Toru Hirata

Complete Surgical Resection of a Leiomyosarcoma Arising from the Inferior Vena Cava

A 76-year-old Japanese man was referred to our hospital with chief complaint of right hypochondoralgia. Abdominal ultrasound showed a retroperitoneal tumor in the suprarenal region of the right kidney. Computed tomography revealed an enhanced lobular tumor with irregular, circumscribed, and indistinct border. Ultrasound-guided biopsy was performed. The tumor consisted of spindle-shaped cells with a giant nucleus and multinuclear cells. The diagnosis was leiomyosarcoma by immunohistochemical staining. The patient underwent surgery accessed by a right eighth intercostal thoracoabdominal incision. The tumor was completely resected, accompanied by removal of the posterosuperior segment of the right hepatic lobe, right adrenal gland, and a portion of the inferior vena cava (IVC). The histopathologic diagnosis was leiomyosarcoma arising from the IVC. We present a rare case of a successfully managed leiomyosarcoma of the IVC. This case suggests the importance of curative surgical resection of the tumor due to low efficacy of adjuvant chemotherapy for leiomyosarcoma.

Leucovorin, Cisplatin, and 5-Fluorouracil for Advanced Esophageal Cancer

Biochemical modulation involves the use of one drug (modulating agent; modulator) to change the pharmacokinetics and/or pharmacodynamics of a cytotoxic agent (effector), in a way that the therapeutic index of the effector is enhanced [1]. The modulator is often also a cytotoxic agent, but a non-cytotoxic agent like leucovorin is sometimes used as well. The modulating agent improves selectivity or sensitivity of an effector and decreases its toxicity to normal cells via a biochemical or metabolical mechanism. Currently, several biochemical modulations such as the sequential methotrexate (MTX)/5-fluorouracil (5-FU), leucovorin (LV)/5-FU, and cisplatin (CDDP)/5-FU have been evaluated clinically in terms of their efficacy for alimentary tract malignancies.

Giant Polypoid Tumor Expressing on the Pyloric Ring

A 66-year-old Japanese man was referred to our hospital because of suspected duodenal cancer. Upper gastric endoscopy revealed a giant polypoid-type tumor that extended from the duodenum bulb to the pyloric ring. A computed tomography scan revealed a slightly enhanced lobular tumor protruding into the duodenum bulb. Positron emission tomography showed an accumulation of 18F-fluorodeoxyglucose in the area extending from the antrum of the stomach to the duodenum bulb. Since an endoscopic ultrasound test suggested that the tumor might invade the muscular tunic, indications of endoscopic mucosal resection were not favored, and the tumor was curatively removed via distal gastrectomy. The histopathologic diagnosis was papillary adenocarcinoma, and the invasion depth was the mucosal layer without vascular invasion, which was different from the preoperative diagnosis. Our case suggests the difficulties in precise diagnosis of the invasion depth of the giant polypoid cancer.

Resection of carcinoma in the cervical esophagus following prior removal of a thoracic esophageal carcinoma — A case report—

We report herein, a rare case of a patient who, having undergone resection of a thoracic esophageal cancer, underwent removal of a cervical esophageal cancer, for which a free jejunal graft with microvascular anastomoses was utilized. The tumor in the cervical esophagus had originated from a second primary squamous cell cancer, which had occurred synchronously but had unfortunately escaped detection before the first operation. Due to the high incidence of other multicentric neoplasma or metastatic skip lesions accompanying esophageal carcinoma, careful evaluation during preoperative examinations in order to avoid overlooking another lesion, especially in the cervical portion of the esophagus is imperative.