Transdiaphragmatic extension of pyogenic liver abscess is the rarest cause of pericarditis and pleural empyema. It is a rapidly progressive and highly lethal infection with mortality rates reaching 100% if left untreated. However, the transmission route, treatment methods and prognosis have not been well studied. A 65-year-old male patient presented with a fever, dyspnea, and right upper quadrant abdominal pain. Computed tomography of the chest and abdomen showed huge liver abscess without full liquefaction in the left lobe, large amount of left pleural effusion, and mild pericardial effusion, and the patient was treated with parenteral antibiotics and pigtail insertion at the left pleura. However, four days later, cardiac tamponade was developed and surgical drainage of the abscess and pericardium was performed. Klebsiella pneumonia was isolated from pleural empyema. Twenty-five days after surgery, the patient was discharged without any complications. Herein, we report a rare case of pleural empyema and pericarditis in that resulted from the extension of huge pyogenic liver abscess. Early surgical treatment may have prevented progression of the pericarditis to the more dismal purulent pericarditis. We also review pertinent English literature on pericarditis as a complication of PLA.

Song SH, et al. Ann Hepatobiliary Pancreat Surg. 2020 Feb;24(1):57-62. https://doi.org/10.14701/ahbps.2020.24.1.57

Pancreatic metastasis from papillary thyroid cancer (PTC) is extremely rare; only 18 cases have been reported in the literature. However, several reviews have highlighted similar characteristics between metastatic and primary pancreatic tumors. The patient was a 51-year-old male with a history of total thyroidectomy, modified radical neck dissection, and radioactive iodine ablation for PTC in 2014. Nodules suspected of metastasis were found in both lungs on chest computed tomography (CT). However, after 6 months, a follow-up chest CT showed no increase in size; thus, a follow-up observation was planned. Six years after his initial diagnosis, abdominal CT and pancreas magnetic resonance imaging revealed a 4.7 cm cystic mass with a 2.5 cm enhancing mural nodule in the pancreas tail. We diagnosed the pancreatic lesion as either metastatic cancer or primary pancreas cancer. The patient underwent distal pancreato-splenectomy. After surgery, the pathological report revealed that the mass was metastatic PTC. Pancreatic metastasis from PTC indicates an advanced tumor stage and poor prognosis. However, pancreatectomy can increase the survival rate when the lesion is completely resectable. Therefore, surgical resection should be considered as a treatment for pancreatic metastasis from PTC.

Hyung Sun Kim, Mee Joo Kang, Jingu Kang, Kyubo Kim, Bohyun Kim, Seong-Hun Kim, Soo Jin Kim, Yong-Il Kim, Joo Young Kim, Jin Sil Kim, Haeryoung Kim, Hyo Jung Kim, Ji Hae Nahm, Won Suk Park, Eunkyu Park, Joo Kyung Park, Jin Myung Park, Byeong Jun Song, Yong Chan Shin, Keun Soo Ahn, Sang Myung Woo, Jeong Il Yu, Changhoon Yoo, Kyoungbun Lee, Dong Ho Lee, Myung Ah Lee, Seung Eun Lee, Ik Jae Lee, Huisong Lee, Jung Ho Im, Kee-Taek Jang, Hye Young Jang, Sun-Young Jun, Hong Jae Chon, Min Kyu Jung, Yong Eun Chung, Jae Uk Chong, Eunae Cho, Eui Kyu Chie, Sae Byeol Choi, Seo-Yeon Choi, Seong Ji Choi, Joon Young Choi, Hye-Jeong Choi, Seung-Mo Hong, Ji Hyung Hong, Tae Ho Hong, Shin Hye Hwang, In Gyu Hwang, Joon Seong Park. Ann Hepatobiliary Pancreat Surg 2024;28:161-202. https://doi.org/10.14701/ahbps.23-170

Several treatment guidelines for sporadic, nonmetastatic nonfunctioning neuroendocrine tumors of the pancreas (NF-pNETs) have recommended resection, however, tumors ≤ 2 cm do not necessarily need surgery. This study aims to establish a surgical treatment plan for NF-pNETs ≤ 2 cm. From 2000 to 2017, 483 patients who underwent resection for NF-pNETs ≤ 2 cm in 18 institutions from Korea and China were enrolled and their medical records were reviewed. The median age was 56 (range 16–80) years. The 10-year overall survival rate (10Y-OS) and recurrence-free survival rate (10Y-RFS) were 89.8 and 93.1%, respectively. In multivariable analysis, tumor size (>1.5 cm; HR 4.28, 95% CI 1.80–10.18, p = 0.001) and nodal metastasis (HR 3.32, 95% CI 1.29–8.50, p = 0.013) were independent adverse prognostic factors for OS. Perineural invasion (HR 4.36, 95% CI 1.48–12.87, p = 0.008) and high Ki-67 index (≥3%; HR 9.06, 95% CI 3.01–27.30, p < 0.001) were independent prognostic factors for poor RFS. NF-pNETs ≤ 2 cm showed unfavorable prognosis after resection when the tumor was larger than 1.5 cm, Ki-67 index ≥ 3%, or nodal metastasis was present. NF-pNET patients with tumors ≤ 1.5 cm can be observed if the preoperative Ki-67 index is under 3%, and if nodal metastasis is not suspected in preoperative radiologic studies. These findings support the clinical use to make decisions about small NF-pNETs.

Chaeyung Oh, Hee Joon Kim, Sang Hwa Song, Eun Kyu Park, Young Hoe Hur, Yang Seok Koh, Chol Kyoon Cho. Ann Hepatobiliary Pancreat Surg -0001;0:. https://doi.org/10.14701/ahbps.21-126