Mixed ductal-acinar cell carcinoma of the pancreas: A case report.

Mixed carcinoma of the pancreas is defined as the concurrent existence of pancreatic ductal carcinoma, acinar cell carcinoma, and/or islet cell carcinoma within the same neoplasm. We herein report a rare case of mixed ductal-acinar cell carcinoma in a 74-year-old man who was undergoing treatment for hypertension and diabetes at another hospital. After an abrupt worsening of his blood glucose control, the patient was referred to our hospital for further evaluation. Abdominal contrast-enhanced computed tomography and magnetic resonance imaging revealed a tumor with a multilocular cystic lesion in the head of the pancreas. Endoscopic retrograde cholangiopancreatography revealed obstruction of the main pancreatic duct and dilation of the dorsal pancreatic duct; in addition, adenocarcinoma was detected in the pancreatic juice cytology. Based on the abovementioned findings, the patient was diagnosed with carcinoma of the pancreatic head and underwent subtotal stomach-preserving pancreaticoduodenectomy. Based on the histopathological and immunohistochemical findings, the patient was diagnosed with mixed ductal-acinar cell carcinoma. The patient was prescribed TS-1 as postoperative adjuvant chemotherapy upon discharge. However, treatment was discontinued 2 months later due to marked general malaise, and the patient succumbed to tumor recurrence in the residual pancreas 12 months after the surgery.

[Endocrine cell carcinoma of the esophagus without recurrence for more than 7 years after chemoradiotherapy].

We report a case of endocrine cell carcinoma (ECC) of the esophagus with long term survival after chemoradiotherapy. The patient had a complete response and remains without any recurrence. A 69-year-old woman visited our hospital because of progressive dysphagia. The patient was diagnosed by computed tomography and histology examination of biopsy specimens with small cell ECC of the esophagus, cT2N1M0, cStage II based on the Classification of Esophageal Carcinoma. She was treated with chemoradiotherapy comprising 45Gy of irradiation and four courses of cisplatin and etoposide chemotherapy. After completion of the treatment, she was found to have a complete response. She remains alive to date without evidence of any recurrence after 7 years. This case suggests that chemoradiotherapy is an effective treatment for ECC of the esophagus.

Surgical treatment of abdominal aortic aneurysm associated with horseshoe kidney: symphysiotomy using harmonic focus.

Coexistence of horseshoe kidney and abdominal aortic aneurysm (AAA) is a rare entity that presents a technical challenge to vascular surgeons. How to approach such an AAA with horseshoe kidney and whether to divide the renal isthmus remains a controversial issue. We report here the successful surgical repair of an AAA with horseshoe kidney via the transperitoneal approach with division of the renal isthmus by Harmonic Focus, which allowed easy division of the isthmus without bleeding. Harmonic Focus, a hand-held type of harmonic scalpel, was thus useful in symphysiotomy of the horseshoe kidney.

[Cisplatin and S-1 combination therapy after reduction surgery for stage IV gastric cancer].

To evaluate the efficacy of cisplatin and S-1 combination therapy after reduction surgery for Stage IV gastric cancer, we retrospectively examined 73 patients with Stage IV gastric cancer who underwent gastrectomy. We classified the patients into the following four groups according to their postoperative therapies and analyzed their outcomes: A) S-1 +CDDP therapy (n=22); B) oral 5-FU therapy (n=30); C) 5-FU+CDDP therapy (n=14); and D) S-1 therapy (n= 7). The median survival time was 465 days in the S-1+CDDP therapy group, 158 days in the oral 5-FU therapy group, 332 days in the 5-FU+CDDP therapy group, and 374 days in the S-1 therapy group. The respective 2-year and 3-year survival rate was 37.8% and 20.2% in the S-1+CDDP therapy group, 3.4% and 3.4% in the oral 5-FU therapy group, 7.1% and 0% in the 5-FU+CDDP therapy group, and 0% and 0% in the S-1 therapy group, respectively. We consider that S-1+CDDP therapy after reduction surgery improves survival in patients with Stage IV gastric cancer and should be further investigated.

Clinicopathological study of patients undergoing resection of hilar cholangiocarcinoma.

Of the patients who underwent resection of hilar cholangiocarcinoma, those who received palliative surgery, or could not be followed up clinicopathologically, were excluded from this study. In the remaining 37 patients, the cumulative postoperative survival rate (simply referred to as the cumulative survival rate below) was analyzed according to gross types, histopathological parameters, final stages, and final curability. These patients showed a 5-year survival rate of 17.7% and a 50% survival of 2.2 years. By gross type, patients with a localized papillary or nodular expansion type tended to have a better survival rate than those with an invasive papillary or nodular expansion type. A greater histological depth of invasion tended to be associated with a poorer prognosis: the s(-) group, that is, a group of patients without serosal exposure of cancer (invasion depths of m, fm, and ss) had a significantly better prognosis than the s(+) group, a group of patients with serosal exposure of cancer (invasion depths of se and si). Other histopathological parameters, such as ly, pn, pHinf, pHM, and pEM, were associated with significant prognostic differences. By final stage, the stage I/II group and stage III or higher group showed a particularly significant difference in prognosis. By final curability, the curability A/B group had a significantly better prognosis than the curability C group. Taken together, surgery providing curability A and B promises a good long-term prognosis. Therefore, it is important that efforts are made to detect cancer early, adequately evaluate the degree of cancer extension, and determine the extent of resection and the surgical technique.

[A patient with middle bile duct cancer who showed rapid obstruction on contrast radiographs 1 week after insertion of a non-covered stent, but this case obtained a long-term stent opening and long survival after re-insertion of a covered stent].

A 73-year-old female with jaundice was referred to our department and admitted. Blood examination on admission showed an abnormal liver function and an increase in CA19-9. Ultrasonography of the abdomen revealed a well-delineated round mass in the middle bile duct. After admission, PTBD was performed, and a complete obstruction was observed in the middle bile duct. Cytological examination of the bile demonstrated adenocarcinoma. Based on these findings, a diagnosis of middle bile duct cancer was made. Because of delirium and frequent wandering during the night due to dementia, a radical operation was abandoned, and a non-covered stent was placed. However, since 1 week after insertion of a non-covered stent, contrast radiography showed tumor protrusion (rapid obstruction) in the stent, and a covered stent was placed in the stent. The stent was open for 486 days after stent re-insertion. PTBD was performed for re-obstruction, but she died 596 days after admission. In patients for whom surgery is impossible for reasons other than tumor factors, internal fistula construction using a metallic stent, which neither impairs QOL nor shorten survival, can be indicated.

A case of hilar bile duct cancer with intestinal Behçet's disease.

We encountered a hilar bile duct cancer patient with intestinal Behçet's disease who manifested various symptoms during a short period in the acute stage after liver resection. Under a diagnosis of hilar bile duct cancer, a 52-year-old Japanese male was referred and admitted to our hospital. Hepatectomy and resection of the extrahepatic bile duct were performed. During the postoperative course, a large number of painful aphthous ulcers developed in the oral mucosa, along with a genital ulcer. A deep excavation-type ulcer was confirmed by colonoscopy in the ileum on the orifice side. We administered colchicine and mesalazine. Thereafter, the patient was treated at the outpatient clinic. Recurrent localized hilar bile duct cancer developed, and the patient died about 8 months after surgery. We present the clinical details of this rare case of hilar bile duct cancer with intestinal Behçet's disease.