A 72-year-old woman was admitted with an abdominal tumor, which had been detected by computed tomography scanning. Endoscopic examination of the upper gastrointestinal tract revealed a type 3 tumor in the descending limb of the duodenum. A diagnosis of adenocarcinoma was made on the basis of the histological analysis of the biopsy sample. Pancreatoduodenectomy was performed, and peritoneal dissemination was confirmed at surgery. The pathological findings indicated primary duodenal cancer (mucinous carcinoma) associated with tumor thrombosis in the accessory pancreatic duct. Postoperative chemotherapy was performed. Carcinomatous peritonitis was controlled and the patient showed long-term survival.
A 79-year-old woman with colon cancer and multiple liver metastases was admitted to our hospital for systemic chemotherapy. She underwent first cycle of modified FOLFOX6 chemotherapy. She was confused on treatment day 5. Blood test revealed her serum ammonia level to be 121 μg/dl. We diagnosed 5-fluorouracil (5FU)-induced hyperammonemia. Conservative treatment resulted in improvement of metal status. The reason for hyperammonemia after administration of 5FU was the excess production of ammonium from metabolites of 5FU.
A 64-year-old man was admitted to our hospital with anal pain on evacuation. MRI revealed a large rectal submucosal tumor, more than 6 cm in diameter. Fine needle histological diagnosis indicated GIST with moderate risk. The patient was treated with imatinib mesylate in order to preserve the anus. The anal pain and tumor size decreased. Trans-anal local excision was performed. This case suggests that imatinib mesylate can make it possible to treat large rectal GIST cases by preserving anus, if neoadjuvant chemotherapy can be effective.
A 45-year-old male active homosexual was given a diagnosis of HIV-1 and acute hepatitis B in August 2007. Since his liver function became rapidly impaired, anti-HBV therapy with oral administration of entecavir (ETV) was started, and resulted in a favorable outcome. However, serum concentration of HIV-RNA decreased by log 1.26 within 60 days, which strongly suggested the inhibition of HIV proliferation by ETV. To prevent the appearance of mutated HIV, novel therapeutic strategies should be established in HIV/HBV-coinfected patients.
We encountered a case of portal-systemic shunt encephalopathy cured by balloon-occluded retrograde transvenous obliteration (B-RTO). A 73-year-old man had been observed for membranous nephropathy at our hospital since 1987. There was no past history of liver dysfunction. He was admitted with encephalopathy. Abdominal enhanced computed tomography showed a portosystemic shunt through the inferior mesenteric vein and right internal iliac vein. We diagnosed hepatic encephalopathy due to this porto-systemic shunt, and B-RTO was performed. After B-RTO, he has not had repeated encephalopathy. B-RTO can be effective for portosystemic encephalopathy. Inferior mesenteric-right internal iliac shunt encephalopathy is rare and our patient is the first case of B-RTO performed in cases with this shunt.
A 47-year-old otherwise healthy woman, presented elevation of alpha fetoprotein (AFP) and des-γ-carboxy prothrombin (DCP) levels at a general health checkup. Both HCV antibody and hepatitis B surface antigen were negative. A screening abdominal CT revealed no abnormal change. An abdominal MRI and repeated CT, however, revealed a 20-mm tumor adjacent to the inferior vena cava and adjacent to or involving the liver. A surgical resection of the tumor was performed. The tumor was adjacent to, but distinct from, the liver. The Capsule of the tumor was connected to the liver but it was distinct from hepatic, renal, and adrenal tissue. A histological examination yielded a diagnosis of moderately differentiated hepatocelluar carcinoma, with positive staining of hepatocyte-specific antigen and AFP.
A 34-year-old woman was admitted because of severe liver dysfunction due to excessive alcohol intake. Liver biopsy performed on the fifth day showed liver tissue with marked granulocyte infiltration and pericellular fibrosis. As there were no improvements in white blood cell count and serum total bilirubin levels despite the use of corticosteroids and plasma exchange, hemodiafiltration, we performed granulocytapheresis (GCAP). Peripheral white blood cells decreased from just after GCAP. Her condition remained stable and she was discharged on the 54th day. We suggest that GCAP can be recommended as an effective therapy for severe alcoholic hepatitis.
A 31-year-old woman with epigastric pain was given a diagnosis of a pseudocyst associated with pancreatitis. Despite treatment, symptoms did not completely improve and she was referred to our hospital. Since imaging examinations demonstrated findings characteristic of mucinous cystic neoplasm, the lesion was resected. Histopathologic examinations revealed mucinous cystic adenoma. Remains of intracystic hemorrhage were evident and short-term morphological changes were presumed to be associated with hemorrhage.