Kaname Ishiguro

Retroperitoneal mucinous cystadenoma : Report of two cases and review of the literature

Primary retroperitoneal cystic tumor is extremely rare, and its histogenesis and biological behavior remain speculative. Two surgical cases of retroperitoneal mucinous cystadenoma (Case 1, an 18‐year‐old woman; and Case 2, an 85‐year‐old woman) are reported. The cystadenomas in these cases were mainly lined by a monolayer of columnar or thin flat cells. Case 1 was positive for mucin and epithelial membrane antigen, whereas Case 2 was positive for a mesothelial marker (calretinin). Ciliated epithelium was also interspersed in Case 2. Some parts showed papillary projections, resembling well‐differentiated papillary mesothelioma. Within the cyst walls of both cases, ovarian‐like stroma that was positive for both estrogen and progesterone receptors was found. Interestingly, focal nodular hyperplasia of the liver was also detected in Case 1. We believe the retroperitoneal mucinous cystadenoma might have arisen from the peritoneum via mucinous epithelial metaplasia with a phenotype of extragenital Mullerian system.

Evaluation of A Novel Information-Sharing Instrument for Home-Based Palliative Care: A Feasibility Study.

Aim: To examine the feasibility and usefulness of a novel region-based pathway: the Regional Referral Clinical Pathway for Home-Based Palliative Care. Method: This was a feasibility study to evaluate the frequency of variances and the perceived usefulness of pathway using in-depth interviews. All patients with cancer referred to the palliative care team between 2011 and 2013 and received home care services were enrolled. Result: A total of 44 patients were analyzed, and pathway was completed in all the patients. The target outcome was achieved in 61.4% while some variances occurred in 54.5%. Nine categories were identified as the usefulness of the pathway, such as reviewing and sharing information and promoting communication, education, motivation, and relationships. Conclusion: This novel pathway is feasible and seems to be useful.

A CASE OF ILEAL PERFORATION DUE TO CANDIDA INFECTION IN A PATIENT WITH LONG-TERM STEROID THERAPY

症例は68歳,女性.慢性関節リウマチのため10年以上プレドニゾロン10mg/日を服用していた. 2003年9月18日,腹痛を認め救急車にて搬送された.腹部CT検査にて小腸穿孔・汎発性腹膜炎と診断,手術を施行した.回盲部より30cm口側の回腸に穿孔を認め,小腸切除術を施行した.病理組織学的検査では,潰瘍底にカンジダの増殖を伴う潰瘍を2カ所に認め,うち一方が穿孔していた.医学中央雑誌で過去10年間を検索したが,カンジダによる成人の小腸穿孔の報告はなかった.カンジダは易感染性の患者に日和見感染症を起こし重篤になる場合がある.小腸カンジダ症は稀ではあるが,潰瘍や穿孔の一因になりうるということを,再度認識する必要があると思われた.