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小腸内視鏡検査, FDG PET/CT検査を診断に使用した小腸平滑筋腫の1例 小肠内视镜检查,FDG PET/CT检查用于诊断的小肠平滑肌瘤1例
Pub Date : 2012-09-01 DOI: 10.11405/NISSHOSHI.109.1561
光徳 前田, 一成 菅家, 貴子 笹井, 洋子 知花, 美奈 星野, 武史 菅谷, 広行 加藤, 秀幸 平石
: A 49-year-old man was admitted to our hospital because of recurrent gastrointestinal bleeding of unknown origin, after repeated negative endoscopic and radiographic evaluation, including colonoscopy, esophago-gastro-duodenoscopy, CT and angiography. His condition had not been diagnosed for the past 18 years. ¹⁸F-fluorodeoxyglucose (FDG) on positron emission tomography (PET/CT) showed mild FDG uptake by a tumor of the small bowel (SUVmax 2.83), and capsule endoscopy (CE) and double balloon endoscopy (DBE) revealed a well-defined smooth submucosal tumor in the jejunum. The patient underwent a laparotomy and small bowel resection. The pathologic diagnosis was a small intestinal leiomyoma. Our report suggests the significance of combination of CE, DBE and PET/CT in the diagnosis of small bowel leiomyoma.
一名49岁男性患者因复发性不明原因消化道出血入院,经多次内镜和影像学检查,包括结肠镜检查、食管胃十二指肠镜检查、CT和血管造影检查均阴性。在过去的18年里,他的病情一直没有被诊断出来。¹⁸氟脱氧葡萄糖(FDG)在正电子发射断层扫描(PET/CT)上显示轻微的FDG被小肠肿瘤摄取(SUVmax 2.83),胶囊内窥镜(CE)和双气囊内窥镜(DBE)显示在空肠有一个界限清晰的光滑粘膜下肿瘤。患者接受了剖腹手术和小肠切除术。病理诊断为小肠平滑肌瘤。我们的报告提示CE、DBE和PET/CT联合检查对小肠平滑肌瘤的诊断意义。
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引用次数: 1
大腸癌の二次予防 : 早期発見・早期治療の実現に向けた内視鏡の役割 大肠癌的二次预防:内窥镜的作用实现早发现、早治疗
Pub Date : 2012-07-05 DOI: 10.11405/NISSHOSHI.109.1156
尚久 松田, 正宇 関口, 琢 坂本, 健 中島, 豊 斎藤, 寧 佐野, 隆広 藤井
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引用次数: 0
腸管嚢腫様気腫症の診断における大腸3D-CTの有用性―当院の5例の検討から― 大肠3d - ct在诊断肠囊肿样气肿症上的有用性——从我们的5例研究中——
Pub Date : 2012-04-05 DOI: 10.11405/NISSHOSHI.109.615
貴司 加藤, 晶義 鎌田, 宗一 中川, 良樹 藤澤, 卓郎 町田, 修二 碇, 清貴 佐々木, 裕人 山田, 英俊 加賀谷, 英明 中村, 高志 目黒, 彰一 堀田
: Computed tomography colonography (CTC) was performed in 5 patients with pneumatosis cystoides intestinalis (PCI). The virtual colonoscopy view of CTC as well as total colonoscopy (TCS) findings showed polypoid lesions in the colon, and multiplanar reconstruction images of the colon revealed in the polypoid lesions of the colon. We confirmed the diagnosis of PCI in all cases. CTC also detected the PCI lesions in the subserosa of the colonic wall which were not detected by TCS. Accurate evaluation of the extent of PCI involvement was obtained by CT air-contrast enema images. CTC is useful for detection of PCI lesions, assessment of the exact site and final diagnosis for PCI.
对5例肠囊性肺肿(PCI)患者行ct结肠镜检查。CTC虚拟结肠镜及全结肠镜(TCS)显示结肠息肉样病变,结肠多平面重建图像显示结肠息肉样病变。所有病例均行PCI治疗。CTC还能检出TCS未检出的结肠壁浆膜下PCI病变。通过CT空衬灌肠图像准确评估PCI受累程度。CTC对PCI病变的检测、确切部位的评估和PCI的最终诊断都是有用的。
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引用次数: 0
術後, 肝転移に対する全身化学療法, ラジオ波焼灼療法による治療が奏効した胃腺扁平上皮癌の1例 术后,针对肝转移的全身化疗和射频烧灼疗法的治疗奏效的胃腺鳞状细胞癌1例
Pub Date : 2012-04-05 DOI: 10.11405/NISSHOSHI.109.606
康弘 福田, 史直 竹島, 久美 荻原, 寛之 庄司, 祐子 赤澤, 卓也 堤, 邦子 安倍, 陽平 水田, 一 磯本, 一彦 中尾
: A 70-year-old man was given a diagnosis of advanced type 3 gastric cancer and underwent surgery. In addition to total gastrectomy and D2 lymph node resection, partial liver resection was performed due to detection of a solitary liver metastasis which was initially overlooked on preoperative CT. Histopathologically, the tumor was diagnosed as gastric adenosquamous carcinoma (Int, INFβ, pT2 (ss), H1, ly1, v2 (mp), EVG, n (-), pPM (-), pDM (-)). Three metastasic lesions appeared in the liver on abdominal CT scan performed 3 months after the operation. The patient underwent adjuvant chemotherapy with S-1. Since enlargement of the liver metastases was observed following 2 courses of treatment, the patient received combination chemotherapy of irinotecan and cisplatin. Of 3 metastatic lesions, 1 disappeared and 2 decreased to less than 2 cm in diameter after 8 courses of 2nd line treatment. Radiofrequency ablation (RFA) was successfully performed to treat the remaining liver metastases. The patient has been free of recurrence for 41 months.
一名70岁的男性被诊断为晚期3型胃癌并接受了手术。除全胃切除和D2淋巴结切除外,由于术前CT未发现单发肝转移,行部分肝切除。组织病理学诊断为胃腺鳞癌(Int、INFβ、pT2 (ss)、H1、ly1、v2 (mp)、EVG、n(-)、pPM(-)、pDM(-))。术后3个月腹部CT扫描显示肝脏3个转移灶。患者行S-1辅助化疗。治疗2个疗程后发现肝转移灶扩大,患者接受伊立替康联合顺铂化疗。3例转移灶中,经8个疗程的二线治疗后,1例转移灶消失,2例转移灶直径减小至小于2cm。射频消融(RFA)成功地治疗了剩余的肝转移灶。患者已41个月无复发。
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引用次数: 1
出雲 渉らによる「回盲部切除を行った成人特発性腸重積症の1例.日消誌 108;1540-1545:2011」に関して 关于出云涉等人的“进行回盲部切除的成人特发性肠重积症1例。日消志108:1540-1545:2011”
Pub Date : 2012-03-05 DOI: 10.11405/NISSHOSHI.109.460
武利 藤本, 渉 出雲
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引用次数: 0
治療的PEG(内視鏡的胃瘻造設術)後,再捻転し手術を要した,Duchenne型筋ジストロフィー症にともなう習慣性胃軸捻転症の1例 治疗性PEG(内窥镜胃造瘘术)后,需要再扭转手术的Duchenne型肌肉萎缩症所导致的习惯性胃轴扭转症1例
Pub Date : 2012-03-01 DOI: 10.11405/NISSHOSHI.109.418
寛 田中, 聖史 平松, 智広 飯田, 照基 井上, 秀敏 安岡, 古謝 亜紀子, 秀一 斉藤, 孝 広松
A 20-year-old man with Duchenne muscular dystrophy (DMD) with recurrent gastric volvulus underwent percutaneous endoscopic gastrostomy (PEG). Four months later, he developed vomiting and consciousness disturbance. CT revealed gastric volvulus recurrence along the gastrostomy axis. Endoscopic repositioning failed and fistula perforation necessitated emergency surgery. The upper position of the stomach was twisted counter-clockwise and revolved on the gastrostomy axis sliding between the lower stomach and abdominal wall. The fistula showed necrotic perforation and was thus resected. The anterior stomach wall was fixed to the abdominal wall at 3 triangular points. Thereafter, gastric volvulus did not recur. PEG is reportedly effective for preventing gastric volvulus, but there are rare cases of postgastrostomy recurrence. This successfully managed case provides valuable clinical insights.
一位20岁的杜氏肌营养不良症(DMD)伴复发性胃扭转的男性接受了经皮内镜胃造口术(PEG)。4个月后,他出现呕吐和意识障碍。CT示胃扭转沿胃造口轴复发。内窥镜复位失败,瘘管穿孔需要紧急手术。胃上部逆时针旋转,绕胃造口轴在胃下部与腹壁之间滑动。瘘管出现坏死穿孔,因此被切除。胃前壁与腹壁固定3个三角形点。此后,胃扭转未再发生。据报道,聚乙二醇对预防胃扭转有效,但很少有胃造口术后复发的病例。这个成功管理的病例提供了宝贵的临床见解。
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引用次数: 2
osteoclast-like giant cell tumor(OGCT)of the liverの1剖検例 肝破骨细胞样巨细胞瘤(OGCT
Pub Date : 2012-02-05 DOI: 10.11405/NISSHOSHI.109.255
隆祐 松本, 晃 吉田, 淳 中島, 智文 新, 剛 竹田, 秀之 柳澤, 英明 菊池, 慶介 菊地
: A 57-year-old man presented with jaundice. Abdominal computed tomography showed a 10-cm left hepatic lobe heterogeneous solid mass with low attenuated areas in the mass, multiple liver metastases and lung metastasis. Serology for hepatitis B and C were negative. Serum alpha-fetoprotein, CEA and CA19-9 were normal. The patient died a few weeks later of progressive liver failure and an autopsy was performed. Histologically, the tumor consisted of sarcomatoid mononuclear cells and osteoclast-like giant cells. The liver tissue surrounding the tumor showed no cirrhotic pattern. The osteoclast-like giant cells were uniformly and strongly immunoreactive with CD68. The mononuclear cells demonstrated expression of vimentin but were negative for CAM5.2. The MIB-1 index was 20% for the mononuclear cells. In conclusion, the histopathological diagnosis revealed an osteoclast-like giant cell tumor of the liver.
男性,57岁,黄疸。腹部ct示左侧肝叶10cm不均匀实性肿块,肿块内低衰减区,多发肝转移及肺转移。乙肝和丙肝血清学均为阴性。血清甲胎蛋白、CEA、CA19-9正常。几周后,患者死于进行性肝功能衰竭,并进行了尸检。组织学上,肿瘤由肉瘤样单核细胞和破骨细胞样巨细胞组成。肿瘤周围的肝组织未见肝硬化。破骨细胞样巨细胞对CD68呈均匀且强烈的免疫反应。单核细胞表达vimentin, CAM5.2表达阴性。单核细胞的mb -1指数为20%。总之,组织病理学诊断为肝脏破骨细胞样巨细胞瘤。
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引用次数: 1
微小乳頭癌成分をともなった大腸原発CK7陽性,CK20陰性,CDX2陰性低分化腺癌の1例 带微小乳头状癌成分的大肠原发CK7阳性,CK20阴性,CDX2阴性低分化腺癌1例
Pub Date : 2011-12-05 DOI: 10.11405/NISSHOSHI.108.2016
祥子 高橋, 巌志 黒岩, 眞章 平山, 弘敏 飛岡
: A 53-year-old woman had a tumor in the ascending colon. CT revealed tumor invasion to the surrounding tissue and also showed multiple swollen lymph nodes, liver metastases and ascites. Colonic tumor with severe stenosis was diagnosed by colonoscopy and the obtained biopsy specimen revealed poorly differentiated adenocarcinoma. Immunohistochemically, the tumor was positive for CEA, CK7, MUC2, MUC5AC·MUC6 (spotty) and negative for CK20, CDX2, TTF-1, GCDFP-15. Cytology of ascites also showed malignant cells. Although these protein expressions were specific for not primary colonic cancer but metastasis from ovarian cancer, the case was clinically and pathologically diagnosed as poorly differentiated adenocarcinoma of the colon with peritoneal metastases composed of micropapillary carcinoma. MLH1 and MSH2 protein expressions were normal. Even though modified FOLFOX6 chemotherapy was administered, the patient rapidly worsened due to pulmonary carcinomatous lymphangiosis and died a month after diagnosis. To determine the high-risk group of metastases, it seems necessary to require the accumulation of further cases evaluated by a precise immunohistochemistrical approach.
例一名53岁的妇女在升结肠有肿瘤。CT显示肿瘤浸润周围组织,多发淋巴结肿大,肝转移及腹水。结肠镜检查诊断为严重狭窄的结肠肿瘤,活检标本显示为低分化腺癌。免疫组化结果:肿瘤CEA、CK7、MUC2、MUC5AC·MUC6阳性(斑点),CK20、CDX2、TTF-1、GCDFP-15阴性。腹水细胞学检查也可见恶性细胞。虽然这些蛋白表达不是原发性结肠癌的特异性表达,而是卵巢癌转移的特异性表达,但该病例在临床和病理上被诊断为结肠低分化腺癌伴腹膜转移的微乳头状癌。MLH1、MSH2蛋白表达正常。尽管进行了改良的FOLFOX6化疗,但由于肺癌性淋巴管病,患者病情迅速恶化,并在确诊后一个月死亡。为了确定转移的高危人群,似乎有必要通过精确的免疫组织化学方法来评估更多病例的积累。
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引用次数: 3
血清ALP異常高値を契機に診断し,低用量S-1療法によりDICへの移行を回避し得た高齢者胃癌・骨髄転移・多発骨転移の1例 以血清ALP异常高值为契机诊断,通过低剂量S-1疗法避免DIC转移的高龄胃癌、骨髓转移、多骨转移1例
Pub Date : 2011-11-05 DOI: 10.11405/NISSHOSHI.108.1879
章彦 竹田, 史明 河原, 勝 大西, 明博 東田, 聡 間森, 兆 芦田, 俊夫 奥谷, 元 山田, 武士 近藤
We report an 87-year-old woman who was admitted to our hospital due to anemia and extremely elevated serum alkaline phosphatase (ALP) levels. We diagnosed advanced gastric cancer with disseminated carcinomatosis of the bone marrow and multiple bone metastasis. She was immediately treated with low-dose S-1 (50mg/body, p.o., days 1-14) and zoledronic acid hydrate (4mg/body, i.v., day 1) to avoid disseminated intravascular coagulation (DIC). After 1 course of the treatment, she could completely avoid DIC and we found the primary lesion and the metastasis had decreased. Now she is an outpatient and continues treatment without relapse for about 6 months. We consider low-dose S-1 and zoledronic acid hydrate combination therapy to be an effective strategy against advanced gastric cancer with disseminated carcinomatosis of the bone marrow and multiple bone metastasis in very elderly cases.
我们报告一位87岁妇女因贫血和血清碱性磷酸酶(ALP)水平极高而入院。我们诊断为晚期胃癌伴骨髓播散性癌及多发性骨转移。立即给予低剂量S-1 (50mg/体,口服,第1-14天)和水合唑来膦酸(4mg/体,静脉注射,第1天)治疗,以避免弥散性血管内凝血(DIC)。经过1个疗程的治疗,患者完全避免了DIC,原发灶及转移灶均有所减少。现在她是门诊病人,并继续治疗,没有复发约6个月。我们认为低剂量S-1联合水合唑来膦酸治疗高龄晚期胃癌伴弥散性骨髓癌及多发性骨转移是一种有效的治疗策略。
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引用次数: 2
多発性肺転移をともなった混合型肝癌に対してCDDP肝動注療法および全身化学療法GEM+CBDCA+5-FU/LVが奏功した1例 CDDP肝灌注疗法和全身化疗GEM+CBDCA+5-FU/LV对混合型肝癌的多发性肺转移奏效1例
Pub Date : 2011-11-01 DOI: 10.11405/NISSHOSHI.108.1892
成正 村田, 美歩 田村, 馨 福永, 宗孝 森田, 勇三 平田, 洋也 飯田, 綾子 覚野, 隆之 西上, 若樹 山中
: This patient is a male in his 30's. He was diagnosed as hepatitis B virus-related huge primary liver cancer, 10cm in diameter, located in segment 4, accompanied with left portal thrombus and multiple lung metastases. Ten months after repeating systemic chemotherapy using gemcitabine (GEM)+carboplatin (CBDCA)+5-FU/leucovorin (LV) and hepatic arterial infusion chemotherapy with cisplatin (CDDP) 4 times, extended left lobectomy with caudate lobe could be successfully performed because of marked reducion of the huge tumor. The pathology revealed almost entirely necrotic changes of the main tumor, and the remaining, viable tumor nests showed combined hepatocellular and cholangiocarcinoma. Systemic chemotherapy was repeatedly given afterwards, which kept the pulmonary metastases stable without growth. The present case suggests that systemic chemotherapy using GEM+CBDCA+5-FU/LV may be useful in the multimodal treatment for the combined hepatocellular and cholangiocarcinoma with distant metastases.
例这位病人是一位30多岁的男性。诊断为乙型肝炎病毒相关性原发性巨大肝癌,直径10cm,位于4节段,伴左门静脉血栓及多发肺转移。经吉西他滨(GEM)+卡铂(CBDCA)+5-FU/亚叶酸素(LV)、顺铂(CDDP)肝动脉灌注化疗4次,重复全身化疗10个月后,因巨大肿瘤明显缩小,可成功行左侧尾状叶延长切除。病理显示主要肿瘤几乎完全坏死,剩余的活肿瘤巢显示肝细胞癌和胆管癌合并。随后反复给予全身化疗,使肺转移瘤保持稳定,无生长。本病例提示GEM+CBDCA+5-FU/LV的全身化疗可能有助于肝细胞癌和胆管癌合并远处转移的多模式治疗。
{"title":"多発性肺転移をともなった混合型肝癌に対してCDDP肝動注療法および全身化学療法GEM+CBDCA+5-FU/LVが奏功した1例","authors":"成正 村田, 美歩 田村, 馨 福永, 宗孝 森田, 勇三 平田, 洋也 飯田, 綾子 覚野, 隆之 西上, 若樹 山中","doi":"10.11405/NISSHOSHI.108.1892","DOIUrl":"https://doi.org/10.11405/NISSHOSHI.108.1892","url":null,"abstract":": This patient is a male in his 30's. He was diagnosed as hepatitis B virus-related huge primary liver cancer, 10cm in diameter, located in segment 4, accompanied with left portal thrombus and multiple lung metastases. Ten months after repeating systemic chemotherapy using gemcitabine (GEM)+carboplatin (CBDCA)+5-FU/leucovorin (LV) and hepatic arterial infusion chemotherapy with cisplatin (CDDP) 4 times, extended left lobectomy with caudate lobe could be successfully performed because of marked reducion of the huge tumor. The pathology revealed almost entirely necrotic changes of the main tumor, and the remaining, viable tumor nests showed combined hepatocellular and cholangiocarcinoma. Systemic chemotherapy was repeatedly given afterwards, which kept the pulmonary metastases stable without growth. The present case suggests that systemic chemotherapy using GEM+CBDCA+5-FU/LV may be useful in the multimodal treatment for the combined hepatocellular and cholangiocarcinoma with distant metastases.","PeriodicalId":341053,"journal":{"name":"The Japanese journal of gastro-enterology","volume":"50 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116991501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 4
期刊
The Japanese journal of gastro-enterology
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