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Volume 46, Issue 5
Displaying 1-11 of 11 articles from this issue
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ORIGINAL ARTICLE
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Takanori Konishi, Nobuhiro Takiguchi, Hiroaki Soda, Matsuo Nagata, Yos ...Article type: ORIGINAL ARTICLE
2013 Volume 46 Issue 5 Pages 317-324
Published: May 01, 2013
Released on J-STAGE: May 15, 2013
JOURNAL FREE ACCESS FULL-TEXT HTMLPurpose: There is no consensus regarding indications for additional surgery in postgastrectomy patients with gastric cancer with resection margin involvement. In this study, we examined cases with resection margin involvement at our hospital in order to determine the most appropriate treatment strategy. Methods: Fifty-nine cases with resection margin involvement after surgery for gastric cancer between January 2000 and September 2010 were analyzed clinicopathologically. Results: Positive resection margins were seen in 3.3% of cases, and the highest rate was seen in Stage IV disease. Additional surgery was performed in 3 out of 5 cases with early gastric cancer, and residual cancer was observed in 2 cases. Seventeen Stage II·III cases included significantly elevated numbers of large tumors, lymph node metastasis, invasion depth of serosa, and undifferentiated adenocarcinoma. Additional surgery was performed in 2 cases and chemotherapy was performed in 15 cases. The rate of distant recurrence within 2 postoperative years was 25% in Stage II, 42% in Stage IIIA, and 67% in Stage IIIB. Additional surgery was not performed in 37 cases of Stage IV advanced gastric cancer. Conclusion: Stage I patients may be considered as candidates for additional surgery. On the other hand, additional surgery is not recommended for Stage IV patients. Many cases of Stage II·III have high risk of distant recurrence. Indication for additional surgery is limited, and chemotherapy was performed in many cases. For Stage II·III patients, assessment for the need of additional surgery should be based on histopathological findings.View full abstractDownload PDF (1007K) Full view HTML
CASE REPORT
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Yasutomo Nagasue, Tsuyoshi Konishi, Masami Arai, Keiko Taki, Masashi U ...Article type: CASE REPORT
2013 Volume 46 Issue 5 Pages 325-333
Published: May 01, 2013
Released on J-STAGE: May 15, 2013
JOURNAL FREE ACCESS FULL-TEXT HTMLGastric juvenile polyposis is a rare disease without specific colorectal lesions, and accordingly, clinical diagnosis is extremely hard. Recent studies have elucidated the close association between this rare disease and germline SMAD4 mutations. Here, we report a case of gastric juvenile polyposis successfully diagnosed by identification of a germline SMAD4 mutation. A 42-year-old Japanese woman was referred to our hospital for chronic anemia and hypoalbuminemia refractory to medical treatment. Before referral to our hospital, the patient received steroids under the diagnosis of Cronkhite-Canada syndrome, which failed to improve the symptoms. Endoscopic examination revealed numerous gastric polyps covered with abundant mucus throughout the stomach. Colonoscopy revealed no specific findings in the colorectum. The patient received laparoscopy-assisted total gastrectomy. Histopathological examination of the stomach did not reach definite diagnosis. However, gene analysis successfully identified a novel germ line SMAD4 mutation (c. 904delT [p. Trp302fsX34]), which confirmed diagnosis of gastric juvenile polyposis. The present case suggests efficacy of mutation analysis for germline SMAD4 mutations when gastric juvenile polyposis is suspected.View full abstractDownload PDF (2174K) Full view HTML -
Masatsugu Kojima, Hiroshi Yamamoto, Satoshi Ugi, Satoshi Murata, Tsuyo ...Article type: CASE REPORT
2013 Volume 46 Issue 5 Pages 334-341
Published: May 01, 2013
Released on J-STAGE: May 15, 2013
JOURNAL FREE ACCESS FULL-TEXT HTMLA 33-year-old obese woman was given a diagnosis of type 2 diabetes mellitus (T2DM) at 15 years of age and had been treated with insulin for 8 years. Laparoscopic sleeve gastrectomy (LSG) was performed because of the poor control of T2DM and obesity. After LSG, T2DM rapidly improved to normal glucose tolerance, so that insulin and oral hypoglycemic agents were discontinued. However, the glucose tolerance worsened gradually. Eleven months after the surgery, she was given dipeptidyl peptidase-4 (DPP-4) inhibitor and the glucose tolerance improved. Not only weight loss but also gastrointestinal hormones including ghrelin and glucagon-like peptide-1 (GLP-1) may play important roles in the improvement of glucose tolerance after LSG. In cases where the glucose tolerance becomes worse after LSG, the DPP-4 inhibitor would be a significant choice of treatment.View full abstractDownload PDF (1621K) Full view HTML -
A Resected Case of Carcinoid Tumor of Vater’s Papilla in a Patient with von Recklinghausen’s DiseaseYuji Shishido, Tadafumi Asaoka, Atsushi Miyamoto, Kazuyoshi Yamamoto, ...Article type: CASE REPORT
2013 Volume 46 Issue 5 Pages 342-349
Published: May 01, 2013
Released on J-STAGE: May 15, 2013
JOURNAL FREE ACCESS FULL-TEXT HTMLIt has been known that von Recklinghausen’s disease (VRD) is often associated with gastrointestinal disease. We report a very rare case of carcinoid of Vater’s papilla in a patient with VRD. A 50-year-old man visited our hospital to investigate the cause of the elevation in serum hepatobiliary enzymes. Abdominal CT scan demonstrated the dilation of intrahepatic bile duct. A 15-mm tumor was found at Vater’s papilla by endoscopy and an endoscopic biopsy was performed. No malignant findings were detected pathologically, but clinically, there was a possibility of carcinoma or carcinoid of Vater’s papilla. He underwent a pylorus-preserving pancreatoduodenectomy. Pathologic examination of the isolated specimen revealed a carcinoid tumor in Vater’s papilla. In addition, he had café-au-lait spots and multiple neurofibromatosis at the precordia region, and carcinoid tumor of Vater’s papilla associated with VRD was diagnosed.View full abstractDownload PDF (2621K) Full view HTML -
Yoshiki Chinen, Yasuharu Ikeda, Kenichi Taguchi, Kippei Ohgaki, Shinic ...Article type: CASE REPORT
2013 Volume 46 Issue 5 Pages 350-355
Published: May 01, 2013
Released on J-STAGE: May 15, 2013
JOURNAL FREE ACCESS FULL-TEXT HTMLWe report a case of liver pseudotumor that consisted of blue liver that was caused by an adverse effect of chemotherapy. A 45-year-old woman was given a diagnosis of rectal cancer and underwent a laparoscopic high anterior resection with D3 lymph nodes dissection. As adjuvant chemotherapy, she received 9 courses of modified FOLFOX6. Enhanced abdominal CT scan, at 6 postoperative months, showed low-density areas in the liver of segments 5/8 and segment 4. MRI revealed the same findings, suggesting metastatic lesions, therefore we performed a hepatic resection. Operative findings showed congestive lesions in S5/8. The frozen section of the area demonstrated sinusoidal dilatation without malignancy. Permanent specimens confirmed the lesions as pseudotumor consisting of blue liver. In this case, it was difficult to differentiate the metastatic liver tumor from the pseudotumor by modern imaging modalities such as CT and MRI.View full abstractDownload PDF (2691K) Full view HTML -
Hidetaka Sugihara, Akira Chikamoto, Shin-ichi Akaboshi, Hiroyuki Komor ...Article type: CASE REPORT
2013 Volume 46 Issue 5 Pages 356-361
Published: May 01, 2013
Released on J-STAGE: May 15, 2013
JOURNAL FREE ACCESS FULL-TEXT HTMLA 51-year-old woman was referred to our hospital with a liver tumor detected by abdominal screening. Computed tomography demonstrated a low-density area located in segments 4 and 8 of the liver, and its peripheral area was stained strongly in the early phase and slightly in the late phase, while the central part was not enhanced in the both phases. With a diagnosis of intrahepatic cholangiocarcinoma (ICC) or combined type hepatocellular carcinoma, left medial sectionectomy and segment 8 segmentectomy of the liver was performed. On pathological examination, there were two components of cell differentiation. In the peripheral areas of the tumor, histological features corresponded to the bile duct adenoma (BDA). In the central component, the feature corresponded to the ICC. There was a transition between the BDA and ICC. p53-immunostaining was performed. The nuclei of the BDA component were stained less than those of the ICC component. The present case shows an ICC that developed in a BDA, which may indicate that there is an adenoma-carcinoma-sequence in ICC.View full abstractDownload PDF (1385K) Full view HTML -
Mitsuyoshi Okazaki, Ryuichiro Suto, Kensuke Miyazaki, Masaaki Hidaka, ...Article type: CASE REPORT
2013 Volume 46 Issue 5 Pages 362-368
Published: May 01, 2013
Released on J-STAGE: May 15, 2013
JOURNAL FREE ACCESS FULL-TEXT HTMLA 75-year-old woman was referred to our hospital with vague epigastric pain. At age 53, she was suspected to have a benign tumor of the pancreas head, and pancreaticoduodenectomy was performed. At that time, a pancreatic tumor producing somatostatin was diagnosed. At age 55, a partial hepatectomy was performed, and she was given a diagnosis of liver metastasis of the tumor producing somatostatin. Acute exacerbation of chronic pancreatitis was finally diagnosed, and abdominopelvic computed tomography revealed a 28×20 mm low density mass and a hypervascular lesion in the left lateral segment of the liver (S3). Based on a preoperative diagnosis of liver metastasis of an endocrine tumor, we performed a segmentectomy in the patient at her most recent referral. A histological examination of the specimen demonstrated another liver metastasis from the tumor producing somatostatin. Tumors producing somatostatin are extremely rare endocrine tumors mainly found in the pancreas or duodenum. We report a case of a long-term survivor of a pancreatic tumor producing somatostatin with liver metastasis treated by partial hepatectomy two and 22 years after initial surgery.View full abstractDownload PDF (1485K) Full view HTML -
Daisuke Takeuchi, Naohiko Koide, Akira Suzuki, Fumiaki Shimizu, Shinic ...Article type: CASE REPORT
2013 Volume 46 Issue 5 Pages 369-376
Published: May 01, 2013
Released on J-STAGE: May 15, 2013
JOURNAL FREE ACCESS FULL-TEXT HTMLWe report on 2 cases of intra-abdominal desmoid tumor mimicking locoregional recurrence after gastrectomy for early gastric cancer. Case 1: A 66-year-old woman underwent a distal gastrectomy with D2 lymph node dissection for gastric cancer. Pathological diagnosis was pT1a (m) pN0 cM0: pStage IA. Abdominal CT showed a tumor near the residual stomach 12 months after surgery. The tumor size increased, and PET showed a mild uptake of fluorodeoxyglucose (FDG). Because we could not deny the possibility of recurrence from gastric cancer, the tumor was removed. The histological diagnosis was desmoid tumor. Case 2: A 72 year-old woman underwent a distal gastrectomy with D2 lymph node dissection for gastric cancer. Pathological diagnosis was pT1a (m) pN0 cM0: pStage IA. Abdominal CT showed a tumor near the residual stomach 16 months after surgery. The tumor was removed, and histological diagnosis was desmoid tumor. In gastric cancer patients after gastrectomy, it is difficult to distinguish desmoid tumor from recurrence of gastric cancer. When the possibility of recurrence is low, surgical resection as a diagnostic treatment should be recommended.View full abstractDownload PDF (2086K) Full view HTML -
Naoya Kawakita, Yasuo Fukui, Kazuyuki Oishi, Akihito Koduki, Fuminori ...Article type: CASE REPORT
2013 Volume 46 Issue 5 Pages 377-384
Published: May 01, 2013
Released on J-STAGE: May 15, 2013
JOURNAL FREE ACCESS FULL-TEXT HTMLActinomycosis of the ileocecal region, which is a favored site for abdominal actinomycotic infection, is often difficult to diagnose and treat in the presence of any complication. We report a case of ileocecal actinomycosis after chemoradiotherapy for uterine cervical cancer. A 46-year-old woman received chemoradiotherapy for uterine cervical cancer in September 2009. A positron emission tomography-computed tomography (CT) examination in May 2010 showed abnormal fludeoxyglucose accumulation in the pelvic lymph nodes and on the dorsal side of the ascending colon; therefore, we suspected recurrence of uterine cervical cancer. The patient presented at our hospital with a complaint of pain in the right lower abdomen in June 2010. Abdominal CT examination showed a periappendiceal abscess. Blood tests suggested an inflammatory reaction. Because of signs of peritoneal irritation, the patient underwent emergency surgery and ileocecal resection. Histopathological examination indicated actinomycosis. The patient started taking ampicillin orally for 6 months. At the same time, she received anticancer drug therapy for uterine cervical cancer. Actinomycosis did not worsen during cancer treatment.View full abstractDownload PDF (1496K) Full view HTML -
Masaya Suenaga, Toshiaki Mori, Akiharu Ishiyama, Kazuki Yokoi, Yuichi ...Article type: CASE REPORT
2013 Volume 46 Issue 5 Pages 385-392
Published: May 01, 2013
Released on J-STAGE: May 15, 2013
JOURNAL FREE ACCESS FULL-TEXT HTMLA 46-year-old woman was admitted because of abdominal pain. She was given a diagnosis of a ruptured right ovarian tumor. Abdominal computed tomography and magnetic resonance imaging showed an 8-cm cystic tumor in the right ovary, which was strongly suspected of malignancy. Endoscopic and radiological examinations revealed protruded lesion of the sigmoid colon. Invasion of the right ovarian cancer was considered, and surgery was performed. Intraoperative findings of a right ovarian tumor and a sigmoid colon tumor were separately demonstrated, necessitating total hysterectomy and bilateral salpingo-oophorectomy and sigmoidectomy, respectively. Histological examination revealed adenocarcinoma cells which were positive for ER and PgR in the specimen of the sigmoid colon. Endometrial glands were seen in proximity to the adenocarcinoma cells. The histological diagnosis was endometrioid adenocarcinoma, which was called generically endometriosis-associated intestinal tumor (EAIT). Moreover, the right ovarian tumor was histologically diagnosed as endometrioid adenocarcinoma. These were considered not metastases but double cancer because each tumor had endometrial glands. We report a very rare case of EAIT, which developed with ovarian endometrioid carcinoma.View full abstractDownload PDF (1488K) Full view HTML
CLINICAL EXPERIENCE
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Satoru Matono, Toshiaki Tanaka, Naoki Mori, Takeshi Nagano, Hiromasa F ...Article type: CLINICAL EXPERIENCE
2013 Volume 46 Issue 5 Pages 393-399
Published: May 01, 2013
Released on J-STAGE: May 15, 2013
JOURNAL FREE ACCESS FULL-TEXT HTMLBackground: Esophageal stenosis and/or fistula often occur after chemoradiotherapy (CRT) for unresectable esophageal cancer. In such patients, an esophageal stent can help achieve oral intake. However an esophageal stent cannot be inserted where there is complete stenosis or where the tumor is located. In such cases, esophageal bypass surgery may be necessary. Here, we investigated the clinical characteristics and outcomes in patients who underwent esophageal bypass surgery in our institution. Patients: We reviewed 10 cases of esophageal bypass surgery (gastric tube in 8 cases, colon in 2 cases) after CRT for unresectable esophageal cancer, between 2001 and 2009. Results: There were 5 of stenosis-only cases, 4 fistula-only cases, and 1 case of stenosis and fistula. There were postoperative complications in 5 cases (50%), and all these were treated conservatively and healed. The median survival from surgery to peroral intake was 20 days (range 9–90 days), and the median survival after starting peroral intake was 130 days (range 48–293 days). Conclusions: Esophageal bypass surgery can achieve good performance status and improve peroral intake.View full abstractDownload PDF (1143K) Full view HTML
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