Hiroaki Honjyo

Resection of an esophageal schwannoma with thoracoscopic surgery: a case report

BackgroundEsophageal schwannomas are rare primary submucosal esophageal tumors. We herein report a case of an esophageal schwannoma that was difficult to diagnose.Case presentationA 39-year-old woman presented with chief complaints of difficulty swallowing and epigastric pain. Enhanced computed tomography of her chest revealed a tumor mass at the upper thoracic esophagus with internal heterogeneity. 18-Fluorodeoxyglucose positron emission tomography/computed tomography showed a hypermetabolic appearance matching the tumor mass; the accumulation had a maximum standardized uptake value of 5.5. We performed endoscopic ultrasound-guided fine-needle aspiration biopsy under general anesthesia, but the small specimens obtained prevented a definitive diagnosis. Thoracoscopic esophagectomy was performed due to the large size of the tumor, suspicion of its malignant potential, and the patient’s symptoms. Histopathological examination revealed spindle-shaped cells in a fasciculated and disarrayed architecture in the proper muscle layer. Immunohistochemical studies showed S100 protein positivity and the absence of CD34 and c-kit. We diagnosed the tumor as a benign schwannoma.ConclusionsWe herein report a relatively rare case of schwannoma of the esophagus that was diagnosed with difficulty.

Surgical management for achalasia after coronary artery bypass graft using the right gastroepiploic artery: a case report

BackgroundThe right gastroepiploic artery is commonly used in coronary artery bypass grafting. Appropriate strategies are required when performing upper abdominal surgeries after the right gastroepiploic artery has been used in coronary artery bypass grafting because compressing or injuring the graft may cause myocardial ischemia and fatal arrhythmias. To our knowledge, this is the first reported case of surgery for achalasia performed after coronary artery bypass grafting using the right gastroepiploic artery. We have discussed the surgical procedure and particular intraoperative considerations.Case presentationA 62-year-old man who had undergone coronary artery bypass grafting using the right gastroepiploic artery presented with achalasia. Because medication and balloon dilation had been ineffective and he was having difficulty ingesting food, we performed a Heller–Dor procedure via laparotomy. The right gastroepiploic artery was not damaged during this surgery, and there were no perioperative cardiovascular complications. Adequate control of symptoms was achieved.ConclusionsWhen performing upper abdominal surgeries after coronary artery bypass grafting with the right gastroepiploic artery, it is necessary to investigate the patient carefully preoperatively and adapt the intraoperative procedure to minimize risk of injury to the graft and consequent cardiovascular complications.

18F-FAMT-PET is useful for judging clinical complete response in advanced esophageal cancer patients who have received definitive chemoradiotherapy

Abstract Background: We developed 18F-FAMT as an amino acid tracer for PET imaging. In esophageal cancer, 18F-FAMT PET was significantly higher than that of 18F-FDG PET and CT in the evaluation of individual lymph node groups. Definitive CRT has been considered to be a potentially curative treatment for locoregional esophageal cancer and may achieve the same survival benefits as surgical resection. Clinical evaluation of complete response (CR) is important using several modalities. Patients and Methods: We evaluated 6 patients who had been diagnosed with clinical CR by FAMT-PET following definitive CRT for esophageal SCC between June 2008 and July 2012. Treatment evaluation of 18F-FAMT was performed following CRT, and approximately 1 month later. Results: In primary tumors, 66.7% of patients (4/6) showed FDG uptake following CRT, whereas that of FAMT was 33.3% (2/6). In lymph node metastases, 50% of patients (3/6) showed FDG uptake following CRT, whereas that of FAMT was 0% (0/6). In the present study, FA...

18F-FAMT PET Is Useful to Distinguish between Specific Uptake and Nonspecific Uptake Compared to 18F-Flourodeoxyglucose Position Emission Tomography in Esophageal Cancer Patients

Background: L-[3-¹⁸F]-α-methyltyrosine (¹⁸F-FAMT) solely accumulates in tumor cells via an amino acid transport system. This selective uptake pattern results in a very high tumor-to-background ratio, enabling clear delineation of the tumor. The purpose of the present study was to assess the significance of ¹⁸F-FAMT PET, which shows little nonspecific uptake compared to ¹⁸F-flourodeoxyglucose position emission tomography (FDG PET) in esophageal cancer patients. Methodology: PET-CT studies with ¹⁸F-FAMT and ¹⁸F-FDG were performed as part of pretreatment work-up in 82 patients with histologically confirmed esophageal cancer. We evaluated nonspecific uptakes of ¹⁸F-FDG and ¹⁸F-FAMT PET. Results: The nonspecific uptake of ¹⁸F-FAMT PET was lower than that of ¹⁸F-FDG PET (p = 0.282). In the operation group, 26.1% demonstrated nonspecific uptake in ¹⁸F-FDG PET, whereas only 2.38% (1 case) demonstrated nonspecific uptake in ¹⁸F-FAMT PET (p = 0.433). In the inoperable group, 47.5% showed nonspecific uptake in ¹⁸F-FDG PET, whereas 5.0% showed nonspecific uptake in ¹⁸F-FAMT PET (p = 0.079). Conclusion: A crucial point for the diagnostic value of PET is distinguishing specific and nonspecific uptake. ¹⁸F-FAMT-PET is a very superior modality with regard to the lower rate of nonspecific uptake in esophageal cancer.

Successful Tumor Navigation Technique During Intrathoracoscopic Esophagectomy: Laparoscopic Ultrasonography Using Endoscopically Placed Marking Clips

Received July 20, 2015; Revised August 17, 2015; Accep 2015. From the Department of General Surgical Science, Gunma ulty of Medicine, Gunma University, Gunma, Japan (Miy Sohda, Sakai, Hara, Tanaka,Yokobori, Kuwano) and the Fi of Surgery, Dokkyo Medical University, Tochigi, Japan (N Correspondence address: Tatsuya Miyazaki, MD, PhD, ment of General Surgical Science, Gunma University, 3 machi, Maebashi, Gunma 371-8511, Japan. email: tat gunma-u.ac.jp