An extremely rare case of malignant schwannoma of the esophagus with lymph node metastasis is reported. A 49-year-old woman was found to have an abnormal shadow on a chest X-ray film taken during an ...annual checkup. Upper gastrointestinal series showed extrinsic pressure on the middle thoracic esophagus, without a mucosal lesion. An exploratory operation was performed, with a tentative diagnosis of esophageal leiomyoma. The tumor was enucleated with part of the esophageal mucosa, and a few enlarged lymph nodes around the tumor were dissected. The resected tumor was an elastic firm mass, measuring 8.2 x 5.8 x 3.7 cm, and had a smooth surface. Histological examination of the tumor revealed the proliferation of spindle-shaped cells with chromatin-rich nuclei. The nuclei were variable in size and showed remarkable atypia. A paraesophageal lymph node had same findings as the main tumor. Immunohistochemically, the tumor cells were diffusely positive for S-100 protein and neuron-specific enolase. The pathological diagnosis of this tumor was malignant esophageal schwannoma with lymph node metastasis. Esophageal schwannoma is extremely rare. We reviewed the literature on 19 cases of esophageal schwannoma, including that in our patient. The majority of the tumors were benign. Only three cases of schwannoma were malignant, and this is the first reported case of malignant schwannoma with lymph node metastasis.
A 72-year-old man with hepatitis C was transferred to our hospital because of hepatocellular cell carcinoma (HCC) in January 2012. CT and MRI showed two liver tumors at S7 and S8. In March 2012, ...laparoscopy-assisted partial hepatectomy was performed. The HCC then recurred four times and was treated with radiofrequency ablation (RFA) each time. At the fifth recurrence, there was a tumor of about 10 mm near the right renal upper pole. A minilaparotomy was performed, and the tumor was located in the retroperitoneal space. The HCC then recurred four more times and was treated with RFA each time. In February 2016, CT showed that more than 20 tumors recurred around the right kidney. During surgery, peritoneal dissemination was not seen. Resection of Gerota's fascia was performed, along with extensive resection of the retroperitoneum with the right kidney. The pathological diagnosis was retroperitoneal metastasis of HCC. Two years after the third operation, he remains well with liver recurrence. We propose that surgical resection should be considered as a suitable treatment option for management of HCC in the retroperitoneal space.
A Case of Mucinous Adenocarcinoma of the Distal Bile Duct IKESHOUJI, Hiroomi; OZEKI, Yutaka; IMAI, Naoki ...
Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association),
2017, 2017-00-00, Volume:
78, Issue:
3
Journal Article
Open access
Here, we describe a case of mucinous adenocarcinoma of the distal bile duct. A 67-year-old man was referred to our clinic with liver dysfunction. Although he was asymptomatic, computed tomography ...revealed bile duct dilation and a mass in the distal bile duct. Following endoscopic biliary biopsy through the duodenal papilla Vateri, which revealed adenocarcinoma, he was diagnosed with cancer of the distal bile duct. A subtotal stomach preserving pancreatoduodenectomy was performed for a cT2, cN0, cM0 tumor. The pathological diagnosis was poorly differentiated mucinous adenocarcinoma, and the discovery of multiple lymph node metastases indicated stage pT3a, pN1, M0, II B disease. Although his postoperative course was uneventful, he died of a cancer recurrence 10 months after surgery. We further address the rarity of mucinous adenocarcinoma of the distal bile duct through a review of the literature.
A 68-year-old man diagnosed with peritonitis due to perforated acute appendicitis underwent and appendectomy and drainage. The postoperative pathological diagnosis was primary moderately ...differentiated adenocarcinoma of the appendix. Abdominal CT showed 4 metastatic liver tumors in the right lobe. We followed the man up 3 month after appendectomy. Right hemicolectomy and right hepatic lobectomy were done. The pathological diagnosis was moderately differentiated metastatic adenocarcinoma of the liver and lymph nodes. The man was discharged on post 28 operative day, but died of the recurrence 20 months after the first operation. Primary adenocarcinoma of the appendix is rare, In addition to, as is hepatectomy for liver metastasis. Although the prognosis of primary appendiceal adenocarcinoma with liver metastasis is dismal, aggressive hepatectomy is indicated unless distant metastasis and peritoneal dissemination existed. Hepatectomy after the first operation should be done as soon as the patient's general condition allows.
A 76-year-old man with a gastric abnormality detected in October 2001 had normal tumor markers in blood examination, but soluble IL-2 receptor of 926U/ml. UGI and endoscopy showed a type 2 tumor in ...the antrum. Malignant lymphoma was counterindicated by biopsy, so total gastrectomy and splenectomy were conducted in December 2001. We diagnosed small cell carcinoma of the stomach by immunopathological and histopathological examination. Postoperative chemotherapy was conducted by CPT-11. Abdominal CT in August 2003 showed a tumor measuring 22mm at S7 of the liver. No other recurrence was seen, so partial resection of S7S8 was conducted in November 2003. Histopathologicaly, we diagnosed metastatic small cell carcinoma from the stomach. Chemotherapy by VP-16 was done because of doubt of metastasis to the lung, and he is alive 3 years after gastrectomy and 1 year and 1 month after hepatectomy.
A 61-year-old woman with a 40 mm cystic lesion of the pancreatic body was kept under observation by a local physician. When follow-up imaging showed enlargement of the tumor, she was subsequently ...referred to our institution. We investigated by CT and discovered the tumor had grown to 130 mm. The same CT also revealed a small amount of blood accumulated in the Douglas pouch (recto-uterine pouch). We diagnosed the condition as ruptured mucinous cystoadenocarcinoma (MCC) of the pancreatic body with intra-abdominal bleeding and we opted to surgically remove the tumor. Intra-operatively, we visually confirmed the blood accumulation in the Douglas pouch. We also observed whitish nodules surrounding the tumor suggesting peritoneal dissemination. We resected the tumor en-bloc to halt the abdominal hemorrhaging. The resected organs were: the pancreatic tail and body, the spleen, the stomach, the left hepatic lobe, and part of the transverse colon. The pathology report confirmed the diagnosis of anaplastic carcinoma derived from mucinous cystadenocarcinoma with ovarian-like stroma. The whitish nodules were also confirmed as peritoneal dissemination. Her postoperative recovery was uneventful and the patient was discharged three weeks after the operation. However, liver metastasis and peritoneal dissemination advanced rapidly and the patient passed away 3 months after surgery. Previously, only two cases of ruptured MCC were reported in Japan; this case marks the third.
A 53-year-old woman underwent a pylorus preserving pancreatoduodenectomy (PPPD) with intestinal reconstruction by means of modified Child method for a submucosal tumor in the descending part of the ...duodenum in August 1994. Two years later, dilatation of the main pancreatic duct became apparent on an abdominal CT scan. Thereafter the diameter of the main pancreatic duct increased to 3cm in 2000 and then 4cm in 2003. Since a mucin-producing tumor of the pancreas was considered probable, the patient was operated on again in 2004, 10 years after the first operation. During surgery adhesions at the pancreatojejunostomy in the former operation was easily dissected, and no anastomotic opening was identified in both the pancreas and jejunum. An incision of the main pancreatic duct disclosed the retension of yellowish white cloudy fluid. Inraoperative frozen section histology showed absence of pancreatic tumor, so that anastomosis of pancreatic duct to jejunum was performed again. The patient's postoperative course was uneventful.
Endometriosis is a disease in which endometrial tissues grow in locations outside the uterus. Of such ectopic sites, the ileum is very rare. In this paper, we report a case of endometriosis of the ...ileum that presented as an ileal obstruction. A 41-year-old woman was referred to our hospital because of abdominal pain and vomiting. She had undergone a left adnexectomy for the removal of a chocolate cyst of the left ovary 9 years earlier. Laboratory data showed an elevated WBC count and an elevated CRP level. X-ray and CT images showed a dilated ileum and small amount of ascites. An emergency operation was performed under a diagnosis of ileal obstruction and strangulation. During the operation, two points of the ileum, located 10 and 20cm proximal to the ileocecal junction, were found to have adhered to the back side of the uterus. The ileum between the two points formed a loop and was not strangulated. Because the two points were stenotic and obstructive, we performed a partial resection of the ileum. Histopathologial examination showed endometriosis of the ileum. We report a rare case of ileus caused by endometriosis of the ileum.
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