A metastatic ureteral tumor successfully treated with multidisciplinary therapy including radiotherapy.

Introduction: Metastatic ureteral tumors are difficult to diagnose pathologically. Treatment is only available for the primary disease, and prognosis is generally poor. Case presentation: A 63-year-old patient with a history of gastric cancer presented with asymptomatic right-sided hydronephrosis. Ureteroscopic examination revealed tissue in the ureter consistent with gastric cancer. The lesion was localized, and the patient was treated with chemotherapy and radiotherapy as part of a multidisciplinary treatment. The prognosis was better than in other reports. To the best of our knowledge, this is the first case of a patient with metastatic gastric cancer who received multidisciplinary treatment including radiotherapy and had a good prognosis. Conclusion: In cases where a localized metastatic ureteral tumor cannot be ruled out, ureteroscopy is an effective therapeutic strategy.

Hand-assisted laparoscopic surgery for Bochdalek hernia in an adult patient with a history of laparotomy: A case report.

INTRODUCTION: Bochdalek hernia (BH) is a congenital diaphragmatic hernia that generally occurs in infants and is rarely seen in adults. Surgical repair of BH is recommended, but the approach for repairing BH should be selected carefully in individual cases. It is well known that hand-assisted laparoscopic surgery (HALS) has the advantage of preserving tactile sensation compared with standard laparoscopic surgery. We describe an adult patient with a history of abdominal incisional hernia who developed BH that was treated safely by HALS. PRESENTATION OF CASE: An 87-year-old woman was admitted to our hospital with nausea. She had a history of right hemicolectomy and repair of an abdominal incisional hernia using mesh at 5 years after hemicolectomy. Chest and abdominal computed tomography revealed herniation of the gastric corpus through the left posterior diaphragm. BH was diagnosed and hernia repair by HALS was selected as the approach because dense adhesions were expected in the abdominal cavity. The operation was performed safely and her postoperative course was uneventful. CONCLUSION: HALS was useful, especially when removing adhesions around the hernial orifice. HALS is a feasible approach for BH and should be considered as one of the options in patients with a history of previous abdominal surgery.

Metachronous bilateral pulmonary metastases from cancer of the ampulla duodeni.

We present a 76-year-old man who underwent two lung resections for metastases originating from cancer of the Ampulla duodeni, 9 years-after pancreaticoduodenectomy with lymphadenectomy. Pancreaticoduodenectomy was performed in 2002; histological examination of the original tumor revealed a stage III tubular adenocarcinoma (pT3, N0, M0). Repetitive lung resection was performed in 2007 (left S8) and 2011 (right S1 and extirpation of a pericardial cyst). Although rarely performed, resection of bilateral pulmonary metastases from carcinoma of the papilla of Vater was done to improve the patient's chances for longterm survival.

Study of colorectal cancer with Crohn's disease.

BACKGROUND: Crohn's disease (CD) cases have been increasing and prolonged cases are now frequent. In addition, in Japan, more cases with concomitant malignant disease have also recently been reported. There is a particularly high risk of cancer occurring simultaneously in the lower rectum and the anal area. PATIENTS AND METHODS: Two-hundred and eighty-six patients with CD had undergone surgery at this department, up to December, 2005. We studied malignant diseases concomitant with CD, based on empirical examples. RESULTS: Thirteen (4.5%) were cases concomitant with malignant disease: six patients had colorectal cancer, 1 had rectal carcinoid, 1 had stomach cancer, 1 had uterine cancer, 1 had thyroid cancer, 1 had skin cancer and 2 had acute leukemia. Regarding the seven cases other than colorectal cancer, they were all juvenile patients under the age of 50, except for the stomach cancer case (69 years of age). Among the 6 cases of colorectal cancer, 5 cases were anorectal cancer and 1 was lower rectal cancer. The average age was 42.8 years (30-54 years) and the average term from CD occurrence to cancer diagnosis was 208 months (69-387 months). The one case with lower rectal cancer was intramucosal cancer which did not recur after surgery. The five cases of anorectal cancer were advanced, with invasion of the adjacent organs and 2 of them were unresectable. Four cases were of the infiltrative type, and regarding the histological findings, 4 cases were cancer with mucous production and 1 case was a poorly-differentiated endocrine tumor. Four cases had a history of anal fistula, but there was no clear causal relationship. CONCLUSION: In Japan, prolonged CD cases have been increasing and more and more cases of malignant disease with concomitant CD have been reported. There is a particularly high risk of cancer occurring simultaneously in the lower rectum and the anal area. Therefore, careful observation, taking all appropriate diagnostic surveillance modalities into consideration, is thus believed to be important in order to achieve an early detection of such cancer.

A clinicopathological investigation of "tumor nodules" in colorectal cancer.

PURPOSE: Tumor nodules (tn) have been histologically identified within the fatty tissue or the detached fatty tissue around dissected lymph nodes, or else picked up as lymph nodes from resected specimens with no lymph node components. The TNM classification of malignant tumors provides a description of how to deal with tn, but there has so far been no description within the Japanese classification of colorectal carcinoma. The aim of this study was to determine whether we should regard tn as metastatic lymph nodes from the viewpoint of prognosis. METHODS: A total of 544 patients who underwent a resection of colorectal adenocarcinoma between 1985 and 1995 were reviewed. RESULTS: Tumor nodules were found in 54 (17.6%) of 307 colon cancer patients, and in 41 (17.3%) of 237 rectal cancer patients. We classified the curability A patients into four groups for both colon and rectal cancer; positive lymph nodes with tn (Group A), negative lymph nodes with tn (Group B), positive lymph nodes without tn (Group C), and negative lymph nodes without tn (Group D). The prognosis was not significantly different between Groups A, B, and C, but it was significantly different between Group D and Groups A, B, and C (P < 0.01) in both the colon and the rectum. CONCLUSION: From the viewpoint of prognosis, it thus appears justifiable to regard tn as lymph node metastasis.

Malignant potential regarding mucin phenotypes and endocrine cell differentiation in gastric adenocarcinoma.

BACKGROUND: This study was designed to define the relationship between the mucin phenotype and differentiation in endocrine cells, including their biological behavior in gastric adenocarcinoma. MATERIALS AND METHODS: A total of 337 cases of solitary gastric adenocarcinoma were studied. The depth of tumor invasion was the mucosa in 58 cases, the submucosa in 206 cases and the muscularis propria in 73 cases. The mucin phenotype was divided into four phenotypes (gastric, intestinal, mixed and null types) based on immunohistochemical staining (HGM, Muc2 and CD10) and histochemical staining (PCS). Endocrine cells were identified by immunohistochemical staining (serotonin, gastrin, pancreatic polypeptide and Chromogranin A staining) in order to examine their relationship to mucin phenotype. Lymph node metastasis was used as a major indicator of the malignant potential. RESULTS: When lymph node metastasis was analyzed for tumors with submucosa(sm) or muscularis propria invasion, the incidence was significantly higher in the endocrine cell-positive [ECs(+)] group than in the endocrine cell-negative [ECs(-)] group. Namely, in gastric type, the incidence was 22.7% for the ECs(+) group and 0% for the ECs(-) group (p < 0.05). In intestinal type it was 26.9% for the ECs(+) group and 4.5% for the ECs(-) group (p < 0.05). When the 5-year survival rate of patients with a depth of sm or mp carcinoma was analyzed in relation to the mucin phenotype, no significant difference was seen in the survival rate according to the mucin phenotype, but the prognosis tended to be less favorable in the ECs(+) group than in the ECs(-) group (p = 0.06). CONCLUSION: The expression of endocrine cells was thus found to be more important as a prognostic factor than the mucin phenotype.