Saburo Murakami

Congenital bile duct dilation —Possibly an hereditary condition—

A female patient underwent resection of a large choledochal cyst and hepaticojejunostomy when she was 11 years old at Tokyo Medical and Dental University Hospital. Her mother, 48 years old, also had congenital bile duct dilatation (CBD) with cancer. The mother had an anomalous pancreatico-biliary ductal junction. To investigate the possibility of a genetic link, family members of another three consecutive CBD cases were examined for bile duct dilatation and anomalous pancreatico-biliary junction. Endoscopic retrograde choledocho-pancreatography (ERCP) revealed an anomalous pancreatico-biliary ductal junction, without bile duct dilatation in the mother of a 17-year-old CBD patient. Two familial occurrences of CBD had been reported in the Japanese literature. Their combinations were; a father—a daughter and two sisters, respectively. Considering that the sex ratio of CBD is one male to 2.6 females, our results suggest that CBD or anomalous pancreatico-biliary ductal junction may be 1) an X-linked dominant trait or 2) autosomal dominant trait with relatively low penetrance in males. Since anomalous pancreatico-biliary ductal junction does not necessarily develop into bile duct dilatation, more familial investigations on pancreatico-biliary ductal junction and bile duct dilatation are essential to clarify the genetic contribution to CBD.

A case of renal cell carcinoma with metastasis to the thyroid gland and concomitant early gastric cancer

Metastatic lesions from renal cell carcinoma are commonly recognized in the lung and bone, however, thyroid metastasis has rarely been reported in the literature. We present herein a case of a man with lung and thyroid metastatic tumors from renal cell carcinoma. Although making a preoperative diagnosis of thyroid metastasis is difficult because there is no established diagnostic criteria, we were able to identify this thyroid lesion as a metastatic tumor from renal cell carcinoma by the pathological findings. Interestingly, hypercalcemia was recognized in this patient whose serum parathyroid hormone (PTH) level was not increased. Moreover, this patient also had early gastric cancer simultaneously, being a so-called ‘double cancer’. After surgical resection of the right kidney and stomach, interferon was administered without any efficacy against the metastatic lesions of the lung and thyroid gland.

Biliary Cystadenoma of the Extrahepatic Bile Ducts: Report of a Case and Review of the Literature

Benign neoplasms of the extrahepatic bile ducts are rare and there have only been thirteen reported cases of cystadenoma. One case of cystadenoma of the common hepatic duct and solitary hepatic cyst is presented here and a total of fourteen cases are reviewed. The patient was a 45 year old woman, who complained of abdominal pain with rigidity, but without jaundice. Ultrasonography of the liver showed a 6 cm cyst of the right lobe. Percutaneous transhepatic cholangiography revealed a multilobular cystic mass. At emergency laparotomy, a polypoid multilobular tumor with a stalk was found hanging from the common hepatic duct and was excised. Almost all the patients reported were middle aged woman with jaundice. Preoperative diagnosis was made possible by percutaneous transhepatic cholangiography, endoscopic retrograde cholangiography or ultrasonography. The treatment of choice was complete excision. In three cases, a solitary hepatic cyst accompanied the cystadenoma of the common hepatic duct.

Stercoraceous perforation of the sigmoid colon: Report of two cases

Stercoraceous perforation of the sigmoid colon has rarely been reported in the literature. This lesion is assumed to be produced by the pressure from a hard scybalum resulting in a perforated ulcer with necrotic edges. Two cases of stercoraceous perforation of the sigmoid colon are presented in this paper. It is difficult to diagnose this lesion preoperatively, although ultrasonograms proved useful in showing the colon perforation. This lesion should always be suspected when a patient who has had chronic constipation presents with sudden severe abdominal pain. It is possible that this lesion is becoming more common as the mean age of the population increases and we stress the importance of immediate surgery and intensive care for improving the prognosis.

The syndrome of inappropriate secretion of antidiuretic hormone by rectal cancer —A case report—

The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is commonly observed in patients with bronchogenic carcinoma. We report here a rare case of SIADH induced by rectal cancer. Laboratory findings showed that the serum sodium concentration and serum osmolarity were low, and that the ADH level was high. Resection of the rectal cancer resulted in a complete correction of the associated inappropriate ADH. The titer of the rectal cancer tissue proved to be high (80 pg/g).