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Ovarian metastasis of colorectal cancer is relatively rare. The present study reports two cases of synchronous ovarian metastasis from colorectal cancer, which were managed by cytoreductive surgery. In case one, a 60-year-old female patient presented with a multilocular pelvic tumor and ascites. Virtual colonoscopy revealed a mass in the sigmoid colon; however, no tumor cells were identified on histological examination. Ovarian metastasis from sigmoid colon cancer was suspected and adnexectomy was subsequently performed. Histological examination of the excised tumor revealed adenocarcinoma. Immunohistochemical analysis of the resected tumor revealed positive staining for cytokeratin (CK)20 and caudal-type homeobox 2 (CDX2), and negative staining for CK7, estrogen receptor, progesterone receptor and inhibin. The immunohistological results supported the diagnosis of ovarian metastasis from sigmoid colon cancer. In case two, a 56-year-old female patient presented with a multilocular pelvic tumor and ascites. Colonoscopy identified a rectal tumor, and histological examination revealed moderately-differentiated adenocarcinoma, which was confirmed by cytological analysis of ascites. Subsequently, ovarian metastasis from rectal cancer with peritoneal dissemination was diagnosed, and left ovariectomy and transverse colostomy were performed. Histological examination of the excised tumor revealed moderately-differentiated adenocarcinoma, and immunohistochemical investigation revealed positive staining for CK20 and CDX2, but negative staining for CK7. These immunohistological results indicated ovarian metastasis from rectal cancer. Both patients recovered well and are currently undergoing regular follow-up examinations. The observations from the two cases indicate that ovarian metastases of primary colorectal cancer may present as pelvic tumors and, thus, preoperative examination of the gastrointestinal tract is required. Furthermore, even in cases of widespread colorectal cancer metastases, excision of the ovarian tumor is required to establish a histological diagnosis for the selection of appropriate treatments.

In this report, a case of hemorrhagic shock caused by a gastrointestinal stromal tumor (GIST) of the ileum, which was successfully treated by emergency surgery, is presented. A 67-year-old male patient presented to the Ibaraki Medical Center, Tokyo Medical University (Ami, Japan) in July 18, 2014, with dizziness and blood in the stool. Upper endoscopy and colonoscopy failed to reveal the source of the hemorrhage, although abdominal contrast-enhanced computed tomography revealed extravasation of the contrast medium into the small intestine. The patient developed hemorrhagic shock; thus, double-balloon enteroscopy (DBE) was performed, which revealed a Meckel's diverticulum and a submucosal tumor with excessive bleeding at 60 and 100 cm proximal to the ileocecal valve, respectively. Subsequent emergency partial resection of the ileum, including the tumor and the Meckel's diverticulum, was performed in July 20, 2014. Histological examination of the excised tumor revealed proliferation of spindle-shaped cells, and immunohistochemical staining of the tumor was positive for CD34, KIT and α-smooth muscle actin, but negative for S-100 protein. These immunohistological results supported the diagnosis of GIST of the ileum. The patient had an uneventful recovery and has been monitored at our outpatient clinic for 14 months after surgery. This case demonstrated the efficacy of DBE for the diagnosis of small intestinal bleeding, and immediate emergency surgery should be considered for cases of small intestinal GISTs with excessive bleeding.

症例は40歳，女性．バリウムによる上部消化管造影検査を施行2日後より腹痛出現し，近医受診した．消化管穿孔疑いと診断され当院紹介となった．CT検査ではS状結腸にバリウムの貯留を認め，その周囲に異常ガス像を認めた．消化管穿孔疑い，腹膜炎の診断にて緊急手術を施行した．S状結腸の一部が壊死しており，同部の腸間膜側には気腫状の変化を認めた．S状結腸を部分切除し，人工肛門を造設した．標本を切り開いたところS状結腸の腸間膜側にバリウムの塊がはまり込んでおり，これを取り除くと3.5×2.5cmの穿孔を認めた．穿孔部位には肉眼的に腫瘍，憩室などは認めなかった．病理所見では穿孔部位に血栓，塞栓の形成は認めず，悪性所見も認めなかった．術後経過は良好で退院となった．約4ヵ月後に人工肛門閉鎖術施行し，その後の経過は良好である．バリウムによる上部消化管造影検査後に大腸穿孔を起こした症例を文献的考察を加えて報告した．

71歳の男性.主訴は心窩部痛,嘔吐.腸閉塞の診断にてイレウス管を挿入後,イレウス管造影にて回腸の圧迫・狭窄が疑われた.腸閉塞は一時解除され経口摂取を開始するも再び腸閉塞となり開腹術を施行. Bauhin弁より約30cm口側の回腸が腫瘤を先進部に約15cmの重積をきたしていた.用手的に整腹を試みるも重積は解除されず,同部位を含め回腸を約25cm切除し吻合した.切除肉眼所見は,腫瘤は2.5cm大の有茎性ポリープで,病理診断はPeutz-Jeghers (以下, P-J)型の過誤腫性ポリープであった.本患者には粘膜・皮膚の色素沈着および遺伝性疾患を疑うような家族歴もなく不完全型P-J症候群と考えられた.成人腸重積症は比較的稀であり,さらに原因となる器質的疾患が単発性P-J型過誤腫性ポリープによる報告例は少ない.今回われわれは,その1例を経験したので文献的考察を含め報告する.

The aim of the present study was to assess the clinical relevance of the pre-operative granulocyte/lymphocyte (G/L) ratio as a predictive marker of post-operative complications in patients with colorectal cancer. In total, 85 patients (59 males and 26 females; mean age, 68.9 years) underwent surgery for colorectal cancer at the Department of Surgery, Ibraki Medical Center, Tokyo Medical University (Ami, Japan), and were divided into post-operative complication and non-complication groups. Clinical data, including age, gender, body mass index, tumor localization, tumor pathological type, cancer staging, surgery time, volume of surgical bleeding, pre-operative G/L ratio and further pre-operative laboratory data, including levels of albumin and C-reactive protein, Glasgow Prognostic Score, white blood cell count and levels of hemoglobin, creatine kinase, lactate dehydrogenase, carcinoembryonic antigen and carbohydrate antigen 19-9 were analyzed between these groups. The total post-operative complication rate was 18.8%. On univariate analysis, the amount of surgical bleeding and the pre-operative G/L ratio were significantly higher in the complication group than in the non-complication group (299.8±361.7 vs. 155.6±268.6 ml, P

In the current study, a case of recurrent desmoplastic small round cell tumor (DSRCT) is presented, which was successfully treated by repetitive debulking surgery. In May 2010, a 39-year-old male, with a history of surgical resection of intra-abdominal DSRCT, visited the Ibaraki Medical Center, Tokyo Medical University Hospital (Ami, Japan) with severe lower abdominal discomfort. Abdominal computed tomography revealed a large tumor in the pouch of Douglas with a small number of nodules in the abdominal cavity. The recurrent DSRCT was diagnosed and removed via lower anterior resection; however, complete resection was impossible due to multiple peritoneal metastases. One year later, the patient developed pain in the right groin due to the growth of metastasized tumor cells in the groin lymph nodes. The affected lymph nodes were removed utilizing an extra-peritoneal approach. At the time of writing, the patient continues to survive without any symptoms 60 months since the initial surgery. In conclusion, surgical debulking is a significant procedure for relieving patient symptoms as well as improving the survival time of patients with metastatic and recurrent DSRCT.

Recent studies have shown that the interactions between tumor cells and stromal cells are important in tumor development. A possible correlation between tumor-activated myofibroblasts, the main component cells of tumor stroma, and lymphatic microvessel density (LMVD) or other clinical parameters in carcinoma was investigated.Immunohistochemical examination of alpha-smooth muscle actin and podoplanin were performed in 83 cases of early-stage invasive colorectal carcinoma.There was a good correlation between proliferation of myofibroblasts (PMpt) and LMVD (LMVDpt) in the peri-tumoral area (p = 0.0034). Increased PMpt was also associated with lymphatic invasion (p = 0.0051) and with lymph node metastasis (p = 0.011). However, proliferation of myofibroblasts in intra-tumoral (PMit) areas was not associated with these clinical parameters.Proliferation of myofibroblasts in peri-tumoral areas seem to play an important role in lymphangiogenesis, and is also associated with lymph node metastasis.

Purpose This study aims to assess the clinical relevance of postoperative arterial blood lactate (LAC) level as a prognostic factor in patients with colorectal perforation. Methods Forty-two patients (22 males, 20 females; mean age, 70.8 years) underwent emergency surgery for colorectal perforation. The patients were divided into mortality and survivor groups. As a prognostic scoring system, Acute Physiological and Chronic Health Evaluation II (APACHE-II), Sequential Organ Failure Assessment (SOFA), and Systemic Inflammatory Response Syndrome criteria were calculated. These scores, postoperative LAC level, and other data, including site and etiology of perforation, elapsed time from onset to surgery (eTIME), preoperative white blood cell (WBC) and platelet counts, preoperative C-reactive protein (CRP), and preoperative arterial blood base excess were assessed between the groups. Results The total mortality rate was 33.3 %. On univariate analysis, the APACHE-II and SOFA scores were significantly higher, and eTIME was significantly longer in the mortality group than in the survivor group. The postoperative LAC level was significantly higher in the mortality group (43.1 ± 14.1 mg/dl) than in the survivor group (23.8 ± 12.7 mg/dl; p