[A Case of Solid Pseudopapillary Neoplasm of the Pancreas in a Male Patient].

The patient was a 50-year-old man. Abdominal ultrasound performed as part of a regular check-up suggested the presence of a tumor in the left kidney, and he was referred to our hospital for further examination. Computed tomography(CT) and magnetic resonance imaging(MRI)revealed the presence of a cystic neoplasm of the pancreas with partial calcification. The tumor had a maximum diameter of approximately 12 cm. Based on these findings, the patient was diagnosed with solid pseudopapillary neoplasm(SPN)and underwent distal pancreatectomy and splenectomy. Pathological findings indicated that a large proportion of the tumor was composed of cells with clear cytoplasm and small, oval nuclei, while some parts of the tumor were composed of atypical cells. Immunohistochemistry further demonstrated that the tumor expressed vimentin, nuclear b-catenin, and CD10. These findings confirmed the diagnosis of SPN. Atypical cells in the tumor were p53-positive, and some were exposed with damaged membranes. The patient has been followed up due to the possibility of tumor recurrence. The tumor has not recurred for approximately 32 months since surgery. Previous studies demonstrated that SPN is more common in women. We report the case of SPN in a male patient and discuss the literature.

[Usefulness of Laparoscopic Stoma Creation for Unresectable Colorectal Cancer].

Laparoscopic stoma creation enables good visualization of viscera within the abdominal cavity to ensure adequate mobilization of the large intestine. Laparoscopic stoma creation/construction was indicated and performed at our hospital in 7 patients who were diagnosed with unresectable colorectal cancer between July 2015 and May 2017. Duringthe ileostomy procedure, we made a skin incision at the stoma site and performed a single-incision(3-port)laparoscopic surgery. For the colostomy procedure, we made a small incision at the umbilicus and mobilized the large intestine with laparoscopic dissection of any interveningadhesions. Operation time ranged between 34 and 127 minutes, and the volume of intraoperative blood loss was low in all cases. There were no fatal complications related to the operation. Laparoscopic stoma creation can be performed safely and may be useful for staging of malignant colorectal tumors and reducing the risk of complications.

[A Case of Adult Invagination Caused by Rectal Cancer].

An 87-year-old man visited our hospital with a chief complaint of melena. Invagination caused by rectal cancer or sigmoid colon cancer was suspected as a result of physical and radiological examinations. Since there were no subjective symptoms, laparoscopic surgery was planned electively. As an operative finding, a tumor was found in the rectosigmoid colon and caused invagination. The invagination was released during an operation, and high anterior resection with D3 dissection was performed laparoscopically. The operation time was 108 minutes and the amount of blood loss was 22 mL. Although anastomotic leakage occurred as a postoperative complication, recovery was achieved conservatively by percutaneous drainage. In many cases, invagination of adults is caused by a solid tumor such as bowel carcinoma, which commonly occurs at the cecum or sigmoid colon. Although invagination of the rectosigmoid colon fixed to the retroperitoneum is relatively rare, the fragility of the supporting tissues in the pelvis accompanied by aging is considered to be a cause. In cases of a large tumor occupying the lumen of the intestine, appropriate preoperative diagnosis is needed and the method of operation should be chosen carefully.