Kenzo Okumura

Radical resection of primary malignant melanoma of the gallbladder with multiple metastases : report of a case

We present herein an usual case of primary malignant melanoma of the gallbladder in a 51-year-old man in whom an exploratory laparotomy for melena revealed six malignant melanoma lesions located in the gallbladder, main pancreatic duct, stomach, duodenum, jejunum, and a mesenteric lymph node. Total pancreatectomy was performed and histologically, junctional activity was seen only in the gall-bladder, suggesting that this was the primary site. No melanotic lesions were found on the skin or eyes. The metastases to the main pancreatic duct and gastrointestinal tract appeared likely to have occurred as a consequence of the mucosal dissemination of the tumor cells shed into the bile. The post-operative course was uneventful and combined chemotherapy was administered for 16 months. No new metastatic lesions were found until 21 months postoperatively, when metastases were detected in the brain and thoracic spinal cord. These metastatic tumors were removed surgically, but the patient died from cerebral disturbance 26 months after the initial operation. Thus, we consider that aggressive surgical therapy was effective for extending the survival time and improving the quality of life of this patient.

Increased expression of the multidrug-resistance gene in undifferentiated sarcoma

We analyzed multidrug‐resistance gene (mdr1 gene) expression in a patient with undifferentiated sarcoma of the liver using the cloned cDNA for the mdr1 gene. Tissue samples were available at the time of initial diagnosis and of two intracranial relapses after chemotherapy with a regimen including doxorubicin and teniposide. The level of mdr1 gene expression was increased sevenfold in the intracranial tumor at the time of first relapse and 11‐fold at the second relapse. This case may be an example of acquired multidrug resistance associated with overexpression of the mdr1 gene.

Aggressive resection for advanced pancreatic carcinoma

An aggressive pancreatectomy was performed on a 53 year old Japanese man with advanced cancer of the pancreas. The tumor originated from the body of the pancreas and invaded the stomach, duodenum, left kidney, transverse colon and common hepatic artery. An unexpected cancer was also found in the head of the pancreas during the operation. Therefore, total pancreatectomy, total gastrectomy, left adrenonephrectomy, resection of the left transverse colon and dissection of the regional lymph nodes were performed. Resection of the common hepatic artery was also performed, followed by an end-to-end anastomosis between the common hepatic artery and celiac trunk. The postoperative course was uneventful and the patient was doing well until nine months after the operation when multiple metastatic lesions were noted in the liver. He died 391 days after the operation from hepatic failure.

Gastric varices formation due to pancreatic tumor: a case of successful resection of cystadenocarcinoma.

We report a 70-year-old woman with gastric varices due to splenic vein obstruction by a cystadenocarcinoma of the caudal pancreas. Most of the pancreatic cancer had already extensively progressed and was unresectable when an obstruction of the splenic vein was also discovered. Two contributing factors are thought to have enabled us to perform a curative resection in this cases: (1) the gastric varices were detected by chance in a mass survey, (2) the cancer was not so advanced as to be unresectable.

Carcinoma Overlying Leiomyoma of the Esophagus

We describe a case in which esophageal carcinoma invaded a coexisting leiomyoma. A 45-year-old Japanese man had complained of slight dysphagia and showed an abnormal shadow on the chest X ray film 10