A 52-year-old man undergoing distal gastrectomy for gastric cancer in July 1998 was found to have a 0-IIa type gastric tumor near EC junction in January 2005. Histological examination showed the tumor was moderately differentiated adenocarcinoma. As the tumor was diagnosed as mucosal cancer, endoscopic mucosal dissection was performed. But pathological findings showed the depth of cancer cell invasion into deep submucosal layer. Then total resection of remnant stomach was performed. Both tumors were diagnosed as EBV-associated carcinoma. It is speculated that the mucosa changing after initial operation would give risk to a new occurrence of EBV-associated remnant gastric carcinoma. And then follow up after operation is important. Although some cases of EBV-associated remnant gastric carcinoma is found for short period after the primary surgery, our case second primary cancer was found 7 year after primary surgery. Long term follow-up by Endoscopy seems to be important.
We describe a case of 41-year-old Japanese man with Crohn's ileocolitis and cytomegalovirus infection, confirmed by histology of ileal ulcers. Although his colonoscopic and radiological features resembled those of intestinal tuberculosis, granulomas of typical Crohn's disease were evident on histology of biopsy specimens taken from the duodenum and colon. The lesions remain unchanged even after 1.5 years by oral administration of salazosulphapyridine 3g daily.
A 74-year-old woman was admitted to our hospital to treat her hepatocellular carcinoma (stage IVB) with multiple lung metastases. She was treated with 3 times of hepatic arterial infusion of cisplatin powder (IA-call®). After the treatment, liver mass and lung tumors were disappeared and high levels of tumor markers (AFP and PIVKA-II) were markedly decreased. These data revealed that a complete response (CR) was obtained for her. She has still been maintained in CR for 2 years since the first treatment.
A 69-year-old man complaining of enlarged cervical mass, appetite loss and lower abdominal pain was found to have abdominal tumors in heaps forming a large mass around the retroperitoneum. The biopsy specimen in the cervical mass showed undifferentiated carcinoma with neuroendocrine feature. This malignancy followed a poorly aggressive course and caused death in only 24 hospital days. The disease was diagnosed as undifferentiated neuroblastoma arising in the retroperitoneum by autopsy with appropriate immunohistochemical studies. Adult neuroblastoma in the peritoneum is rare and our case showed a aggressive behavior and unfortunate outcome.
A 16-year-old man was admitted to our hospital with nausea, general fatigue, and consciousness disturbance along with extreme hyperammoniemia eight days after the onset of symptoms. Familial history and the high concentration of orotic acid in urine lead us to a diagnosis of OTCD. We immediately initiated intensive treatment such as continuous hemodiafiltration and sodium benzoate administration;however, the patient died twelve days after admission. Since OTCD is not so rare and can be found in all ages, it should be considered fundamental for evaluation of hyperammoniemia. This case suggested that for a better prognosis of OTCD patients it is very important to prevent such an onset, and to make an as early as possible diagnosis and start to treatment.
When a 32-year-old man was 18 a traffic accident caused splenic rupture, for which he underwent splenectomy, complicated postoperatively by hepatitis. As part of routine follow-up with his family doctor for chronic hepatitis C, a hepatic tumor was detected on plain abdominal computed tomography (CT), and he was admitted to our hospital for further investigation and treatment. Based on the results of abdominal dynamic CT, abdominal magnetic resonance imaging(MRI), abdominal angiography, CT during hepatic arteriography (CTHA) and CT during arterial portography (CTAP), we performed a laparotomy for suspected hepatocellular carcinoma. The operative findings were a 40mm dark purple-brown nodule on the surface of the S7 segment of the liver, as well as multiple nodules, less than 20mm in size but otherwise of similar appearance, scattered over the abdominal viscera and peritoneum, in particular the greater omentum. A hepatectomy was not performed, as we considered this to be a case of intrahepatic splenosis, so the abdomen was closed after a liver biopsy was taken. Histopathological examination of this specimen confirmed the diagnosis. As there have been only 19 previous reported cases of intrahepatic splenosis, we hereby present this valuable case with a review of the literature.
We report a resected case of small spindle cell carcinoma of the pancreas, In a Japanese 71-year-old woman with upper abdominal pain, a computed tomography (CT) showed a solid tumor 10 mm in diameter in the body of the pancreas. We perfomed distal pancreatectomy with splenectomy. Twenty months after the operation, the patient is alive without recurrence. Although the outcome of spindle cell carcinoma of the pancreas has been reported to be very poor, there may be hope of cure in the patients with small spindle cell carcinoma.
A 50-year-old man was admitted because of increasing massive ascites. While lymphoma cells (diffuse large B-cell lymphoma: DLBCL) were detected in the ascites, pleural effusion, cerebrospinal fluid and bone marrow, no tumor masses other than a submucosal lymphoma lesion in the stomach only 1 cm in diameter were identified. The patient was treated with chemotherapy including rituximab (R-CHOP-ESHAP) and injection of methotrexate and dexamethasone into the medullary cavity as well as radiation to the whole brain, and achieved complete remission 4 months later. The present case suggests that DLBCL can initially manifest as a form of effusion lymphoma with minimum solid tumor component. The distinctive clinical features of Japanese patients with primary effusion lymphoma are also reviewed.