Masanori Ishii

Bile duct carcinoma arising from the anastomotic site of hepaticojejunostomy after the excision of congenital biliary dilatation: A case report

A SIGNIFICANT ASSOCIATION between congenital biliary dilatation (CBD) mad hepatobiliary malignancies is well established, t The cause of the association is presumed to be the reflux of pancreatic juice into the bile duct and the accumulation of bile juice in choledochal cyst caused by anomalous un ion of the pancreaticobiliary ductal system. These malignancies arise mostly in the gallbladder and the extrahepatic bile duct. Therefore the standard surgical managemen t of CBD is to excise the whole extrahepatic bile duct and to perform hepaticoenterostomy. We will describe a case of a 60-year-old woman who had undergone cyst excision, cholecystectomy, and Roux-en-Y anastomosis for CBD (Todani s classification type I) 5 years earlier and who suffered from bile duct carcinoma arising in the anastomotic site of hepaticojejunostomy. This is the second reported case of a carcinoma that arose from the anastomotic site of hepaticojejunostomy for CBD.

Juxtacaval liver resections with the use of an internal IVC shunt tube.

Almost one tenth of more than 370 hepatectomies, mostly for tumors, involved resection of major parts of the caudate lobe, subsegment 1. Five of them were for tumors or hemangiomas here, compressing or invading the vena cava; two were for metastases of colorectal cancer located very close to the junctions of the right and middle hepatic veins with the vena cava. We would previously have deemed these tumors unresectable. In these patients the vein was banded above and below the liver, an internal shunt tube placed in preparation for shunting of blood, and the afferent liver blood flow controlled. Control of the vena cava by tightening of the bands was needed in two cases. Tumor-invaded parts of the vein wall were resected in two other cases, in whom the presence of the tube facilitated the resection but the bands did not have to be tightened. The procedure did not cause morbidity and we conclude that tumors close to the vena cava can often be resected without complex vascular exclusion techniques, even when they invade the vein.

Gallbladder adenocarcinoma with human chorionic gonadotropin: a case report and review of literature

BackgroundThe case of adenocarcinoma with human chorionic gonadtropin (HCG), primary in the male gallbladder, is extremely rare. A Medline search has shown only a few similar cases reported.MethodsWe herein describe a case of primary gallbladder adenocarcinoma associated by ectopic HCG positive tumor cells in a 79-year-old male.ResultsPathological examination showed a mixture of moderately and poorly differentiated adenocarcinoma with ectopic HCG and placental alkaline phosphatase (PlAP) in tumor cells, though the increase of serum or urinary HCG secretion was not confirmed. The literatures were also reviewed.ConclusionsA case of gallbladder cancer with ectopic HCG production is quite rare in the literature, though many similar cases in other site, especially in GI tract, are reported. Embryological consideration suggests the increased frequency of similar cases more than being thought now.

Carcinosarcoma of the ampulla of Vater.

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Arterial infusion therapy: Lipiodol-cytostatics with and without embolization

The liver has a dual blood supply by the arterial and portal systems. Primary and secondary liver tumors are mainly nourished arterially, as first suggested by Breedis and Young [1]. This knowledge has guided numerous attempts to affect the growth of liver tumors by reduction of the nutritive arterial flow and/or addition to it of antitumor agents. In both cases, some selectivity of action is expected because the normal liver is to a great extent also supplied by the portal venous flow. The regional infusion of toxic agents could be expected to give diminished side effects as compared to systemic treatment because the agents may be more or less cleared or modified by passage through the liver.

Scarless surgery for a huge liver cyst: A case report

Highlights • Fenestration is the definitive treatment for symptomatic/complicated liver cysts.• NOTES, which has been reported recently, enables surgery without scars.• Multiple clinical and technological barriers impede further progress with NOTES.• Our safe and unique method enables minimally invasive surgery with small incisions.• This “scarless surgery” is expected to yield some clinical benefits.

Segmental Resection of the Duodenum for Early Cancer of Papilla of Vater

近年, 十二指腸乳頭部早期癌や良性疾患に対して, 根治的かつ縮小手術として, 膵温存の十二指腸下行脚分節切除, 部分切除の報告が散見される. 紹介した本術式は膵温存が可能で膵管, 胆管共通管を十二指腸壁外, 膵外で切離して十二指腸乳頭部を完全摘出でき, 十二指腸腔内の水平方向へ進展した腫瘍に対応できる. 今回, 我々は十二指腸乳頭部早期癌の2症例に膵温存十二指腸下行脚分節切除を行ったので文献的考察を含め報告する. 症例1は61歳の女性で, 非露出腫瘤型の早期癌の診断で上記手術を行い, H0, P0, M (-), pN0, pEM0, m, stage Iであった. 症例2は77歳の女性で, 露出腫瘤型の乳頭部早期癌の診断で手術を行い, 病理診断はH0, P0, M (-), pN0, pEM0, od, stage1であった. 2症例ともに術後若干の胃排泄遅延を認めたが, その後の食事摂取は良好であった. 本症例は今後, 長期の経過観察を要するが, 十二指腸乳頭部早期癌に対する根治術式として有用であると考えた.

2 Long Term Survival Cases of Small Pancreatic Cancers Performed Middle Pancreatectomy

われわれは, 膵中央切除術を施行し5年生存が得られた小膵癌2例を経験した. 症例1: 72歳の女性で, 心窩部痛で来院し超音波検査で膵体部腫瘤が指摘された. 精査の結果, 小膵癌と診断, 膵中央切除術を施行. 病理診断は中分化型管状腺癌, stage Iであった. 術後5年7か月無再発生存中である. 症例2: 68歳の男性で, 無症状にて検診超音波検査で膵管拡張と膵腫瘍が指摘され来院した. 精査の結果. 膵体部小膵癌と診断, 膵中央切除術を施行, 病理診断は中分化型管状腺癌, stage IV aであったが術後5年3か月無再発生存中である. 従来, 予後不良な膵管癌では, 脈管侵襲, 膵外進展および転移率の高さから, 小膵癌でも拡大手術を求める傾向があるが, 縮小手術でも長期生存する症例もある. TSP-1, EGFRなどの癌増殖転移関連因子の発現の有無を検討することは, 拡大手術を避け, 縮小手術の可能性を示唆するものと考えられた.