Shinichi IWANAGA

Uji Hospital

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Yasuhide Fuchino

Uji Hospital

Yoshifuku Nakayama

National Kyushu Medical Center

Junya Yamamoto

Osaka University

Hiroshi Toyoshima

Uji Hospital

Hiroki Tani

Fujita Health University

Hiroshi JYOZAKI

Uji Hospital

Yohichi Yasunami

Fukuoka University

Takanori Harimura

Koga Hospital

Hiroshi Jyouzaki

Uji Hospital

Yoshihiro Hamada

Fukuoka University

Cooperative Institutions

Fukuoka University

Uji Hospital

Kyushu University

Fukuoka University Hospital

National Hospital Organization

Kumamoto University

Kanazawa University

Ehime University

Osaka University

Kagoshima University

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A CASE OF ALPHA-FETOPROTEIN-POSITIVE ADVANCED ACINAR CELL CARCINOMA OF THE PANCREAS MERKEDLY IMPROVED BY INTRA-ARTERIAL INFUSION CHEMOTHERAPY

The journal of the Japanese Practical Surgeon Society (1996)

Takehiro FUJIKI Yasuhide Fuchino T Maki Kenji Ogata Tsuneo Higuchi

We report a case of alpha-fetoprotein-positive advanced acinar cell carcinoma of the pancreas which was highly sensitive to the intra-arterial infusion of chemotherapeutics. A 41-year-old woman was admitted to the hospital because of jaundice. Preoperative computed tomography revealed a mass extending from the head to body of the pancreas. Angiography via gastroduodenal artery and dorsal pancreatic artery showed hypervascularity at the lesion. Serum alphafetoprotin level at the preoperative stage was extremely high, 23, 003 ng/ml. On laparotomy, severe invasion of the malighant tissue was found to the adjoining tissue of the pancreas. The lesion was judged to be unresectable. Therefore, gastrojejunostomy, ligation, of the right gastric artery and biopsy were performed. The histopathological finding indicated acinar cell carcinoma of the pancreas with proliferation of malignant neoplastic cells, which were immunohistochemically positive with antibodies against AFP. Intra-arterial superselective infusion of chemotherapeutic agents (EPIR 60 mg, MMC 20 mg, 5-FU 500 mg) was done twice after the operation. The size of the tumor was and the serum alpha-fetoprotein level markedly decreased. Quality of life of the patient improved after these treatments.

Hypervascularity

10.3919/ringe1963.57.2793

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Citations (1)

A CASE OF MUCINOUS BORDERLINE TUMOR OF URACHAL ORIGIN

Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) (2010)

Shuzo Kohno Yasuhide Fuchino Shinichi IWANAGA Kaori NI Hiroshi Ohtani

症例は80歳，男性．脳梗塞で近医入院中に腹部腫瘤を疑われ，精査加療目的にて当院紹介となった．精査でも確定診断には至らず，診断も兼ねた手術を施行した．腫瘍は膀胱前腔から腹膜前腔に存在し，表面平滑な小児頭大の巨大腫瘤を呈していたが，消化管や腸間膜との癒着は認めなかった．膀胱頂部と強固に癒着しており剥離は困難であったため，正中臍索を切離し，膀胱部分合併切除にて腫瘤を摘出した．免疫組織学的検査で尿膜管起源の低悪性度粘液性腫瘍の診断に至った．本疾患は非常に稀であり有効な治療法は確立されておらず，若干の文献的考察を加えて報告する．

Mucinous Tumor

10.3919/jjsa.71.2433

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Citations (2)

A Laparoscopic Right Hemicolectomy Performed on a Patient with Ascending Colon Cancer Accompanied by Adult Intestinal Malrotation

The Japanese Journal of Gastroenterological Surgery (2007)

Junya Yamamoto Yasuhide Fuchino Jun Ohishi Takanori Harimura Shinichi IWANAGA

Multidetector row CTは, 低侵襲かつ短時間に腹腔内の多くの情報を得ることが可能で, さまざまな疾患の術前検査として用いられている. 症例は63歳の女性で, 成人腸回転異常症を伴った上行結腸癌に対して, multidetector row CTを用いて術前精査を行い, D3郭清を伴う腹腔鏡補助下結腸右半切除術を施行した. 注腸造影X 線検査にmultidetector row CT (multiplanar reconstruction, volume rendering, 3D-CT Angiography) を加えることで, 解剖学的異常, 腫瘍の部位と腫瘍栄養血管の走行を十分に把握し, より安全に手術を行うことができた. Multidetector row CTは, 自験例のような解剖学的異常を伴う疾患や, 腹腔鏡下手術の術前検査として非常に有用であると考えられた.

Ascending colon

Right hemicolectomy

Multidetector computed tomography

Hemicolectomy

10.5833/jjgs.40.1960

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Citations (5)

Isolation and characterization of glutathione reductase from the dark muscle of pacific mackerel.

NIPPON SUISAN GAKKAISHI (1980)

Tsuyoshi Muramatsu Shinichi IWANAGA Suminori Kan

Glutathione reductase

Thiol

Flavoprotein

10.2331/suisan.46.757

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Citations (5)

Synchronous and metachronous primary gastric lymphoma and adenocarcinoma

Cancer (1997)

Shotaro Nakamura Kunihiko Aoyagi Shinichi IWANAGA Takashi Yao Masazumi Tsuneyoshi

The occurrence of both malignant gastric lymphoma and adenocarcinoma in the same patient is very rare.The resected specimens from 12 patients who had both primary gastric lymphoma and adenocarcinoma were analyzed using immunohistochemistry and in situ hybridization.Two different tumors were found synchronously in 10 patients (5 with independent tumors and 5 with contiguous/collision tumors) and metachronously in 2. The size of the lymphomas (mean, 7.2 cm) was larger than that of the adenocarcinomas (mean, 3.6 cm) (P < 0.005). Histologically, 9 of the 12 lymphomas (75%) were mucosa-associated lymphoid tissue lymphomas, and all lymphomas invaded the deep portion of the submucosa or deeper. Conversely, 10 of the 12 adenocarcinomas (83%) were early carcinomas. Six adenocarcinomas were intestinal type, whereas the other 6 were diffuse type. The MIB-1 index of the adenocarcinomas (mean, 50.4%) was higher than that of the lymphomas (mean, 29.3%) (P < 0.05). Helicobacter pylori (H. pylori) was documented in all 12 patients, whereas Epstein-Barr virus-encoded RNA 1 was detected in only 2. During the follow-up period after surgery, 6 patients died, 4 due to adenocarcinoma. The survival probability of all 12 patients appeared to be similar to that of previously reported patients with gastric adenocarcinoma alone, and was significantly worse than that of the 217 patients with gastric lymphoma alone (P < 0.05).An H. pylori infection is considered to be associated with the development of these double malignancies. In many such synchronously observed cases, lymphomas may precede carcinogenesis, while the prognosis appears to be more closely associated with the adenocarcinoma than the lymphoma.

Gastric lymphoma

Submucosa

10.1002/(sici)1097-0142(19970315)79:6<1077::aid-cncr4>3.0.co;2-d

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Citations (110)

A CASE OF HEPATOBILIARY CYSTADENOCARCINOMA

Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) (2005)

Junya Yamamoto Shinichi IWANAGA Yasuhide Fuchino Yukiko Ishibashi Yasuyoshi Fukami

症例は63歳,女性.腹部超音波検査にて肝外側区域に隔壁を伴う径21mm大の嚢胞が指摘され,定期的に経過観察していた. 17カ月後の超音波検査にて,嚢胞は径43×25mm大に増大し,嚢胞内に充実性病変を認めた.腹部超音波検査,腹部CT, MRI, 血管造影検査にて肝嚢胞腺癌と診断された.手術は肝外側区域切除術,胆嚢摘出術が施行された.摘出標本では,腫瘍は境界明瞭な多房性嚢胞性病変で,内部は多房性褐色粘液で満たされており,一部に内腔方向に発育する白色調の乳頭状病変を認めた.病理組織検査では,嚢胞壁は円柱上皮で構成された肝嚢胞腺癌で,嚢胞内腔の乳頭状病変は構造異型,核異型を認め肝嚢胞腺癌と診断された.肝嚢胞の経過観察中,画像検査にて肝嚢胞腺癌と診断し嚢胞完全切除を行った肝嚢胞腺癌の1例を経験したので臨床病理学的検討に文献的考察を加え報告する.

Cystadenocarcinoma

Mucinous cystadenocarcinoma

10.3919/jjsa.66.2529

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Citations (2)

Intraductal Tubular Adenoma of the Pancreas, Pyloric Gland Type

The American Journal of Surgical Pathology (2005)

Yoshifuku Nakayama Hiroshi Inoue Yoshihiro Hamada Morishige Takeshita Hiroshi Iwasaki

The intraductal tubular adenoma (ITA), pyloric gland type, of the pancreas is an uncommon benign tumor, akin to the pyloric gland type adenoma of the gallbladder. We report 6 cases of ITA of the pancreas: 3 male and 3 female aged 50 to 79 years (mean, 63.5 years; median, 65 years); all were examined clinicopathologically. Four patients showed no symptoms, but appetite loss and/or general fatigue presented in two. Grossly, all tumors formed a localized polypoid mass protruding into the lumen of the dilated pancreatic duct. Five of the six tumors were found within the main duct, and the other arose within the branch duct of the pancreas. Microscopically, the tumors were composed of closely packed tubular glands resembling pyloric type glands. They were lined by columnar or cuboidal epithelial cells with foci of mild to moderate dysplastic change. In 2 cases, the adjacent pancreas showed foci of intraductal papillary-mucinous adenoma. Histochemically, the tumors largely showed neutral mucin with a lesser amount of acidic mucin made up mainly of sialomucin. Endocrine cells were found in five tumors. Immunohistochemically, all tumors were labeled with M-GGMC-1 and MUC6, whereas MUC1 and MUC2 stains were negative. Pepsinogen II was positive in 5 tumors; thus, the results displayed a pattern of differentiation similar to those of ordinary gastric pyloric or metaplastic pyloric glands. DPC4 expression was maintained in all tumors and p53-positive nuclei were hardly encountered. All patients are alive with no evidence of disease 3 to 10.5 years after surgical resection.

Lumen (anatomy)

Tubular adenoma

10.1097/01.pas.0000157939.03409.ec

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Citations (49)

Survival and Quality of Life after Pancreatic Resection for Carcinoma of the Pancreas.

The Japanese Journal of Gastroenterological Surgery (1999)

Kensei Maeshiro Seiyo Ikeda Yoshihiro Hamada Shinichi IWANAGA Tsurayuki Shinohara

長期予後とquality of life (QOL) という観点から, 浸潤性膵管癌の治療戦略について検討した. 1984年4月より1998年2月までに膵切除術を行った通常型膵管癌88例 (切除術41.5%) を対象とした. 占居部位は膵頭部62例, 体部15例, 尾部4例, 2区域以上7例であった. この中から術後3年以上生存したものを長期群 (15例), 1年未満で再発死亡したものを短期群 (26例) とした. 2群間の臨床像と病理組織像を比較すると, 長期群では膵酵素高値例が80%を示し, ERCPで診断される例が多かった. 組織像において長期群は膵周囲浸潤が軽微な症例に限られ, 門脈内腔に癌の露出した症例に長期生存はなかった. 術直後からの化学療法は短期死亡を減少させ, 生存率で一定の効果が得られた. 画期的な治療法が望めない現状では正確な進展度診断に基づいて, 長期予後とQOLを考慮した細かい治療方針の設定が必要である.

Pancreatic carcinoma

10.5833/jjgs.32.1122

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A CASE OF AMYLOIDOSIS PRESENTED WITH INTRACTABLE INTESTINAL OBSTRUCTION DUE TO SEVERE NARROWING OF THE SMALL INTESTINE

Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) (2007)

Shinichi IWANAGA Shunji Kawamoto Kazuo Inada Yoshitoshi Kida Yasuto Iwanaga

小腸の高度狭窄を呈した難治性腸閉塞にて発症し, 切除標本の病理学的検索にてアミロイドーシスの診断を得た1例を報告する. 症例は74歳, 女性. 腹痛, 腹部膨満, 嘔吐など腸閉塞症状と下痢症状を繰返し, 保存的加療にて軽快せず, 外科に転科となった. 小腸造影にて中部小腸は高度の狭窄を示した. 腹部造影CTにて小腸の狭窄像とその口側小腸の拡張および壁肥厚を認めた. 絞扼性イレウスは否定的であったが, 小腸狭窄の原因は明らかでなかった. 難治性の腸閉塞にて手術となった. 小腸は全長約200cmと短縮し, 2カ所の高度狭窄を認めた. 小腸切除を施行し, 空腸・横行結腸側々吻合を行った. 病理学的検索にてアミロイドーシスの診断を得た. 消化管アミロイドーシスは, 腸管運動障害にて, 機能的腸閉塞をきたすが, 腸管狭窄による機械的腸閉塞の報告は稀であり, 若干の文献的考察を加え報告する.

10.3919/jjsa.68.355

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Citations (1)

A COMPARISON BETWEEN OPEN SURGERY AND LAPAROSCOPIC SURGERY FOR POSTOPERATIVE ADHESIVE INTESTINAL OBSTRUCTION

Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) (2007)

Junya Yamamoto Yasuhide Fuchino Jun OISHI Takanori Harimura Shinichi IWANAGA

1995年から2006年の12年間に術後癒着性イレウスで手術を行った90例について検討した. このうち20例は, 腹腔鏡での視野確保が難しく安全な手術が困難と判断され, 初めから開腹手術が行われた. 残りの70例中53例は腹腔鏡下あるいは腹腔鏡補助下にてイレウス解除が可能であった. 腹腔鏡下手術は手術時間, 術後経口開始時期, 術後在院期間ともに最短であった. 既往手術でみると, 手術創が大きく高難度な手術既往症例ほど癒着が強く開腹手術が必要であった. 腹腔鏡補助下や開腹手術への移行は, 剥離困難な腸管同士の癒着が主な要因であった. 術後癒着性イレウスに対して, 腹腔鏡下手術は侵襲が少ない術式であるが, 臓器損傷などの危険がある場合は腹腔鏡下手術に固執せず, 早期に開腹手術に移行すべきであると考えられた.

Open surgery

10.3919/jjsa.68.2947

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Citations (2)