Makoto Iwasa

Solitary pancreatic metastasis occurring eight years after nephrectomy for renal cell carcinoma. A case report and surgical review.

SummaryConclusionPancreatic metastasis from renal cell carcinoma is extremely rare. The average time between nephrectomy and the diagnosis of metachronous metastases is reported to exceed 10 yr. Therefore, the initial diagnosis may be neglected in the cases of prolonged disease-free interval. When it does occur simultaneously or metachronously, aggressive surgical resection, when possible, seems to be the most effectives treatment for this metastatic lesion.BackgroundAn 81-yr-old female patient, who 8 yr previously had undergone right radical nephrectomy for renal cell carcinoma, presented with solitary pancreatic metastasis, which was suscessfully treated with a distal pancreatectomy. Only 66 cases of clinically diagnosed renal cell carcinoma metastatic to the pancreas are reported in the world literature and 49 of the patients (including ours) underwent a definitive surgical resection. Our case, treated by distal pancreatectomy, and a review of the relevant literature including all reported cases of renal cell carcinoma metastatic to the pancreas, are presented.ResultsThe patient was well without any evidence of recurrence at 22 mo after the operation.

A case report of gastric cancer associated with sarcoid reactions in the regional lymph nodes and liver

Epithelioid cell granulomas identical to those of systemic sarcoidosis are occasionally observed within malignant neoplasms, particularly in the lymphatics draining a primary tumor. These histologic changes have been termed sarcoid reactions and are easily confused with systemic sarcoidosis. This report describes an extremely rare case of gastric cancer accompanied by sarcoid reactions in the regional lymph nodes and liver parenchyma near a tumor metastasis. A 63-year-old woman with advanced gastric cancer was treated by subtotal gastrectomy with dissection of the regional lymph nodes and local excision of the liver tissue involved by metastasis. Microscopic examination of the resected lymph nodes and liver disclosed the presence of sarcoid-like granulomas. The absence of any clinical manifestations and the negative results of the Kveim test, chest radiograph, and laboratory tests, including that for the serum angiotensin converting enzyme excluded the possibility of systemic sarcoidosis. The presence of a sarcoid reaction in the liver parenchyma adjacent to a metastasis has never been reported previously.

Malignant melanoma with mesenteric metastasis causing an intrapelvic abscess: report of a case

We present herein the case of a 66-year-old woman with disseminated malignant melanoma in whom a metastasis in the ileal mesentery ruptured into the peritoneal cavity causing an acute abdomen. The patient suddenly developed lower abdominal pain and a computed tomography (CT) scan of the pelvis confirmed the presence of an intrapelvic abscess. At emergency laparotomy, a 10×10 cm ruptured metastatic melanoma was found in the ileal mesentery, which demonstrated no communication with the ileum itself. To our knowledge, no other case of an acute abdomen being caused by the rupture of mesenteric metastatic melanoma lacking any communication with the bowel lumen has ever been reported.

A Case Report of Villous Adenoma of the Rectum Presenting as Prolapse through the Anus.

症例は75歳の男性で, 主訴は腫瘤の肛門外脱出.約3年前に腫瘤の肛門外脱出を認め近医にて直腸ポリープを指摘されるも放置していた.その後症状の増悪と肛門出血を認め当科入院.直腸指診にて肛門縁より5～6cm, 7時方向に柔らかい腫瘤を触知し, 注腸透視では下部から上部直腸にかけて径約7cmで, カリフラワー様の腫瘤陰影がみられ, 大腸内視鏡検査では表面が分葉し, 顆粒状で粘液に覆われた腫瘍を認めた.腹部CTでは直腸内腔を脳回状で内部均一な腫瘍が占居しており, endoscopic ultrasonographyでは固有筋層以深への浸潤が疑われたが, 脱出した腫瘍には, 潰瘍や硬結などの浸潤癌を疑わせる所見は認めなかった.重積法にて腫瘍を切除した.腫瘍は8.5×8.0cm大の広基性病変で, 組織学的にはvillous adenomaであり悪性所見はみられなかった.