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Introduction Only 12 cases of gallbladder (GB) cancer associated with leptomeningeal carcinomatosis (LMC) have been reported so far. Herein, we report the first known case of LMC originating from GB cancer after curative resection and discuss the risk factors of LMC associated with GB cancer. Case Presentation An 85-year-old Japanese woman presented with vomiting and impaired awareness 2 years after curative extended cholecystectomy for GB cancer. Computed tomography showed hydronephrosis of the right kidney and ureteral thickening. Magnetic resonance imaging revealed areas of hyperintense reflecting lesions along the cerebral sulci, suggesting meningitis. A spinal tap showed an elevated cerebrospinal fluid pressure of >270 mmH2O and cytologic examination of the spinal fluid revealed the presence of adenocarcinoma cells. The patient was diagnosed with retroperitoneal metastasis and LMC originating from GB cancer. The patient was given palliative care and died 4 weeks after the onset of symptoms. Conclusion The findings of this study show that LMC could occur even after curative resection of GB cancer and should be considered when patients present with neurologic symptoms. Retroperitoneal metastases and poorly differentiated tumors are possible risk factors of LMC originating from GB cancer.

Background A delayed perforation can often occur after endoscopic treatment for duodenal neoplasms and may be fatal due to leakage of pancreatic and bile juices. We aimed to evaluate the feasibility and safety of laparoscopic and endoscopic cooperative surgery for duodenal neoplasms (D-LECS) in a multicenter, retrospective study. Methods The clinical characteristics and surgical outcomes of 206 patients with duodenal neoplasms in whom D-LECS had initially been attempted at one of 14 institutions were reviewed retrospectively. Results Of the 206 patients, 63 (30.6 %), 128 (62.1 %), and 15 patients (7.3 %) had lesions at the bulb, second portion, and third portion of the duodenum, respectively. The rates of en bloc and R0 resections during D-LECS were 96.1 % and 95.1 %, respectively. Intraoperative and delayed perforations occurred in 10 (4.9 %) and 5 patients (2.4 %), respectively. No cases of recurrence were observed. Surgical duration of ≥ 180 minutes was an independent risk factor for postoperative complications. Conclusions The results revealed that D-LECS was performed with oncological safety and technical feasibility.

Purpose: Serotonin (5-hydroxytryptamine, 5-HT) is well known for its growth stimulatory effect on several types of carcinoma and tumor cells. Since a large portion of 5-HT is stored and transported by platelets, the aim of this study was to assess the influence of platelet-sequestered 5-HT on post-resection hepatocellular carcinoma (HCC) recurrence. Methods: This pilot study was conducted in a cohort of forty patients diagnosed with HCC undergoing partial hepatectomy. 5-HT levels in serum, plasma and intra-platelet (IP) were monitored preoperatively and four weeks after liver resection. The patients were followed every three months after the surgery. Results: Follow-up was standardized to a fixed length of time. Fifteen patients (37.5%) developed HCC recurrence during 18 months follow-up. Patients with recurrence had significantly reduced serum and IP 5-HT levels at four weeks of liver resection (P = 0.003 and P = 0.014 respectively). Accordingly, in the Cox regression hazard model, serum and IP 5-HT were able to independently predict the recurrence (hazard ratio = 0.1, 95% confidence interval = 0.01 - 0.75 and hazard ratio = 0.1, 95% confidence interval = 0.01 - 0.89 respectively). The optimal cut-off value of 42.77 ng/ml for serum [area under the curve (AUC): 0.78, P = 0.003] and 0.3117 ng per 106 platelets (AUC: 0.733, P = 0.015), on receiver operating characteristic (ROC) curve corresponded to maximum sensitivity and specificity of prediction. The disease free interval was significantly worse in patients with low serum and IP 5-HT (P = 0.001 and P = 0.029 respectively). Conclusion: IP 5-HT monitored during early follow-up, after liver resection may represent a useful marker of early HCC recurrence.

The present study reports a case of eosinophilia-associated rectal cancer that was successfully stabilized using chemotherapy, and reviews the mechanisms of eosinophilia and the importance of chemotherapy. A 65-year-old man, who had previously been diagnosed with suspected rectal cancer, presented with the chief complaint of melena. Eosinophilia, abnormal blood coagulation, and elevated carcinoembryonic antigen and carbohydrate antigen 19-9 tumor marker levels were observed, and the patient was subsequently diagnosed with advanced rectal cancer accompanied by multiple lymph node metastases that extended from the para-aortic lymph nodes to the left axillary lymph nodes. The complication of deep vein thrombosis was also observed. Tumor hemorrhage was exacerbated, and thus, Hartmann's procedure was performed. Pathological findings included poorly- to moderately-differentiated adenocarcinoma; however, no eosinophil infiltration was observed within the tumor. Following surgery, the eosinophilia and lymph node metastasis were exacerbated, and an oxaliplatin plus capecitabine chemotherapy regimen was initiated. The patient's eosinophil count and tumor marker levels normalized, and the lymph nodes decreased in size; however, re-enlargement of the lymph nodes was observed 6 months after surgery. The patient was then administered a chemotherapeutic regimen of irinotecan/fluorouracil/folinic acid + bevacizumab, and stable disease was maintained until pleural and peritoneal dissemination were observed at 22 months post-surgery. Following a rapid deterioration in condition, the patient succumbed to the disease at 23 months post-surgery. The present case indicates that although eosinophilia-associated colon cancer exhibits a poor prognosis, early chemotherapeutic intervention may improve this.

下大静脈（inferior vena cava;以下，IVC）へ浸潤または腫瘍栓を合併した腎・副腎癌は一般的に予後不良であるが，腫瘍栓による肺梗塞や心不全による突然死の回避目的や根治的切除による長期生存例の報告が散見される．今回われわれは，肝臓およびIVC浸潤またはIVC腫瘍栓を呈した腎細胞癌3例・副腎皮質癌2例の計5症例に対し，肝臓外科手技を応用した手術手技とその成績について検討した．結果，全肝血流遮断法を3例に行い，うち1例に大腿動静脈バイパスによる体外循環を併用した．肝直接浸潤の1症例に，後区域切除を行った．全症例で肉眼的根治術が可能であった．5例の平均生存期間は30.6カ月で，遠隔死亡は2例あった．従来手術困難とされた肝臓やIVCへの浸潤あるいはIVC腫瘍栓を合併した腎・副腎癌であっても，肝臓外科手技を応用し，心臓血管外科・泌尿器科共同による根治的切除で長期生存も期待しうると考えた．

症例は59歳,女性.平成7年肺サルコイドーシス,平成9年心サルコイドーシスと診断されステロイド内服を開始した.平成16年6月以降,脳梗塞,両下肢動脈閉塞をくり返し,平成16年8月右下肢急性動脈閉塞で当科を紹介され,血栓除去術を施行した.心臓超音波検査で,び慢性の左室壁運動低下と両心室内に可動性のある腫瘤を認めた.腫瘍または血栓を疑い,平成16年9月開心術を施行した.両心室内に器質化血栓を認め摘出した.術後経過良好で,第23病日に自宅退院した.心サルコイドーシスによる壁運動低下に伴い,両心室内に血栓を形成したものと考えられた.

結腸憩室症の合併症としては極めて稀な結腸子宮瘻の2例を経験した. 症例1は72歳の女性で, 便性帯下を主訴に来院した. CT上子宮内にガス像を認め, 消化管との交通が示唆された. 注腸透視では, S状結腸に多発する憩室を認め, 瘻孔は確認できなかったもののS状結腸子宮瘻が強く疑われ手術を施行した. 症例2は75歳の女性で, 便性帯下と不正出血を主訴に来院した. 注腸透視で多発するS状結腸憩室を認め, これより子宮内腔へバリウムの漏出を確認できた. S状結腸子宮瘻と診断し手術を施行した.2症例ともS状結腸, 子宮, 両側附属器をen blockに切除摘出し, 一期的に結腸の吻合再建を行った. 病理組織学的所見では, 憩室から子宮筋層内への膿瘍形成が確認され, この一部が子宮内腔に達し瘻孔が形成されていた. 結腸子宮瘻の発生機序, 診断, 治療について文献的考察を加え報告する.

症例は59歳,男性.心窩部痛を自覚し,近医にて上部消化管内視鏡検査を施行,胃角部から前庭部にかけて広範な潰瘍性病変を認め,生検でB細胞悪性リンパ腫(びまん性大細胞型CD20陽性)と診断された.その後,化学療法目的で当院内科に入院しR-CHOP療法を開始した. 3クール終了後に嘔吐が頻回にみられるようになり,上部消化管内視鏡検査を施行したところ,潰瘍性病変は縮小していたが,幽門部の狭窄を認めるようになった.胃悪性リンパ腫による胃流出路狭窄の診断で,幽門側胃切除を施行した.しかし,切除標本では悪性リンパ腫の遺残は認められず,完全寛解と診断された.狭窄の原因は,化学療法による瘢痕治癒後の狭窄であった.本症例の如く,化学療法後に胃流出路狭窄をきたした症例は稀であり,本邦報告例および自験例を含め文献的考察を加え報告する.

Background Mucins are implicated in survival in various cancers, but there have been no report addressed on survival in appendiceal carcinoma, an uncommon disease with different clinical and pathological features from those of other colon cancers. We aimed to investigate the clinical implications of expression of mucins in appendiceal carcinoma. Methods Expression profiles of MUC1, MUC2, MUC3, MUC4, MUC5AC, MUC6, MUC16 and MUC17 in cancer tissue were examined by immunohistochemistry in 108 cases of surgically resected appendiceal carcinoma. Results The following relationships of mucins with clinicopathologic factors were identified: MUC1 with positive lymphatic invasion (p = 0.036); MUC2 with histological type (mucinous carcinoma, p

Mucins have been associated with survival in various cancer patients, but there have been no studies of mucins in small bowel carcinoma (SBC). In this study, we investigated the relationships between mucin expression and clinicopathologic factors in 60 SBC cases, in which expression profiles of MUC1, MUC2, MUC3, MUC4, MUC5AC, MUC6 and MUC16 in cancer and normal tissues were examined by immunohistochemistry. MUC1, MUC5AC and MUC16 expression was increased in SBC lesions compared to the normal epithelium, and expression of these mucins was related to clinicopathologic factors, as follows: MUC1 [tumor location (p = 0.019), depth (p = 0.017) and curability (p = 0.007)], MUC5AC [tumor location (p = 0.063) and lymph node metastasis (p = 0.059)], and MUC16 [venous invasion (p = 0.016) and curability (p = 0.016)]. Analysis of 58 cases with survival data revealed five factors associated with a poor prognosis: poorly-differentiated or neuroendocrine histological type (p

This study aimed to examine expression profile of MUC4 in intraductal papillary mucinous neoplasm of the pancreas (IPMN).We performed immunohistochemistry (IHC) of MUC4 in 142 IPMNs, with evaluation of the specificity of 2 anti-MUC4 monoclonal antibodies, 8G7 and 1G8, in cancer cell lines.Monoclonal antibody 8G7 showed a clear immunoreactivity, whereas MAb 1G8 did not show any immunoreactivity, in the Western blotting and IHC for human pancreatic carcinoma cell lines expressing MUC4 messenger RNA. However, IHC signals detected by both monoclonal antibodies were observed in the tissue specimens. The expression rates of MUC4/8G7 detected by MAb 8G7 and MUC4/1G8 detected by MAb 1G8 in the intestinal-type IPMNs were significantly higher than those in the gastric-type IPMNs. In the intestinal-type IPMNs, MUC4/8G7 was expressed mainly in the cytoplasm of the neoplastic cells, whereas MUC4/1G8 was expressed mainly at the cell apexes. Even in the gastric-type IPMNs with rare MUC4 expression in the low-grade dysplasia, both MUC4 expression rates increased when dysplasia advanced.A significantly higher expression of MUC4 in intestinal-type IPMNs than in gastric-type IPMNs will be one of the biomarkers to discriminate between the intestinal-type IPMNs with high malignancy potential from gastric-type IPMNs with low malignancy potential.

Parenchyma-sparing pancreatic resections have been reported increasingly in recent years; however, for multifocal diseases involving the head and the tail of the pancreas, total pancreatectomy is still the preferred procedure. The possible consequence of this procedure is loss of normal pancreatic parenchyma, resulting in insufficiency of pancreatic exocrine and endocrine functions. Various types of limited resection have been introduced for isolated or multiple pancreatic lesions, depending on the location of the tumor. Even for multifocal diseases, if the pancreatic body is spared, a middle-preserving pancreatectomy (MPP) can be performed to assure maximal pancreatic function and uncompromised quality of life. Yet, few papers have introduced the feasibility of MPP for a better outcome. This report describes a new surgical technique for MPP using an alternative approach for the remnant pancreas anastomosis. We used this technique successfully to remove a bifocal neoplasm: adenocarcinoma of the distal bile duct and mucinous cyst adenoma in the tail of the pancreas.

We report a case of malignant fibrous histiocytoma (MFH) of the chest wall. A 70-year-old man admitted for recurrent chest wall tumor diagnosed for MFH histologically and resected 7 months and 13 months before admission. Chest computed tomography (CT) revealed a tumor located at right posterior chest wall. In May 1997, resection of the tumor was done (the 3rd operation), but metastasis to the ribs (the 4th operation), subcutaneous tissue (the 5th operation), and local recurrence (the 6th operation) was found within 4 years postoperatively. Resection was done for each metastasis, and postoperative radiotherapy (66 Gy) and chemotherapy (CYVADIC) were done. The patient is doing well without apparent recurrence 57 months after last surgery, and survives 113 months after initial surgery. Multidisciplinary treatment may provide longer survival for patients with MFH of the chest wall.