Experience with chemotherapy for postoperative metastases of adenosquamous carcinoma of the esophagogastric junction and pathological study of its development.

We report here a case of postoperative recurrent adenosquamous carcinoma (ASC) of the esophagogastric junction (EGJ) treated with S-1 therapy. A 79-year-old woman was diagnosed with carcinoma of the EGJ. Thoracoscopic subtotal esophagectomy was performed, and pathological examination revealed advanced ASC with lymph node metastasis. Five months after surgery, multiple lung metastases and multiple lymph node metastases were observed, and the patient was treated with S-1 monotherapy, which showed partial response and may be effective for advanced ASC of the EGJ. On the other hand, immunohistological analysis of the tumors showed a relatively wide range of areas that could differentiate into both adenocarcinoma and squamous cell carcinoma, suggesting that tumor cells with multidifferentiation potential, or at least the ability to differentiate into both adeno-epithelial and squamous epithelial cells, were the likely source of the tumors.

[A Case of Advanced Esophagogastric Junction Adenocarcinoma with Enlarged Lymph Node Metastases of the Middle Mediastinum and Intraperitoneal That Exhibited pCR by Preoperative SOX Therapy].

A 79-year-old man was diagnosed with esophagogastric junction adenocarcinoma, cT3N3M0, cStage Ⅲ, including enlarged lymph node metastases(Bulky N)in the middle mediastinum and intraperitoneal. A total of 2 cycles of S-1 plus oxaliplatin(SOX)was administered. After neoadjuvant chemotherapy, the primary tumor and enlarged lymph nodes had greatly decreased in size. Subsequently, thoracoscopic subtotal esophagectomy and reconstruction with a gastric tube were performed. Histopathological examinations showed no residual cancer cells in the primary lesion and dissected lymph nodes (pathological complete response). Preoperative chemotherapy containing SOX could be a useful treatment strategy for patients with esophagogastric junction adenocarcinoma with enlarged lymph node metastasis.

Laparoscopic reduction and repair of a strangulated interparietal inguinal hernia.

An interparietal hernia is defined as a hernia in which the hernial sac lies between the tissue layers comprising the abdominal wall. A strangulated interparietal inguinal hernia without an external bulge is a rare cause of an acute abdomen and difficult to diagnose preoperatively. We report a patient with a history of a right inguinal hernia who presented with abdominal pain without inguinal bulging. An interparietal (preperitoneal) inguinal hernia was diagnosed and treated by laparoscopic reduction and a transabdominal preperitoneal hernia repair. This is the first case report of an interparietal inguinal hernia managed entirely laparoscopically. Although the laparoscopic approach is not considered standard treatment for strangulated intestinal obstruction, it may be worth considering, especially for patients with uncertain etiology, because of its decreased invasiveness compared to open exploration.

Blunt pharyngeal trauma detected by ultrasound sonography: A case report.

Pharyngeal perforation related to blunt neck trauma is a rare clinical entity. Here in, we report a case of pharyngeal perforation secondary to minor blunt neck trauma. A 46 year old female was brought to our emergency room with neck pain. She fell down and hit her neck directly to the edge of a bed. There was no crepitation in physical examination. Neck ultrasound showed a small amount of air in her deep neck space. Followed CT and nasopharyngeal scope supported the presence of pharyngeal perforation. So emergency exploration was done. We found a laceration of hypopharynx and it was repaired. She could discharged without any complication on day 7. The indirect finding of pharyngeal perforation is subcutaneous emphysema. However if the air is localized only in deep cervical space, physical assessment is difficult. Although CT scan is potent modality to find air in the deep organs, ultrasound may be alternatives. Emphasis is based on the suspicion that minor blunt neck trauma may cause pharyngeal perforation.

Superior mesenteric venous thrombosis after laparoscopic exploration for small bowel obstruction.

Mesenteric venous thrombosis is a rare cause of intestinal ischemia which is potentially life-threatening because it can lead to intestinal infarction. Mesenteric venous thrombosis rarely develops after abdominal surgery and is usually associated with coagulation disorders. Associated symptoms are generally subtle or nonspecific, often resulting in delayed diagnosis. A 68-year-old woman underwent laparoscopic exploration for small bowel obstruction, secondary to adhesions. During the procedure, an intestinal perforation was identified and repaired. Postoperatively, the abdominal pain persisted and repeat exploration was undertaken. At repeat exploration, a perforation was identified in the small bowel with a surrounding abscess. After the second operation, the abdominal pain improved but anorexia persisted. Contrast enhanced abdominal computed tomography was performed which revealed superior mesenteric venous thrombosis. Anticoagulation therapy with heparin was started immediately and the thrombus resolved over the next 6 days. Although rare, this complication must be considered in patients after abdominal surgery with unexplained abdominal symptoms.

[Long-term survival of a patient with giant liver metastatic breast cancer treated with trastuzumab].

We report the long-term survival of a patient with metastatic breast cancer treated with trastuzumab and chemoendocrine therapy. The patient was a 60-year-old female. She underwent right mastectomy with axillary lymphadenectomy I c for advanced right breast cancer in 1999. In 2007, she consulted our hospital for treatment of recurrent giant liver metastasis. A giant liver metastasis up to 15 cm in diameter was detected by CT upon arrival. After 4 years of trastuzumab and chemoendocrine therapy, she was diagnosed as in progressive remission with good quality of life. Breast cancer with liver metastasis often can be life-threatening. Therefore, an optimal chemotherapy should be applied as soon as possible. Trastuzumab and chemoendocrine therapy showed efficacy for the treatment of a HER2-positive breast cancer with recurrent giant liver metastasis.