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1.
J Surg Case Rep ; 2024(3): rjae163, 2024 Mar.
Article in English | MEDLINE | ID: mdl-38524679

ABSTRACT

The prognosis of recurrent gastric cancer is generally poor, and aggressive surgical treatment is rarely performed. Herein, we present the case of a patient who underwent resection of cerebellar and adrenal gland metastases from gastric cancer. The patient was treated for gastric cancer with distal gastrectomy at 23 years and for remnant gastric cancer with completion gastrectomy at 48 years. At 59 years old, she experienced vertigo and nausea and was diagnosed with cerebellar and left adrenal gland tumours. First, the cerebellar tumours were resected and diagnosed as metastases of gastric cancer. After 1 month, the adrenal gland tumour was resected and diagnosed as metastatic. She underwent whole-brain radiotherapy and subsequent chemotherapy with S-1. One year after the surgery, the patient died of meningitis carcinomatosa. There are few reports on long-term survival after the resection of brain metastases. Herein, we report our experience along with a review of the literature.

2.
Sci Rep ; 12(1): 502, 2022 01 11.
Article in English | MEDLINE | ID: mdl-35017567

ABSTRACT

The introduction of the guidelines has resulted in an increase of laparoscopic surgeries performed, but the rate of early surgery was still low. Here, the initial effect of the introduction of the guideline was confirmed in single center, and factors disturbing early cholecystectomy were analyzed. This study included 141 patients who were treated for acute cholecystitis from January 2010 to October 2014 at Kanazawa Medical Center. Each patient was assigned into a group according to when they received treatment. Patients in Group A were treated before the Tokyo Guidelines were introduced (n = 48 cases), those in Group B were treated after the introduction of the guidelines (93 cases). After the introduction of the guidelines, early laparoscopic cholecystectomy was significantly increased (P < 0.001), however, the rate of early operations was still 38.7% only. There are many cases with cardiovascular disease in delayed group, the prevalence had reached 50% as compared with early group of 24% (P < 0.01). Approximately 25% of patients continued antiplatelet or anticoagulant therapy. In the early days of guidelines introduction, the factor which most disturbed early surgery was the coexistence of cardiovascular disease. These contents could be described in the next revision of the guidelines.


Subject(s)
Cardiovascular Diseases/complications , Cholecystitis, Acute/complications , Cholecystitis, Acute/surgery , Surgeons/psychology , Aged , Aged, 80 and over , Cholecystectomy, Laparoscopic , Cholecystitis, Acute/psychology , Comorbidity , Female , Humans , Japan , Length of Stay , Male , Middle Aged , Practice Guidelines as Topic , Time Factors
3.
Surg Case Rep ; 7(1): 90, 2021 Apr 13.
Article in English | MEDLINE | ID: mdl-33847839

ABSTRACT

BACKGROUND: Pancreatic acinar cell carcinoma (PACC) is a rare exocrine malignant tumor. Its widespread intraductal extension into the main pancreatic duct (MPD) is also rare. CASE PRESENTATION: We report the case of a 71-year-old man with PACC with MPD extension. The patient was assessed with laboratory and radiographic investigations that facilitated a preoperative diagnosis. Endoscopic ultrasonography (EUS) and dynamic thin-slice multi-detector row computed tomography (MDCT) were useful for determining the resection line of the pancreas. EUS-guided fine needle aspiration (EUS-FNA) was also helpful in determining the tumor biology and treatment strategy. Distal pancreatectomy was performed. The MPD was occupied by the tumor 35 mm downstream and 5 mm upstream. Histopathologically, the pancreatic tail tumor extended continuously into the MPD. The tumor was solid with cells showing eosinophilic and granular cytoplasm, indicating the diagnosis of PACC. This is an interesting case of PACC with intraductal extension into the MPD. We discuss the possible mechanisms of tumor extension in this rare case together with a review of the literature. CONCLUSIONS: We describe a rare pancreatic acinar cell carcinoma that could be adequately treated using preoperative precise imaging and histopathological evaluations. When an intraductal tumor extension in the MPD is encountered, the diagnosis of a rare pancreatic tumor should be considered, as in our case.

4.
Am J Case Rep ; 22: e927562, 2021 Jan 11.
Article in English | MEDLINE | ID: mdl-33424018

ABSTRACT

BACKGROUND Type 1 neurofibromatosis (NF1) is known to be associated with not only neurogenic tumors but also gastrointestinal (GI) neoplasms. However, there are few reports on vascular lesions and the incidence is unknown. CASE REPORT We report here the case of a 45-year-old woman with a history of NF1 referred to our hospital for the purpose of detailed examination for positive fecal occult blood test. On the basis of the investigation reports, she was diagnosed with a neuroendocrine tumor (NET)-G1. We planned a subtotal stomach-preserving pancreaticoduodenectomy. The abdominal structures, including the vascular system, were abnormally fragile, and it was very difficult to achieve satisfactory hemostasis. The total amount of intraoperative blood loss was 7580 mL. Fulminant intra-abdominal bleeding occurred on postoperative day (POD) 3. Urgent angiography showed a rupture of the gastroduodenal artery. Transarterial embolization was performed, but the patient died of multiorgan failure on POD5. On histological examination, neurofibroma cells proliferating into the surrounding blood vessels were seen; moreover, immunohistochemistry staining with S-100 antibody showed positive neurofibroma cells surrounding the vascular wall. The pathological diagnosis was duodenal NET-G1 with multinodal involvement. CONCLUSIONS This case is a rare presentation of a NET with multiple gastrointestinal stromal tumors associated with NF1, which led to a fatal outcome due to the extreme fragility of the vessel walls. Since patients with NF1 might have vulnerable vessel walls, adequate surgical preparation for major surgical treatment is necessary.


Subject(s)
Duodenal Neoplasms , Gastrointestinal Stromal Tumors , Intestinal Neoplasms , Neuroendocrine Tumors , Neurofibromatosis 1 , Duodenal Neoplasms/complications , Duodenal Neoplasms/diagnosis , Duodenal Neoplasms/surgery , Female , Gastrointestinal Stromal Tumors/complications , Gastrointestinal Stromal Tumors/diagnosis , Humans , Middle Aged , Neuroendocrine Tumors/complications , Neuroendocrine Tumors/diagnosis , Neurofibromatosis 1/complications , Neurofibromatosis 1/diagnosis
5.
Int J Surg Case Rep ; 79: 302-306, 2021 Feb.
Article in English | MEDLINE | ID: mdl-33493860

ABSTRACT

INTRODUCTION AND IMPORTANCE: The incidence of intestinal malrotation is 1 in 6000 births, and 90% of cases occur within the first year of life. Adult cases are rare, with a reported incidence of 0.2%-0.5% of all cases. The significance of reporting this case is to recognize that some adult-onset cases require surgery even in the absence of intestinal necrosis. CASE PRESENTATION: A 36-year-old man was infected with streptococcus and treated with antibiotics. He developed appetite loss and his weight decreased 12 kg in 4 months. His abdomen was flat and soft with no tenderness. A computed tomography scan showed that the horizontal duodenal leg was not anchored to the retroperitoneum. Rotation of the mesentery, which was wrapped around the superior mesenteric artery in a clockwise direction, was observed, suggesting midgut volvulus. We performed emergency surgery and Ladd's procedure. CLINICAL DISCUSSION: A previous study reported that the most common symptom in the chronic course of intestinal malrotation was abdominal pain in 41.2% of cases, and weight loss was observed in only 2.6% of patients. The high degree of intestinal adhesion suggests that repeated torsion and release and the development of collateral vessels may have contributed to the asymptomatic course. CONCLUSION: Adult-onset intestinal malrotation should be considered as a differential diagnosis in the presence of weight loss and gastrointestinal symptoms. The timing of surgery is still controversial. In chronic cases, severe adhesion might be expected and laparoscopic surgery should be considered carefully.

6.
Clin J Gastroenterol ; 14(1): 370-374, 2021 Feb.
Article in English | MEDLINE | ID: mdl-33063294

ABSTRACT

Pancreatic lymphoepithelial cysts (LECs) are rare cystic lesions filled with a keratinous substance and lined by squamous epithelium with underlying lymphoid tissue. Because pancreatic LECs are entirely benign, correct preoperative diagnosis is important to avoid unnecessary surgery. However, the imaging features of pancreatic LECs are not specific and preoperative diagnosis has proven difficult. A pancreatic mass was incidentally detected through abdominal ultrasonography in a 63-year-old male presenting without any symptoms. Computed tomography showed an exophytic cystic lesion in the pancreatic head. The lesion had heterogeneous high signal intensity with partial low intensity on T2-weighted magnetic resonance imaging (MRI) and high signal intensity on diffusion MRI. Endoscopic ultrasound (EUS) examination showed an encapsulated cystic lesion with relatively homogenous and highly echoic contents. EUS-guided fine-needle aspiration (EUS-FNA) revealed caseous appearance and rare fragments of apparently benign squamous epithelium on a background of keratinous debris, cyst contents, and scattered lymphocytes. We diagnosed a pancreatic LEC and opted for conservative management without surgery. Pathological evaluation based on images obtained through EUS-FNA showed macro- and microscopic features that were critical to determining the management strategy. In conclusion, the imaging and pathological features of pancreatic LECs can inform preoperative diagnosis, which may enable conservative management.


Subject(s)
Pancreatic Cyst , Pancreatic Neoplasms , Conservative Treatment , Endoscopic Ultrasound-Guided Fine Needle Aspiration , Endosonography , Humans , Male , Middle Aged , Pancreas/diagnostic imaging , Pancreatic Cyst/diagnostic imaging , Pancreatic Cyst/therapy
7.
Gan To Kagaku Ryoho ; 47(13): 2038-2040, 2020 Dec.
Article in Japanese | MEDLINE | ID: mdl-33468793

ABSTRACT

An 86-year-old woman underwent mastectomy with sentinel lymph node biopsy for cStage ⅡA breast cancer. The subtype of tumor was triple negative breast cancer. Pulmonary metastasis was found 1 month after surgery. Chemotherapy was done because of her good performance status(PS)and her hope. Administration of S-1 produced SD status of tumor for 8 months. However, NCC-ST-439 was increased and tumor size was enlarged. Therefore, the second line of chemotherapy by low-dose- biweekly paclitaxel and bevacizumab was planned because of her high age and good PS. Thereafter, tumor maker levels dramatically decreased and lung metastasis turned to be small. This therapy had been continued without any severe adverse events for 9 months. Unfortunately, this therapy was failed because of proteinuria, but pulmonary metastasis kept favorable efficacy during administration. Biweekly low-dose paclitaxel and bevacizumab therapy can be safe and effective therapy even for elderly patient with recurrent and metastatic breast cancer.


Subject(s)
Breast Neoplasms , Paclitaxel , Aged , Aged, 80 and over , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Bevacizumab/therapeutic use , Breast Neoplasms/drug therapy , Breast Neoplasms/surgery , Female , Humans , Mastectomy , Neoplasm Recurrence, Local/drug therapy , Paclitaxel/therapeutic use
8.
J Med Case Rep ; 12(1): 314, 2018 Oct 27.
Article in English | MEDLINE | ID: mdl-30367665

ABSTRACT

BACKGROUND: Most colorectal cancer liver metastases form nodules within the hepatic parenchyma, and hepatectomy is the only radical treatment for synchronous metastases. There is concern about intrabiliary tumor growth which may affect the surgical margin, resulting in local recurrence after hepatectomy for colorectal cancer liver metastasis; however, there has been no report of the dissemination in the bile duct after hepatectomy. Here, we report an unusual case of biliary dissemination of colorectal cancer that caused recurrent intrabiliary growth after hepatectomy, and discuss the management of intrabiliary metastasis of colorectal cancer. CASE PRESENTATION: A 69-year-old Japanese man underwent treatment for liver dysfunctions 3 years after aortic valve replacement. Computed tomography revealed an enhanced tumor within the hilar bile duct and dilatation of the left hepatic duct, typical of hilar cholangiocarcinoma. Endoscopic retrograde cholangiopancreatography revealed tumor shadow in his bile duct, and the cytology confirmed malignant cells in the bile. We performed extended left hepatectomy with bile duct resection; his postoperative course remained good without acute complications. After 3 months postoperatively, he was readmitted for subacute cholangitis and obstructive jaundice. Immediately, percutaneous transhepatic cholangiography drainage was performed, followed by cholangiography that exhibited intrabiliary tumor growth in the remnant liver. On immunohistochemical examination, tumor cells were positive for cytokeratin 20 and CDX2 but negative for cytokeratin 7. Then, computed tomography revealed an enhanced tumor-like lesion at the descending colon. After 3 months, left hemicolectomy was performed. Meanwhile, the percutaneous transhepatic cholangiography drainage fluid turned bloody, which was considered to be bleeding from a residual bile duct tumor. Accordingly, radiotherapy was initiated to prevent tumor bleeding around the hilar bile duct, but, unfortunately, the effects were short-lived, and cholangitis rebooted after 1 month leading to our patient's death due to septic liver failure. Autopsy revealed a remnant tumor in the bile duct, but no noticeable nodular metastasis was observed, except for a single small metastasis in the lower lobe of the left lung. CONCLUSIONS: The intrabiliary growth of metastatic colorectal cancer mimics cholangiocarcinoma occasionally. To date, as the effect of chemotherapy or radiotherapy remains uncertain, the complete resection of a bile duct tumor is the only method which could result in a better prognosis.


Subject(s)
Bile Duct Neoplasms/pathology , Bile Ducts/pathology , Cholangiocarcinoma/pathology , Colonic Neoplasms/pathology , Hepatectomy , Liver Neoplasms/secondary , Liver/pathology , Aged , Bile Duct Neoplasms/surgery , Colonic Neoplasms/surgery , Fatal Outcome , Humans , Liver Neoplasms/surgery , Male , Neoplasm Recurrence, Local , Tomography, X-Ray Computed
9.
Am J Case Rep ; 19: 133-136, 2018 Feb 06.
Article in English | MEDLINE | ID: mdl-29402880

ABSTRACT

BACKGROUND Primary small bowel cancer is a rare malignancy; the common histopathological types are carcinoid and adenocarcinoma. Inflammatory bowel diseases and familial adenomatous polyposis are known risk factors for small bowel cancer. Additionally, cases of surgery-induced small bowel adenocarcinoma are sometimes reported after ileostomy. CASE REPORT A 84-year-old woman, who had undergone ileotransversostomy for intestinal obstruction due to postoperative adhesion following appendectomy at the age of 31 years, was referred to our hospital for further examination after experiencing abdominal pain in the right lower quadrant for 2 weeks. Laboratory data showed elevated serum levels of carcinoembryonic antigen (CEA, 102.9 ng/ml) and carbohydrate antigen 19-9 (CA19-9, 104 U/ml). Enhanced computed tomography (CT) revealed a 10-cm mass in the terminal ileum and a distention of the ileum and colon in the blind loop, with retention of feces. The patient was suspected of having ileal cancer by preoperative examination; therefore, right hemicolectomy with en bloc resection was performed. The tumor was histopathologically diagnosed as a well-differentiated and mucinous adenocarcinoma of the ileum. At over 12 months after surgery, tumor recurrence had not been observed. CONCLUSIONS Difficulties in diagnosis can cause delays in treatment and lead to poor prognosis, mainly because tumors in the small bowel rarely cause clinical symptoms. Adenocarcinoma of the ileum should be considered in postoperative patients with ileotransversostomy.


Subject(s)
Adenocarcinoma/diagnosis , Ileal Neoplasms/diagnosis , Ileostomy , Adenocarcinoma/surgery , Aged, 80 and over , Appendectomy/adverse effects , Female , Humans , Ileal Neoplasms/surgery , Intestinal Obstruction/etiology , Intestinal Obstruction/surgery , Postoperative Complications/etiology , Postoperative Complications/surgery , Time Factors
10.
Ann Med Surg (Lond) ; 10: 57-60, 2016 Sep.
Article in English | MEDLINE | ID: mdl-27547398

ABSTRACT

INTRODUCTION: Sevelamer is an anion exchange resin used to treat hyperphosphatemia. A common adverse effect of sevelamer is constipation. According to a review of the available literature, colon perforation associated with this resin agent was less common. PRESENTATION OF CASE: A 66-year-old man complaining of lower abdominal pain was transferred to our hospital. The patient had been undergoing hemodialysis for chronic renal failure due to rapidly progressive glomerulonephritis, and had been receiving sevelamer hydrochloride 4.5 g/day for 8years as treatment for hyperphosphatemia. Abdominal computed tomography revealed ascites, free air in the abdominal cavity, multiple diverticula of the sigmoid colon, as well as increased fat tissue surrounding the sigmoid colon. We diagnosed colonic perforation and performed emergency surgery, which revealed a 5 × 5 mm perforation in the sigmoid colon surrounded with soft stool. Histopathologically, sevelamer crystals were detected at the perforation site. DISCUSSION: We theorize that physical stimulation by sevelamer crystals contributed to colon perforation at the already vulnerable diverticulum site. CONCLUSION: When sevelamer is administered to patients with hemodialysis, the risk of intestinal perforation should be considered.

11.
J Endovasc Ther ; 21(4): 589-97, 2014 Aug.
Article in English | MEDLINE | ID: mdl-25101592

ABSTRACT

PURPOSE: To report a rare and complicated case of immunoglobulin (Ig) G4-related periaortitis involving both the aortic wall and the retroperitoneum without aneurysmal formation. CASE REPORT: A 79-year-old man with IgG4-related periaortitis suffered aortic rupture despite a normal caliber aorta after 6 months of steroid therapy (20 mg/d). Endovascular repair with an aortic cuff sealed the rupture. Steroid therapy was halted 2 weeks later due to infection. Four months later, a biopsy during esophagogastroduodenoscopy to investigate gastrointestinal bleeding suggested a relapse of IgG4-RD in the duodenum. Subsequent aortoduodenal fistula formation proved fatal. Generally, IgG4-related periaortitis does not result in such complications due to the absence of aneurysm formation and a thick aortic wall. CONCLUSIONS: Our report highlights a rare case of IgG4-related periaortitis where complications resulted following steroid therapy and surgical intervention, emphasizing the difficulties in dealing with IgG4-related cardiovascular lesions.


Subject(s)
Aortic Aneurysm, Abdominal/surgery , Aortic Rupture/surgery , Aortitis/immunology , Duodenal Diseases/immunology , Endovascular Procedures/adverse effects , Immunoglobulin G/analysis , Intestinal Fistula/immunology , Vascular Fistula/immunology , Aged , Aortic Aneurysm, Abdominal/diagnosis , Aortic Aneurysm, Abdominal/immunology , Aortic Rupture/diagnosis , Aortic Rupture/immunology , Aortitis/complications , Aortitis/diagnosis , Aortitis/drug therapy , Aortography/methods , Biopsy , Blood Vessel Prosthesis Implantation , Duodenal Diseases/diagnosis , Endoscopy, Gastrointestinal , Escherichia coli Infections/immunology , Escherichia coli Infections/microbiology , Fatal Outcome , Gastrointestinal Hemorrhage/immunology , Humans , Immunocompromised Host , Intestinal Fistula/diagnosis , Male , Risk Factors , Steroids/adverse effects , Time Factors , Tomography, X-Ray Computed , Vascular Fistula/diagnosis
12.
Cancer Immunol Immunother ; 63(5): 479-89, 2014 May.
Article in English | MEDLINE | ID: mdl-24633336

ABSTRACT

Cancer vaccine therapy is one of the most attractive therapies as a new treatment procedure for pancreatic adenocarcinoma. Recent technical advances have enabled the identification of cytotoxic T lymphocyte (CTL) epitopes in various tumor-associated antigens (TAAs). However, little is known about which TAA and its epitope are the most immunogenic and useful for a cancer vaccine for pancreatic adenocarcinoma. We examined the expression of 17 kinds of TAA in 9 pancreatic cancer cell lines and 12 pancreatic cancer tissues. CTL responses to 23 epitopes derived from these TAAs were analyzed using enzyme-linked immunospot (ELISPOT), CTL, and tetramer assays in 41 patients, and factors affecting the immune responses were investigated. All TAAs were frequently expressed in pancreatic adenocarcinoma cells, except for adenocarcinoma antigens recognized by T cells 1, melanoma-associated antigen (MAGE)-A1, and MAGE-A3. Among the epitopes recognized by CTLs in more than two patients in the ELISPOT assay, 6 epitopes derived from 5 TAAs, namely, MAGE-A3, p53, human telomerase reverse transcriptase (hTERT), Wilms tumor (WT)-1, and vascular endothelial growth factor receptor (VEGFR)2, could induce specific CTLs that showed cytotoxicity against pancreatic cancer cell lines. The frequency of lymphocyte subsets correlated well with TAA-specific immune response. Overall survival was significantly longer in patients with TAA-specific CTL responses than in those without. P53, hTERT, WT-1, and VEGFR2 were shown to be attractive targets for immunotherapy in patients with pancreatic adenocarcinoma, and the induction of TAA-specific CTLs may improve the prognosis of these patients.


Subject(s)
Adenocarcinoma/immunology , Antigens, Neoplasm/immunology , Cancer Vaccines/immunology , Pancreatic Neoplasms/immunology , Adenocarcinoma/mortality , Aged , Epitopes, T-Lymphocyte/immunology , Female , Flow Cytometry , Humans , Kaplan-Meier Estimate , Male , Pancreatic Neoplasms/mortality , Real-Time Polymerase Chain Reaction , T-Lymphocytes, Cytotoxic/immunology , Telomerase/immunology , Tumor Suppressor Protein p53/immunology , Vascular Endothelial Growth Factor Receptor-2/immunology
13.
Oncol Rep ; 30(4): 1561-74, 2013 Oct.
Article in English | MEDLINE | ID: mdl-23863893

ABSTRACT

The eligibility criteria of liver transplantation (LT) for hepatocellular carcinoma (HCC) must clearly confirm the prognosis not only from pathological diagnosis but also from pre-operative imaging diagnosis. In the present study, we evaluated published eligibility criteria for LT based on both pre-operative imaging diagnosis and pathological diagnosis using living donor liver transplantation (LDLT) recipients at our hospital by α-smooth muscle actin (SMA)-positive cancer-associated fibroblasts (CAFs) in HCC. The Up-to-seven (Up-to-7), Asan and Tokyo criteria were evaluated, in both overall survival and HCC disease-free survival, to be statistically significantly beneficial criteria to define post-LDLT prognosis. Recipients only within Up-to-7 criteria based on both pre-operative imaging diagnosis and pathological diagnosis survived without HCC recurrence. Recipients with proliferation of α-SMA-positive CAFs in HCC had significantly poorer prognosis. All survival recipients without HCC recurrence, who were above the Up-to-7 criteria in pathological diagnosis, had no proliferation of α-SMA-positive CAFs. As a result of multivariate analysis, the significant independent factors defining prognosis of recipients after LDLT for HCC were Up-to-7 criteria and proliferation of α-SMA-positive CAFs. The ideal eligibility criteria for LDLT with HCC is Up-to-7 criteria and α-SMA-positive CAFs was considered to be an important factor in HCC recurrence. LDLT should be limited to recipients within Up-to-7 criteria or without proliferation of α-SMA-positive CAFs.


Subject(s)
Carcinoma, Hepatocellular/surgery , Eligibility Determination/methods , Liver Neoplasms/surgery , Liver Transplantation , Living Donors , Actins/metabolism , Carcinoma, Hepatocellular/metabolism , Disease-Free Survival , Female , Humans , Liver Neoplasms/metabolism , Male , Middle Aged , Neoplasm Recurrence, Local/surgery , Neoplasm Staging , Patient Selection , Prognosis , Treatment Outcome
14.
World J Gastroenterol ; 19(20): 3161-4, 2013 May 28.
Article in English | MEDLINE | ID: mdl-23716999

ABSTRACT

We present the first case of an intraductal papillary neoplasm of the bile duct (IPNB) accompanying a mixed adenoneuroendocrine carcinoma (MANEC). A 74-year-old woman presented with fever of unknown cause. Laboratory data revealed jaundice and liver injury. Contrast-enhanced computed tomography revealed a 20 mm polypoid tumor in the dilated distal bile duct, which exhibited early enhancement and papillary growth. Upper gastrointestinal endoscopy revealed mucus production from the papilla of Vater, characterized by its protruding and dilated orifice. Endoscopic ultrasonography visualized the polypoid tumor in the distal bile duct, but no invasive region was suggested by diagnostic imaging. Therefore, the initial diagnosis was IPNB. After endoscopic nasobiliary drainage, a pylorus-preserving pancreaticoduodenectomy was performed. Pathological examination of the resected bile duct revealed papillary proliferation of biliary-type cells with nuclear atypia, indicating pancreaticobiliary-type IPNB. In addition, solid portions comprised of tumor cells with characteristic salt-and-pepper nuclei were evident. Immunohistochemistry revealed expression of the neuroendocrine marker synaptophysin in this solid component, diagnosing it as a neuroendocrine tumor (NET). Furthermore, the MIB-1 proliferation index of NET was higher than that of IPNB, and microinvasion of the NET component was found, indicating neuroendocrine carcinoma (NET G3). This unique case of MANEC, comprising IPNB and NET, provides insight into the pathogenesis of biliary NET.


Subject(s)
Adenocarcinoma/pathology , Bile Duct Neoplasms/pathology , Carcinoma, Neuroendocrine/pathology , Carcinoma, Papillary/pathology , Neoplasms, Complex and Mixed/pathology , Neoplasms, Multiple Primary/pathology , Adenocarcinoma/chemistry , Adenocarcinoma/surgery , Aged , Bile Duct Neoplasms/chemistry , Bile Duct Neoplasms/surgery , Biomarkers, Tumor/analysis , Biopsy , Carcinoma, Neuroendocrine/chemistry , Carcinoma, Neuroendocrine/surgery , Carcinoma, Papillary/chemistry , Carcinoma, Papillary/surgery , Drainage , Endoscopy, Gastrointestinal , Endosonography , Female , Humans , Immunohistochemistry , Neoplasms, Complex and Mixed/chemistry , Neoplasms, Complex and Mixed/surgery , Neoplasms, Multiple Primary/chemistry , Neoplasms, Multiple Primary/surgery , Pancreaticoduodenectomy , Predictive Value of Tests , Tomography, X-Ray Computed
15.
J Hepatobiliary Pancreat Sci ; 20(5): 518-24, 2013 Jun.
Article in English | MEDLINE | ID: mdl-23430053

ABSTRACT

PURPOSE: Hepatectomy of segments 4a and 5 (S4a+5) is the recommended treatment for pT2 gallbladder cancer. However, gallbladder bed resection is also occasionally used. Using nationwide data from the Japanese Biliary Tract Cancer Registry and a questionnaire survey, we retrospectively compared these 2 methods of treatment. METHOD: The study involved 85 patients with pT2, pN0 gallbladder cancer (55 treated with gallbladder bed resection, and 30, with S4a+5 hepatectomy). The prognosis and mode of tumor recurrence following treatment were analyzed retrospectively, with overall survival as the endpoint. RESULTS: The 5-year survival rate did not differ significantly between the 2 groups. Univariate analysis showed that bile duct resection and perineural tumor invasion were significant prognostic factors, but the extent of hepatectomy, location of the major intramural tumor, regional lymph node excision, and histological type were not. Multivariate analysis identified perineural tumor invasion as a significant prognostic factor. Recurrence occurred most frequently in both lobes than S4a+5 of the liver following gallbladder bed resection. CONCLUSION: In the present study of cases of Japanese Biliary Tract Cancer Registry, it was not possible to conclude that S4a+5 hepatectomy was superior to gallbladder bed resection.


Subject(s)
Gallbladder Neoplasms/surgery , Hepatectomy/methods , Aged , Female , Gallbladder Neoplasms/epidemiology , Gallbladder Neoplasms/pathology , Humans , Japan/epidemiology , Lymph Node Excision , Male , Neoplasm Grading , Neoplasm Invasiveness , Neoplasm Recurrence, Local , Postoperative Complications/epidemiology , Prognosis , Registries , Retrospective Studies , Surveys and Questionnaires , Survival Rate
16.
Surg Today ; 43(9): 1058-61, 2013 Sep.
Article in English | MEDLINE | ID: mdl-22886607

ABSTRACT

This report presents a case that was successfully treated for acquired factor VIII inhibitor after extensive visceral surgery. A 71-year-old male who underwent surgery for bile duct cancer had active bleeding in the abdominal drainage tube on postoperative day (POD) 5, and prolonged activated partial thromboplastin time (aPTT) was detected (83.1 s) on POD 7. An extensive coagulation work-up revealed factor VIII deficiency (1 %), and a diagnosis of an acquired factor VIII deficiency was established when a factor VIII inhibitor of 8 Bethesda units was demonstrated. The patient was treated with activated prothrombin complex concentrate (aPCCs) and bloody discharge was stopped within 3 days. Inhibitor elimination was started using prednisolone on POD 20; rituximab, was administered on POD 74 and 81. Factor VIII inhibitor had disappeared by POD 124, and factor VIII (72 %) and aPTT recovered to 45.9 s. This case report demonstrated the efficacy of aPCCs and rituximab in the treatment of acquired hemophilia associated with visceral surgery.


Subject(s)
Blood Coagulation Factor Inhibitors/blood , Blood Coagulation Factors/therapeutic use , Factor VIII/antagonists & inhibitors , Hemophilia A/drug therapy , Postoperative Complications/drug therapy , Postoperative Hemorrhage/drug therapy , Postoperative Hemorrhage/etiology , Aged , Antibodies, Monoclonal, Murine-Derived/therapeutic use , Bile Duct Neoplasms/surgery , Biomarkers/blood , Hemophilia A/complications , Hemophilia A/diagnosis , Hemophilia A/etiology , Humans , Male , Partial Thromboplastin Time , Postoperative Care , Postoperative Complications/diagnosis , Postoperative Complications/etiology , Rituximab , Time Factors , Treatment Outcome
17.
Mol Clin Oncol ; 1(3): 418-422, 2013 May.
Article in English | MEDLINE | ID: mdl-24649185

ABSTRACT

Although pancreatic carcinoma frequently extends posteriorly beyond the pancreatic parenchyma, retroperitoneal organs such as the inferior vena cava (IVC) and the adrenal gland are rarely involved. The fusion fascia lies between the pancreas and these retroperitoneal organs. This study investigated the role of the fusion fascia in the prevention of infiltration of retroperitoneal structures by pancreatic carcinoma. This study was conducted on 140 patients who underwent pancreatic carcinoma resection at our hospital. Retropancreatic infiltration was divided into three grades as follows: Grade 0, carcinoma confined within the pancreatic parenchyma; grade 1, carcinoma infiltrating beyond the parenchyma but within the fusion fascia; and grade 2, infiltration of retroperitoneal tissues beyond the fusion fascia. Grade 0 was found in 24%, grade 1 in 73% and grade 2 in 3% of the cases. There was no significant difference in the prevalence of grade 2 between pancreatoduodenectomy (PD) and distal pancreatectomy (DP). Pancreatic carcinoma infiltrated posteriorly beyond the parenchyma in over 70% of our cases; however, grade 2 infiltration was a rare finding and tumor invasion was confined within the fusion fascia in almost all the cases. Thus, the fusion fascia may act as a barrier against retroperitoneal tissue infiltration by pancreatic carcinoma.

18.
Asian J Surg ; 35(2): 57-61, 2012 Apr.
Article in English | MEDLINE | ID: mdl-22720859

ABSTRACT

BACKGROUND/OBJECTIVE: Recently, endoscopic and radiological procedures for various symptoms related to cirrhosis have improved. Thus, the role of Hassab's operation (gastroesophageal decongestion and splenectomy) has changed for cirrhotic patients. METHODS: Hassab's operation was performed on patients who had gastroesophageal varices that were difficult to control with balloon occluded retrograde transvenous obliteration or an endoscopic procedure, or had hypersplenism. Thirteen consecutive patients underwent this operation, and the outcomes of all patients were reviewed retrospectively. RESULTS: There was no operative morbidity or rebleeding varices. In the preoperative endoscopic injection sclerotherapy treated group (n=6), only one patient (16.7%) developed recurrent varices. Mean platelet counts were significantly higher 6 months after surgery (201 ± 65 × 10(3)/mm(3)) than preoperatively (64 ± 54 × 10(3)/mm(3)). In patients with hepatocellular carcinoma, percutaneous therapies, such as radio frequency ablation, were safely performed with adequate therapeutic effect. Interferon therapy was given to patients with hepatitis C virus (HCV)-related cirrhosis without interruption. CONCLUSION: Hassab's operation is a satisfactory approach to controlling varices, especially when combined with preoperative endoscopic treatment. Platelet counts were significantly higher after surgery. This therapy was important for cirrhotic patients contraindicated for liver transplantation in that they could continue their therapy for hepatocellular carcinoma (HCC) and HCV as needed.


Subject(s)
Esophageal and Gastric Varices/surgery , Esophagus/surgery , Gastrointestinal Hemorrhage/surgery , Hypersplenism/surgery , Liver Cirrhosis/complications , Splenectomy , Adult , Aged , Combined Modality Therapy , Esophageal and Gastric Varices/etiology , Esophageal and Gastric Varices/therapy , Esophagus/blood supply , Female , Follow-Up Studies , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/therapy , Humans , Hypersplenism/etiology , Male , Middle Aged , Retrospective Studies , Sclerotherapy , Treatment Outcome
19.
Nihon Geka Gakkai Zasshi ; 112(3): 164-9, 2011 May.
Article in Japanese | MEDLINE | ID: mdl-21688459

ABSTRACT

Curative resection has been shown to be one of the key factors affecting the survival of patients with carcinomas of the head of the pancreas. However, local recurrence is very common, and Esposito and colleagues stated that: "Most pancreatic cancer resections are R1 resections." In 2002, we developed a new method for en bloc resection of the pancreatic head including the superior mesenteric artery (SMA) and vein (SMV) for pancreatic head carcinoma with portomesenteric invasion, called "augmented regional pancreatoduodenectomy (ARPD)." The technical and general eligibility criteria for ARPD are: 1) presumed achievement of R0 status; 2) tumor infiltration proximal to the SMV and SMA; and 3) tumor respecting the hepatic artery, splenic artery, and celiac trunk and neither hepatic nor paraaortic nodal metastasis. Between 2002 and 2010, 17 patients underwent ARPD in our institution. Postoperative death occurred in 2 patients. One death occurred after full-dose radiotherapy and the other after rupture of an aortic aneurysm. The surgical margins (R0) were histologically negative in 14 patients (82%). The overall 5-year survival probabilities were 24% in R0. Three patients survived more than 5 years. The ARPD procedure has advantages in obtaining sufficient margins at the uncinate and posterior site in patients with pancreatic head carcinoma.


Subject(s)
Mesenteric Artery, Superior/surgery , Mesenteric Veins/surgery , Pancreatectomy/methods , Pancreatic Neoplasms/surgery , Adult , Aged , Female , Humans , Male , Middle Aged , Pancreatic Neoplasms/mortality , Survival Rate
20.
Surg Today ; 41(6): 859-64, 2011 Jun.
Article in English | MEDLINE | ID: mdl-21626338

ABSTRACT

Metastasis of the small intestine that derives from a primary hepatic neoplasm is rare. We encountered a case of intrahepatic cholangiocarcinoma (ICC) with jejunal metastasis after resection of a primary lesion. A 61-year-old male patient was referred to us with a diagnosis of liver tumors. Partial hepatectomy was performed, and the pathological diagnosis was ICC. Seventeen months after surgery, the patient was found to have a mass in the jejunum and lymph node swelling by positron emission tomography-computed tomography. The jejunal tumor was preoperatively diagnosed as a metastasis of ICC from a biopsy specimen obtained by double balloon endoscopy, and the tumor was resected. The patient received systemic chemotherapy but succumbed with ICC recurrence 46 months after the primary surgery. To the best of our knowledge, this case is the first report of jejunal recurrence of ICC. In addition, this report suggests the usefulness of double balloon endoscopy to make the correct diagnosis of the jejunal tumor.


Subject(s)
Bile Duct Neoplasms/pathology , Bile Ducts, Intrahepatic , Cholangiocarcinoma/secondary , Jejunal Neoplasms/secondary , Bile Duct Neoplasms/surgery , Cholangiocarcinoma/surgery , Endoscopy, Gastrointestinal , Fatal Outcome , Hepatectomy , Humans , Jejunal Neoplasms/surgery , Male , Middle Aged , Positron-Emission Tomography , Tomography, X-Ray Computed
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