node ratio classification (LNR) had a lower Akaike information criterion value, which means that it has a higher prognostic value than the other classifications. ROC curves and the area under the curve (AUC) were utilised for the analysis of predictive value of the different classifications in patients with gastric cancer. Conclusion. One may conclude, therefore, that the lymph node ratio staging system is the best classification of the lymphatic system in the presented group of patients.
5
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Krwiak śródścienny żołądka imitujący guz podścieliskowy przewodu pokarmowego – opis przypadku i przegląd literatury

71%
Spychała A., Nowaczyk P., Budnicka A., Antoniewicz E., Murawa D.
Polish Journal of Surgery
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2017
|
vol. 89(2)
62-65
PL
W pracy przedstawiono opis przypadku pacjenta z krwiakiem śródściennym żołądka. W przeprowadzonych badaniach diagnostycznych wysunięto podejrzenie guza podścieliskowego przewodu pokarmowego. W badaniu gastroskopowym stwierdzono obraz prawidłowy, natomiast w badaniu tomografii komputerowej jamy brzusznej uwidoczniono wzdłuż krzywizny większej żołądka zmianę guzowatą wychodzącą z jego tylnej ściany, przylegającą do trzustki i śledziony. Chorego zakwalifikowano do leczenia chirurgicznego. Wykonano laparotomię, całkowitą resekcję żołądka, rekonstrukcję przewodu pokarmowego metodą Roux-en-Y. W pooperacyjnym badaniu histopatologicznym zaobserwowano obecność rozległego krwiaka penetrującego do tkanki tłuszczowej okołożołądkowej oraz liczne hemosyderynofagi i odcinkowe wykładniki tworzenia ziarniny zapalnej wskazujące na przewlekły charakter zmiany. Wyniki badań immunohistochemicznych w kierunku GIST (CD117, DOG-1, CD34, CD31, SMA, S-100, CKAE1/AE3, Ki-67) były ujemne. Przebieg pooperacyjny bez powikłań. Pacjent pozostaje pod stałą kontrolą i obserwacją. W kontrolnym badaniu gastroskopowym i tomografii komputerowej jamy brzusznej po 6 miesiącach od operacji stwierdzono obraz prawidłowy.
6
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Masywny stan zapalny po usunięciu uszkodzonego implantu silikonowego maskujący inwazyjnego raka piersi – opis przypadku i przegląd piśmiennictwa

71%
Nowaczyk P., Budnicka A., Wichtowski M., Kurzawa P., Murawa D.
Polish Journal of Surgery
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2016
|
vol. 88(1)
67-77
PL
W pracy przedstawiono opis przypadku pacjentki z rakiem przewodowym inwazyjnym piersi po zabiegu powiększenia piersi. W marcu 2013 r. po pęknięciu implantów, podjęto decyzję o ich usunięciu – w badaniu histopatologicznym rozlany silikon z naciekami zapalnymi, bez zmian nowotworowych. W kontrolnych badaniach obrazowych stwierdzono w obu piersiach liczne zmiany o charakterze otorbionego silikonu oraz skupisko makrozwapnień pozapalnych. W styczniu 2014 r. chora zgłosiła się z objawami masywnego zapalenia piersi lewej. Po konsultacji chirurgicznej podjęto decyzję o mastektomii radykalnej lewostronnej z limfadenektomią. W badaniu histopatologicznym materiału pooperacyjnego rozpoznano wieloogniskowego zaawansowanego raka przewodowego inwazyjnego G3 pT3pN3a (inwazja naczyń, przerzuty w 11/12 węzłach pachy). Po operacji pacjentka została zakwalifikowana do dalszego leczenia – chemioterapia, radioterapia, hormonoterapia. W „omówieniu” dokonano przeglądu piśmiennictwa dotyczącego oceny ryzyka współwystępowania chorób nowotworowych piersi u kobiet z silikonowymi implantami piersi oraz przedstawiono problemy diagnostyczne raka piersi w tej grupie chorych.
7
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Massive inflammatory reaction following the removal of a ruptured silicone implant masking the invasive breast cancer – case report and literature review

71%
Nowaczyk P., Budnicka A., Wichtowski M., Kurzawa P., Murawa D.
Polish Journal of Surgery
|
2016
|
vol. 88(1)
41-47
EN
This paper presents a case of a patient with invasive ductal breast cancer following breast augmentation. Following breast implants rupture in March 2013 the breast implants have been removed – histopathological examination revealed leaked silicone with inflammatory infiltration, without evidence of cancerous lesions. Diagnostic imaging revealed multiple encapsulated silicone particles and clusters of post-inflammatory macrocalcifications in both breasts. In January 2014 the patient presented with symptoms of massive inflammation of the left breast. Following surgical consultation the patient had undergone radical left-sided mastectomy with lymphadenectomy. Postoperative histopathological examination revealed a multifocal advanced invasive ductal cancer G3 pT3pN3a (vascular invasion, metastases in 11 of 12 examined axillary lymph nodes). Following surgery the patient was qualified for further treatment – chemotherapy, radiotherapy, hormone therapy. The discussion includes a review of literature on the risk evaluation of co-occurrence of breast cancers in women with silicone breast implants and presents diagnostic challenges of breast cancer in this patient group.
8
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Intramural gastric hematoma imitating a gastrointestinal stromal tumor – case report and literature review

71%
Spychała A., Nowaczyk P., Budnicka A., Antoniewicz E., Murawa D.
Polish Journal of Surgery
|
2017
|
vol. 89(2)
62-65
EN
The article presents a case report of a patient with an intramural gastric hematoma. Diagnostic examinations were suggestive of a suspected gastrointestinal stromal tumor Normal image was observed in gastroscopic examination while abdominal CT scan revealed a nodular lesion along the greater curvature of the stomach extending from the posterior wall and adjoining the pancreas and the spleen. The patient was qualified for surgical treatment. Laparotomy was performed followed by total gastric resection and Roux-en-Y reconstruction of the gastrointestinal tract. Post-operative histopathological examination revealed the presence of an extensive hematoma penetrating the perigastric fat tissue along with numerous hemosiderinophages and segmental indicators of formation of inflammatory granulation tissue suggestive of a chronic nature of the lesion. Immunohistochemical GIST assays (CD117, DOG-1, CD34, CD31, SMA, S-100, CKAE1/AE3, Ki-67) were negative. No complications were observed in the post-operative course. Patient is subject to continued follow-up and observation. Follow-up gastroscopy and abdominal CT scan performed 6 months after the surgery revealed an unremarkable image.
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