Kenichiro Hirata

Carcinoma arising from ectopic pancreas in the stomach: Endosonographic detection of malignant change

We present a case of a submucosal tumor in the stomach that was suspicious for malignancy on preoperative endosonography. The resected tumor was histologically diagnosed as a ductal adenocarcinoma that originated in ectopic pancreatic tissue in the gastric wall. Although malignant transformation in ectopic pancreas is extremely rare, it remains an important consideration in the differential diagnosis of gastric submucosal masses.

Endoscopic ultrasonography of the esophagus

Endoscopic ultrasonography (EUS) is a generally accepted technique for the preoperative staging of malignant tumors in the upper and lower gastrointestinal tracts. In particular, EUS has been considered the method of choice in diagnosing esophageal carcinoma due to the relative ease in performing the examination and the accuracy of staging based on high-resolution ultrasonic imaging from within the lumen of the esophagus. This comprehensive review covers currently available EUS instruments, image characteristics of esophageal carcinoma, and images by the recently introduced miniprobe scanner. The role of the method in diagnosing superficial esophageal carcinoma and the possible treatment by endoscopic mucosal resection of this particular disease entity are discussed.

Selective Embolization of the Splenic Vein in Patients with Hepatic Encephalopathy and Splenorenal Shunt

Obliteration of portal-systemic shunts is effective for portosystemic encephalopathy but is often associated with complications such as retention of ascites and worsening of esophageal varices. Selective embolization of the splenic vein was performed on six patients with hepatic encephalopathy and splenorenal shunts. Hepatic encephalopathy was not observed in four patients after the procedure. Neither retention of ascites nor rupture of esophageal varices was observed because postoperative elevation of portal venous pressure was not as great as that seen when shunt obliteration is performed. This procedure can be an effective and safe treatment option for hepatic encephalopathy with a splenorenal shunt.

Advanced pancreatic carcinoma showing a complete response to arterial infusion chemotherapy

We report a patient with advanced carcinoma of the pancreatic body and tail with multiple liver metastases who showed a complete response to hepatic and splenic arterial infusion chemotherapy (HSAIC) with gemcitabine and 5-fluorouracil, following transcatheter peripancreatic arterial embolization (TPPAE) and partial splenic embolization (PSE). Nonresectable advanced pancreatic carcinoma tends to have a low response to medical treatment, with the median survival time being 6 months or less for stage IV cases. We disclose herein that the median survival time of patients receiving HSAIC after TPPAE is more than three times longer than the survival time attained with conventional treatments. However, in patients with advanced carcinoma of the pancreatic tail, for which TTPAE is not applicable, survival times remain low. Thus, in the patient described here, we also performed embolization of the left gastric and short gastric arteries as well as PSE to increase the flow within the great pancreatic and caudal pancreatic arteries via the splenic artery, and gemcitabine and 5-fluorouracil were administered via the splenic artery. As a result of these procedures, marked reduction in the advanced carcinoma of the pancreatic body and tail and of liver metastases was attained.

Mass survey of hepatocellular carcinoma by ultrasound

Hepatocellular carcinoma (HCC) is rather rare in the Western Hemisphere and in Europe, however, it is far more prevalent in the Orient and Africa and is indeed one of the most common causes of cancer death in these areas [1–3].