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.
The purpose of this study was to examine the antitumor effect of strangulation to cease blood flow on tumor tissue. AH130 cells were implanted in the mesentery near the ileocecal portion of rats 10 ...days previously. A recovery rate of blood flow was observed in the tumor tissue and normal tissue (cecal wall) after reperfusion with a charge-coupled device microscope (CCD). Five days after reperfusion, the tumor volume ratio was measured. On the death or sacrifice of the animals, the tumor necrotic area ratio was examined. The vascular morphology and the changes of a recovery rate of blood flow after reperfusion differed from the tumor tissue and the normal tissue by CCD observation. In the 15-min and 30-min groups, the tumor vessels underwent little or no destruction, with only a few showing a cessation of blood flow. However, the 60-min and 90-min groups showed a cessation of blood flow and hemorrhage due to vascular destruction in many vessels, and few vessels showed intact blood flow. In 60 and 90-minutes strangulated groups, a recovery rate of blood flow after 60 minutes was lower in tumor tissue than in the normal tissue. The tumor volume ratio decreased more in the 60 and 90-minutes strangulated groups than in the non-strangulated group and the tumor necrotic area increased more in all strangulated groups than in the non-strangulated group. These findings suggest that strangulation for ischemia for 60-90 minutes injures the tumor tissue and shows the antitumor effect.
We used the Billroth-1 method and multiple staples to quickly and safely create anastomoses in critical patients with ulcer perforations who required an emergency gastrectomy. One patient with a ...gastric cancer perforation, 6 patients with gastric ulcer perforations, and 4 patients with duodenal ulcer perforations, for a total of 11 patients, were treated using this minimally invasive method. We did the transection of the duodenum after having put on a purse-string suture device. Furthermore, we fixed an anvil in the duodenum. We did the stomach excision with a linear stapler after having done the gastroduodenostomy with a ring stapler which was inserted on the excised stomach side of the anastomosis. The time to need for the anastomosis and the resection of stomach, by the above, was less than 10 minutes, and the overall operation time averaged. 104 minutes. This method is suitable for high risk cases, because it can be safely completed in a short time and does not require a great deal of experience to perform. This method should be considered as a minimally invasive option when performing emergency gastrectomies.
We performed abdomino-perineal resection of the rectum and partial resection of a vagina in a 78-year-old woman on a diagnosis of anal canal basaloid carcinoma with vaginal invasion. We did not ...perform specific adjuvant therapy pre- or postoperatively, but no recurrence appeared for 5 years. Anal canal basaloid carcinoma is a comparatively rare disorder, and the prognosis is relatively good. It seemed that determination of the indication of postoperative adjuvant therapy will require the accumulation of future further cases and enough appearance with operative methods in the treatment of anal canal basaloid carcinoma.
A female patient in her sixties with gastric follicular lymphoma is presented. She was initially diagnosed as having double cancers in the rectum and ascending colon. As pre-operative screening, ...gastrofiberscopy was performed and a submucosal tumor was found in the stomach. It was 5mm in diameter and was deemed to require follow-up only. A year later, the tumor had grown to 15mm in diameter. Endoscopic ultrasonography showed the tumor to exist in the second and third layers. Immunofluorescent staining indicated a diagnosis of follicular lymphoma. With no evidence of metastasis on other examinations, we performed laparoscopic wedge resection of the stomach including the tumor. Ten months after laparoscopic surgery, there are no symptoms of recurrence.
A 70-year-old woman seen for anemia was found in upper gastrointestinal endoscopy to have a type OIIc lesion at the posterior wall of the gastric body and an unclearly bounded elevated lesion at the ...bottom. Biopsy specimens from the type O IIc lesion showed signet-ring cell carcinoma and from the elevated lesion highly infiltrated plasma cells. She underwent total gastrectomy. Histopathologically the bottom lesion showed MALT lymphoma and H. Pylori infection. The development of simultaneous primary gastric MALT lymphoma and signet ring cell carcinoma is rare. Some data suggests signet ring cells occurring in gastric MALT lymphoma represent a particular lymphoepithelial lesion in which foveolar cells disaggregated by lymphomatous infiltration acquire a globoid, signet ring appearance. It is thererfor important that physicians bear in mind the possible presence of signet ring cell carcinoma when checking for MALT lymphoma.
A CASE OF MESOSIGMOID LEIOMYOSARCOMA YOSHIDA, Naomasa; SUMI, Yasuhiro; SAWADA, Suguru ...
Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association),
2003, Volume:
64, Issue:
4
Journal Article
Open access
A 51-year-old woman was admitted to the hospital because of abdominal distension. She had a neonatal head-sized hard mass in her lower abdomen. Abdominal computed tomography (CT) and magnetic ...resonance imaging (MRI) revealed a tumor 18×12cm in diameter in her pelvis. We diagnosed the case as mesenteric or ovarian tumor and performed a laparotomy. We found a firm tumor with uneven surface in the mesosigmoid, which looked like to penetrate the mesosigmoid from its ventral to dorsal and had no continuity to the uterus and intestine. The tumor was resected with a part of the sigmoid colon. The resected tumor was a whitish solid tumor with central necrosis, and 18×12×10cm in dimension. Histologically the tumor was diagnosed as mesosigmoid leiomyosarcoma. On immunochemical stainings, the tumor gave positive response for smooth muscle actin and negative for S-100. Although mesenteric leiomyosarcomas are rare, we should consider them for the patients with an almost silent abdominal mass.
We report a case of pancreatic injury that underwent an operation on 3 months after trauma. A 17-year-old man bruised his abdomen in an accident on April 10, 2001. He referred to a doctor and ...diagnosed with traumatic pancreatic injury. Despite conservative therapy, his serum amylase remained high. He was referred to another hospital and diagnosed in abdominal computed tomography (CT) and other studies with obstruction of the main pancreatic duct. He was referred to us for surgery, conducted on July 11. The pancreatic body and tail were very hard due to obstructive inflammation, necessiting pancreatojejunostomy. His postoperative course was uneventful and he was discharged on postoperative day 19.
We report a case of hepatocellular carcinoma (HCC) with tumor emboli in the inferior vena cava (IVC). A 51-year-old man suffering from HCC due to HBV cirrhosis since 3 years previously and undergoing ...TAE and percutaneous ethanol injection (PEI) several times was referred to our hospital for surgery for recurrent HCC. Abdominal CT in July 2000 showed a 3 cm tumor in segment 7 that extended to the IVC through the middle right hepatic vein (MRHV). The tumor continuously formed 4.0 cm emboli in the IVC in August 2000. Right hepatic lobectomy and tumor emboli removal were conducted by total hepatic vasculr exclusion (THVE). His postoperative course was uneventful and he was discharged on postoperative day 24. THVE is useful in HCC embolectomy, which extended to the IVC, provides a survival benefit for patients. We recommend the operation for HCC with tumor emboli into the IVC because of the improved quality of life (QOL).
PDF
