Hirotoshi Maruo

Necrotizing fasciitis caused by a primary appendicocutaneous fistula

We report a case of necrotizing fasciitis in the loin of a 76-year old man with several coexisting or past health issues, including diabetes mellitus, hypertension, alcohol-related liver cirrhosis, gastrectomy for gastric cancer, subarachnoid hemorrhage, normal pressure hydrocephalus, and cerebral infarction. Incision of the necrotizing fasciitis was successful, but it revealed an appendicocutaneous fistula; thus, we performed appendectomy and fistulectomy. We think that the necrotizing fasciitis was caused by appendicitis perforation involving the retroperitoneum, inducing the formation of an appendicocutaneous fistula. Necrotizing fasciitis and appendicocutaneous fistulae are rare complications of appendicitis. Moreover, to our knowledge, this is the first report of fluoroscopic examination demonstrating that a primary appendicocutaneous fistula had caused necrotizing fasciitis. Our search of the literature found 12 cases of necrotizing fasciitis caused by preoperative appendicitis. We discuss the characteristics and findings of these cases.

Adenomyoma of the ileum leading to intussusception.

Adenomyoma of the ileum is a rare condition. A 68-year-old Japanese man presented with nausea and distension of the abdomen. Enhanced computed tomography of his abdomen revealed wall thickening in the ileum and dilation of the proximal small intestine. Open laparotomy was performed to find the cause of the patient’s small bowel obstruction, and a tumor was found in the ileum, which had resulted in intussusception. The tumor and 20 cm of the adjacent ileum were resected. The resected specimen displayed a macroscopic appearance suggestive of a submucosal tumor. Histopathological evaluation showed duct cell proliferation and bundles of smooth muscle cells from the mucosa to the serosa, leading to a diagnosis of adenomyoma. Immunohistochemical examination found that cytokeratin 7 and carbohydrate antigen 19-9 were expressed in the duct epithelia. We report a rare case of ileal adenomyoma leading to intussusception in an adult and present the immunohistochemical evaluation of the adenomyoma.

Inflammatory pseudotumour-like follicular dendritic cell tumour of the spleen

We describe an unusual case of a 73-year-old woman presenting with a solitary splenic mass 8 cm in diameter and an elevation of serum soluble interleukin-2 receptor level. The preoperative diagnosis was primary malignant lymphoma of the spleen. Splenectomy was conducted. Histological analysis confirmed an inflammatory pseudotumour-like follicular dendritic cell tumour that showed different clinicopathological features from those of the classic follicular dendritic cell tumour. Only 33 cases of inflammatory pseudotumour-like follicular dendritic cell tumour have so far been reported. We discuss the incidence, presentation and management of this rare disease.

Laparoscopic Partial Hepatectomy of Focal Nodular Hyperplasia

Focal nodular hyperplasia is a benign liver lesion incidentally discovered with increasing frequency because of the proliferation of imaging studies. Radiographic characterization can diagnose this pathologic lesion and nonoperative therapy is the standard of care. However, surgical resection may be required for diagnostic reasons or symptomatic patients. Depending on the anatomic location of the lesion, biopsy and/or resection can be performed laparoscopically. We herein report the case of a 26-year-old Japanese woman with a hepatic tumor who required a medical examination. Her medical history was negative for alcohol abuse, oral contraceptive administration and trauma. Clinical examination showed no significant symptoms. Ultrasonography, computed tomography and magnetic resonance imaging showed a mass located in the left lateral segment of the liver with a diameter of about 40 mm. It was difficult to diagnose the tumor definitively from these imaging studies, so we performed laparoscopic partial hepatectomy with successive firing of endoscopic staplers. The histopathological diagnosis was focal nodular hyperplasia. Surgical procedures and postoperative course were uneventful and the patient was discharged from the hospital on postoperative day 5.

Simultaneous Occurrence of Early Gastric Carcinoma and Mucosa-Associated Lymphoid Tissue Lymphoma of the Omentum

The simultaneous association of gastric carcinoma with omental mucosa-associated lymphoid tissue (MALT) lymphoma is a rare event that has not been reported previously. We focused on the hypothetic pathogenetic mechanisms, diagnosis and treatment of this rare condition. A 55-year-old woman with Helicobacter pylori infection underwent distal gastrectomy in our hospital. Three independent early gastric cancers and a mass near the cecum were diagnosed preoperatively. Pathological review of the resected stomach showed three independent early signet ring cell gastric carcinomas, and the mass in the omentum near the cecum was shown to be omental MALT lymphoma. Due to the nature of the patients disease, she was started on medical eradication of H. pylori. Synchronous gastric adenocarcinoma and omental MALT lymphoma is a rare event. Special attention given to H. pylori-associated gastric cancer patients can avoid misdiagnosis and lead to adequate treatment.

A Case of Retroperitoneal Mucinous Cystadenocarcinoma.

後腹膜原発の嚢胞腺腫, 嚢胞腺癌はきわめてまれな疾患である.今回われわれは後腹膜原発嚢胞腺癌を経験したので報告し, 同時に本邦報告例11例について併せて検討を加えた.症例は50歳女性で, 右下腹部膨満感を主訴とした.右下腹部に小児頭大の無痛性腫瘤が触知され, 腹部computed tomography, 腹部超音波検査にて大きさ16.5cm×10cm×15cmの嚢胞性腫瘤とその内腔に突出した直径3cm大の嚢胞内腫瘤を認めた.開腹所見では, 巨大腫瘤が上行結腸の後外側方に位置し, 結腸を壁外性に圧排していた.多臓器との連続性, 癒着は認められず容易に摘出でき, 他臓器の異常所見もなく, 後腹膜原発の腫瘤と考えられた.摘出標本は10.5×17.5×16.5cmの嚢胞性腫瘤で, 内腔は粘液で満たされ, また内腔に突出する2.3×1.5×2.0cmの乳頭状腫瘤を認め, 病理組織学的には粘液性嚢胞腺癌と診断された.術後4か月現在, 再発の兆しなく生存中である.