A 59-year-old man was admitted to the hospital because of upper abdominal pain. Endoscopic examination and computed tomography showed a polypoid tumor located in the 2nd portion of the duodenum with invasion to the pancreas head, and biopsy findings suggested a gastrointestinal stromal tumor. He underwent a pancreaticoduodenectomy, and the tumor, which measured 6.5×6.5 cm, was resected. Histologically, the tumor contained two divergent components: differentiated tubular adenocarcinoma and sarcomatoid tissue composed of spindle tumor cells. The tumor directly extended to the pancreas head and metastasized to multiple lymph nodes. The adenocarcinoma cells were positive for AE1/3 and cytokeratin 7 and negative for vimentin. In contrast, the sarcomatoid tissue was negative for epithelial markers and positive for vimentin. The tumor was finally diagnosed as duodenal carcinosarcoma. Duodenal carcinosarcoma is very rare, and only seven cases have been reported to date.
We encountered two cases of malignant lymphoma with peritoneal localization complicated by sigmoid colon cancer and hepatocellular carcinoma. Multiple primary cancers were suspected on the basis of differences in absorption values on computed tomography (CT) and differences in the degree of accumulation on positron emission tomography CT; however, a definitive diagnosis based on these findings alone was difficult. Endoscopic ultrasound-guided fine-needle aspiration was useful for determining the diagnosis and treatment strategy. In cases of double cancers involving malignant lymphoma with peritoneal localization and malignant abdominal tumor, differentiation and staging are often difficult, which increases the risk of selecting the wrong treatment strategy. Therefore, care must be taken when diagnosing these diseases.
A 53-year-old female who complained of constipation and abdominal fullness was referred to our hospital. A tender low abdominal mass was palpable. Imaging (abdominal ultrasonography, CT, and MRI) revealed that the tumor had spread to the mesosigmoid and the superior mesentery. The tumor was very difficult to diagnose on the basis of imaging alone. Therefore, we obtained a biopsy at the time of laparotomy for definitive diagnosis. The biopsy showed extensive fibrosis and lymphocyte, plasma cell, and eosinophil infiltration in the associated adipose tissue. Sclerosing mesenteritis was diagnosed. The patient's symptoms improved immediately after initiating steroid therapy. Pathological examination and empirical steroid therapy are useful for the diagnosis and medical treatment of sclerosing mesenteritis, respectively.
An 89-year-old man was admitted to our hospital for thorough investigation of refractory diabetes mellitus, which revealed primary squamous cell carcinoma of the duodenum. After two courses of chemotherapy, follow-up esophagoduodenogastroscopy and duodenal biopsy showed no evidence of tumor. No findings were suggestive of recurrence of the primary lesion 19 months after starting chemotherapy. This case suggests that chemotherapy including TS-1 may be effective for treating unresectable primary squamous cell carcinoma of the duodenum.
A man in his 70s experienced cardiopulmonary arrest (CPA) due to acute myocardial infarction. He was resuscitated and treated with a multimodal approach, and he fortunately survived CPA without neurological damage. However, abdominal pain and vomiting occurred 45 days after the CPA. Small intestinal endoscopy showed pinhole-like stenosis of the ileum. Although balloon dilation was performed through the scope, his symptoms did not improve. Partial small bowel resection was eventually performed 139 days after the CPA. Pathological findings revealed ischemic changes in the mucosa at two spots. We speculate that an ischemic event occurred in the small bowel during CPA.
Some cases of portal hypertension developing during the course of oxaliplatin-based chemotherapy have been reported. However, there have been no reports of rupture of esophagogastric varices (EGV) in Japan. We present two cases of rupture of EGV during the course of oxaliplatin-based chemotherapy. One case was treated via balloon-occluded retrograde transvenous obliteration, and the other case was treated by using endoscopic variceal ligation and endoscopic injection sclerotherapy. On the basis of our results, we recommend careful monitoring for the occurrence of EGV during the course of oxaliplatin-based chemotherapy.
A woman in her 70s with fever and abdominal distension was referred to our hospital for investigation. She had just finished a course of pegylated interferon and ribavirin combination therapy for chronic hepatitis C. Abdominal computed tomography revealed peritoneal thickening and ascites. QuantiFERON®-TB Gold was positive, ascitic adenosine deaminase was high, and fluorine-18-fluorodeoxyglucose positron emission tomography (FDG-PET) showed diffuse accumulation in the peritoneum. Although these findings suggested tuberculous peritonitis, we did not detect Mycobacterium tuberculosis in any bacterial cultures, ascites, or other specimens. However, laparoscopic peritoneal biopsy demonstrated a large number of miliary white nodules in the parietal and visceral peritonea. Pathological examination of these nodules revealed epidermoid granuloma with giant Langhans' cells and caseous necrosis. Finally, the diagnosed of tuberculous peritonitis was established. It is important to consider tuberculosis in patients presenting with new symptoms while receiving interferon therapy.
A man in his 40s presented with liver dysfunction on a screening examination. He was working in the printing industry and had been exposed to a chlorinated organic solvent for 12 years from the age of 20. Detailed examination revealed hilar bile duct cancer; proton radiotherapy was initiated. About three years after completing the proton radiotherapy, recurrence was suspected in hepatic hilar lymph nodes on radiological examination, and he was referred to our hospital. Endoscopic ultrasound-guided fine-needle aspiration of hepatic hilar lymph nodes revealed adenocarcinoma, and systemic chemotherapy was started. Two years later, the lymph nodes showed tumor regrowth, and surgical lymph node resection was performed. To date, 20 months after resection, no recurrence has been identified. We report a case of bile duct carcinoma that was recognized as a work-related accident in an individual working in the printing industry.