Chronic gastric anisakiasis presenting as pneumoperitoneum.

Typically, the diagnosis of gastric anisakiasis is made at endoscopy with the identification of anisakis larvae. We report a case of gastric anisakiasis presenting as pneumoperitoneum. A 70-year-old Japanese woman was admitted to our hospital with abdominal fullness and pain. Plain chest X-ray in the upright position showed the presence of free gas below the diaphragm. A tentative diagnosis of perforation peritonitis was made and an emergency laparotomy was performed. At laparotomy, a 4 cm, circumscribed red mass was noted on the anterior wall of the upper body of the stomach near the lesser curvature and a partial gastrectomy was carried out. The histological diagnosis showed a foreign body, assumed to be a part of anisakis larvae, seen in the centre of the granuloma. On the serosal aspect, there was histological evidence of peritonitis with fibrin and neutrophils. In addition, an antianisakis larvae immunoglobulin G antibody test was positive. Chronic gastric anisakiasis was suspected because of the presence of eosinophilic granuloma in the resected area and denatured anisakis larvae. Thus, we interpret this case as gastric perforation acutely based on chronic gastric anisakiasis.

Increased expression of MUC1 in advanced pancreatic cancer.

BACKGROUND: MUC1 is associated with tumor invasion and metastasis, and is expressed in pancreatic cancer with a high frequency. This study explored whether MUC1 expression affected the survival of patients with pancreatic cancer. METHODS: Tissue specimens obtained from 70 patients with invasive ductal carcinoma of the pancreas, in pTNM stage III or IV, were immunostained with the anti-MUC1 monoclonal antibody DF3. The results of immunostaining were determined to be positive when more than 50% of the total cancer cells were positively stained. Association of the expression of the DF3 epitope with clinicopathological parameters or patients' survival was statistically evaluated. RESULTS: The incidence of positivity of MUC1 expression was 55.7% (39/70) and this incidence was significantly higher in pTNM stage IV than in stage III (odds ratio [OR], 4.015; 95% confidence interval [CI], 1.459-11.0541; P = 0.0076). As there was a clear difference in overall survival between pTNM stages III and IV ( P = 0.0016), the effect of MUC1 expression on survival was separately evaluated in each stage. It was shown that the expression of MUC1 was associated with unfavorable overall survival in stage IV ( P = 0.0197). CONCLUSIONS: Our data suggest that the expression of MUC1 may be related to the progression of pancreatic cancer.

Successful surgical treatment for metachronous advanced cancers of the gallbladder and the common bile duct--case report.

A 73-year-old woman with a tentative diagnosis of gallbladder cancer had undergone cholecystectomy with liver resection and dissection of regional lymph nodes. Pathological examination of the resected specimen revealed well-differentiated papillary adenocarcinoma of the gallbladder with subserosal invasion. No evidence of metastasis was noted in the dissected lymph nodes. After surgery, she had been disease free in the follow-up study. Ten years after surgery, however, carcinoma arising from the common bile duct was newly found, and pancreaticoduodenectomy with regional lymph nodes dissection was performed. Histological examination confirmed well-differentiated adenocarcinoma of the common bile duct. Lymph nodes had no evidence of malignancy. The patient has been doing well with no evidence of recurrence 20 and 10 years after each operation, respectively. Apparently, these two cancers occurred independently and each surgical treatment for this patient was successful.

Percutaneous sclerotherapy for intractable external biliary fistula after hepatectomy.

A 59-year-old man was diagnosed with cholangitis and a liver abscess caused by intrahepatic stones and underwent a hepatectomy of the left lobe and a side-to-side hepaticojejunostomy. After the operation, the patient developed an intractable external biliary fistula in the left remnant medial region. For the purpose of closing the fistula as a conservative treatment, an injection of 95% dehydrated ethanol was started after confirming the absence of any communication with the central bile duct; 1.5-5 ml was used for each injection, and the tube was clamped for 2 hours after injection. The excretion of bile juice decreased from the second injection, the excretion became serous, and the fistula completely closed after about 2 months without any particular complications. Percutaneous sclerotherapy by the injection of ethanol was found to be useful for closing a noncommunicating external biliary fistula.

Solitary splenic metastasis from gastric cancer: report of a case.

We report a rare case of metachronous and solitary metastasis to the spleen from gastric cancer. A 69-year-old man who had undergone a distal gastrectomy for gastric cancer 48 months earlier was found to have a solitary lesion in the spleen, and an increased serum carcinoembryonic antigen (CEA) level. The patient underwent a laparotomy for suspected metastasis to the spleen. At laparotomy, a tumor was found in the upper pole of the spleen without involvement of other organs, and a splenectomy was performed. Histological examination confirmed that the splenic tumor was a well-differentiated adenocarcinoma similar to the primary gastric cancer. The postoperative course was uneventful and his serum CEA decreased to within normal levels. The patient died of multiple metastases to the liver and peritoneal dissemination 40 months after the splenectomy.

Gastric outlet obstruction caused by a heterotopic pancreas in a pregnant woman: report of a case.

A 26-year-old Japanese woman who was 23 weeks pregnant presented with nausea, vomiting, and abdominal pain. Gastroduodenal endoscopic examination revealed an oval-shaped submucosal tumor obstructing the gastric outlet at the prepyloric area in the stomach. Magnetic resonance imaging showed a 5-cm cystic tumor and we suspected a degenerated gastrointestinal stromal tumor. No other radiological tests were done because of the associated risks to the fetus. Distal gastrectomy was performed and a histological diagnosis of heterotopic pancreas was confirmed. The patient had an uneventful postoperative course and was discharged 19 days after her operation. She delivered a healthy, full-term male infant 3 months later. This case of an ectopic pancreas obstructing the gastric outlet in a pregnant woman is reported and discussed due to its rarity.

Pancreatic tuberculosis.

A 63-year-old Japanese man visited our institute with fever of unknown origin. Findings on preoperative imaging modalities were consistent with pancreatic carcinoma, but a positive tuberculin skin test indicated tuberculosis infection. Negative results for MycobacteriumDNA polymerase chain reaction from sputum and bone-marrow aspiration biopsy specimens ruled out pulmonary and miliary tuberculosis, respectively. Positron emission tomography (PET) with 2-[fluorine-18]-fluoro-2-deoxy- d-glucose (FDG) showed multiple labeled spots within the pancreas body and chest. Distal pancreatectomy was performed with a diagnosis of suspected pancreatic carcinoma, but the histological and microbiological diagnosis was Mycobacterium infection. A rare case of pancreatic tuberculosis evaluated by FDG PET is reported and discussed herein.