Vascular Anomaly Associated with Ectopic Pancreas in the Pylorus.

The ectopic pancreas is a relatively rare congenital condition, defined as pancreatic tissue lacking anatomical or vascular continuity with the normal pancreatic body. The ectopic pancreas is most frequently found in the stomach, usually asymptomatic and discovered incidentally. We report the case of a 72-year-old man who was diagnosed with cancer in the gastric vestibule. Distal gastrectomy was performed, and 3 cm of the ectopic pancreas was found on the anterior surface of the pylorus intraoperatively. The gastroduodenal artery was not found by approaching the inferior border of the pancreas but by following the branches from the common hepatic artery. Posterior view CT confirmed that the GDA terminated in the ectopic pancreas. An ectopic pancreas may be associated with vascular anomalies. Clinicians must consider the possibility of vascular anomalies when operating on patients with an ectopic pancreas. If the gastroduodenal artery cannot be found intraoperatively, identification should be attempted by following the common hepatic artery.

Simultaneous occurrence of early gastric carcinoma and mucosa-associated lymphoid tissue lymphoma of the omentum.

The simultaneous association of gastric carcinoma with omental mucosa-associated lymphoid tissue (MALT) lymphoma is a rare event that has not been reported previously. We focused on the hypothetic pathogenetic mechanisms, diagnosis and treatment of this rare condition. A 55-year-old woman with Helicobacter pylori infection underwent distal gastrectomy in our hospital. Three independent early gastric cancers and a mass near the cecum were diagnosed preoperatively. Pathological review of the resected stomach showed three independent early signet ring cell gastric carcinomas, and the mass in the omentum near the cecum was shown to be omental MALT lymphoma. Due to the nature of the patient's disease, she was started on medical eradication of H. pylori. Synchronous gastric adenocarcinoma and omental MALT lymphoma is a rare event. Special attention given to H. pylori-associated gastric cancer patients can avoid misdiagnosis and lead to adequate treatment.

Necrotizing fasciitis caused by a primary appendicocutaneous fistula.

We report a case of necrotizing fasciitis in the loin of a 76-year old man with several coexisting or past health issues, including diabetes mellitus, hypertension, alcohol-related liver cirrhosis, gastrectomy for gastric cancer, subarachnoid hemorrhage, normal pressure hydrocephalus, and cerebral infarction. Incision of the necrotizing fasciitis was successful, but it revealed an appendicocutaneous fistula; thus, we performed appendectomy and fistulectomy. We think that the necrotizing fasciitis was caused by appendicitis perforation involving the retroperitoneum, inducing the formation of an appendicocutaneous fistula. Necrotizing fasciitis and appendicocutaneous fistulae are rare complications of appendicitis. Moreover, to our knowledge, this is the first report of fluoroscopic examination demonstrating that a primary appendicocutaneous fistula had caused necrotizing fasciitis. Our search of the literature found 12 cases of necrotizing fasciitis caused by preoperative appendicitis. We discuss the characteristics and findings of these cases.

Adenomyoma of the ileum leading to intussusception.

Adenomyoma of the ileum is a rare condition. A 68-year-old Japanese man presented with nausea and distension of the abdomen. Enhanced computed tomography of his abdomen revealed wall thickening in the ileum and dilation of the proximal small intestine. Open laparotomy was performed to find the cause of the patient's small bowel obstruction, and a tumor was found in the ileum, which had resulted in intussusception. The tumor and 20 cm of the adjacent ileum were resected. The resected specimen displayed a macroscopic appearance suggestive of a submucosal tumor. Histopathological evaluation showed duct cell proliferation and bundles of smooth muscle cells from the mucosa to the serosa, leading to a diagnosis of adenomyoma. Immunohistochemical examination found that cytokeratin 7 and carbohydrate antigen 19-9 were expressed in the duct epithelia. We report a rare case of ileal adenomyoma leading to intussusception in an adult and present the immunohistochemical evaluation of the adenomyoma.

[A case of rectal cancer with liver metastases successfully treated with modified FOLFOX6 therapy].

We report a case of a 71-year-old male with rectal cancer accompanied by liver metastases. Abdominal CT scan revealed a hepatic tumor (S2, 3) about 4 cm in diameter. We performed a Mile's operation and planned to resect the liver metastases after chemotherapy of modified FOLFOX6(mFOLFOX6)regimen: l-leucovorin (200 mg/m2) and oxaliplatin (85 mg/m/2) were given as a 2-hour infusion followed by bolus injection of 5-FU 400 mg/m2 and a 46-hour infusion 5-FU 2,400 mg/m2 every 2 weeks. An abdominal CT scan 6 months later demonstrated regression of the liver metastases. Hepatectomy was performed after chemotherapy, and no viable tumor cells were seen.

Left paraduodenal hernia successfully treated with laparoscopic surgery: a case report.

A 60-year-old Japanese man was referred for examination of abdominal pain. Abdominal MRI exactly demonstrated paraduodenal hernia. Propylthiouracil was administered until the patient became euthyroid, because Graves' disease was detected during the subsequent general examinations. Laparoscopic repair was then carried out. The sac collar, which had a diameter of about 30 mm, was located lateral to the ascending portion of the duodenum. Bowel incarcerated in the hernia sac was reduced and the hernia orifice closed. The postoperative course was good, and the patient was discharged 7 days after surgery. The diagnosis by MRI has made possible laparoscopic surgery for paraduodenal hernia.

[A case of gastric cancer with liver invasion responding to TS-1/low-dose CDDP chemotherapy].

We report the case of a 79-year-old female with gastric cancer accompanied by liver invasion. She underwent simple subtotal gastrectomy in another hospital. Five months after surgery, combination chemotherapy with TS-1 (100 mg/body/day, 3 weeks) and CDDP (10 mg/body/day, day 1, 8, 15 drip infusion) in 1 course was performed, and complete response (CR) was noted. No severe adverse effects were observed during this combined therapy. TS-1 and low-dose CDDP therapy may prove effective for treating gastric cancer with liver invasion in advanced age.

Orthotopic implantation of a colon cancer xenograft induces high expression of cyclooxygenase-2.

The aim of the present study is to investigate the relation of cyclooxygenase (COX)-2 with liver metastasis. Pieces of human colon cancer xenograft were implanted orthotopically (CI), as well as intraperitoneally, and subcutaneously. Liver metastasis developed most frequently, and the COX-2 expression of both mRNA and protein of the tumors was the most dominant in the CI group. In contrast, the expression of COX-1 or vascular endothelial cell growth factor mRNAs had no significant differences among the groups. The intensity of COX-2 mRNA was negatively correlated with the apoptotic index. In conclusion, COX-2 plays an important role in organ-specific metastasis of the colon cancer.

Cyclooxygenase-2 expression correlates with uPAR levels and is responsible for poor prognosis of colorectal cancer.

Considering recent findings that cyclooxygensase-2 (COX-2) is involved in the progression of colorectal carcinoma (CRC), the role of COX-2 in promoting invasion and angiogenesis was investigated by evaluating the relationship of COX-2 expression to various clinicopathological variables, including plasminogen activating system (PA system) and vascular endothelial growth factor (VEGF). Tumor tissues from 71 patients with CRC were assayed to determine the antigen levels of urokinase-type plasminogen activator (uPA), uPA receptor (uPAR), and plasminogen activator inhibitor-1 and -2 (PAI-1 and PAI-2), as well as immunohistochemical expression of VEGF. COX-2 was assayed immunohistochemically in 56 patients. COX-2 expression was detected in cancer cells and it was also expressed by stromal cells in some patients. Fourteen patients (25%) were COX-2 positive, whereas 42 were negative. COX-2 expression was significantly related to lymphatic invasion (P = 0.0317), but was not related to microvessel density or VEGF expression. In the PA system, uPAR antigen levels were significantly higher in tumors with COX-2 expression than in tumors without (P = 0.0233). Univariate analysis showed that significant prognostic variables for survival were tumor size, lymph node involvement, lymphatic invasion, vascular invasion, liver metastasis, high uPAR level, and COX-2 expression, but only liver metastasis was an independent prognostic factor (P = 0.0065) in multivariate analysis. COX-2 expression was a more important prognostic indicator than any other factor except liver metastasis (P = 0.0526). The significant relationship between the presence of COX-2 protein and uPAR antigen levels contributed to the enhancement of tumor invasion and the poor outcome in patients with CRC.

Pancreaticoduodenectomy for perforated gastric malignant lymphoma: report of a case.

We herein report the case of a 65-year old man with gastroduodenal malignant lymphoma (diffuse large B-cell type) accompanied with a bulbar perforation. A pancreaticoduodenectomy was performed because the duodenal second portion and pancreatic head were involved. However, extensive lymphadenectomy was not carried out because many lymph nodes were involved. The postoperative course was uneventful and CHOP therapy (pirarubicin 30 mg/m2, cyclophosphamide 500 mg/m2, vincristine 1 mg/m2, prednisolone 30 mg/m2) was started 1 month after surgery. Seven cycles of CHOP therapy markedly reduced the residual lesions including lymph nodes, and a computed tomography scan after the final chemotherapy revealed no obvious lesions. Complete remission was obtained and the patient was discharged 9 months after surgery.