[Six-year survival with recurrent intrahepatic cholangiocarcinoma achieved by simple S-1 administration].

We report here a rare case of a patient with recurrent intrahepatic cholangiocarcinoma that was treated with simple S-1 chemotherapy, who is still alive 6 years later. A liver tumor was identified in segments 5 to 6 in a 60-year-old male asymptomatic hepatitis B carrier. The tumor was diagnosed as hepatocellular carcinoma by MRI and CT. However, following its resection by extended posterior segmentectomy of the liver, pathological findings identified it as an intrahepatic cholangiocarcinoma. The surgical margin was cancer-negative. No additional adjuvant chemotherapy was administered because of the patient 's impaired renal function. When tumor recurrence was found by MRI 30 months later, an additional liver resection was planned but a laparotomy was eventually performed. This was because intraoperative findings revealed Glissonian sheath invasion with involvement of the umbilical portion. S-1 treatment(100mg/body/day)was started. Although the dose had to be reduced(mostly 75mg/body/day)due to hyperbilirubinemia and there were some interruptions in the regimen, in total of 42 g of S-1 was administered. The patient is currently still alive, 6 years after the detection of the tumor recurrence. This represents a rare case in patients with intrahepatic cholangiocarcinoma.

Xanthogranulomatous pancreatitis mimicking a malignant cystic tumor of the pancreas: report of a case.

Xanthogranulomatous pancreatitis (XGP) is a rare inflammatory disease of the pancreas. A correct diagnosis is usually made only after pathological examination. A 76-year-old man was referred to our hospital for investigation of erythroderma, muscle weakness, and weight loss. We suspected dermatomyositis as a paraneoplastic phenomenon and investigated accordingly. Computed tomography showed a cystic lesion encapsulated by a thick wall in the pancreatic body. On magnetic resonance imaging, the lesion had low intensity on the T1-weighted images and heterogeneously high intensity on the T2-weighted images. (18)F-Fluorodeoxyglucose positron emission tomography showed abnormal uptake with a maximum standardized uptake value of 9.1. Based on these findings, we made a preoperative diagnosis of intraductal papillary-mucinous carcinoma and performed a distal pancreatectomy. Macroscopically, the cyst was surrounded by a yellow-tan mass with an unclear border, and was filled with hemorrhagic and necrotic tissue. Microscopically, the mass contained an aggregation of many foamy histiocytes, lymphocytes, and plasma cells. These microscopic findings were consistent with xanthogranulomatous inflammation, and the lesion was diagnosed as XGP. Although it is a rare benign pancreatic lesion, XGP should nevertheless be considered in the differential diagnosis of cystic lesions of the pancreas.

Adenocarcinoma in an intrapancreatic accessory spleen: report of a case.

We report a case of adenocarcinoma in an intrapancreatic accessory spleen (IPAS). A 78-year-old woman presented with abdominal discomfort, and investigations revealed an elevated serum carbohydrate antigen 19-9 level, to 161.8 U/ml (normal, <37 U/ml). Ultrasonography showed a heterogeneous echogenic tumor with a vascular hilum. Computed tomography showed a heterogeneously enhanced tumor, 8 cm in diameter, adjacent to the pancreatic body, accompanying a feeding artery arising from the splenic artery, and a drainage vein flowing into the splenic vein. We performed a distal pancreaticosplenectomy. The tumor was surrounded by a fibrous capsule and was in contact with the pancreatic body. Histological examinations revealed invasive growth of adenocarcinoma in a structure identical to the spleen. The results of both radiological and histological examinations suggested that the tumor originated from an intrapancreatic accessory spleen. Extensive examinations revealed no other malignancy, based on which we concluded that the adenocarcinoma was primary. Surgical intervention is strongly recommended when a malignancy in an IPAS cannot be ruled out.

True enteroliths linked to non-specific multiple ulcers of the small intestine: report of a case.

This report presents a case of true enteroliths linked to non-specific multiple ulcers of the small intestine (CNSU). A 53-year-old male presented with abdominal pain and vomiting, and was admitted to our hospital under a diagnosis of ileus. He had anemia and hypoalbuminemia. Abdominal computed tomography showed that several radio-opaque bodies were present in the dilated small intestine. Double-balloon enteroscopy revealed an eccentric stricture accompanying a linear open ulcer. Well defined oblique and branching ulcers were continuous with the stricture. At laparotomy, we observed 18 stenoses of the small intestine from 190 cm to 110 cm proximal to the ileocecal valve. The stenotic and dilated segments were 1.7 ± 0.4 and 5.4 ± 3.0 (mean ± SD) cm in width, respectively. He underwent a resection of the affected small intestine. The macroscopic observation revealed various types of multiple shallow ulcers that were linear or had a tall, triangular configuration, and their alignment was circular or oblique. The ulcers had fused, thus showing a geographic configuration. The microscopic findings showed the maximum depth of the ulcers to be the submucosal layer. The enteroliths were mainly composed of calcium oxalate. As a result, the patient was diagnosed as having true enteroliths linked to CNSU. True enteroliths are a rare complication of CNSU.

Mucosal necrosis of the small intestine in myopathy, encephalopathy, lactic acidosis, and stroke-like episodes syndrome.

This report presents a case of massive mucosal necrosis of the small intestine in a patient with mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS), which particularly affects the brain, nervous system and muscles. A 45-year-old Japanese female, with an established diagnosis of MELAS, presented with vomiting. Computed tomography showed portomesenteric venous gas and pneumatosis intestinalis. She underwent a resection of the small intestine. A microscopic study showed necrosis of the mucosa and vacuolar degeneration of smooth muscle cells in the arterial wall. Immunohistochemistry showed anti-mitochondrial antibody to be highly expressed in the crypts adjacent the necrotic mucosa. The microscopic and immunohistochemical findings suggested the presence of a large number of abnormal mitochondria in MELAS to be closely linked to mucosal necrosis of the small intestine.

Effect of heat shock preconditioning on NF-kappaB/I-kappaB pathway during I/R injury of the rat liver.

Hepatic ischemia-reperfusion (I/R) injury continues to be a fatal complication after liver surgery. Heat shock (HS) preconditioning is an effective strategy for protecting the liver from I/R injury, but its exact mechanism is still unclear. Because the activation of nuclear factor-kappaB (NF-kappaB) is an important event in the hepatic I/R-induced inflammatory response, the effect of HS preconditioning on the pathway for NF-kappaB activation was investigated. In the control group, NF-kappaB was activated 60 min after reperfusion, but this activation was suppressed in the HS group. Messenger RNA expressions of proinflammatory mediators during reperfusion were also reduced with HS preconditioning. Concomitant with NF-kappaB activation, NF-kappaB inhibitor I-kappaB proteins were degraded in the control group, but this degradation was suppressed in the HS group. This study shows that HS preconditioning protected the liver from I/R injury by suppressing the activation of NF-kappaB and the subsequent expression of proinflammatory mediators through the stabilization of I-kappaB proteins.