Kenji Narumi

T-Cell Malignant Lymphoma of the Ileum Causing Ileac Fistulas: Report of a Case

We herein present a rare case of three fistulas caused by a recurrence of T-cell lymphoma of the ileum. A 67-year-old man presented at a local hospital with left lower abdominal pain in May 1997. Upper and lower gastrointestinal examinations did not reveal any abnormal findings, but an abdominal aortic aneurysm was diagnosed by computed tomography, and thus was determined to be the source of the pain. The patient was referred to our hospital to undergo a grafting operation; however, a laparotomy performed in July 1997 revealed an unexpected small intestinal tumor, and therefore a partial ileectomy between 15 and 70 cm in an oral direction from the terminal ileum was carried out instead. Histopathological and genetic examinations demonstrated diffuse small malignant lymphocytic T-cell lymphomas of the ileum invading all layers. Metastasis of the facial skin and local recurrence were recognized 5 months later, and chemotherapy with THP-COP and ESHAP only resulted in progressive disease. An ileac fistula was found to have formed between the intestine and abdominal wall in March 1998, and the patient died in May 1998. An autopsy revealed three fistulas caused by metastatic tumors, one of which communicated with the duodenum from the ileum, one with the skin from the ileum, and one to the transverse colon from the ileum.

A Case of Esophageal Cyst Excised Successfully Using Laparoscopy

Laparoscopic excision of an esophageal cyst was successfully performed on a 29‐year‐old male. The patient, complaining of back pain, was admitted to our hospital for further evaluation of a submucosal esophageal tumor. Close examination revealed a cystic tumor originating from the proper muscular layer at the distal esophagus, measuring 3 cm in diameter. Under general anesthesia, the tumor was excised laparoscopi‐cally without esophageal mucosal injury, with monitering by esophagoscopy. Postoperative esophagography showed no stagnation or stenosis. He was discharged on the 11th postoperative day. The cyst was diagnosed pathologically as an inclusion cyst of the esophagus. Laparoscopic or thoracoscopic surgery is a useful treatment for benign esophageal tumors, because it is less invasive giving more rapid recovery. Concomitant esophagoscopic monitering is beneficial to avoid injury of the esophageal mucosa, especially in such benign tumors that are firmly adherent to the esophageal muscle and mucosal layer.