Shigetoshi Matsuo

Ruptured Aneurysm of the Visceral Artery: Report of Two Cases

Abstract We present herein two cases of a ruptured aneurysm of the visceral artery. The first case involved a 74-year-old man with abdominal pain who was admitted to our hospital with a tentative diagnosis of intra-abdominal bleeding of unknown origin. Computed tomography revealed a hematoma in the greater curvature of the stomach. At surgery, a hematoma along the right gastroepiploic artery was found and totally removed. Histological examination showed a pseudoaneurysm of unknown etiology. The second case involved a 68-year-old man with progressive anemia who presented with spontaneous intra-abdominal bleeding. A ruptured aneurysm of the accessory middle colic artery was diagnosed by superior mesenteric angiography. The ruptured aneurysm was ligated and totally resected without a colectomy. Histological examination showed a pseudoaneurysm of unknown etiology. The postoperative courses were uneventful, and both patients were doing well at the time of writing.

Gastrocolic fistula originating from transverse colon cancer: report of a case and review of the Japanese literature.

A 72-year-old woman was admitted to our hospital complaining of loss of weight, general fatigue, and upper abdominal pain. Barium studies suggested that a fistula was present between the proximal transverse colon and the stomach which originated from a carcinoma of the colon. A plain computed tomography (CT) scan confirmed the presence of a gastrocolic fistula. A two-thirds distal gastrectomy and right hemicolectomy with a resection of a bulky tumor in the mesocolon were performed en bloc. Histological examination revealed a well-differentiated adenocarcinoma of the transverse colon which was involved with the wall of the stomach. We were able to obtain information on 14 previous cases of gastrocolic fistula originating from transverse colon cancer in the Japanese literature, including the present case. The most common symptom was abdominal pain (64%). A preoperative diagnosis of fistula was confirmed in 10 of the 11 cases examined by barium studies. A plain CT and a CT scan after the barium studies may also be helpful in detecting fistula formation. A fistula between the carcinoma of the middle or distal transverse colon and the stomach was found in 13 of 14 cases, but not in our case. Only one case lived longer than 9 years, even though a surgical resection was possible in 9 of 11 cases.

Small-Cell Carcinoma of the Gallbladder: Report of a Case

Abstract: We report herein the case of an 81-year-old woman in whom a mass in the gallbladder was revealed by an ultra-sound examination conducted as part of a follow-up study for a silent gallstone. The mass showed evidence of invasion into the adjacent liver parenchyma. Under the tentative diagnosis of malignant neoplastic disease originating in the gallbladder, a cholecystectomy with partial hepatectomy was performed. Histological examination of the tumor confirmed a diagnosis of small-cell carcinoma of the gallbladder, which is considered to be a rare type of neoplasm.

The surgical treatment for carcinoma of the gallbladder: rationale of the second-look operation for inapparent carcinoma

Eighty-seven patients with carcinoma of the gallbladder treated in our hospital over a 15-year period were reviewed. Macroscopic curative resection was performed in 30 cases, 6 of which received second-look operations, and their cumulative five-year survival rate was 42.6 per cent. Histological and clinical analysis of our cases initially diagnosed by postoperative histologic examination revealed that the depth of carcinomatous invasion was the most important criterion for the indication of second-look operation, and that the second-look operation is mandatory for the inapparent carcinoma limited to the muscularis or subserosa. The surgical procedures of the second-look operation were: resection of the anterior inferior and medial inferior areas of the liver and dissection of the regional lymph-nodes. The presence of invasion of carcinoma to the cut end of the cystic duct or severe carcinomatous invasion to the lymphatic vessels were also important histopathologic findings for a second-look operation. Cases in which lymphatic invasions are remarkably observed, should receive an en bloc hepato-cholecystectomy plus a resection of the extrahepatic bile duct with neural tissues and soft fatty tissues in the hepatoduodenal ligament in a two-stage operation.

Intrahepatic cholangiocarcinoma with extensive sarcomatous change: Report of a case

A 77-year-old woman was admitted to our hospital with severe upper abdominal pain. Ultrasonography showed a well-defined hypoechoic mass with heterogeneity in the left lobe of the liver, and computed tomography demonstrated a low-density mass with enhanced peripheral areas. Magnetic resonance imaging revealed a mass with iso- to low signal intensity on T1-weighted images (WI) and heterogeneous high and low signal intensity on T2 WI. The tumor was found to be hypovascular by angiography. During 5 months of observation, the tumor increased in size, which strongly suggested malignancy. A laparotomy was performed under the provisional diagnosis of a neoplasm other than hepatocellular carcinoma, revealing that the hepatic mass had invaded the gastric wall. Therefore, a left hepatic lobectomy with dissection of the lymph nodes and hemigastrectomy was carried out. Histologically, the tumor was found to be composed of a large amount of sarcomatous elements and a small amount of adenocarcinomatous elements, both of which were partly intermingled. Immunohistochemically, the sarcomatous element demonstrated the features of malignant fibrous histiocytoma (MFH). Thus, a diagnosis of intrahepatic cholangiocarcinoma with MFH-like sarcomatous change was confirmed.

Intussusception of an appendiceal mucocele: Report of a case

A 66 year old Japanese female was admitted to our department for the examination and treatment of a mass in the cecum. She had experienced no symptoms or signs other than a positive test result for fecal occult blood. The mass in the cecum was confirmed by barium enema, colonofiberscopy and CT scanning. The presumptive diagnosis was a submucosal tumor of the cecum, however, a laparotomy subsequently revealed intussusception of an appendiceal mass. An ileocaecal resection with an ileocolic anastomosis was therefore performed and the mass was histologically diagnosed as a mucocele of the appendix. This patient is only the 24th case of intussusception of a mucocele of the appendix to be reported in Japan. A review of the available literature on this condition follows the case report.

An Unusual Perforation of the Colon : Report of Two Cases

Abstract.We herein present two cases of a colorectal perforation due to uncommon reasons. First, we treated a 45-year-old woman for a stercoral perforation of the sigmoid colon. The pathognomonic etiology was a barium fecaloma originating from an upper gastrointestinal series 9 months before admission. The second case was a 46-year-old woman who was admitted with a perforation of the transverse colon. She had experienced perforations of the sigmoid colon at 32 years of age and of the rectum at 44 years of age, respectively. The second and third conditions were diagnosed to be idiopathic, and were histologically proven by an abrupt obliteration and a thinness of the colonic wall with some infiltration of inflammatory cells. The first condition, however, was most likely a stercoral perforation. The postoperative course of these patients was uneventful, and both are doing well at this writing.

Review to better understand the macroscopic subtypes and histogenesis of intrahepatic cholangiocarcinoma

Intrahepatic cholangiocarcinoma is macroscopically classified into three subtypes, mass-forming-type, periductal infiltrating-type, and intraductal growth-type. Each subtype should be preoperatively differentiated to perform the valid surgical resection. Recent researches have revealed the clinical, radiologic, pathobiological characteristics of each subtype. We reviewed recently published studies covering various aspects of intrahepatic cholangiocarcinoma (ICC), focusing especially on the macroscopic subtypes and stem cell features to better understand the pathophysiology of ICC and to establish the valid therapeutic strategy.

Attenuated Familial Adenomatous Polyposis Associated with Advanced Rectal Cancer in a 16-Year-Old Boy: Report of a Case

Abstract We herein present a case of attenuated familial adenomatous polyposis (AFAP) with advanced rectal cancer in a 16-year-old boy. His mother and younger brother both had subcutaneous soft tissue tumors in the back and sparse-type colorectal polyposis. His mother also had dental anomalies and gastric fundic gland polyposis. The patient was admitted to our hospital for investigation of bloody stools. Barium enema and colonofiberscopy revealed advanced rectal cancer and sparse (<50) colorectal polyps. He also had dental anomalies, a subcutaneous soft tissue tumor in the back, and gastric fundic gland polyposis as extracolonic manifestations. A total proctocolectomy and ileoanal anastomosis were performed, and histological examination of the resected specimens confirmed moderately differentiated adenocarcinomas of the rectum with metastases to the regional lymph nodes. The other colorectal polyps were tubular adenomas with no evidence of malignancy. Germline mutations in the APC gene were observed in codons 486, 545, 1493, and 1556. This case serves to demonstrate that a total proctocolectomy with ileoanal anastomosis should be the procedure of choice for young patients found to have advanced rectal cancer associated with FAP.

Parenchymal leiomyoma of the breast : a case report with special reference to magnetic resonance imaging findings and an update review of literature

Parenchymal leiomyomas of the breast are extremely rare, with only 25 cases reported in the literature. We report the 26th case of parenchymal leiomyoma of the breast in a 63-year-old woman who presented to us with a right breast tumor detected on her screening mammography. This tumor was evaluated by mammography, ultrasonography, and MR imaging. To the best of our knowledge, this is the first case of a parenchymal leiomyoma of the breast examined by MR imaging. MR imaging revealed an oval mass with circumscribed margins that appeared as a high-intensity lesion in both T1 and T2. A dynamic MRI study showed a gradual increase pattern on the mass. Excisional biopsy revealed a growth pattern of interlacing fascicles of spindle cells without atypia or mitoses, consistent with parenchymal leiomyoma of the breast. Here we report a case of parenchymal leiomyoma of the breast, and describe the clinical, pathological, and immunohistochemical findings. In addition, we review the literature on parenchymal leiomyoma of the breast with regard to clinical characteristics and pathological features of this entity.