A Case Report of Intraductal Papillary-Mucinous Neoplasm of the Pancreas Showing Morphologic Transformation during Followup Periods

A 64-year-old man underwent MRCP for further examination of gallbladder stones and IPMN of branch-type (IPMN-Br) was pointed out. Yearly MRCP had revealed the gradual increase of the cystic components, marked dilation of the main pancreatic duct (MPD), and filling defects in the MPD. After follow-up for three years, he underwent pancreatoduodenectomy. Histologically, the dilated MPD and connecting dilated branch ducts were filled with nodular growth of tumor cells consisting of gastric-type adenoma with pyloric gland-like structures. In the MPD, a transition from gastric-type adenoma to intestinal-type carcinoma was observed. In addition, in a dilated branch duct, some components of intestinal-type carcinoma with marked arborizing structures were observed. A minimally invasion was observed around branch ducts. Immunohistochemistry revealed diffuse nuclear accumulation of PCNA and Ki67 in the tumor cells of branch dusts. Our observations suggest that the secondary infiltration to the MPD of IPMN-Br and IPMN-Br possesses malignant potential for microinvasion

A Case Delayed Hemorrhage from the Stump of the Superior Rectal Artery after Abdominoperineal Resection of the Rectum

A 66-year-old man underwent abdominoperineal resection for advanced rectal cancer. On day 3 post surgery, a decompression tube was placed for postoperative ileus. Symptoms associated with ileus immediately disappeared. On day 7 post surgery, the patient vomited large amounts of fresh blood and became hemodynamically unstable. An emergency angiography revealed active bleeding from the stump of the superior rectal artery communicating with the third portion of the duodenum. Complete obliteration of the stump by proximal coil embolization was performed to achieve successful hemostasis. The postclinical course was uneventful and the patient was discharged on day 40 post surgery

Liver Abscess after Common Hepatic Artery Embolization for Delayed Hemorrhage Following Pancreaticoduodenectomy: A Case Report

A 55-year-old man underwent pancreaticoduodenectomy for bile duct carcinoma in March 2009. The patient developed anastomotic leakage and had a short episode of hemorrhage from the drainage tubes with spontaneous disappearance. CT and upper endoscopy did not reveal the source of bleeding. A massive life-threatening hemorrhage occurred on the 18th postsurgical day. Emergency angiography showed a 2.7-cm pseudoaneurysm of the gastroduodenal artery stump, and hepatic artery embolization was performed. After embolization, an abscess appeared in segments 2/3 of the liver without involving the right lobe. We treated conservatively by drainage and antibiotics. During the course of therapy after embolization, the patient experienced several episodes of high fever but did not develop hepatic failure. On the 68th day after embolization, the abscess had penetrated to the lesser sac, which was immediately treated by percutaneous drainage. Anastomotic leakage was treated by continuous irrigation from the drain, for which complete resolution was achieved by the 34th day after embolization. The patient was discharged 101 days after embolization. Imaging and the clinical course demonstrate a unique mechanism of abscess formation after embolization

Successful Surgical Resection for Peritoneal Implantation of Hepatocellular Carcinoma at the Paracardial Portion

Peritoneal implantation from hepatocellular carcinoma has been rarely reported. It may occur at various sites. Here we present a surgically resected case of peritoneal implantation to the diaphragm from hepatocellular carcinoma. A 50-year-old woman underwent right hemihepatectomy extended to a medial part of Couinaud segment IV for hepatocellular carcinoma in May 2000. In December 2008, the elevation of alpha-phetoprotein and the appearance of a heterogeneously enhanced mass, with dimensions of 9 × 7 cm, and adjacent to the remnant liver and pericardium suggested intrahepatic recurrence with markedly enhanced growth. After transcatheter arterial embolization, surgical resection under laparotomy combined with median sternotomy was selected. Samples of pericardial fluid showed no malignancy after cytological examination. At the superior border of the tumor, the confluence of pericardium and diaphragm was displaced, but the tumor itself showed a generally expanding but not invasive growth. The resected tumor showed moderately differentiated hepatocellular carcinoma whose pathology revealed a peritoneal implantation to the diaphragm. The patient is in good health without any postoperative complications or any further sign of recurrence

Mucinous cystic neoplasm of the pancreas in a male patient

Mucinous cystic neoplasms (MCNs) make up a morphologic family of similar appearing tumors arising in the ovary and various extraovarian organs such as pancreas, hepatobiliary tract and mesentery. MCNs of the pancreas occur almost exclusively in women. Here, we report a rare case of MCN in a male patient. A 39-year-old man was admitted to our hospital with the chief complaint of back pain. Abdominal computed tomography revealed a multilocular cyctic mass 6.3 cm in diameter in the pancreatic tail. In addition, the outer wall and septae with calcification were demonstrated in the cystic lesion. On magnetic resonance imaging , the cystic fluid had low intensity on T1-weighted imaging and high intensity on T2-weighted imaging. Endoscopic retrograde cholangio-pancreatography (ERCP) showed neither communication between the cystic lesion and the main pancreatic duct nor encasement of the main pancreatic duct. Endoscopic ultrasonography revealed neither solid component nor thickness of the septae in the cystic lesion. Consequently, we performed distal pancreatectomy with splenectomy under the diagnosis of cystic neoplasia of the pancreas. Histopathologically, the cystic lesion showed two distinct component: an inner epithelial layer and an outer densely cellular ovarian-type stromal layer. Based on these findings, the cystic lesion was diagnosed as MCN

ナンキョク ショウワキチ ニ オケル セイジョウ タイキ カンソクシツ ノ セッチ ニツイテ

南極大気のモニタリング観測およびプロジェクト研究観測に資するため,南極・昭和基地に19m^2の清浄大気観測室(通称エアロゾル観測小屋)を設置した.第45次日本南極地域観測隊の夏季作業で,昭和基地の主要部から約300m風上に建設し,2004年2月10日から大気エアロゾルとオゾンの連続観測を開始した.この観測室は電気暖房と外気の取り込みで室温を約20°C に保つようになっている.6m高の観測タワーとエアロゾル観測用の試料大気導入管も有している.この報告では,設置に至る背景から観測室の詳細と初年度から2年度の運用状況と問題点,導入管の特性などについて述べる.運用初年度は,基地主要部に位置する観測棟で従来から行っているエアロゾル濃度やオゾン濃度のモニタリングと並行して観測を行った.双方の観測値を比較したところ,観測棟における従来の状況に比べて,清浄大気を観測した有効率は最大で1割ほど向上したことがわかった.An observatory (19m^2 inside area) was built for monitoring clean air constituents, such as aerosol particles and ozone, near the core block of Syowa Station. The observatory is located about 300m windward of the main buildings of Syowa Station to reduce atmospheric contamination from an electric power plant and other station activities. Continuous observations of aerosols and surface ozone started on February 10, 2004. The observatory uses electric heaters and outside cool air to control room temperature at about 20°C ±3°C to avoid self contamination by heating fuel combustion. The observatory has a 6-m height tower for an air inlet system that connects to an aerosol sub-sampling line under constant laminar air flow condition. Comparison of aerosol data between the Kansokutou (Atmospheric Observatory in the main station area) and this new observatory from February 2004 to January 2005 suggests that the effectiveness for monitoring clean air was improved about 10%