[Show abstract][Hide abstract] ABSTRACT: The patient was a 75-year-old woman with advanced esophageal cancer and lymph-node swelling in the mediastinum(cStage RR). We administered preoperative chemotherapy(5-FU 500mg/body×10, CDDP 10mg/body×10). She received the two courses without showing any serious side effects. The primary tumor revealed remarkable improvement, but the rigidity of the esophagus wall and swelling of the lymph nodes were not resolved, and images showed that the patient exhibited a partial response to the treatment. Radical resection of the esophageal carcinoma was performed. Pathological examination of the resected specimens revealed no malignant cells in the esophagus, no metastasis of the lymph node, and the response evaluation was grade 3. The patient showed no recurrence 4 years and eleven months after the operation. In lonclusion, this rare case of esophageal carcinoma showed a pathologically complete response when treated with low-dose 5-FU/CDDP as neoadjuvant chemotherapy.
No preview · Article · Nov 2012 · Gan to kagaku ryoho. Cancer & chemotherapy
[Show abstract][Hide abstract] ABSTRACT: Although gastric cancers(GCs)with rhabdoid features are rare, they are known to show a poorer prognosis compared with conventional GCs. Indeed, more than half of reported GCs with rhabdoid features died within 6 months after receiving any kind of initial treatment. Obviously, no effective chemotherapy has been reported. In this study, we present a case of GC with rhabdoid features which showed a better response to a chemotherapy, S-1/CDDP, and lived for over 12 months after the initial chemotherapy. A 75-year-old man was seen in our hospital for epigastralgia. Detailed examinations revealed that he had GC at Stage IV. Consequently, he underwent S-1/CDDP treatment. This treatment produced a good response for 6 months, minimizing the size of the primary tumor and eradicating distant metastases. Re-growth of the primary tumor without uprising distant metastasis was confirmed 8 months after the initialS -1/CDDP treatment, and the patient went through a gastrectomy for curative care. After surgery, a precise pathological examination revealed that the primary tumor possessed a poorly differentiated adenocarcinoma that contained tumor cells with typical rhabdoid features. In the end, the patient died of liver metastasis 13 months after the initial S-1/CDDP chemotherapy.
No preview · Article · May 2012 · Gan to kagaku ryoho. Cancer & chemotherapy
[Show abstract][Hide abstract] ABSTRACT: An abnormal shadow was detected on the chest radiograph of a 55-year-old man during a medical check up. The chest CT showed a round mass with calcification, 3 cm in size, in the left pulmonary hilum. The tumor size increased slightly during the 5 years of follow-up and the PET scan was positive. Left upper lobectomy was performed due to suspicion of lung cancer and extensive adhesion was demonstrated between the tumor and left pulmonary artery. The histopathological diagnosis was hyaline vascular type of Castleman's disease. The postoperative course was uneventful, and the patient still remains disease-free 2 years after the operation.
[Show abstract][Hide abstract] ABSTRACT: Background. Sarcomatoid carcinoma of the thymus is a very rare malignant tumor. No methods for the treatment of this carcinoma have been established, and the prognosis is poor. We encountered a patient with sarcomatoid carcinoma of the thymus, and performed combined modality therapy. Case. The patient, a 54-year-old male, was admitted to our hospital because a large tumor shadow was observed in the left thoracic region by radiography in October 2002. The lesion was suspected to be a malignant teratoma by percutaneous biopsy under ultrasonography. Since the tumor was very large, we perfomed chemotherapy, and a 61 percent tumor reduction (partial response) was obtained. After chemotherapy, the entire tumor was removed by excision of the left upper lobe and the pericardium in Feburary 2003. Histologically, the patient was diagnosed as sarcomatoid carcinoma of the thymus. Postoperative radiotherapy (60 Gy) was performed in the mediastinal space. In September 2003, disseminated recurrence was observed in the thoracic cavity, and re-excision was performed under thoracoscopy. Since metastasis was detected in the posterior head (meninx), whole-brain irradiation (40 Gy) was performed. Then disseminated recurrence was detected in the thoracic cavity, and second chemotherapy was performed, but it was not effective. The patient died in December 2004 (22 months after surgery). Conclusion. We encountered a patient with sarcomatoid carcinoma of the thymus, of which the prognosis is very poor, and the incidence is very low. After examination of whole body and definitive diagnosis by tumor biopsy are performed, it is recommended that radio-chemotherapy followed by surgery should be done. Therefore, we hope the development of an effective chemotherapy.
[Show abstract][Hide abstract] ABSTRACT: A 66-year-old man who had undergone esophagectomy for intrathoracic esophageal cancer developed a peptic epithelial ulcer and edema on the anterior aspect of the reconstructed gastric tube while undergoing regular follow-up examinations. On admission, he received ulcer therapy, but the ulcer didn't heal and the gastric tube was partialy resectioned under local anesthesia. The ulcer recurred twice, and we conducted a thorough investigation. A detailed history revealed that he had been treated of the shoulder with NSAIDS and long-term steroid therapy, and they were thought to be factors contributing to formation of the ulcers. A secretin test was performed to rule out the Zollinger-Ellison syndrome, but it was negative because the patients' plasma gastrin level was continuously high (1,210-1,620pg/ml) and there was no paradoxical response. The plasma gastrin level was much higher than in other cases reported in Japan, and we attempted to find the cause. Parietal cell antibody (PCA) was negative. The patient was positive for urophanic and serum antibodies to Helicobacter pylori, but the gastric tube resection specimens were negative, and the cause remained unclear. Because of the generally long-term survival after esophageal cancer surgery, patient education is necessary to prevent the development of gastric tube ulcers.
No preview · Article · Mar 2006 · Nippon Shokaki Geka Gakkai zasshi
[Show abstract][Hide abstract] ABSTRACT: We report a case of primary appendiceal cancer that metastasized to the ureter. The patient was a 51-year-old woman who complained of persistent left back pain and right lower abdominal pain. After a detailed examination she was diagnosed to have cancer of the appendix, multiple liver metastases, and left hydronephrosis. Since an obstruction of the ileocecum was obvious, she underwent an ileocecal resection and a resection of the spindle-shaped tumor invading the left ureter. Lymph node metastases were found at the root of the superior mesenteric artery. The spindle-shaped tumor was considered to be due to invasion of the appendiceal cancer to the left ureter. The patient died 5 months postoperatively.
[Show abstract][Hide abstract] ABSTRACT: We report the rare case of a gallbladder cyst arising from the foregut remnants. A 36-year-old woman was referred to our hospital after screening ultrasonography (US) detected a tumor in the gallbladder. On admission, she was well and her blood analyses were all normal. US showed a cystic mass with internal high-echoic lesions, and computed tomography (CT) demonstrated a protruding tumor with slight enhancement in the gallbladder. Angiography provided no additional information; however, sequential CT-arteriography (CTA) clearly demonstrated that this tumor was a cystic lesion. Surgical exploration was performed, first because of the difficulty in establishing a definite diagnosis, and also because the patient wanted the tumor removed. The resected specimen contained a unilocular cystic tumor that looked like a submucosal tumor. Histologically, the wall of the cyst was lined by ciliated stratified columnar epithelium with interspersed goblet cells and underlying smooth muscle fibers. The mass was finally diagnosed as a congenital ciliated foregut cyst of the gallbladder. Cysts of the gallbladder are uncommon and the majority are acquired. To our knowledge, this represents only the fourth report of a ciliated foregut cyst of the gallbladder in the literature. Although rare, an awareness of this entity could allow a preoperative diagnosis to be made, whereby surgical exploration may be avoided. CT-A is a very useful diagnostic tool, especially when the nature of the tumor presents a difficult differential diagnosis.
[Show abstract][Hide abstract] ABSTRACT: We report an extremely rare case of a gastric duplication cyst together with an aberrant pancreatic ductal system, which communicated with the stomach rather than the pancreatic ductal system with no evidence of pancreatitis. A 46-year-old woman developed severe abdominal pain after a 10-year history of occasional mild abdominal pain. Upper gastrointestinal barium radiography showed a rigidity of the stomach wall, and gastroscopy revealed a fistula orifice at a greater curvature of the gastric body. Subsequent endoscopic suction of mucous secretion from within the fistula provided immediate pain relief. Abdominal computed tomography and ultrasonography showed a cystic mass contiguous with the stomach wall. Surgical exploration revealed an uncommon anomaly of a gastric duplication cyst with the aberrant pancreatic lobe. The patient made an uneventful recovery and remains well 4 years after surgery. We also herein review ten other similar cases of this uncommon congenital anomaly reported in the literature.
[Show abstract][Hide abstract] ABSTRACT: One hundred twenty-one cases were diagnosed as choledocholithiasis at Kagawa Rousai Hospital between Sep. 1991 and Mar. 1998. Thirty-eight patients undergoing primary closure (primary closure group) and eighty patients undergoing T-tube drainage (T-tube group) were compared clinically to evaluate the effectiveness of primary closure of the common bile duct for choledocholithiasis and associated problems. The incidence of postoperative bile leakage in the primary closure group was 14.3%. The incidence of localized peritonitis after removal of the T-tube because of incomplete fistula formation in the T-tube group was 5.0%. Post-operative liver dysfunction was noted in 5.3% in the primary closure group and in 5.0% in the T-tube group. The duration of postoperative hospital stay was 18.5 days in the primary closure group, and significantly shorter than the 36.0 days in the T-tube group. The primary closure group had fewer complications. Shortening the duration of postoperative hospital stay and the same outcome as in the T-tube group were obtained in the primary closure group. We concluded that primary closure of the common bile duct for choledocholithiasis is more effective than the T-tube drainage.
No preview · Article · Jan 2000 · Nippon Shokaki Geka Gakkai zasshi
[Show abstract][Hide abstract] ABSTRACT: A case with a rapid clinical course of ruptured solitary splenic abscess on chronic hemodialysis is reported. A 76-year-old woman who had been on hemodialysis for the preceding 14 years due to chronic renal failure complained of appetite loss, nausea and diarrhea. Three days later, she felt a left upper abdominal pain and became febrile. On the next morning, she consulted with her general practitioner because of remarkable tenderness in the entire abdomen, and was immediately transferred to the hospital. On arrival, she had already been in a shock condition. With the diagnosis of panperitonitis, an emergency laparotomy was performed and generalized peritonitis due to rupture of splenic abscess was found out. Despite any treatments in the intensive care unit (ICU), she died one day after the operation. No case of splenic abscess with chronic hemodialysis has been reported in the literature as far as we could review. However, some complications associated with chronic hemodialysis appear to have correlation with etiologic factors of splenic abscess, and hence a future increase in splenic abscess is predictable. We should take the disease into consideration for chronic hemodialysis patients who complain general malaise, though it is relatively rare.
No preview · Article · Jan 1998 · Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)