Mitsuhiro Soda

A rare case of recurrent alpha-fetoprotein-producing gastric cancer without re-elevation of serum AFP.

We report an extremely rare case of recurrent alpha-fetoprotein (AFP)-producing gastric cancer without re-elevation of serum AFP. The patient was a 78-year-old woman with AFP-producing gastric cancer, a rare type of gastric adenocarcinoma. A Borrmann III gastric tumour was surgically resected and AFP-producing gastric cancer was diagnosed based on high levels of serum AFP (705.44 ng/ml) and immunohistochemical examination of the tumour. The serum AFP level decreased to the normal range after resection without any sign of recurrence by imaging, but the patient developed local recurrence of the cancer and died 13 months after surgery. No re-elevation of serum AFP levels was observed after recurrence. Although serum AFP levels are believed to be useful for follow-up in the post-operative period, the possibility that serum AFP levels do not always correlate with the extent of the cancer should be kept in mind.

A CASE OF SIALADENOMA PAPILLIFERUM OF THE ESOPHAGUS

Sialadenoma papilliferum of the esophagus is an extremely rare benign tumor that derives from the submucosal gland duct of the minor salivary gland. A 45‐year‐old man underwent upper gastrointestinal series. A 13 mm diameter esophageal polyp was suspected in the mid esophagus. Endoscopy examination revealed a pedunculated polyp arising from the posterior wall of the esophagus. The head of the polyp was covered with exudate and was slightly nodular but the pedicle had normal mucosa. We performed endoscopic mucosal resection (EMR) and the histological examination of the polyp showed that it was compatible with sialadenoma papilliferum of the esophagus.

CLINICAL FEATURES AND SURGICAL MANAGEMENT OF THE POSTOPERATIVE MASSIVE GASTRDUODENAL HEMORRHAGE

上部消化管手術を除く術後胃十二指腸大量出血の15手術症例を経験したが, 原疾患は血管と消化器疾患が大半を占め, 発生頻度は0.5%である.出血は73%が原疾患手術後2週間以内に起こり, 概ね重篤なほどより早期に出血している, 症例は出血性胃炎2, 胃潰瘍6, 十二指腸潰瘍7からなり, 多発性病巣が多い.広範囲胃切除術による治療成績は生存率67%, 死亡率33%, 再出血1例であり, 術前合併症を有するものの成績が不良である.胃潰瘍症例は全例救命しているが, 他の病変の成績がわるい.待期々間別の成績は3日以内が75%で最も良好である.治療にさいしては合併症の存否を斜酌して, 早期に手術適応の可否を決断すべきである.