岡山医学会Acta Medica Okayama0030-155812732015術前内照射および化学療法が著効し,根治切除し得た巨大異所性褐色細胞腫の1例213218ENKazuyaYasuiYuzoUmedaKenjiroKumanoMasahiroTabataFumioOtsukaTakahitoYagiToshiyoshiFujiwaraA 46-year-old man was found to be positive for occult blood at a medical checkup and was revealed to have a 14-cm tumor on the right side of abdominal aorta by a subsequent abdominal CT scan. The endocrinology laboratory data showed elevations in the levels of serum noradrenaline, and ectopic pheochromocytoma was suspected.
The tumor was compressing the inferior vena cava and portal vein, the superior mesenteric artery and the pancreas. Since it would be difficult to cure by operation, neoadjuvant therapy was started using radioisotope therapy by I-131 metaiodobenzylguanidine (131I-MIBG) and chemotherapy (CVD therapy ; cyclophosphamide, vincristine, dacarbazine). He was treated with three courses of radioisotope therapy and 16 courses of chemotherapy, which significantly reduced the tumor size. This made radical resection possible ; we were able to avoid the merger excision of great vessels and other organs.
On pathological and immunopathological findings, the tumor was diagnosed as ectopic pheochromocytoma. Regarding the safety and curability of the treatment, neoadjuvant therapy may be useful in treating very large tumors that show invasion of other organs.No potential conflict of interest relevant to this article was reported.岡山医学会Acta Medica Okayama0030-155812412012膵炎を伴った胃異所性膵の1切除例5962ENSusumuShinouraTakahitoYagiHiroshiSadamoriHiroakiMatsudaYuzoUmedaRyuichiYoshidaDaisukeSatohMasashiUtsumiNaosukeYokomichiTakashiKuiseToshiyoshiFujiwaraWe experienced a case of gastric aberrant pancreas with acute pancreatitis. The patient was a 42-year-old man. He was referred to our hospital because of epigastric pain. A CT scan and endoscopic examination revealed a gastric submucosal tumor with inflammation. His serum amylase level was high at 222 IU/l. Endoscopic ultrasonography revealed a hypoechoic mass lesion, 3 cm in diameter, at the body of his stomach. Endoscopic ultrasoundscopy-guided fine needle aspiration was performed. Pathological examination showed pancreatic tissue. So, he underwent partial gastrectomy due to gastric aberrant pancreas with pancreatitis. There are very few cases of gastric aberrant pancreas with pancreatitis on record.No potential conflict of interest relevant to this article was reported.岡山医学会Acta Medica Okayama0030-155812332011多発肝内転移を伴う進行肝細胞癌に対して減量手術を含めた集学的治療が奏功した一例213216ENDaisukeSatohTakahitoYagiHiroshiSadamoriYuzoUmedaToshiyoshiFujiwaraWe report a case of advanced HCC with multiple intrahepatic metastases who obtained long-term survival by reductive hepatic resection as part of a multidisciplinary treatment. The patient was a 75-year-old man who had HCC, 13.5 cm in diameter in the right lobe of the liver with multiple intrahepatic metastases around the main tumor and 7 intrahepatic metastases in the left lobe of the liver. The large main tumor and intrahepatic metastases around the main tumor were initially resected by right lobectomy as reduction surgery. Transcatheter arterial chemoembolization (TACE) with epirubicin for intrahepatic metastases in the remnant liver was started 1 month after initial hepatectomy and repeated every 3 months. Twelve months after initial hepatectomy, lung metastases appeared, so we started systemic chemotherapy with 5-fluorouracil (5-FU) and cisplatin (CDDP). In addition, we changed epirubicin to CDDP for TACE. Despite this combination therapy, 20 months after the initial hepatectomy, the lung metastases showed an increase in size. We decided to discontinue systemic chemotherapy and administer sorafenib. The patient was alive without progression of intrahepatic metastasis and lung metastasis more than 26 months after the initial hepatectomy.No potential conflict of interest relevant to this article was reported.岡山医学会Acta Medica Okayama0030-155812332011脾動脈結紮を伴う生体肝移植後に脾動脈症候群を呈した一例207211ENDaisukeSatohTakahitoYagiHiroshiSadamoriHiroakiMatsudaSusumuShinouraYuzoUmedaRyuichiYoshidaTakashiUtsumiToshiyoshiFujiwaraAfter orthotopic liver transplantation, splenic artery syndrome (SAS), a phenomenon by which the main blood flow of the impaired hepatic artery is shifted to the splenic artery or gastroduodenal artery despite the absence of a structural lesion involving the anastomosis, has occasionally been observed. We report a 20-year-old women who developed SAS with pancytopenia and refractory ascites after living donor liver transplantation despite intraoperative ligation of the splenic artery as a prophylactic treatment for SAS. In this case SAS was diagnosed by digital subtraction angiography (DSA). A celiac trunk angiogram showed relative hypoperfusion of the hepatic artery together with augmentation of the blood flow toward the spleen with the unique collateral circulation through the left gastric artery, stomach and short gastric artery, and distal splenic artery. Embolization of one of the two left gastric arteries was performed. After embolization the hepatic artery perfusion showed significant improvement, but reduced again the next day. We ultimately conducted splenectomy. This case showed portal hyperperfusion and portal hypertension, consistent with previous reports that have described an association of SAS with portal hyperperfusion. After splenectomy, there was significant improvement in the hepatic artery perfusion, ascites disappeared promptly, and pancytopenia was significantly improved.No potential conflict of interest relevant to this article was reported.Acta Medica Okayama2008Effects of prophylactic splenic artery modulation on portal overperfusion and liver regeneration in small- for- size graftENYuzoUmedaNo potential conflict of interest relevant to this article was reported.