Masatoshi Ishizaki

Rosai-Dorfman disease of the colon presented as small solitary polypoid lesion

Rosai-Dorfman disease (RDD) was formerly known as “sinus histiocytosis with massive lymphadenopathy”, and cases involving the gastrointestinal tract are rare. We present a case of pure extranodal RDD, resected as a polypoid lesion in colonoscopic study. The patient was a 62-year old woman with a history of sigmoidectomy for unexplained peritonitis. Microscopic study of the polypoid lesion showed the submucosal mass with histological and immunological features of RDD. The whole body computed tomography revealed neither lymphadenopathy nor tumor-like mass.

Dermoid Cyst of the Colon

Dermoid cysts are benign cystic teratomas lined by skin and epidermal appendages. We report a dermoid cyst occurring in a 26-year-old female whose chief complaint was irregular vaginal bleeding. Abdominal magnetic resonance image demonstrated a space-occupying lesion in the right lower abdomen. The mass showed hyperintensity on the T2 image and the signal was homogeneous for the interior. During abdominal surgery we made the diagnosis of subserous tumor of the colon and resected the ileocecal portion of the colon. The tumor measured 5.4 × 4.8 × 3.5 cm and was soft and elastic. On cross section, a unilocular cyst filled with atheromatous material was found. Pathological examination revealed a dermoid cyst. In the view of this diagnosis, a simple excision would have been an adequate treatment.

Idiopathic Omental Bleeding: Report of a Case

We report a case of idiopathic omental bleeding in a 27-year-old man who was brought to our hospital after the sudden development of intermittent abdominal pain, nausea, and fainting. Computed tomography showed intra-abdominal fluid and emergency laparotomy revealed a hemorrhagic mass in the omental bursa, which was excised. The patient was successfully treated and a diagnosis of idiopathic omental bleeding was made.

Liver Hemorrhage Due to Idiopathic Peliosis Hepatis Successfully Treated With Hepatic Artery Embolization

Peliosis hepatis is an extremely rare condition that may cause fatal hepatic hemorrhage and liver failure. We report a case of liver hemorrhage due to idiopathic peliosis hepatis. A 60-year-old woman was admitted to our hospital with slight right hypochondriac pain. She went into hemorrhagic shock, and computed tomography (CT) showed multiple low-density areas in the right liver with massive subcapsular blood collection. Selective transfemoral arteriography of the celiac artery revealed no signs of vascular malformation or tumor stain, but showed signs of pooling in the right posterior segmental artery. The artery was embolized with particles of gelatin sponge, and hemostatic control was successful. Although peliosis hepatis is extremely rare, the diagnosis is significant because of its urgent clinical status, and transarterial embolization is a useful and minimally invasive procedure for liver hemorrhage due to peliosis hepatis.

Body fat accumulation and postoperative morbidity in colorectal-cancer surgery

SummaryBACKGROUND: Obesity is reported to increase the risk of colorectal cancer. We investigated whether it was associated with mortality or morbidity after colorectal-cancer surgery. METHODS: 70 colorectal-cancer patients who underwent elective surgery were investigated in this study. The intra-abdominal fat (IAF) and subcutaneous fat (SCF) areas were quantified by CT scan preoperatively. We investigated whether body mass index (BMI), IAF, or SCF were associated with postoperative mortality or morbidity. RESULTS: The mortality rate was 0%. 11 (16%) of 70 patients had medical complications (pneumonia, 9; arrhythmia, 2) and 16 (23%) had surgery-related complications (wound infection, 12; anastomotic leakage, 5) postoperatively. There was no significant difference in the postoperative medical or surgery-related morbidity rate between the IAF+ (males, ≥160 cm2; females, ≥120 cm2) and IAF– groups. The surgery-related morbidity rate was significantly higher in the SCF+ group (male, ≥180 cm2; female, ≥250 cm2) than in the SCF– group and multilogistic regression analysis confirmed that diabetes mellitus and SCF were significant for surgery-related morbidity. CONCLUSIONS: Subcutaneous fat accumulation is significantly associated with postoperative surgery-related morbidity after colorectal-cancer surgery.ZusammenfassungGRUNDLAGEN: Fettleibigkeit soll das Risiko von kolorektalem Karzinom erhöhen. Ein etwaiger Zusammenhang mit postoperativer Mortalität oder Morbidität bei kolorektalen Eingriffen wurde untersucht. METHODIK: Zu der Untersuchung wurden 70 an kolorektalem Karzinom erkrankte und operierte Patienten herangezogen. Präoperativ wurde das Fett im Inneren der Bauchhöhle (IAF) und das subkutane Fett (SCF) mittels Computertomographie quantifiziert. Dann wurde untersucht, ob ein Zusammenhang zwischen Body-Mass-Index (BMI), IAF oder SCF und der postoperativen Mortalitäts- oder Morbiditätsrate bestand. ERGEBNISSE: Die Mortalitätsrate betrug 0 %. Postoperativ hatten 11 (16 %) der 70 Patienten medizinische Komplikationen (Pneumonitis, 9; Arrhythmie, 2) und 16 (23 %) hatten chirurgische Komplikationen (Wundinfektion, 12; Anastomoseninsuffizienz, 5). Ein signifikanter Unterschied in der postoperativen, auf medizinische oder chirurgische Faktoren zurückzuführenden Morbiditätsrate zwischen der IAF+- (Männer, ≥160 cm2; Frauen, ≥120 cm2) und der IAF–-Gruppe bestand nicht. Die chirurgische Morbiditätsrate in der SCF+-Gruppe (Männer, ≥180 cm2; Frauen, ≥250 cm2) war bedeutend höher als in der SCF–-Gruppe, und eine multilogistische Regressionsanalyse bestätigte, dass Diabetes mellitus und SCF bei der auf chirurgischen Eingriff zurückzuführenden Morbidität eine bedeutende Rolle spielten. SCHLUSSFOLGERUNGEN: Subkutane Fettablagerung ist an der auf chirurgischen Eingriff zurückzuführenden Morbidität nach einem operativen Eingriff bei kolorektalem Karzinom maßgeblich beteiligt.

Ten-Year Survival of a Patient Treated with Stereotactic Gamma Knife Radiosurgery for Brain Metastases from Colon Cancer with Ovarian and Lymph Node Metastases: A Case Report.

Brain metastasis from colorectal cancer is infrequent and carries a poor prognosis. Herein, we present a patient alive 10 years after the identification of a first brain metastasis from sigmoid colon cancer. A 39-year-old woman underwent sigmoidectomy for sigmoid colon cancer during an emergency operation for pelvic peritonitis. The pathological finding was moderately differentiated adenocarcinoma. Eleven months after the sigmoidectomy, a metastatic lesion was identified in the left ovary. Despite local radiotherapy followed by chemotherapy, the left ovarian lesion grew, so resection of the uterus and bilateral ovaries was performed. Adjuvant chemotherapy with tegafur-uracil (UFT)/calcium folinate (leucovorin, LV) was initiated. Seven months after resection of the ovarian lesion, brain metastases appeared in the bilateral frontal lobes and were treated with stereotactic Gamma Knife radiosurgery. Cervical and mediastinal lymph node metastases were also diagnosed, and irradiation of these lesions was performed. After radiotherapy, 10 courses of oxaliplatin and infused fluorouracil plus leucovorin (FOLFOX) were administered. During FOLFOX administration, recurrent left frontal lobe brain metastasis was diagnosed and treated with stereotactic Gamma Knife radiosurgery. In this case, the brain metastases were well treated with stereotactic Gamma Knife radiosurgery, and the systemic disease arising from sigmoid colon cancer has been kept under control with chemotherapies, surgical resection, and radiotherapy.

A case report of intracholecystic papillary neoplasm of the gallbladder resembling a submucosal tumor

BackgroundIntracholecystic papillary neoplasm (ICPN) is defined as papillary tumors detected macroscopically in the gallbladder. We report a case of ICPN which exhibited the atypical form like a submucosal tumor.Case presentationA 70-year-old man was admitted to our hospital because of hepatic disorder. Computed tomography and magnetic resonance imaging showed irregular thickening of the wall within the gallbladder fundus. Because the lesion might have been malignant, we performed laparoscopic cholecystectomy and liver bed resection. Macroscopic findings showed the mucosal surface of the tumor was smooth, and its form was similar to that of a submucosal tumor. Histopathological examination revealed papillary tumors within the mass with low-grade dysplasia; therefore, we diagnosed ICPN.ConclusionIn the present case, ICPN was resembling a submucosal tumor macroscopically because the tumors arose into the Rokitansky-Aschoff sinus and the adenomyomatous hyperplasia was merged with the ICPN. It is necessary to consider the possibility of tumor lesions within adenomyomatous hyperplasia.

Successful surgical treatment of a spontaneous rupture of the esophagus diagnosed two days after onset.

Esophageal perforation is a relatively uncommon disease with a high rate of mortality and morbidity. Delay in the diagnosis and treatment occurs in more than 50% of cases, leading to a mortality rate of 40–60%. Primary repair is generally considered the gold standard for patients who present within the first 24 h following perforation of the esophagus. In this paper, we present a case of successful surgical treatment of spontaneous rupture of the esophagus that was diagnosed 2 days after onset. The patient was a 42-year-old man admitted to internal medicine with a diagnosis of pleuritis and complaining of chest and back pain. The next day, computed tomography revealed left-sided pleural effusion and mediastinal emphysema. An esophagogram revealed extravasation of the contrast medium from the lower left esophagus to the mediastinal cavity. These results confirmed a rupture of the esophagus, and an emergency left thoracotomy was performed. The perforation was repaired with a single-layered closure and was covered with elevated great omentum obtained by laparotomy. The patient was discharged 23 days after the first surgery. In conclusion, primary repair surgery must be selected as the best treatment beyond 24 h if the patient’s general state was stable and there was no evidence of clinical sepsis.

Soluble Human Leukocyte Antigen class I antigen and interleukin‐12 in hepatectomized patients

Background:  Interleukin‐12 (IL‐12) has been shown to enhance the cytotoxic activity of NK cells and CTL. IL‐12 also acts as a growth factor for activated NK, T and NKT cells. The soluble HLA class I (sHLA‐I) has been reported to bind a killer‐cell inhibitory receptor, which is expressed on the NK cell, and its signals inhibit NK cell‐mediated cytotoxicity. Effects of fresh frozen plasma (FFP) on post‐operative immune status have not yet been completely examined.