Shigehiko Ito

Obturator hernia: the usefulness of emergent computed tomography for early diagnosis

The diagnosis of obturator hernia is difficult, and delayed treatment is associated with serious complications. Recently, computed tomography (CT) has been used successfully for establishing a correct diagnosis. We encountered nine cases of obturator hernia from 1988 to 1997. All the patients were elderly women. In six of them, a correct diagnosis was established by emergent CT scan. In two of the remaining cases, diagnosis could not be established because of unavailability of CT, and the other patient was diagnosed correctly based on clinical features, including a positive Howship-Romberg sign. Surgical repair was performed successfully. One patient died postoperatively because of septicemia associated with anastomotic leakage. Our cases indicate that emergent CT scan is useful for the diagnosis of obturator hernia, particularly in elderly patients presenting with ileus of unknown origin.

Clinical and histopathological features of colonic stromal tumor in a child

Abstract: Neoplasms of the colonic submucosa are rare in children. Gastrointestinal stromal tumors (GISTs) are undifferentiated tumors, usually diagnosed by immunohistochemistry. We report a 4-year-old girl with a submucosal GIST of the ascending colon, which was detected by computed tomography. Diagnosis after ileocecal resection was established by histology. In addition, sections were examined immunohistochemically, using antibodies against vimentin, desmin, α-smooth muscle actin, S100, neuron-specific enolase, c-kit, and CD34. Hematoxylin and eosin-stained sections showed interlacing fascicles with occasional palisades of epithelioid and spindle cells. The tumor cells were positive for vimentin and CD34. To our knowledge, this is the first reported case of colonic stromal tumor in a child.

Small nonfunctioning islet cell tumor in the body of the pancreas: report of a case.

Islet cell tumors of the pancreas are uncommon, and nonfunctioning tumors are even rarer than functioning ones. We report the case of a 67-year-old woman with a small nonfunctioning islet cell tumor, 6 × 5 mm in diameter, which was detected incidentally by ultrasonography, and subsequently confirmed by double-helical computed tomography. Diagnosis was established by histopathological examination after 80% distal pancreatectomy with splenectomy, and by various laboratory tests. Histologically, the islet cell tumor showed highly cellular spindle or epithelioid cells, which were positive for Grimelius stain. Immunohistochemical examination revealed that the tumor cells were positive for chromogranin A, but negative for somatostatin, insulin, glucagon, and gastrin. Its small size, location, and benignity make this a very rare type of nonfunctioning islet cell tumor.

Video-assisted mediastinoscopic resection of a thymic cyst by sternum lifting.

We performed mediastinoscopic surgery on two patients with a thymic cyst using a new instrument by sternum-lifting with tape. The merits of this technique are that a resection of the thymus and cyst can be achieved without a midline sternotomy, and under bilateral ventilation, and in cases with pleural adhesion. This technique can be applicable to most benign thymic lesions including thymectomy for myasthenia gravis and to selected cases with a malignant thymic tumor.

Experience with thoracoscopic surgery for primary bronchial stump fistula after pneumonectomy

UNLABELLED After a left pneumonectomy, thoracoscopic closure with fibrin glue was performed for a fistula on the bronchial stump and the postoperative state progressed favorably thereafter. In this paper, we report on this successful case. CASE A 61 year-old male, who underwent a left pneumonectomy on January 17, 1996 for pulmonary carcinoma (T 3 N 1M 0 stage III A). The bronchial stump was covered with anterior serratus muscle flap. On April 1 (the 76th postoperative day), after two courses of Carboplatin and Vindesine treatment, the patient suddenly developed a fistula on the bronchial stump. Bronchofiberscopic closure with fibrin glue was attempted, but failed to close the fistula. Thoracoscopic surgery was then performed on May 15 (the 45th day after the onset of the fistula). After the intrathoracic opening of the fistula was found with a contrast medium, fibrin glue was injected to fill up to the bronchial stump, and communication with the thoracic cavity was blocked. Owing to coverage with a myocutaneous flap, the patients general postoperative state remained relatively stable. Thoracoscopic surgery is useful as a treatment for some cases of bronchial stump fistula after pneumonectomy.

A CASE OF HUGE CHOLANGIOCELLULAR CARCINOMA WITH EXTRAHEPATIC GROWTH

We experienced a case of huge cholangiocellular carcinoma with an extrahepatic growth. An 89-year-old woman was admitted to the hospital because of an abdominal mass and abdominal discomfort. The tumor markers showed marked increases, CEA and CA 19-9 were 1.275ng/ml and 4.950U/ml, respectively. Abdominal echo visualized a huge tumor with a well defined margin, which was growing expansively from the right lobe of the liver. Abdominal CT revealed that the tumor was so huge as to reach to the pelvic cavity. Angiography showed that the tumor was fed from a 5 and a 6 arteries of the liver and no parasitic vessels were detected. Curative operation was performed with limited resection of segment 5 and 6 of liver. The excised tumor was 15×10×8cm in size, and 1, 300g in weight. Histopathologically, the tumor was diagnosed as well differentiated tubullar adenocarcinoma with some papillary proliferation. This case is very rare, since the huge cholangiocellular carcinoma with an extrahepatic growth have been reported in only two cases in Japan.