There are some reports of cases of aneurysm associated with median arcuate ligament syndrome（MALS）, however, cases of hemorrhagic duodenal ulcer in such cases are rare. A 58-year-old man visited a ...neighborhood clinic with a history of hematemesis. Upper gastrointestinal endoscopy revealed intractable bleeding from a duodenal ulcer and emergency laparotomy with omental plombage was performed. However, the hemorrhage recurred and the patient was transferred to our hospital. Abdominal CT revealed a gastroduodenal artery aneurysm near the ulcer, which was thought to be the actual source of the bleeding. Therefore, coil embolization was performed as an emergency interventional radiologic（IVR）procedure and was successful. The patient was diagnosed as having MALS by the detection of stenosis at the origin of the celiac artery. Therefore, median arcuate ligament release was performed 3 months later, and the bleeding has not recurred since. Based on this experience, we wish to emphasize that it is important to be alert to the possibility of MALS in patients presenting with an intractable hemorrhagic duodenal ulcer and IVR should be performed immediately when MALS is detected.
Although rectovaginal fistula is a rare complication of rectal cancer surgery, it is usually difficult to cure with conservative treatment, and patients generally need surgical intervention. A woman ...in her 70s underwent laparoscopic low anterior resection with right lateral lymph node dissection for rectal cancer. On postoperative day(POD)6, she had an anastomotic leakage and received conservative treatment. On POD 9, she underwent emergent laparotomy for urinary peritonitis as well as ileostomy and ureteral stenting. On POD 21, the rectovaginal fistula was confirmed with lower gastrointestinal tract fluoroscopic examination. The patient received conservative therapy for the rectovaginal fistula with estriol vaginal tablets and vaginal lavage for 2 weeks. Subsequently, the fistula was completely cured. After continuation of the estriol vaginal tablets for 4 weeks, the rectovaginal fistula has not recurred at the most recent follow-up.
Surgical resection is the most effective treatment for liposarcoma, a retroperitoneal malignant soft tissue tumor, and a reliable negative margin is required because of the high risk of local ...recurrence. We reported a case of pelvic liposarcoma that could be resected by laparoscopic and transsacral hybrid approach. A 60's-man had a mixed liposarcoma occupying the right rear of the pelvis in the rectum. The operation was preceded by a laparoscopic operation, and the right internal iliac artery and vein and the superior rectal artery were dissected. The tumor was separated along the right pelvic wall. The oral rectum was transected and the colon was elevated by the extraperitoneal route. After conversion to the Jackknife position, the anterior sacrum was exfoliated with the right transsacral approach, the coccyx was resected, and the rectal anus, tumor, and surrounding fatty tissue were removed as an en bloc fasion. Histopathological examination showed mixed type of liposarcoma and negative margin of the stump. The patient is alive without recurrence 8 months after the surgery.
The patient was a 66-year-old male who had undergone an operation for lung cancer and solitary brain metastases. Follow- up PET-CT after 1 year detected FDG accumulation in the stomach. We performed ...esophagogastroscopy and found an approximately 20 mm-sized Type 2 tumor on the greater curvature of the upper stomach. A pathological diagnosis of lung adenocarcinoma metastasis in the stomach was made. Laparoscopic surgery was performed on the metastatic lesion to prevent bleeding and perforation, and resection was achieved with minimal invasion. The current development of chemotherapy, including immunotherapy, has contributed to the improved prognosis of cancer patients, including those with lung metastasis in the stomach. Considering these backgrounds, preventive surgical resection under laparoscopy may be an effective approach for improving prognosis and preventing acute life-threatening adverse events. We report this case along with a literature review.
Abstract
Background
Recently, endoscopic submucosal dissection (ESD) has been used as a less invasive treatment for superficial esophageal cancer. Additional treatment is often required after ...non-curative resection to prevent local recurrence and lymph node metastasis. Here, we present the outcomes of various additional treatments for patients with superficial esophageal cancer who underwent ESD.
Methods
Between 2006 and 2017, we performed ESD in 179 patients (210 lesions) with superficial esophageal cancer and 44 cases resulted in the non-curative resection diagnosed by the pathological examination. Among them, 29 patients received additional treatment, whereas 15 patients with no additional treatment were followed up. Additional treatment included esophagectomy (8 patients), chemoradiotherapy (15 patients), ablation using argon plasma coagulation (4 patients), and chemotherapy alone (2 patients). We examined the clinicopathological characteristics and prognosis of patients in the additional esophagectomy group (S group) and chemoradiotherapy group (CRT group).
Results
Twenty-three patients with pT1a-MM, pT1b, lymphatic invasion, venous invasion, and positive resection margins (both horizontal and vertical) were divided into two treatment groups. Clinicopathological characteristics of patients in the S and CRT groups were not significantly different. Pathological findings after additional esophagectomy showed one residual tumor and one lymph node metastasis. There were no recurrences in the two groups. There was no statistically significant difference in the 5-year overall survival rate between the S group (87.5%) and the CRT group (93.3%). One patient from the S group died due to respiratory pneumonia, and one patient died due to radiation pneumonia. However, five out of the 15 (33.3%) patients who were followed up with no additional treatment developed recurrence. The 5-year overall survival rate was 40.4%, which was not significantly different from that in the additional treatment group. However, the 5-year relapse-free survival rate (30%) was significantly different from that in the additional treatment group (P > 0.05).
Conclusion
Additional treatment is essential after non-curative endoscopic submucosal resection for esophageal cancer. Additional esophagectomy and chemoradiotherapy were both safe and effective in this cohort.
Disclosure
All authors have declared no conflicts of interest.
Abstract
Background
Neuroendocrine cell carcinoma (NEC) of the esophagogastric junction is rare and usually has a very poor prognosis.
Methods
Here we present two cases of NEC occurred in the ...esophagogastric junction.
Results
Case 1
A 50-year-old man was admitted to the introduction origin medical institute with an abdominal pain and dysphagia. Upper gastrointestinal endoscopy revealed a type 2 tumor at the esophagogastric junction, and the pathological examination showed the diffuse proliferation of relatively homogeneous tumor cell with chromatin-enriched nuclear and immunohistologically, the tumor cells were positive for Chromogranin A, CD56, AE1/3. MIB-1 index was 80%, we diagnosed neuroendocrine carcinoma (small cell type).
TNM Stage was GE, Type 3, cT4, cN1, cM0 cStage IIIB (ENETS TNM classification) He had undergone total gastrectomy and lower esophagectomy with transhiatal approach and 2 field of lymph node dissection.
Pathological examination revealed NEC component developed under the muscularis mucosa, differentiated adenocarcinoma localized upper the muscularis mucosa and Chromogranin A positive cells were scattered inside.
Pathological findings showed NEC (MIB-1 72.5%) with tub1, 70 × 56 mm, pT3 pN1(7/36), stage IIIB (HER2 score0). Adjuvant chemotherapy using S-1 was started, but the follow up CT showed recurrence in mediastinum, left subclavian and paraaortic lymph nodes 7 months after surgery. S-1 followed by CPT-11 + CDDP, CT showed the shrinkage of paraaortic lymph nodes metastasis. The patient alive for 55 months without any evidence ofprogression being continued chemotherapy.
Case 2
A 57-year-old man was admitted to the introduction origin medical institute with dysphagia. Upper gastrointestinal endoscopy revealed a type 2 tumor at the esophagogastric junction, and the pathological examination showed NEC (small cell type). CT and PET revealed mediastinal lymph node metastasis, aortic invasion and adrenal metastasis. TNM stage was NEC, EG, cT3, cN1, cM1 cStage IV. We performed a systemic chemotherapy with CPT-11 + CDDP, the evaluation of treatment effect after 5 course chemotherapy revealed partial response. However the patient underwent the endoscopic stent graft due to stenosis, and died due to progressive disease 18months after chemotherapy induction.
Conclusion
We reported here two cases of NEC occurring in the esophagogastric junction. It's clinical behavior remains unclear and the treatment strategy for NEC of esophagogastric junction is not established. Further investigation of accumulated cases of this rare entity is necessary.
Disclosure
All authors have declared no conflicts of interest.
•A rare case of Tuberculosis Peritonitis regarding the aspect of perioperative infection control.•The importance of characteristic intraperitoneal findings, which contributes to the rapid and ...accurate diagnosis combined with pathological findings.•Diagnostic laparoscopy must be less invasive and more effective compared with conventional methods.
Tuberculous peritonitis (TBP) is uncommon in Japan, and its diagnosis with conventional methods is time taking and requires a high clinical index of suspicion. Laparoscopy with peritoneal biopsy is a tool for rapid and accurate diagnosis of TBP. However, few cases have mentioned the infectious control and prevention during the perioperative period.
This case is written following the SCARE scale for case report writing.
A 30-year-old man from Southeast Asia with a past medical history of pulmonary tuberculosis at 3-year-old admitted to our institution with abdominal pain and slight fever lasting for a week. With the elevation of inflammatory response and CA125, we conducted CT (Computed tomography). Not only ascites, panniculitis with peritoneal nodules, and the thickening of the omentum were found. Considering the possibility of malignancy and TBP, we performed a diagnostic laparoscopy. Slightly cloudy ascites, peritoneal and thickening omentum with white nodules were seen, and pathological diagnosis from the omentum during the operation raised the possibility of TBP due to its caseating granuloma and these findings allowed us to start the rapid treatment.
We reported the effectiveness of diagnostic laparoscopy along with the aspect of perioperative prevention for TBP.
We report 2 cases of superficial non-ampullary duodenal tumor resected using laparoscopic endoscopic cooperative surgery( LECS). A man in his5 0's underwent screening esophagogastroduodenoscopy. ...Endoscopy revealed a 0-Ⅱc lesion at the anal side of the papilla of Vater that measured 5 mm. We performed LECS, and pathologic examination revealed tubular adenoma with no tumor cellsat the edge of the specimen. A man in his 80's underwent screening esophagogastroduodenoscopy. Endoscopy revealed a 0-Ⅱc lesion at the posterior wall above the papilla of Vater that measured 10 mm. The biopsy showed a well-differentiated adenocarcinoma. We performed LECS, and the pathological examination revealed a tubular adenocarcinoma in the mucosal layer with no carcinoma cells at the edge of the specimen. As the treatment strategy for superficial duodenal tumors has not established yet, further accumulation of cases and investigation are necessary.
Neoadjuvant chemotherapy plus surgery is recommended for clinical StageⅡ and Ⅲ esophageal cancer treatment by the JCOG9906. In contrast, definitive chemoradiotherapy(dCRT)is also a curative ...treatment. We encountered a case of recurrence in the cervical lymph nodes that was confirmed 6 years later, although thoracic esophageal cancer had completely disappeared following dCRT. Since there was no recurrence or metastasis in the primary lesion or other organs, we performed bilateral cervical lymph node dissection. There were 3 lymph node metastases among the dissected cervical lymph nodes pathologically. After the surgery, no relapses have occurred without the adjuvant chemotherapy.
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