Masayuki Matsumori

A two-stage operation successfully performed for giant leiomyosarcoma of the esophagus with hepatic metastasis

Leiomyosarcoma of the esophagus is a rare neoplasm, with only 95 cases having been reported in the literature. Dysphagia is the most commonly noted symptom, however, because of its location in the submucosal layer, the tumor has usually grown to a considerable size by the time this presents. We report herein a case of a 39-year-old man who had no symptoms other than a 7 month history of a cough. After several investigations, the patient underwent resection of the thoracic and abdominal esophagus with lower lobectomy of the right lung through a right and left thoracotomy. The tumor measured 18×15×8cm in length and weighed 1,500g, being the biggest such tumor ever reported. Forty days after the first operation, an extended right hepatic lobectomy of the liver was performed for hepatic metastasis. He was discharged from the hospital 20 days after the second operation and is now doing well. The clinical features and surgical treatment of leiomyosarcoma of the esophagus are discussed herein.

Metastasis of cancer to cancer: Report of a case of esophageal carcinoma metastasizing to early gastric cancer

A rare case of esophageal carcinoma metastasizing to early gastric cancer is reported herein. A 66 year old man who had experienced dysphagia for 8 months was preoperatively diagnosed as simultaneously having esophageal and gastric cancers. Thus, a lower esophagectomy and total gastrectomy with paraesophageal and paragastric lymph node dissection were performed. The surgical specimen revealed an ulcerative tumor in the lower esophagus and a slightly depressed lesion with a central elevation similar to that of early type IIc+IIa1 gastric cancer in the upper part of the stomach. Microscopically, the esophageal tumor was revealed to be well differentiated squamous cell carcinoma while the gastric tumor was found to be early gastric cancer with a metastatic focus of esophageal cancer in the center. Though less than one hundred cases of metastasis of cancer to cancer have previously been reported, metastasis from cancer of one digestive organ to that of another digestive organ is very rare. To our knowledge, this report represents the first case of an esophageal carcinoma metastasizing to a gastric carcinoma.

Multiple calcified aneurysms of splenic artery, hypersplenism and concomitant cholelithiasis

Multiple calcified, aneurysms of splenic artery with hypersplenism and concomitant cholelithiasis were found in a 73-year-old Japanese woman. The symptoms and radiological findings were referable to the aneurysms. The predisposing factors are reviewed. Proximal ligation of the splenic artery and splenectomy gave a good postoperative result. Histopathological examination revealed an atherosclerotic origin, nevertheless specimens from an elderly person may obscure the actual pathology.

The Immunological Changes After Operation for Esophageal Cancer and the Effect of Lentinan

It has generally accepted that surgical intervention produces immunodeficiency [1, 2]. Malnutrition is also immunosuppressive [3]. So, in the patient with esophageal cancer, with the presence of preoperative starvation, the host defense mechanism is markedly suppressed by operations which involve intraabdominal and intrathoracic procedures.

Studies on the Relationship Between Desmosomes and Metastasis and Prognosis of Esophageal Cancer

Desmosomes are intercellular junctions, particularly characteristic of epithelial cells, and they are major contributors to cell-cell adhesion in many epithelial cells. Decreased intercellular adhesion has been reported for many carcinomas, and it has been suggested that in part, such alterations in adhesion may be due to changes in adhering junctions, such as the desmosome [1]. In the human urinary bladder, a correlation between decreased numbers of desmosomes and aggressiveness of transitional cell carcinomas has been reported [2]. To define highly malignant esophageal squamous cell carcinoma (SCC) we have investigated the relationship of desmosome numbers to tumor invasiveness and metastasis in esophageal SCCs in a quantitative electron microscopic study [3]. We have also studied this structure with reference to outcome, because all cases studied had been followed for at least 5 years.

Two Resected Cases of Giant Leiomyosarcoma of the Esophagus.

食道平滑筋肉腫はまれな疾患で文献的にはこれまで95例が報告されているにすぎない.最近, われわれは2例の巨大な食道平滑筋肉腫の手術切除例を経験したので報告する.症例1は39歳の男性, 多発性の肝転移をともなった巨大な腫瘍であったが, 手術を2期に分けて切除しえた.まず1回目の手術で右開胸により腫瘍が浸潤した右肺下葉を切除し, 体位を変え左開胸開腹連続切開により1,500gの腫瘍を切除した.食道再建は胃管により胸骨後経路で行った.2回目の手術は40日後に非定型的肝右葉拡大切除術を施行し肝の内側区, 前下および後下区域の肝転移巣を切除しえた.術後経過は良好で20日後に退院したが, 第1回目手術から1年2か月後に多発性縦隔および肝転移で死亡した.症例2は46歳男性, 左開胸開腹連続切開により腫瘍が浸潤した左肺下葉と下部食道を切除した.腫瘍の重量は800gであった.再建は空腸を間置し術後経過良好であり, 現在術後3か月目になるが外来で経過観察中である.