Toshio Noriyuki

Complete spontaneous necrosis of hepatocellular carcinoma confirmed on resection: A case report

Highlights • Spontaneous necrosis of hepatocellular carcinoma without any pretreatment or angiography is extremely rare.• Spontaneous necrosis of HCC was highly suspected given the history of alcoholic hepatitis, based on the elevation of AFP and the CT findings.• The mechanisms of spontaneous regression are still unclear.• Recurrence after regression or viable malignant cells in resected specimen are reported.• The ideal management strategy for this disease is surgical intervention if the liver function is acceptable.

Measuring reduced cytochrome aa3 in cadaveric lungs using near-infrared spectroscopy

Researchers are investigating the use of cadaveric lungs to make up for the shortage of donors. However, no method to enable accurate evaluation of cadaveric lung viability has been established. We designed the present study to evaluate the viability of cadaveric lung tissue using near-infrared spectroscopy (NIRS). Male Lewis rats were anesthetized, mechanically ventilated, and subjected to a left thoracotomy. After cardiac arrest induced by an injection of sodium pentobarbital, we continued mechanical ventilation using oxygen (Group 1, n = 16) or nitrogen (Group 2, n = 20). Using NIRS, we monitored the redox state of cytochrome aa3 at intervals of 20 minutes for a period of 5 hours. We harvested the lung tissues of each group at 2 and 5 hours post-mortem and performed pathologic examination. The reduced cytochrome aa3 in Group 2 increased from 2 hours post-mortem. We observed no significant changes in Group 1. We found and scored the formation of hyaline membranes, intra-alveolar edema, edema around bronchioles and small vessels, and congestion in the cadaveric lungs. In Group 1, histologic findings were mild to moderate. In Group 2, findings were moderate at 2 hours post-mortem but became much more severe at 5 hours post-mortem. The measurement of reduced cytochrome aa3 using NIRS may reflect the histologic condition of cadaveric lung tissue. We expect that this evaluation method will be advantageous for lung transplantation in the future.

Large primary pleural synovial sarcoma with severe dyspnea: a case report.

BackgroundSynovial sarcoma is a malignant neoplasm of soft tissues. It occurs mainly in the extremities and is closely related to tendons, tendon sheaths, and bursal structures. Primary synovial sarcoma of the pleura and lungs is extremely rare.Case presentationWe present the case of a 62-year-old man with a large synovial sarcoma of the left pleura. He presented with general fatigue and severe dyspnea. Chest computed tomography (CT) revealed a 20-cm tumor in the left thoracic cavity. We first diagnosed the tumor as a sarcomatoid mesothelioma based on CT-guided needle biopsy. We speculated that his severe dyspnea was because of ventilation-perfusion mismatch due to the left pulmonary collapse. Furthermore, we thought that there was a discrepancy between the CT findings and the pathological findings from the biopsy specimen. We performed pleuropneumonectomy through an anterior approach with median sternotomy and 5th-intercostal thoracotomy. The resected specimen contained a 22-cm pleural tumor with parenchymatous hemorrhage. We diagnosed the tumor as monophasic synovial sarcoma based on its morphologic and immunohistochemical features. We suspected there was microscopic residual tumor in the left diaphragm and therefore performed radiation therapy. After radiotherapy, he received adjuvant chemotherapy with ifosfamide and Adriamycin. One year after surgery, the patient is alive with no signs of tumor recurrence.ConclusionsWe report a case of a large synovial sarcoma of the pleura in a patient with severe dyspnea. He was treated with pleuropneumonectomy, radiotherapy, and adjuvant chemotherapy. Although the best treatment for this rare condition has not been defined, we thought that tumor resection and adjuvant therapy were appropriate to control the disease in this case.

Characteristics of the portal vein thrombosis recurrence pattern without liver parenchymal invasion from colorectal cancer: a case report

BackgroundPortal vein tumor thrombosis from colorectal cancer is rare, and this recurrence pattern was mainly reported in patients with renal cell carcinoma and hepatocellular carcinoma. Furthermore, the recurrence pattern of portal vein tumor thrombosis without liver parenchymal invasion from colorectal carcinoma has not been previously reported. Herein, we present a patient with progressive portal vein tumor thrombosis without liver parenchymal invasion following curative resection.Case presentationA 61-year-old man with a chief complaint of constipation with abdominal pain associated with rectal carcinoma was admitted to our hospital. Computed tomography (CT) showed that the rectosigmoid colon wall was thickened, regional lymph nodes were swollen, and the light space-occupying lesion (SOL) was detected at segment 8 (S8). Neoadjuvant chemotherapy was performed, which was followed by laparoscopic anterior resection. The final diagnosis was stage IIIb (SS, N2, M0). After operation, systemic adjuvant chemotherapy was introduced. At first, tumor marker levels were within the normal range and there were no accumulations on positron emission tomography (PET). Tumor marker levels were elevated, and contrast-enhanced CT demonstrated that the portal vein SOL slowly extended from S8 to S5. Additionally, PET showed that the standardized uptake value was abnormally high at 5.8. Based on the diagnosis of portal vein tumor thrombosis, right hepatectomy was performed. On pathological analysis, tumor thrombosis was associated with rectal carcinoma, and there was no invasion toward the liver parenchyma. Additionally, the surgical cut end was tumor free. Six months after the hepatectomy, the paraaortic lymph nodes showed swelling. The patient is currently undergoing systemic chemotherapy.ConclusionAggressive surgical resection should be considered in cases of portal vein tumor thrombosis. A good long-term prognosis could be obtained by a combination of curative resection and systemic chemotherapy.

Palliative surgery for advanced gastric cancer: Partial gastrectomy using the inverted laparoscopic and endoscopic cooperative surgery method

Highlights • We performed partial gastrectomy with LECS as palliative treatment.• It was an invasive gastric cancer, but the patient had many comorbidities.• LECS was successfully used as minimally invasive palliative treatment.

Impact of comorbidities on the postoperative outcomes of acute cholecystitis following early cholecystectomy

PurposesThe purpose of this study was to evaluate the influence of comorbidities on the surgical outcomes of early cholecystectomy for acute cholecystitis.MethodsData were retrospectively collected for patients with acute cholecystitis who underwent early cholecystectomy. Patients were separated into three groups based on the cholecystitis severity grade, and the surgical outcomes of early cholecystectomy were analyzed. Patients with mild and moderate cholecystitis were subdivided into a comorbidity group (n = 10) and a non-comorbidity group (n = 83).ResultsThere were 57 (55.3%) patients with mild cholecystitis, 36 (35.0%) with moderate cholecystitis, and 10 (9.7%) with severe cholecystitis. The surgical outcomes were significantly worse for patients with severe cholecystitis than for patients with mild or moderate cholecystitis. There were no postoperative deaths after cholecystectomy. There were no significant differences in the complication rate (P = 0.629), conversion rate (P = 0.114), or intraoperative blood loss (P = 0.147) between the comorbidity and non-comorbidity groups.ConclusionOur findings suggest that early cholecystectomy can be performed safely for patients with mild and moderate cholecystitis even if comorbidities are present. Early cholecystectomy may be an alternative treatment strategy for patients with severe cholecystitis who are candidates for anesthesia and surgery.

Tow cases of primary small intestinal cancer.

原発性小腸癌は, 比較的まれな疾患であるが, われわれは最近2手術症例を経験したので報告する.症例1は59歳男性, イレウス症状で発症, CAI9-9の高値および, 小腸造影でTreitz靱帯より10cm肛側で全周性の狭窄を認めた.腫瘍は同部の空腸にあり, 空腸および回腸の腸間膜付着部側に動脈血行性転移と思われる小病巣を多発性に認めた.原発巣を含む空腸部分切除を行いえた.術後1年5か月で死亡した.症例2は53歳女性.約6か月間心窩部痛, 悪心, 嘔気が続き, イレウス症状が出現, 小腸造影で空腸末端付近での閉塞を認めた.腫瘍はTreitz靱帯より130cm肛側の空腸にあり, napkinringconstrictionを認め, 腹膜播種もあった.空腸部分切除を行った.術後1年11か月で死亡した.