A woman in her 50s presented to our department of plastic surgery with a complaint of a nodule in the umbilical region. CT revealed an umbilical tumor and thickening of the anterior wall of the stomach, raising suspicion of gastric cancer with umbilical metastasis. She was referred to surgery. Upper endoscopy identified advanced gastric cancer(type 2)in the greater curvature of the gastric body. PET-CT showed abnormal uptake in the greater curvature of the gastric body, umbilical region, right ovary, and lymph nodes. She was diagnosed with gastric cancer(T4aN3aM1, cStage ⅣB)and underwent chemotherapy. A CT scan after the fourth course showed significant tumor shrinkage, making identification difficult. After 9 months of chemotherapy, upper endoscopy showed marked tumor shrinkage, and CT and PET-CT scans showed that the primary and metastatic lesions were indistinguishable. Exploratory laparoscopy and umbilical biopsy revealed no gross dissemination, and histologically, no tumor cells were found in the umbilical area or ascites. Conversion surgery was deemed appropriate and performed, including distal gastrectomy with bilateral salpingo-oophorectomy. No metastases were found in the lymph nodes or adnexa, and she was diagnosed with ypStage ⅠB(T2N0M0). Adjuvant chemotherapy was administered, and she remains recurrence-free 14 months post-surgery.
Cholesterol polyp is the most common benign disease of gallbladder polyps, and is considered not to be the origin of malignancy. Herein, we report a rare case of a well-differentiated adenocarcinoma arising in a gallbladder cholesterol polyp. A pedunculated mulberry-like gallbladder polyp diagnosed with a cholesterol polyp preoperatively consisted of two distinct components macroscopically: a yellow-whitish lobulated lesion and a brownish irregular lesion. Microscopically, the former revealed to be a cholesterol polyp, but the latter demonstrated a well-differentiated adenocarcinoma. Even if imaging findings suggest a gallbladder cholesterol polyp, it is important to keep in mind that carcinoma can coexist like our case.
Vitamin K deficiency caused by antituberculous agents was examined in clinical patients and in experimental rats. When antituberculous agents given to the patients who had only total elental diet because of small intestinal dysfunction, a marked increase in plasma PIVKA-II and a decrease in thrombo-test value were observed. These changes were quickly normalized by administration of vitamin K, despite of succeeding or stopping of antituberculous agents. In rat experiments, effects of four agents (ethambutol, isoniazid, paraaminosalicylate, and rifampicin) on prothrombin time were studied. Among these agents, only rifampicin prolonged prothrombin time. This prolongation depended on drug doses and duration of administration. In addition to this hypoprothrombinemia, an increase in plasma PIVKA-II was also observed, and these changes were normalized within 24 hours of vitamin K administration. These data suggest that rifampicin inhibits vitamin K epoxide reductase interfering re-use of vitamin K and caused vitamin K deficiency in patients with total elental diet.
The development of hepatocellular carcinoma (HCC) after a sustained virologic response (SVR) due to interferon (IFN) therapy for hepatitis C virus infection remains a serious problem. We herein report 2 cases of HCC that developed more than 20 years after SVR with IFN therapy for chronic hepatitis C. The patients were 89- and 72-year-old men with HCC that developed 24-25 years after an SVR with IFN therapy. These patients regularly underwent imaging examinations; therefore, the HCC was detected in the early stage, when it was still curable. Both cases suggest that long-term surveillance after an SVR is effective for the detection of HCC, and radical treatment is possible.
Background:A precise preoperative assessment of cancer spread and concomitance disease is important to determine the best treatment strategy for patients with early gastric can‑ cer(ECG) . The purpose of this study was to assess the diagnostic performance of multidetector row computed tomography(MDCT)and to examine whether an examination of both routine MDCT and ultrasonography(US)are necessary for preoperative assessment of ECG. Patients and method:From January 2 0 0 6 to December 2 0 0 8 16 8 consecutive patients with gastric cancer underwent a gastrectomy at this institution. Sixtythree of these 1 6 8 patients were preopera‑ tively diagnosed as ECG with gastroscopy upper gastrointestinal enema MDCT and abdominal US. Results:The sensitivity specificity and accuracy of MDCT for detection of lymph node metastasis were 3 3.3% 98.1% and 88.9% respectively. The US findings were not able to detect any lymph node metastasis. A structural anomaly was detected by MDCT and US in 92 pl aces without lymph node metastases. Fortyfour of these 9 2 abnormalities were found by both examinations. Inguinal hernias and incisional hernia were found by MDCT but not by US. In contrast gallbladder polyps and chronic hepatitis were found by US but not by MDCT. Five cases(7.9%)required additional treatment based on abnormalities detected only by preoperative MDCT or US examination. Conclusion:MDCT and US are effective for the assessment of can‑ cer spread and concomitant disease before surgery. It is therefore not necessary to routinely perform both MDCT and US for preoperative assessment of ECG.
A 6 6yearold male with the mass in his left inguinal lesion came to our hospital on June 2 0 0 3. Com puted tomography(CT)followed up for hepatitis C showed the huge retroperi‑ toneal tumor extended from left inguinal area to surrounding of left kidney. Retroperitoneal li‑ posarcoma was suspected with imaging studies. The patient received the surgery of left in‑ guinal hernia and the fatty mass was resected at deep inguinal ring. The biopsy of retroperito‑ neal tumor was done at the same operation under laparotomy. Pathological findings of ingui‑ nal mass revealed fatty tissue and the findings of retroperitoneal tumor was definitive in di‑ agnosing well differentiated liposarcoma. The tumor was removed with the left kidney. How‑ ever the patient had been followed up without adjuvant chemotherapy CT three years after the first surgery showed the mass behind spleen. The recurrence of liposarcoma was highly suspected. The tumor with a part of diaphragm pancreatic tail a nd spleen had been re‑ moved. Pathological findings demonstrated dedifferentiated liposarcoma. Metastasis had not been occurred up to six months after the second surgery. The patient died from cerebral hemor‑ rhage on February 2 0 0 7. We w ill report very rare case of a retroperitoneal dedifferentiated li‑ posarcoma found out from left inguinal tumor and had underwent several surgeries.
Revision of WHO guidelines in 2016 led to the classification of solitary fibrous tumours(SFTs)and haemangiopericytomas(HPCs)as a single tumor entity characterized by NAB2-STAT6 fusion. Standard-of-care treatment involves surgery, but local recurrence and distant metastasis sometimes occur. The average latency to metastasis after surgery is 99 months. A 38-year-old female patient presented with a complaint of headache. An 8×5×2cm lesion showing Gd-T1 enhancement was detected near the superior sagittal sinus. Pathological assessment following resection revealed proliferating, polymorphic, atypical tumor cells with distinct nucleoli in a "patternless pattern." Cellularity was moderate to high, and mitotic figures were observed in 15/10 high power fields. Immunohistochemically, tumor cells tested positive for STAT6, and RT-PCR revealed a NAB2-STAT6 fusion gene(exons 6 and 17, respectively), supporting a diagnosis of SFT/HPC WHO grade III. Despite postoperative radiotherapy, multiple metastases to the spleen were detected 8 months after surgery, and distal pancreatectomy with splenectomy was performed. The pathology of the splenic tumor was similar to that of the intracranial tumor. Recurrent disease in a lymph node was detected 1 month later, and local radiation therapy was administered. The patient died of cancerous peritonitis 5 months later. In this case, exceedingly rapid metastasis to the spleen occurred, despite the administration of vigorous treatment. Here, we review SFT/HPC incidence, treatment, and outcomes to better understand this rare malignancy.
