Hideo Kishimoto

A CHILD CASE OF PYOGENIC LIVER ABSCESS AFTER AN OPERATION FOR APPENDICITIS

A 7-year-old boy was admitted to the hospital because of high fever and right lower abdominal pain. An abscess in the right lower quadrant was detected by ultrasonography (US) and computed tomography (CT). Appendectomy and drainage of the abscess were performed. Postoperative course was uneventful except a mild fever. However, he developed a high fever and pain in the right upper quadrant on 15th postoperative day. CT showed an abscess about 4 cm in diameter in the right lobe of the liver. Although an antibiotic therapy was started immediately. CT on the 27th postoperative day showed that the abscess was enlarged measuring 6 cm in diameter. Therefore US-guided percutaneous abscess drainage was performed under general anesthesia. About 100 ml pus was drained and B. fragilis was isolated. His clinical symptoms improved steadily and he was discharged from the hospital on the 58th postoperative day. Percutaneous abscess drainage for pyogenic liver abscess should be performed at an appropriate stage even in a child case.

A CASE OF MUCIN PRODUCING TUMOR OF THE PANCREAS IN WHICH INTRAOPERATIVE PANCREATOSCOPY WAS USEFUL

The existence diagnosis of mucin producing tumor of the pancreas is not so difficult because of its typical duodenoscopic findings and pancretographic finding. But the extent diagnosis often presents difficulty, because it mainly spreads along the mucosal layer histopathologically. This time we experienced a case of mucin producing tumor of the pancreas in which intraoperative pancreatoscopy was useful for the definite diagnosis of the mucosal spread. A 77-year-old female was seen at the hospital because of repeated epigastralgia, and was diagnosed as having a main duct type mucin producing tumor of the pancreas in the pancreatic head. Pyloruspreserved pancreatoduodenectomy was performed, and we observed the papillary tumor and irregular mucosa by intraoperative pancreatoscopy and could make the definite diagnosis of the mucosal spread. The pathological examination revealed intraductal papillary adenocarcinoma.

A CASE OF APOCRINE CARCINOMA OF THE BREAST

A 68-year-old female visited the hospital because of a left breast tumor and nipple discharge. Palpation of the breast revealed a tumor 5×4 cm in size in the upper outer quadrant of the left breast with a lot of purulent discharge from the left nipple. Mammography showed a mass with ill-defined margins and ultrasonography showed an irregular, heterogeneous low echoic area of about 4 cm in diameter in the upper outer quadrant of the left breast. Thermography showed that a mass was surrounded with irregular vascular hyperthermia in the left breast. A lactic cytological examination was false positive. Lactic CEA value was as low as 104 ng/ml. These finding indicates a breast cancer, and biopsy was performed. From pathological exploration the tumor was diagnosed as non-invasive apocrine carcinoma of the breast. Radical mastectomy was performed in addition.The apocrine carcinoma of the breast is pathologically classified into invasive carcinoma, a special type in the general rules for he breast cancer study, and non-invasive apocrine carcinoma of the breast pathologically can not exist in the rules. Here we describe a very rare case which can not but be diagnosed as non-invasive apocrine carcinoma of the breast, which reveals non-invasive ductal carcinoma with intensive apocrine metaplasia, with reference to the literature.