Nihon Gekakei Rengo Gakkaishi (Journal of Japanese College of Surgeons)

A 90-year-old Japanese male was referred to our hospital with severe abdominal pain and vomiting. A diagnosis of strangulation of the small intestine was made, and emergency surgery was performed. Intraoperative exploration revealed that a loop of small intestine was strangulated in an opening formed by adhesion of the thickened tip of a Meckel's diverticulum to the mesentery of the small intestine. Pathological examination confirmed severe chronic inflammation at the tip of the Meckel's diverticulum. In the classification by Rutherford and Akers this type of strangulation is included in a rare group of intestinal obstructions following inflammation of Meckel's diverticulum.

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The patient was a 48-year-old man who had been found to have a hepatic tumor 6.6 cm in diameter on a CT scan and was admitted to our hospital for further examination. His past medical history included left nephrectomy for papillary renal cell carcinoma in December 2003. An abdominal CT scan revealed a multilocular cystic mass showed 75 mm in diameter in S7 of the right lobe of liver. Abdominal ultrasonography showed a highly echoic mass 70 mm in diameter in the right lower abdomen. On abdominal MRI a multilocular cystic mass measuring 80 mm×65 mm was seen in S7 of the right lobe of liver, and it was depicted as mild high intensity on the T1-weighted images and very high intensity on the T2-weighted images. Celiac arteriography showed a hypervascular mass in the arterial phase and a tumor stain in the venous phase. Based on these findings, a diagnosis of cystadenocarcinoma of the liver was made, and surgery was performed. Intraoperative exploration revealed that the tumor was located in the right lobe of the liver. Right lobectomy was performed, and macroscopic examination of the surgical specimen showed that the tumor measured 70 mm×70 mm×50 mm. The cut surface was cavenous and brown. The histopathological diagnosis was papillary carcinoma, and the histological findings resembled those of the papillary renal cell carcinoma in the surgical specimen obtained previously. The multilocular cystic mass in the liver misdiagnosed as a cystadenocarcinoma of the liver was a metastasis from the papillary renal carcinoma in the previous surgical specimen.

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A Japanese man with chronic hepatitis C underwent distal pancreatectomy because of intraductal papillary-mucinous tumor (IPMT) located in the pancreas tail. Seven years later, when the patient was 72, liver tumor was detected by computed tomography in the anterior superior segment. Eight months after angiography, CT-A and CT-AP showed a hypervascular tumor which was enlarging gradually and a small satellite tumor. Subsegmental hepatectomy was performed in August, 2005. The two tumors were different from each other immunopathologically. The main tumor was diagnosed as cholangiocellular carcinoma (CCC), and the satellite tumor as hepatocellular carcinoma (HCC). Both liver tumors differed from metastasis of IPMT which was previously resected. The patient is still alive without recurrence 17 months after resection of the liver.
Triple primary cancers with IPMT, CCC and HCC are very rare. No combination like this was found in a PubMed search.

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