A 30-year-old woman with chest discomfort at swallowing and occasional vomiting was referred to our department with a diagnosis of esophageal submucosal tumor. CT visualized a mass 70mm in diameter in the middle esophagus. Esophagogastroduodenoscopy revealed a pedunculated submucosal tumor, and endoscopic resection was considered. As the size of the tumor was so large, retrieval of the resected specimen via the stomach following incision, laparotomy was planned. En bloc resection by endoscopic submucosal dissection with a Hook-knife was performed. Retrieval of the resected specimen was carried out as planned. The specimen, which was 53×48×43mm in size with a distinct margin, was diagnosed as leiomyoma derived from the muscularis mucosae histologically. Her postprocedural course was uneventful. Endoscopic resection can be chosen when an esophageal submucosal tumor is pedunculated with abundant mobility, making it possible to avoid invasive surgery.
We report 3 cases of locoregional failure or remnant esophageal squamous cell carcinoma after chemoradiotherapy that were successfully treated by argon plasma coagulation (APC) as a salvage treatment. Ablation was performed using argon plasma coagulation APC300 (ERBE). A power setting of 60W and an argon gas flow of 1.8L/min was used. APC is able to be repeated multiply without adverse reaction, and is an effective treatment to control the tumor growth.
A 74 year-old man underwent subtotal gastrectomy for advanced gastric cancer in 2000. The histological type of the cancer was signet-ring cell carcinoma, and the clinical stage was stage II (T2, N1, M0). In June 2008 the patient was referred to our hospital complaining of dysphagia. Esophageal endoscopy revealed a circular stenosis with covered with normal mucosa between the lower esophagus and the esophago-gastric junction. Histologically, samples obtained by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) revealed signet-ring cell carcinoma. Our experience suggests that EUS-FNA was useful for the histological diagnosis of recurrence of gastric cancer.
A 81-year-old woman admitted with general fatigue was found to have a giant polyp in the gastric antrum by endoscopy. The polyp prolapsed into the duodenum through the pylorus. Angiographic examination of the abdomen revealed the polyp to be about 90×35mm in size. Laparotomy was performed. It was finally diagnosed as heterotopic Brunner's gland adenoma which had a stalk on the antrum of the stomach. Heterotopic Brunner's gland adenoma is rare. Only 3 cases including the present case have been reported in Japan.
A 50-year-old woman was admitted to our hospital because of abdominal pain and vomiting. Ileus with ulcerated jejunal tumor was diagnosed and biopsy revealed adenocarcinoma. Because her serum level of DUPAN-2 was high, she was examined by PET scan, which revealed that she had a left ovarian mass in addition to the jejunal tumor. Surgical resection was performed: both tumors were adenocarcinoma, but the ovarian tumor was considered to be metastatic clinically and histologically. Immunostaining for DUPAN-2 was positive in the both tumors. The serum level of DUPAN-2 returned to normal after the surgery, and has been within normal limits for about 3 years without any additional therapy. This case shows a possible relation between small bowel adenocarcinoma and DUPAN-2.
An 81-year-old woman was referred to our hospital with a diagnosis of acute cholangitis. Endoscopic retrograde cholangiography revealed a common bile duct (CBD) stone. In addition, CT showed thrombus of the right portal vein. Endoscopic sphincterotomy was performed to remove the CBD stone. Thrombosis was treated successfully with danaparoid sodium. It was speculated that the treatment of the acute cholangitis induced thrombolysis by the auto-fibrinolysis system and danaparoid sodium prevented the development of thrombus formation in this case.
We report a case of well differentiated mucinous carcinoma of the gallbladder. An 80-year-old man was admitted to our hospital because of fever and CT showed a mass in the fundus of the gallbladder and choledocholithiasis. Endoscopic removal of the common bile duct stones was done. Abdominal ultrasonography and CT showed a 4cm mass in the fundus of the gallbladder. Based on a diagnosis of adenomyomatosis or mucinous carcinoma of the gallbladder, a laparotomy revealed a white mass in the fundus of gallbladder. Intra-operative pathological diagnosis of lymph node of cystic duct was mucinous carcinoma. Therefore, we conducted partial resection of the liver with D1 lymph node dissection. Pathological diagnosis confirmed well differentiated mucinous carcinoma of the gallbladder. His postoperative course was uneventful, and he is doing well without recurrence.
Pancreatic neoplasms during pregnancy are rare. We describe two cases of mucinous cystic neoplasm (MCN) associated with pregnancy. A 34-year-old woman in the 26th week of pregnancy was given a diagnosis of MCN measuring 19cm in diameter. We decided to resect it post partum in consideration of the risk of abortion. She had a healthy infant in the 40th week of pregnancy and three months later, distal pancreatectomy was performed. Pathological analysis revealed a mucinous cystadenoma of the pancreas. The second case was a 36-year-old woman. She was given a diagnosis of MCN, measuring 16cm in diameter, post partum and distal pancreatectomy was performed. Pathologically, the tumor was an invasive mucinous cystadenocarcinoma of the pancreas. In this report, we did an extensive literature review and discussed the management of MCN during pregnancy with special reference to the timing of the operation and the relationship between tumor growth and sex hormones.