A Case of Preserved Blood Flow to the Portal Vein Due to the Concurrent Reconstruction of the Superior Mesenteric Vein and the Splenic Vein Using an Artificial Blood Vessel.

Pancreatic cancer is often advanced and invades the major blood vessels around the pancreas. Portal vein (PV) and/or superior mesenteric vein (SMV) resection is performed for radical resection. In such cases, end-to-end anastomosis is best if the remnant vein is sufficiently long. However, when the excision distance is long, reconstruction requires an artificial blood vessel. In contrast, there is no consensus concerning the need for splenic vein (SV) reconstruction. We herein report a case in which portal vein thrombus and congestion of the bowel that occurred after PV-SMV reconstruction were improved by additional anastomosis of the PV-SV.

Successful Pre-Operative Local Control of Skin Invasion of Breast Cancer Using a Combination of Systemic Chemotherapy and Mohs Paste.

Locally advanced breast cancer (tumor > 5 cm, widespread infiltration of the skin and muscle, or metastases to lymph nodes) is difficult to resect by surgery, and even when it is resectable, there is a high probability of local recurrence and distant metastasis. Therefore, systemic therapy should be administered first. However, as cutaneous infiltration progresses, the patient's quality of life is impaired by pain, bleeding, presence of exudates, and a foul-smelling odor. Treatment with Mohs paste with systemic therapy can control symptoms associated with skin infiltration and can also be expected to decrease tumor volume. Herein, we report a case in which a tumor was resected following Mohs paste and systemic chemotherapy administration, and the skin defect was reconstructed with a latissimus dorsi myocutaneous flap. We also review the literature for previously reported cases of breast cancer involving Mohs paste.

The Lymphocyte-to-monocyte Ratio Is an Independent Prognostic Indicator in Pancreatic Head Cancer that Correlates With Obstructive Jaundice.

BACKGROUND/AIM: Several indicators of systemic inflammation have been reported to predict the outcomes of patients with malignant tumors but have not been fully investigated. The aim of this study was to evaluate whether the preoperative lymphocyte-to-monocyte ratio (LMR) can predict the outcomes of patients with pancreatic head cancer. PATIENTS AND METHODS: We studied 32 patients who underwent curative surgery for pancreatic head cancer in our hospital between 2006 and 2016. Patients were classified into high and low groups according to their LMR. RESULTS: The low LMR group had a significantly lower survival rate than the high LMR group (p=0.0313). A multivariate analysis showed that the pretreatment LMR (p=0.01) was an independent risk factor for cancer-related death. The LMR was correlated with obstructive jaundice (p=0.001). CONCLUSION: Preoperative LMR is a significant predictor of the outcome after pancreaticoduodenectomy in patients with pancreatic head cancer.

A case of gastric adenocarcinoma with conspicuous binuclear cytologic features.

Binuclear cells have been occasionally observed in nonneoplastic and carcinoma cells. However, in clinical cases, few reports have analyzed and discussed the origins and features, including the proliferative capacity, of binuclear cells. We describe the case of a 75-year-old man with gastric cancer with microscopically prominent binuclear cells in the resected tissue and ascitic fluid. Image cytometry and chromosomal analysis were performed on cells isolated from the ascitic fluid. The DNA histogram pattern showed aneuploidy and the fluorescence in situ hybridization pattern of centromeres 7 and 11 was similar to that of most other mononuclear cancer cells. Furthermore, the binuclear cells showed low proliferative capability based on 5-bromo-2'-deoxyuridine incorporation. Our results demonstrated that the binuclear cells were derived from mononuclear aneuploid cells through incomplete cell division, and, in this case, may have impaired proliferative capacity.

Use of the continuous suture technique in dunking pancreatojejunostomy without stenting.

PURPOSE: To evaluate the newly developed continuous suture technique in dunking pancreatojejunostomy without pancreatic duct stenting after pancreatoduodenectomy (PD). METHODS: Thirty-four consecutive pancreaticojejunostomies (patient age 73 ± 11, 41-88) with continuous sutures without stenting after PD were performed from 2006 to 2011. This study evaluated the operation time, intraoperative blood loss, initial postoperative day of oral feeding, postoperative hospital stay, postoperative early complications, and late complications. The indications for surgery included bile duct cancer (n = 12), pancreatic cancer (n = 11), intraductal papillary mucinous neoplasm (n = 3), cancer of the papilla (n = 3), duodenal cancer (n = 2), and others (n = 3). Portal vein or superior mesenteric vein resections and reconstructions were performed in 7 patients, and another organ was resected in 3. RESULTS: No operative or in-hospital deaths occurred. The operation time (minutes) was 315 ± 68 and, postoperative hospital stay (days) was 27 ± 16. Pancreatic fistula, wound infection, and delayed gastric emptying were observed in 15, 15, and 9 %, respectively. Grade C pancreatic fistula was seen in 2 patients. Both recovered after laparotomy and drainage and were successfully discharged. Worsening diabetes mellitus was seen in 2 of 34 patients, and dilatation of the pancreatic duct was seen in 3 of 28 patients. CONCLUSION: The newly developed continuous suture technique in dunking pancreatojejunostomy without stenting may therefore produce favorable results in PD.

[Inflammatory myofibroblastic tumor suspected of lung cancer; report of a case].

A 57-year-old man admitted to our hospital with a pulmonary nodule detected by chest X-ray. Chest X-ray and chest computed tomography (CT) showed a solitary nodule with a spiculation in the right lower lobe (S8), 17 x 15 mm in size. His laboratory findings were almost within normal ranges. Positron emission tomography (PET) showed positive detection correspond to the nodule (SUV max: 5.76). Pathological diagnosis by CT-guided lung biopsy was suspected of gastrointestinal stromal tumor (GIST). Further examination of digestive organs revealed no abnormalities. The enlargement of the nodule was noted 2 weeks later, 23 x 18 mm in size. We couldn't rule out a malignant tumor and performed partial resection of the right lower lobe. Pathological diagnosis by intraoperative frozen section was "inflammatory myofibroblastic tumor (IMT), no malignancy". The patient is alive without any signs of recurrence for 4 months postoperatively.