Stool filling of an intestinal duplication cyst at the ileocecal valve triggers colonic intussusception: a case report.

BACKGROUND: Intestinal duplication, a congenital malformation, is considered a rare condition, particularly in adults. Although it affects young children, a minority of patients remains asymptomatic until adulthood. Here, we describe a case of an intestinal duplication cyst that caused intussusception by a unique mechanism. CASE PRESENTATION: A 19-year-old man was admitted to our hospital for intermittent abdominal pain. Computed tomography revealed colonic intussusception induced by a nodular mass in the ileocecal region. Urgent ileocecal resection was performed because of the risk of colonic ischemia. The resected material comprised a stool-filled noncommunicating cyst that protruded into the enteric lumen at the ileocecal valve. Histological analyses revealed that the inner wall of the cyst was lined with colonic mucosa and that the muscle layer of the cyst was shared with that of the original enteric wall; furthermore, the cyst had a vestige of an opening site in the wall. We concluded that the cyst was an intestinal duplication that poured stool into its lumen through the tiny orifice, thereby triggering intussusception. CONCLUSIONS: The present case suggests that stool-pouring can cause intussusception into the space of an intestinal duplication lesion.

Postsurgical radiation therapy for gastric carcinosarcoma with c-kit expression: a case report.

Gastric carcinosarcomas are rare morphologically biphasic tumors, consisting of carcinoma and sarcoma components, with a poor clinical course. Here we report the case of a 70-year-old man with advanced Borrmann type III carcinosarcoma arising from the upper body of the stomach with extensive lymph node metastasis who underwent a total, but palliative, gastrectomy. Histology showed the tumor consisted of a biphasic structure of tubular adenocarcinoma and spindle cell sarcoma. Immunohistochemistry revealed sarcoma cells expressing c-kit (CD117) and CD34, which are criteria for gastrointestinal stromal tumors. Nine months after the surgical operation, tumor metastases had extended to the hepatohilar, retroperitoneal and mediastinal lymph nodes. Radiation therapy of 50 Gy markedly decreased the size of each of these nodes and reduced the risk of respiratory complications and jaundice. However, the patient died of respiratory failure due to bronchopneumonia with multiple lung metastases 22 mo after resection. Autopsy revealed severe necrosis in most of the lymph nodes with tumor metastases. Radiation therapy combined with gastrectomy should be considered to improve survival in patients with gastric carcinosarcomas that express c-kit.

[Concurrent low-dose cisplatin/5-FU chemotherapy and radiation for the recurrent gastric carcinoma--case reports].

We report two postoperative cases of recurrent gastric carcinoma successfully treated with concurrent low-dose cisplatin/5-FU chemotherapy and radiation therapy. Case 1: A 74-year-old man underwent total gastrectomy and splenectomy for advanced gastric carcinoma followed by a local recurrence at the anastomotic site 6 months after surgery. Case 2: A 75-year-old man underwent total gastrectomy and splenectomy for advanced gastric carcinoma followed by multiple lymph node swelling along the abdominal aorta one year after surgery. We employed concurrent radiation therapy and low-dose CDDP/5-FU therapy for the recurrent gastric carcinoma tumor which consisted of 5-FU (125-250 mg/body/day, as a 24-h intravenous injection for 4 weeks) and low-dose cisplatin (10 mg/body on day 1, 8, 15, 22). X-ray radiation was delivered to the target tumor in a daily fraction of 1.8 Gy, 6 days/week, with a total dose of 50.4 Gy. PR and CR were obtained after the therapy. Grade 3 leucopenia was observed in Case 1,which was successfully treated with G-CSF injection. The concurrent low-dose cisplatin/5-FU chemotherapy and radiation therapy could be an effective treatment modality for the recurrent tumors of gastric carcinoma after surgery.

Concurrent proton beam radiotherapy and systemic chemotherapy for the metastatic liver tumor of gastric carcinoma: a case report.

We report a case of a woman with a metastatic liver tumor from gastric carcinoma, who has been successfully treated with concurrent proton beam therapy and systemic chemotherapy. A 76-year-old woman underwent distal gastrectomy with regional lymph node dissection for advanced gastric carcinoma on January 17, 2002. She received five courses of sequential chemotherapy with methotrexate-5-fluorouracil after the surgical resection. A metastatic liver tumor was detected in the caudate lobe of the liver by computed tomography at 6 months after the surgical resection. We employed concurrent proton beam therapy and systemic chemotherapy which consisted of 5-fluorouracil (250 mg/body per day, as a 24-h intravenous injection for 4 weeks) and low dose cisplatin (10 mg/body on days 1-5 every week for 4 weeks). Proton beam therapy targeting the metastatic liver tumor was performed in a daily fraction of 3 Gy, 5 days per week, with a total dose of 66 Gy over 30 days. The tumor disappeared 3 months after the treatment and no recurrence has been observed for 2 years after termination of the treatment. Throughout the entire course of treatment, the patient received injections of granulocyte stimulating factor subcutaneously for grade 3 leukopenia. She never complained of abdominal symptoms, such as epigastralgia, nausea or diarrhea. Liver failure related to proton irradiation has not been observed. This concurrent proton beam radiotherapy with systemic chemotherapy could be an effective treatment modality for metastatic liver tumor from gastric carcinoma.

Endoscopic management of upper gastrointestinal bleeding from a duodenal diverticulum.

Hemorrhage from duodenal diverticulum is a rare cause of upper gastrointestinal hemorrhage. The side-viewing endoscope was used for almost all cases of diagnosis and endoscopic hemostasis. However, a forward-viewing endoscope is used in emergent endoscopic study for upper gastrointestinal hemorrhage. We report a case in which the endoscopic hemostasis of bleeding duodenal diverticulum was performed during emergent forward-viewing endoscopic study.

Pancreatic carcinoid: transcatheter arterial chemoembolization of liver metastases.

Carcinoid tumors are a common disease in the gastrointestinal tract, but are extremely rare in pancreas. To our knowledge, only 33 carcinoid tumors of pancreas have been reported in the English literature. Complete surgical resection of pancreatic carcinoid contributes to prolonged survival. But distant metastases, including liver metastasis, prevent long-term survival. We report here one resected case of pancreatic carcinoid tumor with liver metastases. Postoperatively, multiple liver metastases had arisen in the bilateral lobe of the liver and were treated with transcatheter arterial chemoembolization. In this case, transcatheter chemoembolization was effective for palliation for postoperative liver metastases.

E-cadherin expression in the primary tumors and metastatic lymph nodes of poorly differentiated types of rectal cancer.

PURPOSE: Dysfunction of E-cadherin, a cell-cell adhesion molecule, correlates with the grade of dedifferentiation and/or invasiveness of rectal cancer. However, the relationship between E-cadherin expression in the primary tumor and the potential for metastasis has never been reported. METHODS: E-cadherin expression in 43 primary rectal cancer, including 10 poorly differentiated type, and their associated metastatic lymph nodes (LN mets.) were immunohistochemically evaluated. RESULTS: Heterogeneous immunostaining, suggestive of damage to the E-cadherin-mediated cell-cell adhesion system, was seen in 13 of the 28 LN mets positive primary lesions, but in 0 of the 15 LN mets negative primaries. Furthermore, the incidence of heterogeneous immunostaining differed significantly between poorly differentiated and differentiated cancers, being seen in 8 of 10 cases and 5 of 33 cases, respectively (P = 0.0003 by Fisher's exact test). Interestingly, most of the LN mets. foci (25 of 28 cases) showed homogeneous staining regardless of the E-cadherin staining pattern of the primary lesion. CONCLUSION: Heterogeneous immunostaining of E-cadherin in poorly differentiated rectal cancer was associated with lymph node metastasis. Its staining pattern in metastatic lymph nodes were, however, generally homogenous.