Shinsuke Imai

Cystic mesothelioma of the peritoneum

We report a case of cystic mesothelioma of the peritoneum (CMP), a rare tumor. The magnetic resonance imaging (MRI) findings and the histochemical features were studied. The patient was an 18-year-old woman who presented with upper abdominal pain. Abdominal ultrasonography and computed tomography showed a well defined cystic mass with a solid papillary projection in its lumen. MRI of the cyst showed high intensity on T2- and proton weighted images and low intensity on T1-weighted images, and the solid projection showed low intensity on T2- and proton-weighted images and slight low intensity on T1-weighted images, on which it was well enhanced. The lesion was suspected to be a benign cyst, such as a hemangioma, lymphangioma, or a splenic or pancreatic cyst. Complete surgical resection was performed. The resected specimen consisted of a unilocular cystic mass, with a solid projection, weighing 260g and measuring 10 cm in diameter. The final diagnosis, arrived at by histopathological examination, was low-grade malignant CMP. The tumor cells were strongly positive for keratin, weakly positive for vimentin, and negative for epithelial membranous antigen. The patient is now well and symptom-free with no recurrence 19 months after operation. CMP is a rare tumor; only 12 cases have previously been reported in Japan.

The Experience of Transarterial Infusion Therapy by Trans-axillary Arterial Approach for Metastatic Liver Tumor.

転移性肝癌12例に対して, 経腋窩動脈的に肝動注用カテーテル留置を行い, 動注療法を施行した.2名の放射線科医が, セルディンガー法により左腋窩動脈を穿刺し, シースイントロデューサーは使用せず, カテーテルを直接に選択的に肝動脈に留置し, 外科医と交代してリザーバーを左前胸部皮下ポケットに埋め込んだ.術後は左上肢のみ安静とし, 歩行は可能とした.重篤な合併症はなく, カテーテル留置の操作時間は止血時間も含め平均118.8分, 入院期間は術前検査, 術後入院中の動注療法の期間も含め平均10.3日であった.肝転移巣に対する直接効果は評価可能な11例中CR1例, PR4例, NC3例, PD3例, 奏効率45%であった.平均生存期間はH1+H2症例では775.4日, H3症例では626: 2日であった.本法は患者にとっても低侵襲で入院期間も短く, 複数科が協力して行うことにより短時間で最小限の人員で済み, 肝動注用のカテーテル留置法として有用な方法と思われる.

CLINICOPATHOLOGICAL EVALUATION OF CANCER OF THE REMNANT STOMACH

To clarify the pathogenesis of cancer of the remnant stomach, we clinicopathologically evaluated 16 patients more than 10 years postgastrectomy. Four had undergone gastrectomy for gastric cancer (group A) and 12 for peptic ulcer (group B). Patients in group B were older than in group A. Billroth-I method was used in 13 cases and Billroth-II method in 3 cases. Billroth-II method was not used in group A. The interval after gastrecotmy was 12.3±3.9 years in group A and 25.3±7.6 years in group B (p<0.001). Resectability was 100% in group A and 50% in group B. Nine patients located in the surgical stump and 7 at other sites. Early gastric cancer was found in 5 cases and advanced cancer in 11 cases. Invasive advanced cases, such as type 3 or 4, accounted for 58.3% in group B. Nine cases (56.3%) were curable and curability in group B was less than in group A. Undifferentiated adenocarcinoma was found in 12 cases (75.%) and it accounted for 83.3% in group B. Histological stage III and IV lesions accounted for 58.3% of the cases in group B. Five-year survival rates after operation were 75.0% in group A and 31.4% in group B. The survival rates for the early cases or for the curative cases were better in both group than for the advanced cases or for the noncurative cases. Appropriate follow up enabled early detection for cancer of the remnant stomach and improved results of therapy in postgastrectomy patients regardless of whether the reason for the gastrectomy was cancer or peptic ulcer.