We evaluated the therapeutic effect of gemcitabine (GEM) therapy in 153 unresectable pancreatic cancer (UPC) patients, divided into younger patients (under 65), early-stage elderly patients (age 65-74) and advanced-stage elderly patients (age 75 and over). Among those patients who received only best supportive care (BSC), the most common reasons to be selected for BSC were family requests in the advanced-stage elderly patients, and poor general condition in the rest. Among the patients who received GEM therapy, there were no significant differences in response rate, or adverse events including the rate of dose reduction, postponement or cessation of GEM administration due to toxicity. Multivariate analysis using patient backgrounds and response to GEM therapy showed that CA 19-9 response and performance status did not change with age. GEM therapy for both early-stage and advanced-stage elderly UPC patients was as safe and useful as in younger patients.
We report a case of hepatic portal venous gas (HPVG) caused by transient type ischemic enteritis. The patient was a 65-year-old woman, previously given a diagnosis of hypertension and diabetes mellitus. She was admitted to our hospital because of vomiting and epigastric pain. Abdominal computed tomography showed dilatation of the stomach and small intestine, with hepatic portal and superior mesenteric venous gas. Upper gastrointestinal endoscopy showed diffuse edematous and erosive change, and an extensive ulcer in the duodenum. There was no muscular defence, and physical and laboratory examinations did not indicate necrotic bowel. We diagnosed as HPVG caused by ischemic enteritis, and she responded to conservative treatment. We discuss a rare case of HPVG caused by transient type ischemic enteritis with references.
A 25-year-old woman was admitted with fever and right lower abdominal pain that had started 3 days after the administration of antituberculosis agents for pulmonary tuberculosis. She was given a diagnosis of intestinal tuberculosis with ileo-ileal fistula formation on computed tomography, colonoscopy and laboratory test findings. She was kept on anti-tuberculosis agents. Soon after, ileus and a micro abscess appeared near the fistula. Ileocecal resection with partial ileal resection resulted in a good postoperative clinical course. Tuberculosis is still a major infectious disease. Intestinal tuberculosis is very rarely associated with fistula formation, and when it occurs, is difficult to differentiate from Crohn disease. Our case strongly suggests that typical intestinal tuberculosis findings can help in differential diagnosis between intestinal tuberculosis and Crohn disease.
Familial Mediterranean fever (FMF) is an autoinflammatory disease. The patient was a 28-year-old Japanese man with attacks of fever and abdominal pain, which recurred at 1-to 3-month intervals. These symptoms usually improved spontaneously 1 week later. Physical examination showed tenderness in the right lateral abdomen. Routine laboratory tests demonstrated an increase in inflammatory reactions in the serum with leukocytosis. No abnormal findings were found on either chest, or abdominal CT scans, or endoscopic examinations of the upper or lower gastrointestinal tracts. Renal and hepatic function were within the normal limits, and no positive results were obtained for an anti-nuclear antibody. DNA analysis demonstrated a heterozygous mutation in the MEFV gene, the compound pyrin variant E148Q/M694I, leading to a diagnosis of FMF. His father had also had the same symptoms for 30 years, and was also heterozygous for the pyrin variant E148Q/M694I. They both responded dramatically to colchicine treatment and have remained in full remission until the time of writing.
We report a rare case of spontaneous regression (SR) of hepatocellular carcinoma (HCC). A 70-year-old man consulted us for general fatigue. Enhanced abdominal computed tomography (CT) showed two HCCs, of 5cm in the posterior segment and 8cm around the right Glissonean pedicle with tumor thrombus in the main portal trunk. He refused to undergo any treatment, but 28 months later, CT showed complete disappearance of the hilar tumor and portal tumor thrombus, and partial regression in the posterior tumor with shrinkage of the right lobe of the liver. His PIVKA-II levels decreased from 23358 to 217mAU/ml. In the present case, tumor infarction of the portal thrombus, and the administration of imidapuril hydrochloride and Hochu-ekki-to may have caused SR.
We report a case of gastrointestinal stromal tumor (GIST) with liver metastases which was undetectable by B-mode ultrasonography, effectively treated by radiofrequency ablation using contrast-enhanced ultrasonography US. A 43-year-old woman was admitted for the treatment of 6 lesions up to 4cm in diameter, which had emerged from necrotic sites within the liver after imatinib treatment. The recurrent lesions were not detected on B-mode US, and it was difficult to perform radiofrequency ablation (RFA) treatment. Using a contrast-enhanced agent (sonazoid®), the recurrent lesions were detected and treated by RFA. RFA is considered to be an effective treatment for GIST with liver metastases that tolerate imatinib administration.
A 58-year-old man was followed up for HBV-associated chronic hepatitis. A low echoic hepatic nodule 1.6cm in diameter developed in segment 8 of the liver. The tumor was hypervascular and showed enhancement on CV during hepatic arteriography (CTHA) and a defect on CT during arterial portography (CTAP). Strong enhancement, which lasted for 30 seconds, was observed at the margin of the tumor on single-level dynamic CTHA. The resected tumor was whitish, had no capsule, and consisted mainly of intermediate immature cells together with HCC-like and CCC-like tumor cells. These findings led to the diagnosis of primary liver carcinoma of intermediate (hepatocyte-cholangiocyte) phenotype. Cytokeratin (CK) 7, CK8, CK19, EMA and vimentin were positive and HP-1 and c-kit tests were negative on immunohistochemical staining. Staining with CD34+αSMA showed more muscular arterial vessels and sinusoid-like vessels in the peripheral zone of the tumor than in the central zone. Six months after the resection of the tumor, swollen abdominal lymph nodes were observed on US and CT, which aspiration needle biopsy showed to be metastasis of a hepatic tumor.
A 76-year-old man presented with fever of unknown origin. Diagnostic imaging showed a liver tumor measuring 3cm in maximam dimension. The tumor was subsequently resected, and histopathology showed a moderately differentiated adenocarcinoma. This showed a number of bile ductules with variable amounts of stroma, well circumscribed but not encapsulated, so the lesion was diagnosed as a cholangiocarcinoma. Within the tumor there was also a cholangiolocarcinoma-like lesion. In addition, cystically dilated ductules resembling bile duct hamartoma and bile duct adenoma adjacent to the tumor were found, but with no area of transition among them. In the Glisson's capsule around the tumor, there was also a bile duct hamartoma.