Radical Resection HPB Tumors Presenting as
Metastatic Lesions: Report of 2 Cases and Literature
Review by Monika Gupta in Research in Medical & Engineering Sciences
60 yr old lady referred to department of GI and HPB surgery
for management for GB with ascetic, who underwent diagnostic
laparoscopy
for supposed to be metastatic ca GB at oncology hospital.
Presenting features-Pain and distension abdomen, vomiting,
generalized edema for 10 days. Diagnostic laparoscopy and biopsy
findings of which were-diffuse ascitis with frozen subheptic region
with GB not visualized, was biopsy negative for malignancy (exact
site not mentioned). O/E- pt ASA GR3 pedal edema+, ascetic +,
abdomen soft no s/o icterus/Lymphadenopathy/peritonitis /Mets
Investigations-Hb-9.8gm/dl-, TLC-12700, DLC-N-74%, L-22%,
E-2%, M-2%, urea-17 creatinine-0.6, HIV, HBS Ag, anti HCV -ve,
serum bilirubin- 0.3, SGOT-98, SGPT-78, ALP-327, alb -2.3 CXR-B/L
pleural effusion, tapping done. USG-CBD normal, mass in GB lumen
not involving liver, liver normal, moderate ascitis. Ascetic cytologyve
CTSCAN - Mass in GB lumen localized to GB wall filling the
lumen with no Mets /LNs, ascetic+ ca 19-9 -3u/ml. Management
-She was treated for gastritis, hyponatremia, hypoprotinemia with
PPIs, high protein diet, albumin infusion &TPN for 7 days. After
nutritional build up reevaluation showed serum albumin- 3.1gm/
dl, CECT findings same with resolution of ascitis. The ascitis was
a result of hypoprotinemia as ascetic cytology was negative which
disappeared after protein replacement. So decision was taken to
proceed with diag. lap &radical cholecystectomy. Intraoperative
Findings: Diag. lap-no free fluid, no Mets.
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