Masaki Kawahara

A rare case of pseudomyxoma peritonei presenting an unusual inguinal hernia and splenic metastasis

Abstract Pseudomyxoma peritonei (PMP) is a rare clinical entity in which a diffuse collection of intraperitoneal gelatinous fluid is associated with gelatinous implants on the peritoneal surfaces and omentum. Hematogenic or lymphatic metastasis is extremely rare. In addition, an inguinal mass as an initial presentation is also relatively rare. This is a case report of a PMP patient who had splenic metastasis and showed an inguinal tumor as an initial presentation. A 59‐year‐old female patient, who had undergone bilateral oophorectomy because of a ruptured ovarian mucinous tumor of boderline malignancy 12 years previously, presented a presumptive diagnosis of a left inguinal irreducible hernia. Computed tomography revealed a low density mass in the pelvic cavity and in the inguinal lesion, as well as in the spleen without any diseases around the organ. The preoperative serum carcinoembryonic antigen (CEA) level was elevated. The patient underwent a resection of gelatinous tumor in the pelvic cavity, splenectomy, and appendectomy, as well as left inguinal herniorrhaphy. Histological examinations revealed a splenic metastasis of PMP originating from the ovarian low‐grade mucinous tumor. She received postoperative intraperitoneal lavage as well as chemotherapy, and has survived for over 7 years postoperatively without any evidence of recurrence, as confirmed by repeated follow‐up CT examinations and CEA determination. Splenic metastasis of PMP is extremely rare; this represents only the third reported case of its kind in the literature. Furthermore, it should be noted that an inguinal tumor can sometimes be an initial presentation of PMP.

Telomere shortening with aging in human thyroid and parathyroid tissue.

Progressive telomere shortening with aging was studied using normal thyroid tissue specimens from 46 human subjects aged between 0 and 98 yr and normal parathyroid tissue specimens from 21 human subjects aged between 0 and 83 yrs. There has hitherto been no information documented about telomere length in such thyroid and parathyroid tissues. Age-related shortening at rates of 91 and 92 base pairs (bp) per year, respectively, were observed. Telomere lengths of normal thyroid tissues were 16.53 +/- 1.10 (mean +/- SE), 14.31 +/- 0.80, 11.27 +/- 0.68 and 8.73 +/- 1.08 kbp for age groups less than 2, 20-50, 51-80 and more than 80 yr. Telomere lengths of normal parathyroid tissues were 15.80 +/- 1.46 (mean +/- SE), 15.36 +/- 0.86 and 10.93 +/- 0.78 kbp for age groups less than 4, 20-50 and 51-80 yr. Telomere shortening occurred after 50 yr of age in thyroid and parathyroid tissues. Human thyroid and parathyroid tissues do not seem to show the rapid reduction in telomere length early in life that was reported for some human cell types, suggesting that the rate of telomere shortening has tissue-specific characteristics.

Early gastric cancer development in a familial adenomatous polyposis patient.

Familial adenomatous polyposis (FAP) is inherited as an autosomal dominant gene characterized by hundreds of adenomas of the colon, and FAP patients, if untreated, will eventually develop colonic cancer. Recently, FAP patients have been found to have benign and/or malignant diseases not limited to the large intestine. Extracolonic lesions occur in the entire gastrointestinal tract, particularly in the stomach and duodenum, as well as in the extraalimentary organs such as the thyroid, pancreas, and biliary tract (1–6). The gastric and duodenal lesions in FAP patients usually include benign fundic gland hyperplastic polyps, gastric adenomas, and duodenal adenomas, their prevalences varying from 11 to 50, 2 to 44, and 33 to 100% of cases, respectively (7–13). In a large Western series, cancer has been reported to occur most frequently in the duodenum, with an incidence of 3.1% of FAP patients (1), while gastric cancer has rarely been found (0.6%) among extracolonic cancer patients (1), being reported only sporadically (14, 15) following the first report of such a case in 1962 (16). In contrast, a recent Japanese series appears to exhibit a relatively higher incidence of gastric cancer in FAP patients (4); however, to date, only 30 cases have been found in the literature from Japan, including the cases accumulated recently by Kamoi et al. (17). In this report, we describe a case of a FAP patient who had rectal cancer as well as multiple early gastric cancer and duodenal adenoma. We then introduce an overview of the clinicopathological characteristics of gastric cancer in FAP patients, as based on a review of the literature. This overview, the first to be performed in the English literature,

Consistent Decrease in Telomere Length in Parathyroid Tumors but Alteration in Telomerase Activity Limited to Malignancies: Preliminary Report

AbstractTelomerase is known to be activated and telomere length altered in various types of malignant and benign tumors, but whether this is also the case for parathyroid lesions has hitherto been unclear. We therefore investigated telomerase activity and telomere length in 3 parathyroid metastatic cancers, 6 adenomas, 2 cases of parathyroid hyperplasia, and 16 samples of normal parathyroid tissue. Telomerase activity, assayed by the telomeric repeat amplification protocol, was detected in all of the parathyroid cancers (100%), in none of the 8 parathyroid benign lesions, and in only 1 of the 16 normal parathyroid samples (8.3%). Telomere length, determined by the terminal restriction fragment assay, was reduced in the tumor tissues with a mean telomere length of 8.23 ± 0.86 kbp compared with the 12.61 ± 0.81 kbp for the 16 age-matched subjects (p = 0.002). The results indicate that telomerase activity and telomere length may reflect the biologic behavior of individual parathyroid lesions.

Bochodalek Hernia in a Young Adult: Report of a Case

Abstract A Bochodalek hernia is rarely seen in adults. An 18-year-old man was referred to our institute with the chief complaint of a sudden onset of left subcostal pain, nausea, and vomiting. A radiograph and a computed tomographic scan of the chest revealed a Bochodalek hernia. Emergency surgery was thus performed. The herniated organs were put back into the peritoneal cavity and the hernial hilum was closed. The postoperative course was uneventful. A routine chest radiograph 1 month before had shown a slight elevation of the left hemidiaphragm and further examination using computed tomography suggested a Bochodalek hernia, but he had merely been followed up since there were no symptoms. As soon as a diagnosis is made, specific repairs should be carried out even if no symptoms are present, to prevent such complications as strangulation or perforation.

Complete Response of Esophageal Cancer Achieved by Combination Therapy with 5-Fluorouracil, Low-Dose Cisplatin, and Radiation : Report of a Case

2 per day, from days 1–5 combined with the daily administration of low-dose cisplatin, 10 mg/m2 per day before each fraction of radiation, given as 2 Gy each time, throughout the entire treatment period of 3 weeks beginning on day 1. The benefits of our preoperative chemoradiation therapy included no severe side effects, down-staging and resectability of the tumor, as well as a pathological complete response, which could prolong the survival time. Our experience of this case prompts us to recommend the concurrent daily preoperative chemoradiation therapy for patients with locally advanced esophageal cancer.

Familial Urachal Sinus Associated with a Possible Congenital Malformation: Report of a Case

Abstract.We report a rare case of familial urachal disease associated with a congenital malformation. A 34-year-old woman was referred to our hospital with recurrent umbilical purulent discharge. She had undergone partial resection of the small intestine for obstruction and, later, a pyeloplasty for a stricture of the ureter-pyelo junction. Her younger brother had also undergone surgery for a urachal sinus 1 year earlier. She was found to have an umbilical granuloma with a fistulous track that could be probed for 3 cm distally. Computed tomography (CT) and ultrasonography confirmed the fistulous track. Under a diagnosis of urachal sinus, a urachal remnant was excised. Histological analysis of the excised specimen revealed only inflammatory granulomatous tissue with marked infiltration of lymphocytes and foreign body giant cells. Urachal cysts are associated with a risk of intestinal strangulation and therefore, the finding of urachal disease justifies detailed evaluation.

Surgical Treatment and Survival Rate of Early Cancer

Subtotal gastrectomy with lymphadenectomy including Group 2 lymph nodes, D2 lymphadenectomy, has been performed in Japan as a standard surgical treatment for gastric cancer regardless of its stage, and good survival rates have been obtained. However, retrospective analysis of the results revealed that about 80% of early cancers have no lymph node involvement, suggesting curative treatment of these early cancers without the standard D2 lymphadenectomy; they may be curative with limited surgery. Limited surgery includes two limitations, the scope of the gastrectomy and lymphadenectomy. In terms of quality of life (QOL) after gastric surgery, preservation of the gastric function and less invasive surgery are desirable. In this section, we discuss indications and results of limited surgery for early gastric cancer. Furthermore, application of a newly developed surgical treatment will be proposed.

Experimental laser anastomosis of the large bowel: conclusive results and future prospect

Completely sutureless end-to-end large bowel anastomoses were successfully performed in New Zealand white rabbits by using 1064 nm, 0.4-W power pulsating Nd:YAG laser to produce welding. Purpose: The aim of this study was to assess the results of our whole experimental data and summarize our experimental work on laser colon anastomosis. Methods: This experimental study investigated integrity of anastomosis, degree of narrowing, macroscopic appearance, microscopic findings, animal body weight change, and collagen concentration of laser colon anastomoses, compared with those of conventional sutured anastomoses up to ninety postoperative days. Results: Bursting pressures of laser anastomoses were at first low and came to be equivalent at seven days, but the laser group exhibited a consistent narrowing tendency. However, laser anastomoses demonstrated fewer and milder adhesions, and animals showed a better recovery of body weight. Histologically, laser anastomoses showed better layer-to-layer reconstitution without foreign body response and with less fibrosis. Difference in collagen concentration did not reach statistical significance. Conclusion: The technique of laser anastomosis presents a promising alternative to suturing in reconstitution of the large bowel.