Noriyuki Tohnosu

A comparison between ultrasonography and mammography, computed tomography and digital subtraction angiography for the detection of breast cancers.

Ultrasound (US) was compared with mammography (MMG), computed tomography (CT), and digital subtraction angiography (DSA) in its effectiveness to detect breast cancer masses and metastatic axillary nodes. Forty-seven breast cancer patients who all underwent MMG, US, CT, and DSA preoperatively in our institution between 1986 and 1990 were studied. US was able to detect tumors in all cases regardless of tumor size, whereas DSA detected T1-size tumors and MMG detected T2-size tumors in 40% and 64.7% of cases, respectively, being specifically inferior to US. It was found that MMG was least likely to detect papillotubular carcinoma, although microcalcification alone without a tumor mass on MMG improved detectability from 46.2% to 76.9%, according to the histological type. CT was found to be most sensitive to axillary node metastases (81.8%), followed by US (72.7%), but DSA was significantly unfavorable (42.9%). Thus, we concluded that US was superior to MMG, CT, and DSA for detecting breast cancer masses, but that CT was more advantageous than US, while DSA was of little value for evaluating axillary nodal status.

Metastatic Malignant Meningioma of the Liver with Hypoglycemia : Report of a Case

We herein present the case of a 68-year-old male who suffered an episode of hypoglycemic shock 2 years after undergoing total removal of a bifrontal parasagittal malignant meningioma. Imaging studies revealed three giant hypervascular tumors with a cystic portion in the right lobe, but no confirmed preoperative diagnosis could be made. At laparotomy, liver tumors were found in the medial segment of the left lobe as well as in the right lobe, and thus an extended right lobectomy was performed. All the resected tumors were histologically diagnosed as metastatic malignant meningiomas of the liver. Despite subsequent transarterial chemoembolization for a recurrence in the residual liver, the patient died 11 months after surgery. To the best of our knowledge, only one other case of a hepatectomy for liver metastases from an intracranial malignant meningioma has been reported in the literature, but there has never been any report of surgical treatment for a metastatic meningeal tumor in the liver associated with hypoglycemia. Although our surgical treatment provided effective palliation, the prognostic significance of a surgical strategy for such patients has yet to be established.

A case of neurilemmoma of the breast

Neurilemmoma of the breast is rarely seen, although it is common at intracranial or peripheral sites. There have been only 14 cases described in the literature. We present the fifteenth case of a 64-year-old woman with neurilemmoma of the breast, the first to be diagnosed by fine needle aspiration cytology. Fibroadenoma must be distinguished from this tumor. Complete removal is the treatment of choice, considering the possibility of local recurrence and malignant change.

The prognostic significance of resection of primary tumor in gastric and colorectal cancer patients with synchronous liver metastasis.

The significance of primary tumor resection in gastric and colorectal cancer patients with liver metastasis (H(+)) was evaluated in terms of operative mortality and survival rate by dividing the materials [293 gastric cancer and 80 colorectal cancer patients (53 colon and 27 rectum) with synchronous liver metastasis] into the following groups: Firstly, with or without peritoneal dissemination (P), secondly, with or without resection of the primary tumor and thirdly, with or without postoperative adjuvant chemotherapy. The following results were obtained: (1) The direct operative death rate of primary tumor resection, excluding death from other causes, showed an absence of statistically significant differences between the P0H(+) and P(+)H(+) gastric and colorectal cancer patients. (2) There was no significance in the prognosis between the primary tumor resection + postoperative chemotherapy group and the non-resectable group in the P(+)H(+) gastric and colorectal cancer patients, revealing no prognostic value of the primary tumor. (3) In the P0H(+) gastric and colorectal cancer patients, the primary tumor resection + postoperative chemotherapy group was significantly more favorable in prognosis than was the primary tumor resection alone group or the non-resectable group, showing the value of primary tumor resection.

Granular cell tumor of the esophagus —report of a case and review of the literature—

We report herein a case of a 46 year old man presenting with a gastric ulcer in whom an endoscopy happened to detect an elevated lesion in the lower esophagus. Endoscopic biopsy proved sufficient for determining the diagnosis of a granular cell tumor (GCT). Electron and microscopic studies suggest that GCT are derived from Schwann cells. Although commonly found in the tongue and skin, GCT are rarely seen in the gastrointestinal tract, especially in the esophagus. However, advances in endoscopic techniques will increase the opportunity of detecting GCT of the esophagus.

Diffuse schwannoma involving the entire large bowel with huge extramural development: Report of a case

Schwannoma of the large bowel is a rare clinical entity, which has reportedly been recognized to arise from one place with a submucosal tumor morphology. We present herein the unique case of a 25-year-old woman who suffered from a schwannoma diffusely involving the entire large intestine. The patient complained of abdominal distension and imaging studies revealed a giant tumor occupying the whole abdomen, but no confirmed preoperative diagnosis could be made. A laparotomy proved the huge tumor detected preoperatively to be the markedly wall-thickened entire large bowel itself due to the diffuse extramural development of a neoplasm, but no other organs were involved. Biopsy specimens from the tumor were histologically diagnosed as benign schwannoma. However, because of the possibility of malignancy, we later performed a total proctocolectomy followed by an ileal J-pouch-anal canal anastomosis. The final pathological diagnosis was also that of a benign schwannoma originating from the large intestine. The patient remains well without recurrence 15 months after surgery. To the best of our knowledge, no such case of a schwannoma in the entire large bowel has yet been reported in the literature, and the pathogenesis of its occurrence remains unknown.

Successful surgical resection of a huge gastrointestinal stromal tumor of the third portion of the duodenum

Journal of Gastroenterology and Hepatology 22 (2007) 282–287

A surgically recovered case of spontaneous rupture of the esophagus. —The significance of preoperative esophagoscopy for direct sture—

A 65-year-old man with spontaneous rupture of the esophagus survived with a direct suture of the esophagus 15 hours after the onset of symptoms. Endoscopic examination of the esophagus was especially of great help in determining the surgical procedure in this patient, and we want to stress the importance of prompt diagnosis and immediate surgery for this disease.

The Significance of Board-Certified Registered Breast Specialist of the Japanese Breast Cancer Society in Regional Medical Activities

Noriyuki Tohnosu1,2, Jun Hasegawa2,3, Yosio Masuda2,4, Taku Kato5, Satoru Ishii6 and Kanae Iwata7 1Department of Surgery,Funabashi Municipal Medical Center 2Breast cancer screening committee of Funabashi Municipal Medical Association, 3Funabashi Futawa Hospital, 4Masuda Clinic of breast and thyroid diseases, 5Laboratory Section of Cytology, Funabashi Municipal Medical Center, 6Radiotechnical Department, Funabashi Municipal Medical Center 7Department of Pharmacy, Funabashi Municipal Medical Center Funabashi, Chiba, Japan

Successful treatment of an unresectable rectal carcinoma with combined radio-chemo-immunotherapy resulting in complete remission

Abstract We administered multidisciplinary treatment to a 37-year-old man with poorly differentiated adenocarcinoma of the rectum which exhibited a fistula between the rectum and the urinary bladder; the tumor was considered unresectable because of extensive local spread at initial evaluation, including a laparotomy. The patient received radiotherapy, consisting of a total dose of 50 Gy, given as fractions of 2 Gy per day 4 days a week. Concurrently with the radiation, the patient also received twice daily a tegafur [1-(2-tetrahydrofuryl)-5-fluorouracil] suppository (750 mg) and 5-fluorouracil ointment (2.5 g) applied to the perianal involved skin lesion. In addition, 5 KE of OK-432 was injected into the tumor nine times during the course of radiation. Because the tumor responded well to this radio-chemo-immunotherapy, the patient was discharged, and was treated only with tegafur suppositories for almost 3 years on an outpatient basis (total dose of tegafur, approximately 1500 g). As a result of the combined therapy, the tumor completely disappeared, while only the recto-urinary fistula remained. The patient has survived without recurrence for 50 months after his initial presentation, and his levels of carcinoembryonic antigen and immunosuppressive acidic protein have decreased from pretreatment values of 85 ng/ml and 1220 μg/ml, respectively, to 0.8 ng/ml and 459 μg/ml, respectively. Although this is only one case, it shows that appropriate multidisciplinary treatment may achieve excellent results even in patients with unresectable poorly differentiated adenocarcinomas of the rectum.