Hidehiko Yabuki

Metastatic seeding of bile duct carcinoma in the transhepatic catheter tract: Report of a case

We describe herein the case of a 51-year-old woman in whom metastatic tumor seeding of the percutaneous transhepatic biliary drainage tract occurred following a pancreatoduodenectomy for carcinoma of the distal common bile, duct. An abdominal computed tomography scan done 6 months after the initial operation detected a hepatic lesion located at the site of the previous percutaneous transhepatic biliary drainage tract. Implantation of bile duct carcinoma in the drainage tract was diagnosed, and the recurrent tumor was successfully resected by performing a subsegmentectomy of segment 3 and removal of the adjacent abdominal wall. At present, 5 years and 4 months after the second resection, the patient is in good health without any signs of recurrence. This case report demonstrates that an aggressive surgical approach should be performed for tumor seeding of a transhepatic biliary catheter tract.

Rectal mucocele in the anterior wall of the rectum

An 84-year-old man presented in 2009 with a sensation of discomfort in his anus, combined with difficulty in urination. He had previously undergone a haemorrhoidectomy in 1964. After examination, he was diagnosed with a rectal mucosal cyst and followed up for observation. In 2015, he presented to our hospital complaining that the cyst was prolapsing from his anus. CT revealed a 48×41 mm cystic mass in the anterior wall of the rectum. Tumour extirpation, via a transanal route, was performed. The postoperative pathological diagnosis confirmed a rectal mucocele. Rectal mucoceles are extremely rare, with no prior report of a mucocele in the anterior wall of the rectum. In this case, we believe the mucocele developed from an invagination of the mucous membrane or obstruction of the anal gland during suturing during the previous haemorrhoid surgery.

Resected Lymphangioma Originating from the Greater Omentum in an Adult, Diagnosed Preoperatively.

大網原発成人発症のlymphangiomaはまれなものでありその術前診断率も低率であるが, 今回CT, 超音波, MRIにて術前診断可能であった1例を経験したので報告する.症例は55歳の男性. 腹痛, 腹部膨満感を主訴として受診. CTにて胃大彎に接し骨盤内にまで及ぶ充実性腫瘍を認め超音波にて多房性, またMRIにてcystic lymphangiomaパターンを呈した. 他の検査を含め大網原発のlymphangiomaと診断し手術を施行した. 開腹すると腫瘍は薄い皮膜に覆われ腹腔内前面を占居. 網嚢を解放し大網を頭側に脱転してくると膵や胃結腸間膜が認められ, 腫瘍は大網原発であることが確認された. 腫瘍内容は透明なやや粘張性のある液体であった. 病理にて大網内に嚢胞上に拡張するリンパ管の増生を認め内皮細胞に異形性はなくlymphangiomaと診断された.