Carcinosarcoma of the Extrahepatic Bile Duct Presenting with Stone-like Radiological Findings.

A 73-year-old woman was referred to our hospital due to epigastralgia and jaundice. The radiological findings showed a stone-like tumor in the extrahepatic bile duct. The patient was initially thought to have adenocarcinoma of the bile duct based on the findings of a pathological examination of the bile duct biopsy specimen and underwent pancreaticoduodenectomy; the final diagnosis of the lesion was so-called carcinosarcoma of the extrahepatic bile duct. She died of liver metastasis six months after the surgery. This case suggests that surgical resection is not adequate for achieving a radical cure, and the optimal treatment for extrahepatic bile duct carcinosarcoma should be established immediately.

Regression of follicular lymphoma of the duodenum following eradication of H. pylori infection.

A 64-year-old woman was referred for an examination of the upper gastrointestinal (GI) tract. Endoscopy showed an elevated lesion in the duodenum with central depression and multiple white granules. Biopsy specimens revealed lymphoid follicles composed predominantly of centrocytes with scattered centroblasts. The tumor cells were positive for bcl-2. The patient was diagnosed with follicular lymphoma and underwent antibiotic therapy for Helicobacter pylori (H. pylori) infection. The regression of the lesion was obvious. After 5.5 years of follow-up, there has been no evidence of recurrence. This case suggests that H. pylori eradication therapy is effective for treating follicular lymphoma in the duodenum.

[A case of primary gastric malignant lymphoma with chylous ascites].

An 87-year-old man presented with appetite loss and abdominal distension. Routine blood tests revealed hypoproteinemia. Abdominal computed tomography revealed ascites, which was subsequently drained. Biochemical analysis of the ascitic fluid detected chyle. Esophagogastroduodenoscopy revealed nodular swelling of the mucosa, swelling folds, and widespread erosions in the stomach. Stage I diffuse large B-cell gastric malignant lymphoma was diagnosed on the basis of the Lugano International Conference classification system. Six courses of R-CHOP [rituximab, cyclophosphamide, hydroxydaunorubicin (doxorubicin), vincristine (Oncovin(®)), and prednisolone] therapy were administered, following which complete remission was achieved and the chylous ascites mostly disappeared.

Effect of nateglinide on the size of LDL particles in patients with type 2 diabetes.

The objective of the present study was to evaluate the efficacy of nateglinide in controlling blood glucose levels and regulating lipid metabolism in patients with type 2 diabetes by focusing attention particularly on low-density lipoprotein (LDL) particle size. The subjects were 23 patients with type 2 diabetes who were given nateglinide, 90 to 270 mg/d. Laboratory studies were conducted at treatment initiation and 3 mo later. Despite a decline that occurred in the level of fasting plasma glucose before and after administration of nateglinide, no significant difference was recognized. Hemoglobin A1c decreased significantly from 6.37+/- 0.75% to 5.91+/-0.64% (P<.001). A significant decline was also seen in the fasting level of immunoreactive insulin, from 9.82+/-5.69 microU/mL to 8.59+/-4.05 microU/mL (P<.05), and in the homeostasis model assessment for insulin resistance, from 3.06+/-1.83 to 2.55+/-1.26 (P<.05). Regarding lipids, triglycerides significantly decreased from 140.7+/-61.8 mg/dL to 117.3+/-34.7 mg/dL )P<.05). The significant reduction in migration index value, which was used as an index to LDL particle size, from 0.374+/-0.034 to 0.357+/-0.035 (P<.05), confirmed that LDL particle size had increased. The results of the present study show that nateglinide is effective in controlling blood glucose and improving insulin resistance, hypertriglyceridemia, and LDL particle size in patients with mild type 2 diabetes. These effects suggest that nateglinide may effectively control coronary artery disease in this population.

[Ruptured aneurysm of pancreaticoduodenal artery, report of two cases].

We describe two cases of ruptured areurysm of pancreaticoduodenal artery (PDA), whose chief complaints were right upper abdominal pain. They were diagnosed to retroperitoneal hematoma around the duodenum and the uncus of the pancreas by Computed tomography and aneurysm of pancreaticoduodenal artery by Angiography. The patients underwent a coil embolization of the eneurysms, one ending to successful, the other to unsuccessful, so, underwent pancreatioduodenectomy. In our both cases, no history of chronic pancreatitis, trauma, infection and connective tissue disorders, and celiac axis stenosis or occulusion, were found. We reviewed 71 case repotrs of PDA aneurysm in Japanese literature and the treatment of PDA aneurysm.

Malignant endocrine tumor of the pancreas associated with von Recklinghausen's disease.

We describe a case of malignant endocrine tumor of the pancreas associated with von Recklinghausen's disease. A 66-year-old woman with familial von Recklinghausen's disease was admitted to our hospital with weight loss and lower abdominal pain. Endoscopy revealed a submucosal tumor in the second part of the duodenum. Contrast-enhanced computed tomography showed a heterogeneous low-density tumor, measuring 20 x 15 mm, in the head of the pancreas, and metastatic lymphadenopathy. Angiography showed faint tumor staining without encasement or apparent increase in vascularity. Pancreatoduodenectomy was performed. Macroscopically, there was a solid tumor, measuring 20 x 18 mm, in the head of the pancreas. Histologically, a malignant endocrine tumor was shown, with direct invasion to the duodenum, and lymph node metastases. This is the thirteenth case of pancreatic malignant tumor and the fourth case of pancreatic endocrine tumor associated with von Recklinghausen's disease reported in the world literature.