BACKGROUND Colonic diverticulosis is a common disease, and the coexistence of colonic diverticulosis and colorectal cancer is often seen clinically. It is very rare that colon cancer arises from the mucosa of a coloni...BACKGROUND Colonic diverticulosis is a common disease, and the coexistence of colonic diverticulosis and colorectal cancer is often seen clinically. It is very rare that colon cancer arises from the mucosa of a colonic diverticulum. When colon cancer arises in a diverticulum and then tends to develop outside the wall, without developing within the lumen, the differential diagnosis from complicating lesions due to colonic diverticulitis is difficult. CASE SUMMARY A 76-year-old man was admitted to a nearby clinic with a chief complaint of discomfort and urinary frequency. Since a vesicosigmoidal fistula was seen on abdominal computed tomography, he was referred to our hospital. Laparoscopic sigmoidectomy was performed because the various diagnostic findings were diagnosed as a vesicosigmoidal fistula with diverticulitis of the sigmoid colon. However, on histopathological examination, it was diagnosed as a vesicosigmoidal fistula due to colon cancer arising in the diverticulum. Laparoscopic partial resection of the bladder was performed because local recurrence was observed in the bladder wall one and a half years after surgery. It is currently one year after reoperation, but there has been no recurrence or metastasis. CONCLUSION Colon cancer arising in a diverticulum of the colon should be considered when diverticulitis with complications is observed.展开更多
BACKGROUND:Although invasive ductal adenocarcinoma of the pancreas(PDAC) manifests as a relatively uniform histomorphological feature of the pancreatobiliary type,it may be complicated by metaplastic changes and heter...BACKGROUND:Although invasive ductal adenocarcinoma of the pancreas(PDAC) manifests as a relatively uniform histomorphological feature of the pancreatobiliary type,it may be complicated by metaplastic changes and heterogeneous gastric and intestinal elements.This study aimed to investigate the complication rate and clinicopathological significance of such heterogeneous elements.METHODS:Fifty-nine patients who underwent resection of PDAC were examined in this study.Immunohistochemically,tumors showing high expression(>25%) of the intestinal-type(INT) marker CDX2 were classified as PDAC with INT.Those with high expression(>25%) of the gastric-type(GAS) marker MUC5AC were classified as PDAC with GAS,while those with high expression of both markers were classified as PDAC with INT/GAS.These patients were compared with those with PDAC of the negative group in which neither markers was highly expressed to examine their clinicopathological significance.RESULTS:In the 59 patients,31(52.5%) showed high CDX2 or MUC5AC expression.Twenty-eight patients(47.5%) belonged to a negative group,11(18.6%) to a PDAC with INT group,15(25.4%) to a PDAC with GAS group,and 5(8.5%) to a PDAC with INT/GAS group.No significant differences were observed for age,gender,size,localization,T classification,or prognosis among the four groups.Although the PDAC with GAS group had well differentiated types significantly more than the other groups,the rate of lymph node metastasis in this group was significantly higher(PDAC with GAS:73%;other groups:36%).CONCLUSION:Complications with heterogeneous elements are not uncommon in PDAC,and this should be considered during the diagnosis and treatment of PDAC along with histogenesis of the disease.展开更多
Background: Pancreatic carcinoma has a poor prognosis. It is important to focus on early detection and treatment for improvement of the prognosis. Understanding the characteristics of TS1 pancreatic carcinoma (≤2 cm)...Background: Pancreatic carcinoma has a poor prognosis. It is important to focus on early detection and treatment for improvement of the prognosis. Understanding the characteristics of TS1 pancreatic carcinoma (≤2 cm) could improve the treatment outcome of pancreatic carcinoma. Methods: Among 444 patients with conventional pancreatic carcinoma who underwent surgery at our facility, the study targeted 65 (14.6%) with a histopathological diagnosis of TS1 pancreatic carcinoma. We examined 65 cases of TS1 pancreatic carcinoma in reason for hospital visit, examination findings, histopathological findings, and treatment outcomes. Results: The detection rate of TS1 pancreatic carcinoma by ultrasonography was 83.1% for visualization of the tumor mass and 96.9% for main pancreatic duct dilatation. The corresponding rates for endoscopic ultrasound were 92.9% and 100%. With regard to postoperative outcome, 43.1% of patients had a recurrence;the site of recurrence was local in 24.6% and hepatic in 9.2%. On multivariate analysis, intrapancreatic neural invasion was an independent risk factor for recurrence (odds ratio, 6.333;95% confidence interval, 1.834 - 21.872;p = 0.004). Conclusions: To screen for TS1 pancreatic carcinoma, the study first examined for main pancreatic duct dilatation by ultrasonography and then conducted a detailed examination with endoscopic ultrasound. Patients with pancreatic neural invasion require careful attention for local recurrence.展开更多
文摘BACKGROUND Colonic diverticulosis is a common disease, and the coexistence of colonic diverticulosis and colorectal cancer is often seen clinically. It is very rare that colon cancer arises from the mucosa of a colonic diverticulum. When colon cancer arises in a diverticulum and then tends to develop outside the wall, without developing within the lumen, the differential diagnosis from complicating lesions due to colonic diverticulitis is difficult. CASE SUMMARY A 76-year-old man was admitted to a nearby clinic with a chief complaint of discomfort and urinary frequency. Since a vesicosigmoidal fistula was seen on abdominal computed tomography, he was referred to our hospital. Laparoscopic sigmoidectomy was performed because the various diagnostic findings were diagnosed as a vesicosigmoidal fistula with diverticulitis of the sigmoid colon. However, on histopathological examination, it was diagnosed as a vesicosigmoidal fistula due to colon cancer arising in the diverticulum. Laparoscopic partial resection of the bladder was performed because local recurrence was observed in the bladder wall one and a half years after surgery. It is currently one year after reoperation, but there has been no recurrence or metastasis. CONCLUSION Colon cancer arising in a diverticulum of the colon should be considered when diverticulitis with complications is observed.
文摘BACKGROUND:Although invasive ductal adenocarcinoma of the pancreas(PDAC) manifests as a relatively uniform histomorphological feature of the pancreatobiliary type,it may be complicated by metaplastic changes and heterogeneous gastric and intestinal elements.This study aimed to investigate the complication rate and clinicopathological significance of such heterogeneous elements.METHODS:Fifty-nine patients who underwent resection of PDAC were examined in this study.Immunohistochemically,tumors showing high expression(>25%) of the intestinal-type(INT) marker CDX2 were classified as PDAC with INT.Those with high expression(>25%) of the gastric-type(GAS) marker MUC5AC were classified as PDAC with GAS,while those with high expression of both markers were classified as PDAC with INT/GAS.These patients were compared with those with PDAC of the negative group in which neither markers was highly expressed to examine their clinicopathological significance.RESULTS:In the 59 patients,31(52.5%) showed high CDX2 or MUC5AC expression.Twenty-eight patients(47.5%) belonged to a negative group,11(18.6%) to a PDAC with INT group,15(25.4%) to a PDAC with GAS group,and 5(8.5%) to a PDAC with INT/GAS group.No significant differences were observed for age,gender,size,localization,T classification,or prognosis among the four groups.Although the PDAC with GAS group had well differentiated types significantly more than the other groups,the rate of lymph node metastasis in this group was significantly higher(PDAC with GAS:73%;other groups:36%).CONCLUSION:Complications with heterogeneous elements are not uncommon in PDAC,and this should be considered during the diagnosis and treatment of PDAC along with histogenesis of the disease.
文摘Background: Pancreatic carcinoma has a poor prognosis. It is important to focus on early detection and treatment for improvement of the prognosis. Understanding the characteristics of TS1 pancreatic carcinoma (≤2 cm) could improve the treatment outcome of pancreatic carcinoma. Methods: Among 444 patients with conventional pancreatic carcinoma who underwent surgery at our facility, the study targeted 65 (14.6%) with a histopathological diagnosis of TS1 pancreatic carcinoma. We examined 65 cases of TS1 pancreatic carcinoma in reason for hospital visit, examination findings, histopathological findings, and treatment outcomes. Results: The detection rate of TS1 pancreatic carcinoma by ultrasonography was 83.1% for visualization of the tumor mass and 96.9% for main pancreatic duct dilatation. The corresponding rates for endoscopic ultrasound were 92.9% and 100%. With regard to postoperative outcome, 43.1% of patients had a recurrence;the site of recurrence was local in 24.6% and hepatic in 9.2%. On multivariate analysis, intrapancreatic neural invasion was an independent risk factor for recurrence (odds ratio, 6.333;95% confidence interval, 1.834 - 21.872;p = 0.004). Conclusions: To screen for TS1 pancreatic carcinoma, the study first examined for main pancreatic duct dilatation by ultrasonography and then conducted a detailed examination with endoscopic ultrasound. Patients with pancreatic neural invasion require careful attention for local recurrence.
