This study investigated gastric tube cancer (GTC) to clarify the clinicopathological characteristics in different generations. We analyzed 165 cases with metachronous GTC; 9 cases from our institution and 156 from reported Japanese cases. Cases were divided into 3 groups to provide a detailed analysis of age-specific variations. GTC most commonly occurred in the lower gastric tube, and the most common histological type was tubular adenocarcinoma (70%). There were no age-related variations in the site and histological type of GTC. The incidence rate of endoscopic detection increased from 2003 to 74% in 2012, and the incidence of early GTC detection also significantly increased in this period. The rate of endoscopic treatment before 2003 was approximately 20%, and it doubled over the 10-year course of the study. The recent progress made in the diagnosis and treatment of GTC may have contributed to an improvement in its prognosis.
A woman in her 60s was referred to our department with advanced rectal cancer and multiple unresectable metastases of the liver and peritoneum. She had been diagnosed with idiopathic thrombocytopenic purpura (ITP) in her 20s, with a platelet count maintained at approximately 1.0×104/μL by prednisolone; on admission, her platelet count was 0.9×104/μL. Romiplostim, a thrombopoietin receptor agonist, was administered prior to chemotherapy. Her platelet count increased to approximately 10.0×104/μL during chemotherapy with oxaliplatin plus capecitabine, and she developed deep venous thrombosis requiring inferior vena cava filter placement and anticoagulation. No other severe adverse events occurred. There is no standard regimen for the treatment of solid tumors in patients with ITP. This is the first reported case of the concomitant use of romiplostim and chemotherapy for advanced rectal cancer. We believe that romiplostim can effectively salvage the platelet count in emergency situations such as during chemotherapy.
We report an extremely rare case of a calcifying fibrous tumor (CFT) occurring in the abdominal wall. A 43-year-old woman was referred to our hospital because of a gastric submucosal tumor. Imaging findings revealed a gastric submucosal tumor with calcification. Endoscopic ultrasound-guided fine-needle aspiration was attempted to obtain a tissue specimen; however, the tumor was not adequately visualized because of calcification. Local excision was performed because of the tumor growth and the risk of progression to gastrointestinal stromal tumor. The tumor was histologically diagnosed as a CFT. We describe the imaging and pathological findings, and discuss the differential diagnosis and histogenesis of CFT.
A 79-year-old man was diagnosed with hepatocellular carcinoma in 2000 and treated with partial hepatectomy. Intrahepatic carcinoma recurred with lung metastases 7 years later. Several transcatheter arterial chemoembolizations were performed to treat the recurrence, and a right lower lobectomy was performed for lung metastasis. Twelve years after the original carcinoma diagnosis, lip and lung metastases were detected, and he was hospitalized for radiotherapy of the lung metastasis; an oral molecular-targeting drug was initiated. During the therapy, hematochezia was observed, and a colonoscopy was performed. A submucosal lesion with a blood clot measuring approximately 4mm in diameter was found in the sigmoid colon, and endoscopic mucosal resection was performed. Furthermore, an elevated lesion with a 5-mm diameter recess was observed on upper gastrointestinal endoscopy. Both lesions were diagnosed histopathologically as hepatocellular carcinoma metastases.
A 63-year-old woman was admitted to our hospital because of a pancreatic tumor measuring 50mm in diameter. The tumor was considered unresectable due to the involvement of the superior mesenteric artery; therefore, she was treated with chemotherapy. Eight months later, an umbilical tumor was observed; biopsy of the exudate revealed a moderately differentiated tubular adenocarcinoma. The patient died 14 months later (i.e., 22 months after chemotherapy was started).
A 56-year-old man was admitted to our hospital with a history of abdominal discomfort and loss of appetite. Six days later, he suddenly went into shock; despite repeated blood transfusions, he died. Autopsy revealed the cause of death to be a ruptured splenic angiosarcoma, which had metastasized to multiple sites in the liver and bone. Splenic angiosarcoma is rare, and its pathophysiology is unclear. When presented with splenic angiosarcoma or suggestive symptoms, including splenic bleeding, splenomegaly, abdominal discomfort, and abdominal pain, we should carefully monitor the patient for signs of coagulopathy and prepare for the possibility of rapid progression to disseminated intravascular coagulation. In general, patients with angiosarcoma have a poor prognosis. Therefore, we hope this report will help in improving the prognosis of patients suffering from angiosarcoma by contributing to the limited clinical experience.
A man in 40s with skin sarcoidosis presented with signs and symptoms of liver injury and thrombocytopenia. Enhanced computed tomography and magnetic resonance imaging revealed cholecystolithiasis, hepatic deformation, and giant splenomegaly. Gastrointestinal endoscopy showed esophageal varices. Cholecystectomy, splenectomy, and wedge biopsy of the liver were performed. Histopathology of the liver revealed many granulomas and severe periportal fibrosis without lobular reconstruction. These findings were compatible with hepatic sarcoidosis, but not liver cirrhosis. Here we report a rare case of hepatic sarcoidosis presenting with cirrhotic symptoms.
A 43-year-old female patient had high levels of CA19-9 marker; an abdominal ultrasound revealed a cyst. Further investigations with computed tomography (CT), magnetic resonance imaging, and endoscopic ultrasound CT identified a multilocular cystic lesion on the pancreatic tail. An abnormal wall was noted, and different signal strengths were measured in each cyst. Thus, a mucinous cystic tumor was diagnosed, and distal pancreatectomy combined with splenectomy was performed. During the surgery, we identified a multilocular pancreatic cyst with internal bleeding at its distal end. The lesion was ultimately diagnosed as an epidermoid cyst of an intrapancreatic accessory spleen. This diagnosis was based on the histological observation that the vascular construction of the cystic wall was equivalent to that of the spleen, and that its internal tissue was covered by squamous epithelium.