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Volume 45, Issue 12
Displaying 1-10 of 10 articles from this issue
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CASE REPORT
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Katsuji Hisakura, Hideo Terashima, Kentaro Nagai, Keisuke Kohno, Sosuk ...Article type: CASE REPORT
2012 Volume 45 Issue 12 Pages 1145-1152
Published: December 01, 2012
Released on J-STAGE: December 14, 2012
JOURNAL FREE ACCESS FULL-TEXT HTMLIt has been reported that proton beam therapy is an effective treatment method for patients with locally confined esophageal cancer. However, there seems to be serious problems related to post-radiotherapy (RT) esophageal ulcers. We treated 7 patients who developed post-RT esophageal ulcers with the earliest symptom of esophageal stenosis, which was observed 7–17 months (median, 10.0) after completion of RT. Five of the patients had unhealed ulcers leading to lethal events such as perforation or penetration. The mean time between the appearance of the earliest symptom and lethal episode was no more than 2 months (mean, 2.1). The first 3 patients who underwent conservative therapies died from severe complications caused by perforation or penetration of post-RT esophageal ulcers. In the case of 2 consecutive patients, we performed surgical treatment as soon as possible since there were indications of penetration in post-RT developed esophageal ulcers. Therefore, they could be cured by a salvage operation which was subtotal esophagectomy using the stomach for esophageal replacement. Through the above-mentioned experience, we discussed surgical management for esophageal ulcers after proton beam therapy.View full abstractDownload PDF (1529K) Full view HTML -
Yushi Yamakawa, Hiroshi Sato, Kimihide Kusafuka, Haruhiko Kondo, Yasuh ...Article type: CASE REPORT
2012 Volume 45 Issue 12 Pages 1153-1160
Published: December 01, 2012
Released on J-STAGE: December 14, 2012
JOURNAL FREE ACCESS FULL-TEXT HTMLA 61-year-old asymptomatic woman, who was given a diagnosis of submucosal tumor in the middle thoracic esophagus by endoscopic examination, was referred to our institution. Chest CT revealed a well-defined cystic mass that was located behind the tracheal bifurcation. The diagnosis of duplication cyst was made preoperatively by endoscopic ultrasonography based on the contiguity of the muscularis propria of the esophagus with the muscle layer of the cyst wall. A posterolateral thoracotomy was successfully performed, and the mass was completely removed along with a portion of the muscular layer of the esophagus. A pathological examination revealed a cystic mass with both a muscular layer and squamous epithelium, and the final diagnosis was an esophageal duplication cyst.View full abstractDownload PDF (1503K) Full view HTML -
Takahiro Kamiga, Ryoichi Anzai, Hiroaki Tanno, Takuya Moriya, Michiaki ...Article type: CASE REPORT
2012 Volume 45 Issue 12 Pages 1161-1169
Published: December 01, 2012
Released on J-STAGE: December 14, 2012
JOURNAL FREE ACCESS FULL-TEXT HTMLA 53-year-old man was seen in our hospital for examination of a tumor in the hepatic left lobe. Upper gatrointestinal endoscopy detected a type-3 tumor with deep ulceration in the anterior wall of the upper gastric corpus. Biopsy of the tumor yielded a diagnosis of moderately differentiated adenocarcinoma. Abdominal enhanced CT revealed a tunicate tumor in the small omentum, connecting to the gastric wall via gastric cancer. The tumor had fatty tissue, cystic lesions and fine calcification on diagnostic clinical imaging. We diagnosed the tumor in the small omentum as gastric teratoma. Based on the diagnosis of gastric cancer and gastric teratoma, we performed total gastrectomy and splenectomy. Pathological findings showed gastric cancer in a gastric true diverticulum and a mature gastric teratoma with no malignancy. The gastric diverticulum had resulted from traction of the exogastric teratoma. Both gastric teratoma in adults and gastric cancer in gastric diverticula are rare. To the best of authors’ knowledge, gastric teratoma associated with gastric cancer in a gastric diverticulum has not been reported previously.View full abstractDownload PDF (2723K) Full view HTML -
Masayoshi Iwamoto, Naohiko Nakamura, Hideki Harada, Fumiaki Yotsumoto, ...Article type: CASE REPORT
2012 Volume 45 Issue 12 Pages 1170-1179
Published: December 01, 2012
Released on J-STAGE: December 14, 2012
JOURNAL FREE ACCESS FULL-TEXT HTMLA 45-year-old man was admitted to our hospital because of epigastric pain. Upper gastrointestinal endoscopy revealed several ulcers in the lesser curvature of the body and antrum of the stomach. Histologic analysis of biopsy specimens revealed T-cell type lymphoma. Anti-HTLV-1 antibody was positive in serum. Abnormal lymphocytes were not found in either peripheral blood or bone marrow. CT and PET showed no lymph node swelling or metastasis to other organs, except to the lymph nodes around the stomach. Primary gastric lymphoma was diagnosed, and we performed total gastrectomy, cholecystectomy with D2 lymph node dissection. HTLV-1 proviral DNA was positive in the resected specimen but negative in the peripheral blood, so he was given a diagnosis of HTLV-1 associated primary gastric lymphoma. After surgery, he was treated with 6 cycles of THP-COP as adjuvant chemotherapy, and he is alive without recurrence at 27 months. Treatment strategy for HTLV-1 associated primary gastric lymphoma has not been established because of its extremely rare occurrence. Further accumulation of cases is needed to establish a strategy for treating such conditions.View full abstractDownload PDF (2421K) Full view HTML -
Daisuke Fujimoto, Shiho Kono, Takuro Terada, Takeshi Mitsui, Yasuni Na ...Article type: CASE REPORT
2012 Volume 45 Issue 12 Pages 1180-1185
Published: December 01, 2012
Released on J-STAGE: December 14, 2012
JOURNAL FREE ACCESS FULL-TEXT HTMLA 67-year-old woman, who had been diagnosed and treated with acute pancreatitis, was referred to our hospital to determine the cause of acute pancreatitis. Pancreaticobiliary maljunction without bile duct dilatation was diagnosed on endoscopic retrograde cholangiopancreatography (ERCP). Moreover, she was found to have an irregular thickened gallbladder fundus wall, suggestive of carcinoma, on abdominal computed tomography (CT). She underwent an extended choleocystectomy. The pathological examinations confirmed that the mucosa showed papillary hyperplasia (PHP) in the gallbladder neck and body, but in the gallbladder body and fundus, the mucosa showed dysplasia and carcinoma in situ. In this case, multistep carcinogenesis was found with a background of papillary hyperplasia. We think that this case suggests the process of carcinogenesis in pancreaticobiliary maljunction.View full abstractDownload PDF (1201K) Full view HTML -
Tsuyoshi Ichikawa, Masao Ogawa, Masayasu Kawasaki, Koichi Demura, Kats ...Article type: CASE REPORT
2012 Volume 45 Issue 12 Pages 1186-1193
Published: December 01, 2012
Released on J-STAGE: December 14, 2012
JOURNAL FREE ACCESS FULL-TEXT HTMLA 71-year-old woman who complained of vomiting was admitted to our hospital because abdominal computed tomography detected bowel obstruction due to gallstone. C reactive protein markedly elevated although white blood cell counts were not elevated, and serum concentrations of CEA and CA19-9 were within normal range. Gastrointestinal imaging showed cholecystduodenal fistula, aircholangiogram, and gallstone in the ileum. We diagnosed gallstone ileus. An ileus catheter was inserted, and surgery was performed when renal function recovered. A gallstone 3 cm in diameter was found in the ileum 100 cm on the oral side of the ileocecal valve, and atrophic gallbladder with cholecystoduodenal fistula was found. We performed cholecystectomy with resection of the fistula and removed the gallstone in the small intestine. Microscopically, cancer cells were found in the gallbladder mucosa, and immunohistochemically, cancer cells were positive for p53 antibody and MIB-1 antibody respectively. Pseudo-pyloric gland type metaplasia was found in non-tumorous mucosa, however intestinal metaplasia was not found. Finally, intramucosal gallbladder carcinoma was diagnosed, and the surgical margin was positive. Additionally, a curative resection was performed after 2 months from the first operation. Biliary carcinoma must be carefully considered in patients with internal biliary fistula.View full abstractDownload PDF (2079K) Full view HTML -
Atsushi Hirose, Hidehiro Tajima, Isamu Makino, Hironori Hayashi, Hisat ...Article type: CASE REPORT
2012 Volume 45 Issue 12 Pages 1194-1201
Published: December 01, 2012
Released on J-STAGE: December 14, 2012
JOURNAL FREE ACCESS FULL-TEXT HTMLA 62-year-old man admitted to another hospital suffered severe diarrhea, high blood sugar and hyperketonemia in December 2010. He had been treated for diabetes for 10 years and deformation of the pancreas was pointed out in 2007. After various examinations, pancreatic VIPoma with a metastatic lesion in the liver was diagnosed and he was transferred to our hospital in January 2011. Although it was possible to control electrolytes and dehydration, watery diarrhea could not be controlled. Our examinations further revealed concurrent cholecystolithiasis and choledocolithiasis, thus we decided to treat surgically. In early February, distal pancreatectomy with splenectomy, partial hepatectomy, cholecystectomy and choledocolithotomy were performed. Diarrhea reduced after the tumor resection and stopped on the first postoperative day. Serum VIP levels declined significantly after three hours from resection, and hyperglycemia, face flushing and hypercalcemia improved by the third post operation day.View full abstractDownload PDF (1390K) Full view HTML -
Yousuke Kuroda, Yuichirou Nakashima, Takanobu Masuda, Seiji Maruyama, ...Article type: CASE REPORT
2012 Volume 45 Issue 12 Pages 1202-1209
Published: December 01, 2012
Released on J-STAGE: December 14, 2012
JOURNAL FREE ACCESS FULL-TEXT HTMLWe report two cases of invasive pancreatic cancer smaller than 30 mm in diameter which were suggested to be derived from small intraductal papillary mucinous neoplasm (IPMN). The patient in case 1 was a 67-year-old man, and a 17 mm branched IPMN was detected close to a pancreatic cancer. Pancreaticoduodenectomy was performed and the two tumors were histologically revealed to be adjacent to each other. Transitional features were also detected at the boundary. The patient in case 2 was a 59-year-old man, who had been followed for a 25 mm branched IPMN at the uncus of the pancreas for two years. The solitary pancreatic cancer close to this IPMN had been newly detected and pancreaticoduodenectomy was performed. Histologically, the cystic lesion contained components of IPMN and invasive adenocarcinoma. International consensus guidelines for the management of IPMN shows the indications for resection of branched duct IPMNs as those fitting the following 5 conditions, namely, larger than 30 mm in size, the presence of a mural nodule, cytologically positive pancreatic juice, dilatated main pancreatic duct, or symptomatic. However, similar to both of these two cases, invasive pancreatic cancer can be derived from small branched duct IPMN without any mural nodule. Careful attention is thus required to follow IPMNs.View full abstractDownload PDF (3614K) Full view HTML -
Maiko Ito, Izuru Endo, Hiroki Ohtani, Masatoshi Kubo, Tetsunobu Udaka, ...Article type: CASE REPORT
2012 Volume 45 Issue 12 Pages 1210-1217
Published: December 01, 2012
Released on J-STAGE: December 14, 2012
JOURNAL FREE ACCESS FULL-TEXT HTMLWe report a case of a 44-year-old man who developed shock due to massive bleeding from multiple jejunal diverticula. He was admitted to our hospital with massive melena. CT scan revealed extravasation in a lumen protruding from the jejunum, suggesting bleeding from the jejunal diverticula. The bleeding site could not be revealed from double balloon endoscopy and radiologic enteroclysis, but instead revealed multiple jejunal diverticula. Laparotomy was performed and multiple jejunal diverticula on the mesenteric border were distributed throughout the small intestine. A jejunal diverticulum with a diameter of approximately 3 cm, located at about 770 cm proximal to the terminal ileum, was thought to be the source of bleeding. A segment of the jejunum containing the large diverticulum was resected. Microscopic findings revealed the mucosal ulceration on the muscular layer in the jejunal diverticula, suggesting that the bleeding originated from the true diverticula.View full abstractDownload PDF (1264K) Full view HTML -
Masato Ohara, Taku Omura, Kazuaki Hatsugai, Tadashi Ishii, Iwao KanedaArticle type: CASE REPORT
2012 Volume 45 Issue 12 Pages 1218-1223
Published: December 01, 2012
Released on J-STAGE: December 14, 2012
JOURNAL FREE ACCESS FULL-TEXT HTMLA 65-year-old man with a high aortic occlusion was found to be positive for fecal occult blood. Colonoscopy showed a Isp polyp with a central ulcer in the sigmoid colon, which suggested cancer in adenoma. On computed tomography, the mass didn’t invade nor metastasize to the surrounding organs (c stageI). 3D-CT angiography revealed that IMA provided collateral flow from the Riolan arcades. We safely performed sigmoidectomy with D1 radical dissection to avoid ischemia of the anastomosis. The patient’s postoperative course was uneventful, and the patient was discharged on the 7th POD.View full abstractDownload PDF (1901K) Full view HTML
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