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Volume 43, Issue 11
Displaying 1-18 of 18 articles from this issue
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ORIGINAL ARTICLE
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Satoru Matono, Toshiaki Tanaka, Yuichi Tanaka, Takeshi Nagano, Kohei N ...Article type: ORIGINAL ARTICLE
2010 Volume 43 Issue 11 Pages 1089-1097
Published: November 01, 2010
Released on J-STAGE: December 27, 2011
JOURNAL FREE ACCESSIntroduction: Definitive Chemoradiotherapy (CRT) for esophageal cancer has become common, raising the incidence of salvage esophagectomy for residual and recurrent tumors after definitive CRT. We investigated indications, for salvage esophagectomy based on outcome. Methods: We reviewed 18 cases of subjects with esophageal cancer who underwent salvage esophagectomy after definitive CRT with more than 50 Gy of radiation from 1986 to 2008. Results: Seven had cStage I-III (nonT4), and 11 cStage III (T4) -IVa before definitive CRT. Definitive CRT (former cStage/later cStage) resulted in responders for 6/7, non-responders for 1/4. Median duration definitive CRT to salvage esophagectomy (former cStage/later cStage) was 6/2 months. Curative surgery was underwent 2/4 (former cStage/later cStage) and palliative surgery was underwent 5/7 (former cStage/later cStage). One, 3 and 5-year survival after curative surgery was 83%, 33% and 17%. No patient survived more than one year after palliative surgery. One, 3 and 5-year survival after responders to CRT was 39%, 15% and 7%. No patient survived more than one year after non-responders. Morbidity was 94%. Postoperative severe complications occurred more after palliative surgery than after curative surgery. Hospital mortality occurred only palliative surgery. Survival was better among responders to CRT and in those undergoig curative surgery. There is no relation between cStage and survival. Conclusions: It appears to offer some survival benefit to responders to definitive CRT and to those undergoing curative surgery.View full abstractDownload PDF (436K) -
Hideyuki Nishi, Kazuhiro Washio, Hiroshi Kawai, Yasushi Omura, Masayuk ...Article type: ORIGINAL ARTICLE
2010 Volume 43 Issue 11 Pages 1098-1105
Published: November 01, 2010
Released on J-STAGE: December 27, 2011
JOURNAL FREE ACCESSBackground/Aims: Rare malignant peritoneal mesothelioma appears to be increasing in incidence. Its unusual presentation however has left its natural history, diagnosis, and management obscure. We report 12 cases of malignant peritoneal mesothelioma, its clinicopathological features, and its relationship to asbestos exposure. Patients and methods: Subjects were 12 persons-10 men and 2 women averaging 66 years of age, 11 of whom (91.7%) had confirmed asbestos exposure-seen from January 1993 to March 2009 for malignant peritoneal mesothelioma. Results: Malignant peritoneal mesothelioma involves an occupational history, e.g. shipyard work or asbestos product manufactures of heavy asbestos exposure and complications of asbestosis and pleural plaque. Ten of our 12 subjects were definitively diagnosed by laparoscopy and open surgery. Histologically 11 had epithelial and 2 biphasic mesothelioma. Chemotherapy was conducted in 10 (83.4%), surgery in 1 (8.3%). Median survival was 12.0 months. Two-year survival was 19.3%. Conclusion: Malignant peritoneal mesothelioma is strongly related to asbestos exposure, and its diffuse nature makes a radical resection. Combined treatments may reduce local recurrence and systemic spread.View full abstractDownload PDF (534K)
CASE REPORT
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Kazuhiko Shien, Isao Nozaki, Takaya Kobatake, Kouzi Ohta, Yoshiro Kubo ...Article type: CASE REPORT
2010 Volume 43 Issue 11 Pages 1106-1111
Published: November 01, 2010
Released on J-STAGE: December 27, 2011
JOURNAL FREE ACCESSWe report two cases of esophageal schwannoma. A 66-year-old woman (case 1) and a 56-year-old man (case 2) were admitted for abnormal shadows pointed out in barium esophagography. In case 1, an esophageal submucosal tumor was resected by transthoracic esophagectomy with gastric tube reconstruction. In case 2, esophageal tumor was enucleated by thoracoscopic surgery. To remove the tumor from the muscular layer, a Sangstaken-Blakemore tube (S-B tube) was used intraoperatively inserted into the esophagus preoperatively. Both tumors consisted histopathologically of spindle-shaped cell bundles and S-100 protein expression was immunohistochemically confirmed in both tumors. The definitive diagnose was benign esophageal schwannoma in both cases. Esophageal schwannoma is extremely rare, and we review 26 cases from the Japanese literature.View full abstractDownload PDF (654K) -
Akiko Okada, Toshiyuki Arai, Satomi Saeki, Yoshito Okada, Takashi Hiro ...Article type: CASE REPORT
2010 Volume 43 Issue 11 Pages 1112-1116
Published: November 01, 2010
Released on J-STAGE: December 27, 2011
JOURNAL FREE ACCESSInvasive micropapillary carcinoma (IMPC) has been reported in the breast, lung, urinary bladder, ureter, salivary glands and colon, but rarely in stomach. IMPC's frequent lymph node metastasis indicates a dismal clinical outcome. A 77-year-old man seen for melanorrhagia was found in upper gastrointestinal endoscopy to have a type 2 tumor on the pyloric antrum, and biopsy indicated adenocarcinoma, necessitating distal gastrectomy with D2 lymph node dissection. Pathological examination indicated papillary adenocarcinoma, pT2 (SS), ly1, v1, and pN0. Among carcinoma cells, 50-60% formed small clusters surrounded by clear spaces, showing IMPC finding. Immunohistochemical staining showed that the stromal edge of carcinoma cell clusters stained positive for epithelial membrane antigen (EMA). Postoperative adjuvant chemotherapy was not added. Computed tomography (CT) scan 6 months postoperatively showed multiple hepatic metastases. Treatment has been continued with TS-1.View full abstractDownload PDF (554K) -
Hayato Nakamura, Kazuhiro Hiramatsu, Takehito Katoh, Masaomi Suzuki, Y ...Article type: CASE REPORT
2010 Volume 43 Issue 11 Pages 1117-1122
Published: November 01, 2010
Released on J-STAGE: December 27, 2011
JOURNAL FREE ACCESSWe report a case of suture-line gastric cancer recurrence in both esophagojejunostomy and the elevated jejunal stump, diagnosed 4 months after total gastrectomy for advanced gastric cancer. A 76-year-old woman underwent total gastrectomy and splenectomy with D2 lymph node dissection for type 3 gastric cancer of the upper gastric body and IIa type early gastric cancer of the lower gastric body, and hernioplasty for esophageal hiatal hernia in August 2005. Histological examination showed the upper lesion to be moderately differentiated tubular adenocarcinoma (pT2 (ss), ly1, v0) and the lower lesion to be well-differentiated tubular adenocarcinoma (pT1 (m), ly0, v0) without nodal involvement. The proximal surgical margin was negative for cancer. Four months later, she was seen for dysphagia and endoscopy showed an irregular elevated tumor of the esophagojejunostomy, suggesting gastric cancer recurrence. The recurrent tumor was resected using a left thoracoabdominal approach. Histological study confirmed that the tumor was suture-line gastric cancer recurrence. We concluded that recurrence was due to implantation, judging from the negative surgical margin and the absence serious lymphatic involvement in the previous specimen.View full abstractDownload PDF (632K) -
Kazuhisa Mikami, Noritoshi Saito, Hiroshi Yasumatsu, Takashi Nakamura, ...Article type: CASE REPORT
2010 Volume 43 Issue 11 Pages 1123-1128
Published: November 01, 2010
Released on J-STAGE: December 27, 2011
JOURNAL FREE ACCESSWe report a rare case of early gastric cancer invaginating into the jejunum. A 88-year-old woman who had been diagnosed with a tumor of the small intestine admitted with anorexia and subsequent body weight loss. Abdominal computed tomography showed a tumor 8.5 cm in diameter in the jejunum and the distal stomach invaginating into the jejunum through the duodenum. Gastrointestinal endoscopy showed a multiple-nodule tumor 10 cm in diameter on the greater curvature of the lower gastric body invaginating into the inferior duodenal angle. The diagnosis was early gastric cancer -Type 0I SM- invaginating into the jejunum, necessitating laparoscopic partial gastrectomy. Histological examination showed well-differentiated tubular adenocarcinoma pT1 (M), ly0, v0, PM (-), DM (-). No report such as our case has been made, as far as we could review.View full abstractDownload PDF (637K) -
Yasunori Kurahashi, Yoshiharu Shirakata, Koji Hirata, Hisashi Shinohar ...Article type: CASE REPORT
2010 Volume 43 Issue 11 Pages 1129-1133
Published: November 01, 2010
Released on J-STAGE: December 27, 2011
JOURNAL FREE ACCESSChoriocarcinoma of the major duodenal papilla is extremely rare because, to the best of our knowledge, it has never been reported in the literature. An 80-year-old woman hospitalized with dysbasia, cholangitis with elevated hepatobiliary enzymes, and marked biliary tract dilatation was found in upper gastrointestinal endoscopy to have cancer of the major duodenal papilla. After the biliary tract was drained, she underwent pancreatoduodenectomy and regional lymph node dissection. Histopathologically, well- to moderately differentiated tubular adenocarcinoma was observed at the tumor border, and large atypical trophoblast-like cells dominated the invasive tumor. Positive immunohistochemical staining for the human chorionic gonadotropin (hCG) beta subunit was observed, yielding a diagnosis of choriocarcinoma of the major duodenal papilla.View full abstractDownload PDF (1021K) -
Atsushi Yamamoto, Yasuhiro Sumi, Makoto Takeuchi, Yoshihiro Ito, Fumio ...Article type: CASE REPORT
2010 Volume 43 Issue 11 Pages 1134-1140
Published: November 01, 2010
Released on J-STAGE: December 27, 2011
JOURNAL FREE ACCESSWe report a case of tumor thrombi of the inferior vena cava (IVC). A 38 years old woman underwent sigmoidectomy, trisegmentectomy, and partial resection of hepatic S3 for sigmoid colon carcinoma with multiple liver metastases. Computed tomography (CT) 15 months later showed a left pulmonary S8 nodule, paraaortic lymph node swelling, and a retrohepatic IVC defect. We conducted video-assisted thoracotomy and partial resection of pulmonary S8. Pathological diagnosis confirmed a pulmonary infarction. Two years later, CT showed no marked changes in paraaortic lymph node swelling or the IVC defect. Based on a diagnosis of paraaortic lymph node and IVC thrombi metastases or IVC tumor thrombi, we resected paraaortic lymph nodes and graft replacement of the IVC. Pathological diagnosis confirmed metastases from sigmoid colon carcinoma. The postoperative course was uneventful and she is currently doing well and remains recurrence-free.View full abstractDownload PDF (758K) -
Masahiro Ikeda, Zenichi Morise, Chinatsu Takeura, Tadashi Kagawa, Yosh ...Article type: CASE REPORT
2010 Volume 43 Issue 11 Pages 1141-1145
Published: November 01, 2010
Released on J-STAGE: December 27, 2011
JOURNAL FREE ACCESSWe report what is, to our knowledge, only the third reported case of double hepatocellular carcinoma (HCC) and cholangiolocellular carcinoma (CoCC). A 64-year-old man with positive hepatitis B virus (HBV) liver cirrhosis hospitalized for hepatic lesions had elevated plasma AFP and PIVKA-II. Abdominal computed tomography (CT) and magnetic resonance imaging (MRI) showed hypervascular nodules at S8a and S8c, necessitating partial hepatic resections. Histologically, the S8a tumor was HCC and the S8c tumor CoCC.View full abstractDownload PDF (862K) -
Takekazu Iuchi, Shigeyuki Naka, Hisanori Shiomi, Yoshimasa Kurumi, Mit ...Article type: CASE REPORT
2010 Volume 43 Issue 11 Pages 1146-1151
Published: November 01, 2010
Released on J-STAGE: December 27, 2011
JOURNAL FREE ACCESSA 21-year-old woman seen for appetite loss and diagnosed with obstructive jaundice caused by a cystic liver tumor underwent endoscopic bile duct drainage elsewhere. Cholangiography showed a smooth oval defect in the common hepatic duct. Abdominal CT and MRI showed a cystic lesion with the septum in the left medial liver segment with the cystic lesion developing into the common hepatic duct. Based on a diagnosis of intrahepatic bile duct cystadenoma, left hepatectomy was conducted. The resected specimen showed a cystic lesion in the left medial hepatic segment and a small cystic lesion developing into the common hepatic duct. Ovarian-like stroma cells were seen in the H.E.-stained specimen and she was diagnosed as having intrahepatic bile duct cystadenoma. She has had no clinical recurrence eight months after operation. No report has, to our knowledge, been made of a cystadenoma developing into the bile duct and showing a defect in common hepatic duct with cholangiography.View full abstractDownload PDF (662K) -
Shuka Arai, Masao Nunomura, Katsuhiko Ando, Kenji Oda, Masayuki Shioba ...Article type: CASE REPORT
2010 Volume 43 Issue 11 Pages 1152-1158
Published: November 01, 2010
Released on J-STAGE: December 27, 2011
JOURNAL FREE ACCESSA 71-year-old woman seen for unusual weight loss and diagnosed with a gall bladder tumor and situs inversus totalis (SIT) was found in ultrasonography, computed tomography, magnetic resonance cholangiopancreatography, and abdominal magnetic resonance imaging to have xanthogranulomatous cholecystitis (XGC) and SIT. Laparoscopic cholecystectomy (LC) was conducted with trocars inserted opposite to the conventional arrangement and surgery conducted double-handed. Surgery lasted 134 minutes and was completed without complications safely and easily. The patient was discharged on postoperative day 6. This is, to our knowledge, the first case report in Japan of LC for XGC in a subject with SIT.View full abstractDownload PDF (864K) -
Mototaka Inaba, Masafumi Kataoka, Isao Yasuhara, Tsuyosi Okada, Toshin ...Article type: CASE REPORT
2010 Volume 43 Issue 11 Pages 1159-1164
Published: November 01, 2010
Released on J-STAGE: December 27, 2011
JOURNAL FREE ACCESSPrimary undifferentiated small-intestine carcinoma is rare and the prognosis is dismal. A 66-year-old man with a history of laryngeal and lung cancer was admitted for slight fever and abdominal pain. Computed tomography (CT) indicated a mass from the mesentery to the small-intestine wall and swollen mesentery lymph nodes, necessitating emergency surgery due to bowel obstruction. Perioperative findings for the ileum 170 cm from the ligament of Treitz showed a 7 cm mass and swollen lymph nodes around the superior mesenteric artery. We conducted dissection and radical surgery. Histopathologically, it had the primary undifferentiated small-intestine carcinoma with the lymph nodes metastasis diagnosed by immunostaining. The postoperative course was good and the man was discharged on postoperative day 19. No recurrence has been seen in the 37 months since.View full abstractDownload PDF (786K) -
Hirotaka Miyai, Tetsushi Hayakawa, Yasunobu Shimizu, Moritsugu Tanaka, ...Article type: CASE REPORT
2010 Volume 43 Issue 11 Pages 1165-1169
Published: November 01, 2010
Released on J-STAGE: December 27, 2011
JOURNAL FREE ACCESSWe report a case of multicentric dedifferentiated liposarcoma. A 47-year-old woman seen for lower abdominal pain and fever was found on palpation to have slight overall abdominal tenderness with slight rebound tenderness and guarding. Laboratory data showed leucocytosis (WBC 11,800 /mm3) and inflammation (CRP 20.6 mg/dl) and plain abdominal computed tomography (CT) showed tumors in the upper and lower right abdominal cavity. We conducted laparotomy, finding multiple mesenteric lipoma or liposarcoma from abdominal enhanced CT and Magnetic resonance imaging (MRI), etc. The pedunculated pelvic tumor was twisted and caused ischemia and severe inflammation. Finding radical resection to be unfeasible, we resected as many tumors as possible. Residual tumors slowly increased and abdominal symptoms became marked, necessitating three times of progressive tumor-reductive resection and laparotomy over 3 years 6 months.View full abstractDownload PDF (646K) -
A Case of Appendiceal Endometriosis occurring 13 years after Hysterectomy with Bilateral AdnexectomyYoshiki Sato, Toshihisa Kimura, Toshiyuki Nakazawa, Shinsuke Obata, Ka ...Article type: CASE REPORT
2010 Volume 43 Issue 11 Pages 1170-1175
Published: November 01, 2010
Released on J-STAGE: December 27, 2011
JOURNAL FREE ACCESSWe report a case of appendiceal endometriosis occurring over 13 years after hysterectomy with bilateral adnexectomy. A 60-year-old woman who had undergone this hysterectomy for uterine myoma at age 47 was seen in September 2008 for lower right abdominal pain. Abdominal computed tomography indicated possible appendiceal perforation, necessitating emergency surgery, which showed erythematous appendix with a thickened wall. After appendectomy removing the appendix at the root, histopathological examination showed an atrophic appendix with mucosal epithelial loss. The resected appendix wall evidenced chronic inflammation and endometrial tissue, with enlarged glandular cavities and endometrial stroma. Immunohistochemistry of endometrial tissue showed positive staining for the estrogen receptor and weakly positive staining for the progesterone receptor, yielding a final diagnosis of appendiceal endometriosis. Appendiceal endometriosis occurs predominantly in reproductive-age women and is rarely reported in those postmenopausal. No reports have been published, to our knowledge, of appendiceal endometriosis occurring over a decade after hysterectomy with bilateral adnexectomy, making ours an interesting case worth reporting.View full abstractDownload PDF (572K) -
Yoichiro Mori, Takao Kasugai, Kazutaka SakakibaraArticle type: CASE REPORT
2010 Volume 43 Issue 11 Pages 1176-1182
Published: November 01, 2010
Released on J-STAGE: December 27, 2011
JOURNAL FREE ACCESSAdult bilateral retrosternal hernia is very rare. A 87-year-old woman seen for repeated nausea, vomiting, and epigastralgia was found in computed tomography (CT) to have a bilateral retrosternal hernia prolapsed with the stomach the right hernia sac and the transverse colon the left. Laparoscopic surgery recognized two hernia sacs in the anterior aspect of the diaphragm, but with the transverse colon herniated into the right hernia sac, unlike on CT. The herniated transverse colon was easily placed into the abdominal cavity and Composix mesh placed over the bilateral hernia hilum without hernia sac resection. Postoperative recovery was uneventful and the woman has remained free of recurrence and complications in the 10 months since surgery.View full abstractDownload PDF (484K) -
Ito Kondo, Yoshinobu Nishioka, Tadao Murayama, Naoaki Hoshino, Tihiro ...Article type: CASE REPORT
2010 Volume 43 Issue 11 Pages 1183-1188
Published: November 01, 2010
Released on J-STAGE: December 27, 2011
JOURNAL FREE ACCESSWe report the case of a Morgagni-Larrey hernia, a rare diaphragmatic type that is often asymptomatic and usually detected incidentally in X-ray imaging. A76-year-old woman seen for vomiting was found in computed tomography (CT) to have a diaphragmatic hernia with an incarcerated stomach, duodenum, transverse colon, and fat tissue. Laparoscopic repair was attempted and laparoscopy showed it to be a Morgagni-Larrey hernia with a hiatus 5×8 cm. The defect was closed by direct sutures and covered with Composix mesh® fixed in place using a hernia stapler. The outcome was satisfactory. The laparoscopic approach is minimally invasive in bedridden adults with liver cirrhosis.View full abstractDownload PDF (816K) -
Naoya Okada, On Suzuki, Youhei Hashimoto, Takehiro Noji, Toru Nakamura ...Article type: CASE REPORT
2010 Volume 43 Issue 11 Pages 1189-1193
Published: November 01, 2010
Released on J-STAGE: December 27, 2011
JOURNAL FREE ACCESSWe report a case of small-bowel obstruction due to transverse mesocolon hernia. An 84-year-old woman seen for abdominal pain and vomiting was found to have periumbilical tenderness without guarding or rebound. Computed Tomography (CT) showed small-bowel distension, but not the focus of obstruction. The day following admission, tenderness became severe and rebound pain prompted emergency diagnostic laparoscopy for suspected incarcerated bowel. Intraoperatively, a hernia orifice 3 cm in diameter was found in the transverse mesocolon and small intestine adhering to the mesocolon 20 cm from this orifice. The hernia orifice was sutured closed and the strangulated intestine, which had no necrosis, needed no resection. Postoperative recovery was uncomplicated and the woman was discharged in good condition on postoperative day 8.View full abstractDownload PDF (397K)
Letters to the editor
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[in Japanese], [in Japanese]Article type: Letters to the editor
2010 Volume 43 Issue 11 Pages 1194-1196
Published: November 01, 2010
Released on J-STAGE: December 27, 2011
JOURNAL FREE ACCESS
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