A case of a mesenteric cyst in the sigmoid colon of a 3-year-old girl.

Mesenteric cysts are rare. In this paper we present a case of a mesenteric cyst in the sigmoid colon of a 3-year-old girl. On the first visit to our department, a smooth-surfaced soft mass approximately 15 cm in diameter was noticed in the right lower abdomen. Although the patient complained of lower abdominal pain, there was no tenderness or guarding. Laboratory tests indicated no abnormality except a slightly increased level of C-reactive protein (2.3 mg/dL). A plain abdominal X-ray film revealed displacement of colonic gas from the right lower abdomen, and abdominal ultrasonography and computed tomography revealed a smooth cystic mass measuring 9.5 x 8.7 x 4.7 cm that contained many internal septa. Because the patient had several symptoms, we performed a surgical operation under general anesthesia. We found a light-red cystic mass, 8.5 x 8.0 x 3.0 cm in size, in the mesentery of the sigmoid colon and surrounding the sigmoid colon, without adhesion to any other organ. We approached the cystic mass from the sigmoid colon and the mesentery of sigmoid colon and completely resected it without complications. The content of the cystic mass was a pale-yellow serous fluid. A cytological examination revealed mainly lymphocytes with reactive mesothelial cells. The resulting pathological diagnosis was a multi-lobular mesenteric cyst. Immunohistochemical staining with D2-40 antibody was positive value along the wall of the cyst, indicating that the cyst was derived from a lymphatic vessel.

[A patient with hepatic, pulmonary, and nodal metastases of colon cancer responding to CPT-11/TS-1 therapy].

In December 2002, a 67-year-old man underwent right colectomy (stage IIIa, cur B) for cancer of the ascending colon. Chemotherapy with 5'-DFUR and PSK was performed after surgery, but was discontinued due to grade 3 diarrhea. The patient refused treatment with other drugs. An increased CEA level was observed in July 2004, and metastasis of his colon cancer to the liver, lungs, and supraclavicular lymph nodes was confirmed. The patient agreed to resume chemotherapy in December 2004, and received outpatient treatment with CPT-11 (70 mg/m(2) on days 1 and 8) and TS-1 (100 mg/day on days 1-14). There was a significant decrease of tumor markers and a decrease in the size of the metastatic tumors, with these findings being judged as PR. Diarrhea (grade 1) and oral ulceration (grade 2) were observed during treatment. However, these side effects were transient and resolved temporarily without suspending therapy. Although hepatic dysfunction (grade 2) was observed after the completion of cycle No.5, the patient decided to discontinue treatment. CPT-11/TS-1 chemotherapy seems to be useful for maintaining the QOL of patients with metastatic colon cancer.

Intratumoral induction of thymidylate synthase mRNA by 5-FU in colorectal cancer patients: association with survival.

Dihydropyrimidine dehydrogenase (DPD) is the rate-limiting enzyme in 5-fluorouracil (5-FU) catabolism. Thymidylate synthase (TS) is inhibited to form an inactive ternary complex by 5-fluoro-dUMP and is considered to be a target enzyme of 5-FU treatment. Two enzymes, DPD and TS, have been reported to be major determinants of individual sensitivity to 5-FU, and it has been reported that TS mRNA levels are modified by 5-FU treatment. We investigated their impact on treatment efficacy in colorectal cancer patients. TS and DPD mRNA levels, which correlated to the corresponding enzyme activities, were quantified in tumor tissues before and after treatment in 40 advanced colorectal cancer patients who had been treated with Doxifluridine (5'-DFUR) for 14 days before surgery. Furthermore inter-individual variations of TS mRNA levels after 5-FU treatment were found, and the individual TS induction varied between patients (0.2-2.4). Increased TS mRNA levels were found in 19 out of 40 cases. The samples were divided into two groups according to their TS mRNA induction (< or >1; TS/beta-actin ratio after treatment divided by values prior treatment) and compared with tumor reduction and survival. TS and DPD mRNA levels in tumor biopsies before treatment were not related to 5-FU responses by histological evaluations in this study. However the efficacy of 5-FU treatment was enhanced in patients with no or low TS mRNA induction (odds ratio: 6.2, p<0.05). Furthermore, longer periods of survival were observed in the group without increased TS mRNA levels. These findings suggest that TS mRNA was induced by 5-FU treatment, and the overall induction level varied between individuals. Therefore, the estimation of TS mRNA induction may be useful to predict the efficacy of 5-FU treatment.

Good embolization response for colorectal liver metastases with hypervascularity.

BACKGROUND/AIMS: We investigated whether tumor hypervascularity in diagnostic images predicts response to transcatheter arterial embolization in colorectal liver metastases. METHODOLOGY: Forty-five patients undergoing transcatheter arterial embolization for liver metastases were grouped by tumor vascularity on contrast-enhanced computed tomography and angiography. Group IA (n = 10) included patients with hypervascular tumors by both contrast-enhanced computed tomography and early-phase angiography; group IB (n = 15), hypervascularity by contrast-enhanced computed tomography and only late-phase angiography; group IIB (n = 2), hypovascularity by contrast-enhanced computed tomography and only early-phase angiography; group IIC (n = 18), hypovascularity by contrast-enhanced computed tomography and both angiography phases (unmentioned groups included no patients). Tumor response assessed by computed tomography and changes in serum carcinoembryonic antigen concentration at 1 month, as well as survival rates, were compared between groups. RESULTS: Patients with a partial response numbered only 5, all in group IA. Patients with no change included 26 (group IA, 4; group IB, 10; group IIB, 1; group IIC, 11), while patients with progressive disease numbered 14 (group IA, 1; group IB, 5; group IIB, 1; group IIC, 7). Serum carcinoembryonic antigen concentrations were 0.62, 1.03, 1.31, and 2.01% of pretreatment rates in groups IA, IB, IIB, and IIC, respectively. Carcinoembryonic antigen increases in group IA plus IB were significantly lower (P = 0.04) than in group IIB plus IIC. The decreases in group IA differed significantly from changes in group IB plus IIB (P = 0.05), or group IIC (P = 0.02). Survival rates were somewhat higher group IA than in other, but not significantly. CONCLUSIONS: Transcatheter arterial embolization is effective against colorectal liver metastases only when hypervascularity is evident.

Ultrasonography of non-perforated appendicitis in young children.

BACKGROUND/AIMS: The role of ultrasonography in diagnosing non-perforated appendicitis in young children is reviewed. METHODOLOGY: Between January 1997 and September 1999, three children with abdominal pain due to non-perforated appendicitis were admitted to the Nippon Medical School Hospital. Ultrasonography of the right lower quadrant was performed using a 7.5-MHz curved array transducer with the graded compression technique. RESULTS: Edema of the appendix was detected in all cases. The appendiceal diameter was 9 to 18 mm, and the thickness of the muscular wall was 3.5 to 6 mm. An echogenic submucosal layer, increased periappendiceal echogenicity, and the acoustic shadow of the proximal appendix was detected in each case. Localized fluid collection was not observed in any patient. Surgical and histopathological findings were nonperforated gangrenous appendicitis with fecal stone in all three cases. CONCLUSIONS: Ultrasonography provides valuable clinical information about the ileocecal region in children with acute abdominal pain. Even when the clinical diagnosis seems well established, performing ultrasonography routinely may help reduce the rate of perforation by decreasing the time required to establish the diagnosis.