PRIMARY MALIGNANT LYMPHOMA OF THE BREAST A Case Report and Review of the Japanese Literature

A 26-year-old pregnant woman was admitted to Nagasaki University Hospital complaining rapid enlargement of masses in the bilateral breasts and the right axilla. Biopsy of the right breast revealed malignant lymphoma. Simple mastectomy plus axillary node dissection on the right side (Br+Ax) and excision of the tumor in the left breast were performed. Histologically, the tumor was a diffuse lymphoma of the medium-size cell type according to the LSG classification, originated from B cells. After operation, Vincristine, Adriamycin, and Cyclophosphamide were administrered, but chemotherapy was terminated because of marked leukopenia. The patient has remained asymptomatic for 7 years without any treatment, and there is no evidence of recurrence. We have collected 79 cases of malignant lymphoma of the breast reported in the Japanese literature, including the present case, and examined factors that might affect the prognosis of patients. However, age, size of tumor, axillary lymph node involvement, histological findings, and type of therapy did not exert a significant influence. The most critical factor in a poor prognosis was the extramammary involvement of malignant lymphoma

Resection of Hepatic Metastasis from Colorectal Cancer : Survival, Factors Influencing Prognosis, and Follow-up

The purpose of this retrospective study was to analyze the surgical results of hepatic resection in our patients with colorectal hepatic metastasis. During a 26-year period, 223 patients among 1,484 patients with colorectal cancer suffered liver metastasis. In 44 curatively resected patients, the one-, three- and five-year cumulative survival rates were 85.9%, 44.9% and 23.0%, respectively. The prognostic importance of seven factors was evaluated. Synchronous or metachronous resection, the type of liver resection, and histologic differentiation did not influence the prognosis, whereas the number and size of metastases, and lymph node involvement did significantly affect prognosis as single factors. The mean diameter of metastatic lesions in the liver was 2.5 cm in the synchronous group and 4.5 cm in the metachronous group, the difference being significant (p = 0.0005). The presence of tumors with large diameters in the metachronous group might mean our failure of early detection of the recurrence of hepatic metastases. It is necessary to make steady efforts such as introducing regular follow-up imaging of colorectal cancer. The median interval between the primary operation and liver metastasis resection was 15.7 months in the lymph node involvement group and 37.7 months in the no lymph node involvement group. In 19 patients among 21 metachronously resected patients, the hepatic resection was done within three years. In conclusion, it was considered that hepatectomy could be done safely, that detection of an earlier lesion could improve the surgical results, and that follow-up for liver metastasis should be done intensively between 12 and 36 months after colorectal cancer surgery

A STUDY ON POSTOPERATIVE MORTALITY AND MORBIDITY AFTER PANCREATODUODENECTOMY

The early postoperative results of pancreatoduodenectomy performed in our institute during the last 20 years were reviewed, dividing the cases into two groups, from 1970 to 1979 and from 1980 to 1989. Among a total of 136 pancreatoduodenctomies, 52 were performed in the earlier decade and 84 in the latter decade. Patients were significantly older in the latter than in the earlier decade. In the earlier decade, postoperative complications developed in 28.8% of the patients with a 19.2% overall mortality rate. In the latter decade, the complications occurred in 27.4% with a 6.0% mortality rate. There was a significant decrease in overall mortality rate between the two decades. The most common complication was the dehiscence of pancreatojejunostmy, but life-threatening major leakage was decreased. It was considered that recent improvements in surgical techniques and intraoperative and perioperative management contributed to the improvement of the results of this procedure. However, continuing efforts are needed to reduce the morbidity rate, which remains high

Evaluation of bone density and skeletal muscle mass after sleeve gastrectomy using computed tomography method

Introduction: Sleeve gastrectomy is the most common surgical procedure to reduce weight and treat metabolic complications in patients with moderate-to-severe obesity; however, it affects the musculoskeletal system. Dual-energy X-ray absorptiometry (DXA), which is commonly used to measure bone mineral density (BMD), may be affected by excess fat tissue around the bones, interrupting BMD measurement. Due to the strong correlation between DXA and the Hounsfield units (HU) obtained from computed tomography (CT) scans, BMD assessment using clinical abdominal CT scans has been useful. To date, there has been no report of detailed CT evaluation in patients with severe obesity after sleeve gastrectomy. Objective: This study investigated the effect of sleeve gastrectomy in severely obese patients on bone and psoas muscle density, and cross-sectional area using retrospective clinical CT scans. Methods: This was a retrospective observational study that included 86 patients (35 males and 51 females) who underwent sleeve gastrectomy between March 2012 and May 2019. Patients' clinical data (age at the time of surgery, sex, body weight, body mass index (BMI), comorbidities, and preoperative and postoperative blood test results, HU of the lumbar spine and psoas muscle and psoas muscle mass index (PMI)) were evaluated. Results: The mean age at the time of surgery was 43 years, and the body weight and BMI significantly reduced (p < 0.01) after surgery. The mean hemoglobin A1c level showed significant improvement in males and females. Serum calcium and phosphorus levels remained unchanged before and after surgery. In CT analysis, HU of the lumbar spine and psoas muscle showed no significant decrease, but PMI showed a significant decrease (p < 0.01). Conclusions: Sleeve gastrectomy could dramatically improve anthropometric measures without causing changes in serum calcium and phosphorus levels. Preoperative and postoperative abdominal CT revealed no significant difference in the bone and psoas muscle density, and the psoas muscle mass was significantly decreased after sleeve gastrectomy

Percutaneous Transhepatic Drainage of Pyogenic Liver Abscess under Ultrasonography Guidance

Nineteen patients with liver abscess were treated in our department over a period of 14 years. The cause of the liver abscess was biliary disease in 13 of the 19 or 68%, and 8 of these 13 patients had undergone surgical procedures. The 13 patients with liver abscess received both percutaneous transhepatic abscess drainage (PTAD) under ultrasonography (US) guidance and antibiotics. The remaining 6 were treated with antibiotics alone. Among the 13 cases treated with PTAD, 11(84%) were cured in an average of 22 hospital days. One case (8%) with liver abscess caused by tuberculosis was unchanged and 1 (8%) died of hepatic failure due to liver cirrhosis. There were no complications related to PTAD, but the mortality rate among patients receiving antibiotics only was 33%. PTAD is the most advisable treatment for liver abscess and should be followed by appropriate supplemental management of the original conditions. Moreover, amputation of the distal bile duct is an indispensable part of bile diversion procedures because it prevents reflex cholangitis which may cause future liver abscesses

PRIMARY MALIGNANT LYMPHOMA OF THE BREAST A Case Report and Review of the Japanese Literature

A 26-year-old pregnant woman was admitted to Nagasaki University Hospital complaining rapid enlargement of masses in the bilateral breasts and the right axilla. Biopsy of the right breast revealed malignant lymphoma. Simple mastectomy plus axillary node dissection on the right side (Br+Ax) and excision of the tumor in the left breast were performed. Histologically, the tumor was a diffuse lymphoma of the medium-size cell type according to the LSG classification, originated from B cells. After operation, Vincristine, Adriamycin, and Cyclophosphamide were administrered, but chemotherapy was terminated because of marked leukopenia. The patient has remained asymptomatic for 7 years without any treatment, and there is no evidence of recurrence. We have collected 79 cases of malignant lymphoma of the breast reported in the Japanese literature, including the present case, and examined factors that might affect the prognosis of patients. However, age, size of tumor, axillary lymph node involvement, histological findings, and type of therapy did not exert a significant influence. The most critical factor in a poor prognosis was the extramammary involvement of malignant lymphoma