Intrahepatic Cholangiocarcinoma with Sarcomatous Changes

A 61-year-old Japanese male was seen at an outside hospital with abdominal pain and distention. An intraabdominal mass was found on abdominal computed tomography (CT), and he was referred for further evaluation. He was afebrile, with mild tenderness in the upper abdomen and massive distention. Routine blood work showed severe inflammation and anemia. Repeat CT showed a large solitary heterogeneous mass, 25 cm in diameter, in the left upper quadrant with evidence of intratumoral bleeding and irregular enhancement peripherally. There was no clear distinction between the mass and the peripheral organs. Surgery was performed with persistent anemia and exacerbation of abdominal pain. Lateral segmentectomy, total gastrectomy, cholecystectomy and partial resection of the diaphragm and parietal peritoneum were performed. The final diagnosis was cholangiocarcinoma with sarcomatous changes. On the 16th postoperative day a CT scan revealed recurrent tumor. The patient died on the 34th postoperative day from rapid tumor progression

Usefulness of a Flexible Port for Natural Orifice Transluminal Endoscopic Surgery by the Transrectal and Transvaginal Routes

We developed a flexible port for NOTES which allows the use of conventional forceps for laparoscope-assisted surgery without change. The port is not affected by the location of the through hole in the gastrointestinal tract or vagina which elicits a problem in conventional NOTES, and its length can be adjusted during surgery by cutting the port itself. The port is made of polymer resin with a low friction coefficient. Furthermore, the port walls have a square wave structure which contributes to (1) the prevention of devices, for example, endoscope, from getting stuck at the time of insertion and retrieval, (2) the prevention of port slippage in the surgical opening for port insertion, (3) the prevention of unexpected port removal, (4) the prevention of port bore deformation, and (5) the improvement of port flexibility in the longitudinal direction. We validated the insertion and retrieval capacities of commercially available forceps for laparoscope-assisted surgery and power devices. Furthermore, we used the flexible port to conduct cholecystectomy and partial gastrectomy. We could confirm that the selection of the flexible port diameter according to the device type allowed the smooth insertion and retrieval of the device and that the port produced no air leakage. We affirmed that it is possible to conduct surgery by the cross or parallel method similarly to single port surgery. We considered that the flexible port has a potential of becoming a revolutionary port in NOTES

Perovskite Solar Cells Prepared by Advanced Three-Step Method Using Additional HC(NH2)2I Spin-Coating: Efficiency Improvement with Multiple Bandgap Structure

In the conventional two-step prepared perovskite solar cells, the CH3NH3PbI3 (MAPbI3) film usually contains an unreacted PbI2 at the interface between an electron transport layer (ETL) and a perovskite active layer. To reduce the unreacted PbI2 in the two-step prepared MAPbI3 film, we have recently reported a new three-step method, which was realized by an additional MA(I,Br) spin-coating. Here, we propose an advanced three-step method, viz., an additional HC(NH2)2I (FAI) spin-coating on the two-step prepared MAPbI3 film. The additional FAI spin-coating formed a FAxMA1–xPbI3 solid solution by the incorporation of FA ion into MAPbI3. Also, the additional FAI spin-coating yielded a FAyMA1–yPbI3 layer (y > x) by converting the unreacted PbI2, which resulted in the layered structure with different FA concentrations and hence, with the multiple bandgap structure. The best PCE of 18.1% was achieved by optimizing the FAI spin-coating process

Papillo-Choledochectomy in the Operative Management of Mucosal Neoplasms of the Periampullary Region

Two patients with mucosal cancer of the periampullary region were treated with papillocholedochectomy, which entails removal of the papilla of Vater and the whole length of the common bile duct. The neoplasm is dissected out through the plane between the duodenal circular and longitudinal muscles, deep to the sphincter of Oddi and the fibromuscular layer of the bile duct. Pathological examination showed that cancer was confined to the mucosal layer without stromal invasion, and that the operation achieved radical cure. For mucosal cancer, papillo-choledochectomy is an alternative to pancreatoduodenectomy, provided that repeated frozen-section studies confirm the completeness of excision

Pancreatic tumor insulin responsiveness

The aim : Pancreatic cancer, a rapidly progressive malignancy, is often diagnosed in patients with diabetes. The incidence of pancreatic cancer has risen dramatically over recent decades. Early diagnosis of this malignancy is generally difficult because the symptoms do not become apparent until the disease has progressed, generally leading to a poor outcome. To achieve earlier diagnosis, we analyzed the clinical characteristics of pancreatic cancer patients showing deterioration of plasma glucose levels while hospitalized. Method : Thirty-six cases were divided into 2 groups ; those diagnosed with diabetes more than a year prior to identification of pancreatic cancer and diabetes secondary to pancreatic cancer. These 2 groups were further subdivided according to the tumor site (head or body / tail), allowing analysis of 4 subgroups. Anthropometric measurements, laboratory values were determined. Results : Both groups with diabetes lost at least 4 kg and showed HbA1c deterioration of at least 1% within 5 months of the pancreatic cancer diagnosis. The post-meal elevation of serum C-peptide immunoreactivity (CPR) was significantly decreased in the group with cancer of the pancreatic head, and this was unrelated to tumor size. Conclusion : Characteristically, pancreatic head cancer was associated with decreased endogenous insulin secretion as compared to body / tail cancer

Predicting rectal cancer T stage using circumferential tumor extent determined by computed tomography colonography

SummaryBackground and aimPatients with stage T3 or T4 rectal cancer are candidates for neoadjuvant chemoradiation therapy. The aim of this study is to clarify the usefulness of circumferential tumor extent determined by computed tomography (CT) colonography in differentiating T3 or T4 from T1 or T2 rectal cancer.MethodsSeventy consecutive rectal cancer patients who underwent curative-intent surgery were enrolled in this study. All patients underwent colonoscopy and CT colonography on the same day. The circumferential tumor extent was estimated in 10% increments. The pathological T stage was used as the reference.ResultsThe median circumferential tumor extent evaluated by colonoscopy for T1 (n = 6), T2 (n = 21), and T3/T4 (n = 43) were 10%, 30%, and 80%, respectively (T1/T2 vs. T3/T4, p < 0.0001). The median circumferential tumor extent evaluated by CT colonography for T1, T2, and T3/T4 is 10%, 30%, and 70%, respectively (T1/T2 vs. T3/T4, p < 0.0001). The correlation coefficient between colonoscopy and CT colonography was very high (0.94). By defining a circumferential tumor extent ≥50% by CT colonography as the criterion for stage T3 or T4, the sensitivity, specificity, positive predictive value and accuracy were 72%, 88%, 91%, and 79%, respectively.ConclusionCircumferential tumor extent ≥50% determined by CT colonography is a simple and potentially useful marker to identify candidates for neoadjuvant chemoradiation therapy

Post-ERCP pancreatogastric fistula associated with an intraductal papillary-mucinous neoplasm of the pancreas – a case report and literature review

BACKGROUND: Fistula formation has been reported in intraductal papillary-mucinous neoplasms (IPMNs) with or without invasion of the adjacent organs. The presence or absence of invasion is mostly determined by postoperative histological examination rather than by preoperative work-up. CASE PRESENTATION: A 72 year-old Japanese woman showed remarkable dilatation of the main pancreatic duct (MPD) in the distal region of the pancreas. Subsequent ERCP also showed MPD dilatation, after which the patient suffered moderate pancreatitis. A subsequent gastroscopy revealed a small ulceration that had not been observed in a gastroscopy performed 3 months prior. Mucinous discharge from the ulceration suggested it might be the orifice of a fistula connected to the MPD. En bloc resection including the distal region of the pancreas, spleen, stomach and part of the transverse colon was performed under the pre- and intraoperative diagnosis of an invasive malignant IPMN. However, histopathology revealed the lesion to be of "borderline malignancy" without apparent invasion of the stomach. Light microscopy showed inflammatory cellular infiltrates (mainly neutrophils) around the pancreatogastric fistula, but there was no evidence of neoplastic epithelia lining the fistulous tract. CONCLUSION: This case highlights that a pancreatogastric fistula can develop after acute inflammation of the pancreas in the absence of cancer invasion. Further information regarding IPMN-associated fistulae is necessary to clarify the pathogenesis, diagnosis, appropriate surgical intervention and prognosis for this disorder