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Shinichi Yabuuchi, Kunitoshi Nakagawa, Yukimasa Suzuki, Kojin Endo, Te ...
2010 Volume 35 Issue 1 Pages
21-25
Published: 2010
Released on J-STAGE: February 25, 2011
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We report a case of adenoid cystic carcinoma (ACC) of the breast diagnosed by preoperative core–needle biopsy (CNB), which proved useful in determining appropriate treatment.
A 43–year–old woman reporting a right–breast mass and pain was found in clinical examination to have an elastic hard movable well–defined tumor 1.0 cm in diameter in lower outer right breast quadrant (D). Mammography showed focal asymmetric density (FAD) category 3. Ultrasonography showed an oval heterogenous hypoechoic tumor. CNB showed the cribriform pattern typical of ACC. ACC of the breast, a rare neoplasm accounting for 0.1% of all breast carcinom, has a favorable prognosis with minimad lymph node or distant metastasis involvement. Given the nature of ACC, we conducted breast–conserving surgery and adjuvant radiotherapy based on this useful preoperative diagnosis.
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Ryuta Saka, Toshimichi Hasegawa
2010 Volume 35 Issue 1 Pages
26-29
Published: 2010
Released on J-STAGE: February 25, 2011
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We report a case of congenital pyloric atresia, a very rare anomaly. The 21–year–old mother transferred for premature preterm membrane rupture was found in ultrasonography to have polyhydramnios and a distended stomach. A 2114 g female infant was born at 34 weeks. Abdominal x–ray and an upper gastrointestinal series yielded a diagnosis of congenital pyloric atresia, necessitating pyloroplasty at 4 days after birth. The postoperative course was uneventful.
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Koji Matsui, Hiromi Tanemura, Hiroo Ohshita, Makoto Yamada, Takahito A ...
2010 Volume 35 Issue 1 Pages
30-33
Published: 2010
Released on J-STAGE: February 25, 2011
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We report a case of afferent loop obstruction following total gastrectomy requiring immediate diagnosis and treatment.
A 72–year–old man undergoning total gastrectomy for adenocarcinoma of the remnant stomach with Roux–en Y reconstruction suffered abdominal pain 9 days later. Abdominal computed tomography showed a severely dilated afferent loop and obstruction, necessitating emergency surgery. The obstruction, due to panniculitis, necessitated partial resection of the greater omentum remnant and adhesion exfoliation. Symptoms disappeared postoperatively and dilation decreased gradually.
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Shinya Imada, Motohiro Hirao, Kazumasa Fujitani, Masayoshi Yasui, Masa ...
2010 Volume 35 Issue 1 Pages
34-38
Published: 2010
Released on J-STAGE: February 25, 2011
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A 69–year–old–woman suspected of having gastric cancer was found in gastrointestinal endoscopy to have a type 0–IIc+III lesion in the lower stomach. Biopsy showed signet cell carcinoma necessitating distal gastrectomy. Pathologically, the tumor contained signet cell carcinoma associated with mucosa–associated lymphatic tissue (MALT) lymphoma (MALToma) mixed with surrounding diffuse large B cell lymphoma (DLBCL). Gastrointestinal endoscopy 22 months after initial surgery showed two ulcerative lesions. Biopsy showed malignant lymphoma with diffuse large cells. Chemotherapy yielded a complete response. Malignant lymphoma with gastric signet cell carcinoma not associated with Helicobacter pylori as in this case is rare.
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Kenichi Matsuzu, Hideyuki Ike, Norio Yukawa, Nobuyuki Wada, Yasushi Ri ...
2010 Volume 35 Issue 1 Pages
39-44
Published: 2010
Released on J-STAGE: February 25, 2011
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A 46–year–old woman responding poorly to antiulcer drugs for epigastric pain and fullness and admitted for vomiting was found in abdominal computed tomography (CT) to have wall thickening of the third duodenal portion and gastric and proximal duodenal dilation. Duodenography and endoscopy showed a type 2 tumor at the third duodenal portion. Biopsy showed moderately differentiated adenocarcinoma necessitating pancreatoduodenectomy. Macroscopic findings showed a 45x35 mm type 2 tumor. No lymph node metastasis was seen. She was discharged after an uneventful postoperative course on postoperative day 21 and experienced no recurrence in 2–year 5–month follow–up.
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Hirohito Fujikawa, Tsutomu Hayashi, Keita Fujii, Yasuyuki Kojima, Kazu ...
2010 Volume 35 Issue 1 Pages
45-50
Published: 2010
Released on J-STAGE: February 25, 2011
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We report two cases of primary adult small–intestine volvulus. Case 1: A 67–year–old man admitted for sudden severe abdominal pain was found in abdominal computed tomography (CT) to show the whirlpool sign indicating volvulus. Under a diagnosis of primary small–intestine volvulus, he underwent emergency surgery confirming ileal strangulation due to anticlockwise 180–degree bowel torsion. We resected the necrotic bowel and conducted functional end–to–end anastomosis. Case 2: A 38–year–old woman admitted for abdominal pain was found in CT to have a dilated intestine and ascites. Strangulated ileus could not be ruled out, necessitating emergency surgery. We resected the necrotic bowel of the ileum, which was rotated 180 degrees clockwise, and conducted functional end–to–end anastomosis. Both patients recovered without problems.
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Masato Tomita, Noriaki Kameyama, Hiroaki Mitsuhashi, Nobuaki Matsumoto ...
2010 Volume 35 Issue 1 Pages
51-55
Published: 2010
Released on J-STAGE: February 25, 2011
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Inguinal hernia reduction en masse is a rare condition in which the intestines and hernial sac come together, the intestines are incarcerated, and the aggregation slides into the preperitoneal space. A 57–year–old man experiencing inguinal swelling that spontaneously improved and disappeared the next day then had repeated epigastralgia, abdominal distension, and vomiting. When seen, his entire abdomen was distended but no inguinal hernia was found. Abdominal computed tomography (CT) suggested inguinal hernia but not the cause of ileus. When conservative treatment failed, we undertook emergency surgery with an inguinal approach. We found the intestines incarcerated in a hernial sac in the preperitoneal space and repaired the hernia.
We found that minimally invasive laparoscopic surgery enables detailed examination and is useful in rare clinical conditions as in this case.
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Atsuo Matsumoto, Kazuhiko Yoshimatsu, Hajime Yokomizo, Gakushi Ohsawa, ...
2010 Volume 35 Issue 1 Pages
56-60
Published: 2010
Released on J-STAGE: February 25, 2011
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We report a case of cecal adenosquamous carcinoma. An 81–year–old woman admitted for right abdominal pain and constipation and treatment for an ascending colon tumor was found in computed tomography (CT) to have a type 2 tumor diagnosed pathologically as well–differentiated adenocarcinoma. Operative findings showed a tumor 11cm in diameter invading the transverse colon from the ascending colon to the cecum, necessitating right hemicolectomy with lymph node dissection. The final diagnosis was SI, ly2, v1, N0 (0/23), PM0, DM0, RM0, fStage II, curA. The histological type was adenosquamous carcinoma. No indications of recurrence have been seen in the 84 month (12 years) since surgery. of No adjuvant chemotherapy was done. Pathological findings suggest that adenosquamous carcinoma may be squamous differentiation from adenocarcinoma.
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Tomohide Mukogawa, Fumikazu Koyama, Shoichi Kinoshita, Tadashi Nakagaw ...
2010 Volume 35 Issue 1 Pages
61-65
Published: 2010
Released on J-STAGE: February 25, 2011
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A asymptomatic 85–year–old woman found to have anemia elsewhere in June 2007 was found in computed tomography (CT) to have a target sign in the ascending colon. Barium enema showed a filling defect in the hepatic flexsure and colonoscopy an elevated lesion in the lumen. Intussusception was reduced by air injection and she was admitted for intussusception due to the ileocecal tumor. In laparoscopy–assisted ileocecal resection with lymph node dissection, the ileocecal region was found invaginated into the ascending colon, although this was easily reduced by minimal terminal ileum traction. Pathological findings showed well–differenciated adenocarcinoma invading the subserosa. Most adult intussusception is caused by neoplastic lesions and often require emergency surgery, but a few are treated by laparoscopy–assisted surgery. We reviewed 7 such cases in the Japanese literature, including our own, treated by laparoscopy–assisted surgery.
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Chihiro Kosugi, Keiji Koda, Hideki Yasuda, Masato Suzuki, Masato Yamaz ...
2010 Volume 35 Issue 1 Pages
66-71
Published: 2010
Released on J-STAGE: February 25, 2011
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We present a case of intussusception due to advanced ascending–colon cancer necessitating radical laparoscopic surgery after colonoscopic repositioning. A 42–year–old woman seen for lower abdominal pain was found in abdominal ultrasonography to have a target sign of the ascending colon. Enhanced computed tomography (CT) showed multiple concentric ring signs and local colon–wall thickening diagnosed as tumor–induced intussusception. Colonoscopy indicated a polypoid ascending–colon tumor with intussusception, reduced by air injection. Histological findings showed moderately differenriated adenocarcinoma. Seven days after intussusception repositioning, laparoscopic right hemicolectomy with lymph node dissection was conducted with 4 trocars. Pathologically, the 7.5×4.0 cm tumor was moderately differentiated adenocarcinoma type 1 pSS in depth, ly1, v2, and pN0. Adult intussusception is rare and mostly tumor–induced. If intussusception is reduced by colonoscopy or enema, elective laparoscopic surgery is a possibility.
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Takahiro Umemoto, Mitsuo Saito, Kazuyoshi Ishibashi, Gaku Kigawa, Hiro ...
2010 Volume 35 Issue 1 Pages
72-77
Published: 2010
Released on J-STAGE: February 25, 2011
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We report a case of a minute rectal carcinoid associated with a huge metastatic retroperitoneal carcinoid. A 65–year–old man was hospitalized because of constipation. Abdominal computed tomography (CT) showed a 130–mm diameter giant tumor with intratumoral necrosis, occupying the pelvic cavity and compressing the rectum. Colonoscopy revealed the primary lesion to be a small, yellowish, submucosal rectal tumor of 8 mm diameter with central collapse, located in the lower rectum. With no alternative diagnostic measures available, a percutaneous biopsy was performed and a diagnosis of carcinoid was made. We performed Hartmann's procedure of the primary tumor with lymph node dissection. Histologically, the retroperitoneal tumor did not display cytologic atypia, but did exhibit extensive necrosis, and was identified as a typical carcinoid by chromogranin A and synaptophysin immunohistochemical markers. For pelvic tumors of unknown origin, the alimentary tract must be examined to rule out the possibility of metastatic carcinoids.
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Masaki Yamada, Seigo Ono, Shun Ishiyama, Kiichi Sugimoto, Makoto Takah ...
2010 Volume 35 Issue 1 Pages
78-84
Published: 2010
Released on J-STAGE: February 25, 2011
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Malignant anorectal–origin melanoma is relatively rare and its prognosis oppressive. We report a case in which chemotherapy was effective in early postoperative anorectal malignant melanoma metastasis/redevelopment. A 77–year–old woman noting blood during bowel movements in August 2007 underwent transanal resection elsewhere under a diagnosis of anal polyp. Histopathologically, moderately to poorly differentiated adenocarcinoma had invaded to the submucosa. Postoperative FDG positron emission tomography (PET) showed abnormal pararectal lymph node accumulation, but definite diagnosis was not possible based on colonoscopic biopsy after reexamining previous pathological samples. Based on a diagnosis of malignant melanoma, we conducted abdominoperineal rected resection in November 2007. Pathological diagnosis indicated malignant rectal melanoma with SM, N
2 (35/62), ly
3, and v
0. Despite a favorable postoperative course and discharge on hospitalization day 17, she was diagnosed with metastasis/redevelopment of melanoma in the early postoperative phase. Chemotherapy proved effective, and she is currently continuing it.
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Ryuta Saka, Toshimichi Hasegawa, Hiroshi Sonobe
2010 Volume 35 Issue 1 Pages
85-88
Published: 2010
Released on J-STAGE: February 25, 2011
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Human tail, a rare congenital "tail–like" anomaly, is usually attached to the sacrococcygeal skin. We report an extremely rare case of perianal tail in a 2–month–old boy. Physical examination and magnetic resonance imaging (MRI) showed no associated anomaly. The tail was resected without complications. Microscopically, it consisted mainly of fatty tissue, with nerve fibers and striated muscle fibers. The dermis showed smooth–muscle hyperplasia. This case is classified as a"caudal appendage" based on Harrison's classification and as a"true tail" based on Dao's and Lin's classification.
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Takebumi Usui, Shunichi Shiozawa, Dal Ho Kim, Akira Tsuchiya, Kotaro K ...
2010 Volume 35 Issue 1 Pages
89-93
Published: 2010
Released on J-STAGE: February 25, 2011
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We report a case of hepatic sclerosed hemangioma difficult to distinguish from a metastatic liver tumor. A 57–year–old woman undergoing high anterior resection in February 2008 for rectosigmoid colon cancer had been noted preoperatively to have a small nodule at hepatic segment II that appeared to have grown slightly postoperatively. Left hepatic lobectomy was conducted in June 2008 for a suspected metastatic liver tumor. Typical histopathological findings were hyalinized tissue and collagen fibers with varying vascular channel size, yielding a diagnosis of hepatic sclerosed hemangioma. The relatively rare fibrosed, hyalinized cavernous hemangioma was due to degenerative change making it difficult to differentiate it from ischemic hepatic malignancy. The possibility of hepatic sclerosed hemangioma should therefore be considered in differential diagnosis of a highly fibrous liver tumor.
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Kazuo Ishizuna, Keisuke Minamimura, Tohru Hirata, Masaki Wakasugi, Aki ...
2010 Volume 35 Issue 1 Pages
94-99
Published: 2010
Released on J-STAGE: February 25, 2011
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A 49–year–old man admitted for a splenic mass found in abdominal ultrasonography in an annual checkup was confirmed in abdominal contrast–enhanced computed tomography (CT) to have a solitary low–densityarea with a maximum 3.8 cm diameter at the splenic apex. In the absence of physical and serum biochemistry abnormalities, the man was monitored. Fourteen months later, CT scan growth to 4.4 cm. 18–fluorodeoxyglucose positron emission tomography (FDG–PET) showed high uptake in the same area. With a malignant tumor not able to be ruled out, we conducted open abdominal splenectomy. The histopathological diagnosis was inflammatory splenic pseudotumor.
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Hiroyuki Tomioka, Shuji Saito, Yusuke Kinugasa, Akio Shiomi, Yosuke Ha ...
2010 Volume 35 Issue 1 Pages
100-104
Published: 2010
Released on J-STAGE: February 25, 2011
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A 55–year–old woman admitted for right lower abdominal pain, nausea, vomiting, and a 14 kg weight loss in 12 months was found to have a type 2 cancer lesion 4 cm in diameter in the ascending colon. Computed tomography (CT) showed the second and third duodenal portions to be dilated. The SMA–aorta angle was 24°with a normal range of 25° to 60°, and the SMA–aorta distance was 5.4 mm with a normal range of 10 to 28 mm, yielding a diagnosis of superior mesenteric artery syndrome (SMAS). She underwent duodenojejunostomy for SMAS and right colectomy for ascending colon cancer. SMAS symptoms disappeared after surgery and she underwent adjuvant chemotherapy. Surgical treatment may thus be an good indication for those with concomitant SMAS and resectable abdominal malignancy.
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Masaki Nakui, Seiji Chubachi
2010 Volume 35 Issue 1 Pages
105-108
Published: 2010
Released on J-STAGE: February 25, 2011
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Morgagni hernia is a relatively uncommon diaphragmatic form. A 53–year–old man seen for a diaphragmatic hernia and having slight dyspnea on effort was found in chest X–ray, computed tomography (CT), and barium enema to have Morgagni hernia, with the transverse colon herniating into the right thoracic cavity. He underwent laparoscopic surgery, which confirmed a 6×4 cm diaphragmatic defect in the right retrosternum. The herniated transverse colon and omentum were replaced easily into the abdominal cavity and the diaphragmatic defect closed by subcutaneous extraperitoneal closure. Bard Composix Mesh
® 10.2×15.2 cm placed over the closed diaphragm using a hernia stapler (Davol Salute
®) reinforced it. The hernia sac was not resected. No postoperative complications occurred and the man was discharged on postoperative day 7. No recurrence or seroma was seen in the 30 months since. We concluded that this course is easy, effective, and minimally invasive for Morgagni hernia.
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