Pathological Study of the Intestinal Infarction -especially Non -occlusive Intestinal Infarction

Among intestinal infarctions, there is a relatively high incidence of non-occlusive intestinal infarctions, which have no evidence of apparent mesenteric vascular occlusion . In these cases, etiology and/or pathogenesis are not known, though some authors described congestive heart failure, digitalis intoxication, minute vessel occlusion , vasospasmus and so on as the trigger of the disorders. The purpose of this study is to examine the vascular factors which have not been reported systematically. Fifteen autopsy cases were used for this study including five cases of vascular occlusive intestinal infarction (two of arterial occlusions, two of venous occlusions and one of strangulation) and ten non-occlusive ones. Specimens for pathological study were obtained from both mesenteries and intestinal walls. As to the lesions of the intestinal walls, there were some differences between arterial and venous occlusions. Arterial occlusion showed mucosal necrosis and submucosal congestion while venous occlusion showed marked edema and hemorrhage of intestinal walls with less common necrosis of the mucosa. Ten cases of non-occlusive intestinal infarctions consisted of eight diffuse and two segmental cases. In the latter, in addition to marked stenotic atherosclerosis of the proximal superior mesenteric artery(SMA), the branch of the SMA toward the impaired parts of intestine was also narrowed by arteriosclerosis. Three of eight diffuse infarction cases also had stenotic proximal SMA and one of them had diffuse arteriosclerotic narrowing from proximal SMA to small mesenteric arteries (vasa recta). One of the other five cases presented microthrombi in the intestinal wall, suggesting Disseminated intravascular coagulation (DIC). The remaining four cases had no obvious vascular changes. In clinical aspects, six of ten non-occlusive intestinal infarction cases had cardiac diseases such as congestive heart failure, myocardial infarction and pericardial effusion . Hypertension was also found in five of ten cases. Hypotension (shock) before intestinal symptoms became manifest was not seen in any cases

Castleman\u27s Disease of the Retroperitoneum

A case of retroperitoneal CASTLEMAN\u27s disease of hyaline-vascular type is presented. A 58-year-old woman was admitted with a four month history of lower back pain. Although a retroperitoneal tumor was found on sonography and CASTLEMAN\u27s disease was included in the differential diagnosis, further imaging procedures such as computed tomography and angiography could not confirm the preoperative diagnosis of CASTLEMAN\u27s disease. After the surgical removal of the tumor, the patient has been doing well with no evidence of recurrent disease

Radiation-induced carcinoma of the rectum

Two patients with rectal cancer induced by irradiation for the treatment of uterine cancer were reported. Surgical outcome for radiation-induced cancer was satisfactory as far as the primary focus was well controlled. Definition of radiation-induced cancer also was discussed. It is the most important factor to be a long time interval of more than 10 years by detection of rectal cancer after irradiation and to reveal a histologic pattern concerning irradiation tissue damage

The Prognostic Significance of Subserosal and Serosal Extent of Cancer Invasion in Gastric Cancer

In order to determine the prognostic significance of subserosal and serosal extent of cancer invasion in gastric cancer, 78 patients were reexamined histologically. In these patients curative resection was performed and cancer invaded the subserosal layer with growth pattern of infiltrating type i.e."*"(30 patients), or exposed outside the serosal surface i.e. "*" (48 patients). The significantly favourable prognosis was seen only in patients with ssr cancer being less than 1 cm in extent with a five-year survival rate of 92.3%, and in patients with small amount of cancer cells in the subserosal layer, having a five-year survival rate of 81.8%. In patients with se cancer the five-year survival rate was less favorable

Early Gastric Cancer Presenting Pyloric or Prepyloric Stenosis

Out of 390 patients with early gastric cancer (EGC) who underwent gastric resection between Jan. 1968 and Jul. 1987, four patients developed pyloric stenosis and one patient developed prepyloric stenosis. Macroscopic types of EGC were II c in three cases and II c + III in two cases. Histologic types were tubular adenocarcinoma in four patients, and poorly differentiated adenocarcinoma in one patient. Cancer existed just right on or immediately adjacent to the pyloric ring in all patients; and extended transversely to the gastric axis in four patients, and longitudinally in one patient. An associated open ulcer and/or ulcer scar in the cancer lesion was seen in four patients, and submucosal fibrosis in three patients to a variety of degree, both of which were thought to be greatly attributed to pyloric or prepyloric stenosis. A duodenal ulcer was not present in any patients

Gastritis Cystica Polyposa-Report of a Case

A case of gastritis cystica polyposa is presented. A 45-year-old woman developed gastritis cystica polyposa at the gastroduodenostomy anastomotic site four years after Billroth II gastrectomy for adenomatous polyp. There was no association of gastric cancer in the lesion

Ileocolic Intussusception Caused by a Malignant Lymphoma of the Terminal Ileum

A 59-year-old man with ileocolic intussusception caused by a malignant lymphoma of the terminal ileum is presented. On the barium enema examination, a typical ileocolic intussusception and a tumor as a leading point were demonstrated. After a spontaneous reduction of the interssusception, the second barium enema clearly showed a polypoid tumor in the terminal ileum. The patient was seccessfully managed by surgery

Surgical Treatment of Gastric Cancer with Invasion Into the Contiguous Organs

Between 1968 and 1983, out of 1,137 gastric cancer patients who underwent laparotomy, 344 patients had cancer invasion into a contiguous organ based on gross findings. The incideces of peritoneal dissemination, metastasis to the liver and extensive lymph node involvement were observed at the rates of 52.9%, 17.2% and 37.8%, respectively. Two hundred and twenty-one patients had gastrectomy with or without combined resection of other organs. The resectability rate was 62.9%. The commonly invaded organs were the pancreas(49.3%), transverse colon (13.1%), liver (10.4%), and diaphragma (5.9%). Combined resection of the stomach and the surrounding organ was performed in 139 patients (62.9%). The operative motality rate was 4.9%. The crude five-year survival rate for gastrectomy was 10.8% ; 27.4% in curative resection and 3.5% in non-curative resection. In contrast, none of the 123 patients in the non- resected group survived 3 years postoperatively. The results support that aggressive gastrectomy is indicated in selected patients as far as curability can be expected by means of combined resection