Hisashi Hirosawa

A case of macrocystic serous cystadenoma of the pancreas

SummaryA case of macrocystic serous cystadenoma of the pancreas is presented, and literature is reviewed. A 35-yr-old woman presented with mild upper abdominal pain. Abdominal ultrasonography and an abdominal computed tomography revealed a multiloculated and calcified cyst in the body of the pancreas. A T1-weighted image, using magnetic resonance imaging, revealed a low-intensity mutiloculated, pancreatic mass. In contrast, T2-imaging of the tumor showed a high-intensity mass. Endoscopic retrograde cholangiopancreatography showed no contact between the main pancreatic duct and the tumor. The preoperative diagnosis was a mucinous cystic neoplasm. Tumor enucleation was performed. Subsequent microscopic examination of this tumor suggested the diagnosis of a macrocystic serous cystadenoma of the pancreas.

Currarino syndrome in an adult presenting with a presacral abscess: a case report

IntroductionCurrarino syndrome (Currarino triad) was described in 1981 as a triad syndrome with a common embryogenesis in infants and with three characteristics: anorectal stenosis, a defect in the sacral bone, and a presacral mass. We describe here an unusual case of Currarino syndrome in an adult presenting with a presacral abscess but no meningitis.Case presentationA 32-year-old Japanese man presented with fever, arthralgia and buttock pain. A digital rectal examination showed mild rectal stenosis with local warmth and tenderness in the posterior wall of his rectum. Computed tomography showed a scimitar-shaped deformity of his sacrum and an 8cm presacral mass, which continued to a pedicle of his deformed sacrum. This was diagnosed as Currarino syndrome with a presacral abscess. The abscess was drained by a perianal approach with our patient treated with antibiotics. His symptoms soon disappeared. After three months, an excision was performed through a posterior sagittal approach. His postoperative course was uneventful and he was discharged 10 days after surgery. A histopathological examination revealed an infected epidermoid cyst. He has been free from recurrence as of four years and six months after surgery.ConclusionsWe report a case of Currarino syndrome in an adult who presented with a presacral abscess but no meningitis. Abscess drainage followed by radical surgery resulted in a successful outcome.

Metastatic gastric carcinoma from breast cancer mimicking primary linitis plastica: A case report

Metastases to the gastrointestinal tract rarely occur in breast cancer except in invasive lobular carcinoma. The present study reports a rare case of metastatic gastric cancer from invasive ductal carcinoma (IDC) of the breast mimicking primary gastric linitis plastica. A 51-year-old premenopausal female, who had a history of partial mastectomy for right breast cancer at the age of 40, was referred to Toyama City Hospital (Toyoma, Japan) for an endoscopic diagnosis of gastric linitis plastica. Abdominal computed tomography (CT) revealed left hydronephrosis, while peritoneal metastasis and malignant ascites were not detected. Chest CT detected a left lung tumor, which had invaded the left upper bronchus. Biopsy specimens were obtained and the histopathological findings on both the gastric tumor and lung tumor demonstrated poorly differentiated adenocarcinoma, whereas the histology of the original breast cancer was IDC with a solid-tubular type. Immunohistochemistry revealed that the biopsied specimens of the gastric and lung tumors were positive for estrogen receptor (ER), progesterone receptor (PgR) and negative for human epithelial growth factor receptor-2 (HER2). These molecular characteristics indicated the case was metastatic gastric carcinoma from the breast cancer with lung metastasis, since the statuses of ER, PgR and HER2 were concordant with those of the original breast cancer. However, the possibility of primary gastric cancer could not be completely ruled out. Therefore, a total gastrectomy was performed for the purpose of both diagnosis and treatment. Pathological examination of the resected specimen provided a definite diagnosis of multiple metastatic gastric carcinomas from the breast. To the best of our knowledge, metastatic gastric cancer derived from the breast presenting as linitis plastica 11 years following the surgical removal of IDC has not been described previously.

Sigmoid colon cancer arising in a diverticulum of the colon with involvement of the urinary bladder: a case report and review of the literature

BackgroundColon cancer can arise from the mucosa in a colonic diverticulum. Although colon diverticulum is a common disease, few cases have been previously reported on colon cancer associated with a diverticulum. We report a rare case of sigmoid colon cancer arising in a diverticulum with involvement of the urinary bladder, which presented characteristic radiographic images.Case presentationA 73-year-old man was admitted to our hospital for macroscopic hematuria. Computed tomography and magnetic resonance imaging revealed a sigmoid colon tumor that protruded into the urinary bladder lumen. The radiographs showed a tumor with a characteristic dumbbell-shaped appearance. Colonoscopy showed a type 1 cancer and multiple diverticula in the sigmoid colon. A diagnosis of sigmoid colon cancer with involvement of the urinary bladder was made based on the pathological findings of the biopsied specimens. We performed sigmoidectomy and total resection of the urinary bladder with colostomy and urinary tract diversion. Histopathological findings showed the presence of a colovesical fistula due to extramurally growing colon cancer. Around the colon cancer, the normal colon mucosa was depressed sharply with lack of the muscular layer, suggesting that the colon cancer was arising from a colon diverticulum.ConclusionThe present case is the first report of sigmoid colon cancer arising in a diverticulum with involvement of the urinary bladder. Due to an accurate preoperative radiological diagnosis, we were able to successfully perform a curative resection for sigmoid colon cancer arising in a diverticulum with involvement of the urinary bladder.

Malignant Mesenchymoma of the Retroperitoneum Involving Cecal Carcinoma. A Case Report.

患者は78歳の女性.後腹膜の黄色肉芽腫で左腎摘出術を施行された既往がある.主訴は左下腹部痛で, 同部に一致して径10cmの腫瘤を触知し, 血液検査ではCEA とCA19-9が高値を示した. CTでは左後腹膜に石灰化を有し周囲に脂肪成分を伴う腫瘤を認めた.注腸造影では下行結腸は内側に圧排され, また盲腸に腫瘤陰影を認めた.2型盲腸癌と黄色肉芽腫の再発との診断で手術を施行した.下行結腸周囲の後腹膜腔に複数の腫瘤を認め, 迅速病理にてmyxoid sarcomaと診断されたため結腸左半切除術を施行し, また盲腸癌にて回盲部切除術を併施した.切除標本では漿膜下から後腹膜に黄褐色または灰白色な弾性硬の腫瘤を認めた. 組織学的には分化型の軟骨肉腫や骨肉腫, 平滑筋肉腫および脂肪肉腫の成分を認め悪性間葉腫と診断された.盲腸癌は2型の高分化腺癌でss, ly2, v0, n1 (+) であった. 本疾患はまれであり組織発生を検討する上で興味ある症例と考えられたので報告する

A CASE OF RECURRENT GASTRIC CANCER WITHOUT JAUNDICE FOR 1 YEAR AND 6 MONTHS AFTER BILIARY ENDOPROSTHESIS USING AN EXPANDABLE METALLIC STENT

A 49-year-old man underwent a curative gastrectomy for a type 3 advanced gastric cancer. Liver dysfuntion was recognized 10 days after the operation. PTCD was carried out because of complete obstruction at the middle portion of the common bile duct. Under a diagnosis of biliary obstruction due to inflammation, second time operation was performed. A mass formation was recognized around the hepatoduodenal ligament. Adenocarcinoma cell invasion was found in the connective tissue in the induration at the biliary obstruction by intraoperative frozen section diagnosis. Only the biliary reconstruction was impossible. Expandable metallic stent was inserted using the route of PTCD after the operation. On the 30th day after the insertion, the PTCD tube was removed and complete biliary endoprosthesis was accomplished. From just before discharge, UFT-E 1.5g/day and PSK 3g/day were administered. Moreover CDDP 25 mg and MMC 2 mg were injected at the time of consultation. The injections were carried out 16 times until now. As of 1 year and 6 months after insertion of the stent, no evidence of exacerbation of gastric cancer has been recognized and the patient leads an ordinary life. During this period, no evidence of cholangitis and dilatation of intrahepatic bile duct on X-ray is recognized.

CLINICAL STUDY OF PANCREATICODUODENECTOMY FOR GASTRIC CARCINOMA

Thirteen patients with gastric carcinoma undergoing pancreaticoduodenectomy (PD group) in a recent one decade were subjected to a historical evaluation of the long term survival by radical operation. These cases were compared with 103 cases undergoing subtotal gastrectomy (non-PD group) for advanced carcinoma occupied lower third of the stomach in the same period. The five-year survival rates were 46% and 21% in PD-group and non-PD group, respectively. When the pancreas head was involved from the main tumor or metastatic lymph nodes, the 5-year survival rate was 53% in PD group, versus no survivors in non-PD group (p<0.05). Recurrence of lymph node metastasis occurred in 9% by Billroth I method, and 21% by Billroth II. For this, the prognosis was estimated in cases with positive lymph nodes of No.12, 13, 14 and 17 which were able to be dissected completely by PD, and resulted in the 2-year survival rates of 50% and 24% in PD and non-PD groups, respectively. These results suggest that PD for advanced carcinomas located in the lower third of the stomach may be recommended to the cases with invasion to the pancreas or metastasis to the lymph nodes around the pancreas head.

Clinical Significances of External Biliary Drainage before Pancreatoduodenectomy in Patients with Obstructive Jaundice.

従来より閉塞性黄疸患者の外科的治療に当たっては, まず術前PTCDを行って, 肝機能の改善を計ってから行うべきといわれている.そこでわれわれは, 閉塞性黄疸に対する術前PTCDの意義を探るべく検討した.163例の膵頭十二指腸切除例を術前総ビリルビン3.0mg/dl以上の黄疸群 (83例), 3.0mg/dl未満の非黄疸群 (80例) に分け, 黄疸群をさらにPTCDを行ったPTCD群 (65例) とPTCDを行わなかった非PTCD群 (18例) に分け, 3群間で治療成績を比較検討した.その結果, 黄疸群, 非黄疸群の間には手術時間, 術中出血, 術後入院日数, 術後合併症のいずれにおいても差はみられなかった.ただPTCD群は非PTCD群に比べ, 術前の入院日数が有意に長かった.以上より手術手技や術中, 術後の患者の管理が向上した今日では, 閉塞性黄疸患者には血清ビリルビン値のいかんにかかわらず, 術前PTCDを行うことなしに1期的に根治術を行うことは可能と考えられた.