We report a rare case of a 73-year-old man with gastric metastasis from colorectal cancer. Tumors of the stomach and the right side abdominal wall were diagnosed by FDG/PET-CT. Upper gastrointestinal endoscopy revealed a submucosal tumor with central depression in the fornix of the stomach. Since sigmoidectomy had been performed for cancer 39 months ago, we suspected metastasis. Proximal gastrectomy and resection of the tumor of the abdominal wall were performed. Histological findings showed moderately differentiated adenocarcinoma in the submucosal tumor. Immunohistochemical studies revealed focal positive staining for CK20 and diffuse for CDX2. These findings were similar to those of his primary sigmoid colon cancer and therefore metastasis was diagnosed.
A 74-year-old man was referred to our hospital with positive fecal occult blood test. Colonoscopic examination revealed a 7-mm 0-Is type polyp in the sigmoid colon. Endoscopic mucosal resection for this lesion completely removed the lesion and the histologic diagnosis was well differentiated adenocarcinoma. Cancer cells invaded the submucosa to a depth of 900μm, and vascular invasion was found. Therefore, the patient underwent additional surgical resection with lymph node dissection. During follow-up, however, serum CEA increased beyond the normal limit 18 months after surgical operation, and a 15-mm single liver metastasis was found through enhanced CT scan abdominal imaging, the FDG-PET scan, and ultrasonography. We have to pay attention to metachronous liver metastasis especially when the vascular invasion is suspected in the resected sample, even if the lesion is completely removed.
A 34-year-old woman was referred to our hospital with ileus. She had undergone surgical resection following chemotherapy for yolk sac tumor at the age of 12 years, and had received additional surgery and radiation therapy for a local recurrence at age 13. Following evaluation, a sigmoid colon tumor was detected and was surgically resected. Histology proved well differentiated adenocarcinoma with chronic irradiation colitis, suggesting that irradiation may have induced the colon cancer.
A 56 year-old man with chronic hepatitis C (HCV) was treated with interferon therapy and achieved sustained virological response (SVR) in 1993. Thirteen years later, in 2006 two liver tumors, 35-mm and 11-mm in diameter respectively, were detected in liver segment 6. Hepatic resection was performed, and pathologically one nodule was diagnosed as cholangiocellular carcinoma (CCC) and the other hepatocellular carcinoma (HCC). Continuity was not recognized between these tumors, thus, we diagnosed this case as double cancer (CCC and HCC). Here, we report a rare case of double cancer (CCC and HCC) that developed 13 years after achieving SVR for HCV infection.
A 75-year-old woman was admitted to our hospital with a gallbladder tumor by detected ultrasonography (US). On endoscopic ultrasonography (EUS), and abdominal CT, we diagnosed the Is+IIa+IIb-like ss lesion invasive gallbladder cancer, but endoscopic double contrast cholecystography suggested IIa+IIb-like ss invasive gallbladder cancer because the lesion had the same granular membrane a other cancer membrane and cholecystectomy was carried out. The pathologic diagnosis was IIa+IIb-like ss invasive gallbladder cancer.
Fistula between the gallbladder and colon is a rare condition. Even more infrequent is spontaneous resolution of the fistula. We encountered a case of cholecystocolic fistula associated with xanthogranulomatous cholecystitis (XGC) that was diagnosed definitively using CT, MRI, and colonoscopy. An 82-year-old woman with no remarkable medical history presented with fever and right hypochondralgia that had continued for 8 days. Abdominal ultrasound showed a hyperechoic area as air in the lumen of the gallbladder with a hypertrophic wall. Contrast-enhanced CT, with the peripheral layer enhanced homogeneously by contrast medium, indicated air in the gallbladder with a thickened wall. Furthermore, MRI and colonoscopy revealed a fistula between the gallbladder and transverse colon strongly suggested. Those findings suggested cholecystocolic fistula associated with XGC. The patient was treated initially by administration of antibiotics, while fasting. Unfortunately, surgical specimens did not show the fistula, thus it was decided that the existence of cholecystocolic fistula with spontaneous resolution were highly suspected by the clinical course and imaging in this patient.
A 70-year-old man was initially referred to our hospital complaining of back pain and jaundice. Autoimmune pancreatitis was diagnosed. He responded well to steroid therapy. When he was 73 years old, he was referred to our hospital again because of anemia. He had a low hemoglobin level of 9.3g/dl, and positive Coombs tests, which were suggestive of autoimmune hemolytic anemia. His laboratory data revealed the recurrence of autoimmune pancreatitis, although he had no symptoms. Steroid therapy was very effective on both occasions. This case is the second reported case of autoimmune pancreatitis accompanied by autoimmune hemolytic anemia in Japan.