Background: Laparoscopy-assisted colectomy (LAC) for p stage 0-I colon cancer (LAC0-I) has become widely accepted, in Japan, but the oncological validity of this surgery remains to be well analyzed, especially for advanced cancer, and LAC for p stage II-III colon cancer (LACII-III) is not yet accepted. Objectives: Our objectives were to (1) compare LAC0-I and LACII-III safety and efficacy for sigmoid colon based on clinical outcome, i.e., intraoperative findings and perioperative and postoperative course, and (2) assess the oncological outcomes of LAP for p stage II-III sigmoid colon cancer. Methods: Subjects were 996 persons undergoing laparoscopic colorectal cancer surgery between March 1994 and January 2009. The cases of 231 cases whose pathological findings were curability A stage 0-III sigmoid colon cancer (0/I/II/IIIa/IIIb=17/81/68/41/24) were included in this study. Results: No significant statistical difference was seen in demographic data between LAC0-I and II-III. In LN dissection, LACII-III subjects required more D3. Results for other clinical outcomes were similar in both groups. Overall and disease-free 5-year survival was 100/99% in stage I, 96/94% in stage II, 93/89% in stage IIIa, and 85/76% in stage IIIb. Conclusions: Although further evaluation is required, laparoscopic surgery for p stage II/III sigmoid colon cancer appears to be safe, and oncologically adequate in treating colon cancer.

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We report a rare case of intraluminal pedunculated liomyosarcoma of the esophagus. A 74-year-old man admitted for dysphagia due to blocked food was found in esophagoscopy to have an giant intraluminal esophageal mass. Upper gastrointestinal study, computed tomography, and biopsy under esophagoscopy showed an intraluminal pedunculated liomyosarcoma 10 cm long necessitating subtotal esophagectomy followed by an intrathoracic esophagogastric anastomosis. Histopathologically, liomyosarcoma arose from 96×50×30 mm muscularis mucosae. A pedunculated giant liomyosarcoma of the esophagus necessitates esophagectomy and close follow-up because of reports of lymph node metastases and brain metastasis from the lesion.

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We report an extremely rare case of adenosquamous carcinoma with lymph node metastasis involving an adenocarcinoma component. A 62-year-old man admitted for chest pain was found in esophagoscopy to have an elevated lesion in the middle thoracic esophagus diagnosed as squamous cell carcinoma, necessitating transthoracoabdominal subtotal esophagectomy with 2-field lymph node dissection. Gastric pullup was made intrathoracically. The postoperative course was uneventful and he remains alive without carcinoma recurrence in the 13 months since surgery. Histologically, the tumor consisted of squamous cell carcinoma components in 80% of the mass and adenocarcinoma components in 20% with lymph node metastasis from the latter. Pathological diagnosis and staging was adenosquamous carcinoma of pT1bN2M0 and pStage II. Esophageal adenosquamous carcinoma involved lymph nodes in several cases, but many consisted of squamous cell carcinoma tumor components.

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A 50-year-old man referred for abdominal pain had taken hypertension and general eczema medication from age 48 originated for autosomal dominant polycystic kidney disease (ADPKD) diagnosed when he was 35 years old. His father had died of "chronic renal failure" for which no details were known. Based on a diagnosis of scirrhous gastric cancer indicated by upper gastrointestinal series and fiberscopy, he underwent total gastrectomy. The definitive diagnosis was poorly differentiated adenocarcinoma including signet ring cell carcinoma and peritonitis carcinomatosa. He was discharged on postoperative day12 and remains alive 1 year and 3 months undergoing anticancer-agent chemotherapy. The relationship between ADPKD and neoplasm was reported to account for polycystin-1 and polycystin-2 produced from a pathogenesis gene of ADPKD, which is caused by genes mutation in vitro. This is clinically controversial however, and was not reported about gastric cancer. We studied autopsy cases in Japan form 2002 to 2006, which showed no association on sideration about gastric cancer in ADPKD and also showed many nondifferentiated type gastric cancer, it is not ascertained.

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We report a very small sarcomatous hepatocellular carcinoma (HCC) in a patient with no history of anticancer therapy. A 68-year-old woman being followed up for chronic hepatitis C found in abdominal ultrasonography (US) to have a hepatic tumor presenting as a low echoic mass 17 mm in diameter in the right hepatic lobe and containing a cystic region at the tumor center. The margin was well enhanced, but the center was hypovascular in both contrast-enhanced computed tomography and angiography, suggesting HCC, but we were at a loss to explain the central hypovascular area. Microscopically, the tumor consisted mainly of dense fibrous tissue, and well-differentiated HCC was observed at the periphery, yielding a definitive diagnosis of sarcomatous HCC. The tumor center was necrotic. In the six years since surgery, and the woman is alive without recurrence.

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A 60-year-old woman administered intravenous fluid and electrolyte replacement one year for refractory diarrhea, was hospitalized several times for hypokalemia and general muscle weakness. Computed tomography showed a 10 cm pancreatic body tumor. She was referred for hemodialysis after her diarrhea caused renal failure. Suspecting vasoactive intestinal polypeptide-secreting tumor, we attempted unsuccessfully to ease the diarrhea with loperamide hydrochloride and octreotide acetate. Hemodialysis, then continuous hemodialysis with filtration, was introduced against circulatory failure, severe acidosis, and renal failure. Distal pancreatectomy was done as soon as high serum vasoactive intestinal polypeptide was identified. Diarrhea subsided within 2 days of surgery, and she was removed from life-support equipment. Even under life-threatening conditions requiring artificial organ support, including continuous hemodialysis and filtration, tumor resection is the only way to enable patients to resume regular lives.

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Incidental detection of pancreatic tumors has in recent years become more frequent owing to progress made in diagnostic imaging. We report a case of a preoperatively diagnosed intrapancreatic accessory spleen performed limited surgery for not being able to ruled out malignancy of cystic component. A 55-year-old woman with suspected appendicitis underwent computed tomography which detected a cystic lesion with a solid component 3 cm in diameter at the pancreatic tail. We suspected the tumor to be an intrapancreatic accessory spleen because endoscopic ultrasonography showed identical image patterns for both the solid component of the tumor and spleen. Superparamagnetic iron oxide magnetic resonance imaging showed a decrease in signals, and 99mTc-Sn colloid scintigraphy indicated an uptake in both lesions. The patient was given a diagnosis of intrapancreatic accessory spleen, and informed that malignancy could not be ruled out completely upon which she requested surgery. The tumor at the pancreatic tail was soft, brownish, and 3 cm in diameter, and spleen preserving pancreatic tail resection was performed confirming the diagnosis of intrapancreatic accessory spleen by intraoperative frozen section. The postoperative course was uneventful and she was discharged on postoperative day 16. To the best of our knowledge only 9 cases of preoperatively diagnosed intrapancreatic accessory spleen have been reported in the literature, and we therefore report this rare case.

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A sixty nine-year-old woman who had undergone oophorectomy for a right ovarian tumor in November 2004 underwent resection for a tumor 2 cm in diameter arising in Meckel's diverticulum in the ileum 70 cm above the ileocecal valve. Histopathologically, both tumors were diagnosed as moderately differentiated adenocarcinoma. Immunohistochemistry results were as follows: cytokeratin (CK) 7 (-), 20 (+), mucin core protein (MUC) 1 (+), MUC 2 (-), and MUC 5AC (+). CK profiles and MUC expression indicated that the Meckel's diverticulum tumor may be adenocarcinoma arising from ectopic epithelium and that the ovarian tumor was metastatic. After systemic chemotherapy with TS-1 and cisplatin (CDDP), she remains alive for 4 years and 3 months since initial surgery. Of the 46 cases of adenocarcinoma arising in Meckel's diverticulum and reported worldwide since 1950, this is, to our knowledge, the first combined with Krukenberg's tumor. We suspect that this case may have been "ectopic gastric cancer" and successful treatment may lead to a comparatively long survival.

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An 84-year-old man with tarry stool and advanced anemia admitted in an emergency was found in upper gastrointestinal endoscopy, colonoscopy, abdominopelvic enhanced computed tomography (CT), and scintigraphy for gastrointestinal hemorrhaging to have, at least two bleeding sites in the ileocecal region and in the left side of the small intestine. Laparotomy identified a submucosal tumor 20 cm distal from the ligament of Treitz. Intraoperative enteroscopy showed a submucosal tumor at the same site and a small erosion 50 cm proximal to the ileocecal valve and flat elevated lesions at the ascending colon. The jejunum was partially resected for the submucosal tumor, and colectomy was done on the right side with ilectomy for the ileal erosion and flat colonic elevations. Histopathological study showed gastrointestinal stromal tumor (GIST) for the jejunal submucosal tumor, vascular ectasia for the ileal erosion, and tubular adenoma for the flat colonic elevations. Bleeding has not recurred. Enteroscopy was the only procedure enabling ileal vascular ectasia to be diagnosed accurately. In a diagnosis of small-intestinal bleeding, we strongly recommend total enteroscopy for the entire small intestine, including intraoperatively, regardless of tumor existence.

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We report a case of complete intussusception induced by appendiceal cancer with a review of the literature. A 96-year-old woman seen for melena was found in colonofiberscopy and barium enema to have a cecal tumor. Abdominal computed tomography showed a cecal mass with a target sign. Based on a preoperative diagnosis of intussusception with a cecal tumor, we conducted ileocolectomy. Appendiceal intussusception was found intraoperatively and in the postoperative specimen. Microscopic examination showed well-differentiated adenocarcinoma in tubulovillous adenoma localized to the appendix mucosa. Diagnosis of intussusception with carcinoma of the appendix is often difficult because appendiceal carcinoma is rare. Although this disease can be diagnosed by radiographic imaging, colonoscopy, and computed tomography, it should always be considered in diagnosing diseases of the cecum. Minimal surgical intervention should be performed in the event of failure of recognition of lymph node metastasis, because early cancer and cancer in adenoma are reported to be the most probable reasons for appendiceal intussusceptions caused by appendiceal cancer.

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We report a very rare case of multiple cancer and adenomas of Japanese schistosomiasis (JS) indicating colorectal carcinogenesis of JS infection. A 66-year-old man admitted for abdominal pain had lived in Yamanashi Prefecture, an area endemic for JS. He had suffered liver dysfunction at the age of 10 years diagnosed as JS infection. X-ray imaging showed several niveaus indicating mechanical obstruction. Following ileus-tube decompression, colon fiberscopy showed advanced double cancer and one adenoma of the sigmoid colon and another of the rectosigmoid colon. Biopsy showed many JS ova around the cancer and adenomas. We conducted anterior resection with lymph node dissection. Five days after surgery jaundice appeared and was treated conservatively. Liver biopsy showed many JS ova. Such cases of multiple tumor or liver dysfunction thought to be at high risk for colon and liver cancer should be stringently followed up via colon fiberscopy and ultrasound observation.

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A 53-year-old man whose pruritus ani was diagnosed by a dermatologist as Paget's disease and referred for further confirmation was found in total colonoscopy to have a tumor of the anal canal. Biopsies of the erythematous perianal skin lesion and the anal canal tumor showed anal canal adenocarcinoma with pagetoid spread, necessitating abdominoperineal resection with wide excision of the perianal skin. Pathology results showed that poorly differentiated and signet-ring cell adenocarcinoma in the anal canal invaded the muscularis propria and Paget cells occupied the perianal epidermis. Immunohistochemical staining was positive for cytokeratin (CK) 20, but negative for CK7 and gross cystic disease fluid protein 15 (GCDFP-15). The definitive diagnosis was anal canal adenocarcinoma with pagetoid spread. Although 42 cases, including ours, of rectal and anal adenocarcinoma with pagetoid spread have been reported, the prognosis remains unknown, making it essential to closely observe perianal skin changes and to biopsy skin lesions.

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We report a case of adult mesenteric pseudocyst. A 76-year-old man admitted for a palpable, growing abdominal mass and bilateral edema in lower extremities was found in abdominal computed tomography to have an apparently unilocular 21×14×20 cm cyst. Abdominal magnetic resonance imaging showed the cyst to be of low intensity in T1 weighed imaging and high intensity in T2 weighed imaging. Based on a preoperative diagnosis of an abdominal cyst strongly suspected of being a hepatic cyst, we conducted laparoscopic surgery, finding cystic mass in the gastrocolic ligament and resecting it. Histologically, the cyst wall consisted of fibrous tissue lacking epithelial lining in the lumen, typical of pseudocysts. We review 17 cases of mesenteric pseudocysts, including 2 cases involving laparoscopic surgery, reported in the Japanese literature.

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