A 52-year-old man admitted for palpitation and exertional dyspnea was found by our internal medicine department to have anemia and sigmoid colon carcinoma. The patient had situs inversus (Kartagener ...syndrome), and preoperative diagnosis of complicated anomalies were right-sided heart, two-lobe lung, multiple spleens, IVC defect and intestinal malrotation. Surgical findings were left-sided liver, right-sided stomach, total situs inversus, and nonrotational intestinal malrotation in which the cecum was on the median. Since sigmoid colon carcinoma inveded the cecum we conducted sigmoidectomy with ileocecal resection. The man was discharged on postoperative day 18. Situs inversus is a rare congenital disease and often has several complicated anomalies. Although this case involved sigmoid colon carcinoma with some complicated anomalies, no severe problems occurred during surgery.
A CASE OF CHOLANGIOCELLULAR CARCINOMA IN THE YOUNG KANEKO, Tadashi; SAWADA, Suguru; SUMI, Yasuhiro ...
Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association),
2002, Volume:
63, Issue:
11
Journal Article
Open access
We report a young patient with cholangiocellular carcinoma. A 30-year-old man with icterus was diagnosed with cholangiocellular carcinoma of the left hepatic lobe with invasion to the right hepatic ...duct and the right anterior branch of the portal vein. Left hepatic trisegmentectomy, caudate lobectomy, and resection and reconstruction of the bile duct and portal vein were done. His postoperative course was uneventful and he was discharged on postoperative day (POD) 19. Five months after surgery, portal hypertension due to recurrence at the portal anastomosis was noted, but he died 14 months after initial surgery despite additional treatment and follow-up. The rarity of cholangiocellular carcinoma in the young prompted us to report this case.
A 49-year-old man with anemia was found in endoscopic examination to have a subpedunculated polypoid tumor in the descending colon. The top of the tumor was white, lustrous, and movable with almost ...normal mucosa. We suspected it as a cancer of the descending colon and conducted left hemicolectomy. Macroscopically, the tumor was 22×18 mm and elastically soft. Microscopically, it showed proliferation of uniform atypical lymphocytes with hyperchromatic unclei in the superficial layer of the tumor head. Singularly, the tumor had hyalinofibrous connective tissue in the center of the head and peduncle. Immunohistochemically, tumor cells were positive to T-cell markers (CD3, MT1) and negative to B-cell markers (L26, MB1). The tumor had invaded the submucosal layer without lymph node metastasis and was diagnosed as non-Hodgkin's lymphoma, diffuse medium cell, T-cell in LSG. This case case was extremely rare, since it involved the descending colon, was subpedunculated, was early lymphoma, and was T-cell.
A 54-year-old woman complaing of right upper abdominal pain was referred to the hospital with a diagnosis of a giant hepatocellular carcinoma (HCC) 20cm in size on admission, the HCC occupied the ...entire right and medial lobes of the liver, and contacted with the left hepatic vein. The tumor emboli advanced to the main to left branchs of portal vein (Vp4). A right trisegmentectomy, a caudate lobectomy, a removal of the tumor emboli in the portal vein, a bile duct resection and a hepaticojejunostomy were performed. During the removal of the tumor emboli, a baloon catheter inserted from the umbilical vein was used as a method of hemostasis. The postoperative course was uneventful and she was discharged from the hospital on 24th POD. However, recurrence occurred in the remnant liver two months later. Inspite of additional therapies such as intermittent, intraarterial chemotherapy with reservor and radiation, she died of recurrence ten months after the operation. Pathologically, the mass was moderately differentiated HCC with vp4 and the tumor emboli invaded the wall of the bifurcation of the portal vein. We think that this HCC revealed a rare mode of progression as HCC.
We report a case of gastrointestinal stromal tumor (GIST) of the pylorus ring which is a rare site. A 71-year-old woman was admitted to the hospital because of anemia detected by a mass screening. We ...had great difficulty in decision making of tumor location. On CT and magrotic resonance imaging, a movable tumor measuring 6cm seemed to be located in the stomach. But, on endoscopy and gastroduodenography, the tumor was considered to be a submucosal lesion in the duodenum. We perform a laparotomy under a diagnosis of submucosal tumor near the pylorus. A gouse egg sized mass was found and resection of the antrum and duodenal bulb was performed. The resected speciemen showed a solid mass measuring 7.5×5.5cm on the pylorus ring. Pathological examination showed that the tumor was GIST positive for CD34 and c-kit and negative for actin-SM and S-100. GIST on the pylorus ring has not yet been reported so far. This rare case is presented with some bibliographical discussion.
The patient was a 52-year-old man who had been diagnosed as having a gastric ulcer and a duodenal ulcer by upper gastrointestinal endoscopy and received sanitization treatment for Helicobacter pylori ...in another hospital. He was referred to the hospital because a submucosal tumor of the stomach was detected by a follow-up examination. We performed upper gastrointestinal endoscopy again and diagnosed it as gastric malignant lymphoma by a biopsy. The patient was admitted to the hospital for the purpose of operation. Endoscopic examination of the lower digestive tract disclosed a submucosal tumor in the lower rectum and, as a result of a biopsy, it was diagnosed as rectal malignant lymphoma. On this account we performed total gastrectomy and abdominoperineal resection of rectum at the same time. As a result of histopathological examination, both the gastric and rectal lesitions were follicular lymphoma. After discharge from the hospital, he received chemotherapy in another hospital. Thereafter he has been recurrence-free. It is considered very rare that gastric malignant lymphoma coexists with rectal malignant lymphoma. In the treatment of such condition, we can attempt to perform total gastrectomy and abdominoperineal excision of recturm at the same time. And it appears to be best that chemotherapy is combined with these operative procedures to which the patient may be tolerable.
A 48-year-old woman was admitted to our hospital with the complaint of right lower abdominal pain. On admission, the physical examination revealed tenderness, muscle guarding and rebound tenderness ...in the right lower part of the quadrant. Although ultrasonography and computed tomography showed a right ovarian cyst, a diagnosis of panperitonitis due to appendicitis was made. An emergency operation was performed. At laparotomy, a great deal of ascitic fluid and a ruptured right ovarian cyst measuring about 5 cm in diameter were found. She was diagnosed as having panperitonitis due to a ruptured right ovarian cyst. Moreover, exploration of the cecum showed a tumor surrounded by a hard adhesion. The appendix could not be found. It was suspected that the tumor was a malignant neoplasm of the cecum and right hemicolectomy with right oophorocystectomy was performed. This case was diagnosed as appendiceal intussusception associated with endometriosis by pathological findings. The overall incidence of intussusception and endometriosis of the appendix is estimated as 0.01% and 0.05%, respectively. According to the literature, only 3 cases of appendiceal intussusception associated with endometriosis including ours have been reported in Japan. As histopathological diagnosis was difficult to obtain prior to the resection, meticulously planned treatment strategies are called.
We present herein on an 89-year-old female patient with perforated obstructive colitis. A gastrographin enema showed the apple-core sign on the rectum as well as leakage of contrast media proximal to ...that point. The patient was diagnosed as having rectal cancer followed by perforation. She underwent Hartmann's operation. During her postoperative course, polymyxin B direct hemoperfusion treatment was introduced, which was expected to diminish the risk for endotoxemia or sepsis. Neutrophil elastase inhibitor was also administered for her respiratory deficiency. Eventually she overcame her septic condition and was free from the respirator on the seventh postoperative day. However, dehiscence of her abdominal wound occurred revealing the intestines on the fourteenth postoperative day, and a second operation was therefore performed. We examined the Douglas pouch to see why suppurative exudate had been seen via a drainage tube and found out the stump of the resected rectum had completely opened out. An automatically suturing device with 3-layred staple lines was used to repair this deficit. The patient had a good postoperative course and was discharged from our hospital 63 days after the second operation.
We report a small cholangiocellular carcinoma found during a hepatectomy for hepatocellular carcinoma (HCC). A 64-year-old man was referred to the hospital with a diagnosis of multiple HCCs in S4, S5 ...and S7, while he was followed-up for liver cirrhosis. During operation, we found a white hard mass near the HCC in S5. So partial resections of S4 and S7 and a S5 segmentectomy including the new 4th lesion were performed. Pathological study demonstrated three HCCs, and one moderately differentiated adenocarcinoma that was tumor-forming small cholangiocellular carcinoma (CCC). This CCC showed perineural and lymphatic invasion. We report this rare case of double cancer with HCC and CCC, in which the CCC exhibited features of advanced cancer despite it was as small as 1cm in diameter.
The protective effect of 5,6,7,8-tetrahydroneopterin (NH.) against radiation injury in mice was studied. (C57BL/6x A/J)F
mice received whole body irradiation with a single fatal dose of 8.0 Gy X-ray. ...NH
was injected intraperitoneally into irradiated mice at various protocols. NH. was significantly effective to prolong the survival of the irradiated mice. The most effective protocol of NH
administration was 3 times injections (10 minutes before and after irradiation and additional one 12 hours after that.) with a dose of 30 mg/kg body weight for each. Some mice that received such treatment survived more than 30 days after irradiation. In conclusion, these results indicate that NH
has an inhibitory potential on radiation injury as an endogenous superoxide dismutase like substance.
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