Tadashi Miyashita

Myocardial metastasis from squamous cell carcinoma of the esophagus

A 62-year-old woman was admitted to our hospital because of cancer of the middle thoracic esophagus. We performed a right transthoracic subtotal esophagectomy with systemic three-field lymphadenectomy. Histopathological findings resulted in a diagnosis of well-differentiated squamous cell carcinoma staged as pT3N0M0, pStage IIA, with clear surgical margins. Although she had no clinical symptoms, solitary cardiac metastasis located in the ventricular septum close to the apex was detected on the follow-up computed tomography scans during postoperative month 6. Regardless of chemotherapy followed by radiotherapy, she died of the cancer 17 months after the initial operation. An autopsy revealed metastatic lesions to the heart, lungs, kidneys, and liver. There were two metastatic masses in the heart without direct invasion from the outside of the heart. In cases of esophageal cancer, tumor spread to the heart is usually caused by direct invasion; thus, solitary hematopoietic cardiac metastasis is quite rare.

Thrombosis of the Left Brachiocephalic Vein After Subtotal Esophagectomy with Reconstruction Using a Retrosternally Shifted Gastric Tube: Report of a Case

We performed a right transthoracic subtotal esophagectomy with systemic three-field lymph node dissection, followed by reconstruction with a gastric tube shifted retrosternally into the left side of the neck, for esophageal cancer in a 62-year-old woman. The patient had an uneventful postoperative course until postoperative day (POD) 9, when a venous thrombosis originating from the left brachiocephalic vein and elongating to the left subclavian vein was detected occasionally on computed tomography scans, although there were no clinical symptoms. The left brachiocephalic vein seemed narrowed by compression from the reconstructed gastric tube, and this was considered the cause of the thrombosis. The patient was commenced on thrombolytic therapy, using urokinase, and on anticoagulation therapy, using heparin and warfarin. The thrombus had disappeared completely by POD 38. The anticoagulation therapy was continued for 6 months and no recurrence of the thrombosis has been detected in the 4 months since its completion.

Pancreatic pseudocyst with pancreatolithiasis and intracystic hemorrhage treated with distal pancreatectomy: a case report

IntroductionHemorrhage from pancreatic pseudocyst is one of the serious complications of chronic pancreatitis. We experienced intracystic hemorrhage from a huge pancreatic pseudocyst and successfully treated it with distal pancreatectomy.Case presentationA 65-year-old-man with a history of alcohol abuse was admitted to our hospital for abdominal pain and was diagnosed as having chronic pancreatitis with pancreatolithiasis and pseudocyst in the pancreatic tail. The pancreatic pseudocyst increased in size gradually for 4 month observation period. For intracystic hemorrhage we performed an urgent distal pancreatectomy with splenectomy. Postoperative course was good and the elevated serum amylase level decreased to the normal range.ConclusionProlonged observation resulted in intracystic hemorrhage. Drainage or surgery in adequate time is important for the management of pancreatic pseudocysts to prevent complications.