We report an extremely rare case of hepatocellular carcinoma accompanied by sarcoid reaction in regional lymph nodes. A 67-year-old man with chronic hepatitis C admitted for back pain had serum ...α-fetoprotein elevated to 60ng/ml. Abdominal ultrasonography showed a hyperechoic tumor about 4cm in diameter in segment 5 of the liver. Dynamic bolus computed tomography (CT) showed peripheral enhancement of the tumor, accompanied by enlarged lymph nodes around the common hepatic artery and the inferior vena cava. Hepatic arteriography showed tumor staining, and CT during arterioportography showed a perfusion defect, yielding a diagnosis of hepatocellular carcinoma. Transcatheter arterial embolization (TAE) of the right hepatic artery was conducted, followed by microwave coagulation therapy to the liver tumor with lymph node dissection under laparotomy. Microscopically, biopsy specimens of the liver tumor showed poorly differentiated hepatocellular carcinoma, and dissected lymph nodes involved tumor metastasis including marked epithelioid granulomas.
A Case of Peritoneal Serous Papillary Carcinoma Sunami, Takeshi; Kanemura, Mizuyuki; Ohira, Masaichi ...
Nippon Shokaki Geka Gakkai zasshi,
2003, 2003-00-00, Letnik:
36, Številka:
9
Journal Article
Odprti dostop
A 67-year-old woman reporting abdominal fullness was found in abdominal ultrasonography (US) and computed tomography (CT) to have massive ascites. She was admitted for further examination. Ascites ...were serobloody and the result of cytology was class V (atypical adenocytes). Serum CA125 was elevated. Abnormal findings were not seen in the gastrointestinal tract, uterus, or ovaries. Surgery was done under a diagnosis of peritoneal carcinomatosis of ovarian cancer, or peritoneal serous papillary carcinoma. We found gross ascites, many disseminated nodules on the peritoneum and mesenterium, and a hard tumor on the omentum. Bilateral ovaries were normal in size and shape. We conducted omentectomy and bilateral salpingooophorectomy. Histological examination showed cancer cells extensively on the surface and inside the omentum, with findings resembling typical ovarian serous carcinoma, but the tumor invaded only the surface of the ovaries. The final diagnosis was peritoneal serous papillary carcinoma. After surgery, she underwent a combination chemotherapy of carboplatin and paclitaxel.
We report a case in which 5-fluorouracil/l-leucovorin (5-FU/l-LV) combination therapy was remarkably effective for non-resectable advanced rectal cancer with multiple liver metastasis. A 68-year-old ...man complaining of severe abdominal distension and abdominal pain was diagnosed as having ileus due to rectal cancer. We established a diagnosis of non-resectable rectal cancer with multiple liver metastasis and therefore performed only rectal colostomy. Systemic chemotherapy with 5-FU/l-LV was scheduled for a total of 22 courses postoperatively. After the chemotherapeutic regimen, a CT scan and colonofiberscopy revealed the primary lesions had disappeared, and a histological examination of biopsy confirmed that the patient had achieved complete response (CR).
A 68-year-old man was admitted to another hospital because of progressive weight decrease and appetite loss. Endoscopic examination revealed type 4 advanced gastric cancer at the upper body of the ...stomach. In February, 2003, he patient had probe laparotomy because there was a small amount of ascites in his peritoneal cavity, and intraoperative washing cytology revealed cancer cells in ascites.Subsequently, we started chemotherapy using S-1 and CPT-11. S-1 at a dose of 100 mg/day was orally administered for 2 weeks, and CPT-11 at a dose of 90 mg/body was intravenously administered once a week for 2 weeks followed by a 2-week drug-free period as 1 course. After 7 courses of the chemotherapy, the main lesion endoscopically vanished.Subsequently, the patient underwent curative total gastrectomy together with D2 lymph node dissection. Intraoperative cytology revealed no cancer cells, and histological examination of the primary lesion showed cancer cells invading the subserosa with no metastasis to any dissected lymph nodes. This therapy induced Grade 2 effect on cancer cells.Postoperatively, only S-1 was administered to the patient, who has remained alive with no recurrence for 4 years as of January, 2007.
An 80-year-old woman hospitalized for dizziness underwent pelvic CT scan, because bloody mucinous attachment was recognized on her under wear. Pelvic CT showed multi concentric ring sign around a ...mass at the lower rectum. We suspected that the mass might cause intussusception. The irregular tumor was palpable at the 3cm oral side from the anal verge. Barium enema visualized the tumor as hay-fork sign at first, but the appearance changed into apple core sign as the tumor was elevated and intussusception was reduced by inflation. Colonofiberscopy visualized the type 2 tumor near the anal verge, and it moved to the 7cm oral side from the anal verge by inflating the rectum. Biopsy revealed group V (well differentiated adenocarcinoma). Low anterior resection was performed under a diagnosis of rectal cancer with intussusception. Upon laparotomy, we saw that intussusception had been reduced. Intussusception caused by rectal cancer is very rare. We reviewed seven cases of adult intussusception or rectal prolapse caused by rectal cancer previously reported in the Japanese literature, with some bibliographical comments.
A CASE OF BOCHDALEK HERNIA WITH GASTRIC VOLVULUS SUNAMI, Takeshi; KANEMURA, Mizuyuki; YAMADA, Shinobu ...
Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association),
2003/01/25, Letnik:
64, Številka:
1
Journal Article
Odprti dostop
A 51-year-old man admitted for epigastralgia and repeated vomiting was diagnosed with diaphragmatic hernia with gastric volvulus based on chest radiography, contrast radiography of the upper ...gastrointestinal tract, barium enema, and abdominal computed tomography (CT). Surgery used an abdominal approach. The stomach, left part of the transverse colon, and greater omentum were displaced into the left thoracic cavity through a defect in the posterolateral part of the left diaphragm (Bochdalek foramen). Mesenterioaxial volvulus of the stomach was also confirmed. The Bochdalek foramen was closed and the stomach was fixed to the abdominal wall. In the 2 years since surgery, the man remains well and symptom-free.
A CASE OF ADULT BOCHDALECH HERNIA HA, Sin-Soo; CHUNG, Yong-Suk; YAMASHITA, Takashi ...
Nihon Rinshō Geka Igakkai zasshi,
1993, Letnik:
54, Številka:
2
Journal Article
Odprti dostop
A case of adult Bochdalech hernia in a naturally healthy 45-year-old woman is reported. The patient was seen at the hospital for further examination, because she was indicated as having an abnormal ...shadow in the left lower lung field after consulting a nearby doctor for a slight abdominal pain. Barium enema revealed a dislocation of the colon into the thorax through the left posterior-lateral diaphragma and adult Bochdalech hernia was indicated. The resection method used for the postero-lateral diaphragma defect was done via the abdominal cavity, resulting in a 5-year trouble-free period. Adult Bochdalech hernia is relatively rare, and only 69 case sincluding this case have been reported in the Japanese literature. Most cases involved persons in their twenties and the oldest was a 76-year-old person. The most common symptom included a slight abdominal pain, cough, or ileus. Since some cases affected by ileus driven shock, and mother and child died together due to herniation were reported, radical operation should be recommended when asymptomatic.
A 14-year-old girl was admitted to the hospital for a suspecion of metastatic liver mass on abdominal CT and ultrasonography. There was a history of undergoing bilateral oophorectomy with ...histerectomy for a left ovarian immature teratoma 2 years before. After the operation chemotherapy was added. On admission ultrasonography revealed a solitary metastatic tumor in the S8 are of the liver, but abdominal angiography showed no abnormal finding. MRI revealed an apparent extrahepatic tumor. The patient was diagnosed as having a disseminated metastatic tumor in the right diaphragm. There was no other abnormal finding, so a laparotomy was performed. The tumor was on the right diaphragm and compressed the liver. There was neither adhesion nor invasion into the liver. Some red bean or broad bean-size disseminated tumor were found in the Douglas pouch, anterior wall of the rectum and right kidney area. All those tumors were excised. These tumors were mature teratoma histologically. In general, extra or intrahepatic tumors often present difficulty in diagnosing. This paper describes such a case in which MRI was useful in differential diagnosis.
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