Masahiro Fujikawa

Case series of 17 patients with cholangiocarcinoma among young adult workers of a printing company in Japan.

An outbreak of cholangiocarcinoma occurred among workers in the offset color proof‐printing department at a printing company in Japan. The aim of this study was to clarify the characteristics of the patients with cholangiocarcinoma.

Pathological spectrum of bile duct lesions from chronic bile duct injury to invasive cholangiocarcinoma corresponding to bile duct imaging findings of occupational cholangiocarcinoma

We aimed to identify the pathological characteristics of occupational cholangiocarcinoma.

Outcomes after resection of occupational cholangiocarcinoma

Cholangiocarcinoma caused by exposure to 1,2‐dichloropropane and/or dichloromethane is recognized as occupational cholangiocarcinoma. The aim of this study was to investigate the outcomes after resection of occupational cholangiocarcinoma to establish a treatment strategy for this disease.

The PD-1/PD-L1 axis may be aberrantly activated in occupational cholangiocarcinoma

An outbreak of cholangiocarcinoma in a printing company was reported in Japan, and these cases were regarded as an occupational disease (occupational cholangiocarcinoma). This study examined the expression status of programmed death‐1 (PD‐1) and programmed death‐ligand 1 (PD‐L1) in occupational cholangiocarcinoma. Immunostaining of PD‐1, PD‐L1, CD3, CD8, and CD163 was performed using tissue sections of occupational cholangiocarcinoma (n = 10), and the results were compared with those of control cases consisting of intrahepatic (n = 23) and extrahepatic (n = 45) cholangiocarcinoma. Carcinoma cells expressed PD‐L1 in all cases of occupational cholangiocarcinoma, whereas the detection of PD‐L1 expression in cholangiocarcinoma cells was limited to a low number of cases (less than 10%) in the control subjects. In cases of occupational cholangiocarcinoma, occasional PD‐L1 expression was also noted in precancerous/preinvasive lesions such as biliary intraepithelial neoplasia and intraductal papillary neoplasm of the bile duct. Additionally, tumor‐associated macrophages and tumor‐infiltrating T cells expressed PD‐L1 and PD‐1, respectively. The number of PD‐L1‐positive mononuclear cells, PD‐1‐positive lymphocytes, and CD8‐positive lymphocytes infiltrating within the tumor was significantly higher in occupational cholangiocarcinoma compared with that in control cases. These results indicate that immune escape via the PD‐1/PD‐L1 axis may be occurring in occupational cholangiocarcinoma.

A case of intra-abdominal bleeding from injured round ligament after inguinal hernia repair associated with endometriosis

32歳女性, 3年前から子宮内膜症にてホルモン療法.月経時の右鼠径部の違和感,圧 痛を認め,子宮内膜症を合併したNuck管水腫疑いで2010年 3 月手術施行.右子宮円靱 帯を通常どおりテーピング.ヘルニア囊は内腔が腹腔内と交通しており,右外鼠径ヘル ニアと診断.ヘルニア囊内にヘモジデリンの沈着を認め,子宮内膜症の所見と考え,高 位結紮,子宮円靱帯と伴にヘルニア囊を切除した.術翌日,腹痛および貧血を認めた. CTにて腹腔内出血と診断,緊急腹腔鏡下止血術を施行した.骨盤に子宮内膜症による 炎症,癒着を認めた.右子宮円靱帯が断裂し,出血源であった.バイポーラ電気メスお よびクリップで止血した.子宮円靱帯のテーピング牽引操作で,子宮内膜症の炎症によ り脆弱になった腹腔内の右子宮円靱帯が断裂,出血したと考えられた.子宮内膜症の患 者では,鼠径ヘルニア手術の際,子宮円靱帯のテーピング牽引操作は愛護的に行う必要 がある.

Spontaneous esophageal rupture treated with staged operations

Spontaneous esophageal rupture is a life-threatening entity. Here, a 64-year-old male who presented with sudden onset of severe back pain was diagnosed as having an esophageal rupture to the right pleural cavity. Emergency operation was carried out 16 hours after the onset. The rupture was as large as 7 cm and the surrounding tissue was fragile and necrotic. We performed an esophagectomy as a primary salvage procedure. An esophageal reconstruction was carried out successfully 6 months after the initial operation. Staged operative strategy including esophagectomy is still an important option to treat this kind of high risk patient.

POSTOPERATIVE GASTRIC EMPTYING AND QOL IN RECONSTRUCTION PROCEDURE USING GASTRIC TUBE AFTER PROXIMAL GASTRECTOMY FOR UPPER GASTRIC CANCER

胃上部癌に対して噴切後,食道胃管吻合を施行した15例を対象とした.年齢は47～81歳,男性12例,女性3例であった.手術適応はEC-junction近傍の早期癌やhigh risk症例でU領域を占拠する進行癌とした.リンパ節は(1), (2), (3), (7)番のみ郭清し,胃管の長さは約20～25cmとした.術後のQOLとして経口摂取量の変化,体重の推移,臨床症状の有無,内視鏡所見,排出能を検討した.退院時,経口摂取量は術前の50～85%,体重は術前の80%まで低下したが術後1年目には15例中8例が術前のレベルに回復した.食後のつかえ感は1例にみられたが,胸やけやDumping症状は認めなかった.内視鏡検査では逆流性食道炎を12例中3例に認めたが保存的に軽快した.残胃炎や胃石は認めなかった.噴切症例の排出能は墜落型のパターンを呈した.胃上部癌に対する噴切後の大彎側胃管を用いた再建法は手術手技も簡便であり,術後のQOLも良好に保たれていた.

A case of choledochoduodenal fistula.

特発性内胆汁瘻は全胆道系手術症例の1～5%を占めるまれな疾患である.今回術前に診断し得た総胆管十二指腸瘻の1例を経験したので報告した.患者は54歳の女性.上腹部痛と発熱を主訴として来院し, 上部消化管造影, 内視鏡的逆行性胆管造影 (以下ERCP) により診断した.総胆管と十二指腸球部の間に瘻孔を認め, 胆嚢摘出術, 瘻孔切離術およびT管ドレナージを行った.術後軽度の肝機能異常が出現したが徐々に軽快し術後2か月で退院した.次に1979～1988年の10年間に本邦で報告された総胆管十二指腸瘻95例に自験例1例をあわせ, その臨床像, 診断, 治療について若干の検討を加えた.臨床症状では腹痛, 発熱, 黄疸の順に多く, 本症に特異的な症状は認められなかった.診断法としてはERCPが有効であり, 同検査法の普及による本症特に傍乳頭部総胆管十二指腸瘻の診断率の向上が認められた.