Initial experiences with MR Image-guided laparoscopic microwave coagulation therapy for hepatic tumors.

PURPOSE: Percutaneous thermal ablation is used for treating hepatic tumors. Recent advances in laparoscopy and imaging modalities have led to the development of a novel image-guided minimally invasive loco-regional treatment. The aim of this trial was to apply laparoscopic assistance to magnetic resonance (MR) image-guided thermoablation instead of ultrasonography, because of its various advantages. METHODS: Patients with hepatic tumors and liver cirrhosis underwent magnetic resonance (MR) image-guided laparoscopic microwave coagulation therapy using a borescope and endoscopic forceps. Six cases of laparoscopic microwave coagulation treatment using MR image guidance were successfully performed between January 2000 and December 2008. Tumors were detected, punctured, and ablated in an open-configured MR scanner. A total of nine hepatocellular carcinoma nodules were preoperatively identified in S3, S5 and S6 (mean diameter = 20.8 ± 5.4 mm). RESULTS: MR-guided microwave coagulation was laparoscopically achieved in all patients without any significant complications that required invasive treatment. The mean length of the operation was 275.3 ± 60.5 min, and the mean postsurgical hospital stay was 10.0 ± 2.3 days. Postoperative confirmation scanning was performed without moving the patients. CONCLUSION: MR-guided laparoscopic microwave coagulation therapy is an effective treatment for hepatic tumors adjacent to other organs, as it allows for more accurate detection of lesions and for tumors to be treated safely while avoiding adjacent organs. It is less invasive than conventional procedures, because the MR real-time guidance enabled continuous monitoring throughout the procedure.

Cell transplantation therapy for a rat model of secondary lymphedema.

BACKGROUND: Although lymphedema is a progressive and lifelong condition, substantial advances in therapeutic intervention are limited. The development of a novel therapy for lymphedema is urgent for those patients suffering from it. The aim of this study was to investigate the usefulness of a new cell transplantation therapy in the rat tail model of secondary lymphedema. MATERIALS AND METHODS: We prepared two cell sources, human dermal microvascular endothelial cells (HDMECs) and lymphatic endothelial cells (LECs), which were collected from the resected normal dermis of patients with breast cancer. After the animal model of secondary lymphedema of the nude rats' tails was established, phosphate-buffered saline, purified LECs, or unpurified HDMECs were injected in the rats' tails five times for more than 14 d. The evaluations were performed by measuring the circumference, fluorescence lymphography, and histologic analysis of the rats' tails between each group. RESULTS: The isolated cells by the simple immunomagnetic sorting from HDMECs were positive for a pan-endothelial marker (CD31) and lymphatic-specific markers (podoplanin, lymphatic vessel endothelial hyaluronan receptor-1 [LYVE-1], and prospero homebox 1 [Prox-1]), and were considered to be LECs. In the cell transplantation group, which was injected with human LECs, the circumference, lymphatic flow, and thickness of the skin of the rat tail became thinner than the groups injected with unpurified HDMECs or phosphate-buffered saline. Immunohistochemistry of the rat tails showed that the number of own lymphatic vessels was increased in the purified LEC transplantation group compared with the other groups. Furthermore, in the LEC transplantation group, some vessels were immunopositive for human-podoplanin or -LYVE-1 and the areas adjacent to the vessels were rat-podoplanin or -LYVE-1 immunopositive. CONCLUSIONS: Our findings indicate that cell transplantation therapy using human LECs improved the secondary lymphedema in the nude rat tail. This therapeutic strategy may merit clinical investigation in patients with lymphedema.

Resectable carcinoma developing in the remnant pancreas 7 years and 10 months after distal pancreatectomy for invasive ductal carcinoma of the pancreas: report of a case.

BACKGROUND: Pancreatic ductal adenocarcinoma, which represents 90% of pancreatic cancers, is one of the most lethal and aggressive malignancies. Operative resection remains the only treatment providing prolonged survival, however, recurrence of pancreatic ductal adenocarcinoma occurs in up to 80% of patients with pancreatic cancer within 2 years of a potential curative resection. There are few reports of pancreatic carcinoma recurrence (primary second cancer) in the remnant pancreas after pancreatectomy. CASE PRESENTATION: A 52-year-old woman underwent a distal pancreatectomy for pancreatic cancer in September 2004. Adjuvant chemotherapy was started after surgery and continued for 4 years. In March 2012, marked elevation of DUPAN-II was observed, followed by an irregular stenotic finding in the main duct. We performed an en bloc resection of the remnant pancreas in July 2012. Histologically, the tumor contained a second primary pancreatic carcinoma with lymph node metastasis. At follow-up 20 months after the second operation, the patient was alive without recurrence. Fourteen cases of resectable cancer developing in the remnant pancreas after a pancreatectomy for cancer have been reported; a minority of these was identified as second primary tumors. Therefore, our patient's primary second cancer is a rare event. CONCLUSION: The patient is considered to have shown a rare, unique pancreatic cancer recurrence. Persistent elevation of a tumor marker and extensive imaging led to proper diagnosis and treatment.

Feasibility and toxicity of docetaxel before or after fluorouracil, epirubicin and cyclophosphamide as adjuvant chemotherapy for early breast cancer.

BACKGROUND: The tolerance and safety associated with the administration order of the anthracycline and taxane drugs have not been evaluated. PATIENTS AND METHODS: Breast cancer patients with node-positive or high-risk patients with node-negative were eligible. The feasibility and toxicity were evaluated in the following regimens--arm A, 3 courses of fluorouracil 500 mg/m(2), epirubicin 100 mg/m(2) and cyclophosphamide 500 mg/m(2) (FEC) followed by 3 courses of docetaxel 100 mg/m(2) (DOC); arm B, 3 courses of DOC followed by 3 courses of FEC. RESULTS: Forty-two patients were registered. The relative dose intensity was 94.2 % for FEC and 97.8 % for DOC in arm A, and 98.9 % for DOC and 95.2 % for FEC in arm B. In arm A, grade 3 or higher hematological toxicity was observed in nine patients, and febrile neutropenia developed in three patients with FEC. In arm B, grade 3 or higher hematological toxicity was observed in seven patients, but febrile neutropenia was not noted in any patient. CONCLUSION: The regimens in both arms A and B were safe regarding adjuvant chemotherapy for early breast cancer. However, DOC followed by FEC might be more tolerable. Further studies will maximize the results obtained with DOC followed by FEC.

Laparoscopic surgery simulator using first person view and guidance force.

In general, minimally invasive surgery is seen as the most difficult surgery because there is limited field of view with an endoscope and force sensation from surgical instruments such as forceps is poor. Especially in early clinical education for medical students, a virtual reality surgical simulator would be an effective tool. In this paper, we propose a visuohaptic surgery training system for laparoscopical techniques. We recorded a video from a first person point of view of the instructor (expert). And we also recorded operation information (i.e. trajectory) of surgical instruments of the instructor. Then, we displayed the recorded video and the guidance force to trainees. We constructed a prototype surgery training system and the effectiveness of our approach was confirmed.

Myeloid cells positive for CD10 at invasion front can predict poor outcome in stage II colorectal cancer.

BACKGROUND: Prediction of poor patient outcome as a effect of adjuvant therapy in stage II colorectal cancer (CRC) remains a matter of controversy. Tumor expression of CD10 and CD15 is reportedly related to poor outcome in CRC. In this study, we investigated whether the expression of CD10 and CD15 is a predictor of outcome and the effect of adjuvant therapy in stage II CRC. MATERIALS AND METHODS: Immunohistochemical analyses for CD10 and CD15 and some additional markers (CD11b, CD14, CD163, CD3, and CD20) were performed using paraffin sections of CRC specimens from 57 patients who had undergone curative surgical treatments between 1998 and 2004. Forty of these patients received postoperative adjuvant therapy. We distinguished between expression in tumor cells (tCD10 and tCD15), in stromal cells (sCD10), and infiltrating immune cells (iCD10 and iCD15). RESULTS: Expression of iCD10 was observed in 21.1% (12/57) of the specimens examined. Of all expression patterns, only iCD10 expression at the cancer invasion front was a useful predictor of a disease-free period and overall survival in stage II CRC. Adjuvant therapy improved the outcome of iCD10(+) patients. CD10(+) immune cells were heterogeneous in origin and partially overlapped the cells positive for myeloid lineage markers, including CD11b and CD15. CONCLUSIONS: iCD10 expression at the tumor invasion front is a useful marker for predicting a high risk of recurrence and mortality in stage II CRCs. CD10(+) immune cells appear to be of myeloid origin.

Abnormal development of intrinsic innervation in murine embryos with anorectal malformations.

INTRODUCTION: Constipation, soiling, and incontinence are common problems after definitive repair of anorectal malformations (ARMs) in children. We studied the expression of substance P (SP), vasoactive intestinal peptide (VIP), and c-kit in the rectum of murine embryos with or without ARMs at later developmental stages. METHODS: On the 9th embryonic day (E9), pregnant Institute of Cancer Research mice were fed etretinate, a synthetic vitamin A analogue (60 mg/kg), whereas controls were fed only with sesame oil. Embryos were excised between E14 and E18, and prepared for histological examination. The SP, VIP, and c-kit expressions were examined by immunohistochemical staining for the SP, VIP, and c-kit antigens, respectively. RESULTS: On E14 and E15, the expression levels of the anti-SP and anti-VIP antibodies in the rectum did not differ between the control and etretinate-treated group. However, as compared to the controls, a decreased SP and VIP immunoreactivity was observed in the circular muscle layer of the rectum between E16 and E18. On the other hand, on E14 and E15, the expression of anti-c-kit antibody in the rectum did not differ between the etretinate-treated and control group. However, c-kit immunoreactivity was slightly higher in the circular muscle layer of the rectum in the controls on E16 and E17, and considerably higher on E18 than that of the muscle layer in the etretinate-treated group. CONCLUSION: At later developmental stages, the expression levels of SP, VIP, and c-kit reduced in the circular muscle layer of the rectum in mice with etretinate-induced ARMs. This result indicates that reduced SP, VIP, and c-kit expression levels in the circular muscle layer may cause severe constipation in children who develop severe ARMs after definitive surgery.

[Current situation and issues regarding preoperative chemotherapy for HER2-positive breast cancer].

OBJECTIVE: The clinical significance of preoperative chemotherapy, including trastuzumab for HER2-positive breast cancer, was examined based on hormone receptors(HR)to clarify future issues. SUBJECTS: 104 HER2-positive breast cancer patients who completed preoperative chemotherapy and underwent surgery from May 2005 to August 2010. All patients received sequential treatment with taxane±trastuzumab for FEC(5-FU+epirubicin+cyclophosphamide)therapy, and from 2008 they received trastuzumab postoperatively for one year. RESULTS: Concerning the histological effects, the rate of comprehensive pCR(CpCR)in the 104 patients(31 HR-negative administered trastuzumab, 15 HR-negative not administered trastuzumab, 28 HR-positive administered trastuzumab, 30 HR-positive not administered trastuzumab)was 65%, 47%, 21% and 23% for each group, respectively CpCR was a significant factor(p<0. 05)in prolonged distant disease-free survival(DDFS)in the HR-negative group. Distant metastasis occurred in 14 patients, namely, brain metastasis in 7 patients(4 HR-negative administered trastuzumab, 1 HR-negative not administered trastuzumab, 2 HR-positive administered trastuzumab). The therapeutic efficacy was pINV in 5 of these 7 patients(3HR-negative administered trastuzumab, 1 HR-negative not administered trastuzumab, 1 HR-positive administered trastuzumab), and 4 of those 5 patients received trastuzumab postoperatively. DISCUSSION: The responsiveness to preoperative chemotherapy including trastuzumab for HER2-positive breast cancer differs between HR-positive and HR-negative. pINV patients seem to be at a high risk for brain metastasis regardless of HR, and it may be difficult to suppress its occurrence only with trastuzumab adjuvant therapy.

Usefulness of Novel Atherogenic Lipid Indices for the Evaluation of Metabolic Status Leading to Coronary Heart Disease in a Real-World Survey of the Japanese Population.

We evaluated the usefulness of two novel cholesterol-triglyceride subgroup (CTS) indices, CTSqlt and CTSqnt, that potentially reflect the metabolic status regarding risk of coronary heart disease (CHD) using a retrospective longitudinal study of the Japanese general population. We recruited 12,373 individuals from the annual users of our healthcare center. Among them, the first onset of CHD was recorded in 131 individuals between April 2014 and March 2020. The multivariate Cox proportional hazards regression analyses for all normalized lipid indices revealed that the CTSqnt index showed a comparable hazard ratio for the CHD outcome to non-high-density lipoprotein cholesterol (nonHDL-c) and triglycerides. The HR of the CTSqlt index was significantly lower than for CTSqnt, but still comparable to that for low-density lipoprotein cholesterol (LDL-c). In comparison with the other indices, CTSqlt is more sensitive to risk increment while the index value increases. Linear regression analyses for the CTS indices and previously known lipid indices suggest that the CTSqnt and CTSqlt indices reflect the quantity of atherogenic lipoproteins and particle size (quality) of smaller and denser LDLs, respectively. Furthermore, the CTSqnt/HDL-c index can be used as a comprehensive risk indicator that may represent the status of lipid metabolism determined by the CTSqlt and CTSqnt indices and thus may be useful for screening. The CTS indices can be used to evaluate the metabolic status of individuals, which may increase the risk of future CHD.

Needle Tip Detection Using Ultrasound Probe for Vertical Punctures: A Simulation and Experimental Study.

Current ultrasound-guided punctures are difficult to perform as they are performed at an angle to the ultrasound image of the affected area, resulting in longer puncture times, lower success rates, and higher unexpected injury rates. Vertical puncture techniques have also been investigated, but the principle of needle tip detection remains unclear. To optimize ultrasound probes for puncture, the principle of needle tip detection should be understood. This study aimed to verify the principle of needle tip detection and optimal measurement conditions for vertical puncture. Needle tip detection was performed in animal experiments using a probe with a central puncture slit. Moreover, the needle tip was detected at short distances using a puncture spacer. We also investigated the signal from the needle tip using a ring probe and confirmed the principle of needle tip detection, effect of needle tip angle, and insertion depth on needle tip detection through simulation and experiments. Needle tip detection using ultrasound-guided waves was described, and the relationship among needle tip angle, detection intensity, and phase change was verified. The needle tip can be detected by the leakage of the ultrasound-guided wave generated inside the needle tip.

Indocyanine green fluorescence imaging system for sentinel lymph node biopsies in early breast cancer patients.

PURPOSE: This study presents a new method that enables the detection of sentinel lymph nodes (SLN) with high sensitivity using indocyanine green (ICG) fluorescence imaging. METHODS: This study enrolled 128 patients with clinically node-negative breast cancer. Fluorescence imaging was obtained after ICG was injected into the areola. Subcutaneous lymphatic channels were immediately visible. RESULTS: Lymphatic channels and SLN were successfully visualized in all patients. One lymphatic channel was 60%, two channels were 24%, and three channels were 16%. The number of fluorescence SLN ranged from 1 to 6, and blue-dyed SLN ranged from 0 to 3. In the latter, SLN were not identified in 44 patients. Nineteen patients had pathologically identified lymph node metastases. All of them were recognized by fluorescence imaging, but 8 patients had lymph nodes with metastases were not identified by dye method. CONCLUSION: This ICG fluorescence imaging technique is feasible and safe for detecting SLN in a less invasive manner than conventional mapping, with real-time observations.

Real-time magnetic resonance-guided microwave coagulation therapy for pelvic recurrence of rectal cancer: initial clinical experience using a 0.5 T open magnetic resonance system.

PURPOSE: This study aims to evaluate consecutive cases of recurrent rectal cancer in the pelvic cavity treated with microwave coagulation therapy using real-time navigation by an open magnetic resonance system. METHODS: Nine recurrent pelvic lesions in 8 patients after curative resection of rectal cancer were treated with real-time magnetic resonance-guided microwave coagulation therapy as a palliative local therapy to reduce tumor volume and/or local pain. Clinical and pathological data were collected retrospectively by reviewing medical records and clinical imaging results. RESULTS: Seven patients received other treatments before real-time magnetic resonance-guided microwave coagulation. Six patients had distant synchronous metastases. Three patients underwent surgery under lumbar anesthesia. Microwave coagulation was performed percutaneously in 5 lesions and under laparotomy in 4 lesions. Although adverse events related to microwave coagulation (skin necrosis and nerve injury) were observed, no fatal complications occurred. Local re-recurrence was observed in 2 of 9 ablated lesions. Except for 1 patient who died of chronic renal failure, the remaining 7 patients died of cancer. Median overall survival after microwave coagulation for all patients was 10 months (range, 4-37 mo). Median overall survival after discovery of pelvic recurrence in all patients was 22 months (range, 9-42 mo). CONCLUSIONS: The benefits of using an open magnetic resonance system in the pelvic cavity include the abilities to treat tumors that cannot be visualized by other modalities, to demonstrate internal architectural changes during treatment, to differentiate treated vs untreated areas, and to allow adjustments to the treatment plan during the procedure. Additional studies are required to clarify the efficacy of tumor coagulation for local control.

Occult breast cancer with EDTA-dependent pseudothrombocytopenia -a case report-.

A case of occult breast cancer with pseudothrombocytopenia (PTCP) is reported. A 50-year-old woman was consulted with a left axillary tumor. Ductal carcinoma was found by the core needle biopsy, and no primary lesion was detected. Her preoperative platelet count, obtained from an ethylene diamine tetraacetic acid (EDTA) sampling bottle, was 3.1 x 10(4) per mL, but she had no history of bleeding problems. A heparinized blood sample showed a normal platelet count of 390 x 10(4) per mL. These findings suggested a diagnosis of occult breast cancer with EDTA-dependent PTCP, and level II axillary lymph node dissection was performed. She received adjuvant chemotherapy and radiotherapy, but she died 2 years and 5 months after the surgery because of lung and brain metastases. Awareness of the phenomenon and knowledge of the underlying physiological principles will enable surgeons to manage patients with EDTA-dependent PTCP appropriately.

[Feasibility of FEC 100 followed by DOC 100 as adjuvant chemotherapy for breast cancer].

UNLABELLED: As adjuvant chemotherapy for breast cancer, the addition of taxane to regimens containing anthracycline has been shown to be effective. However, in Japan, it is not probability yet as for safety. We examined the feasibility of FEC 100 followed by DOC 100 as adjuvant chemotherapy for breast cancer. METHODS: Node-positive breast cancer patients or node-negative high-risk patients were eligible. The treatment completion rate and toxicity were evaluated in 3 courses of FEC 100 mg/m2 followed by 3 courses of DOC 100 mg/m2. RESULTS: Twenty-one patients were registered and completion rate was 100%. The relative dose intensity (RDI) was 94.2% for FEC 100 and 97.8% for DOC 100. Grade 3 or higher neutropenia observed in 38% and febrile neutropenia developed in 14%. Non-hematological toxicities were slight. CONCLUSION: The regimen of FEC 100 followed by DOC 100 was safe in adjuvant chemotherapy for breast cancer in our country.

[An effective case of liver metastasis of breast cancer treated with capecitabine + docetaxel combination therapy using vitamin B6].

Capecitabine + docetaxel combination therapy proves highly effective against the advanced or recurrent breast cancer. Therefore, it has been investigated as a first-line treatment for metastatic breast cancer. Hand-foot syndrome (HFS), a typical side effect of capecitabine, decreases the QOL of patients and sometimes prevents further medication using capecitabine. A 56-year-old woman who had liver, bone and local skin metastases two years after her left breast cancer operation, was treated with capecitabine + docetaxel combination therapy. Severe HFS disturbed the continuation of the therapy. Some other chemo-therapies were attempted after discontinuing the therapy; however, the metastases progressed. Finally, we tried to prevent HFS with vitamin B6 and started the capecitabine + docetaxel combination therapy. HFS was controlled completely. The liver tumor disappeared in MRI and CT images after 18 courses. In this case, vitamin B6 seemed to be effective to control HSF and allow continuation of capecitabine + docetaxel combination therapy.

[Adjuvant trastuzumab can be infused safely over 30 minutes].

UNLABELLED: It has been thought that there is a possibility that infusion speed generally affects the manifested frequency of infusion reaction and its strength. The infusion prescription time of trastuzumab should be over 90 minutes according to the package insert. In the infusion US, is possible over 30 minutes after the second time. We sought to evaluate the safety and tolerability of trastuzumab administered as a 30-minute infusion. PATIENTS: Eighteen patients of HER2-positive breast cancer were treated, and their age ranged from 37 to 65 years old(median, 54 years old). METHOD: PATIENTS were infused with 8 mg/kg of trastuzumab over 90 minutes and, if tolerated, all subsequent maintenance doses of 6 mg/kg are over 30 minutes. RESULT: The infusion times for 30 minutes were twice to 17 times(16 times the median). Mild infusion reactions were seen in 2 cases at the time of the initial prescription, but the infusion reaction was not judged from the prescription for 30 minutes. Mild eczema was admitted by 3 cases after prescription. No decline in cardiac function was seen. CONCLUSION: Our data strongly suggest that trastuzumab can be safely infused over 30 minutes for 6 mg/kg maintenance doses. However, it is thought that the number of cases will increase in future, and confirmation is necessary.

Expression level of thymidylate synthase mRNA reflects 5-fluorouracil sensitivity with low dose and long duration in primary colorectal cancer.

OBJECTIVES: To investigate the prognostic marker for the adjuvant chemotherapy of primary colorectal carcinoma. METHODS: Primary colorectal cancer tissue from 24 patients was investigated to evaluate the relationship between the mRNA expression level of several 5-fluorouracil (5-FU)-related metabolic enzymes (thymidylate synthase, TS; dihydropyrimidine dehydrogenase, DPD; and thymidine phosphorylase, TP) and chemosensitivity to two different 5-FU doses and duration (1: 5-FU concentration 1.0 microg/mL (7.68 microM), 24 h exposure and 2: 5-FU concentration 0.3 microg/mL (2.30 microM), 144 h exposure). Chemosensitivity and mRNA expression levels were measured using collagen gel droplet embedded culture drug sensitivity tests and real-time quantitative reverse transcription-polymerase chain reaction. Clinicopathological features and chemosensitivity were also compared. RESULTS: The TS mRNA expression level was significantly higher in the 5-FU resistant group (T/C > 60%) compared with the 5-FU sensitive group (T/C < 60%) in both 5-FU regimens (1: 5.03 +/- 0.92 vs. 1.58 +/- 0.76, p < 0.01, 2: 4.88 +/- 0.91 vs. 0.96 +/- 0.20, p < 0.001). The group with the higher TS mRNA expression level (>3.83, the average) were more resistant to both 5-FU regimens than those with lower TS mRNA (<3.83) (1: T/C = 80 vs. 66%, p = 0.11, 2: T/C = 89 vs. 64%, p < 0.005). The TS mRNA expression level inversely correlated with the sensitivity to the latter 5-FU regimen (R = 0.577, p < 0.01). There were no relationships between chemosensitivity to 5-FU and the mRNA expression level of DPD and TP and clinicopathological factors. CONCLUSIONS: The TS mRNA expression level might be a good marker of chemosensitivity to 5-FU in primary colorectal cancer, especially the sensitivity to low dose 5-FU with a long duration.

Correlation between high field MR images and histopathological findings of rat transplanted cancer immediately after partial microwave coagulation.

PURPOSE: To investigate the immediate effects of microwave coagulation on rat tumors in various magnetic resonance (MR) images at high magnetic field strength using histopathological examinations as reference. MATERIALS AND METHODS: Tumors implanted in rat femurs were partially thermocoagulated by microwave. Immediately after, T1- and T2-weighted images, diffusion-weighted images (DWIs), and contrast-enhanced T1 weighted images (CE-T1WIs) were acquired with a 7-tesla MR scanner. After measurements, tumors were examined histopathologically with hematoxylin-eosin (HE) staining and histochemically for acid phosphatase activity. RESULTS: Without contrast, boundaries of coagulated areas were unclear on MR images, including apparent diffusion coefficient (ADC) maps. CE-T1WIs clearly showed immediate contrast enhancement of untreated areas of tumor, and the area of enhancement gradually enlarged in 5 min. Quantitative analyses were conducted by classifying tumor areas by contrast enhancement results. Signal intensities of the areas in the MR images showed no significant differences, but at the periphery, ADC values were significantly higher in areas with delayed enhancement than those with immediate enhancement. Compared with histopathological findings, with microwave thermocoagulation, increased ADC value seemed to derive from collection of extracellular fluid in the outer zone, where acid phosphatase activity was attenuated. CONCLUSION: ADC values in the areas with delayed enhancement of CE-T1WIs were higher than those in non-affected areas, but MR images could not show areas of coagulation within tumors. Clear detection of the boundaries of coagulated areas required contrast enhancement, even at magnetic field strength of 7T.

Clinical potential of an antitumor drug sensitivity test and diffusion-weighted MRI in a patient with a recurrent solid pseudopapillary tumor of the pancreas.

A solid pseudopapillary tumor (SPT) of the pancreas is a rare type of pancreatic neoplasm found predominantly in young women. SPTs typically behave as though benign; however, in some cases they also have malignant potential. We encountered a rare case of a recurrent SPT that developed 4 years after the initial surgery in an elderly male patient. Abdominal computed tomography (CT) revealed that the 61-year-old patient had four intra-abdominal masses, suggesting a recurrence of SPT. The patient had a history of distal pancreatectomy due to SPT in the pancreatic tail 4 years previously. These tumors showed positive signals on diffusion-weighted magnetic resonance imaging (MRI), and were treated successfully by aggressive surgical resection. Microscopic diagnosis was compatible with recurrent tumors of SPT. A chemosensitivity test, the collagen gel droplet-embedded culture drug sensitivity test (CD-DST), showed that the resected tumors were sensitive to several antitumor drugs. We suggest that the CD-DST may be used to indicate promising antitumor agents for treating SPTs with malignant tendencies. In addition, a diffusion-weighted MRI can be useful for accurately visualizing SPTs of the pancreas.

Laparoscopic-endoscopic cooperative surgery for a duodenal neuroendocrine tumor: A case report.

For neuroendocrine tumor G1, local resection is one of the primary treatment options. Endoscopic submucosal dissection has been proven to ensure complete resection with sufficient margins. However, duodenal endoscopic submucosal dissection has a high risk of duodenal perforation because of the thin duodenal wall and poor endoscopic maneuverability. During laparoscopic dissection, suturing can resolve perforation. Therefore, laparoscopic-endoscopic cooperative surgery (LECS) can ensure complete resection with a minimal margin to prevent stenosis, and suturing can resolve perforation. In short, LECS combines the advantages of both techniques. In the present case, a duodenal neuroendocrine tumor G1 in a 75-year-old man was successfully treated using LECS. The patient remained free from recurrence at 21 months postoperatively. LECS is feasible for a neuroendocrine tumor G1 ≤20 mm in size that has not invaded the muscularis propria or the lymphatic and venous vessels.