The usefulness of laparoscopic surgery for inguinal endometriosis.

BACKGROUND: Inguinal endometriosis is a rare clinical disease with an unclear etiology and pathogenesis, and its diagnosis requires accurate medical history-taking and histological examination. However, surgical treatment for the condition has not yet been standardized. This report presents two cases of inguinal endometriosis. CASE PRESENTATION: The first patient was a 36-year-old woman who complained of pain and swelling in her right inguinal region. Physical examination revealed a soft, tender right inguinal mass. The size of the mass repeatedly increased and decreased during menstruation and did not show swelling with abdominal pressure. Magnetic resonance imaging showed a 3.5 × 2.5 cm mass with high intensity on T2-weighted imaging in the right inguinal canal, and no communication was found between the lesion site and the abdominal cavity. We diagnosed this case as inguinal endometriosis and managed it using an anterior approach and laparoscopic observation. The second patient was a 51-year-old woman who presented with an intermittently painful mass in her right inguinal region. The mass tended to increase in size, with worsening pain before menstruation. Abdominal computed tomography revealed a 2 × 2 cm cystic mass in the right inguinal region. We made a diagnosis of inguinal ectopic endometriosis and decided to operate via the totally extraperitoneal (TEP) method for excision plus transabdominal observation. The postoperative course in both cases was uneventful with no recurrence. CONCLUSIONS: Inguinal endometriosis is a rare entity that should be suspected in patients with cyclical symptoms of inguinal pain and swelling that correlate with their menstrual cycle, which might otherwise be attributed to inguinal hernia. It is crucial to make a preoperative diagnosis based on a careful medical review, physical examination, and imaging studies, and to make an appropriate surgical plan. Particularly, in the case of ectopic inguinal endometriosis involving the canal of Nuck, laparoscopic observation is useful for the intraoperative diagnosis of inguinal endometriosis to help rule out the involvement of other abdominal sites. However, it is important to select and modify the surgical technique to avoid rupturing the endometrisis mass and prevent postoperative recurrence.

[A case of unresectable rectal cancer with severe pelvic infiltration responding to FOLFOX].

The patient was a 54-year-old male with a huge advanced rectal cancer tumor. Abdominal CT showed liver metastasis and local progressive cancer of the rectum measuring 13 × 9 × 7 cm in diameter, which invaded the urinary bladder and sacrum. We established a diagnosis of unresectable rectal cancer and then performed sigmoid colostomy. After 16 courses of FOLFOX4, abdominal CT revealed the liver metastases to have disappeared, and the large-sized advanced rectal cancer had also remarkably decreased in size. Consequently, the patient underwent a resection of the rectum while his bladder was preserved. For 2 years 10 months after surgery, no local recurrence or distant metastasis has been observed, and the patient has received no postoperative chemotherapy. FOLFOX may therefore be a useful preoperative chemotherapy for the patients with unresectable primary rectal cancer.

The ratio between metastatic and examined lymph nodes is an independent prognostic factor for patients with resectable middle and distal bile duct carcinoma.

BACKGROUND: The lymph node ratio, defined as the ratio between the number of lymph node metastasis and the total number of lymph nodes examined, has been reported to be an important prognostic factor in other gastrointestinal carcinomas except middle and distal bile duct carcinomas. METHODS: Between 1991 and 2004, 62 consecutive patients who underwent surgery for middle and distal bile duct carcinoma were retrospectively analyzed concerning prognostic factors. RESULTS: The median number of lymph nodes examined was 12 (range 5 to 38). The overall 5-year survival rates of patients with lymph node ratio of 0, lymph node ratio of 0 to .2, and lymph node ratio >.2 were 62%, 41%, and 0%, respectively. A multivariate analysis revealed that a lymph node ratio >.2 and perineural invasion were independent predictive factors for survival. CONCLUSIONS: Lymph node ratio >.2 is an important factor to predict survival after resected middle and distal bile duct carcinoma.

A case of isolated pancreatic metastasis of gastric cancer presenting problematic discrimination from gastropancreatic double cancer.

We experienced a case of isolated pancreatic metastasis caused by gastric cancer which showed high levels of the tumor markers relevant to pancreatic cancer. The patient was a 59-year-old man who had tumors in both the gastric antrum and pancreatic head. He was diagnosed as having double cancer of the stomach and pancreas on account of the high values of pancreatic cancer-associated markers, and underwent operation. This resulted in non-curable resection attributable to broad lymph node metastasis. The resected specimen lacked continuity between the pancreas tumor and gastric tumor, and the pancreatic tumor was histologically diagnosed as metastasis from the gastric cancer. Moreover, the advanced lymph vessel invasion suggested possible metastasis through the lymph ducts. The present case is a rare metastatic form because there has been no report of lymphogenous isolated pancreatic metastasis of gastric cancer. In advanced gastric cancer, the possibility of pancreatic metastasis should be always borne in mind, and pancreatic biopsy may be taken into account at times. Radical operation may be performed corresponding to the degree of each stage of the double cancer of stomach and pancreas. However, considering the low possibility of curable resection for pancreatic metastasis of gastric cancer, other treatments than surgery should also be considered.