Abstract : A 71-year-old woman, gravida 4 para 3, presented with abnormal genital bleeding.　Transvaginal ultrasonography showed a thickened endometrium of 11.5 mm, but no bilateral adnexal enlargement.　Cervical cytology was negative for intraepithelial lesion or malignancy, and endometrial curettage was performed, and no malignant findings were found histologically.　Pelvic MRI showed only 9 mm endometrial thickening and no ovarian tumor.　Serum estradiol was elevated （55 pg/mL）, and CA125, CA19-9, and CEA were not elevated.　A hormone-producing ovarian tumor was suspected, and total laparoscopic hysterectomy and bilateral salpingo-oophorectomy were performed.　Although no tumor was found macroscopically in the bilateral ovaries, histopathology revealed a 1.5 × 1.5 mm Leydig cell tumor in the right ovary.　Serum E2 decreased after surgery.　Thus, in cases with postmenopausal irregular bleeding and endometrial thickening, it is essential to consider Leydig cell tumor, even in the absence of ovarian tumors on imaging.

Abstract : Several cases of gastrointestinal amyloidosis and non-occlusive mesenteric ischemia （NOMI） have been reported in Japan, suggesting that amyloid deposition in the gastrointestinal tract can be a risk factor for the development of NOMI.　We herein present a case of NOMI complicated by gastrointestinal amyloidosis which was treated without intestinal resection.　The patient was an 81-yearold man who came to our hospital with a complaint of hematemesis.　Blood pressure reductions were observed, and an abdominal CT scan showed gas in the intestinal wall and portal vein.　A diagnosis of intestinal necrosis was made, and an emergency laparotomy was performed.　The intestinal tract and mesentery were reddish, but the overall intestinal color and peristalsis were fine.　Despite the diagnosis of NOMI, it was judged that irreversible intestinal necrosis had not yet occurred, and the operation was completed only by exploratory laparotomy without intestinal resection.　Post-operatively, the patient was admitted to the ICU for circulatory management.　His general condition gradually improved, and he was discharged on post-operative day 14 from the hospital.　After discharge from hospital, the patient complained of diarrhea, and an upper gastrointestinal endoscopy was performed.　A diagnosis of gastrointestinal amyloidosis was made based on findings from biopsies of the stomach and duodenum and association of NOMI and gastrointestinal amyloidosis was suspected.

Abstract : A 56-years-old male presented at our hospital due to the symptoms of anemia, liver disfunction and colon polyps.　He had resected rectal cancer at the ages of 41 and has no family history of colorectal cancer.　A thorough examination for anemia resulted in detection of multiple colon cancer and cancer on ampulla of Vater.　We performed total colectomy with dissection of regional lymph nodes and pancreaticoduodenectomy with dissection of regional lymph nodes.　Immunohistochemical analysis showed a lack of MSH2 and MSH6 protein in the colon cancer and cancer on ampulla of Vater, and germline mutation of hMSH2 gene was recognized.　Therefore, we diagnosed the case as Lynch syndrome.