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An adenosquamous-cell carcinoma of the bile duct is relatively rare. A 65-year-old woman was admitted to our hospital because of obstructive jaundice. Percutaneous transhepatic biliary drainage (PTBD) was performed. Cytology of the PTBD bile showed many keratinizing squamous carcinoma cells and a few clusters of adenocarcinoma cells. Cholangiography through the PTBD tube and endoscopic retrograde cholangiography, performed simultaneously, revealed irregular stenosis of the lower bile duct. Endoscopic ultrasonography also revealed a hyperechoic tumor and no choledochal stone. Pancreaticoduodenectomy was performed for the diagnosis of adenosquamous-cell carcinoma of the lower bile duct. Pathological examination of the tumor showed nodular invasive type of cholangioma and histological findings showed an adenosquamous-cell carcinoma. The patient has had hepatic metastasis for about one year, since the operation, but she is still alive and being treated with chemotherapy.

We experienced four cases of tumor forming pancreatitis. In this paper two out of four cases are presented with some notes on differential diagnosis from pancreatic cancer. Case 1, A 54-year-old man was admitted to the hospital with a doubt of pancreatic cancer with obstructive jaundice. Abdominal US, EUS, and ERCP revealed specific findings, and so we diagnosed the patient as having tumor forming pancreatitis. Case 2, A 53-year-old woman was admitted to the hospital with a suspicion of pancreatic tumor. The patients was diagnosed as tumor forming pancreatitis on EUS and ERCP. We studied the images of four patients of tumor forming pancreatitis retrospectively, and found that the most reliable image for diagnosis was ERCP, followed by US, and EUS. CT and angiography were comparatively poor in diagnosis. The reason might lie in that CT was uncapable of offering relieable differentiation of the density between the lesion and surrounding pancreas, and that angiography was not most appropriate for differentiation between hypovascular (pancreatic cancer) and isovascular areas (tumor forming pancreatitis).

Case 1: A 57-year-old man was admitted to the hospital because of a rest pain of the right lower limb. Angiography revealed that the right common iliac artery was obstructed for arteriosclerosis obliterans (ASO). The patient was complicated with ischemic heart disease, so we selected interventional therapy. Iliac revascularization by percutaneous transluminal angioplasty (PTA) and stenting were performed successfully. Case 2: A 73-year-old man was admitted to the hospital because of intermittent claudication and rest pain of the left lower limb. Angiography showed an obstruction of the left common iliac artery due to ASO. We revascularized the left common iliac artery with percutaneous transluminal angioplasty and stenting, with a successful outcome. Angioplasty and stenting is useful for iliac obstruction due to ASO. In the Western countries, the stenting has been applied to ASO of the pelvic or lower limb vein which does not respond to PTA alone and we can see favorable outcomes. This regimenwith angioplasty and stenting would promise to be a selectable therapy for ASO in the future.

Case 1: A 60-year-old man was seen at the hospital because of upper abdominal pain. A tumor in the body and tail of the pancreas was suspected on the upper gastrointestinal radiography and CT. Laparotomy was performed on April 19, 1983. A tumor of the size of a fist was observed in the body and tail of the pancreas. Because the tumor directly invaded the stomach and liver, the body and tail of the pancreas was resected together with the lateral segment of the liver, cardiac side of the stomach and spleen. Then, the gastrointestinal tract was reconstructed with the jejunum placed between the esophagus and stomach. On the 31th day after surgery, the patient died of DIC and respiratory failure induced by ruptured suture in esophagojejunostomy. Case 2: A 60-year-old man was suspected to have a cancer of the head of the pancreas on ultrasonography, CT, and Ga scintigraphy. Laparotomy was carried out on October 19, 1988. A tumor of the size of a quail egg was noted in the head of the pancreas. Because the tumor infiltrated into the posterior peritoneum, resection of the tumor was impossible, and gastrojejunostomy and jejunojejunostomy were performed. Both tumors were histologically pancreatic squamous cell cartinoma. In the Japanese literature, 40 cases of pancreatic squamous cell cartinoma and pancreatic adenosquamous cell cartinoma have been reported so far and the prognosis was poor in all cases. Radical resection is often difficult. Multidisciplinary treatment with radical resection, radiotherapy and chemotherapy are recommended like in the treatment of other pancreatic cartinomas.

A 14-year-old girl was admitted to the hospital because of watery diarrhea and edema of the lower extremities. Barium enema and endoscopy of the large intestine revealed multiple colorectal polyps with a circumferential IIa. group-like elevated lesion at the rectum. Leakage of isotopes from the rectum to the sigmoid colon was proved on 99mTc-HSA scintigram, and marked hypoproteinemia (TP 3.7g/dl), low level of IgG and increase in α1-antitrypsin clearance were recognized. From the above findings a diagnosis of multiple cold-rectal polyps with protein losing gastroenteropathy was made. Although the intestinal lesion in this patient was a tubular adenoma with slight atypia, it was a so-called IIagroup-like lesion macroscopically, assuming a form whose canceration rate is called high, and was complicated with protein losing gastroenteropathy. And hence proctosigmoidectomy was performed though the patient was young. This paper describes this case together with some literature discussion.

A case of giant duodenal cancer showing high serum AFP level, in which production of AFP was demonstrated by immunohistochemical staining is described.A 53-year-old woman was admitted to the hospital because of right hypochondralgia. Serum AFP level on admission was 9210 ng/ml. The tumor was 14×12×8 cm in size and developed from the second portion of the duodenum partially over the pancreas head, pressing the gallbladder and right lobe of the liver, invading the transverse colon, uncus of the pancreas and superior mesenteric vein. However, there was no liver metastasis. Pancreatoduodenectomy and transverse colectomy were performed. Histological diagnosis was moderately differentiated tubular adenocarcinoma, and AFP was demonstrated by immunohistochemical staining with PAP method.In Japan, duodenal cancer with high serum AFP level has been observed in only 8 patients including this, and in 6 patients of them the existence of AFP positive tumor cells was evidenced by immunohistochemical staining. Liver metastasis was positive in 5 patients. Prognosis of AFP producing cancer of the duodenum is very poor, so active resection and potent adjuvant chemotherapy would be important.

A relatively rare case of leiomyoma of the sigmoid colon is described. The case was a 46-year-old female with the chief complaint of melena. Barium enema and endoscopy of the colon revealed a subpedunculated submucosal tumor of the sigmoid colon. Sigmoidectomy was performed. The tumor was 4.0×3.6×2.8 cm in size and was covered with normal epithelium. It was a leiomyoma which might arise in the muscular layer of mucosa.A total of 54 cases of leiomyoma of the colon was collected from the Japanese literature and reviewed. Some considerations of the treatments are also presented.

A case of spontaneous rupture of the sigmoid colon with Ehlers-Danlos syndrome in a 60-year-old woman is reported, whose life could be successfully saved. The patient was admitted with sever lower abdominal pain. On laparotomy a 12cm perforation was found on the antimesenteric side of the sigmoid colon, and Hartmann's operation was performed. She was diagnosed as Ehlers-Danlos syndrome by clinical signs and histopathological findings of the skin, but immunofluorescence with anti-collagen antibody showed that the distribution pattern of type I, III, IV and V collagen in the skin was normal. So, it seems that further examination of cultured skin fibroblasts from the patient is necessary. In the domestic literature, this is the first case of colonic perforation With Ehlers-Danlos syndrome, in which patient's life could be saved. For better management of this syndrome, it is important to avoid an increase in intraintestinal pressure. Moreover, primary anastomosis and subsequent closure of the colostomy should be avoided for the colonic perforation associated with this syndrome.

Gastric cancer associated with calcification is comparatively rare. Only 54 such cases including ours (33 cases worldwide and 21 cases in Japan) have so far been reported. The patient was a 62-year-old man with the chief complaint of dysphagia. Upper GI, CT and gastrocamera examination revealed gastric cancer associated with small stippled calcification. Total gastrectomy was performed. The tumor was a fist-sized advanced cancer in the cardia, and histology revealed mucinous adenocarcinoma of the stomach. The mechanism of calcification in gastric cancer is discussed with reference to the literature.

Sclerosing hemagioma of the lung is a relatively rare disease, and has been ragarded as a benign tumor arising in the alveolar epithelial cells. Recently, however, the malignant cases have been found. We report two cases of the disease, together with a review of the domestic reference. Case 1 is a 42-year-old female who had a round shadow, 4×3cm in size with smooth and clear edge, in the right lower lung field, which was found at physical examination. Bronchographic examination showed a suppressed peripheral branch B5, in which incisurae were found by CT. The middle lobe was resected. Case 2 is a 48-year-old female who had atelectasis of the middle lobe and a round shadow of 3×2.5cm in chest X-ray film taken at when she suffered from fever. Bronchographic examination revealed a narrowed and suppressed introitus of the middle lobar branch, a convergence of peripheral branches, and a passage of the contrast medium into around the tumor. Bronchial angiography revealed a new formation of the peripheral vessels of the tumor, that is, so-called melon-peel-like stitched vascularity. The middle lobe which presented atelectasis as well as the tumor was resected. In both case 1 and 2, pathologic findings suggested a sclerosing hemangioma without heterologous cells in the tumor and no sign of lymph node metastasis.