A 59-year-old man underwent distal pancreatectomy and splenectomy for Intraductal Papillary Mucinous Carcinoma (IPMC) with minimal invasion in April 1999. As a cystic tumor at the stump of the remnant pancreas was revealed, partial resection of the remnant pancreas was performed in November 2002. The pathological diagnosis was invasive pancreatic cancer derived from IPMC. In July 2004, total resection of the remnant pancreas and duodenectomy was performed for invasive pancreatic cancer in the unchus of the pancreas. As patients with invasive IPMCs have high risk of recurrence and have possibilities of occurrence of ordinary-typed pancreatic cancer, we should be careful in the follow-up of these patients.

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Neuroendocrine carcinoma of the pancreas, especially presented with hematemesis is rare. We experienced a case of pancreas neuroendocrine carcinoma, nonfunctioning, presented with hematemesis. A 64-year-old man complaining of hematemesis was suspected to have hemorrhage from a gastrointestinal stromal tumor of the stomach and he was emergently transferred to our hospital. Cancer of the pancreatic body and tail was diagnosed by preoperative MRI and PET-CT scan. We considered that his hematemesis was caused by bleeding from gastric varices which had been formed by sinistral portal hypertension due to invasion of the pancreatic cancer to the splenic vein. The ridge like a submucosal tumor might be due to the compression by the pancreatic cancer. Distal pancreatectomy was performed. The histological diagnosis was well differentiated neuroendocrine carcinoma of the pancreas, nonfunctioning.
Pancreatic cancer is often associated with upper gastrointestinal lesions like in this case. It would be necessary to consider the possible presence of some pancreatic disease if esophagogastric varices are observed without liver dysfunction.

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We report a case of a huge cyst in the mesentery of the transverse colon, which was histologically confirmed with the diagnosis of cystic lymphangioma. A cystic mass in the pelvic cavity was pointed out in a 29-year-old woman when she consulted a gynecologist for primary sterility. She was diagnosed with a huge mesenteric cyst by UCG, CT and MRI. Laparotomy showed a 15×11×8 cm multiloculated mass in the transverse mesocolon. The tumor was excised with a partial resection of the transverse colon. Histological findings showed that the cyst was lined by flat endothelial epithelium, which was positive for D2-40 in immunohistochemistry. This case was reviewed and compared with similar case reports of mesenteric cyst.

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A 60-year-old woman admitted to the hospital because of general fatigue and abdominal distention was found in upper gastrointestinal series to have a compression of the stomach. Abdominal computed tomographic scan showed a giant splenic cyst and an enlarged appendix with massive ascites, yielding a diagnosis of pseudomyxoma peritonei with the lesion in the spleen. Laparotomy was carried out. Operative findings showed perforation of the appendix with a large amount of mucus which was jelly-like. The spleen was enlarged to the size of an infant's head and mucus was retained inside of it. We performed ileocectomy and splenectomy followed by irrigation with sodium bicarbonate. Histopathologically, it was diagnosed as mucinous cystic tumor of the appendix, associated with metastasis in the spleen.

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A 54-year-old man was referred to our hospital for clinical evaluation of a retroperitoneal mass. Subsequent ultrasonography and CT scan demonstrated that a well circumscribed tumor was located between the abdominal aorta and the left kidney, and its inside appeared markedly heterogenous. MRI imaging also demonstrated that the tumor was associated with cystic degeneration inside. The vascurality of the tumor was not abundant on angiography, and FDG was not significantly accumulated in the tumor on PET-CT. Results of image analysis suggested the diagnosis of neurogenic tumor but the possibility of other lesions could not be ruled out. The surgical removal of the tumor was performed and macroscopically the tumor appeared to be derived from the sympathetic trunk. Subsequent histological analysis revealed that the tumor was benign Schwannoma associated with hyalinization, calcification including ossification, cystic degenerations, intratumoral hemorrhage and other degenerative changes arising from the paraaortic symphathetic trunk because of the presence of ganglion cells located at the periphery of the tumor.
Schwannoma is a tumor derived from the Schwann cells surrounding the peripheral nerves. But this case was so rare because we could not found the case of Schwannoma arising from the paraaortic symphathetic trunk has been reported in Japan so far.

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A 31-year-old male visited our hospital due to pain in the left flank. On CT, a mass, about 10 cm in size, was noted in the lower abdomen. Laboratory examinations suggested the presence of inflammation ; the serum AFT was increased (13,000 ng/ml). Despite various examinations, a definite diagnosis could not be made. The patient's pain gradually worsened and emergency surgery was done. On histopathology, findings consistent with testis tissue and a mixed germ cell tumor were found, the tumor measured 10 × 8 × 8 cm in size. Since the patient had nomal testes on both sides, a diagnosis of polyorchidism with torsion of the pedicle was made. Only 29 cases of polyorchidism have been reported in the Japanese literature to date.

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