[A Case of Neuroendocrine Carcinoma Originating from the Papilla of Vater].

A woman in her late 70s with fatigue, nausea, and epigastric discomfort was found to have a tumor at the papilla of Vater through endoscopy. We performed subtotal stomach-preserving pancreaticoduodenectomy with regional lymph node dissection. The immunohistological analysis showed positive staining for chromogranin A, synaptophysin, and CD56. The definitive diagnosis was neuroendocrine carcinoma of the papilla of Vater. Although the patient declined adjuvant chemotherapy, she had to start chemotherapy with carboplatin and etoposide because multiple liver metastases, lymph node metastasis, and peritoneal dissemination occurred 6 months after surgery. We performed 6 courses of chemotherapy. However, progressive disease(PD)was assessed, and she died of cancer 13 months after the surgery. The prognosis of the disease is poor when surgery alone is performed. Adjuvant chemotherapy, in addition to surgery, may be necessary.

[Successful Experience of Negative Pressure Wound Therapy with Instillation and Dwelling(NPW Ti-d)for Patient with Wound Dehiscence Developed by Infection after Right-Hemicolectomy for Ascending Colon Cancer].

We report a case of infected and incised wound cured by negative pressure wound therapy with instillation and dwelling (NPWTi-d)after right hemicolectomy for ascending colon cancer. The patient was a 72-year-old male. An ascending colon cancer with abdominal wall invasion and enterocutaneous fistula was found. We performed the right hemicolectomy and debridement of abdominal wall for the patients. However, the leakage of ileum-transverse colon anastomosis was found on postoperative day 3. We performed the resection of anastomosis and ileostomy. Nevertheless, 2 days after second operation, the abdominal wall of debridement became open by infection, and the small intestine was exposed. As the surgical treatment and NPWT was thought to be difficult because of infection, we started NPWTi-d on day 4 after second operation. 25 day after starting NPWTi-d, benign granulation covered the small intestine. NPWTi-d may be useful for wound dehiscence after surgery in infectious conditions.

[A case of long survival after resection and treatment with imatinib mesylate against metachronous liver metastases and a lung metastasis of a small intestine gastrointestinal stromal tumor].

A 68-year-old man was admitted to our hospital because of an abdominal tumor. Computed tomography(CT)showed a 6 cm tumor in the abdominal cavity. Surgery was performed. Upon laparotomy, a 6 cm tumor was found at the small intestine (210 cm)on the anal side from the Treitz ligament. A partial resection of the small intestine was performed. Immunohistochemistry showed positive staining for c-kit, and the diagnosis of gastrointestinal stromal tumor was confirmed. Multiple liver metastases and a lung metastasis were observed over the next 2 years. We started chemotherapy with imatinib mesylate at a dose of 400mg/day. The size of the tumors was unchanged, and no new lesion was observed. The patient has been alive and well as of 6 years after the initial operation.