Keizo Sugino

A case of hepatoblastoma occurring in an adult.

We present herein a rare case of hepatoblastoma occurring in an adult male. The patient was 22 years old and his laboratory investigations on admission showed a marked elevation of α-fetoprotein in the serum. CT scan and other examinations revealed a primary tumor, 6.5 cm in size, in the left hepatic lobe with metastasis in the head of the pancreas. Thus, left hepatic lobectomy and pancreaticoduodenectomy were performed, but metastasis to the right hepatic lobe, left lung and abdominal skin were found 2 months later. Despite repeated courses of chemotherapy with adriamycin and cisplatin, the patient died 9 months after his operation. Pathological findings revealed poorly differentiated type hepatoblastoma. A review of the literature revealed only twelve other such cases.

Gasless laparoscopic hepatic resection for cirrhotic patients with solid liver tumors.

Gasless laparoscopic hepatic resection with a 5-cm minilaparotomy was performed in 10 cirrhotic patients with small liver tumors. To maintain good visualization and working space during hepatic resections, we developed a simple retraction system. Mean operative time and blood loss were 291 minutes and 249 mL, respectively. No blood transfusion was required during the operations. No serious complications occurred such as gas embolism. Our laparoscopic procedures had various advantages. Blood, smoke, and water vapor could be aspirated by suction without disturbance of the visual field. There was no risk of gas embolism. It was possible to use conventional instruments through the ports or the wound made by a minilaparotomy. Hemostasis therefore could be performed easily. The procedure could be applicable to cirrhotic patients with some complications. This laparoscopic procedure is recommended for patients with small HCCs associated with liver cirrhosis who are not candidates for major hepatectomy.

Effect of antileukocyte adhesion molecule antibodies, nitric oxide synthase inhibitor, and corticosteroids on endotoxin shock in mice

We compared the therapeutic effects of anti-leukocyte adhesion molecule antibodies (mAbs), a nitric oxide (NO) synthase inhibitor (monomethyl-l,-arginine, NMLA), and methylprednisolone (MP) on experimental endotoxin-induced shock in mice. Lipopolysaccharide (LPS, 30mg/kg) was administered to ICR mice intraperitoneally, While 1mg/kg mAb, 5–20 mg/kg NMLA, or 30mg/kg MP was administered intravenously. The placebo group received phosphate-buffered saline. The survival rate of the placebo group 48 h after LPS injection was 36%. The administration of anti-CD11a, anti-CD18, anti-lectin cell adhesion molecule-1 (anti-LECAM-1), and MP increased the survival rate to 70, 62, 64, and 100%, respectively; however, NMLA had no significant effect. A FACS analysis revealed that the CD18 expression of granulocytes increased 12-fold within 30 min after LPS administration. MP significantly suppressed its expression. The plasma level of nitrate/nitrite increased from 20 to 260 and 1000μM 4 and 16h, respectively, 20 mg/kg NMLA abolished NO production at 4h, while MP inhibited it for up to 16h. The hepatic malondialdehyde level increased from 0.50 to 2.46 nmol/mg protein at 4h. Administration of anti-CD18 and MP reduced the level to 1.80 and 1.41 nmol/mg protein, respectively, whereas NMLA did not affect it. The mAbs and MP were concluded to be useful agents for endotoxin shock. The abolition of NO production had little influence on the hepatic cellular injury associated with endotoxemia.

De Garengeot hernia with perforated appendicitis and a groin subcutaneous abscess: A case report

Highlights • De Garengeot hernia with a groin subcutaneous abscess is rare.• Appendectomy and herniorrhaphy via the same incision may be more effective.• Clinicians should consider de Garengeot hernia in patients with a groin hernia.

Acute Cholecystitis with Significantly Elevated Levels of Serum Carbohydrate Antigen 19-9.

Serum carbohydrate antigen 19-9 (CA 19-9), a marker of malignant tumors, is generally slightly elevated in benign conditions. We report a case of acute cholecystitis with a significantly elevated level of serum CA 19-9 based on positron emission tomography (PET)-computed tomography (CT) findings. A 65-year-old woman presented with abdominal pain and fever. A CT image revealed an enlarged gallbladder without tumor shadows. The C-reactive protein (CRP) level was elevated to 7.66 mg/dl. Moreover, the serum CA 19-9 level was significantly elevated to 19,392 U/ml. We started antibiotic treatment, because we suspected acute cholecystitis, but still, we could not ignore the possible presence of malignant tumors. After 11 days of antibiotic treatment, serum CRP and CA 19-9 levels decreased to 0.11 mg/dl and 1,049 U/ml, respectively. There was an accumulation of fluorine 18-labeled fluorodeoxyglucose (maximum standardized uptake value, 9.3) without tumor shadows in the liver, near the gallbladder, on the PET-CT examination. We considered the possibility that the inflammation had spread from the gallbladder to the liver, made a diagnosis of acute cholecystitis, and performed a cholecystectomy 33 days after treatment initiation. The serum CA 19-9 level decreased to 45 U/ml after the surgery. One year after the surgery, the patient was alive, and the serum CA 19-9 level was 34 U/ml. Acute cholecystitis with a significantly high elevation of the serum CA 19-9 level is rare. In such cases, it is important to confirm the change in the serum CA 19-9 level over time after antibiotic treatment and perform imaging studies to distinguish between inflammation and malignancy.

h-prune affects anaplastic thyroid cancer invasion and metastasis

Anaplastic thyroid cancer is one of the most aggressive human malignancies and is resistant to multimodal treatments. The expression of h-prune, the human homologue of Drosophila prune, has been reported to be correlated with progression and aggressiveness in various cancers including breast, colorectal and pancreatic cancers. We examined the role of h-prune in anaplastic thyroid cancer cell migration, invasion and metastasis. Immunohistochemical analysis of h-prune was performed with 15 surgically resected specimens of anaplastic thyroid cancers. To investigate cell motility, Boyden chamber, wound healing and matrigel invasion assays were performed using cells from anaplastic thyroid cancer cell lines. A murine orthotopic thyroid cancer model was used to investigate metastatic ability. In the immunohistochemical analysis, only weak focal or no staining of h-prune was observed in non-tumor tissue. In contrast, diffuse staining of h-prune was observed in anaplastic thyroid cancer and lymph node metastasis samples. Both inhibition of h-prune phosphodiesterase activity with dipyridamole and small interfering RNA for h-prune suppressed 8505C and KTC-3 cell motility. In addition, treatment with dipyridamole and decreased expression of h-prune suppressed tumor invasion and pulmonary metastasis in a NOD/Shi-scid, IL-2Rγnull (NOG) mouse orthotopic thyroid cancer model. In conclusion, h-prune is frequently expressed in anaplastic thyroid cancer cells and lymph nodes metastasis, and promotes migration and invasion of anaplastic thyroid cancer cells and metastasis in an anaplastic thyroid cancer model. Thus, h-prune shows promise as a targeting candidate against anaplastic thyroid cancer.

Allochronic overlapping malignancies after renal transplantation in a patient with p53 gene mutation: report of a case.

We report a rare case of the development of various tumors over a 16-year period after renal transplantation. A 56-year-old woman underwent renal transplantation using a US kidney. Immunosuppressive treatment consisted of a triple regimen of methylprednisolone, azathioprine, and mizoribine. Left breast cancer was diagnosed 9 years after the renal transplantation, then colon cancers and meningeal epidermal meningioma were diagnosed, 10 years and 12 years post-transplant, respectively. During the investigations for the breast and colon cancers, a p53 gene mutation was detected. A deterioration of renal function was found 16 years after the transplant and graft biopsy confirmed chronic rejection. We suggest that the effects of the immunosuppressive drugs combined with the p53 gene abnormality accelerated tumor development in this patient.

Sessile serrated adenoma/polyp leading to acute appendicitis with multiple pyogenic liver abscesses: A case report

Highlights • Appendicitis with liver abscess and sessile serrated adenoma/polyp is rare.• Ileocecal resection was performed for an inflammatory mass in the ileocecum.• The patient was successfully treated with a combination of surgery and antibiotics.

Afferent loop obstruction with obstructive jaundice and ileus due to an enterolith after distal gastrectomy: A case report

Highlights • An enterolith occurring in the duodenal afferent loop after distal gastrectomy, leading to obstructive jaundice and ileus is rare.• Although afferent loop enterolith formation is uncommon, it should be considered when a patient with a history of B-II gastrectomy or Roux-en-Y reconstruction presents with fever, abdominal pain, or other symptoms suggesting acute cholangitis.• Surgical treatment should be considered for afferent loop obstruction or intestinal obstruction that is refractory to conservative treatment.

A CASE OF THYROID HEMANGIOMA

甲状腺に発生する血管腫は非常に稀で，本邦での報告例もわずかに13例を数えるのみである1)～11)．今回当科では，画像所見などから甲状腺癌を疑った甲状腺血管腫の1例を経験したので報告する．症例は79歳，男性．嚥下障害を主訴に近医を受診した．頸部超音波検査で甲状腺右葉に腫瘤を指摘され，当科紹介となった．甲状腺右葉下極に30mm大の不整形腫瘍を認め，内部エコーは等～やや低エコーで不均一であった．穿刺吸引細胞診の結果はクラスIであったが，画像上悪性の可能性も否定できず，甲状腺右葉切除術を施行した．摘出腫瘤の割面は白色スポンジ様であり，病理組織検査で，甲状腺血管腫と診断された．