[症例報告]Primary duodenal carcinoma : A case report

A 66-year-old man two developed episodes of massive tarry stool and thereafter was admitted to our University Hospital to detect the cause of the tarry stool. An upper gastrointestinal series showed an irregular stricture of the duodenum just distal to the pylorus. Gastroendoscopy revealed a marked stenosis of the pylorus by swelling of the wall and a 2 cm-ulcerated tumor closely adjacent to the pylorus. He underwent a partial distal gastrectomy and a segmental resection of the first portion of the duodenum with a nodal dissection. Grossly, the tumor was an ulcerated carcinoma measuring 2.2×2.7 cm in size and was located in the posterior wall of the duodenum. Histologically, the tumor was confined to the duodenal wall (into the muscularis propria) and showed papillary adenocarcinoma with no evidence of lymph node metastasis. The patient is presently doing well with no recurrence as at the writing of this report.論文http://purl.org/coar/resource_type/c_650

[症例報告]Colonic cancer associated with radiation colitis : A case report and a brief review of the literature

A 62-year-old Japanese woman was admitted to our hospital because of a slight rectal bleeding and stenosis in the left colon on a barium study. The patient had undergone a total hysterectomy and received radiotherapy for uterine cervical cancer at 35 years of age. Twenty-seven years after the treatment of uterine cervical cancer, the patient presented with slight rectal bleeding. The physical examination revealed a mid-line surgical scar, brown pigmentation of the skin and wall thickness in the lower abdomen consistent with radiation effect. A barium enema study showed stenosis of the descending colon. Colonoscopy was failed because of difficulty in inserting the endoscope. The patient underwent a left colectomy with lymph node dissection. The lower abdominal cavity showed extensive fibrosis (so-called frozen pelvis) which is often associated with the radiation effect. The resected colon showed a macroscopic Type 2 tumor which invaded the retroperitoneal space and the tumor was histologically diagnosed to be well-differentiated adenocarcinoma (stage IV). Severe endoarteritis was also observed in the vicinity of the tumor. The patient is doing well at the time of writing.論文http://purl.org/coar/resource_type/c_650

Laparoscopic dissection of perigastric lymph node metastasis from an unknown primary squamous cell carcinoma: a case report

Carcinoma of unknown primary (CUP) is known to have a poor prognosis with limited treatment options. Here, we report a rare case of a patient who was diagnosed with CUP with perigastric lymph node metastasis. Our patient was a woman in her 60s who was admitted to another hospital with cholangitis. On computed tomography, a solitary swollen lymph node beside the cardia was seen. On follow up after a year and a half, the lymph node seemed to have increased in size, and the patient was referred to our hospital for further scrutiny. Endoscopic ultrasound-guided fine needle aspiration of the lymph node was performed and squamous cell carcinoma was detected histopathologically. Despite further examination, the primary site remained undetectable. Since there was no other metastatic site, a planned laparoscopic dissection of the perigastric metastatic lymph node was carried out successfully. At thirty months after surgery, there was no sign of any recurrence and the primary site still remained unknown.http://purl.org/coar/resource_type/c_650

Prognostic Significance of Simultaneous Presence of Histological and Immunohistochemical Metastasis to Lymph Nodes in Patients with Esophageal Cancer

Purpose: Presence of simultaneous pathological and immunohistochemical nodal metastasis (pNM and iNM, respectively) and/or other clinical factors may be reliable prognostic predictors of survival in esophageal cancer patients who have undergone multidisciplinary treatment.Methods: Univariate and multivariate analysis of the data collected from 77 patients who had undergone R0 esophagectomy was performed to determine the significance of presence of iNM or pNM, presence of simultaneous pNM, and other clinical factors as prognostic indicators in patients who had (n = 40) and had not (n = 37) undergone preoperative treatment.Results: Presence of pNM was found to be a significant prognostic predictor in patients who had undergone preoperative treatment, presence of iNM in patients who had not undergone preoperative treatment, and presence of simultaneous pNM and iNM in both patient groups. Multivariate analysis indicated that the sole prognostic predictor for patients who had undergone preoperative treatment was presence of simultaneous pNM and iNM while that of patients who had not undergone preoperative treatment was clinical T category.Conclusion: Assessment of simultaneous presence of pNM and iNM may facilitate highly accurate prediction of survival in esophageal cancer patients undergoing R0 esophagectomy, regardless of whether they have undergone preoperative treatment.http://purl.org/coar/resource_type/c_650