[Successful R0 Resection of Hilar Cholangiocarcinoma Invading the Inferior Vena Cava through Left Trisegmentectomy with Combined Resection of the Portal Vein and Inferior Vena Cava after Gemcitabine/Cisplatin Combination Chemotherapy-A Case Report].

A 65-year-old woman was admitted to our institution with sonography results indicating a caudate lobe mass. CT showed a large low-density mass in the caudate lobe, extensively involving the inferior vena cava and main portal vein. Moderately differentiated adenocarcinoma was found on transcutaneous biopsy. We therefore regarded this tumor as a severe locally advanced hilar cholangiocarcinoma and initiated gemcitabine/cisplatin combined chemotherapy. The tumor gradually reduced in size. However, after 28 courses of treatment, CT showed persistent tumor invasion in the left trunk of the portal vein and inferior vena cava invasion in succession in the middle; the tumor had not yet invaded the left hepatic vein. Owing to myelosuppression and general malaise, it was difficult to continue chemotherapy. After 32 courses of treatment, the patient underwent a left trisegmentectomy with combined resection of the portal vein and inferior vena cava. Postoperative microscopic findings revealed no apparent invasion of the tumor in the inferior vena cava, thus suggesting successful R0 resection. The patient is alive without recurrence 18 months postoperatively.

Metastatic primary pulmonary leiomyosarcoma to the pancreas diagnosed by endoscopic ultrasound-guided fine-needle aspiration.

A 77-year-old female patient consulted our hospital for an abnormal shadow observed on chest X-ray. Computed tomography revealed the shadow of a mass in the right lower lung lobe and two shadows of masses in the pancreatic head and body. 18F-fluorodeoxyglucose-positron emission tomography showed an intense uptake only in the fields corresponding to these three masses. Each mass was diagnosed as leiomyosarcoma by transcutaneous needle biopsy of the pulmonary mass and endoscopic ultrasound-guided fine-needle aspiration of the pancreatic masses. The primary site was the lung because the pulmonary lesion was solitary, and no tumor was found in other organs. In English language literature, a case of primary pulmonary leiomyosarcoma with metastasis solely to the pancreas has not yet been reported to the best of our knowledge.

Small Cystic Pancreatic Neuroendocrine Neoplasm with Huge Liver and Bone Metastases.

Pancreatic neuroendocrine neoplasms occasionally have a cystic component. We herein report a case of multiple hepatic tumors, including a huge one and a 24-mm sized pancreatic cystic lesion. The hepatic tumor showed an enhancement pattern consistent with hepatic adenoma. The pancreatic cystic lesion revealed a thickened outside border and a solid inside component, which was enhanced following a contrast study, suggesting cystic pancreatic neuroendocrine neoplasm. Surgical resection was performed. After the surgery, somatostatin receptor scintigraphy detected an occult lumbar spine metastasis. Huge multiple liver and bone metastases of the neuroendocrine neoplasm G2 component were seen, with a G1 small primary lesion.

[Two cases of intravascular lymphoma diagnosed by random liver biopsy].

The pathogenesis of intravascular lymphoma (IVL) remains inadequately understood. Furthermore, its prognosis remains extremely poor despite combination chemotherapy. Lymphoma cells and hemophagocytosing cells are commonly observed in the livers of IVL patients and less frequently in the bone marrow. We recently encountered an 83-year-old female and a 78-year-old female with IVL, both of whom presented with fever of unknown origin. Following examination, we decided to perform random liver biopsy for diagnostic purposes. The former patient died because of rapid tumor growth, while the latter achieved remission following treatment with a modified R-VNCOP-B (etoposide, mitoxantrone, cyclophosphamide, vincristine, prednisolone, and bleomycin plus rituximab) regimen. Considering the possibility of IVL is important when examining a patient presenting with fever of unknown origin. This report demonstrates that random liver biopsy represents a useful diagnostic strategy, particularly in patients with elevated liver enzyme levels.

[A patient rescued from unexpected intraoperative massive hemorrhage with ABO incompatible blood transfusion].

A 67-year-old man was scheduled for resection of thoracic intramedullary tumor. His blood type was AB. Unexpectedly rapid and massive hemorrhage occurred during the operation. We infused a large amount of crystalloid, colloid, and 5% albumin. But he went into circulatory collapse before we could get type AB red blood cell (RBC) and hemoglobin was reduced to 3.8 g x dl(-1). We decided to transfuse 4 units of ABO incompatible type O RBC. Later, type AB RBC and other blood components became available and the patient recovered. We conclude that transfusion of ABO incompatible blood in patient with critical hemorrhage should be encouraged to save life.