A 71-year-old man was found to have an elevated lesion with pigmentation in the lower thoracic esophagus by esophagogastroduodenoscopy. The lesion was diagnosed as malignant melanoma. No other ...lesions were identified and a diagnosis of primary malignant melanoma of the esophagus (PMME) was made. We performed subtotal esophagectomy by right thoracotomy and laparotomy with lymph node dissection. Histological examination revealed pT1a (LPM), N0, M0, and stage0 (according to the Guidelines for Clinical and Pathological Studies on Carcinoma of the Esophagus). c-KIT was positive in melanoma cells by immunohistological staining. In addition, a submucosal tumor was found in an area involved in the extention of melanoma and it was diagnosed as gastrointestinal stromal tumor (GIST). Adjuvant chemotherapy was started and he has survived without any recurrence as of 2 years and 3 months after the operation. PMME is rare, there are few reports of c-KIT positive PMME, and no cases of c-KIT positive PMME associated with esophageal GIST have been reported. To our knowledge, this is the first report of coexistence of c-KIT positive PMME and esophageal GIST. We report this case with review of the literature.
A 55-year old man underwent distal gastrectomy with lymphadenectomy for gastric cancer(T1N0M0, Stage I A). Six months after the radical operation, he presented with multiple liver metastases. Based ...on immunohistochemical examination, he was diagnosed with AFP-producing gastric cancer and metachronous liver metastases. He underwent a surgery to remove the liver metastases. Two months after the surgery, recurrent tumors were found in the lung and remnant liver. He received chemotherapy(S-1/CDDP and CPT-11/CDDP)for the recurrent tumor and lived for 15 months after the surgical intervention.
We present a case of interparietal hernia, a rare subtype of inguinal hernia, diagnosed and repaired laparoscopically. A 65-year-old man complaining of nausea and vomiting was admitted to our ...hospital with a diagnosis of intestinal obstruction. Computed tomography (CT) scan showed a dilated small intestine presented to the inside of the inferior epigastric vessels and compressed the testicular vessels and umbilical artery dorsalward. Operation was performed on suspicion of internal hernia or strangulated ileus due to an abnormal band. On laparoscopy, bloody ascites and redness of the small intestine were observed. Incarceration had been released. A hernia sac was recognized on the inner back side of the internal inguinal ring, and incarceration of the small intestine to the space was diagnosed. Dissection of the preperitoneal space disclosed the hernia sac situating between the transverse fascia and peritoneum. From these findings, interparietal hernia was diagnosed. The hernia sac was resected, and the hernia was repaired with mesh in the preperitoneal space by transabdominal preperitoneal repair method.
The patient was a 56-year-old man with advanced esophagogastric junction cancer. He received neoadjuvant chemotherapy with 5-FU plus CDDP followed by lower esophagectomy and total gastrectomy via the ...left thoracoabdominal approach in October 2011. Pathological examination revealed EGJ adenocarcinoma (ypT4aN1M0, Stage ⅢA, Japanese Classification of Gastric Carcinoma ver.14), and histological analysis indicated Grade 0 (no change). Adjuvant chemotherapy with S-1 was administered. Nevertheless, 6 months after the operation, a solitary hepatic metastasis (f: 32 mm) was detected in S7 of the liver. The patient underwent proton beam irradiation of the liver metastasis, resulting in a complete response, and he was followed up without any chemotherapy. However, 21 months after the irradiation, regrowth of the previous lesion with FDG re-accumulation was noted. Given the absence of any neoplasms other than the liver metastasis, right hepatic lobectomy was performed. Pathological examination revealed a small cluster of viable tumor cells surrounded by extensive fibrotic tissue (Grade 2). At 45 months after the initial operation (10 months after the liver lobectomy), the patient is living without any signs of recurrence. Surgical resection for liver metastasis of EGJ cancer may be feasible after careful selection.
A tumor hemorrhage is reported to be a rare adverse reaction of imatinib mesylate in gastrointestinal stromal tumors (GIST). We encountered two patients with tumor hemorrhage under imatinib ...treatment. Case 1: An 18-year-old woman underwent partial gastrectomy for gastric GIST at 14 years old. She complained of abdominal pain, and intraperitoneal relapse of GIST was diagnosed. She received imatinib mesylate treatment and twice developed an abdominal hemorrhage, which on both occasions was cured by conservative therapy. We resected the GIST as best as we could and restarted imatinib mesylate. There were no hemorrhages or relapses for twenty-nine months and five months, respectively. Case 2: A 35-year-old woman had an abnormality on the upper gastrointestinal series at a medical check-up and was given a diagnosis of gastric GIST, abdominal dissemination and multiple liver metastases. She was treated with imatinib mesylate, however she suffered an intra-abdominal hemorrhage which required surgery. We resected the tumors as best as we could and restarted imatinib mesylate. We obtained a clinical complete response for forty months. We have been successful at continuing treatment with imatinib mesylate with no recurrence, suggesting the efficacy for hemorrhage from GIST caused by imatinib mesylate.
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