Early cystoadenocarcinoma of vermiform appendix simulating submucosal tumor of the cecum.

Colonoscopy was performed on a 54-year-old man with occult melena in our hospital. A submucosal tumor with a maximum diameter of 5cm was detected in the cecum. The tissue of the submucosal tumor was not obtained by endoscopic biopsy, and tumor diagnosis could not be confirmed by this method. A large, hypodense, cystic structure extending below the inferior wall of the cecum was revealed by computed tomography (CT). Because the tumor was too large to be a benign tumor, we were able to conclude it was malignant. After receiving informed consent from the patient, laparoscopic right colectomy was performed for both diagnosis and treatment in June 2004. As the swollen vermiform appendix pressed the cecum extraluminally, endoscopic examination indicated the possibility of submucosal tumor. Postoperative pathological diagnosis was cystoadenocarcinoma, the tumor was extended within the mucosal layer, and no lymph node metastasis was detected. Cancer cells were not present in the viscous liquid of the vermiform appendix intracavitary, either. The patient left the hospital in 10 days postoperatively. He regularly underwent examinations including CT, and no recurrence was detected for more than 24 months following the laparoscopic operation.

Intraoperative drainage of intestinal contents in emergency surgical treatment of left-sided colonic obstruction.

BACKGROUND/AIMS: This study was undertaken to verify an original procedure, drainage through anastomosis (DTA), for one-stage operation in emergency surgical treatment of left-sided colonic obstruction. METHODOLOGY: Twenty-two patients underwent emergency surgical treatment for left-sided colonic malignant obstruction between 2001 and 2005 either by DTA or conventional method (CM). The parameters evaluated consisted of the incidence of surgical wound infection, residual abscess, anastomotic leakage, presence of ileostomy, and postoperative hospital stay. RESULTS: Surgical wound infection occurred in 1 patient (10%) in DTA and 8 patients (67%) in CM (p=0.02). The incidence of residual abscess was none (0%) in DTA and 1 patient (8%) in CM. Anastomotic leakage was not observed in either group. The incidence of the patients having ileostomy was none (0%) in DTA and 2 patients (17%) in CM. The postoperative hospital stay in DTA was a mean of 22.2 (range 19-24) days as compared to 28.5 (range 20-52) days in CM (p=0.03). CONCLUSIONS: One-staged surgery with DTA is a safe procedure that minimizes the risk of intraoperative spillage of intestinal contents, which may allow safe one-staged operation for colorectal cancer with left-sided colonic obstruction.

Mesorectum amputation technique for laparoscopic anterior resection.

The objective of this study was to assess our original procedure, the cutting off method (COM), where the rectum and mesorectum are cut off with an autosuture device simultaneously in laparoscopic anterior resection. From 2001 to 2003, laparoscopic anterior resection was performed in 21 patients at our institution using the COM (n = 14) and trimming method (TM; n = 7). We reviewed the medical records for operative duration, intraoperative blood loss, and postoperative complications. The operation lasted 165 minutes (range, 140-215 minutes) in the TM group, but only 120 minutes (range, 95-135 minutes) in the COM group (P < 0.01). Intraoperative blood loss was 90 ml (range, 60-140 ml) in the TM group and 30 ml (range, 5-90 ml) in the COM group (P < 0.01). There were no postoperative complications in the COM group, although one complication of minor leakage was observed in the TM group.

[A case of widespread ileal stenosis caused by metastatic disseminated peritoneal carcinomatosis from lung cancer resected 8 years previously].

A 46-year-old man was admitted because of ileus. He had undergone an operation for lung carcinoma (stage IA) 8 years previously in another hospital. Because small bowel enema study showed widespread stricture of the ileum, we performed an operation. During the operation we diagnosed metastatic small bowel carcinoma. Because the resected sample of the small bowel carcinoma was similar to the lung carcinoma pathologically and detailed examination after the operation showed no other neoplasm, we considered this case to be small bowel metastasis of the lung carcinoma resected 8 years previously.

Malignant melanoma originating on the female nipple: a case report.

We report a very rare case of malignant melanoma arising on a female nipple. A 42-year-old housewife had suffered from a small dark brown nevus on her left nipple for about thirty years without any changes. Six months before her initial visit it had begun to enlarge and rapidly changed from dark brown to black. A small bleeding ulcer was also present in the center of the lesion. Malignant melanoma rather than mammary Paget's disease was suggested based on its clinical course. Excisional biopsy was performed to differentiate between mammary Paget's disease and malignant melanoma. The histopathological examination revealed malignant melanoma, about 4 mm in thickness. She then underwent wide excision with axillary lymph node dissection. The surgical margin was made in a 3 cm radius around the biopsy site. The excision included nipple, areola, and part of the underlying breast parenchyma, adipose tissue and corresponding superficial layer of fascia. Microscopy showed metastasis in one of 13 axillary lymph nodes. After the operation, the patient received adjuvant DAV-Ferron therapy. In such a case, conserving surgery based on correct diagnosis can achieve a good cosmetic result and optimal tumor control.

Importance of thymidine phosphorylase expression at the invasive front of T3 rectal cancer as a prognostic factor.

PURPOSE: Vascular endothelial growth factor (VEGF) and thymidine phosphorylase (TP) are angiogenic factors. We evaluated the relationship between the degree of expression of binary angiogenic factors and the malignant potential of colorectal cancer. METHODS: This study was conducted in 61 patients with T3 rectal cancer who underwent surgical curative resection between 1998 and 2002. Paraffin-embedded sections of their surgical specimens were immunostained for VEGF and TP. The relationship between the expression level of binary angiogenic factors and lymph node metastasis was evaluated. RESULTS: Expression of VEGF was present only in the tumor cells of all patients, and expression was absent in the stromal cells around the invasive front of the tumor. Expression of TP was mainly present in the stromal cells around the cancer nests or around the invasive margin of the cancer. There was no relationship between expression of TP in the stromal cells around the invasive front of the tumor and lymph node metastasis. However, there was a significant relationship between expression of TP at the invasive front of the tumor and lymph node metastasis (p = 0.014). Moreover, TP expression in the tumor cells was the only independent factor that correlated with the postoperative recurrence (p = 0.024) with an odds ratio of 11.973 by multivariate logistic regression analysis. CONCLUSION: Expression of TP at the invasive front of the tumor may be a useful indicator of the malignant potential of advanced rectal cancer.