[Migration of Internal Pancreaticojejunostomy Stents into the Bile Ducts in Patients Undergoing Pancreaticoduodenectomy].

The patient was a 68-year-old male. Pancreaticoduodenectomy(PD)for papillary carcinoma was performed. Computed tomography(CT)3 months after surgery revealed the migration of a lost Pit-stent into the bile duct. However, there were no symptoms. On CT 2 years after surgery, the lost stent had spontaneously fallen off. However, hepaticolithiasis was observed, and lithotripsy was performed using endoscopic retrograde cholangiopancreatography(ERCP). A pancreatic fistula after PD is an important complication. To prevent pancreatic fistulae, pancreatic stenting at the site of PD is performed in many cases. The postoperative in vivo kinetics of a lost stent remains to be clarified. Several case reports on complications have been published. In this study, we report a patient in whom the migration of a lost Pit-stent into the intrahepatic bile duct after PD led to hepaticolithiasis, and review the literature.

[A Patient with Small Intestinal Leiomyosarcoma and Intussusception Who Underwent Single Port Surgery].

The patient was a 33-year-old female. She was referred to our hospital from a previous clinic with abdominal pain and vomiting. Contrast-enhanced abdominal CT revealed intussusception, leading to a diagnosis of intussusception with a small intestinal tumor as an advanced part. Intestinal obstruction symptoms were observed, and emergency surgery was performed on the same day. As a technique, single port surgery was selected, and laparoscopic reduction was attempted. However, it was ineffective. The site of intussusception was induced outside the body through a small laparotomy wound, and reduction was performed using Hutchinson's procedure. As an adjacent lymph node was markedly swollen, the mesentery involving this lymph node was dissected in a fan shape, and the tumor was extirpated. The tumor measured 40 mm in long diameter, being a hemicircular, protruding lesion. Histologically, disarray of short spindle tumor cells was observed. Immunostaining showed Kit- and DOG1-negtive reactions and partially α-SMA and desmin-positive reactions, suggesting leiomyosarcoma. With the establishment of an immunostaining-test-based classification, leiomyosarcoma is currently rare. In this study, we report a patient in whom single port surgery for intussusception related to small intestinal leiomyosarcoma was successful.

[A Case of Preoperatively Diagnosed Early Cystic-Duct Carcinoma].

A 88-year-old man presented with abdominal discomfort. Computed tomography(CT)images showed gallbladder tumor, and the patient was referred to our hospital. In addition to the above, CT images showed a tense gallbladder and EUS showed papillary raised lesions mainly from the cystic duct to the gallbladder neck. Based on the above, we diagnosed cystic duct cancer and performed full-thickness cholecystectomy, extrahepatic bile duct resection, regional lymph node dissection at our department. Macroscopic findings of the resected specimen showed a Villous ridge in the cystic duct. Histopathological findings revealed well-differentiated adenocarcinoma with an irregular papillary structure centered on the cystic duct. The depth of invasion remained within the epithelium, and a diagnosis of primary early cystic duct cancer was made. Primary cystic duct cancer is a relatively rare disease and often does not lead to preoperative diagnosis. This time, we experienced a case in which cystic duct cancer was diagnosed preoperatively due to complaints of abdominal discomfort and could be surgically resected.

[A Case of Small Intestinal GIST Diagnosed by Intussusception].

The patient was a 34-year-old female. She consulted our hospital with epigastric pain. Abdominal computed tomography (CT)revealed a small intestinal tumor, measuring 30 mm in diameter, with contrast effects. For detailed examination, enteroscopy was scheduled, but abdominal pain suddenly occurred. CT showed marked dilatation of the small intestine and intussusception, and emergency surgery was performed on the same day. Intussusception was observed on the anal side 70 cm from Treitz' ligament. The intestinal wall was black, and fissures of the serosa were partially noted. It was difficult to release the intussusception, and a 55 cm area of the jejunum involving the site of intussusception was resected. The patient was discharged on the 8th postoperative day. At the tip of the intussusception, a submucosal tumor measuring 25 mm in maximum diameter was present. Pathologically, the proliferation of spindle-shaped cells originating from the muscularis propria was observed, comprising an intricate structure. On immunostaining, KIT-positive and CD34, S-100, α-SMA-negative reactions were detected, leading to the diagnosis of a gastrointestinal stromal tumor(GIST). Nuclear divisions were noted in <5/50 visual fields. According to the risk classification, the risk was evaluated as low. The patient is being followed-up in accordance with guidelines.

[Patient with Monomorphic Epitheliotropic Intestinal T-Cell Lymphoma with Small Intestinal Perforation Development during Chemotherapy].

Monomorphic epitheliotropic intestinal T-cell lymphoma(MEITL)is classified under type Ⅱ enteropathy-associated T-cell lymphoma(EATL). It is a rare disease with a low incidence rate. This study reports a case of a patient with MEITL who developed small intestinal perforation during chemotherapy. The patient was a 55-year-old woman who presented to a previous clinic with epigastric pain. Enteroscopy results showed a map-like ulcer in the jejunum. Examination of the tissue specimen collected from this site suggested T-cell lymphoma. The patient was referred to our hospital for chemotherapy. Seven days following the initiation of chemotherapy, an abdominal computed tomography(CT)revealed free air, leading to a diagnosis of gastrointestinal perforation. Emergency surgery was performed. Intraoperatively, bowel perforation and a degenerative ulcer were observed at 95 cm and 80 to 115 cm from the Treitz' ligament, respectively. In addition, all-layer intestinal necrosis was noted 150 and 90 cm from the terminal ileum. Total resection and anastomosis were performed. Postoperatively, the patient developed sepsis due to chemotherapy-related pancytopenia but recovered. She was discharged on postoperative day 24. Subsequently, positron emission tomography(PET)-CT revealed residual intestinal tumor cells and peritoneal dissemination. Chemotherapy was initiated, but there was no response. The patient died after 6.5 months. A radical treatment for MEITL has not yet been established. More case reports are needed to improve the prognosis of this disease.

[An Early Gastric Cancer with Sarcoid Reactions of the Regional Lymph Nodes].

The patient was a 73-year-old male who was referred to our hospital for detailed examination because computed tomography(CT)revealed lymph node swelling. Upper gastrointestinal endoscopy revealed a 0-Ⅱc lesion in the greater curvature of the middle gastric body. The periphery of the lesion site was not reached using endoscopy. CT revealed lymph node swelling, but positron emission tomography(PET)-CT did not show abnormal accumulation in any area other than the lesion site involving the lymph nodes. Under a diagnosis of cT2N0M0, Stage Ⅰ tumor, total gastrectomy via laparotomy and lymph node dissection(D2+No.10)was performed. The histopathological diagnosis suggested early gastric cancer pT1b (SM)N0M0, Stage ⅠA. Although lymph node metastasis was not observed, the outgrowth of non-caseating epithelioid cell granulomas was observed in all lymph nodes. There was no granulomatous lesion at any other site, including the lung, leading to a diagnosis of sarcoid reactions. The"sarcoid reaction"refers to non-caseating epithelioid cell granuloma formation in a local area or the regional lymph nodes of a malignant tumor through reactions to extraneous foreign bodies in the absence of the general condition or signs as sarcoidosis. Sarcoid reactions to early gastric cancer are rare. In this study, we report a patient with early gastric cancer who showed sarcoid reactions of the regional lymph nodes and review the literature.

[A Case of Elective Laparoscopic Resection for Sigmoid Colon Cancer with Irreducible Intussusception].

An 85-year-old man was hospitalized for a right greater trochanteric fracture. Rectal intussusception was found by diagnostic imaging but left untreated because of minor gastrointestinal symptoms. As a result of work-up for persistent mucous stool, he was diagnosed with sigmoid colon cancer with intussusception. The intussusception could not be reduced during barium enema examination but could undergo elective laparoscopic surgery with a good postoperative course. Adult intussusception may be asymptomatic and require no emergency treatment. In such a case, elective surgery can be performed. Many facilities employ laparotomy as a standard of care for intussusception. With the recent technological advances in endoscopic surgeries, laparoscopic surgery can be considered as a treatment option.

[A Case of Goblet Cell Carcinoid].

The patient was a 26-year-old female who had undergone conservative treatment for acute appendicitis at another clinic and was referred to our hospital for interval appendectomy. We performed a single-incision laparoscopic appendectomy, and the patient was diagnosed with goblet cell carcinoid(GCC)based on the postoperative pathological examination. Since GCC is considered a high-grade tumor, we performed a laparoscopic ileocolic resection with D3 lymphadenectomy. There was no residual disease or lymph node metastasis detected in the resected specimen. Patients with advanced GCC typically have poor prognosis, because GCC is characterized by peritoneal dissemination and lymph node metastasis. However, our findings suggested that an additional laparoscopic surgery could be one of the curative and safe treatment options for selected pa- tients with GCC.

[Efficacy of Palliative Radiotherapy in Hemorrhage Control in Patients with Unresectable Gastric Cancer].

We report the case of an 80-year-old man with unresectable, advanced gastric cancer and pulmonary cancer because of multiple liver metastases. The serum hemoglobin level declined to 5.3 g/dL during fourth-line chemotherapy. Radiation therapy of 30 Gy was administered in 10 fractions. After radiation treatment was completed, the serum hemoglobin level increased to 8.5g/dL. No new adverse event was observed. Subsequently, the progression of anemia stopped, and oral intake became possible. Thus, palliative radiation therapy is useful for hemorrhage control in unresectable, advanced gastric cancer patients with a poor general condition and difficult surgical treatment.

[Resection of Synchronous Liver Metastasis from Ascending Colon Cancer with Aplastic Anemia-A Case Report].

The aplastic anemia(AA)syndrome is characterized by pancytopenia and bone marrow hypoplasia. Although anemia, bleeding tendency, and susceptibility to infection are issues of concern during surgery, few reports have been published on the perioperative management, and management methods have not been established. A 77-year-old woman visited our hospital with chief complaints of melena and fatigability. Marked pancytopenia was observed at the first visit. After a detailed examination, she was diagnosed with ascending colon cancer accompanied by AA and solitary liver metastasis. As AA responded poorly to treatment, without improvement in pancytopenia, we decided to perform colectomy. The perioperative management, including blood transfusion and administration of a G-CSF preparation, was performed in collaboration with a hematologist, followed by right hemicolectomy and hepatic lateral segmentectomy. She was transferred to the department of hematology on hospital day 8 without complications. In conclusion, a highly invasive surgery, as in the present case, can be performed safely with an appropriate perioperative management even in cases complicated by AA.

[A Case of Mesenteric Undifferentiated Pleomorphic Sarcoma].

Undifferentiated pleomorphic sarcoma develops in adult soft tissues and has a poor prognosis. It often recurs in the limbs and trunk, but is rare in the mesentery. Complete resection of the tumor is the first-line treatment, and there are previously reported cases of the usefulness of chemotherapy and radiation therapy; however, several factors remain to be clarified. We report a case of undifferentiated pleomorphic sarcoma originating in the ascending mesocolon.

[Spontaneous Disappearance of Undifferentiated Pleomorphic Primary Mesenteric Sarcoma-A Case Report].

The patient was a 49-year-old man with persistent fever since the introduction of hemodialysis(HD). Vomiting and abdominal swelling appeared 4 months after initiating hemodialysis. Computed tomography(CT)scan revealed a tumor measuring 9 cm, and disorders of passage from the jejunum. Surgery was performed, and resection was impossible because of peritoneal dissemination. Histopathological examination of the disseminated nodes suggested an undifferentiated pleomorphic sarcoma. Postoperatively, drainage from the gastric fistula was approximately 2,000mL/day. Chemotherapy was considered impossible because of HD, and palliative therapy was selected. However, the volume of drainage from the gastric fistula gradually decreased, and the disorders of passage reduced. CT scan confirmed marked reduction in the size of the intraperitoneal tumor and its subsequent disappearance. At the 2-year-and-5-month postoperative follow-up, no relapses were observed, and the course had been uneventful. Undifferentiated pleomorphic sarcomas develop in the soft tissue of adults and have a poor prognosis. However, mesenteric development is rare. Total tumorectomy is the first choice of treatment. A consensus on the usefulness of chemotherapy or radiotherapy has not been reached. Furthermore, no studies have reported spontaneous tumor disappearance in the absence of treatment. Here, we report a case of minor undifferentiated primary mesenteric sarcoma and its spontaneous disappearance and review the literature.

Report of a case: Retroperitoneal mucinous cystadenocarcinoma with rapid progression.

INTRODUCTION: Retroperitoneal mucinous cystic neoplasms are uncommon, and little is known about the etiology of the disease. Malignant forms of these are extremely rare. Here, we report a case of primary retroperitoneal mucinous cystadenocarcinoma (PRMC), which demonstrated unexpectedly aggressive progression despite finding only a limited area of adenocarcinoma. PRESENTATION OF CASE: A 62-year-old woman with a complaint of abdominal discomfort was admitted to the hospital. Abdominal CT and MRI showed multiple large retroperitoneal cysts dislocating the right kidney nearly to the center of the abdomen. Transabdominal resection of the cysts was performed. Those cysts contained 1100ml of mucinous fluids in total. Cytological examination of those fluids revealed no malignant cells. The cyst wall was lined with mucinous epithelial cells, and contained some ovarian-type stroma. Also, there was a focal area of adenocarcinoma in the cyst wall, and the lesion was diagnosed as primary retroperitoneal mucinous cystadenocarcinoma. Eight months later, the patient developed lumbar bone metastasis. Chemotherapy with S-1, an oral fluoropyrimidine, and docetaxel had been begun immediately; however, the disease had rapidly spread in the retroperitoneum. Eventually, the patient died of the disease 15 months after surgery. DISCUSSION: Retroperitoneal mucinous cystic neoplasms are considered to be metaplasia of embryonal coelomic epithelium. Complete excision without rupture is essential. However, variance of biological aggressiveness might exist in PRMCs. CONCLUSION: Retroperitoneal mucinous cystadenocarcinoma is a rare tumor, and it is urgently necessary to elucidate the etiology of an effective therapy for the disease.

Gastric cancer with multiple intramural metastases and metastasis to the small intestine which eventually developed Trousseau's syndrome: report of a case.

Here we report a rare case of Trousseau's syndrome in a patient with gastric cancer with multiple intramural metastases and metastasis to the small intestine. A 70 year-old male complaining of appetite loss and weight loss of 7 kg within 3 months was admitted to hospital. Esophagogastroduodenal endoscopy revealed an advanced gastric cancer at the pylorus almost occluding the outlet of the stomach, and multiple ulcerative lesions throughout the stomach. A biopsy showed poorly differentiated adenocarcinoma. The patient underwent total gastrectomy. During surgery, part of the distal ileum was found to be abnormally firm and approximately 1 m of the ileum with the cecum colon was resected. Pathologic examination confirmed poorly differentiated adenocarcinoma at the pylorus and multiple intramural metastases in most other areas of the stomach. Lymph node metastases were confirmed in 12 out of 40 harvested regional lymph nodes including one positive paraaortic lymph node. The resected ileum contained multiple tumors with ulceration. Massive lymphatic invasion in the stomach and the small intestine was observed, which strongly suggested lymphatic spread of the gastric cancer. The patient was discharged on post-operative day 21; however, 2 months after surgery, he developed multiple cerebral thromboembolisms and died 2 weeks later.

Use of phenyl 2-alpha-selenoglycosides of N-acetylneuraminic acid as a glycosyl donor for the glycosylation reactions.

Phenyl 2-alpha-selenoglycosides of Neu5Ac were successfully prepared from the corresponding peracetylated chloro derivative of Neu5Ac 1 and phenylselenol in the presence of N,N-di-isopropylethylamine in excellent yields. The reaction of with various alcohols was effectively catalyzed by NIS/TfOH or DMTST to produce a variety of glycosides in moderate yields. Selective activation of over phenyl 2-alpha-thioglycoside of Neu5Ac with AgOTf/K(2)CO(3) was also achieved.