Introduction: Distal gastrectomy (DG) is a standard procedure for early gastric cancer located in lower and middle third of the stomach. Although pylorus preserving gastrectomy (PPG), one of the function preserving gastrectomies which has recently been applied for early gastric cancer, evaluation of this procedure has not yet been finalized. Patients and method: In this study, 71patients who underwent PPG were evaluated by prognosis, postoperative complications, abdominal symptoms examined by questionnaire survey and endoscopic findings of the residual stomach. Patients who underwent DG were examined by same items and the results were compared with those of the PPG group. Results: There was no significant difference in the survival rates of the two groups. The incidence of gastric stasis in the early postoperative period was higher in the PPG group (14.1%) compared with the DG group (3.4%). From the results of the questionnaire, the incidence of symptoms of regurgitation was lower in the PPG group (13.4%) than the DG group (38.0%). Early dumping syndrome such as abdominal sound, abdominal pain and diarrhea occured less frequently in the PPG group (36.2%) than the DG group (60.5%). Sixty-nine percent of PPG group patient had food residue in the remnant stomach as assessed endoscopically, which was higher than the DG group (32.5%). Gastritis and bile reflux in the gastric remnant were observed in 33.3% and 5.1% of the PPG group, and 68.3% and 22.0% of the DG group, respectively. Conclusion: PPG has advantages of lower incidences of the dumping syndrome, bile reflux and gastritis in the remnant stomach compared with DG. On the other hand, PPG has disadvantage in gastric empting over DG, but according to the results of the questionnaire, there was no difference in symptoms concerning residual food. PPG thus, seems to be the better procedure than DG from the point of view of the patient's QOL.

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Purpose: The purpose of this study was to identify the clinical impact of CA72-4 stainig patterns on the prognosis and recurrence patterns in patients with colorectal carcinomas. Materials and methods: Tissue samples were collected from 211 colorectal carcinoma patients who underwent curative resection during the period from January 1996 to December 2000. The correlations between the staining patterns of CEA and CA72-4 and clinicopathological factors were analyzed and then patients outcomes were reviewed. The localization patterns of CEA staining were classified into apicoluminal (AL) and diffuse-cytoplasmic (DC) patterns in the tumor (CEAtumor) and invasive tumor margin (CEAmargin). The patterns of CA72-4 staining were classified into two groups: positive or negative staining patterns in the tumor (CA72-4 (tumor) cyto) and invasive tumor margin (CA72-4 (margin) cyto). In addition, the CA72-4 (B72.3) staining patterns in the extracellular tissue (CA72-4ex) were classified into two groups: positive or negative staining groups. Results: Patients with a positive staining pattern of CA72-4ex showed shorter overall survival than those with a negative CA72-4ex staining pattern. A multivariate analysis showed that the positive CA72-4ex staining pattern affected the overall survival with the highest Hazard rate. Patients with a positive CA72-4ex staining pattern showed a lower survival rate after recurrence than those with a negative CA72-4ex staining pattern. The difference was statistically significant (p=0.0063). Non-hematogenous recurrence developed far more frequently in patients with a positive CA72-4 (tumor) cyto or CA72-4ex staining pattern than in those who stained negative for these patterns, respectively (p=0.0232, p=0.0221). Conclusions: Patients with a positive CA72-4ex staining pattern showed poorer outcomes and lower survival rate after recurrence because of a higher rate of non-hematogenous recurrence. Our study suggested that the extracellular staining patterns of CA72-4 may be useful for decision making regarding treatment after recurrence in patients with colorectal carcinoma.

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A 79-year-old woman complaining of discomfort in swallowing was referred to our hospital, because an endoscopic examination had revealed a deep ulcerative lesion in the cervical esophagus. Biopsy specimens disclosed subepithelial epithelioid granulomas with non-specific granulation tissue without central necrosis and no histological evidence of malignancy. A barium study showed a deep ulcerative lesion, which appeared to be a Type 3 lesion, located from the cervical esophagus to the upper thoracic esophagus. CT scan revealed a cervical esophageal tumor adjacent to the right cervical paraesophageal lymph node with suspicious formation of an esophagolymphnodal fistula. The patient underwent cervicotomy under general anesthesia because malignancy of the lesion was not be able to be ruled out. Intraoperative biopsy from the bottom of the lesion was performed after opening the cervical esophagus. Intraoperative frozen sections demonstrated subepithelial granulomatous inflammation, which was suspected to be a tuberculosis epithelioid granuloma. Acid fast bacilli were seem in Ziehl-Neelsen staining, and this led to the find positive diagnosis of an esophagolymphnodal fistula due to tuberculous cervical lymphadenitis. In the differential diagnosis of tumors of the esophagus, tuberculous lesions must be included.

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A 62-year-old man went to the local hospital for obstructive jaundice and acute cholangitis in August 2003. On admission to our hospital, bile juice from naso-biliary drainage tube contained mucin. Abdominal CT revealed a mass in the lower bile duct and a cystic tumor, 3.5cm in diameter, with intracystic solid components in the segment IV of the liver. Cholangiography demonstrated communication between the cystic lesion and the intrahepatic bile duct. Percutaneous transhepatic cholangioscopy showed papillary tumors in the cyst. We diagnosed him as having synchronous biliary double cancer, namely mucin producing intrahepatic cholangiocarcinoma in the segment IV of the liver and lower bile duct cancer. We performed left hepatic lobectomy, caudate lobectomy and pancreaticoduodenectomy in October 2003. Pathologically, the cystic tumor in the liver was papillary adenocarcinoma with mucin-hypersecretion, and lower bile duct mass was well differentiated tubular adenocarcinoma. Non-cancerous bile duct epithelium was existed between two lesions, therefore we finally diagnosed these lesions as double cancer. The patient is still alive without recurrence 15months after surgery. This is the first report of the synchronous double cancer of intrahepatic and extrahepatic cholangiocarcinoma.

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We report a case of splenic marginal zone lymphoma (SMZL) diagnosed after splenectomy for idiopathic thrombocytopenic purpura (ITP). A 30-year-old woman diagnosed with ITP 5 years earlier and treated with steroids did not have the platelets count increase sufficiently, leading to splenectomy using hand-assisted laparoscopic surgery (HALS). Based on microscopic findings with HE staining and immunohistochemistry staining for CD20 and Ki67, she was diagnosed with SMZL. Platelets counts and PAIgG normalized after splenectomy. These findings suggest that SMZL may have caused ITP.

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We report a rare case of pancreatic cancer, duct-acinar cell carcinoma. The tumor was detected on CT in the pancreatic head of a 63-year-old man who had aggravated diabetes mellitus. Enhanced CT showed a solid tumor with an indistinct border and hypovascularity, 3.5cm in diameter. Angiography showed direct invasion to the iliocecal vein. ERP showed a disrupted main pancreatic duct. Laboratory findings were unremarkable, except for serum CEA of 5.6ng/ml and hyperglycemia. With a diagnosis of ductal invasive cancer of the pancreatic head, we conducted pancreatoduodenectomy with resection of the iliocecal vein and intraoperative radio- therapy. Histopathological examination showed that the tumor consisted of two distinct cell populations: duct and acinar cells. According to immunohistochemical analysis, duct cells were positive for CEA, whereas acinar cells were positive for amylase, trypsin, and alpha-1-antitrypsin. Both were negative for chromogranin A. These findings suggested mixed duct-acinar carcinoma of the pancreas, a very rare occurrence whose clinical and pathological features are little known. Further cases and studies are thus needed to clarify its pathogenesis.

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A 61-year-old man was preoperatively diagnosed with early gastric cancer and pseudomyxoma peritonei associated with an idiopathic intraperitoneal giant cyst was found at the first laparotomy to have a cyst of splenic origin. Splenectomy and debulking of pseudomyxoma implants was done. The mucin-core-protein expression of acsites was MUC1 (-), MUC2 (+), MUC5AC (+), and epithelial cells of the mucinous cyst of the spleen expressed CK-7 (-), CK-20 (+), CEA (+), Vimentin (-). These results strongly suggested the existence of lower primary intesitinal tumor. Partial gastrectomy and appenndectomy done 7 months later confirmed that both mucinous ascites and pseudomyxoma implants disappeared and the presence of mucinous cystade-nocarcinoma of the appendix, diagnosed as psuedomyxoma peritonei of primary appendiceal. Considering the peculiar clinicopathological features of this case, the huge splenic cyst versus the almost normal appendix, we assumed from the literature that mucin- secreting cells of the appendix, which spilled out into the abdominal cavity, redistributed around the splenic hilum, and invaded the spleen, then excessively secreting MUC2 mucin massively accumulated in the spleen, which had no way to drain, unlike the appendix.

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A 74-year-old woman underwent colonoscopy after a positive fecal occult blood test, and was diagnosed as having a submucosal tumor of the cecum. Since the biopsy specimen revealed no evidence of malignancy, she underwent a follow-up colonoscopy and biopsy six months later. She was then diagnosed as having mucosa-associated lymphoid tissue lymphoma (MALToma) of the cecum. An abdominal CT scan revealed thickening of the cecal wall without significant lymphadenectomy, and lymphoma cells were not detected by bone marrow aspiration. She was subsequently treated with ileocecal resection. Histologically, the tumor was diagnosed as a primary MALToma of the appendix with involvement of the serosa but no nodal metastasis. The patient has been disease-free for 28 months after the operation. We report herein a rare case of MALToma of the appendix, with a review of the literature.

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We report a case of multiple early colon cancers associated with Japanese Schistosomiasis. A 85-year-old woman treated for hypertension and diabetes mellitus and reporting melena was found in barium enema and colonoscopic examination to have a sigmoid colon tumor and multiple ascending colon polyps, necessitating sigmoidectomy and mucosal resection of the ascending colon. Pathological findings showed the sigmoid colon tumor to be moderately differentiated adenocarcinoma in tubulovillous adenoma and ascending colon polyps with two tubular adenomas and one moderately differentiated adenocarcinoma in tubular adenoma. We found innumerable ova of Japanese Schistosomiasis centering around the submucosal layer of the resected specimen. We discuss the correlation between interposing ova of Japanese Schistosomiasis and the development of colon caner.

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A 75 years old man, who had undergone radical prostatectomy for prostatic cancer in 1996, was admitted to our hospital for difficulty in passing stools. His serum prostate specific antigen (PSA) level was elevated but the other laboratory data was within the normal range. A colonoscopy and barium enema study revealed an entire stricture in the upper rectum. The specimen from the rectal biopsy showed a poorly differentiated adenocarcinoma. Pelvic CT showed rectal wall thickness and a high-density mass near the urinary bladder far from the following stenosis. Therefore we diagnosed rectal cancer complicated with local recurrence of prostate cancer and we conducted an abdominoperineal resection of the rectum. Microscopic examination of the specimen revealed a poorly differentiated adenocarcinoma located mainly in the deeper part of rectal wall, but a few carcinomas were located in the mucosal layer. Because the tumor cells stained positively for PSA, we made a diagnosis of prostatic cancer with rectal metastasis. We herein report on a case of the prostatic cancer with rectal metastasis, with a review of the literature.

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