[A case regarded as an occult breast cancer treated without mastectomy].

A 51-year-old woman was admitted to our hospital with a chief complaint of left axillary tumors. No such tumors were detected in bilateral breasts by ultrasonic tomography, mammography, computed tomography, and magnetic resonance imaging. The core needle biopsy from the left axillary lymph node was examined, and the specimen revealed an occult breast cancer, because the microscopic findings resembled the breast cancer organization and immunochemistry revealed positivity of the estrogen receptor. The radical left axillary dissection was operated. Tamoxifen and FEC 100 6 cycles were selected as adjuvant treatment. At one year after operation, she has no recurrence. Carcinoma cells had portedly been recognized in the mammary gland with 82.7% of the cases who had undergone mastectomy for occult breast cancer. However, in many cases, the patient's consent for mastectomy was not obtained like as in this case, and the choice of treatment is often difficult. We considered that the case's accumulation was necessary to verify the possibility of the mastectomy omission to an occult breast cancer, presented the case report.

Hepatoblastoma in an adult A case report and clinical review of literatures.

In this paper, our aim is to report a very rare case of adult hepatoblastoma (HB) and to discover clues of diagnosis and adequate treatment by surveying collected English literatures. Our patient was a 20-year-old lady suffering from nausea and appetite loss. The main tumor measuring 18cm was located in the anterior and medial segments. Other tumors were also present in the left lobe. The tumors had cystic areas and hypervascularity. The chemotherapy based on the diagnosis of HCC by needle biopsy had failed. The tumors were resected together with the diaphragm and diagnosed as adult HB of epithelial type. The patient succumbed to cancer 3 months later. We have collected 25 cases of adult HB and discussed clinical features. Diagnostic findings are as follows: single huge tumor, located in the right lobe, having cystic change, calcification (mixed type) and hypervascularity. Preoperative needle cytology or biopsy failed to diagnose all but one case. All living cases were resected without preoperative chemotherapy. No response to chemotherapy was observed in any case. If a tumor has the above clinical features, we have concluded that an excision of the tumor should be considered, without preoperative chemotherapy and tumor puncture.

Role of curative resection in octogenarians with malignancy.

BACKGROUND: Major resective surgery in octogenarians with malignancy is considered risky. Because elderly people are growing in number, there is a greater need to define the role of curative resection (CR) in these patients. METHODS: In this retrospective, consecutive review patients > or = 80 years with malignancy treated by surgery were included and categorized into 3 groups: group 1 = CR group, i.e., no residual disease; group 2 = non-CR group, i.e., microscopic tumor invasion of one or more resection margins; and group 3 = palliative surgery (PS) group. RESULTS: One hundred eighty-two patients were treated surgically with curative intent. Gastric and colorectal cancers were the most frequent (34% and 31.8%, respectively) followed by bile duct and esophageal cancers (15.3% and 5.5%, respectively). CR was performed in 53.3%, non-CR in 14.8%, and palliative surgery in 31.9% of patients. Thirty-day mortality in the 3 groups was 3.1%, 0%, and 5.2%, respectively. Mean hospital stay was similar among all 3 groups. In the CR group, gastric and colorectal cancers were the most common (41.2% and 42.2% respectively). Average survival and actuarial survival were significantly higher in the CR group. Disease-free survival was 645 +/- 744 days. Five-year actuarial survival was 45.4 % in the CR group, and no patient survived 5 years in the other 2 groups. In the CR group, mean survival was significantly better in patients with good performance status and > or = 3 supportive family members per univariate analysis. However, no significant difference was observed in patients with gastric and colorectal malignancy. Multivariate analysis revealed that TNM stage and family size affected survival the most. CONCLUSIONS: Gastric and colorectal cancers were most frequent among octogenarians reporting to our unit. CR was performed in elderly patients with low mortality and was associated with significantly better average and actuarial survival. TNM stage I to III, family size > or = 3 members, and performance status "0" to "1" were favorable factors.

Ruptured pancreaticoduodenal artery aneurysm treated by superselective transcatheter arterial embolization and preserving vascularity of pancreaticoduodenal arcades.

We report a case of a ruptured aneurysm in the anterior superior pancreaticoduodenal artery (PDA) with hypovolemic shock managed successfully by superselective transcatheter arterial embolization of the aneurysm. A 75-year-old male presented to our hospital with hematemesis and melena. On admission, he was in shock. Angiography showed an aneurysm about 1 cm in diameter in the anterior superior PDA. However, extravasation of contrast medium was not seen owing to hypovolemic shock. A catheter was inserted into the aneurysm, and superselective microcoil embolization of the PDA aneurysm was successfully achieved. After the microcoil was inserted into the aneurysm itself, it was observed that duodenal vascularity and pancreaticoduodenal arcades were preserved and aneurysm was not present. There was no complication such as necrosis or abscess formation in the pancreas. The patient recovered and is doing well after 18 months of follow-up. Superselective transcatheter arterial embolization should be considered as the initial treatment of choice for all peripancreatic aneurysms.