A case of primary amyloidosis with spontaneous hepatic rupture.

A 79-year-old man was diagnosed to have primary amyloid light-chain (AL) amyloidosis with associated liver damage and prominent hepatomegaly. He was followed up without any treatment. One year after the diagnosis, he was taken to the hospital with a sudden onset of features of shock. Computed tomography revealed hepatic rupture, and he was treated by emergent transcutaneous arterial embolization. However, the procedure was unable to save his life. AL amyloidosis with prominent hepatomegaly is considered to be a risk factor for spontaneous liver rupture and intra-abdominal hemorrhage.

[A case of esophageal stenosis caused by esophageal intramural pseudodiverticulosis with candida esophagitis].

A 55-year-old man who was a heavy drinker with a history of diabetes mellitus was admitted to our hospital with the complaint of dysphagia. Upper gastrointestinal endoscopy revealed multiple intramural pseudodiverticula of the esophagus with candida infection in the cervical and thoracic esophagus. It was difficult to pass the endoscope through the lower thoracic esophagus, indicating stenosis. Thoracic computed tomography and esophagogram revealed widespread, multiple confluent pseudodiverticula in the submucosa. A diagnosis of esophageal intramural pseudodiverticulosis with candida esophagitis was made. The stenosis of the esophagus was improved by endoscopic balloon dilatation and antifungal therapy.

Resection of distal gastric tube cancer with sentinel node biopsy: a case report and review of the literature.

BACKGROUND: The frequency of gastric tube cancers has increased with advances in surgical techniques and improvement of survival rates in patients with esophageal cancer. However, a standard surgical treatment has not yet been established. Total resection of the gastric tube with lymphadenectomy has been considered a radical treatment, while repeat surgery with both laparotomy and thoracotomy has been associated with severe complications, including anastomotic leakage, recurrent nerve paralysis, bronchotracheal injury, and damage to other organs. CASE PRESENTATION: We present a successful case of a gastric tube cancer that was treated with surgical resection in combination with sentinel node biopsy. The tumor was diagnosed as a type 0-IIc lesion with ulceration, and was located proximal to the pyloric ring. Endoscopic submucosal dissection was not indicated because the primary lesion was submucosally invasive, and undifferentiated. By the dye-guided method, sentinel nodes were detected along the right gastroepiploic artery and vein. Intraoperative pathological examination revealed no metastasis of the sentinel nodes. Resection of the distal gastric tube was safely performed with a Roux-en-Y reconstruction, preserving the right gastroepiploic artery and vein and the perfusion of the proximal gastric tube. CONCLUSION: We suggest distal resection of the gastric tube with sentinel node biopsy as a novel surgical method for a cT1N0 gastric tube cancer located in the abdomen.

[A case of intraventricular dissemination arising from hepatocelullar carcinoma effectively treated with intrathecal administration of methotrexate].

A 78-year-old man with hepatocellular carcinoma was admitted to our hospital for vertigo after transcatheter arterial chemoembolization. Contrast-enhanced magnetic resonance imaging revealed metastasis in the cerebellar vermis. Although the cerebellar metastasis decreased in size after cyberknife radiotherapy, multiple enhancing nodules appeared in the cerebral ventricles. A diagnosis of intraventricular dissemination from the cerebellar metastatic lesion originating from the hepatocellular carcinoma was made. Six intrathecal administrations of 20 mg of methotrexate through lumbar puncture resulted in a dramatic decrease in the intraventricular dissemination. Although intraventricular dissemination recurred 4 months later, these lesions disappeared after an additional 8 administrations of intrathecal methotrexate. Intraventricular dissemination arising from hepatocellular carcinoma is rare. Here we report a case that was successfully treated by intrathecal chemotherapy with methotrexate.

[Esophageal stenosis in a patient with primary biliary cirrhosis and mucous membrane pemphigoid].

A 77-year-old man with primary biliary cirrhosis was admitted to our hospital with a complaint of dysphagia. Upper gastrointestinal endoscopy revealed multiple ulcers in the oral cavity and pharynx, with circumferential ulceration in the cervical and upper thoracic esophagus. It was difficult to pass the endoscope through the upper thoracic esophagus, indicating stenosis. The patient was referred to the ophthalmology department for ocular lesions, where he was diagnosed with symblepharon due to ocular pemphigoid. Furthermore, direct immunofluorescence microscopy of esophageal biopsy specimens revealed linear deposits of IgG, IgA, and C3 in the epithelial basement membrane zone. On the basis of these findings, a diagnosis of mucous membranous pemphigoid was made.

[A case of multiple gastrointestinal stromal tumors of the duodenum and jejunum with von Recklinghausen's disease in which CT during angiography was useful for localization and diagnosis].

A 50-year-old man with von Recklinghausen's disease was admitted to our hospital for anemia. Abdominal computed tomography and small intestinal fiberscopy revealed a submucosal tumor in the third portion of the duodenum. CT during angiography showed three small tumor stains on the jejunum, which were not able to be diagnosed on contrast-enhanced CT. The operative findings showed a tumor in the third portion of the duodenum and three small tumors in the jejunum. These tumors, which were immunohistochemically positive for KIT, were diagnosed as multiple gastrointestinal stromal tumors of the duodenum and jejunum. For this case, CT during angiography was useful for localization and diagnosis of multiple lesions on the small intestines.