Yasutaka Matsuzaki

Pancreaticoduodenal artery aneurysm: A case report and review of the literature☆☆☆

A case of true pancreaticoduodenal artery (PDA) aneurysm is reported. A calcified lesion was initially detected by plain x-ray films, and an essential diagnosis was made before operation by intravenous digital subtraction angiography (IVDSA). Surgical resection of the aneurysm was performed successfully. Additionally, we reviewed a total of 82 cases with PDA aneurysm out of the 88 cases that had been reported in the English-language literature up to 1993. Fifty-three cases were accompanied by aneurysmal rupture (rupture group), and 29, including our case, were without rupture (nonrupture group). Because of the high mortality rate (49.1%) in the rupture group, a precise diagnosis and adequate treatment of PDA aneurysm before rupture is important. In the nonrupture group, a calcification on radiography appeared in 61.6% of the cases in which aneurysms were not found incidentally; this seems to be a significant indication for angiography. Moreover, intravenous digital subtraction angiography is quite useful for the screening of PDA aneurysm because it is an easy and noninvasive examination.

Adenosquamous carcinoma of the gallbladder with tumor thrombus in left portal trunk

We report a surgically resected case of adenosquamous carcinoma of the gallbladder accompanied by portal tumor thrombosis, which is regarded as a rare complication. A 73-year-old man was admitted to our hospital because of epigastralgia. Preoperative examinations led to a diagnosis of advanced gallbladder carcinoma with liver metastasis, and operation was performed. Since intraoperative ultrasonography showed a tumor thrombus in the left main portal trunk originating from the metastatic lesion in the left medial segment of the liver, extended left lobectomy with extrahepatic bile duct resection and lymph node dissection was performed, instead of right trisegmentectomy, as proposed preoperatively. Histological examination revealed adenosquamous carcinoma of the gallbladder with medullary growth that was similar to the hepatocellular carcinoma, most notably in the metastatic lesion of the liver and in the portal tumor thrombus. We discuss the relation between portal tumor thrombosis and medullary tumors, and note the atypical operative method employed.

Primary Malignant Lymphoma of the appendix. A Case Report.

症例は61歳の男性. 平成11年6月右下腹部痛を主訴に近医より当院紹介受診した. 右下腹部に有痛性の腫瘤を触知し急性虫垂炎の術前診断にて同日虫垂切除術を施行した. 病理組織学的には悪性リンパ腫 (diffuse large cell type) であった.腫大した体表リンパ節は触知せず術前の胸部単純X線写真, 他の消化管精査, 腹部CTにても異常所見認めず, 虫垂原発悪性リンパ腫と診断された. 術後化学療法追加した.虫垂原発悪性リンパ腫の本邦報告例は自験例を含め32例で, 文献的考察を含め報告する.

A Case of the Primary Small Intestinal Carcinoma with its Metastasis to the Stomach Accompanied by the Primary Mucinous Carcinoma of the Colon.

症例は68歳の男性で下血で発症し, 血色素4.5g/dLと著明な貧血を認めた. 胃内視鏡および小腸造影検査により胃癌と小腸腫瘍の重複癌と診断し手術した. 空腸に15cm径の腫瘤を認め, 第1, 2空腸動脈を切離してこれを摘出し, さらに幽門側胃切除を施行した. また結腸肝轡曲に結腸粘液癌を認めたため, 右半結腸切除を追加した. 組織学的には小腸病変は印環細胞を伴わない粘液癌であったが結腸の粘液癌には印環細胞が多数認められた. 胃の病変は粘膜下層に病変の主座があり, 小腸病変に類似した粘液癌の中央に正常胃粘膜上皮の配列を認めた. 以上より本例を小腸・結腸の重複癌および小腸癌の胃転移と診断した. 術後は良好に経過し, 術後1年5か月を経た現在は外来通院中で再発の徴候を認めない. 小腸癌はまれで予後不良であり, 小腸癌を原発とする胃転移癌の本邦での報告は認められなかった.