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Radical Resection HPB Tumors Presenting as Metastatic Lesions: Report of 2 Cases and Literature Review: Crimson Publishers

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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