テンイソウ デ ホルモン ジュヨウタイ ノ ヘンイ オ ミトメタ ニュウガン ノ 1レイ

A 44 year old woman visited the hospital with complaint of the right breast tumor which she left for two years. She presented with a large mass of８．５cm in diameter with skin invasion, right axillar lymph nodes, multiple liver, and bone metastases. Core needle biopsy of the main tumor revealed an invasive ductal carcinoma（scirrhous carcinoma）with nuclear grade 2 with ER（＋）,PgR（＋）, HER2（－）. The patient was treated with hormone therapy for three and a half year.The extensive mediastinum lymph nodes metastasis and multiple lung metastasis and a new tumor in the right thyroid lobe were appeared. The liver metastasis also increased in size and number.The therapy switched to chemotherapy with paclitaxel. Although the reductive effect was appeared in the breast mass, lung metastasis and liver metastasis, the thyroid and mediastinal lymph node metastases increased in size aggressively. The cytology of needle biopsy specimen from the thyroid tumor was consistent with breast cancer metastasis. Histopathology of the biopsy specimens from the mediastinal lymph node and the liver metastases also consist with breast cancer metastases, but ER and PgR receptor status converted to negative in mediastinal lymph nodes

コウ CEA ケッショウ オ テイシタ チュウスイ ネンエキ ノウホウ センシュ ノ 1レイ

A case of mucocele of the appendix associated with an increase in serum CEA level is presented. A 80-year-old women was seen at our hospital because she noticed a right lower abdominal mass and three months earlier. Physical examination revealed a mass with a tenderness . Except for anemia detected on admission, there was no biochemical abnormalities. High levels of tumor markers were noted ; CEA was 16.4 ng/ml. CT examination showed a cystic lesion at the ileo-cecal region. With a preoperative diagnosis of appebdiceal mucocele, cecal resection was performed. The resected appendix was smooth in surface and a monolocular cyst, and the lumen was filled a yellowish and gelatine-like substance. The appendix was histologically diagnosed as mucinous cystadenoma. The serum CEA level returned normal,1.5 ng/ml, half a month after the surger

A case report of secretory carcinoma of the breast in elderly

A 67-year-old woman was seen at the hospital because of a tumor in the area of the right breast. On physical examination, the tumor was elastic hard and movable. A core needlebiopsy revealed malignant findings' invasive ductal carcinoma. Mastectomy for right breast was performed. Pathological diagnosis was secretory carcinoma. The immunoprofile data were negative for ER, PR, and HER2, and were positive for the S-100, EMA, Adipophilin. She has been free from recurrence and metastasis so far. Secretory breast carcinomas are rare tumors, low-grade triple-negative carcinomas. Distant metastases from secretory breast carcinomas and local recurrence are extremely rare. Standard treatment has not been deciderd yet. We report a case of secretory carcinoma of the breast together with some bibliographical comments

A case of the gastric metastasis from invasive lobular carcinoma of the breast

A 45-year-old woman underwent total mastectomy with axillary lymph node dissection for right breast cancer in 2015. Histopathological examination of the resected specimen showed triple-negative invasive lobular carcinoma and advanced lymph node metastasis. The patient underwent postoperative adjuvant therapy consisting of a dose-dense epirubicin-cyclophosphamide regimen and weekly paclitaxel and radiotherapy. However, multiple bone metastases were detected, 18 months postoperatively. The patient developed upper abdominal discomfort, 21 months postoperatively, and gastroscopy revealed multiple, irregular depressed lesions in the stomach. Histopathological examination of stomach biopsy specimens revealed tumor cells that showed diffuse invasion of the lamina propria of mucous membrane. Immunohistochemical evaluation of biopsy specimens obtained from the stomach and the excised breast tissue showed cells that were immunopositive for CK7 and GCDFP-15 and immunonegative for CK20. The gastric lesion was therefore diagnosed as metastases from invasive lobular carcinoma of the breast. Although the patient received chemotherapy, she died of meningeal carcinomatosis from breast cancer, 7 month after the diagnosis of stomach metastasis. Immunohistochemical evaluation for CK20, which is expressed in gastric cancer and GCDFP-15, which originates from breast tissue, is useful to distinguish between breast cancer metastases and signet ring cell carcinoma of the stomach

ショクドウガン ジュツゴ ソウキ ニ キカン イカンロウ オ ガッペイ シタ 1レイ

The patient was a４５-year-old man. He had suffered from nephrotic syndrome at time of his twenties and had steroid salvage treatment. But he retired the treatment by himself. Esophageal tumor was suspected at the screening, and he was referred to our hospital. Preoperative diagnosis was the adenocarcinoma of the esophagogastric junction（cT２N０M０ stage Ⅱ）． Thoracoscopy assisted subtotal esophagectomy in prone position with D２dissection was performed. Gastric role was prepared in laparoscopic approach, and pulled up to the neck via posterior mediastinal route. Although early postoperative course was uneventful and esophageal fluoroscopy on the７th day showed no leakage, sudden dyspnea appeared on the８th day. CT examination and Bronchoscopy showed tracheoesophageal fistula. Unfortunately, the fistula didn’t get well, and we considered that it was difficult to close the fistula by only conservative treatment. Esophageal covered stent was inserted on the５６th day. After that, he could start ingestion intake and was discharged from hospital on the８５th day. Now, he is being followed up in our hospital

No-touch pylorus-resecting pancreatoduodenectomy can reduce postoperative complications even in low volume center

Purposes : Pancreatoduodenectomy (PD) was performed for 6 periampullary cancer patients by using methods verified by quality randomized controlled trials (RCT) in a low-volume center (LVC). The purpose of this study was to verify the clinical results. Methods : No-touch pylorus-resecting pancreatoduodenectomy (PrPD), antecolic gastrojejunostomy, pancreatico-jejunostomy with a lost stent tube to the main pancreatic duct, and early removal of a prophylactic drain were performed. Results : The drain could be removed 4 days after operation, and no pancreatic fistula was observed in all cases. Solid food could be started on POD4 after removing the drain. Furthermore, postoperative systemic chemotherapy could be started earlier. Conclusion : Although we have only a few PD cases a year in our institution, PD can be conducted safely without complications by using the methods verified by quality RCTs

Outcome of emergency one-stage resection and anastomosis procedure for patients with obstructed colorectal cancer

Purposes : The purpose of this study was to verify the outcome of the emergency one stage resection and anastomosis procedure for patients with obstructed colorectal cancer. Methods : An emergency one stage resection and anastomosis procedure was performed for 40 patients with obstructive colorectal cancer. The outcome was verified and compared dividing into two groups. 17 patients under the age of 70 in (Group A), 23 patients 70 years and over in (Group B). Results : The operative mortality rate in both groups was 0%. As a result, postoperative complications were not significantly different between the two groups. The overall survival rate after a 5-year period in both groups was 41.8%, regarding all patients and the survival curves for the two groups, was not significantly different. The 5 year survival rate in stage II or III showed no differences between the two groups. Conclusion : The one-stage resection and anastomosis of the large bowel could be applied safely to emergency patients, which in turn allows for excellent shortterm operative results in both groups mentioned. This particular procedure should be positively enforced, even in elderly patients in their 70’s

チュウスイ ゲンパツ フクゴウガタ セン シンケイ ナイブンピツ ガン ノ イチチケンレイ

A５２-year-old man visited our hospital because of epigastralgia. The colonoscopic examination revealed an about ４cm-protruded lesion like SMT on the appendix and findings of the biopsy specimen were compatible with the disgnosis of signet ring cell carcinoma. The primary lesion was unknown by upper gastrointestinal endoscopy, CT and PET, and the tumor markers were normal revel. At laparotomy, severe peritoneal metastasis was revealed in the abdominal cavity, especially appendix. Severe stenosis of ileocecum was found, so we conducted ileocecal resection. The histopathological diagnosis was primary signet ring cell caicinoma of appendix, SE, N２, M０, P３, pStage Ⅳ. Postoperatively mFOLFOX was started, but allergic reaction was seen after１cycle. We started Panitumumab/CPT-１１and the patient attended our emergency department with shivering chill and fever on treatment day１０. The next day he became shock state and CT revealed free air. Operation might not save his life and we started supportive care. He died on the day. The cause of his death was peritonitis by cancer perforation

Huge retroperitoneal dedifferentiated liposarcoma presented as acute pancreatitis : Report of a case

A 74-year-old male with abdominal pain was admitted to the emergency room in our hospital. The high value of serum amylase was shown in his blood test. The postcontrast computed tomography (CT) showed the huge retroperitoneal tumor with a thinwalled mass occupying most of the part of the right retroperitoneal space. The tumor spread into the soft tissues around the pancreas ; as a result, the duodenum was compressed and the pancreas was displaced to the right side. The irregular pancreatic outline, obliterated peripancreatic fatty tissue and fluid in the left anterior pararenal space were revealed, so acute pancreatitis was diagnosed. The diagnostic biopsy of retroperitoneal tumor was done, and the pathological findings of retroperitoneal mass revealed dedifferentiated liposarcoma. The medical treatment against acute pancreatitis was performed firstly. After the patient recovered from that, the surgical resection of the tumor with the right kidney and right adrenal gland was completed successfully. The patient remained well, without any evidence of recurrence three months after surgery. However, the histology showed dedifferentiated liposarcoma ; therefore, postoperative regular examination is necessary