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Treatment results and clinicopathological features of 41 myogenic tumors of the stomach resected a_??_ the institution in the past 30 years were analyzed. No difference in survival curves was observed betwee_??_ the patients who underwent distal or proximal gastrectomy and those who underwent wedge resectio_??_ A likely explanation for this was that no lymph node metastasis was observed among the cases investiga_??_ ed. Wedge resection without lymphadenectomy, therefore, is feasible, provided that the tumor be resecte_??_ en bloc without residual disease. Perfect histological separation of benign and malignant tumors by_??_conventional HE staining was not constantly attained for cases of borderline malignancy even wit_??_ well-fixed resected specimens. This denotes that preoperative diagnosis by biopsy specimens could b_??_ even more unreliable, and there is a need to establish certain criteria for selecting an adequate therapeuti_??_ strategy for each lesion through endoscopic findings and imaging studies alone. At the same time_??_ emergence of a novel prognostic factor that reflects the malignant potential of the tumors is eagerly_??_ awaited to replace the conventional histopathological diagnosis of whether the tumor be benign o_??_ malignant.

Postoperative enterocutaneous fistula is a very serious problem in abdominal surgery. Here in we report a case successfully treated for enterocutaneous fistula with two layer local flaps. Under a diagnosis of ascending colon cancer, a 78-year-old man had undergone right hemicolectomy and resection of the involved ileum and abdominal wall. On the 10th postoperative day, enterocutaneous fistula occurred at the midline incision. Although we tried various conservative treatments, the fistula had not closed six months after the first operation. Thus, we decided to attempt operative treatment. Under local anesthesia, the fistula was closed with a “donor flap”, and the new skin defect was covered with a “rhomboid flap”. Using these two layer local flaps, fistula closure was achieved, and the patient was discharged without fistula recurrence.

Nine-hundred and seventy-six patients with primary gastric cancer, who were operated on in a recent 5-year period from 1985 to 1989, were classified according to the staging system and curability classification of both the Eleventh and Twelfth Editions of the General Rules for Gastric Cancer Study. The object of this study is to evaluate the feasibility of new staging system and curability classification in the Twelfth Edition. The survival curves of the patients belonging to each stage or curability were calculated by Kaplan-Meier's method and comparisons were made between the two editions as to the distribution of the curves. The survival curves for the seven stages as designated in the Twelfth Edition were distributed evently with statistically significant differences between the consecutive stages, a nd the classification was considered feasible. There were, however, subgroups within stage II with differences in depth of the lesion and extent of nodal metastasis, exhibiting significant differences in the survival. The curability classification of the Twelfth Endition, on the other hand, resulted in three distinct groups of patients with statistical differences in the survival curves, and was considered to be much more useful than that of the Eleventh Edition as a prognostic indicator.

Advantages and disadvantages of para-aortic lymph node dissection were retrospectively studied. Of 123 cases of gastric cancer in which dissection of No. 16 was performed, metastasis to these lymph nodes was confirmed in 32 cases (26.0%). The frequencies of metastasis to No. 16 were significantly higher in cases with hepatic metastasis, peritoneal metastasis, serosal invasion of S2 and above, macroscopic lymph node metastasis of N2 and above, a tumor size of 5cm or greater. The 32 cases with histologically confirmed metastasis to No. 16 had a 5-year survival rate of 8.3%. Of these 32 cases, the 22 cases without hepatic or peritoneal metastasis had a 5-year survival rate of 12.1%, with two cases achieving relapsefree prolonged survival. Postoperative complications were studied in another 297 patiens who underwent curative B operation for advanced gastric cancer. The incidence of complications in cases with dissection of three or more areas of No. 16 was significantly higher than in those with dissection of one or two areas and those without dissection of No. 16. Therefore, No. 16 dissection should not be performed on all cases of gastric cancer, but will be useful if performed on the high risk group without hepatic and/or peritoneal metastasis.

Quality of life after surgical procedures of various types of esophagogastrostomy were retrospectively evaluated. Thirty-six patients were divided into three groups; group A (16 patients): end-to-side anastomosis with pyloroplasty, group B (14 patients): end-to-side anastomosis without pyloroplasty, and group C (6 patients): end-to-end anastomosis without pyloroplasty. There were no significant differences among these three groups in the background factors such as age, sex, invasion to the esophagus, pathological type, depth of invasion, lymph node metastasis, degree of dissection and curability. In an early phase after the surgery, smaller proportion of patients complained of vomiting while period of hospitalization was shorter in group A. In a late phase after the surgery (five years postoperatively), inadequate food intake and consequent loss of body weight were frequently observed in group B patients. 25% of group A patients maintained 100% or more of preoperative body weight. Frequent and severe heartburn was observed in group C. From these results, we conclude that the surgical procedure of end-to-side anastomosis of esophagogastrostomy combined with pyloroplasty is the most adequate mode of reconstruction following proximal gastrectomy.

A 74-year-old woman was seen at the hospital because of a right lower abdominal pain. Barium enema revealed a narrowing of the hepatic flexure and remarkable shortenig with pseudo diverticula formation of the ascending colon. Colonoscopy demonstrated a whole circumferential stricture in the hepatic flexure and old inflammation in the anal side area from the stricture. Since an biopsy yielded moderated differentiated adenocarcinoma, right hemicolectomy was performed. The resected specimen showed that the tumor was categorized as carcinoma of Borrmann 2 type. A few the scarred area with discoloration was observed in the shortened ascending colon, and so we recognized this change as the old colonic tuberculosis. This case and 51 cases of colonic tuberculosis with a colonic cancer seen in the Japanese literature were reviewed. It took about 30 years to develop colonic cancer in the cases which actually had a previous history of tuberculosis. The causal relation between colonic tuberculosis and colonic cancer is not indisputably interpretated. But it is assessed that colonic cancer affected with tuberculosis may be exist, because macroscopically atypical carcinoma type was frequently observed and “dysplasia” around the cancer was revealed in about 19% of all cases.

Hepatocellular carcinomas occasionally grow into the bile duct, evidencing itself in symptoms such as obstructive jaundice and abdominal pain. This report discusses a case of small liver cancer grown into the bile duct which was marked by an initial symptom of r-hypochondral pain. In December 1988, a 60-year-old male experienced attacks of abdominal pain similar to that caused by gallstones and came to our hospital. Computed tomography showed liver cirrhosis and a tumor in the left intrabileduct combined with dilatation of its peripheral ducts. Endoscopic retrograde cholangiography (ERC) also revealed a polyp-like tumor in the left bile duct. Cytology of the bile showed the presence of adenocarcinoma. Based on these examinations, a diagnosis was at first made as an intrahepatic cholangiocarcinoma, and surgery was performed. During surgery, a tumor of 2 cm in diameter was found on the surface of the left lateral lobe of the liver. With the diagnosis of hepatocellular carcinoma, combining with initial bile duct tumor, left hepatic lobectomy was performed. Out surface of the excised material showed that the tumor exposed on the surface was connected to the intrabileduct tumor. The final pathological diagnosis resulted in the hepatocellular carcinoma which had grown into the bile duct.

Renal angiomyolipoma is a relatively rare mesodermal mixed tumor. In Japan, 124 cases have been reported. This paper describes our recent experience with a case of renal angiomyolipoma without accompanying nodular sclerosis. The patient was a 48-year-old woman who was admitted under the condition of acute heart failure and was unexpectedly found by abdominal echography to have a mass at the upper pole of the left kidney. Because detailed examination suggested a malignant tumor in the left kidney, the kidney was excised. Histopathological examination of the excised specimen showed a mixture of abundant fatty, muscular and vascular tissues, leading to a diagnosis of renal angiomyolipoma. Preoperative diagnosis of this condition is relatively easy in patients with a complication of nodular sclerosis, who show the triad of epilepsy, mental disturbance and facial sebaceous adenoma. In contrast, cases without that complication are difficult to differentiate from renal carcinoma. The number of cases diagnosed preoperatively has increased recently with the use of CT, because the CT value of the fatty tissue in this tumor is low.