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ABSTRACT: Chyluria is leakage of lymphatic fluid into the urine, following trauma to or obstruction of the lymphatic system. We herein report a rare case of chyluria after esophagectomy for esophageal cancer. A 69-year-old male complaining of epigastric pain and reflux symptoms was diagnosed with advanced esophageal cancer and regional lymph node metastases. After receiving neoadjuvant chemotherapy to control the regional lymph node metastases, the patient underwent transthoracic excision of the esophagus assisted by thoracoscopy, with excision of the azygos vein and thoracic duct, esophagostomy and tube gastrostomy. On postoperative day 22, the urine appeared ivory white in color, and urine tests showed a high triglyceride level, thus confirming the diagnosis of chyluria. The chyluria decreased temporarily after switching the patient from enteral nutrition (EN) to parental nutrition, but it emerged again after the resumption of EN. Lymphangiography at that stage showed the flow of lipiodol into the pelvis of the left kidney. Resolution of the chyluria was noted after lymphangiography. He underwent esophageal reconstruction with a gastric tube through an anterior mediastinal route, and was discharged 36 days after the second operation. He was thereafter followed up at the outpatient clinic with radiotherapy.
Surgery Today 12/2012; · 1.22 Impact Factor
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ABSTRACT: A man in his 60s was diagnosed with a rectal carcinoid tumor(15 mm in diameter) with SM invasion. We performed radical resection of the tumor, and 1 year later, abdominal computed tomography(CT) revealed multiple enhanced liver tumors. Liver biopsy revealed those tumors to be metachronal metastases of the rectal carcinoid. Operation was not indicated because of the spread in the liver, Transcatheter arterial embolization (TAE) was selected as the first-line therapy. Four months after 2 series of TAE, CT/magnetic resonance imaging revealed remarkable (80%) shrinkage of the tumors. Chemotherapy is known to be ineffective against liver metastasis of rectal carcinoid tumors. When surgery is not indicated, TAE may be the first-line therapy of choice because of its low invasiveness, repeatability, and efficacy.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2012; 39(12):2289-91.
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Michiko Hamanaka,
Shin Nakahira,
Yutaka Takeda,
Hiroshi Kawashima,
Yosuke Mukai,
Takeshi Kanemura,
Chieko Uchiyama,
Masatsugu Okishiro,
Atsushi Takeno,
Rei Suzuki,
Hirokazu Taniguchi,
Chiyomi Egawa,
Ken Nakata,
Hirofumi Miki, Takeshi Kato,
Teruaki Nagano,
Shinichi Nakatsuka,
Shigeyuki Tamura
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ABSTRACT: A 74-year-old man presented to a physician with a chief complaint of jaundice. He was diagnosed with bile duct carcinoma and admitted to our hospital. Laboratory data revealed abnormally elevated levels of total bilirubin, serum hepatic transaminase, and CA19-9. Endoscopic retrograde cholangiopancreatography revealed neoplastic stenosis from the hilus hepatis to the common bile duct. Abdominal computed tomography (CT) revealed an enhancing tumor in the hilus hepatis bile duct, and positron emission tomography-CT (PET-CT) revealed abnormal fluorodeoxyglucose accumulation in the tumor. Under a diagnosis of hilar cholangiocarcinoma, the patient underwent an extended right hepatectomy and left hepatico -jejunostomy. Immunohistochemically, the tumor cells were positive for neuroendocrine markers such as chromogranin A, synaptophysin, and CD56. The tumor was diagnosed as primary neuroendocrine carcinoma of the bile duct. The patient exhibited multiple liver metastasis 6 months after the operation. Transcatheter arterial chemoembolization (TACE) was performed for the liver metastasis. Although TACE exerted a cytoreductive effect temporarily, multiple liver abscesses developed. The patient died of liver failure 16 months after the operation. We report this rare case of primary neuroendocrine carcinoma of the bile duct.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2012; 39(12):2125-7.
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Hiroshi Kawashima,
Yutaka Takeda,
Shin Nakahira,
Yosuke Mukai,
Michiko Hamanaka,
Chieko Uchiyama,
Takeshi Kanemura,
Masatsugu Okishiro,
Atsushi Takeno,
Rei Suzuki,
Hirokazu Taniguchi,
Ken Nakata,
Chiyomi Egawa,
Hirofumi Miki, Takeshi Kato,
Shigeyuki Tamura
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ABSTRACT: A 57-year-old woman who was diagnosed with cholangiolocellular carcinoma underwent neoadjuvant chemotherapy with gemcitabine (GEM). The clinical stage was cT3N1M1 (right adrenal grand),cStage IVB (JPS) with invasion to the inferior vena cava (IVC). We were willing to perform hepatectomy if the response to chemotherapy was stable disease (SD) or better according to the Response Evaluation Criteria In Solid Tumors. After 2 courses of preoperative chemotherapy with GEM, SD was obtained. She underwent right lobectomy of the caudate lobe and resection of the right adrenal gland. The IVC was also resected and reconstructed. The pathological diagnosis was as follows: cholangiolocellular carcinoma, im (-), eg, fc(-), sf(-), s0, n0, vp0, vv0, va0, b1, p0, sm(-), 200 μm, pT2N0M0, pStage II, and Cur A2. The IVC was not invaded and the right adrenal gland was diagnosed with adrenocortical adenoma. She underwent continuing adjuvant chemotherapy with GEM for 4 months without recurrence. Therapy for cholangiolocellular carcinoma has not yet been established, but multimodal treatment with GEM and surgical resection is potentially effective for cholangiolocellular carcinoma.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2012; 39(12):2113-5.
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Yosuke Mukai,
Yutaka Takeda,
Shin Nakahira,
Hiroshi Kawashima,
Michiko Hamanaka,
Chieko Uchiyama,
Takeshi Kanemura,
Atsushi Takeno,
Masatsugu Okishiro,
Rei Suzuki,
Chiyomi Egawa,
Hirokazu Taniguchi,
Ken Nakata,
Hirofumi Miki, Takeshi Kato,
Shigeyuki Tamura
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ABSTRACT: A 69-year-old man with recurrent hepatocellular carcinoma (HCC) in S7/8 after radiofrequency ablation therapy (RFA)was admitted to our hospital. Serum alpha-fetoprotein and protein induced by vitamin K absence or antagonists (PIVKA-II) were elevated to 367 ng/mL and 18,973 mAU/mL, respectively. Abdominal computed tomography scan revealed that the size of the tumor was 56 mm and a portal vein tumor thrombus progressed from the right anterior branch to the left main branch(Vp3). The clinical stage was cT3N0M0, cStage III(JPS). He received 3 courses of intra-arterial infusion chemotherapy with cisplatin(CDDP IA-call)into the right hepatic artery at a dose of 65 mg/m2 every 2 months. Elevated serum alpha-fetoprotein(AFP)and PIVKA-II markedly decreased and returned to normal levels after the second course of treatment. The liver tumor and portal vein tumor thrombus disappeared, and only arterioportal shunting remained. The response to treatment was partial response (PR) and complete response (CR), according to the Response Evaluation Criteria In Solid Tumors and the modified version, respectively. He has been alive for more than 1 year without recurrence. CDDP is an effective treatment for advanced HCC with portal vein tumor thrombus.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2012; 39(12):1815-8.
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Masatsugu Okishiro,
Chiyomi Egawa,
Yosuke Mukai,
Hiroshi Kawashima,
Michiko Hamanaka,
Hisako Ono,
Chieko Uchiyama,
Takashi Kanemura,
Atsushi Takeno,
Shin Nakahira,
Rei Suzuki,
Ken Nakata,
Hirofumi Miki,
Yutaka Takeda, Takeshi Kato,
Yuji Asada,
Shigeyuki Tamura,
Yuichi Takatsuka
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ABSTRACT: Mastectomy is recommended for ipsilateral breast tumor recurrence (IBTR) after breast-conserving surgery plus radiotherapy(breast-conserving treatment). However, the number of patients who receive radiation therapy such as breast- conserving treatment in the hope of breast reconstruction is increasing. Radiation therapy has a significant magnifying effect on the difficulties of breast reconstruction. In the study presented here, we compared the patients who underwent mastectomy+ breast reconstruction with a tissue expander and an implant after IBTR and breast-conserving treatment (irradiation group, n=5) with patients who underwent mastectomy+breast reconstruction with a tissue expander and an implant at the time of the first breast cancer operation (non-irradiation group, n=21). The parameters compared were background, complications, reconstruction success rate, and capsular contraction. A significant difference was not observed between the 2 groups. Complications after operation, specifically capsular contracture, are reported to be more frequent in the radiation group than in the non-irradiation group. However, with appropriate explanation of the risks, this surgery is an option for patients who strongly desire breast reconstruction.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2012; 39(12):2030-2.
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Shin Nakahira,
Yutaka Takeda,
Hiroshi Kawashima,
Yosuke Mukai,
Michiko Hamanaka,
Chieko Uchiyama,
Takashi Kanemura,
Masatsugu Okishiro,
Atsushi Takeno,
Rei Suzuki,
Ken Nakata,
Chiyomi Egawa,
Hirofumi Miki, Takeshi Kato,
Shinichi Nakatsuka,
Shigeyuki Tamura
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ABSTRACT: We report 2 rare cases of lower bile duct recurrence resected by pancreatoduodenectomy after hepatectomy for hilar cholangiocarcinoma. Case 1: A 74-year-old man underwent extended right hepatectomy for hilar cholangiocarcinoma (JSBS classification: pT1N0M0, fStage I, fCur A, negative cut end). The serum carbohydrate antigen 19-9 level was elevated 18 months after hepatectomy, but abdominal computed tomography showed no signs of recurrence. However, lower bile duct recurrence was revealed by subsequent magnetic resonance imaging, positron-emission tomography, and endoscopic retrograde cholangiopancreatography. Twenty months after hepatectomy, pancreatoduodenectomy was performed, and the pathological findings showed lower bile duct carcinoma(JSBS classification: pT3N0M0, fStage III, fCur A). The patient survived without recurrence 12 months after a secondary operation. Case 2: A 68-year-old woman underwent extended right hepatectomy for hilar cholangiocarcinoma(JSBS classification: pT3N2M0, fStage IVa, fCur B, negative cut end). Twelve months after hepatectomy, dilatation of the remaining lower bile duct was observed by abdominal computed tomography. Endoscopic retrograde cholangiopancreatography revealed lower bile duct stenosis with suspected malignancy, and positron-emission tomography scan detected increased fluorodeoxyglucose uptake at the stenosis. Fourteen months after the hepatectomy, pancreatoduodenectomy was performed and the pathological findings showed lower bile duct carcinoma(JSBS classification: pT4N2M0, fStage IVb, fCur B). The patient died of local recurrence 6 months after the secondary operation.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2012; 39(12):2119-21.
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Chieko Uchiyama,
Shigeyuki Tamura,
Shinichi Nakatsuka,
Atsushi Takeno,
Hirofumi Miki,
Takashi Kanemura,
Shin Nakahira,
Rei Suzuki,
Ken Nakata,
Yutaka Takeda, Takeshi Kato
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ABSTRACT: Gastric neuroendocrine carcinoma (G-NEC) is a rare, highly malignant tumor that exhibits aggressive growth leading to vascular invasion, distant metastasis and extremely poor prognosis. We studied the clinicopathological findings of seven patients at our institute to better under this disease.
Seven cases of G-NEC were identified among 1,027 cases of gastric carcinoma that underwent gastrectomy at Kansai Rousai Hospital between 2002 and 2010. We studied the pathological and immunohistochemical features of gastric neuroendocrine carcinomas at both the primary site and metastatic lymph nodes.
The mean patient age was 73 years (range 63 to 86 years). There were no females in this series. The final staging was Stage I in one case, Stage II in two, Stage III in two and Stage IV in two. A total of 31 metastatic lymph nodes were found in these patients. This study revealed that the ratio of neuroendocrine cells was similar between the primary and metastatic sites, which tended to show the same expression patterns of neuroendocrine markers.
Metastatic lymph nodes showed heterogeneous immunohistochemical expression patterns similar to the primary sites. G-NEC is far advanced at diagnosis and rapidly reaches the lymph nodes retaining its heterogeneity, carrying a worse prognosis than common gastric cancer. MINI ABSTRACT: G-NEC grows rapidly and metastasizes to the lymph nodes, retaining its pathological and immunohistochemical heterogeneity even at the metastatic sites.
World Journal of Surgical Oncology 06/2012; 10:115. · 1.12 Impact Factor
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Atsushi Takeno,
Shigeyuki Tamura,
Hirofumi Miki,
Hiroshi Kawashima,
Yosuke Mukai,
Michiko Hamanaka,
Hisako Ono,
Chieko Uchiyama,
Takeshi Kanemura,
Rei Suzuki,
Shin Nakahira,
Ken Nakata,
Shu Okamura,
Yutaka Takeda, Takeshi Kato
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ABSTRACT: INTRODUCTION: Wallflex duodenal stent (WDS) placement for gastric outlet obstruction caused by malignant disease has been covered by health insurance in Japan since April 2010. We have placed five-WDS for three gastric outlet obstructions caused by inoperable advanced gastric cancer. CASE 1: A 67-year-old male diagnosed as having Stage IV gastric cancer with liver, lung, and lymph node metastases underwent a WDS placement during first-line chemotherapy. He was able to consume a soft diet orally for about five months thereafter. He underwent a WDS replacement for stent obstruction by tumor ingrowth and finally died due to the primary tumor 11 months after the first visit. CASE 2: A 63-year-old male diagnosed as having Stage IV gastric cancer with liver and lymph node metastases underwent a WDS placement during the first-line chemotherapy. He was able to consume a soft diet orally for about three months thereafter. He died due to the primary tumor six months after the first visit. CASE 3: A 72-year-old male diagnosed as having Stage IV gastric cancer with liver and lymph node metastases underwent a WDS placement during the first-line chemotherapy. He was able to consume a soft diet orally for about four months and subsequently received the fourth-line chemotherapy. He underwent a WDS replacement for stent obstruction by tumor ingrowth and finally died due to the primary tumor nine months after the first visit. CONCLUSIONS: WDS stent placements for gastric outlet obstruction caused by inoperable advanced gastric cancer were performed safely and enabled the consumption of a soft diet orally for at least three months. This approach is expected to be a safe and effective treatment option.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2011; 38(12):2134-6.
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Shin Nakahira,
Yutaka Takeda,
Hiroshi Kawashima,
Yosuke Mukai,
Michiko Hamanaka,
Hisako Ono,
Chieko Uchiyama,
Takashi Kanemura,
Atsushi Takeno,
Rei Suzuki,
Ken Nakata,
Hirofumi Miki,
Syu Okamura, Takeshi Kato,
Shigeyuki Tamura
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ABSTRACT: In this study, we evaluate the capability of pure laparoscopic surgery for repeat hepatectomy. From June 2010 through March 2011, 15 cases of primary hepatectomy (hepatocellular carcinoma 11, liver metastasis 4) and 6 cases of re-hepatectomy patients (all cases were hepatocellular carcinoma) were underwent pure laparoscopic hepatectomy. As for the liver function in primary hepatectomy and re-hepatectomy, liver damage A/B was 8/7 and 2/4, median ICG R15 was 18 (4- 42) % and 30 (10-35) %, respectively. As for operative variables in primary hepatectomy and re-hepatectomy, the median operative duration was 265 (105-673) minutes, 296 (157-475) minutes, the median amount of bleeding was 10 (small amount-2,000) cc, 25 (small amount-140) cc, and the median post-operative hospital stay was 10 (6-17) days and 11 (6-24) days, respectively. Primary hepatectomy and re-hepatectomy represented equal clinical outcomes, although re-hepatectomy patients had lower hepatic function compared with primary hepatectomy patients.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2011; 38(12):2478-80.
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Yutaka Takeda,
Shin Nakahira,
Atsushi Takeno,
Rei Suzuki,
Ken Nakata,
Masatsugu Okishiro,
Chiyomi Egawa,
Shu Okamura,
Hirofumi Miki, Takeshi Kato,
Yuichi Takatsuka,
Shigeyuki Tamura
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ABSTRACT: Sorafenib is a novel, orally administered multi-kinase inhibitor that has recently been approved for the treatment of advanced hepatocellular carcinoma. We report three cases of hepatocellular carcinoma without distant metastasis effectively treated by sorafenib. Case 1 was a 71-year-old male with multiple hepatocellular carcinomas, Child-Pugh status A, and asthma. He received sorafenib 400 mg twice daily. The efficacy evaluated by the RECIST was partial response. Case 2 was a 75-year-old male with multiple hepatocellular carcinomas and Child-Pugh status A. He previously received surgical resection and transarterial chemoembolization. He received sorafenib 400 mg twice daily. The efficacy evaluated by the RECIST and modified RECIST was partial response and complete response, respectively. Case 3 was a 62-year-old male with multiple hepatocellular carcinomas and Child-Pugh status A. He previously received surgical resection, percutaneous radiofrequency ablation therapy and transarterial chemoembolization. He received sorafenib 400 mg twice daily. The efficacy evaluated by the RECIST was stable disease. The majority of adverse events were grade 1-2 stomatitis and hand-foot skin reaction. No patients discontinued the treatment because of adverse events. Sorafenib might be promising as an effective therapy for advanced hepatocellular carcinoma without distant metastasis.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2011; 38(12):2496-8.
