Case 1 was a 70-year-old man, and case 2 was a 65-year-old woman. Both were diagnosed with type 2 advanced HER2-positive gastric cancer. Capecitabine, cisplatin, and trastuzumab (HXP therapy) were administered to both patients. However, both patients developed peritonitis caused by gastric cancer perforation during HXP therapy on day 38 for case 1 and day 8 for case 2. Emergency omentum filling and gastric segmental resection were performed for both patients. The same chemotherapy regimen was continued after the surgery, and partial response was observed in both patients. Because most advanced HER2-positive gastric cancers are ulcers, we should always consider the risk of gastric cancer perforation while administering HXP therapy, which has a high cytoreductive effect. Good convalescence can be expected by continuing chemotherapy after emergency surgery due to gastric cancer perforation.
A 51-year-old woman complaining of weakness in the limbs was diagnosed as having a duodenal gastrinoma on performing a further evaluation. Surgical resection was performed with selective arterial calcium injection for localization. During preoperative hospitalization, she experienced recurrent severe vomiting and diarrhea after endoscopy, leading to acute kidney injury. To our knowledge, this is the first report of gastrinoma with post-endoscopy symptom exacerbation. Although the etiology is unknown, the findings in this case suggest that sufficient fluid replacement, sedation, and high-dose proton pump inhibitor administration should be taken into consideration when performing endoscopy in gastrinoma patients.
A woman in her 70s was an outpatient at our hospital. Esophagogastroduodenoscopy revealed a slightly elevated lesion with erosion, 10mm in diameter, located at the greater curvature of the antrum. Helicobacter pylori testing yielded negative results, and there was no atrophy of the gastric mucosa. Biopsy revealed a well-differentiated tubular adenocarcinoma. Complete en bloc resection was performed via endoscopic submucosal dissection, in accordance with the current Japanese guidelines. The gastric adenocarcinoma of the fundic gland type and coexisting with a hyperplastic or fundic gland polyp was negative according to the histological examination.
A 66-year-old man with recurrent stroke within a short period of time was referred to our department from the neurology department to rule out any malignancy. An endoscopic examination revealed a white depressed lesion in the body of the stomach, and computed tomography revealed a high-density area in the mesentery around the stomach. A mucosa-associated lymphoid tissue (MALT) lymphoma was detected from both the stomach biopsy and resected mesenteric specimen. Systemic chemotherapy was administered for the MALT lymphoma (Lugano classification stage IV). Cerebral infarction did not occur after the treatment. We concluded that Trousseau syndrome associated with the MALT lymphoma disseminated to the mesenteric adipose tissue. A MALT lymphoma has a small probability of occurring in Trousseau syndrome.
A 65-year-old man was referred to our department due to repeated episodes of cholangitis in the past five years. Endoscopic retrograde cholangiopancreatography was performed, and a stricture of the lower bile duct was detected. At a later date, an irregular mucosa of the bile duct was confirmed using nasal endoscopy. Based on the biopsy results, the patient was diagnosed with bile duct cancer and subsequently underwent surgery. Postoperative histopathology did not show lymph node metastasis, and the condition was determined to be early-stage bile duct cancer. In the present case, it was presumed that the cancer had developed due to chronic cholangitis. Therefore, in patients with repeated episodes of cholangitis, attention should be focused on the possible and concomitant development of cancer.
Hepatic aneurysms are rare, but can prove fatal once they rupture. Transcatheter arterial embolization (TAE) is performed as a prophylactic treatment. The position of the aneurysm determines the degree of difficulty of TAE. Maintaining blood flow to the liver can become difficult, particularly when the aneurysm is at an arterial junction. The patient was a 72-year-old man diagnosed with a hepatic aneurysm. The aneurysm was situated on the common hepatic artery at the junction of the gastroduodenal and proper hepatic arteries. TAE was performed with framing, followed by coil embolization. Blood flow to the liver was maintained via the gastroduodenal artery. Appropriate framing is important for safe and efficient TAE.