We experienced a case of colonoscopic release of adult intussusception that was due to cecal cancer which was subsequently treated using elective laparoscopic surgery. An 81-year-old woman being ...treated for upper abdominal pain at our hospital was found to have a target sign in the ascending colon on computed tomography (CT). Enhanced CT showed multiple concentric ring signs and local colon-wall thickening, which were diagnosed as tumor-induced intussusception. Colonoscopy showed an elevated lesion in the cecum, and histological findings of a biopsy specimen from the lesion showed mucinous adenocarcinoma. Intussusception was easily reduced using air injection. Three days after intussusception repositioning, laparoscopic ileocecal resection with lymph node dissection was conducted using five trocars. Examination of the resected specimen revealed a type 1 tumor in the cecum measuring 22×27mm. Pathologically, the tumor was a mucinous adenocarcinoma type1 pMP in depth, ly1, v1, and pN0. The patient had an uncomplicated postoperative course and was discharged 11 days after surgery. Adult intussusception is rare. Most cases of adult intussusception caused by a tumorous lesion tend to be treated by emergency surgery without a definitive diagnosis. Preoperative reduction, if possible, may be important for preoperative diagnosis and appropriate surgical treatment. We reviewed 16 such cases in the Japanese literature, including our own, that were treated using laparoscopic surgery.
We herein report a 76-year-old man with acquired hemophilia A (AHA) who developed gallbladder rupture due to Ceftriaxone (CTRX)-associated pseudolithiasis. The patient was admitted for an examination ...of systemic subcutaneous bleeding. A blood test showed a prolonged activated partial thromboplastin time and sequentially revealed low factor VIII activity (<1%) and a high factor VIII inhibitor level of 143 BU/mL. The patient was thus diagnosed with AHA. After admission, he developed a high-grade fever and was administered intravenous CTRX, considering the possibility of psoas abscess or cellulitis. Although his high-grade fever was improved, computed tomography incidentally showed a high-density lesion in the gallbladder, suggestive of CTRX-associated pseudolithiasis without clinical symptoms. Despite cessation of CTRX, the pseudolithiasis never disappeared, and the patient suddenly died after rapid progression of abdominal bloating. An autopsy revealed that the gallbladder was severely swollen and had ruptured with hemorrhaging because of hemorrhagic cholecystitis, caused by CTRX-associated pseudolithiasis with AHA. Our case demonstrated that CTRX-associated pseudocholelithiasis can unexpectedly induce gallbladder hemorrhaging and rupture in a patient with a bleeding diathesis, including AHA. CTRX-associated pseudocholelithiasis can cause a fatal outcome in patients with a bleeding disorder, even if CTRX is ceased as soon as pseudocholelithiasis is detected.
Since endoscopic morphological changes in minute signet-ring cell carcinoma of the stomach are minimal, it is rarely detected clinically and few cases have been reported. Recently, we encountered ...four patients with minute signet-ring cell carcinomas of the stomach, and analyzed their endoscopic and histopathological features. They were discolored. When sprayed with indigo carmine, all lesions had gastric sulculi, and they became unclear, making their recognition even more difficult. In order to detect gastric signet-ring cell carcinoma endoscopically, careful observation is required to avoid overlooking the discoloration of the gastric mucosa.
Pancreatic adenosquamous carcinoma is a rare primary pancreas malignant tumor with very poor prognosis, for which there is no standard treatment. The case was of a 71-year-old woman who was admitted ...to the hospital with jaundice. A pancreatic head tumor was found, and pancreatic adenosquamous carcinoma was diagnosed in EUS-FNA. Despite confirmed distant metastasis, a multidisciplinary treatment centered on chemoradiotherapy gave her a 28-month prognosis.
Background and purposeThe aim of this study was to investigate factors affecting the proliferative activity of early undifferentiated gastric cancer.MethodWe investigated endoscopic and pathological ...features of early undifferentiated gastric cancer (74 lesions in 73patients). We used Ki-67 staining to evaluate the proliferative activity and identified factors affecting the proliferative activity.Results H.pylori infection was significantly associated with high Ki-67 index.Conclusion H. pylori infection may increase the proliferative activity of early undifferentiated gastric cancer.
We report a case of advanced colon cancer that was effectively treated with mFOLFOX6 plus panitumumab combination chemotherapy. The patient was a 54-year-old man who had type 2 colon cancer of the ...rectum. An abdominal CT scan demonstrated rectal cancer with bulky lymph node metastasis and 1 hepatic node (rectal cancer SI bladder retroperitoneum, N2M0H1P0, cStage IV). He was treated with mFOLFOX6 plus panitumumab as neoadjuvant chemotherapy. After 4 courses of chemotherapy, CT revealed that the primary lesion and regional metastatic lymph nodes had reduced in size (rectal cancer A, N1H1P0M0, cStage IV). Anterior rectal resection with D3 nodal dissection and left lateral segmentectomy of the liver was performed. The histological diagnosis was tubular adenocarcinoma (tub2-1), int, INF a, pMP, ly0, v0, pDM0, pPM0, R0. He was treated with 4 courses of mFOLFOX6 after surgery. The patient has been in good health without a recurrence for 2 years and 5 months after surgery. This case suggests that induction chemotherapy with mFOLFOX6 plus panitumumab is a potentially effective regimen for advanced colon cancer.
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