Nobuo Komatsu

Epidermal Cyst of the Breast Treated by Vacuum-Assisted Biopsy

A 38-year-old woman presented for evaluation of a firm mass (measuring 20 × 20 mm) in the upper outer quadrant of her left breast. On the basis of the clinical and radiologic findings, we diagnosed a benign breast tumor and scheduled removal by a hand-held vacuum-assisted biopsy device (VABD) under ultrasonographic guidance. Because the first specimen removed from the tumor was white, flaky, and waxy material, we strongly suspected that the lesion was an epidermal cyst. We continued VABD treatment until the tumor was invisible on real-time ultrasonography. Histologic examination demonstrated that the tumor was composed of mature stratified squamous epithelium and laminated layers of keratin, findings consistent with a diagnosis of epidermal cyst. These cysts rarely occur in the breast and are sometimes difficult to distinguish from breast cancer. To our knowledge, this is the first report of an epidermal cyst treated by VABD.

A case of acute psittacosis with severe abdominal pain

We report the case of a psittacosis patient with severe abdominal pain who subsequently developed acute respiratory failure. The main symptoms of psittacosis are considered to be upper respiratory inflammation and influenza-like symptoms. However, it should be emphasized that digestive symptoms can be prominent in psittacosis patients. Early diagnosis of this condition is difficult and there is a need for an effective method for rapid diagnosis.

The Indications of Proximal Gastrectomy for Gastric Cancer in the Upper Third of the Stomach.

過去44年間に当教室で切除された上部胃癌 (C, CM, CE) 318例を対象とし, 噴門側胃切除術の適応について検討した. 各深達度別のリンパ節転移の割合はm: 0% (0/23), sm: 6.1% (2/33), mp: 25% (4/16), ss: 74.1% (43/58), se: 81.3% (104/128), si: 91.7% (55/60) で, ss以上でリンパ節転移が高率であったが, mp以深ではリンパ節転移112までであった. またsm, mp癌の転移リンパ節の詳細はsmがNo1, 7, mpがNo1, 2, 3, 11で, No4d, 5, 6, 10に転移を認めなかった. 治癒切除後の再発形式でも深達度mpまでの癌でリンパ節再発を認めたものはなく, 深達度mpまでの5年生存率でも噴切群86.7%に対し全摘群74%と両群間に差を認めなかった. 以上よりC領域の早期胃癌においてはD1+No7, mp癌においてもD1+No7, 11の郭清を加えることにより噴切は適応となる. 深達度ss以深ではn2以上の転移が高率であり噴切の適応とはならず, 拡大郭清が適応となろう.