Atsushi Oyama

Giant T4 rectal carcinoma mimicking urinary bladder adenocarcinoma accurately diagnosed by immunohistochemistry and successfully treated with total pelvic exenteration: report of a case.

A 54-year-old man, with the chief complaints of hematuria, pollakisuria, and pneumaturia, was referred to our hospital, with a diagnosis of giant urinary bladder adenocarcinoma with massive invasion to the rectum. On the basis of the radiological diagnosis and findings of hematoxylin and eosin (H&E) of biopsy specimens, it was difficult to conclude whether the adenocarcinoma originated in the bladder or in the rectum. The immunohistochemical staining of the biopsy specimens showed cytokeratin 7 (CK7)(−) and CK20(+), which supported the notion that the adenocarcinoma possibly originated from the rectum. Although the prognosis of T4 bladder adenocarcinomas has been reported to be quite poor in comparison with that of transitional cell carcinomas, the postoperative prognosis of T4 rectal adenocarcinomas has been reported to be more favorable and such tumors are recommended to be surgically resected. Because no distant metastasis was detected, the patient underwent total pelvic exenteration with a reconstruction of the ileal conduit. Although the resected tumor measured 12 cm in diameter with n1 metastasis, the radial margin was cancer-negative, and the tumor was curatively resected. The immunohistochemical diagnosis of the resected tumor showed carcinoembryonic antigen(+), CK7(−), CK20(+), thrombomodulin(−), and uroplakin(−), which supported the rectal origin. At present the patient is undergoing postoperative adjuvant chemotherapy for rectal cancer.

A Case Report: Repeat Ileal Pouch-anal Anastomosis in a Patients with Severe Ulcerative Colitis Complicated with Intractable Perianastomotic Abscess

回腸肛門吻合術後に難治性吻合部膿瘍を合併したため, 回腸J嚢を再造設し, 回腸肛門再吻合を行った重症潰瘍性大腸炎の1例を経験し, 良好な結果を得たので報告する. 症例は32歳の男性で, 重症潰瘍性大腸炎に対し分割的回腸肛門吻合術を施行したが, ストーマ閉鎖前の回腸.造影にて吻合部周囲に筋筒内膿瘍(cuff abscess)形成が認められた. 難治性のため吻合部の掻爬, 膿瘍ドレナージ, 筋筒部分切除, 再吻合を3度にわたり行ったが, 改善が見られないため, 吻合部を含む回腸J嚢切除と新J嚢回腸肛門再吻合を行った. 術後経過は良好で回腸ストーマ閉鎖後は, 夜間のsoilingはあるもののほぼ満足すべき排便機能を保っている.

An unusual case of abdominal pain

In March 2003, the patient exhibited severe right lower abdominal pain. This 71 year old man was also suffering with severe …