Wataru Fukushima

Detection of incidental breast tumors by noncontrast spiral computed tomography of the chest.

PurposeThe aim of this study was to investigate the frequency of breast tumors and breast cancers with noncontrast spiral chest computed tomography (CT).Material and methodsA clinical study was conducted to evaluate findings in the mammary region of 1008 consecutive patients with no mammary symptoms or signs who underwent noncontrast spiral CT of the chest from April 2003 to March 2006.ResultsSix cases of breast abnormality were detected among the 1008 women. Three were primary breast cancers, one was metastatic breast cancer, and two were benign tumors. All four breast cancer patients were over 70 years old. The characteristics of the tumor margins on CT scans corresponded to the mammography and ultrasonography findings. The mammographic background density ranged from inhomogeneous high-density breast to fatty breast. The detection rate of primary breast cancer by noncontrast spiral CT was 0.30%.ConclusionNoncontrast spiral chest CT occasionally detects nonsymptomatic breast cancers, especially in elderly patients.

Currarino syndrome in an adult presenting with a presacral abscess: a case report

IntroductionCurrarino syndrome (Currarino triad) was described in 1981 as a triad syndrome with a common embryogenesis in infants and with three characteristics: anorectal stenosis, a defect in the sacral bone, and a presacral mass. We describe here an unusual case of Currarino syndrome in an adult presenting with a presacral abscess but no meningitis.Case presentationA 32-year-old Japanese man presented with fever, arthralgia and buttock pain. A digital rectal examination showed mild rectal stenosis with local warmth and tenderness in the posterior wall of his rectum. Computed tomography showed a scimitar-shaped deformity of his sacrum and an 8cm presacral mass, which continued to a pedicle of his deformed sacrum. This was diagnosed as Currarino syndrome with a presacral abscess. The abscess was drained by a perianal approach with our patient treated with antibiotics. His symptoms soon disappeared. After three months, an excision was performed through a posterior sagittal approach. His postoperative course was uneventful and he was discharged 10 days after surgery. A histopathological examination revealed an infected epidermoid cyst. He has been free from recurrence as of four years and six months after surgery.ConclusionsWe report a case of Currarino syndrome in an adult who presented with a presacral abscess but no meningitis. Abscess drainage followed by radical surgery resulted in a successful outcome.

Cryopreservation of hamster pancreatic islets using a rapid cooling rate

To clarify the possibility of developing a rapid colling rate for islet cryopreservation, we used a cooling rate of 25°C/min for hamster pancreatic islet cryopreservation using 15 per cent dimethylsulfoxide as a cryoprotectant. After preservation, these islets were examined for their morphology and function by assaying the insulin release after glucose stimulation and the contents of the insulin and DNA in 10 islets. In addition, islet cell replicatory activity was investigated by an autoradiographic technique. The effects of transplantation of the islets upon isogeneic and xenogeneic transplantation were also examined. Freezing using a rapid cooling rate of 25°C/min was found to be as effective as a slow cooling rate of 1°C/min for hamster islet cryopreservation. Morphologically, the cryopreserved islets appeared to be similar to the non-frozen cultured islets. The glucose-stimulated insulin release and cell replicatory activitiesin vitro also remained unchanged, whereas the number of cells per islet decreased slightly after cryopreservation. The grafting of cryopreserved islets normalized streptozotocin induced hyperglycemia following isogeneic transplantation. On the other hand, no prolongation of graft survivals in the case of the xenogeneic transplantation of hamster islets to rats was observed. The isogeneically transplanted islets exhibited the same cell replicatory activitiesin vivo, which was even higher compared that of normal hamster pancreatic isletsin situ. In conclusion, the present findings indicate that hamster pancreatic islets can be successfully cryopreserved using a rapid cooling rate, however, it does not appear that this treatment reduces islet vulnerability to xenogeneic graft rejection.

A case of intraductal papillary adenocarcinoma of the pancreas associated with mass forming chronic pancreatitis.

A case of intraductal papillary adenocarcinoma of the pancreas associated with mass forming chronic pancreatitis without calcifications is described. Pancreatolithiasis, or calcified pancreas, is recognized as a high risk factor for pancreatic cancer. However, epidemiologic studies have found that carcinoma of the pancreas associated with chronic pancreatits was rare. The question is whether chronic pancreatitis without calcifications is actually a precancerous background lesion or not. This case suggests that hyperplasia of the pancreatic ductal epithelium may be a precancerous lesion for pancreatic cancer in some patients with chronic pancreatitis.

Metastatic gastric carcinoma from breast cancer mimicking primary linitis plastica: A case report

Metastases to the gastrointestinal tract rarely occur in breast cancer except in invasive lobular carcinoma. The present study reports a rare case of metastatic gastric cancer from invasive ductal carcinoma (IDC) of the breast mimicking primary gastric linitis plastica. A 51-year-old premenopausal female, who had a history of partial mastectomy for right breast cancer at the age of 40, was referred to Toyama City Hospital (Toyoma, Japan) for an endoscopic diagnosis of gastric linitis plastica. Abdominal computed tomography (CT) revealed left hydronephrosis, while peritoneal metastasis and malignant ascites were not detected. Chest CT detected a left lung tumor, which had invaded the left upper bronchus. Biopsy specimens were obtained and the histopathological findings on both the gastric tumor and lung tumor demonstrated poorly differentiated adenocarcinoma, whereas the histology of the original breast cancer was IDC with a solid-tubular type. Immunohistochemistry revealed that the biopsied specimens of the gastric and lung tumors were positive for estrogen receptor (ER), progesterone receptor (PgR) and negative for human epithelial growth factor receptor-2 (HER2). These molecular characteristics indicated the case was metastatic gastric carcinoma from the breast cancer with lung metastasis, since the statuses of ER, PgR and HER2 were concordant with those of the original breast cancer. However, the possibility of primary gastric cancer could not be completely ruled out. Therefore, a total gastrectomy was performed for the purpose of both diagnosis and treatment. Pathological examination of the resected specimen provided a definite diagnosis of multiple metastatic gastric carcinomas from the breast. To the best of our knowledge, metastatic gastric cancer derived from the breast presenting as linitis plastica 11 years following the surgical removal of IDC has not been described previously.

Massive pneumoretroperitoneum arising from emphysematous cholecystitis: a case report and the literature review.

BackgroundEmphysematous cholecystitis is a severe variant of acute cholecystitis caused by anaerobic bacteria. Although intraperitoneal air as a complication has been described in association with emphysematous cholecystitis, pneumoretroperitoneum arising from emphysematous cholecystitis is extremely rare. Herein, we describe a rare case of pneumoretroperitoneum arising from emphysematous cholecystitis that was successfully treated with emergency surgery.Case presentationAn 84-year-old male was transported to the Emergency Department of our hospital for acute abdomen. Computed tomography revealed acute cholecystitis accompanied by emphysematous change. Computed tomography also revealed massive pneumoretroperitoneum complicated with pneumobilia and gas in the hepatoduodenal ligament. Clinical findings fulfilled the diagnostic criteria for systemic inflammatory response syndrome and sepsis. Emergency surgery was carried out with a diagnosis of both emphysematous cholecystitis and gastrointestinal perforation. Intraoperative findings revealed acute gangrenous cholecystitis and pneumoretroperitoneum presenting with an odor-free foamy abscess along the loose connective tissue behind the ascending colon and mesocolon. No evidence of gastrointestinal perforation was found during surgery. Therefore, cholecystectomy and lavage drainage were performed. Bacterial culture examination isolated a single species of anaerobe, Klebsiella pneumoniae, which was considered to be the cause of emphysematous cholecystitis, pneumobilia, and pneumoretroperitoneum.ConclusionsEmphysematous cholecystitis should be considered as a possible cause of pneumoretroperitoneum. The present case is the first report of massive pneumoretroperitoneum extending to the dorsal side of the ascending mesocolon as a complication of emphysematous cholecystitis.

Carbohydrate Antigen 19-9-Producing Lymphoepithelial Cyst of the Pancreas: A Case Report with an Immunohistochemical Study

Lymphoepithelial cyst of the pancreas is extremely rare. We present this rare lesion and describe the histological and immunohistochemical features. On gross examination, a cystic mass was present on

Sigmoid colon cancer arising in a diverticulum of the colon with involvement of the urinary bladder: a case report and review of the literature

BackgroundColon cancer can arise from the mucosa in a colonic diverticulum. Although colon diverticulum is a common disease, few cases have been previously reported on colon cancer associated with a diverticulum. We report a rare case of sigmoid colon cancer arising in a diverticulum with involvement of the urinary bladder, which presented characteristic radiographic images.Case presentationA 73-year-old man was admitted to our hospital for macroscopic hematuria. Computed tomography and magnetic resonance imaging revealed a sigmoid colon tumor that protruded into the urinary bladder lumen. The radiographs showed a tumor with a characteristic dumbbell-shaped appearance. Colonoscopy showed a type 1 cancer and multiple diverticula in the sigmoid colon. A diagnosis of sigmoid colon cancer with involvement of the urinary bladder was made based on the pathological findings of the biopsied specimens. We performed sigmoidectomy and total resection of the urinary bladder with colostomy and urinary tract diversion. Histopathological findings showed the presence of a colovesical fistula due to extramurally growing colon cancer. Around the colon cancer, the normal colon mucosa was depressed sharply with lack of the muscular layer, suggesting that the colon cancer was arising from a colon diverticulum.ConclusionThe present case is the first report of sigmoid colon cancer arising in a diverticulum with involvement of the urinary bladder. Due to an accurate preoperative radiological diagnosis, we were able to successfully perform a curative resection for sigmoid colon cancer arising in a diverticulum with involvement of the urinary bladder.

Malignant Mesenchymoma of the Retroperitoneum Involving Cecal Carcinoma. A Case Report.

患者は78歳の女性.後腹膜の黄色肉芽腫で左腎摘出術を施行された既往がある.主訴は左下腹部痛で, 同部に一致して径10cmの腫瘤を触知し, 血液検査ではCEA とCA19-9が高値を示した. CTでは左後腹膜に石灰化を有し周囲に脂肪成分を伴う腫瘤を認めた.注腸造影では下行結腸は内側に圧排され, また盲腸に腫瘤陰影を認めた.2型盲腸癌と黄色肉芽腫の再発との診断で手術を施行した.下行結腸周囲の後腹膜腔に複数の腫瘤を認め, 迅速病理にてmyxoid sarcomaと診断されたため結腸左半切除術を施行し, また盲腸癌にて回盲部切除術を併施した.切除標本では漿膜下から後腹膜に黄褐色または灰白色な弾性硬の腫瘤を認めた. 組織学的には分化型の軟骨肉腫や骨肉腫, 平滑筋肉腫および脂肪肉腫の成分を認め悪性間葉腫と診断された.盲腸癌は2型の高分化腺癌でss, ly2, v0, n1 (+) であった. 本疾患はまれであり組織発生を検討する上で興味ある症例と考えられたので報告する

Surgical Treatment for Esophageal Cancer After Gastrectomy

Gastroesophageal reflux is associated with a high incidence of complications such as ulcer or cancer of the esophagus [1]. Gastrectomy results in regurgitation of bile into the esophagus. However, the etiologic role of gastrectomy in esophageal cancer is still controversial [2]. Surgical treatment of postgastrectomy esophageal cancer is also investigational, because esophageal reconstruction with vascularized graft in the patient who has undergone gastrectomy is sometimes difficult due to the presence of adhesion. In this connection, we reviewed 14 cases of postgastrectomy esophageal cancer among our series.