Embryonal sarcoma of the liver with chondroid differentiation

A 31-year-old female complained of upper abdominal and back pain. Laboratory tests showed elevated levels of aspartate aminotransferase, alanine aminotransferase and α-fetoprotein. Computed tomography revealed that the tumor, measuring 14.5 cm × 10.4 cm, occupied the anterior and medial segments of the liver and consisted of multicystic and solid lesions. The preoperative diagnosis was a hepatic cystadenocarcinoma. The operation was performed urgently because of tumor rupture. Histopathologically, spindle and asteroid cells were found to have proliferated diffusely. There were no neoplastic epithelial tumor cells. Tumor cells had periodic acid-Schiff-positive hyalin globules. At the periphery, trapped normal bile duct cells were observed. The final diagnosis was embryonal sarcoma of the liver (ESL). Interestingly, irregular islands of chondrosarcoma-like lesions were found in the tumor and the tumor-associated vascular endothelium showed immunoreactivity for KIT. Two months after the operation, the tumor recurred. At 6 mo follow-up, the patient is alive with the disease and undergoing chemotherapy. This is the first report of ESL with chondroid differentiation

Aggressive Angiomyxoma Extending Largely into the Pelvis ― A Case Report and Review of the Literature―

Aggressive angiomyxoma (AA) is a rare soft tissue tumor that involves the vulvar and perineal regions of afflicted individuals. It is a slow-growing and locally infiltrating tumor that is characterized by an increased risk of local recurrence. In this report, we describe the case of a large AA in a 39-year-old woman. She was admitted to our hospital with a pelvic tumor,which was discovered during a gynecologic checkup, and magnetic resonance imaging revealed its presence traversing from the pelvic diaphragm to the perineum. The tumor was completely excised using an abdominal approach,and the pathological diagnosis was that of AA. The patient had an uneventful recovery and no evidence of recurrence exists 12 months after surgery. Long-term follow-up and careful monitoring, however, are necessary because AA is slow-growing. As AA is usually reported as a vulvar tumor, the present case is a rare incidence in which the AA grew largely into the pelvic cavity

Successful Treatment of Recurrent Gastric Cancer with Chemotherapy for M ore than 6 Years : A Case Report

A 66 year-old male underwent a distal gastrectomy with D2 dissection in April 2003. Pathological findings showed a well-differentiated carcinoma with a depth of m, n2, stage II. Six months later, a computed tomography revealed multiple lymph node swellings in the para-aortic lesion ; we judged this to be a recurrence of the gastric cancer. As treatment, paclitaxel was administered weekly on days 1, 8, and 15, in combination with doxifluridine for 5 days per week, on a 28-day cycle. Following three courses of chemotherapy, the lymph nodes had almost disappeared. This therapy was continued until January 2007. Because of the appearance of a Virchow lymph node, S-1＋ cisplatin was administered. Following administration of the altered chemotherapy regime, a computed tomography displayed a significant reduction in Virchow lymph node swelling. Four years and ten months following the initiation of chemotherapy, the patient displayed jaundice. A computed tomography revealed lymph node swelling in the hepato-duodenal region. Following bile duct drainage, he received four cycles of paclitaxel and doxifluridine therapy. The patient then received S-1 monotherapy for 5 months. He died in February 2010, 6 years and 3 months after the recurrence in the stomach cancer

Clinical Utility of Three-dimensional Computed Tomography for Esophageal Reconstruction using Colon Interposition after Gastrectomy

Reconstruction after esophagectomy may represent a serious problem when a previous gastric resection has been performed. The colon is frequently used, but the marginal artery is of insufficient caliber to maintain the viability of a transposed colon. Three-dimensional computed tomography(3D -CT) provides abundant information about a patient’s anatomy without requiring an arterial puncture. We present a case in which 3D-CT was used. A 68-year-old man who had previously undergone a gastrectomy was diagnosed with esophageal cancer.3D-CT showed that the left colic artery was straight and long and had a solitary branch from the inferior mesenteric artery. The vascular pedicle of the left colon was found during the operation to be in accord with the 3D-CT evaluation. The patient underwent a transthoracic esophagectomy,followed by reconstruction using left colon interposition. No anastomotic leakage or necrosis of the reconstructive colon occurred