[A Case of Signet-Ring Cell Carcinoma of the Ampulla of Vater in a Young Male].

A male in his twentieth was referred to our hospital for jaundice. Computed tomography(CT)showed dilation of the intrahepatic and extrahepatic bile ducts and showed a lesion at the ampulla of Vater, which caused obstructive jaundice. Upper gastrointestinal endoscopy revealed a tumor of protruded-predominant type with raised margins at the ampulla of Vater, and biopsy from the lesion indicated malignancy. With no apparent distant metastasis, radical resection was assumed to be possible, thus we performed subtotal stomach preserved pancreatoduodenectomy. Before the operation, endoscopic retrograde biliary drainage(ERBD)was unsuccessful because of the existence of the tumor, so percutaneous transhepatic cholangio drainage(PTCD)was conducted. After the operation, although pancreatic fistula(ISGPF Grade B)occurred, it improved with conservative treatment, and he discharged at 30 postoperative days. Histopathological examination revealed signet-ring cell carcinoma among the tumor at the ampulla of Vater, which was infiltrating into the pancreas. Final diagnosis was pT3, pN0, M0, pStage ⅡA. Now he is alive without recurrence for 3 and a half years.

Intra-abdominal desmoid-type fibromatosis successfully resected using laparoscopic fluorescence imaging with indocyanine green after intersphincteric resection for rectal cancer.

Successful resection of intra-abdominal tumors using indocyanine green (ICG) fluorescence imaging has not been reported. Here, we report a rare case of an intra-abdominal desmoid-type fibromatosis successfully resected using this technique after intersphincteric resection (ISR) for rectal cancer. One year after ISR for rectal cancer in a 47-year-old man, computed tomography showed a 50-mm intra-abdominal tumor near the left common iliac vein. Surgical resection was performed. The tumor was located in the mesentery of the remnant rectum after ISR. ICG fluorescence imaging confirmed the blood supply to the mesentery of the distal remnant rectum after tumor excision. The anal canal was successfully preserved without creating a permanent colostomy. The tumor was safely resected with resection margins, diagnosed as desmoid-type fibromatosis. No tumor recurrence was observed 6 months post-resection. This was the first case report to demonstrate the utility of this technique for an intra-abdominal tumor resection.

Successful redo aortic valve replacement using Perceval valve in a patient with prosthetic valve endocarditis complicated by acute cerebral infarction.

INTRODUCTION: and importance: For treatment of prosthetic valve endocarditis (PVE), redo-aortic valve replacement (AVR) is usually required. However, the recurrence of PVE continues to be a serious problem that needs a solution. CASE PRESENTATION: An 83-year-old woman who had undergone AVR for aortic infective endocarditis 12 years ago was diagnosed with PVE complicated with acute cerebral infarction. Urgent redo-AVR was performed. After complete removal of the prosthesis, Perceval S valve was implanted successfully. There were no postoperative neurological deteriorations, and the echocardiogram showed no recurrence of PVE. CLINICAL DISCUSSION: Theoretically, the fewer prostheses left in the heart, the lower the risk of PVE recurrence. CONCLUSION: In patients with PVE, redo-AVR using the Perceval valve may be a suitable option since Perceval reduces the prosthesis in the heart compared with conventional redo-AVR.

[Risk Factors for Recurrence in Patients with Pathological Stage â ¡ Colorectal Cancer].

BACKGROUND: The risk factors for recurrence in patients with pStage Ⅱ colorectal cancer still remains controversial. The aim of this study was to investigate the risk factors for recurrence after surgery in patients with pStage Ⅱ colorectal cancer. METHOD: We retrospectively reviewed 311 patients with primary pStage Ⅱ colorectal cancer who underwent radical resection without neoadjuvant therapy at our institute between January 2014 and December 2019. RESULTS: Of 311 patients, 32 patients(10.3%)developed recurrences after surgery at a median follow-up of 32.9(0.23-74.2)months. The 3-year and 5-year recurrence-free survival(RFS)rate was 88.4% and 87.6%, respectively. A multivariate analysis for RFS showed that only pT4 (HR: 4.06, 95%CI: 1.60-10.29, p=0.003) was an independent risk factor. CONCLUSION: This study revealed that pT4 was an independent risk factor for recurrence after surgery in patients with pStage Ⅱ colorectal cancer.

[A Case of Metastasis to the Pancreas from Colorectal Cancer Which Was Difficult to Distinguish from Primary Pancreatic Cancer].

A man in his 50s underwent laparoscopic sigmoid colectomy for sigmoid colon cancer with liver metastasis(cT4aN1M1a, cStage Ⅳa), followed by partial liver resection(S4, S6). One and a half years after the initial surgery, CEA and CA19-9 increased, and contrast-enhanced CT and MRI showed a hypovascular lesion with dilation of the distal pancreatic duct in the pancreatic body. Adenocarcinoma was detected by brushing cytology of the lesion and pancreatic juice cytology by ERCP. From the results of various examinations, the lesion was diagnosed as pancreatic ductal adenocarcinoma. We performed distal pancreatectomy, and initially the histopathological diagnosis was pancreatic body cancer(pT3N1aM0, pStage ⅡB). In a follow-up CT after surgery, a suspected metastatic lymph node was pointed out in the mediastinum, but it was difficult to distinguish between metastasis from colorectal cancer and one from pancreatic cancer. Immunostaining of the tumor tissue and comparative study of the excised specimens of colon and pancreas was performed in order to assume the primary lesion of the lymph node. As a result, both tissues were CK7(-)/CK20(+), and the lesion at first considered to be primary pancreatic cancer was originally the pancreatic metastasis from colon cancer. Bone metastases were also found on FDG-PET/CT around the same time, and then systemic chemotherapy for colorectal cancer was introduced. Four and a half years have passed since the first surgery, and he is still alive and undergoing treatment.

[Robot Assisted Lower Anterior Resection for Anastomotic Recurrence of Colorectal Cancer-A Case Report].

Patient undergoing R0 resection have the good survival advantage following surgery for recurrent rectal cancer. Robotic surgery for anastomotic local recurrence of rectal cancer has never been reported before. An 80-year-old woman who had undergone high anterior resection for rectal cancer 1 years previously got colonoscopy. It revealed a 10 mm sized, elevated lesion on the anastomotic site, and a biopsy revealed an adenocarcinoma(tub1). Computed tomography and positron emission tomography-computed tomography showed no signs of distant metastasis, and we decided to conduct radical surgery with robot-assisted laparoscope. Robot-assisted laparoscopic lower anterior resection with resection of left hypogastric nerve was carried out. Histological assessment showed that R0 resection was performed. The patient was discharged on postoperative day 8th without postoperative complication. She is alive without recurrence at 1 year after the last operation.