Shinsuke Sato

A case of esophageal schwannoma and literature analysis of 18 cases

An extremely rare case of esophageal schwannoma in a 40-year-old woman is reported. She presented with a history of dysphagia persisting for a few years. After close examination the patient underwent surgery under a diagnosis of leiomyoma of the esophagus. The tumor was found in the muscle layers of the esophageal wall, and was enucleated with part of the esophageal mucosa. Histological examination of the tumor demonstrated proliferation of spindle-shaped cells. Immunohistochemically, the tumor cells were diffusely positive for S-100 protein. The pathological diagnosis of this tumor was esophageal schwannoma. To date, only 18 cases of esophageal schwannoma, including our case, have been reported in Japan. This rare case is reported here, together with a review of the literature.

Video-assisted thoracoscopic esophagectomy in the left lateral decubitus position in an esophageal cancer patient with pectus excavatum.

During thoracic cavity operations, it is difficult to obtain sufficient working space and good operative field visibility in patients with pectus excavatum because the space between the vertebral bodies and sternum is very narrow. Here, we report the successful treatment of esophageal cancer in a patient with pectus excavatum. A 77‐year‐old man with esophageal cancer was referred to our hospital for further treatment. He was diagnosed with multiple early esophageal squamous cell carcinomas. The patient had pectus excavatum, but because it was asymptomatic, a video‐assisted thoracoscopic radical esophagectomy in the left lateral decubitus position without pectus excavatum repair was selected. Despite the patients unusual anatomy, video‐assisted thoracoscopic esophagectomy in the left decubitus position allowed for good operative field visibility, as the videoscope was inserted from the side of the diaphragm. This operative procedure is useful in patients with esophageal cancer who also have pectus excavatum. To the best of our knowledge, this is the second report of video‐assisted thoracoscopic esophagectomy in an esophageal cancer patient with pectus excavatum.

Unusually increased metaiodobenzylguanidine uptake in a gastrointestinal stromal tumor of the stomach

A 70-year-old woman with a submucosal gastric tumor was referred to our hospital for surgical treatment. Upon examination, it was found that she had hypertension, and abdominal computed tomography revealed swelling on both adrenal glands. The patient was examined with gamma camera imaging and iodine-123 metaiodobenzylguanidine (MIBG), because her hypertension was thought to be due to a suspected adrenomedullary tumor. The planar image showed an unexpected abnormal uptake of MIBG in the upper abdomen. On single-photon emission computed tomographic images, the area of abnormal tracer uptake was thought to correspond to the known gastric tumor. The surgical procedure and histological assessments revealed that the gastric tumor was a gastrointestinal stromal tumor (GIST). MIBG can accumulate in GISTs as well as in neuroendocrine tumors of the medulla of the adrenal glands. Although the cause of radiolabeled MIBG uptake in GISTs is uncertain, further studies are necessary to establish the significance of MIBG scintigraphy in GIST imaging.

Severe long esophageal stricture following hyperemesis gravidarum

We report a 32-year-old female patient with esophageal stricture thought to have been caused by hyperemesis gravidarum. Eleven months before admission she had been admitted to another hospital, because of hyperemesis gravidarum, at 26 weeks of gestation. Marked and recurrent vomiting occurred and her consciousness gradually worsened. Three weeks later, her baby was delivered by Cesarean section. Postpartum progress was uneventful except that she developed dysphagia 5 months after delivery. Esophagography and upper endoscopy demonstrated severe esophageal stricture. Endoscopic balloon dilatation was performed four times, but was unsuccessful. Blunt dissection of the esophagus was then performed. Histological examination demonstrated marked fibrosis in the submucosal layer and muscular hypertrophy. Esophageal glands were not identified. In this case, esophageal stricture might have been associated with severe esophagitis due to recurrent vomiting and reflux of gastric contents during hyperemesis gravidarum.

Pedunculated giant fibrolipoma of the esophagus: a case report

A 59-year-old man presented to our hospital with dysphagia. Esophagography and endoscopy demonstrated a large pedunculated tumor. CT scan and MRI showed a large esophageal tumor consisting of fatty tissue. The tumor was diagnosed as lipoma or liposarcoma of the esophagus, and esophagectomy was performed. Histological examination showed fibrolipoma with a vascular component. Lipomas of the esophagus are extremely rare and often become large before causing symptoms. Surgical or endoscopic resection is the preferred treatment. Treatment strategies are dependent on site, size, and characteristics of the peduncle.

Small bowel obstruction due to internal hernia caused by the ureter after laparoscopic radical cystectomy and ileal conduit: A case report: Small bowel obstruction due to hernia

A 74‐year‐old man presented at our hospital with complaints of abdominal pain, nausea, and vomiting. He had undergone laparoscopic radical cystectomy and ileal conduit for urinary bladder cancer 1 month earlier. The patient had abdominal distention, resonant sounds on percussion, and diffuse abdominal tenderness without rebound or guarding. Abdominal CT revealed dilated jejunal loops herniated through a cord‐like structure. Based on these findings, emergency surgery was performed, and intestinal dilatation into the space between the ureter, the ileal conduit, and the sacral bone was detected. The loops were released manually and were not resected. To the best of our knowledge, this is the first case report of small bowel obstruction due to internal hernia caused by the ureter after laparoscopic radical cystectomy and ileal conduit. Retroperitonealization and the minimum required mobilization of the ureters may be necessary when urinary diversion is constructed, especially in laparoscopic or robotic surgeries.