1/25. Metachronous triple cancers of the sigmoid colon, stomach, and esophagus: report of a case.We report herein an unusual case of metachronous triple cancers of the sigmoid colon, stomach, and esophagus. A 60-year-old man was initially admitted to our hospital for investigation of occult fecal blood. This was found to be caused by sigmoid colon cancer which was resected in July 1985 (T3, N0, M0; Stage II). A follow-up endoscopy performed in 1990 showed early gastric cancer, and a gastrectomy was performed in August 1990 (Tis, N0, M0; Stage 0). Another endoscopic examination performed as follow-up in 1993 revealed early cancer of the remnant stomach, and all the remnant stomach was surgically resected in March 1993 (Tis, N0, M0; Stage 0). He presented again in December 1996, complaining of discomfort in the chest which was found to be caused by cancer of the middle thoracic esophagus. Although surgery was considered necessary, the patient refused to undergo any further operations. Instead, radiation was administered from January 1997. An endoscopy after the completion of radiotherapy confirmed that the cancer had almost disappeared; however, it started to grow again from the beginning of 1998. He was hospitalized due to esophageal stenosis in April 1998, and died of carcinomatous cachexia in September of the same year.- - - - - - - - - - ranking = 1keywords = endoscopy (Clic here for more details about this article) |
2/25. Esophageal leiomyomatosis in a woman with a history of vulvar leiomyoma and Barrett's esophagus: a case report and review of the literature.BACKGROUND: The diagnosis and treatment of esophageal pathology remains a challenge despite advances in preoperative endoscopy, radiographic staging, and perioperative care. CASE REPORT: In this article, we present an interesting case of esophageal leiomyomatosis in a woman with a history of vulvar leiomyoma and Barrett's esophagus. This paper represents the first reported simultaneous occurrence of these three pathologic entities in the English literature. CONCLUSIONS: The clinical presentation and characteristic pathologic findings in patients with esophageal leiomyomatosis are reviewed. Diagnostic and therapeutic approaches to esophageal masses are discussed including the indications for esophageal resection.- - - - - - - - - - ranking = 0.5keywords = endoscopy (Clic here for more details about this article) |
3/25. Gastric tube gastrectomy.The incidence of esophageal adenocarcinoma has increased significantly in recent years. Early detection of a small mucosal tumor by endoscopy is occurring more frequently. This, together with improved results of surgical treatment, has created a new population of patients with prolonged post-esophagectomy survival. adenocarcinoma in the reconstructed gastric tube is no longer a rare finding and is expected to be even more common in the future. We report a case of a patient treated for metachronous gastric tube carcinoma and discuss the steps of the surgical procedure.- - - - - - - - - - ranking = 1.2490675025326keywords = surgical procedure, endoscopy (Clic here for more details about this article) |
4/25. A second primary esophageal cancer developing 7 years after chemoradiotherapy for advanced esophageal cancer.We report a rare case of advanced carcinoma and a second primary carcinoma of the esophagus, both of which were successfully cured by chemotherapy and operation at different times. In 1991, a 38-year-old Japanese man was diagnosed with advanced esophageal cancer, which was unresectable because of the bronchial invasion of the tumor. He was given chemotherapy with cisplatin (CDDP), combined with radiotherapy. During a 4-year follow-up, neither regrowth of the primary tumor nor distant metastasis occurred. In 1995, esophagoscopy demonstrated a lugol-unstained region located 3 cm distal from the area of radiation to the primary lesion shown by esophagography. Histological examination of a biopsy specimen showed the mucosa to be normal. Nevertheless, yearly surveillance by endoscopy and histological examinations showed that the mucosa of the esophagus gradually began to demonstrate mild dysplasia, followed by severe dysplasia; in 1998, a diagnosis of squamous cell carcinoma was made. esophagectomy with lymph node dissection was performed. Microscopic examination revealed that there had been pathologic complete response for the original advanced esophageal cancer.- - - - - - - - - - ranking = 0.5keywords = endoscopy (Clic here for more details about this article) |
5/25. Cancer of the gastric tube reconstructed through the posterior mediastinal route after radical surgery for esophageal cancer.Among 750 patients diagnosed with esophageal carcinoma in our department between 1972 and 1997, we reviewed our 10 cases in which cancer occurred within gastric tubes reconstructed through the posterior mediastinal route after radical surgery for esophageal cancer. The interval between esophagectomy and cancer onset in the reconstructed gastric tube was relatively long (mean interval: 72 months). Five of our 10 subjects had gastric tube cancer detected at follow-up endoscopy. Four underwent total or partial gastric tube resection with open thoracotomy using colonic or jejunal reconstruction; 3 underwent endoscopic resection. To the best of our knowledge, this is the first report on patients undergoing total resection of gastric tubes reconstructed through the posterior mediastinal route after esophagectomy and rereconstruction using the pedicled colon for the gastric tube cancer.- - - - - - - - - - ranking = 0.5keywords = endoscopy (Clic here for more details about this article) |
6/25. Myelodysplastic syndrome progresses rapidly into erythroleukemia associated with synchronous double cancers of the stomach and the papilla of Vater.patients with myelodysplastic syndrome (MDS) show a relatively high incidence of developing cancers. However, it is extremely rare that synchronous double cancers develop in an MDS patient. We report a case of MDS that progressed rapidly into erythroleukemia (M6 by French-American-British classification) complicated by gastric cancer and carcinoma of the papilla of Vater. A 66-year-old man was admitted because of pancytopenia with peripheral blasts. A diagnosis of MDS (with refractory anemia with excess of blasts in transformation [RAEB-T]) was made by bone marrow examination. Chromosome analysis revealed 46,XY. An early gastric cancer was also diagnosed by endoscopic examination. The peripheral blasts gradually proliferated and the disease progressed to M6. A chromosome abnormality 46,XY,del(1)(q42) was detected at the leukemic transformation. A CAG (low-dose cytarabine and aclarubicin in combination with granulocyte colony-stimulating factor) regimen was started as a remission-induction therapy. However, obstructive jaundice developed and a marked dilatation of bile ducts was observed by abdominal computed tomography (CT). A carcinoma of the papilla of Vater was detected by endoscopy. As remission was achieved and the pancytopenia improved, the patient subsequently underwent a surgical jejuno-choledochostomy to manage the jaundice. However, the leukemia relapsed thereafter and additional chromosome abnormalities including der(5)t(5;10)(p15:q11) were observed.- - - - - - - - - - ranking = 0.5keywords = endoscopy (Clic here for more details about this article) |
7/25. Monoclonal proliferation of germinal center cells (incipient follicular lymphoma) in an axillary lymph node of a melanoma patient.A monoclonal proliferation of germinal center cells within a lymph node follicle was incidentally discovered during the staging surgical procedures in a patient with Clark III-level cutaneous melanoma. In one of the 19 axillary lymph nodes examined, we identified a single morphologically atypical lymphoid follicle, predominantly composed of medium-sized cells and immunoreactive for B-cell antigens and for the markers of germinal center origin CD10 and bcl-6. A monoclonal rearrangement of the immunoglobulins heavy chains (IgH) was documented by polymerase chain reaction after laser capture microdissection. The cells of the aberrant follicle expressed the bcl-2 protein at higher levels than the surrounding T lymphocytes in the absence of bcl-2 gene rearrangement. We propose for this lesion the designation of incipient follicular lymphoma. The present findings also confirm the previously reported association between melanoma and lymphoproliferative disorders.- - - - - - - - - - ranking = 0.74906750253257keywords = surgical procedure (Clic here for more details about this article) |
8/25. Endoscopic comparison of two cases: distal resection of reconstructed gastric tube.Recently, with the improvement of the prognosis of esophageal cancer, subsequent gastric cancer has increased. However, the standard surgical treatment for such patients has not been established as of yet. Since the patient's physical condition is relatively poor after Ivor-Lewis esophagectomy, it is important that surgical strategies must be decided according to both physical and cancerous conditions. Hence, various surgical procedures have been reported to date. The authors experienced two cases with cancer occurring in the reconstructed gastric tube after Ivor-Lewis esophagectomy. One was subsequent primary gastric cancer, and the other was metastatic gastric cancer. Distal resection of the gastric tube including the dissection of the right gastroepiploic vessels was carried out in both cases. Vascular reconstruction by utilizing microsurgery technique was attempted for each case, but failed in one case. After surgery, four sessions of endoscopic examinations were carried out. In the early period, we could identify mucosal ischemic change in the remnant gastric tube in the case without successful vascular reconstruction. On the contrary, no ischemic change was revealed in the other with successful vascular reconstruction. Hence, we came to the conclusion that vascular reconstruction must be added to the cases, which undergo distal resection of the reconstructed gastric tube with regional vascular dissection.- - - - - - - - - - ranking = 0.74906750253257keywords = surgical procedure (Clic here for more details about this article) |
9/25. A case of cancer on the pharyngoesophageal junction treated by ambulatory endoscopic mucosectomy.A 52-year-old man underwent endoscopy because of discomfort in the hypopharyngeal region, and a 1.5-cm tumor was found on the pharyngoesophageal junction. In 1992, the patient was treated for advanced cervicothoracic esophageal cancer by preoperative chemotherapy and esophagectomy with radical lymph adenectomy and right thoracotomy. Reconstruction with a gastric substitute by cervical esophagogastrostomy was performed and postoperative adjuvant radiotherapy followed. Histologically, the esophageal tumor had invaded the adventitia and showed metastases to regional lymph nodes and vascular involvement with a free surgical margin. hypopharynx was also included in the irradiation field. Therefore, we tried to resect another primary tumor on the pharyngoesophageal junction by the endoscopic mucosectomy technique with an esophageal multipurpose tube (np-EEM). The tumor was resected on August 21, 1996, but follow-up endoscopy revealed residual or another primary tumor on the pharyngoesophageal junction in October 1996. The first resected specimen revealed a positive cut margin that might indicate incomplete resection. Three months later we performed a second mucosectomy. No problems occurred during or after tumor resection. Both treatments were performed without hospitalization, and the patient returned to his normal daily life on the day following tumor resection. Follow-up examinations have shown no sign of cancer recurrence on the pharyngoesophageal junction for more than 4 years.- - - - - - - - - - ranking = 1keywords = endoscopy (Clic here for more details about this article) |
10/25. Metachronous adenocarcinoma occurring at a colostomy site after abdominoperineal resection for rectal carcinoma.Carcinomas rarely occur at the site of a colostomy. A 73-year-old man underwent abdominoperineal resection (Miles' surgical procedure) for rectal carcinoma in September 1988. He did not return to the hospital until September 1995, when he was admitted with stricture of the stoma. Neither tumor nor ulcer was detected at the stoma. The tip of the doctor's little finger was able to pass through the stoma, and manual expanding alleviated the stricture. The patient did not return to the hospital again until August 1996, at age 81 years, when he visited the hospital because of complete stricture of the stoma. A biopsy revealed an adenomatous carcinoma, but the results of various examinations suggested no metastasis. A portion of the intestine, including the stoma and surrounding skin, was resected, and a new stoma was created in the descending colon. We report this rare carcinoma occurring at the site of a colostomy, and we review the literature.- - - - - - - - - - ranking = 0.74906750253257keywords = surgical procedure (Clic here for more details about this article) |
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