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A rare synchrony of adenocarcinoma of the ampulla with an ileal gastrointestinal stromal tumor: A case report

World Journal of Gastrointestinal Oncology 2022年第11期14卷 2253-2265页

作者： Venkata Vinod Kumar Matli gazi B zibari Gregory Wellman Poornima Ramadas Sudha Pandit James Morris Department of Internal Medicine Christus Highland Medical CenterShreveportLA 71106United States Division of Hepatobiliary Surgery Willis-Knighton Health SystemShreveportLA 711103United States Department of Gastrointestinal and Liver Pathology Christus Highland Medical CenterShreveportLA 71105United States Division of Hematology and Oncology Louisiana State University Health Sciences CenterShreveportLA 71103United States Division of Gastroenterology and Hepatology Louisiana State University Health Sciences CenterShreveportLA 71103United States

BACKGROUND This is a unique case of a patient who was found to have two extremely rare primary malignancies synchronously,i.e.,an ampullary adenocarcinoma arising from a high-grade dysplastic tubulovillous adenoma of the ampulla of Vater(TVAoA)with a high-grade ileal gastrointestinal stromal tumor(GIST).Based on a literature review and to the best of our knowledge,this is the first report of this *** ampullary tumors are extremely rare,with an incidence of four cases per million population,which is approximately 0.0004%.Distal duodenal polyps are uncommon and have a preponderance of occurring around the ampulla of *** adenoma of the ampulla(AoA)may occur sporadically or with a familial inheritance pattern,as in hereditary genetic polyposis syndrome such as familial adenomatous polyposis syndrome(FAPS).We report a case of a 77-year-old male who was admitted for painless obstructive jaundice with a 40-pound weight loss over a two-month period and who was subsequently diagnosed with two extremely rare primary malignancies,i.e.,an adenocarcinoma of the ampulla arising from a high-grade TVAoA and a high-grade ileal GIST found *** SUMMARY A 77-year-old male was admitted for generalized weakness with an associated weight loss of 40 pounds in the previous two months and was noted to have painless obstructive *** physical examination was benign except for bilateral scleral and palmar *** results were significant for an obstructive pattern on liver *** lipase and carbohydrate antigen-19-9 levels were *** tomography(CT)of the abdomen and pelvis and magnetic resonance cholangiopancreatography were consistent with a polypoid mass at the level of the common bile duct(CBD)and the ampulla of Vater with CBD *** same lesions were visualized with endoscopic retrograde *** of endoscopic forceps biopsy showed *** of the surgical specimen of the

关键词： Tubulovillous adenoma of the ampulla of Vater Ampullary adenocarcinoma Gastrointestinal stromal tumor Ampullary polyp Small bowel mesenchymal tumor Case report

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Cholestatic liver diseases:An era of emerging therapies

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World Journal of Clinical Cases 2019年第13期7卷 1571-1581页

作者： Hrishikesh Samant Wuttiporn Manatsathit David Dies Hosein Shokouh-Amiri gazi zibari Moheb Boktor Jonathan Steve Alexander Division of Gastroenterology and Hepatology Department of medicine LSU health Shreveport LA 71103 United States John C McDonald Transplant Center Willis Knighton Medical Center Shreveport LA 71103 United States Division of Gastroenterology and Hepatology University of Nebraska Omaha NE 68194 United States Department of Molecular and Cellular Physiology Louisiana State University School of Medicine Shreveport LA 71103 United States

Recently the field of cholestasis has expanded enormously reflecting an improved understanding of the molecular mechanisms underlying bile secretion and its perturbation in chronic cholestatic disease. Novel anti-cholestatic therapeutic options have been developed for patients not favorably responding to ursodeoxycholic acid (UDCA), the current standard treatment for cholestatic liver disease. Important novel treatment targets now also include nuclear receptors involved in bile acid (BA) homoeostasis like farnesoid X receptor and G proteincoupled receptors e.g., the G-protein-coupled BA receptor “transmembrane G coupled receptor 5”. Fibroblast growth factor-19 and enterohepatic BA transporters also deserve attention as additional drug targets as does the potential treatment agent norUDCA. In this review, we discuss recent and future promising therapeutic agents and their potential molecular mechanisms in cholestatic liver disorders.

关键词： Bile acids Drug therapy Cholestatic liver disease Nuclear receptor agonists

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