[Show abstract][Hide abstract] ABSTRACT: A 66-year-old woman had visited a nearby clinic with frequent hiccupping one month earlier. Gastric distension was noted on abdominal X-ray, and she was referred to our hospital with suspected pyloric stenosis. No abnormal findings other than abdominal bloating were apparent. Upper gastrointestinal endoscopy showed severe stenosis in the pylorus and a submucosal tumor-like protrusion at the center of the posterior wall. Biopsy identified a Group 1 mass, but invasion into the duodenal bulb was suspected on abdominal ultrasonography. Submucosal tumor-like gastric cancer could not be ruled out, and she underwent surgery for the purposes of definitive diagnosis and treatment of the obstruction. After distal gastrectomy conforming to treatment for gastric cancer with accompanying duodenal invasion, lymph nodes D2+No.12b/p, 13a, and 14v were dissected. Malignant transformation of an aberrant pancreas was diagnosed from histopathological examination. Lymph node metastasis was observed at No. 5, 6, 8a, and 13a.General findings were pT3, pN2, sH0, sP0, pCY0, pM1, fStage IV. This case suggests that when gastric submucosal tumor is diagnosed, differential diagnosis should include primary adenocarcinoma of aberrant pancreas in the stomach, although this is rare, and a surgical procedure that takes lymph node metastasis into account should be considered.
Preview · Article · Jan 2015 · Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)
[Show abstract][Hide abstract] ABSTRACT: Purpose:
Peritoneal dissemination is the most frequent and life-threatening mode of metastasis and recurrence in patients with gastric cancer. A multicenter phase II study was designed to evaluate the efficacy and tolerability of S-1 and docetaxel combination chemotherapy regimen for the treatment of advanced or recurrent gastric cancer patients with peritoneal dissemination.
Nineteen patients with histologically confirmed unresectable or recurrent gastric cancer with peritoneal dissemination were enrolled. Oral S-1 at 80 mg/m(2)/day was administered twice daily for 2 weeks, followed by 1 drug-free week. Docetaxel infusion at 40 mg/m(2) was performed on day 1, simultaneous with S-1 administration. The primary endpoints were overall survival (OS) and time to progression (TTP). The secondary endpoints were the response rates and safety status.
Patients received a median of 4 cycles of the S-1 and docetaxel regimen (range 1-43). The disease control rate was 73.7 % (14/19). Median overall survival was 459 days (15.3 months), while median time to progression was 212 days (7.1 months). Neutropenia was the most common type of toxicity (n = 7, 36.8 %).
Combination chemotherapy with S-1 and docetaxel is a tolerable and effective treatment for advanced or recurrent gastric cancer patients with peritoneal dissemination.
No preview · Article · Jan 2013 · Cancer Chemotherapy and Pharmacology
[Show abstract][Hide abstract] ABSTRACT: We report long-term survival in a patient after resection for sigmoid colon cancer and pulmonary and pancreatic metastasis. A 56-year-old man undergoing sigmoidectomy for sigmoid colon cancer in May 1993 and right lower lobectomy for lung metastasis (S6) in June 1993 showed was elevated serum CEA from June 1994. Abdominal CT in March 1995 showed a mass lesion in the pancreatic tail, based on a diagnosis of pancreatic tumor, necessitating distal pancreatectomy with splenectomy and left adrenalectomy in April 1995. Histopathologically, the diagnosis was metastatic colon cancer. In November 1995, he underwent partial right upper lobectomy for right upper metastasis (S3). Now, 15 years after resection of the primary cancer, he is doing well with no sign of recurrence. The prognosis of metastatic colon cancer of the pancreas is dismal, but pancreatic resection may achieve long-term survival and we feel surgery should be conducted aggressively if curability is promising.
No preview · Article · Feb 2009 · Nippon Shokaki Geka Gakkai zasshi
[Show abstract][Hide abstract] ABSTRACT: A 78-year-old male was admitted to our hospital complaining of anorexia. Endoscopy revealed gastric cancer with pyloric stenosis and MRI showed multiple metastasis of thoracic vertebral body. Blood examinations showed DIC and CEA was 118.3 ng/mL. Sternum bone marrow biopsy revealed poorly-differentiated adenocarcinoma. Chemotherapy with sequential therapy consisting of MTX and 5-FU (MTX 150 mg/body, 5-FU 1,000 mg/body) was performed in addition to anti-DIC therapy. After 3 courses, DIC was resolved. Then, we changed the chemotherapy regimen to S-1/ paclitaxel (S-1 60 mg/body, PTX 60 mg/body). After 2 courses, the primary tumor was remarkably reduced and CEA decreased to within normal limits. After discharge, the patient has been undergoing chemotherapy on an outpatient basis.
No preview · Article · Dec 2008 · Gan to kagaku ryoho. Cancer & chemotherapy
[Show abstract][Hide abstract] ABSTRACT: A 67-year-old man was admitted to our hospital due to esophageal cancer. Cancer existed at the lower esophagus and subtotal esophagectomy and lymphadenectomy was performed. The postoperative course was uneventful. Pathological findings revealed moderately differentiated squamous cell carcinoma that metastasized to the abdominal lymph nodes which include the paraaortic lymph nodes. He complained of anorexia three months after the operation and was found to have multiple liver and mediastinal lymph node metastases. He was admitted for chemotherapy. Before starting chemotherapy, he suddenly died without any sign of hemorrhage or respiratory disorder. Autopsy showed metastatic lesions to the heart and mediastinal lymph nodes, liver, thoracic vertebrae, kidney, adrenal gland and heart. Metastatic nodules in the heart were on the ventricular septum where the conducting system exists. No direct invasion from the pericardium was observed. Blockade of the conducting system of the heart was considered to have caused the severe arrhythmia and sudden cardiac arrest.
No preview · Article · Aug 2005 · The Japanese Journal of Thoracic and Cardiovascular Surgery
[Show abstract][Hide abstract] ABSTRACT: Ileus caused by impaction of gallstones is a rare disease. This paper describes our experience with seven cases of gallstone ileus from 1965 to 1992. A preponderance of gallstone ileus in the femal and aged patients is suggested. A suspicious history of biliary tract disease or diabetes was frequently noted. The site of obstruction included the smallintestine in all cases. The route of gallstone migration was a cholecystoduodenal fistula in 5 cases and unknown in 2. Resected stones were mixed stones in 3 cases and calcium bilirubinate stones in 4. Two cases were correctly diagnosed preoperatively, and in one of them the diagnosis was made by CT which demonstrated an obstruction of the small intestine and pneumoiblia. The necessity of CT should be emphasized in the diagnosis of gallstone ileus. Surgical procedures included enterolithotomy for 6 cases and cholecystectomy and repair of the fistula with enterotomy for only one. One of 6 cases without cholecystectomy had a gallblandder carcinoma 9 years after enteroli-thotomy. It is important that radical operation on an one-step approach is comploved as far as possible.