Endometrioid adenocarcinoma with high-grade transformation with serous and choriocarcinomatous differentiation - a case report.

A choriocarcinoma component with a malignant tumor is relatively rare. We present a case of an 85-year-old woman with mixed carcinoma, which was endometrioid adenocarcinoma with squamous differentiation, choriocarcinoma and a disseminated peritoneal nodule, which was papillary serous adenocarcinoma. The patient received surgery and conservative treatment. Twenty weeks after surgery, a recurring tumor appeared at the Douglas pouch. Histology showed that the recurring tumor was poorly differentiated carcinoma that was very different from the primary tumor. This case represents an unusual uterine corpus cancer with high-grade transformation with serous and choriocarcinomatous differentiation. This case also demonstrates the capacity of tumor cells to differentiate into divergent elements.

Surgical treatment for abdominal aortic aneurysm in a patient with urinary diversion.

In two cases of abdominal aortic aneurysm (AAA) with urinary diversion after radical cystectomy, surgical aneurysm repair was successfully performed. Based on comprehensive preoperative examinations, the surgical strategy for aneurysm should be carefully planned so as not to injure diverted ureters.

Large perigraft seroma after aortoiliac bypass with an expanded polytetrafluoroethylene graft: report of a case.

A 63-year-old man who had undergone aortoiliac bypass with an expanded polytetrafluoroethylene (PTFE) graft was referred to our hospital for investigation and treatment of a possible pseudoaneurysm of the abdominal aorta. A tender, pulsatile, and bulging mass, about the size of an adult fist, was palpated around the navel. Enhanced computed tomography (CT) showed a large low-density area around the abdominal aorta and PTFE graft, and aortography showed a patent graft with no anastomotic leakage. Operative inspection revealed that the pulsatile mass was a large perigraft seroma, and we replaced the PTFE graft with a new woven Dacron graft. The patient has been well with no sign of recurrence for 1 year, although close long-term follow-up is mandatory.

Surgical treatment of celiac artery aneurysm: in situ aortoceliac artery reanastomosis: a case report.

The authors present a rare case of celiac artery aneurysm treated by aneurysmectomy and vascular reconstruction, and they review the past literature. A 57-year-old man was referred to their hospital with a complaint of epigastric discomfort. Abdominal echography, 3-dimensional computed tomography, and selective angiography showed a sole celiac artery aneurysm. At operation, the origin of the celiac artery and adjacent aorta was exposed through a midline transperitoneal approach alone. A 25 x 20 x 25 mm fusiform aneurysm of the celiac artery was found 5 mm distal from its origin. Aneurysmectomy and in situ aortoceliac artery reanastomosis was performed buttressed with a doughnut-shaped Teflon felt under the partial clamp of the abdominal aorta. The left gastric artery arising from the aneurysm was ligated. Postoperative angiography showed good patency of the splenic and common hepatic arteries. He had an uneventful postoperative course with no aggravation of the liver function and was discharged 11 days after operation. Pathological examination of the aneurysmal wall revealed medial degeneration with a tear of the internal elastic lamina and intimal edema. In situ aortoceliac artery reanastomosis after aneurysmectomy, as was done in this case, has not been previously documented in the past literature.

Surgical treatment for acute ischemia caused by bilateral popliteal artery entrapment syndrome in an elderly patient: report of a case.

We report the unusual case of a 73-year-old man who underwent surgery for bilateral popliteal artery entrapment syndrome (PAES). A medial approach was used to operate on the left leg, and the vein bypass was made from the superficial femoral artery to the crural artery through a subfascial route. A posterior approach was used to operate on the right leg and it was found that the mid-popliteal artery passed medial to and beneath the medial head of the gastrocnemius muscle and was severely compressed by an accessory slip of muscle. The vein bypass from the above-knee to below-knee popliteal artery was established through the original route after resection of the accessory slip of muscle. A postoperative arteriogram showed good bypass flow to the bilateral crural arteries. To our knowledge, this case represents the oldest patient with this disorder to be treated by surgery.