[A Case of Mantle Cell Lymphoma Diagnosed after Surgery for Ileocecal Intussusception].

A 63-year-old woman visited our hospital complaining of abdominal pain and bloody discharge in November 2015. Abdominal CT revealed ileocecal intussusception. After hospitalization, a right colectomy was performed. Pathological diagnosis of the resected specimen was Mantle cell lymphoma. After this diagnosis, chemotherapy was initially administered. Following this, peripheral stem cell transplantation was carried out. We discovered this case of Mantle cell lymphoma by chance; therefore, here, we consider and introduce how this type of disease should be treated. We also introduce a rare case of Mantle cell lymphoma with intussusception at the cecum.

[A case of good response in a rectal cancer patient with decreased dihydropyrimidine dehydrogenase activity because of strict control of the 5-fluorouracil dose].

A 64-year-old man was diagnosed as having rectal cancer in August 2011. At the first medical examination, lymph node metastasis was observed as an abdominal para-aortic lesion. Therefore, before surgery was performed, full dose chemotherapy( capecitabine and oxaliplatin[ CapeOx] plus bevacizumab) was initiated. Immediately after the initiation of chemotherapy, the patient experienced severe side effects. We noticed that the patient had a dihydropyrimidine dehydrogenase (DPD) deficiency. When the patient recovered from the severe side effects, we observed that the abdominal metastasis had disappeared and the rectal cancer had shrunk. We thus performed low anterior resection. No chemotherapeutic regimen except for 5-fluorouracil( 5-FU) elicited a good response. Therefore, we strictly controlled the 5-FU dose, and because of this, the patient continues to have disease-free survival.

Evaluation of preoperative computed tomography in estimating peritoneal cancer index in peritoneal carcinomatosis.

PURPOSE: To evaluate the utility of CT of peritoneal carcinomatosis (PC) by comparing preoperative radiological and intraoperative peritoneal cancer index (PCI) scores. MATERIAL AND METHOD: This study collected 76 patients of PC from different disease origins. The sensitivity, specificity and accuracy were calculated in each of the abdominopelvic region, and by tumor histologic type. RESULT: An overall sensitivity of CT was 69%. The detection rate was highest in appendix and lowest in stomach group( 84% and 47%, respectively) by the origin of primary disease. There was a lower detection rate (59% vs 79%, p=0.001), and a higher underestimation rate (29% vs 21%, p<0.05) of small bowel lesion compared with overall abdomino-pelvic region. CT predicted an individual regional PCI score accurately in 65%, underestimated in 24%, and overestimated in 11%. CT detection rate in small tumor (<0.5 cm) was 29%, and increased to 97% with nodules size exceeding 5 cm. CT significantly underestimated the clinical PCI value in overall. CONCLUSION: The sensitivity of CT in detecting PC was influenced by histologic type, tumor location and size. CT underestimated the clinical PCI score in PC patient.

Indication of peritonectomy for peritoneal dissemination.

A total of 521 patients with peritoneal carcinomatosis (PC) were treated by peritonectomy and perioperative chemotherapy. Each of the 95, 58, 316, 31, 10 and 11 patients were from gastric, colorectal, appendiceal, ovarian, small bowel cancer and mesothelioma, respectively. The distribution and volume of PC are recorded by the Sugarbaker peritoneal carcinomatosis index (PCI). Peritonectomy was performed with a radical resection of the primary tumor and all gross PC with involved organs, peritoneum, or tissue that was deemed technically feasible and safe for the patient. The postoperative major complication of grade 3 was found in 14%, and total 30-day mortality was 2.7%. The survival of gastric cancer patients with a PCI score ≤ 6 was significantly better than those with a PCI score ≥ 7. In appendiceal neoplasm, patients with PCI score less than 28 showed significantly better survival than those with PCI score greater than 29. The survival of colorectal cancer patients with a PCI score ≥ 11 was significantly poorer than those with a PCI score ≤ 10. Among the various prognostic factors in appendiceal neoplasm and gastric cancer patients, CC-0 complete cytoreduction was the most important independent prognostic factor. Peritonectomy is done to remove macroscopic disease and perioperative intraperitoneal chemotherapy to eradicate microscopic residual disease aiming to remove disease completely with a single procedure. Peritonectomy combined with perioperative chemotherapy may achieve long-term survival in a selected group of patients with PC. The higher mortality rate underlines this necessarily strict selection that should be reserved to experienced institutions.

[A case of complete peritonectomy for primary ovarian pseudomyxoma].

A 64-year-old woman had an abdominal distention in February 2002. She was diagnosed with primary ovarian pseudomyxoma. She received a hysterectomy and bilateral salpingo oophorectomy in April 2002. Then, she was referred to our hospital the same year. In October 2002, she received peritonectomy with resection of the hepatic capsule, diaphragmatic peritoneum, pelvic peritoneum, greater omentum and the spleen. Intraperitoneal CDDP administration was done on days 1 and 2 after peritonectomy. She is still alive without recurrence for 3 years after the peritonectomy operation.