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We report 2 cases of splenic vascular tumors that were successfully treated by hand-assisted laparoscopic splenectomy. Two patients, a 41-year-old woman and a 33-year-old man, were admitted to our department for investigation of a splenic tumor. After ultrasonography, computed tomography, and magnetic resonance imaging, we suspected that the masses were hemangioma or inflammatory pseudotumor in the spleen. However, we preoperatively could not rule out the possibility of a malignant neoplasm because they each had previously undergone surgical treatment, one for cervical cancer of the uterus and the other for testicular seminoma. Hand-assisted laparoscopic splenectomy was safely performed for the diagnosis and treatment of the splenic tumors. A histologic diagnosis was venous hemangioma and littoral cell angioma, respectively. Hand-assisted laparoscopic splenectomy may be a good indication for splenic vascular tumors that are difficult to diagnose preoperatively whether they are malignant or benign.

We report on an inflammatory pseudotumor of the spleen. A 72-year-old woman visited our hospital complaining of nausea. Physical examination and laboratory investigations were unremarkable. Ultrasonography, computed tomography, magnetic resonance imaging and angiography showed a hypovascular splenic mass measurinsg about 5 cm in diameter with a calcification in the center of the lesion. Splenectomy was performed. The removed spleen, weighing 145 g, contained a tan-white, circumscribed mass, measuring 6.2 × 5.5 × 5.3 cm. Histologically, the splenic mass was composed of an admixture of inflammatory cellular elements, predominantly plasma cells and lymphocytes with hyalinization, fibrosis, lymph follicles and multinuclear giant cells, suggestive of a inflammatory pseudotumor. The patient is currently alive and asymptomatic, 24 months after surgery. Inflammatory pseudotumors of the spleen are extremely rare and only 39 cases have been reported in the medical literature.

We present the case of a 58-year-old man who underwent distal gastrectomy for Stage III A advanced gastric cancer, identified as poorly-differentiated adenocarcinoma. He was diagnosed with recurrent peritoneal metastasis 11 months after surgery. S-1(80mg/m / 2)was administered as first-line chemotherapy, followed by weekly paclitaxel(80mg/m2)as secondline chemotherapy. Although a partial response was obtained, a peritoneal tumor in the upper abdomen, ascites, and an elevation in the serum carcinoembryonic antigen(CEA)level were observed. As the tumor proved resistant to paclitaxel, making the treatment ineffective, bi-weekly docetaxel(45mg/m2)was initiated. The tumor showed a partial response, the ascites disappeared, and the serum CEA level decreased. The time to progression was seven months until the appearance of ileus and ascites due to tumor re-growth. This paclitaxel-resistant gastric cancer with peritoneal recurrence proved responsive to docetaxel as third-line chemotherapy. Docetaxel may be active against gastric cancer that is resistant to paclitaxel because of the different effects of these two agents. Further clinical studies on the efficacy of docetaxel against paclitaxel-resistant gastric cancer are needed.

We conducted a retrospective study to assess the safety, cosmetic outcome, and patients' satisfaction after skin-sparing (SSM) and nipple-sparing mastectomy (NSM) for breast cancer with immediate reconstruction of the breast (SMIBR).The subjects were patients, who underwent SMIBR, breast-conserving surgery (BCS), and total mastectomy (MST) between 2000 and 2004 at Osaka University Hospital. Cosmetic outcome was estimated by 4 reviewers by scoring postoperative photographs of the patients. Patient satisfaction was evaluated with a questionnaire for assessment of quality of life for Japanese breast cancer patients.Of the 74 patients who had undergone SMIBR, 4 developed local recurrences (5%). The local recurrence rate for SMIBR patients was greater than that for BCS (4/178) and MST (3/178, P = .10). The distant recurrence rate was similar for all three types of patients (5% for SMIBR, 5% for BCS, and 9% for MST). The median averaged score by 4 reviewers for the estimated cosmetic outcomes was 7.8 for the SMIBR and 7.5 for the BCS group (P = .20), and for age-adjusted patients, the corresponding scores were 8.2 and 8.0 (P = .70). There was no difference in cosmetic outcome between the SSM and NSM subgroups (P = .09). Average scores for patient satisfaction (social activity, physical aspects, and general condition) were the same for the 3 groups. For body image, the BCS and SMIBR groups had higher scores than the MST group (p0.05). Average scores for questions relating to bodily pain and sexual aspects were higher for the BCS than the MST group, but were not different between SMIBR and BCS groups. Similar trends for the 3 groups were observed when patients were divided into subgroups by tumor size or axillary dissection.SMIBR is safe with a comparatively low local recurrence rate and the same distant recurrence rate as for BCS and MST. Moreover, it results in objective cosmetic outcome and patient satisfaction as good as those for BCS, and greater patient satisfaction with body image than that for MST.

A 61-year-old woman was referred to our hospital due to a liver tumor discovered at a medical checkup. A hypervascular tumor located in liver segment I, measuring 45 mm in diameter, was visualized on ultrasonography. The tumor showed strong uniform enhancement from an early phase on computed tomography and angiography. Right hepatectomy with total caudate lobe resection was performed. Pathological examination revealed the tumor to be a primary leiomyoma of the liver, positive for smooth muscle actin and desmin on immunohistochemical examination. Primary liver leiomyoma is very rare and only 18 cases have been reported to date. The clinical features of these cases from the literature are also discussed.

We report two cases of large gastrointestinal stromal tumor (GIST) of the stomach that were successfully treated by hand-assisted laparoscopic surgery (HALS). Two patients, a 56-year-old woman and a 60-year-old man, were admitted to our department for the treatment of a large submucosal tumor of the stomach. After gastrointestinal endoscopy, ultrasonography, computed tomography, and magnetic resonance imaging, we suspected that the masses, measuring 7.0 cm and 8.0 cm in diameter, respectively, were GISTs in the stomach. However, preoperatively, we could not rule out the possibility of malignant neoplasms, because they had been bleeding or gradually growing. Hand-assisted laparoscopic wedge resection was safely performed for the diagnosis and treatment of the submucosal tumor of the stomach. The immunohistochemical diagnosis in both patients was GIST of the stomach with intermediate-grade malignancy. HALS may be a good indication for large GISTs of the stomach that are difficult to diagnose preoperatively, whether they are malignant or benign, because it is safe and minimally invasive, promoting rapid recovery.

A 70-year-old man underwent total gastrectomy for advanced gastric cancer in January 2000. He was treated with UFT of 300 mg/day after surgery. In December 2000, liver metastasis was detected. In January 2001, treatment was switched to oral administration of TS-1 at 100 mg/day. In April 2001, there were no extrahepatic lesions. However, the metastatic liver focus showed progression of the disease (PD). TS-1 was discontinued. In May 2001, a hepatic arterial injection reservoir was inserted. Thereafter, arterial injection chemotherapy with 5-FU was administered. However, in November, liver dysfunction was exacerbated, and computed tomography (CT) revealed PD. Therefore, in December, the above chemotherapy was switched to arterial injection of paclitaxel at 100 mg, which was administered once a week for 3 weeks and discontinued for the subsequent week. In March 2002, hepatopathy had subsided at the end of the 4th course, the performance status (PS) improved and CT revealed a minor response. In June 2002, the condition deteriorated to PD. However, there were no side effects other than alopecia. During the administration period, treatment at the outpatient clinic could be safely performed. These findings suggest that hepatic arterial injection therapy with paclitaxel for liver metastasis after surgery for gastric cancer is a useful second line for 5-FU-resistant patients.

Background & Aims Bile formation and secretion are essential functions of the hepatobiliary system. Bile flow is generated by transepithelial transport of water and ionic/nonionic solutes via transcellular and paracellular pathways that is mainly driven by osmotic pressure. We examined the role of tight junction–based paracellular transport in bile secretion. Claudins are cell–cell adhesion molecules in tight junctions that create the paracellular barrier. The claudin family has 27 reported members, some of which have paracellular ion- and/or water-channel–like functions. Claudin 2 is a paracellular channel-forming protein that is highly expressed in hepatocytes and cholangiocytes; we examined the hepatobiliary system of claudin 2 knockout ( Cldn2 −/− ) mice. Methods We collected liver and biliary tissues from Cldn2 −/− and Cldn2 +/+ mice and performed histologic, biochemical, and electrophysiologic analyses. We measured osmotic movement of water and/or ions in Cldn2 −/− and Cldn2 +/+ hepatocytes and bile ducts. Mice were placed on lithogenic diets for 4 weeks and development of gallstone disease was assessed. Results The rate of bile flow in Cldn2 −/− mice was half that of Cldn2 +/+ mice, resulting in significantly more concentrated bile in livers of Cldn2 −/− mice. Consistent with these findings, osmotic gradient-driven water flow was significantly reduced in hepatocyte bile canaliculi and bile ducts isolated from Cldn2 −/− mice, compared with Cldn2 +/+ mice. After 4 weeks on lithogenic diets, all Cldn2 −/− mice developed macroscopically visible gallstones; the main component of the gallstones was cholesterol (>98%). In contrast, none of the Cldn2 +/+ mice placed on lithogenic diets developed gallstones. Conclusions Based on studies of Cldn2 −/− mice, claudin 2 regulates paracellular ion and water flow required for proper regulation of bile composition and flow. Dysregulation of this process increases susceptibility to cholesterol gallstone disease in mice.