A 67-year-old man was admitted to our department with the chief complaint of discomfort in the anus and tenesmus. Abdominoperineal resection of the rectum was performed, and a diagnosis of ...leiomyosarcoma was made preoperatively. The tumor was 12×6×6 cm in size, and its cross section showed a gray-white tumor with central necrosis. Microscopically, it consisted of spindle, oval-shaped cells in interlacing fascicles. The mitotic rate was 4.2 mitotic figures per 10 high power fields. In Japan, only 134 cases of leiomyosarcoma of the rectum had been reported up to 1989. Among these, only 43 (31.9%) were diagnosed preoperatively. Radical resection was performed in 102 (75.6%) cases and local resection in 25 (18.5%). Recently, it was stated that the prognosis of leiomyosarcoma is influenced by histopathological features and operative methods. In conclusion, it is important to diagnose this disease not only by microscopic examination of the biopsy specimen but also by medical imaging such as computed tomography, ultrasonography, and angiography. Radical resection should be performed, once the disease is diagnosed.
A seventy six year-old woman was admitted to our hospital, complaining of fever and epigastric pain. Ultrasonographic examination revealed choledocholithiasis. Endoscopic examinations showed the ...irregular shaped erosion with spontaneous bleeding at the anterior wall of gastric angle (Figure 3) and also showed the erosion with whitish exudate around the papillary orifice (Figure 5). Biopsy specimens taken from both lesions demonstrated well differentiated adenocarcinoma. Pancreato-duodenectomy with subtotal gastrectomy was performed. Resected specimens demonstrated IIc type early gastric cancer, 3×3.5 cm in size (Figure 6) and small protruding lesion with whitish exudate at papilla of Vater, 1.0×0.9 cm in size (Figure 8). Histologically, the former was shown to be the tubular adenocarcinoma, extended to the mucosal layer and the latter the papillotubular adenocarcinoma, with invasion neither to pancreatic parenchyma nor to Oddi sphincter. The double cancer of stomach and pailla of Vater is uncommon. In this paper, we reported the very rare case that both lesions were the early cancer.
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