A 71-year-old man was admitted to our hospital because of dysphagia, and primary endocrine cell carcinoma of the esophagus with multiple liver metastases was diagnosed. After 6 courses of CPT-11+CDDP combination chemotherapy, the liver metastases disappeared, although the esophageal squamous cell carcinoma component remained. Radiation therapy was added to treat the residual esophageal tumor, and a complete response was obtained. This case seems to suggest that multidisciplinary therapy, including chemotherapy, may be effective for treating esophageal endocrine cell carcinoma with other types of organ metastasis.
A 66-year-old man with giant gastric folds had been followed up since February 2000. In March 2010, a submucosal tumor of 35mm was identified with endoscopy and a low echoic mass was identified with endoscopic ultrasonography. After histologic diagnosis by endosonography-guided fine needle aspiration biopsy, he underwent a total gastrectomy. Histologic examination of the resected specimen revealed a tumor 20mm in diameter consisting of well-to-moderately differentiated tubular adenocarcinoma in the thickened wall of the gastric greater curvature, which contained small cystic lesions in the lamina propria. Immunohistochemical staining showed thick gastric wall consisting of not only multiple cysts but also smooth muscle, elastic and collagen fibers. The histologic diagnosis was advanced gastric cancer accompanied by diffuse cystic malformation (DCM). Although it is a rare condition, DCM should be considered in the differential diagnosis of giant gastric folds and as a pre-cancerous lesion.
A 58-year-old man was admitted with fever and arthralgia. He had some symptoms suggesting the incomplete type of Behçet disease, and a routine chest X-ray films showed the presence of massive pneumoperitoneum (PP). Exploratory laparotomy revealed no evidence of gastrointestinal perforation or peritonitis. Thus, we initially diagnosed it as idiopathic PP. However a 2×1-mm induration located on the antimesentric side of the ileum 50cm proximal to the ileocecal valve. The wedge-shaped pathological specimen showed ulcer perforation and its restoration. Finally we concluded it to be nonsurgical PP. This case provides significant information on the etiology of idiopathic PP.
A 40-year-old woman underwent radical hysterectomy and postoperative radiotherapy for uterine cervical squamous cell carcinoma (SCC) 6 years previously. She was referred to our department for the treatment of a rectal lesion located in the posterior wall approximately 8cm from the anal verge. She underwent low anterior resection because the lesion was diagnosed as SCC by preoperative endoscopic biopsy. Pathological examination of the resected lesion demonstrated a 3×3-cm solid tumor expanding mainly in the muscularis propria layer and infiltrating the mucosal layer without lymph node involvement. Moreover, it was diagnosed as metastatic SCC from the uterine cervical tumor. No recurrence has been detected over 5 years after resection. The prognosis of SCC of the rectum without lymph node metastasis has been considered similar to that of node-negative adenocarcinoma of the rectum. Thus, if there is no distant metastasis and/or peritoneal dissemination, aggressive surgical resection should be performed to ensure a good prognosis.
A woman in her fifties had shown a decline of orientation before admission. She had a tumor in the left frontal lobe. The solitary tumor was resected. Rectal cancer was discovered after that, and she underwent the Hartmann procedure. The final diagnosis was metastatic brain carcinoma from primary rectal cancer. Subsequently recurrence of brain metastasis was diagnosed, and gamma knife radiosurgery was performed. She then received adjuvant chemotherapy for about 1 year. Since the gamma knife treatment, she has been followed up without any further evidence of recurrence. We believe that if solitary brain metastases are found early adjuvant therapy should be performed, which should prolong survival.
A woman in her seventies was admitted because of black stool. Esophagogastroduodenoscopy and colonoscopy revealed no bleeding lesions. Balloon endoscopy showed a long and slender polyp. The polyp was covered with normal mucosa and accompanied with ulcerations. The long polypoid lesion was found to be located in the duodenojejunal flexure by a small bowel series. We performed endoscopic polypectomy. The polyp was composed of edematous mucosa and submucosa with dilated blood vessels and lymphangiectasia. The histologic findings of resected specimen were compatible with colonic muco-submucosal elongated polyp. The polyp was considered to be classified as enteric muco-submucosal elongated polyp.
We report a case of hepatocellular carcinoma (HCC) with multiple lymph node (LN) metastases. A 68-year-old man underwent hepatectomy at our hospital. Intrahepatic recurrence and swelling of multiple LNs were detected by enhanced CT 21 months later. FDG-PET was positive for multiple swollen LNs, but all were negative for the intrahepatic recurrences. Biopsy of para-aortic LNs was revealed LN metastases from HCC. Immunohistochemically, the LN metastases were composed of poorly differentiated HCC. The sensitivity of FDG-PET in patients with HCC varies in relation to degree of differentiation and decreased FDG uptake must be noted.
Mucoepidermoid carcinoma of the intrahepatic bile duct is a rare variant of cholangiocarcinoma: it is composed of mucus-secreting squamous cells and glandular cells within the same nests. This tumor is very aggressive, with high-grade malignancy, and has a poor prognosis. In the international literature, only 17 cases of mucoepidermoid carcinoma originating in the hepatic bile duct system have been reported until now. We report an autopsy case of mucoepidermoid carcinoma of the intrahepatic bile duct with metastasis to the cranial skin in a Japanese man who was more than 70 years old. This cancer metastasizes to many organs, but skin metastasis is extremely rare.