[show abstract][hide abstract] ABSTRACT: A 48-year-old woman was admitted to our hospital with abdominal fullness and pain. A barium enema and endoscopy revealed a Borrmann type II-like tumor of the sigmoid colon. Biopsy specimens showed poorly differentiated adenocarcinoma. Sigmoidectomy with lymph nodes dissection was performed. The tumor histologically consisted of proliferation of large and polygonal cells showing an organoid, trabecular or rosette-like pattern. Many mitotic figures were also observed. The tumor cells were immunohistochemically positive for chromogranin A. These findings led us to a diagnosis of large cell neuroendocrine carcinoma (LCNEC). Six months after surgery, liver metastases, para-aortic lymph node metastases and local recurrence were identified, and we commenced to administer FOLFOX, a combination of l-leucovorin and 5-fluorouracil with oxaliplatin. After six courses, a partial response was observed. This entity of the colon is not clearly recognized at present. The clinicopathological characteristics of LCNEC of the colon must be defined so that an appropriate treatment can be developed. Since LCNEC of the lung has been reported to be of high-grade malignancy, LCNEC of the colon must be treated as potentially highly malignant. In addition, the present case suggested that FOLFOX is a promising treatment for LCNEC of the colon
[show abstract][hide abstract] ABSTRACT: We described a 75-year-old female with recurrent breast cancer that presented as stenosis of the ascending colon and right hydronephrosis. The patient underwent a left mastectomy for breast cancer and a right mastectomy for metachronous breast cancer at the ages of 45 and 69, respectively. Histological findings showed primary invasive ductal carcinoma (scirrhous carcinoma). At the age of 73, she suffered from right hydronephrosis, which was suspected to have been caused by metastasis to the ureter. Two years later, stenosis of the ascending colon occurred. Right hemicolectomy and partial resection of the ureter were performed. Resected specimens revealed infiltration of tumor cells in all layers of the colon and the ureter which resembled invasive ductal carcinoma of primary breast cancer. Metastatic breast cancer can manifest itself in a variety of recurrences, including ureteral and colonic metastatic sites
[show abstract][hide abstract] ABSTRACT: We herein present two cases of solitary fibrous tumor (SFT) of the pleura. In case 1, a 66-year-old female was admitted with a nodule in the left lung field gradually inceasing in size for a period of two years. During video-assisted thoracoscopic surgery (VATS), the tumor showed a pedunculated tumor arised from the visceral pleura. Resected specimens were diagnosed to be SFT of the pleura with a malignant potential. In case 2, a 69-year-old female was admitted with a mass lesion in the left lower lung field. MRI showed a tumor with very low signal intensity on T2 weighted images, which was compatible with SFT of the pleura. During VATS, the tumor adhered to the parietal pleura with some fibrous bands but was easily removed. Resected specimens were diagnosed to be a benign SFT of the pleura. MRI was considered to be a helpful modality for the preoperative diagnosis of SFT
[show abstract][hide abstract] ABSTRACT: Gastric necrosis is a rare and often fatal condition. A few reports of gastric necrosis of various etiologies have been published in the literature. This report deals with a case in which gastric necrosis and perforation occurred several years after an infarction of the spleen. Preoperative computed tomography showed the existence of splenic vein thrombosis accompanying splenic infarction. A laparotomy revealed an 8-cm-long laceration with ragged margins in the posterior of the stomach along the greater curvature. Furthermore, massive venous thrombosis was found in the major omentum. As a result, the reduced arterial blood supply and insufficient venous drainage due to splenic venous thrombosis may have together played a major role in the development of gastric necrosis.
Surgery Today 02/2003; 33(11):867-9. · 0.96 Impact Factor
[show abstract][hide abstract] ABSTRACT: Biliary obstruction is rarely caused by a foreign body. This report describes the case of a 60-year-old Japanese man with jaundice caused by an impacted shrapnel splinter in the common bile duct (CBD) that had migrated from the right thoracic cavity 36 years after initial injury. Biochemical data showed a total bilirubin level of 4.2 mg/dl with a direct bilirubin level of 3.1mg/dl, an alanine aminotransferase level of 24IU/l, and an alkaline phosphatase level of 18.5KA units. It was serially documented that the shrapnel had migrated toward the diaphragm, then burrowed into the liver, settling in the CBD, and causing obstructive jaundice. Choledochotomy and T-tube drainage was performed and the postoperative course was uneventful. To our knowledge, this is the first case report of this type of occurrence in the Japanese literature. Although there are few reports of combat injury in Japan, this diagnosis should be considered in the evaluation of any patient with jaundice who has suffered a previous chest wound involving a foreign body.
Surgery Today 02/2002; 32(4):383-5. · 0.96 Impact Factor
[show abstract][hide abstract] ABSTRACT: A 46-year-old female was successfuly treated with repeated transcatheter arterial embolization (TAE) for multiple liver metastases from breast cancer. TAE using mitomycin C and epirubicin hydrochloride with lipiodol emulsion and gelatin sponge particles has been administered to the patient eight times over 4 years. She has also received systemic chemotherapy. She has survived for 6 years and 3 months after the detection of liver metastases
[show abstract][hide abstract] ABSTRACT: A 71-year-old man was admitted with complaints of right lower quadrant pain and abdominal fullness. Barium enema and computed tomography (CT) scan demonstrated a tumor in the terminal ileum. There was no enlargement of superficial lymph nodes. Colonofiberscopy revealed a narrowing of the terminal ileum and biopsy specimens showed evidence of B-cell lymphoma. Laparotomy was performed in view of the small bowel obstruction. An elastic firm tumor, measuring 5.2 by 4.5 cm, was found in the terminal ileum, and the regional mesenteric nodes were enlarged. lleo-cecal resection with dissection of lymph nodes was performed. The resected specimen revealed a diffuse, B-cell lymphoma with 1gM heavy-chain and kappa light-chain restrictions. The patient developed obstructive jaundice 2 weeks after surgery, and CT scan demonstrated tumor in the ampullary region of the duodenum. Endoscopic examination showed an ulcerated tumor in the ampulla of Vater and biopsy specimen again showed B-cell lymphoma. Chemotherapy with cyclophosphamide, prednisolone, adriamycin and vincristine was effective and complete remission was achieved. To our knowledge, this is the first case of simultaneous occurrence of malignant lymphomas in the ileum and the ampulla of Vater
[show abstract][hide abstract] ABSTRACT: A 60-year-old woman was admitted to Nagasaki Prefectural Shimabara Hospital, with a painful tumor in her umbilical region. The tumor was about 1×1 cm in size. Histological examination of biopsied specimens revealed it to be a metastatic adenocarcinoma. Abdominal computed tomography and ultrasonography revealed a cystic tumor of about 23 mm in diameter in the pancreatic body. In addition, serum levels of cancer antigen 19-9 were elevated. With a tentative diagnosis of pancreatic tumor, she underwent surgery. When we opened her peritoneal cavity, there was no evidence of intra-abdominal disseminations, liver metastases or ascites. At that time, distal pancreatectomy accompanied by splenectomy was the procedure of choice. Histological examination revealed a moderately differentiated adenocarcinoma in the pancreatic body along with fatty replacement of the pancreatic tail. The umbilical tumor was a metastatic adenocarcinoma, which is referred to as a Sister Mary Joseph's nodule
[show abstract][hide abstract] ABSTRACT: We treated three patients with Fournier's gangrene, in whom a male aged 75 years and a female aged 65 years were cured while a female aged 78 years died. None of them had a history of anorectal or urogenital disease. Debridement and colostomy were performed for all patients. After debridement, two patients were given imipenem cilastatin sodium and clindamycin phosphate, while the remaining one was given only imipenem cilastatin sodium. The patient who died had necessitated a continuous dopamine injection for stabilizing the blood pressure. The infectious disease was progressive, despite the extensive debridement. In Fournier's gangrene with the involvement of deep fascia, particular attention should be paid for the development of sepsis
[show abstract][hide abstract] ABSTRACT: Video-assisted thoracoscopic surgery (VATS) for a large, midesophageal diverticulum was successfully performed in a 77-year-old male who had dysphagia for one year. Postoperatively, the patient was well without any complications and was relieved of dysphagia. The VATS diverticulectomy was considered to be minimally invasive and constituted a good indication especially for patients of advanced age showing symptomatic esophageal diverticulum
[show abstract][hide abstract] ABSTRACT: The aim of the present study was a clinical analysis of small bowel obstruction caused by bezoars surgically treated. Seven patients with small bowel obstruction caused by bezoars were retrospectively reviewed. Two patients had undergone gastric surgery. The symptoms before surgery lasted from 1 to 3 days in the non-ileus tube group and from 9 to 30 days in the ileus tube group. Four patients were preoperatively diagnosed with bezoar ileus, and one had intestinal tumor. The remaining two patients were diagnosed with postoperative adhesive ileus. The operative procedure was evacuation of bezoars for all patients. One patient needed incisions of the small intestine and the stomach for the complete evacuation of bezoars. The site of the small bowel obstruction was the ileum in all patients, and bezoars ranged from 30 to 60 mm in diameter. Morbidity was present in one patient who underwent insertion of ileus tube for a long-term treatment. Small bowel obstruction caused by bezoars is not uncommon in patients without any gastric surgery. It is important, preoperatively and intraoperatively, to examine the entire gastrointestinal tract for the presence of bezoars. When bezoars ileus was suspected, insertion of ileus tube should be avoided