ABSTRACT
Adult T-cell leukemia/lymphoma(ATLL)can infiltrate throughout various organs and frequently involves the gastrointestinal tract. However, bowel perforation in ATLL patients is rare. Herein, we present a case of ATLL with bowel perforation. A 75-year-old man presented with bowel distension. Computed tomography showed a large mass of the cecum. Edema and stenosis of the ascending colon was seen on colonoscopy, and tumor on the anal side of the stenosis was also found. After admission, the patient complained of abdominal pain with a peritoneal irritation sign. Free air was seen around a large mass of the cecum on computed tomography and an emergency operation was performed under the diagnosis of bowel perforation. Microscopic examination revealed bowel infiltration of ATLL. Gastrointestinal perforation can be caused by ATLL itself and is associated with a poor prognosis. The standard treatment for ATLL is chemotherapy but emergency surgery is necessary in case of perforation. It is important to observe the patient with ATLL carefully.
Subject(s)
Colonic Neoplasms/surgery , Intestinal Perforation/surgery , Leukemia-Lymphoma, Adult T-Cell/surgery , Aged , Colonic Neoplasms/complications , Colonic Neoplasms/pathology , Fatal Outcome , Humans , Intestinal Perforation/etiology , Leukemia-Lymphoma, Adult T-Cell/complications , MaleABSTRACT
BACKGROUND: Treating gastric cancer in remote island hospitals remains a major clinical challenge. Factors affecting prognosis of patients treated in general hospitals are still at large. We sought to determine the characteristics of gastric cancer in the Amamiooshima (Amami) archipelago of Japan and also evaluated the independent prognostic factors by the Cox regression analysis. MATERIALS AND METHODS: A total of 125 patients treated in four sister hospitals in the Amami were analyzed. RESULTS: The median age of patients with resection was 74 years and almost 85% patients had diffuse type of cancer. The 5-year overall survival was 34% for all patients and 58% for those who had a resection. Among the several clinicopathological factors, operation method (distal vs. total gastrectomy), splenectomy, lymphatic and venous invasion, T-stage, metastatic lymph node (MLN) size n-stage and UICC N-stage had significant impact on survival. Only MLN size and intraoperative blood loss had independent effect on survival by multivariable analysis. CONCLUSION: Improved perioperative care may yield a reasonable patient survival in elderly patients with gastric carcinoma treated in remote hospitals. Restricting amount of intraoperative blood loss may further improve the patient prognosis and MLN size may serve as a new metric to stage gastric cancers.