A case of a common bile duct stone that formed around a fish bone as a nidus after distal gastrectomy with Roux-en-Y reconstruction.

BACKGROUND: The presence of a foreign body in the common bile duct (CBD) is a rare phenomenon. Thus, the route and mechanism of its migration remain difficult to fully clarify, especially for cases that occur after gastrectomy with Roux-en-Y reconstruction. Herein, we present a case of a CBD stone that formed around a fish bone as a nidus subsequent to distal gastrectomy with Roux-en-Y reconstruction. CASE PRESENTATION: A 70-year-old man was admitted to our hospital due to repeated episodes of epigastralgia. He had undergone distal gastrectomy with Roux-en-Y reconstruction for gastric cancer approximately 10 years prior. Blood tests revealed obstructive jaundice, hepatobiliary dysfunction, and inflammation. Multi-plane reconstructed computed tomography (CT) revealed a CBD stone with a needle-shaped calcification density at the center, oriented along the length of the CBD. Surgery was performed using an upper median laparotomy approach. Lithotomy with choledochotomy was performed to remove one fragile bilirubin stone that had formed around a 3-cm, needle-shaped fish bone. A choledochoduodenal fistula was not detected intraoperatively. A review of the imaging of a prior examination revealed that the formation of the CBD stone around the fish bone was observable on a follow-up CT performed approximately 2 years prior. However, no clinical symptoms associated with the migration of the fish bone to the CBD were reported and the fish bone was not detected at that time. CONCLUSION: In this case, transpapillary migration of the fish bone could only be speculated in the absence of an observable fistula, choledochostomy, or any clinical symptoms. Our case is clinically relevant as cholangitis developed after CBD stone formation around the fish bone that acted as a nidus.

[A case of trastuzumab-resistant breast cancer responding to lapatinib/capecitabine therapy].

Here we report a case of a 56-year-old woman who presented at our hospital with a chief complaint of a red lump in her right breast. Breast cancer(Rt C, T4bN0M0; ER[-], PgR[-], HER2: 3[+]; stage IIIb)was diagnosed, and subsequent preoperative chemotherapy, mastectomy and axillary lymph node dissection were performed. Five months after surgery, bone metastasis in the thoracolumbar vertebrae developed and trastuzumab/zoledronic acid hydrate therapy was initiated. Four months after the therapy, tumor marker levels increased and docetaxel was added to the treatment regimen. Although the patient's condition temporarily improved, tumor marker levels increased again after 6 months, and the treatment regimen was switched to trastuzumab/nab-paclitaxel therapy. However, such regimen was discontinued owing to the development of liver metastasis, and lapatinib/capecitabine therapy was initiated. Two months after lapatinib/capecitabine therapy, tumor marker levels normalized and the liver metastasis markedly reduced. Side effects included paronychia(grade 3), which improved with dose reduction. The patient's therapy is being continued.

Ectopic hepatocellular carcinoma arising in the bile duct.

We report a case of ectopic hepatocellular carcinoma arising in the bile duct. A 72-year-old woman was transferred to our hospital with fever, abdominal pain, and jaundice. Contrast-enhanced computed tomography revealed a round mass, measuring 25 mm in diameter, in the bile duct. The mass was causing obstructive jaundice. Endoscopic retrograde cholangiography showed a 27 mm x 21-mm round defect in the superior bile duct. These findings led to a diagnosis of bile duct tumor, and the patient underwent extrahepatic bile duct resection and biliary reconstruction. Gross examination of the tumor showed a fibrous capsule and a stalk arising from the bile duct mucosa. The tumor was diagnosed histopathologically as well-differentiated hepatocellular carcinoma arising in the bile duct.