Hiroki Sunagawa

Carcinosarcoma of the duodenum: Report of a case.

This report describes a case of carcinosarcoma of the duodenum. Carcinosarcoma of the duodenum is a very rare tumor. A 72-year-old man was referred to the hospital because of appetite loss. Endoscopy demonstrated an irregularly depressed lesion (type 3) in the descending portion of the duodenum opposite to the ampulla of Vater. Computed tomography showed a thickened duodenal wall and swelling of the abdominal para-aortic lymph nodes. A biopsy specimen revealed a well-differentiated adenocarcinoma. A diagnosis of duodenal carcinoma was made (cT3, cN1, cM1, cStage IV according to the TNM classification). A subtotal stomach-preserving pancreatoduodenectomy and a lymph node resection were performed. On microscopic examination, adenocarcinoma cells and spindle type sarcoma cells were observed separately in the descending portion of the duodenum opposite to the ampulla of Vater. The adenocarcinoma cells were stained with antibodies against epithelial markers keratin and carcinoembryonic antigen for immunohistochemical analyses. In contrast, the sarcoma cells were stained with antibodies to vimentin and smooth muscle actin. The pathological diagnosis of a true duodenal carcinosarcoma was thus made.

Ligament of Treitz approach in laparoscopic modified radical antegrade modular pancreatosplenectomy: report of three cases.

Laparoscopic distal pancreatectomy for pancreatic cancer is being applied increasingly in selected cases. Open radical antegrade modular pancreatosplenectomy (RAMPS) was introduced to obtain a higher rate of tumor‐free margins and a higher lymph node (LN) count. However, there is no standard laparoscopic technique for pancreatic cancer. We treated three patients with RAMPS using a ligament of Treitz approach. We started each procedure by dissecting the ligament of Treitz. We entered and spread the anterior space of the aorta and inferior vena cava. We then dissected the LN of the root of the supra‐mesenteric artery and performed RAMPS. The mean number LN retrieved from the patients was 43 ± 22. All three patients underwent pancreatectomy to obtain tumor‐free margins, and two patients began adjuvant chemotherapy by postoperative day 14. The ligament of Treitz approach in laparoscopic modified RAMPS offered tumor‐free margins and the resection of sufficient regional LN. The procedure also allowed adjuvant chemotherapy to be started early.

Advanced gastric carcinoma combined with extra-adrenal pheochromocytoma resected after three courses of S-1 and cisplatin as neoadjuvant chemotherapy: report of a case.

We herein describe the case of a patient with advanced gastric carcinoma combined with extra-adrenal pheochromocytoma who received a radical operation after undergoing neoadjuvant chemotherapy. A 48-year-old woman was referred to our hospital for gastric carcinoma. Computed tomography revealed an enlargement of the regional lymph nodes and a para-aortic lymph node. A diagnosis of advanced gastric carcinoma was made (cT3, cN3, cM0, cStage IV according to the Japanese Classification of Gastric Carcinoma, 2nd English edition). A reduction in size was observed in both the gastric tumor and the lymph nodes around the stomach after neoadjuvant chemotherapy. However, the paraaortic lymph node showed no remarkable change. We thus suspected this para-aortic tumor not to be a lymph node, but instead to be an extra-adrenal pheochromocytoma, because of the different response from the other regional lymph nodes. An endocrinological examination confirmed the diagnosis of extra-adrenal pheochromocytoma. A gastrectomy and a resection of the pheochromocytoma were thus performed.

Hepatocellular Carcinoma in a Patient with Primary Biliary Cirrhosis and Seronegativity for Markers of Hepatitis B Virus and Hepatitis C Virus: Report of a Case

Abstract.We report a case of hepatocellular carcinoma (HCC) arising in a patient with primary biliary cirrhosis (PBC) in whom both hepatitis B virus (HBV) and hepatitis C virus (HCV) serological tests were negative. A 72-year-old woman was found to have HCC 10 years after a diagnosis of PBC. All serological tests for HBV and HCV were negative. Preoperative liver biopsy findings suggested moderately differentiated HCC. Dynamic computed tomography (CT) showed hypervascular tumors in segments IV and VII. At laparotomy, a 30-mm tumor was palpated in segment VII and a wedge resection was performed. The second tumor, which measured 10 mm in diameter, was detected in segment IV by abdominal ultrasound, and microwave coagulation therapy was done. HCC arising in hepatitis virus marker-negative PBC is rare and past reports do not clarify whether HBV or HCV infections are associated with HCC.

Surgical Treatment of a Sigmoid Volvulus Associated with Megacolon: Report of a Case

Abstract Sigmoid volvulus occurring concomitantly with megacolon is an uncommon cause of bowel obstruction, and various approaches to treatment have been proposed. We report herein a case of sigmoid volvulus with megacolon that was successfully treated by elective surgery following endoscopic reduction during the same hospital stay. A 70-year-old woman was admitted to our hospital with abdominal pain, distension, and severe constipation. Physical examination, plain abdominal X-ray, and barium enema confirmed a sigmoid volvulus and further examinations revealed concomitant megacolon. An elective sigmoid colectomy was performed following successful endoscopic decompression. The postoperative course was uneventful and there was no residual colonic dysmotility. Histologically, no aganglionic tissue was observed in the resected specimen.

Laparoscopic total remnant pancreatectomy after laparoscopic pancreaticoduodenectomy

Total remnant pancreatectomy after pancreaticoduodenectomy (PD) is a difficult procedure. Recently, distal pancreatectomy and PD have been performed laparoscopically. Herein, we present the first case report of a laparoscopic total remnant pancreatectomy. A 72‐year‐old woman underwent a totally laparoscopic pylorus‐preserving PD for inferior bile duct cancer. The tumor was composed of moderately differentiated tubular adenocarcinoma and was diagnosed as pStage III according to the UICC‐TNM classification. Eighteen months later, CT showed a low‐density mass in the remnant pancreas. We conducted a total resection of the remnant pancreas laparoscopically. Histologically, it was diagnosed as a primary pancreatic cancer. The patients postoperative course was uneventful. She was discharged on postoperative day 14. When an initial PD is performed laparoscopically, laparoscopic total remnant pancreatectomy is technically feasible and safe in selected patients.

A Case of Primary Esophageal Adenocarcinoma in the Upper Thoracic Esophagus

症例は59歳の男性で, 鼻出血を主訴に当院を受診. 内視鏡検査にて胸部上部食道に0-Ip+0-IIc型の病変を認め生検にて中分化型食道腺癌, また胃体部大彎に0-IIa+IIc病変あり低分化型胃癌を認めた. 胸部CTにて106recLにリンパ節の転移が疑われるも他に転移性病変なく, 食道亜全摘3領域郭清術, 胃全摘2群郭清術を施行した. 切除標本ではバレット食道や異所性胃粘膜を伴わず, 粘膜下腫瘍様形態を伴わない食道腺癌が確認された. 食道腺癌の辺縁に腺癌への分化を伴う上皮内癌成分を認め, 食道上皮由来の食道腺癌が考えられた. 食道と胃はどちらとも腺癌であったが分化度が違い, また食道腺癌にのみ扁平上皮癌成分を認めた. 胸部上部に発生する食道腺癌はまれであり, その病像を報告するとともに, その組織発生を考察した.