Mamoru Yamada

Synchronous double cancers of the remnant stomach and pancreas: report of a case.

We present here in the case of a 75-year-old man who developed synchronous double cancers of the remnant stomach and pancreas 12 years after undergoing distal gastrectomy for gastric carcinoma. The patient was referred to our hospital in March, 1993, with a provisional diagnosis of carcinoma of the remnant stomach. Laboratory data on admission showed an abnormal level of CA19-9 (116.1 U/ml) and positive occult blood in the stools. An upper gastrointestinal series and gastroendoscopy demonstrated an ulcerative polypoid tumor in the gastric stump proximal to the gastroduodenostomy anastomosis, and a biopsy confirmed the findings of mucinous adenocarcinoma. Abdominal computed tomography (CT) scan revealed a low-density nodule anterior to the abdominal aorta, suggestive of a nodal metastasis. A laparotomy was performed which also disclosed a low-density mass located within the head of the pancreas. The patient was subsequently diagnosed as having double carcinomas of the remnant stomach and pancreas, and total gastrectomy and pancreatoduodenectomy were carried out. The histologic sections from the remnant stomach showed mucinous adenocarcinoma, whereas those from the pancreas showed tubular adenocarcinoma. Double carcinomas in this association are extremely rare and this case may in fact be the first observation of synchronous double cancers of the remnant stomach and pancreas.

Plexiform leiomyoma of the esophagus: A peculiar gross variant simulating plexiform neurofibroma

A plexiform variant of leiomyoma of the esophagus in a 51-year-old woman is reported. The patient was diagnosed with a tumor of the esophagus in an X-ray mass survey of the upper gastrointestinal tract. She was referred to the Ryukyu University Hospital for further examination. She appeared healthy with no complaints. Upper gastrointestinal series revealed an oval, well-defined filling defect in the lower esophagus just above the esophagogastric junction. Endoscopy revealed an undulating bulge covered with normal esophageal mucosa. Endoscopic ultrasonography showed a sharply demarcated hypoechoic mural tumor with internal linear pattern, with no evidence of penetration into the surrounding tissue. These findings were evaluated as consistent with a leiomyoma. Removing the tumor by enucleation was easily accomplished. Unexpectedly, on gross inspection, the tumor was a plexiform type, mimicking a plexiform neurofibroma. Light and electron microscopic examination and immunohistochemistry of the tumor tissue confirmed leiomyoma. Since the enucleation of the tumor, the patient has been free of recurrence and symptoms for 1.5 years at the time of this report.

Immunohistochemical and electron microscopic findings in a case of mixed hamartoma of the liver

A case of mixed hamartoma of the liver in a 36 day old female infant is reported herein. The resected tumor was well demarcated, measured 7.5×7.0 cm and weighed 179 gm. Microscopically, the tumor was composed of loose fibrous stroma intermingled with spindle and polygonal cells and ductular structures. The spindle and polygonal tumor cells displayed the distinct cytoplasmic staining for alpha-1-antitrypsin. Most of the tumor cells showed the characteristic ultrastructural features of immature hepatocytes, having numerous cytoplasmic microvillous structures, abundant rough and smooth endoplasmic reticulum and mitochondria. These findings suggest that embryonic liver cells, which are capable of transforming into biliary structures and hepatocytes, serve as essential elements of mixed hamartoma of the liver.

Flat-Elevated (de novo) Carcinoma of the Sigmoid Colon with a Pedunculated Muscularis propria Mimicking a Polypoid Carcinoma

A small flat-elevated carcinoma with a pedunculated muscularis propria mimicking an early polypoid carcinoma in a 67-year-old woman is reported. The patient was referred with a diagnosis of polypoid carcinoma of the sigmoid colon. Barium enema revealed an angular polypoid tumor, and endoscopy showed a sessile, plateau-like tumor with a central depression. Endoscopic ultrasonography showed a semilunar tumor with penetration into the muscularis propria, which showed a tent-like elevation. In July 1994, sigmoidectomy with lymph node dissection was performed. Macroscopically, the tumor was 2 cm in size and plateau-like with a depression. Microscopically, the tumor exhibited a plateau-like lesion with an ulcerative change on the surface. The section through the mid-portion of the tumor showed a stalk-like elevation of the inner circular muscle layer with carcinoma infiltration. The lymph nodes were involved by carcinoma. The tumor was a well-differentiated adenocarcinoma with invasion of the muscularis propria and positive regional lymph node metastasis (stage IIIb). The postoperative course was uneventful, and the patient is free of recurrence one year after surgery. This pedunculated stalklike formation of the muscle layer with invasive foci may be produced by peristalsis similar to that of the stalk of polyps.