An 86-year-old man was admitted with dysphagia. Endoscopic examination revealed an advanced esophageal cancer located in the lower thoracic esophagus. Histological analysis revealed moderately differentiated squamous cell carcinoma. The clinical stage was diagnosed as T2N0M0, stage II. He received radiation therapy in combination with chemotherapy using docetaxel, 5-fluorouracil and nedaplatin. After chemoradiotherapy (CRT), the carcinoma could not be detected by CT or endoscopy, and endoscopic biopsy revealed no cancer cells in categorization as resulting complete response. Adverse event consisted of grade 2 in leukopenia. We could not detect relapse, metastases or late side effect of CRT at present, 24 months after CRT.
We report two cases of isolated spontaneous dissection of the superior mesenteric artery (SMA). Both patients complained of abdominal pain with sudden onset and were given diagnoses of dissection of the SMA based on abdominal CT scanning. CT showed dissention of the SMA with thrombosis of the false lumen and narrowing of the true lumen. Therefore there were no symptoms of bowel ischemia, and after hospitalization both cases received conservative therapy with anticoagulation and antiplatelet therapy. Spontaneous dissection of the SMA without aortic dissection is very rare, and only 53 cases have been recorded in Japan.
A 60-year-old woman with hepatic encephalopathy was admitted to our hospital. Ultrasonography, computed tomography and hepatic arteriography revealed diffuse hepatic arteriovenous fistulae (HAVF). Overt portosystemic shunt could not be identified. Right heart catheterization showed increased cardiac output. However the patient had never shown any signs of heart failure. Other than that, marked hepatopetal arterial flow from some branches of the superior mesenteric artery was detected and mesenteric arterial flow remarkably decreased. Extensive HAVF can lead to significant complications, including high output heart failure, pulmonary hypertension, portal hypertension, hepatic encephalopathy, biliary ischemia, cirrhosis, postprandial abdominal pain, and reduced liver function. Embolization or ligation of the hepatic artery provides temporal improvement of clinical symptoms, but long-term results are unsatisfactory because of the development of collateral circulation and the risk of refractory intrahepatic cholangitis, subsequently leading to liver failure. Liver transplantation offers another therapeutic option and can be a successful curative treatment.
We report a surgically treated case of lymph node recurrence from hepatocellular carcinoma (HCC) that occurred simultaneously but individually in the mediastinum and abdominal cavity with no metastasis. A 52-year-old man had undergone left lateral segmentectomy for poorly differentiated HCC. Three months after surgery, abdominal computed tomography revealed an enlarged solitary lymph node along the common hepatic artery. Another isolated mediastinal lymph node was also positive on whole body 18F-fluorodeoxyglucose positron emission tomography. Because no other metastatic lesions were identified, we resected these two lymph nodes under a diagnosis of lymph node metastases from HCC. Histopathologically, both of them were classified as poorly differentiated HCC with solid growth. No further recurrence has been found during 20-month follow-up period. Our experience suggested that even though metastatic lymph nodes of HCC were present in the mediastinum and abdominal cavity, resection may provide survival benefit if each metastasis is individually solitary.
A 75-year-old woman who had been given a diagnosis of a giant liver cyst occupying the right hepatic lobe was admitted to our hospital complaining of abdominal pain. CT examination revealed the size of cyst was smaller than before and the level of CRP was elevated, suggesting the development of peritonitis due to rupture of the cyst. As Candida albicans was detected from both ascites and the cyst, we treated her with continuous percutaneous transhepatic drainage and antimycotic agents. The cyst markedly diminished, and she became free of infection and peritonitis, suggesting drainage was exceedingly effective.
A 70-year-old man was admitted to our hospital for further examination of pneumobilia and atrophy in the gallbladder. Abdominal CT scan and EUS revealed that the atrophic gallbladder was occupied by a tumor lesion. In addition, ERCP showed choledochocolonic fistula. Colonoscopy revealed an elevated lesion in the colonic side of fistula, and biopsy of the elevated lesion revealed adenocarcinoma. Cholecystectomy and right hemicolectomy was performed under a preoperative diagnosis of gallbladder carcinoma with choledochocolonic fistula. Pathologically, most of the tumor was localized in the gallbladder, and grew along the mucosa of choledchocolonic fistula. This case was of interest with regard to the relationship between the choledochocolonic fistula and gallbladder carcinoma.
In March, 2004, a 64-year-old man was given a diagnosis of IPMN of the pancreas in postoperative CT of left shoulder blade chondrosarcoma. In October, 2007, because a tumor in the pancreas body was found, distal pancreatectomy was performed a diagnosis of the poorly differentiated adenocarcinoma. Histopathologic diagnosis revealed as pancreatic endocrine tumor and immunity dyeing was useful for differential diagnosis. A case of pancreatic endocrine tumor developing from IPMN has a possibility not rare for frequency, but few reports are available so far.
A 58-year-old woman without any clinical symptoms had a routine health check-up, during which a mass in the head of the pancreas was detected by US. Abdominal US showed a round, hypoechogenic nodule of the pancreatic head. The tumor measured 3cm in diameter and contained an anechoic area. CT revealed a well-demarcated tumor in the pancreatic head. The tumor was partially enhanced by contrast medium, but the left portion of the tumor, which US had shown to be an anechoic area was not enhanced. Imaging findings suggested an endocrine tumor with cystic changes. A pylorus-preserving pancreatoduodenectomy was performed. The tumor was composed of spindle-shaped cells. There was a typical patternless growth of short fascicles and a short storiform arrangement of cells in the stroma with varying degrees of collagenization. Immunohistochemically, the tumor cells were positive for CD34 and Bcl-2. Based on the light microscopic morphology and immunostaining profile, the tumor was classified as a solitary fibrous tumor (SFT) of the pancreas.