[A Case of GIST in the Small Intestine Diagnosed via CT after Repeated Melena and Removed by Laparoscopy-Assisted Surgery].

A 63-year-old man visited an emergency outpatient unit with the chief complaints of melena and lightheadedness. At the time of the visit, blood tests showed Hb of 4.3 g/dL, suggesting severe anemia, and he exhibited repeated melena, even after hospitalization. Small intestinal bleeding was suspected during endoscopic examination of the lower gastrointestinal tract, and abdominalCT examination suggested a 3.5 cm tumor-like lesion in the jejunum. He was diagnosed as having bleeding of a tumor in the small intestine and consequently underwent laparoscopic surgery. Based on intraabdominal observation, Meckel 's diverticulum was confirmed in the jejunum, 100 cm from the ileocecal region, along with a 4 cm tumor in the upper jejunum, located 50 cm from Treitz's ligament. The tumor was visually confirmed to be sarcomatoid with no direct invasion to the surrounding tissues and no disseminated node, showing favorable mobility. These lesions were exteriorized from the abdominal cavity for resection and anastomosis, and the surgery was completed with no severe complications. It was diagnosed histopathologically as a gastrointestinal stromal tumor(GIST)in the small intestine, and no postoperative adjunctive chemotherapy was administered because the case was considered low risk based on the tumor diameter and the number of mitosis events. At present, 1 year after the surgery, the patient is under follow-up observation on an outpatient basis with no findings to suggest recurrence or metastasis.

[A patient treated with partial duodenectomy for invasive transverse colon cancer].

The patient was an 83-year-old woman who visited our hospital with a chief complaint of weight loss. Duodenal invasion by transverse colon cancer was suspected on abdominal computed tomography( CT). An extramural tumor invading the second portion of the duodenum was noted on upper gastrointestinal endoscopy, and a circumferential type 2 lesion was observed in the transverse colon on lower intestinal endoscopy. The pathological diagnosis of both lesions was well-differentiated adenocarcinoma, and right hemicolectomy and partial duodenectomy were performed. The invaded duodenal region was located on the oral side of the papilla of Vater, and the resection involved approximately one-third of the circumference of the second portion of the duodenum and was approximately 5 cm in length. The jejunum was elevated using the Roux- en-Y method, and side-to-side duodenojejunostomy was performed for reconstruction. On histopathological examination, the lesion was diagnosed as SI, N0, Stage II. Tumor markers with elevated levels before surgery showed a rapid decrease to within normal ranges. No evidence of recurrence or metastasis has been observed for 3 years after surgery. Although pancreatoduodenectomy is the standard surgical procedure for duodenal tumorous lesions, this approach is very invasive for elderly patients. Partial duodenectomy may be a favorable treatment option for cancers invading other organs, as was the case for this patient.

[A case of a giant gastrointestinal stromal tumor of the stomach with extramural growth].

The patient was a 58-year-old man who visited our hospital with a chief complaint of rapidly aggravating feeling of epigastric distension and gastralgia. A giant mass, with a major axis of 22 cm, excluding the upper abdominal organs such as the stomach, liver, and pancreas and containing cystic and solid components was observed on abdominal computed tomography( CT). Laparotomy was performed with the aim of differentiating between a gastrointestinal stromal tumor (GIST) arising from the stomach or omentum and abdominal soft tissue tumors. The mass was a giant tumor accompanied by cystic and solid components that had developed extramurally from the stomach wall and strongly adhered to the left hepatic lobe and diaphragm, for which total gastrectomy, Roux-en-Y reconstruction, partial hepatectomy, and combined resection of the diaphragm were performed. Histopathologically, overgrowth of spindle cells in a disarrayed arrangement was noted, and immunostaining was positive for c-kit and CD 34. On the basis of these findings, the patient was diagnosed as having gastric GIST. Imatinib administration was initiated soon after surgery. There was no evidence of recurrence or metastasis for about 1 year after the surgery. We encountered a patient with a giant cystic GIST of the stomach that was larger than 20 cm and that could surgically resected.

Whole-blood platelet aggregation by Porphyromonas gingivalis in patients with peripheral arterial disease.

OBJECTIVES: To measure platelet aggregation promoted by Porphyromonas gingivalis (P. gingivalis) in whole blood, and to investigate the relation between P. gingivalis and peripheral arterial disease (PAD). METHODS AND RESULTS: Subjects were 30 patients who were diagnosed as having PAD (PAD Group), and 26 healthy adults without subjective symptoms or arteriosclerosis as a control (Control Group). PAD patients were classified depending on severity levels by Fontaine classification or toe pressure (TP). Twelve-minute changes of electrical impedance after adding P. gingivalis to whole blood was 10.2 ± 4.8 (range, 5.1-14.3) ohm in PAD Group, and 6.1 ± 5.6 (range, 0.2-10.8) ohm in Control Group. PAD Group showed significantly stronger whole-blood platelet aggregation by P. gingivalis. The patients with more severe PAD showed stronger whole-blood platelet aggregation by P. gingivalis. PAD Group had significantly higher serum IgG against P. gingivalis titers than Control Group. In PAD patients with teeth, there was a strong positive correlation between whole-blood platelet aggregation and IgG against P. gingivalis titers. CONCLUSIONS: Platelet aggregation promoted by P. gingivalis was significantly high in PAD patients, and was related to the deterioration of their symptoms even in whole blood, which was the environment closer to physiological conditions.