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Dentigerous cysts are common odontogenic cysts of the jaw but are rarely associated with supernumerary teeth. Few cases of large dentigerous cysts associated with anterior maxillary supernumerary teeth have been reported. The English literature has documented only four cases of dentigerous cysts>40 mm in diameter associated with supernumerary teeth. A 47-year-old man was referred to our hospital, complaining of minor pain in the maxillary gingiva. Computed tomography revealed a well-defined oval unilocular radiolucent lesion (50×45×35 mm) in the right maxilla, including two impacted supernumerary teeth. A dentigerous cyst associated with impacted anterior maxillary supernumerary teeth was diagnosed. The two impacted teeth were surgically removed, and the cyst was enucleated using the Caldwell-Luc approach. Histopathology confirmed the diagnosis of a large dentigerous cyst associated with impacted anterior maxillary supernumerary teeth. The postoperative course has been uneventful for two years. We also reviewed the relevant English literature. [ABSTRACT FROM AUTHOR]

Background: The absence of the portal bifurcation (APB) is a rare anatomic variation, in which the horizontal part of the left portal vein (PV) is missing. The aim of this study was to identify the vascular architecture in livers with APB. Methods: Computed tomography data for 17,651 patients were reviewed; five patients (0.03%) were found to present with APB. The liver volume and anatomy of APB patients were compared with those of 30 patients with normal livers. Results: All the APB patients exhibited an independent posterior branch of the PV. The intrahepatic left PV (LPV) ran through either the ventral (n = 2, 40%) or dorsal side (n = 3, 60%) of the middle hepatic vein. The frequency of medial branches diverging from the LPV was higher in patients with APB than in normal patients (p < 0.001). The left hepatic duct (LHD) ran through the inside of the left lobe along the left PV in 40% of the patients with APB, whereas in the remaining 60% of the patients with APB, the LHD ran on the outside of the liver separately from the left PV and joined the right hepatic duct. The liver volume of the left lateral section was significantly smaller (p = 0.014), and the posterior section was significantly larger (p = 0.014) in patients with APB than in patients with normal livers. Conclusion: The unique anatomical characteristics and the positional relation of the vessels should be considered preoperatively in patients with APB. [ABSTRACT FROM AUTHOR]

Purpose: The clinical impact of abutment to an artery and its branch on resectability and prognosis in patients with borderline resectable pancreatic cancer is unclear. Methods: Patients diagnosed with borderline resectable pancreatic cancer due to artery abutment between April 2012 and December 2018 were enrolled. Contact between arteries and the tumour was assessed by computed tomography (CT). Results: A primary lesion was resected in 63 patients (R group) and unresected in 19 patients (UR group). Overall survival (OS) was worse in the UR group than in the R group (P < 0.001). Multivariate analysis showed that abutment to the superior mesenteric artery (SMA) branches (P = 0.001) was an independent predictor of poor OS after surgery. Regarding the initial recurrence pattern, abutment to the SMA branches was significantly associated with high incidence of distant metastasis (P < 0.001). According to the most distal SMA branch attached on CT, significant differences in RFS were found between absent–J1A (P = 0.017), J2A–J3A (P = 0.0313) and J3A–middle colic artery (MCA, P = 0.0476) but not between J1A–J2A (P = 0.8207). Significant prognostic differences in OS after initiation of the treatment were found between absent–J1A/J2A (P = 0.006) and J1A/J2A–J3A/MCA (P = 0.033) but not between J3A/MCA–UR (P = 0.494). Conclusion: Abutment to the SMA branches was associated with high incidence of distant metastasis after resection and a poor survival. Especially, abutment to the J3A or MCA was associated with poor prognosis comparable with that of the UR group. [ABSTRACT FROM AUTHOR]

Background and purpose: To perform radical resection without leaving residual cancer, surgeons must distinguish between pancreatic head cancer (PHC) and intrapancreatic bile duct cancer (IPBDC) preoperatively. The aim of this study was to establish the points of difference between these two cancers, especially on preoperative multi-detector computed tomography (MDCT) images.Methods: The subjects of this study were 28 patients with PHC and proven bile duct invasion who underwent pancreatoduodenectomy (PHC group) and 22 patients with IPBDC and upstream bile duct dilation (IPBDC group). We compared the preoperative clinical and radiographic features, including the bile duct angle, calculated on coronal images of MDCT, and the vascularity of the tumor.Results: The optimal cut-off values for the bile duct angle, the CT value ratio of the tumor (late arterial phase/non-enhanced), and the main pancreatic duct (MPD) ratio (diameter of MPD/diameter of parenchyma) were 110°, 3.0, and 0.2, respectively. Multivariate analysis revealed that a bile duct angle < 110°, a CT value ratio of the tumor < 3, and an MPD ratio ≥ 0.2 were independently associated with PHC.Conclusions: A bile duct angle and CT value reflecting the vascularity of the tumor might be useful radiographic features for differentiating PHC and IPBDC, in addition to MPD dilatation. [ABSTRACT FROM AUTHOR]

Introduction Pancreatic cancer often invades major arteries. However, there are few reports about extensive bowl necrosis caused by superior mesenteric artery (SMA) occlusion associated with pancreatic cancer invasion. Case report A 73-year-old woman who was receiving chemotherapy for locally advanced pancreatic cancer (LAPC) was referred to our hospital for abdominal swelling and vomiting that had persisted for 2 days. Contrast-enhanced computed tomography revealed occlusion of the SMA by pancreatic cancer, which had invaded the whole circumference of the SMA. On emergency laparotomy, a large amount of necrotic and ischemic intestine was resected, preserving approximately 100 cm of the ileum. Gastroileostomy was also performed. She had an uneventful postoperative course. Conclusions Surgical treatment is a good option for acute SMA occlusion due to invasion by LAPC. [ABSTRACT FROM AUTHOR]

A 67-year-old woman with epigastric pain was diagnosed with resectable pancreatic head cancer and underwent pancreatoduodenectomy. Preoperative computed tomography showed that the common hepatic artery formed a common trunk with the left gastric artery running to the liver through the lesser omentum, and no other arterial supply to the liver was identified. Pancreatoduodenectomy was performed uneventfully without injury to any hepatic arteries. The postoperative clinical course was largely uneventful, and the patient was discharged on postoperative day 19. An anatomical variation of the common hepatic artery arising from a common trunk with the left gastric artery and coursing within the lesser omentum is rare. Notably, this is the first case report of pancreatoduodenectomy with this anatomical variation. Thorough understanding of hepatic arterial anatomical variations is necessary to prevent complications caused by inadvertent vascular injury and hepatic ischemia. [ABSTRACT FROM AUTHOR]

Although a soft pancreas is a widely-accepted reliable risk factor for postoperative pancreatic fistula (POPF) after pancreatoduodenectomy (PD), there is no established preoperative evaluation of pancreatic texture. Two hundred thirty-seven patients who underwent PD with histological pancreatic assessment were retrospectively enrolled. The degree of fibrosis and fatty infiltration was scored histologically as seven grades and five grades, respectively. Computed tomography (CT) attenuation of the pancreas was measured on preoperative unenhanced CT images. Correlations between the CT attenuation of the pancreas and the histological pancreatic findings, and the development of POPF were analyzed. The fibrosis grade was significantly higher for hard pancreas than for soft pancreas (p < 0.001), whereas the fatty infiltration grade was similar between the two types (p = 0.161). CT attenuation of the pancreas was inversely correlated with both fibrosis grade (Spearman's rank correlation coefficient ([r] = −0.609, p < 0.001) and fatty infiltration grade (r = −0.382, p < 0.001). Multivariate analysis showed that body mass index ≥25 kg/m2 (odds ratio [OR]: 5.64, p < 0.001) and fibrosis grade ≤2 (OR: 18.0, p < 0.001) were independent risk factors for clinically significant POPF. Histological pancreatic texture can be evaluated with CT attenuation and might be helpful in preoperatively predicting the development of POPF after PD. [ABSTRACT FROM AUTHOR]

Some parameters using preoperative computed tomography (CT) have been evaluated to predict the development of pancreatic fistula (PF) after pancreaticoduodenectomy (PD). The present retrospective study evaluated the predictive value of pancreatic attenuation for PF after PD. A retrospective review was conducted of the patients who underwent PD between January 2010 and December 2014. The pancreatic attenuation was measured in unenhanced preoperative CT images. Pre- and intraoperative variables were analyzed for the risk of PF after PD. Of the 346 consecutive patients, PF occurred in 116 (34%). The pancreatic attenuation was significantly greater in patients with PF than in those without PF (median, 40.0 vs. 33.3 Hounsfield units [HU], P < 0.001). A multivariate analysis showed that a pancreatic attenuation ≥30.0 HU (odds ratio [OR], 3.72; P < 0.001), a body mass index ≥25.0 kg/m2 (OR, 3.67; P < 0.001) and a diameter of the main pancreatic duct <3.0 mm (OR, 1.84; P = 0.034) were independent risk factors for PF after PD. The degree of pancreatic attenuation on preoperative CT images was significantly associated with PF, and a pancreatic attenuation ≥30.0 HU was an independent risk factor of PF after PD. [ABSTRACT FROM AUTHOR]