Daisuke Morioka

Objective: To examine the prognostic impact of tumor laterality in colon cancer liver metastases (CLM) after stratifying by Kirsten rat sarcoma 2 viral oncogene homolog (KRAS) mutational status. Background: Although some studies have demonstrated that patients with CLM from a right sided (RS) primary cancer fare worse, others have found equivoca...

Backgrounds and aims: This randomized clinical trial examined efficacy of prolonged elemental diet (ED) therapy after pancreatoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC), which often causes postoperative malnutrition leading to worsened short- and long-term outcomes. Methods: Thirty-nine patients with PDAC receiving PD was ran...

Background/aim: Cholangiocarcinoma and pancreatic carcinoma are major malignancies that cause obstructive jaundice (OJ). This study aimed to develop a simple and easily reproducible rat model of reversible OJ (ROJ). Materials and methods: OJ was induced by clamping the common bile duct (CBD) using a U-shaped titanium hemoclip and its base was at...

Background We sought to expand the clinico‐anatomical limit of the proximal ductal margin (Limit‐PDM) for resectability of hilar cholangiocarcinoma (HCCA). Methods The practical boundary of the hilar plate (PBHP) was defined as the location where the bile duct (BD) could not be isolated by dissection. The distance between PBHP and 2 well‐known cli...

Background The concept of “borderline resectable” was recently introduced to the field of surgery for pancreatic cancer, and surgical outcomes for this disease with extremely dismal prognosis have improved since the introduction of this concept. However, no such concept has yet been introduced to the field of surgery for hilar cholangiocarcinoma (H...

Objective The aim of this study was to examine if the prognostic significance of margin status in hepatectomy for colorectal cancer liver metastasis (CRLM) varies for different levels of tumor burden because hepatectomy indications for CRLM have been recently expanded to include patients with a higher tumor burden in whom achieving an R0 resection...

Introduction The World Health Organization (WHO) proposed an integrated classification for intraductal papillary neoplasm of the bile duct (IPNB) in 2010. However, IPNB reportedly shows considerable geographic variation. This Japanese single-institution study examined outcomes of surgery for IPNB and the prognostic impact of immunohistochemical muc...

Background: NCCN and Japanese clinical guidelines for the treatment of biliary tract cancer (BTC) addressed gemcitabine-cisplatin combination (GC) as first-line chemotherapy for patients with advanced BTC ineligible for surgery in 2013. However, gemcitabine-S1 combination therapy (GS) has been widely used as first-line treatment in Japan because J...

Introduction Ascites necessitating persistent drainage or paracentesis after drain removal is a representative among early postoperative complications after combined hepatectomy and cyst fenestration (CHCF) for polycystic liver disease (PLD). It has been reportedly observed in 20-70% cases and seemed to easily cause recurrent symptoms unless proper...

Background: International Study Group of Liver Surgery (ISGLS) proposed the standardized definition for bile leakage (BL) after hepatectomy (Hx) at 2011 to precisely perceive incidence and predictive factors of this critical condition. Methods: We conducted a multicenter retrospective study using the ISGLS definition of BL after Hx. Results: P...

Background: It has been reported that liver metastasis rarely occurs in a cirrhotic/hepatitic liver. Thus, coexistence of liver metastasis and hepatocellular carcinoma has been scarcely reported. To the best of our knowledge, there are no cases with hepatocellular carcinoma, which developed during an observational period after hepatectomy for colo...

Objective: To apply the principles of the Metro-ticket paradigm to develop a prognostic model for patients undergoing hepatic resection of colorectal liver metastasis (CRLM). Background: Whereas the hepatocellular "Metro-ticket" prognostic tool utilizes a continuum of tumor size and number, a similar concept of a CRLM Metro-ticket paradigm has n...

A 64-year-old woman was diagnosed with advanced gastric cancer with solitary liver metastasis. Although the HER2 status of the tumor was IHC2+, no further examination for HER2 status using FISH was performed. Four courses of S-1 and cisplatin chemotherapy were administered. The primary lesion and metastatic lesion were confirmed to have partially r...

We describe a case of bowel strangulation caused by massive peritoneal adhesion as a result of effective chemotherapy. A 71-year-old man, who had obstructive descending colon cancer with massive peritoneal metastases and, therefore, received palliative surgery consisting of diverting colostomy and sampling of peritoneal nodules, developed bowel str...

Purpose The aim of this study was to assess the efficacy of combined resection and reconstruction (CRR) of the hepatic artery (HA) in surgery for hilar cholangiocarcinoma (HC). Materials and Method Among 172 patients who underwent surgical resection for HC, the following three groups were defined according to the type of vascular reconstruction: VR...

Introduction We present a case of completely obstructed anastomosis after rectal resection which was nonsurgically and successfully treated with a blunt penetration technique using a commonly used device for transanal ileus drainage. The technique we used in this case has not been previously reported. Case presentation A 79-year-old Japanese man u...

Ring calcification in untreated hepatocellular carcinoma (HCC) is extremely rare, with only 3 previously reported cases in the English-language literature. A case of HCC with ring calcification was reported in this paper. Additionally, 3 previously reported cases of HCC with ring calcification were reviewed. In 3 of these 4 cases (including our cas...

From November 1997 to December 2012, 56 cases of living donor liver transplantation were performed at Yokohama City University Hospital. Of these 56 donors, 37 were male and 19 were female. The mean age of donors was 43.2 years. The mean operation-time was 447 minutes. The mean blood loss was 557ml. The mean hospital stay was 13 days. Complications...

Chylous ascites occurring after abdominal surgery is rare. Despite being potentially critical, there is no definite treatment guideline because of its rarity. Here we present a case of massive chylous ascites occurring after rectal surgery which was successfully treated with an oral fat-free elemental diet (ED). A 67-year-old man underwent low ante...

The purpose of our study was to investigate prognostic significance of lymph-node micrometastasis in gallbladder carcinoma. In total, 1,094 lymph nodes from 41 patients who had undergone radical resection with lymph-node dissection, including para-aortic lymph nodes were stained with hematoxylin and eosin (H&E) and immunostained with anti-cytokerat...

Between November 1997 to December 2010, 53 cases of living donor transplantation were performed at Yokohama City University Hospital. Cumulative post-transplant patient survival was 78. 5%, 74.4% and 74.4% at 1, 3 and 5 postoperative years. Neither mortality nor significant residual disability was observed in any of the 53 living donors. The length...

A 27-year-old Japanese man underwent liver transplantation because of uncompensated cirrhosis due to Dorfman-Chanarin syndrome (DCS). At birth, the patient displayed ichthyosis and liver dysfunction. Moreover, mental retardation appeared and intracytoplasmic vacuoles were observed within peripheral blood neutrophils. A fatty liver was also noticed,...

We developed 90%-hepatectomized mice that were the fatal model, and analyzed the gene expression profiles using a complementary DNA (cDNA) microarray to clarify the mechanisms of hepatic failure after excessive hepatectomy. Ribonucleic acid (RNA)s from the remnant hepatic tissue of 70%- and 90%-hepatectomized mice were labeled with fluorescent dyes...

A 47-year-old Japanese man was transferred to our hospital because of acute-on-chronic hepatitis B virus infection. On admission, he was suffering from sepsis due to a catheter infection and respiratory failure caused by pulmonary edema and pneumonia, but, as a result of preoperative intensive care, we avoided septic shock. ABO-incompatible liver t...

Takeda K, Tanaka K, Morioka D, Kumamoto T, Endo I, Togo S, Shimada H. Pathogenesis in ABO incompatible liver transplantation: a clinicohistological evaluation of four patients. Clin Transplant 2010: 24: 747–751. © 2009 John Wiley & Sons A/S. Abstract: The aim of this study was to clarify the pathogenesis of antibody‐mediated rejection (AMR) of ABO...

A 29-year-old man was referred to our hospital with fulminant hepatic failure (FHF) and stage III hepatic coma (somnolence and confusion). Living donor liver transplantation (LDLT) was planned for 2 days after admission to our hospital. However, on the day after admission, he lapsed into stage IV hepatic coma: no right reflexes and no response to p...

Neonatal hepatitis, a syndrome occurring in children, has various etiologies, such as viral infection, unidentified disorders of bile salt synthesis, and other poorly understood metabolic diseases. It is characterized by jaundice, giant cell hepatitis, and, rarely, liver failure necessitating liver transplantation. We experienced 3 cases of idiopat...

We evaluated the usefulness of synthetic absorbable sutures (Vicryl) in preventing surgical site infection (SSI) after hepatectomy. A rat model of 60% partial hepatectomy was used. Bleeding from the cut surface of the liver was controlled by using two suture types: silk and Vicryl. In the Vicryl group, the lesser omentum was slightly adherent to th...

Prostaglandin E1 (PGE1) has a wide-ranging effect on cytoprotection. Overproduction of heat shock protein 70 (HSP70) in the liver protects hepatocytes under various pathologic conditions. In this study, we examined the effect of a nontoxic HSP-inducer, PGE1, on acute liver failure after 95% hepatectomy in rats. PGE1 or vehicle was intravenously adm...

Nitric oxide synthase 2 (NOS2) is expressed during liver regeneration after a partial hepatectomy (PHx); NOS2 subsequently synthesizes nitric oxide (NO). However, the role of NOS2-synthesized NO in post-PHx liver regeneration remains unclear. We investigated the role of NOS2-synthesized NO in liver regeneration. NOS2 knockout (NOS2-KO) mice and con...

We report a case of hepatic mesenchymal hamartoma in an adult; this condition is extremely rare, with only 15 cases having been reported in the English-language literature worldwide. The patient was a 36-year-old woman who was seen at her local hospital for upper abdominal distension. A giant multilocular cystic tumor, which had almost entirely rep...

The clinical symptoms, histological findings, and treatments for antibody-mediated rejection (AMR), which is the leading cause of graft loss in adult ABO-incompatible liver transplantation (ABO-I-LT), have rarely been discussed. We performed adult living donor ABO-I-LT on six patients. We used anti-CD20 monoclonal antibody combined with plasma exch...

Invasive pulmonary aspergillosis (IPA) occurs in 1.5 to 10% of liver transplant recipients. Of the fungal infections, IPA is the most difficult to treat and the most frequently life-threatening. However, the best treatment strategy remains controversial. The patient was a 53-year-old woman who underwent living donor liver transplantation (LDLT) bec...

In Japan and Korea, where availability of deceased donor organs for solid organ transplantation remains rare, living donor liver transplantation (LDLT) using a posterior section graft (PSG; segments VI+VII, according to Couinaud's Nomenclature for liver segmentation) has now been accepted as a standard procedure that balances donor risk and patient...

Application of liver transplantation to methylmalonic acidemia (MMAemia) is controversial because MMAemia is caused by a systemic defect of methylmalonyl-CoA mutase. The clinical courses of seven pediatric patients with MMAemia undergoing living donor liver transplantation (LDLT) were reviewed. Serum and urinary methylmalonic acid (MMA) levels were...

Complex, highly variable, anatomic relationships in the portal hilum complicate the surgical management at hilar cholangiocarcinoma. Preoperative three-dimensional (3D) imaging to stage the tumor and define anatomy may help in planning for curative resection. Between 2003 and 2006, 20 consecutive patients with hilar cholangiocarcinoma underwent pre...

Post-hepatectomy infections require careful attention, because they may deteriorate into liver failure. We retrospectively reviewed such infections in cases without biliary or intestinal reconstruction. This retrospective study involved 535 patients with liver tumors who underwent hepatectomy at the Department of Gastroenterological Surgery of Yoko...

Well-organized turnover of the extracellular matrix is important in liver regeneration, which is regulated by the plasminogen activating system. The aim of this study was to investigate the role of plasminogen activator inhibitor-1 (PAI-1) after excessive hepatectomy and to ascertain whether angiotensin-converting enzyme (ACE) inhibitors, which are...

Background: The effects of living donor liver transplantation (LDLT) on the recurrence of autoimmune liver diseases have not been well documented. Genetic similarities may be beneficial to avoid severe rejection but may facilitate the recurrence of autoimmune diseases. Because familial occurrence of autoimmune liver diseases has been documented, th...

An abstract is unavailable. This article is available as HTML full text and PDF.

Accurate knowledge of partial anatomy is essential in hepatic surgery but is difficult to acquire. We describe the potential impact of a new technique for constructing three-dimensional virtual images of the portal vein, hepatic artery, and bile ducts and present a representative case. An 80-year-old man was suspected of having papillary cholangioc...

Although the usefulness of antimicrobial prophylaxis for clean-contaminated surgery has been recognized, only a few randomized controlled studies on the duration of administration after hepatectomy have been performed. We investigated the duration of antimicrobial prophylaxis after hepatectomy. The subjects were 180 patients who underwent hepatecto...

Massive arterial hemorrhage is, although unusual, a life-threatening complication of major pancreatobiliary surgery. Records of 351 patients who underwent major surgery for malignant pancreatobiliary disease were reviewed in this series. Thirteen patients (3.7%) experienced massive hemorrhage after surgery. Complete hemostasis by transcatheter arte...

To determine outcomes for both donors and recipients of adult-to-adult living donor liver transplantation (AALDLT) and independent factors impacting those outcomes. Deceased donors for organ transplantation remain extremely rare, making living donor liver transplantation (LDLT) practically the sole therapeutic modality for patients with end-stage l...

In the pediatric population, the concomitant presentation of end-stage liver disease and congenital cardiac malformation occurs rarely. Determining the surgical priority in these cases is a challenge due to the presence of hemodynamic alterations that increase surgical risks. We examined five cases that received living-donor liver transplantation....

To clarify the role of the middle hepatic vein (MHV) in liver regeneration of the remnant liver after right hemihepatectomy for hepatic tumors, we reviewed 29 patients to evaluate liver regeneration for up to 12 postoperative months. Volume regeneration of the remnant liver was investigated by computed tomography at 3, 6, and 12 postoperative month...

Patient selection criteria of deceased donor liver transplantation for primary biliary cirrhosis (PBC) are almost completely established. The aim of this study was to establish selection criteria for both patients and donors of living donor liver transplantation (LDLT) for PBC. We used univariate and multivariate analyses to examine patient and don...

To determine whether or not the Milan criteria (MC) should be used to determine the applicability of liver transplantation (LT) as a first-line treatment for patients with cirrhosis with hepatocellular carcinoma (HCC) who are able to endure hepatectomy. Retrospective analysis of 82 patients with cirrhosis with HCC who were treated by hepatectomy wi...

Our objective was to analyze problems in the perioperative management and long-term outcome of living donor liver transplantation (LDLT) for biliary atresia (BA). Many reports have described the effectiveness of liver transplantation (LT) for BA, particularly in pediatric cases, but little information is available regarding LT in adults (> or =16 y...

This study investigated the effects of a repeat 70% major hepatectomy in a rat model. The left lateral and median lobes of the livers of 80 seven-week-old male Wistar rats were excised during primary hepatectomy, removing a total of 70% of the liver. In 40 of the rats, the regenerated right lateral lobe, comprising 70% of the remnant liver, was exc...

Standardization of surgical procedure for pancreatic cancer has been recognized to be necessary and important these days. Recent studies appear to exhibit efficacy of the adjuvant chemoradiation therapy before or after pancreatic surgery. In this study, we examined the standard surgery as part of the multidisciplinary treatment for pancreatic cance...

Smaller-size infants undergoing living-donor liver transplantation (LDLT) are at increased risks of vascular complications because of their smaller vascular structures in addition to vascular pedicles of insufficient length for reconstruction. Out of 585 child patients transplanted between June 1990 and March 2005, 64 (10%) weighing less than 6 kg...

The aim of this study was to assess the prognostic impact of the number of lymph node metastases. The medical records of 33 patients with node-positive gallbladder cancer (GBC) treated at our institution from January 1985 through December 2002 were reviewed. There were 10 cases with a single node metastasis. The sites were as follows: the cystic du...

The aim of the present study was to determine whether rats with moderately fatty liver could withstand a 90% hepatectomy, which rats with normal livers can survive. Nine-week-old male Wistar rats were used. Normal rat chow was fed to the normal liver group, and fat-enriched rat chow was fed to the fatty liver group for 4 weeks to induce a moderatel...

Between November 1997 and August 2006, 28 cases of living donor liver transplantation (LDLT) were performed at Yokohama City University. Only 2 of the 28 were pediatric cases (aged less than 18 years), and the remaining 26 were adult cases (aged 18 years or more). The original diseases prompting LDLT were fulminant hepatic failure (n = 8), primary...

Forty-six pediatric patients who underwent living donor liver transplantation (LDLT) using parental liver grafts for inheritable metabolic disorders (IMD) were evaluated to determine the outcomes of the surgery, decisive factors for post-transplant patient survival and the impact of using donors who were heterozygous for the particular disorder. Di...

To address the current role of liver transplantation (LT) for urea cycle disorders (UCDs), we reviewed the worldwide English literature on the outcomes of LT for UCD as well as 13 of our own cases of living donor liver transplantation (LDLT) for UCD. The total number of cases was 51, including our 13 cases. The overall cumulative patient survival r...

In living donor liver transplantation (LDLT), the liver donor is almost always a blood relative; therefore, the donor is sometimes a heterozygous carrier of inheritable diseases. The use of such carriers as donors has not been validated. The aim of the present study was to evaluate the outcome of LDLT for noncirrhotic inheritable metabolic liver di...

This study was intended to establish in mice: 1) a safety limit for the extent of hepatectomy and 2) the extent of hepatectomy invariably causing fatal hepatic failure, to facilitate gene expression analysis. In 70%-hepatectomy, the left lateral and median lobes were removed, and in 90%-hepatectomy, all lobes except the caudate were resected. One-w...

We report a case of cholecystolithiasis with biliobiliary fistulas from gallbladder to hepatic ducts, which were manifested by worsening liver dysfunction. Although it was not diagnosed preoperatively, it was successfully treated by cholecystectomy with closure of fistulas by the gallbladder wall. This case suggests that an internal biliary fistula...

Prostaglandin E1 (PGE1) has several potential therapeutic effects, including cytoprotection, vasodilation, and inhibition of platelet aggregation. This study investigates the protective action of PGE1 against hepatic ischemia/reperfusion injury in vivo using a complementary DNA microarray. PGE1 or saline was continuously administered intravenously...

To determine an appropriate surgical treatment for patients with multiple liver metastases, we evaluated the efficacy of two-stage hepatectomy in patients with multiple bilobular liver metastases from colorectal carcinoma. Some patients with multiple liver metastases are not candidates for a complete resection by a single hepatectomy, even when dow...

Nutritional disturbances such as ascites and hypoalbuminemia frequently arise after hepatectomy for liver cancer with liver cirrhosis. We examined the possibility of maintaining a favorable state of nutrition by outpatient administration of branched-chain amino acid (BCAA) granules. Forty-three patients who had gross liver cirrhosis complicated by...

To improve the prognosis after hepatectomy for HCC, repeated postoperative transcatheter arterial infusions of anticancer drugs and lipiodol (TAI) were given. TAI may be effective as an adjuvant therapy for prevention of residual liver recurrence after hepatectomy, probably by suppression of the development of intrahepatic micrometastases rather th...

The aim of this study was to identify the role of median sternotomy in the hepatic resection of large hepatocellular carcinomas (HCCs). From 1992 to 2002, 26 patients who underwent hepatectomy for large HCCs greater than 10 cm in diameter were divided into 2 groups according to the type of incision performed: with median sternotomy (10 patients) or...

The necessity of the middle hepatic vein for living donor liver transplantation using right lobe graft is still controversial. We reviewed 7 long-term surviving right-lobe recipients in whom middle hepatic vein tributaries were not reconstructed (group A, n=4) or were reconstructed (group B, n=3). Volume regeneration of the right paramedian (segmen...

The objective of this study were to evaluate the efficacy of hepatic resection for large hepatocellular carcinomas (HCCs) and examine clinicopathologic factors influencing overall survival after resection of a large HCC. The pre-, intra-, and postoperative factors and long-term outcome of 26 patients with HCCs >10 cm who underwent hepatic resection...

To overcome problems arising from a graft of insufficient size, right liver grafts have been used extensively for adult-to-adult living donor liver transplantation (LDLT). However, there are reports of severe congestion in the anterior segment of the graft after transplantation. Right liver transplantation without the middle hepatic vein was perfor...

This study assessed the usefulness of artificial liver support (ALS) for pretransplant patients with fulminant hepatic failure (FHF). Five patients (age 14 to 52 years, 3 men and 2 women) with FHF who were being prepared for living donor liver transplantation (LDLTx) were enrolled in this study. ALS included plasma exchange, using 40 to 50 units of...

Adult ABO-incompatible liver transplantation has been known to be associated with markedly desperate outcomes. Antibody-mediated rejection (AMR) has been recognized as one of the primary causes of these desperate outcomes, but its clinical features and significance have not been well understood. Recently, some clinicians have succeeded in improving...

This study sought to determine whether a prognostic score is a useful indicator of donor safety using 13 consecutive donors enrolled for liver transplantation. The donor operations were right hepatic lobectomies (n = 10) and left hepatic lobectomies (n = 3). The postoperative maximal level of serum total bilirubin was used to assess the magnitude o...

This study was conducted to clarify the management of perioperative infectious complications after adult living donor liver transplantation (LDLT). Fourteen adult LDLT patients were enrolled in this study. We examined the occurrence of infectious complications in these cases and the relationships of infectious complications to UNOS status and MELD...

Hepatic metastasis is the most frequent mode of recurrence of advanced gallbladder cancer after radical resection. The aims of this study were to clarify the clinical significance of microscopic liver metastasis from pT2 gallbladder cancer and to clarify whether partial hepatectomy can prevent hepatic recurrence in patients with microscopic liver m...

The right margin of the caudate lobe is obscure. Therefore, a part of the caudate lobe (a part of the right side of the paracaval portion) seems almost always to remain with the right lobe graft during the standard harvesting procedure. We reviewed the intraoperative findings and the postoperative courses of donors and recipients of 11 consecutive...

The incidence of biliary injury during laparoscopic cholecystectomy remains high and several complications resulting from injuries have recently been reported. The aim of this study is to elucidate the surgical strategy for the management of biliary injury during laparoscopic cholecystectomy. Ten patients with biliary injury during laparoscopic cho...

【目的】転移性肝癌に対する局所凝固療法の有用性について検討した.【対象】当科で局所凝固療法を施行した転移性肝癌は15例21病変であった.施行理由はH3多発肝転移例の切除対側葉13病変,肝切除拒否4病変,呼吸機能不良4病変であった.【結果】マイクロターゼ凝固療法16病変,ラジオ波焼灼療法は5病変であった.腫瘍径は, 1cm未満7例, 1-2 cm 10例, 2-3 cm 2例, 3 cm以上2例で,平均腫瘍径は1.7cmであった.平均観察期間8.3ヵ月で2cm未満の9病変に再発を認めなかったが, 4病変(19%)に局所再発を認めた. H3肝転移7例に対しMCTを併用した肝切除を施行し, 4例は無再発生存中であるが, 3例は多発肺転移と残肝多発再発のため死亡した.【結語】 2 cm未満の病変に対...

Major hepatectomy can now be successfully performed after portal vein embolization, but the effects of portal vein embolization have not been clearly delineated. Our objective is to examine whether portal vein embolization really contributes to the success of major hepatectomy. Thirty-eight patients underwent portal vein embolization and hepatectom...

The aim of this study was to determine whether the minimum necessary volume of a moderate fatty liver graft was similar to the normal liver volume and to elucidate means for improving the function of the transplanted fatty liver if it were inferior in volume to a normal liver under conditions of permissible cold preservation. Nine-week-old male Wis...

Major hepatectomy has been successfully performed after portal vein embolization (PE). However, post-hepatectomy liver failure following hyperbilirubinemia (HB) sometimes occurs even after PE. Our objective was to determine what factors affected post-hepatectomy HB and liver failure. Forty-two patients underwent PE before major hepatectomy or repea...

We describe a patch graft technique using the autologous pericardium for reconstruction of the right hepatic vein after hepatectomy. A male patient underwent hepatectomy for removal of metastatic tumors from colon cancer. A 2.5-cm-diameter tumor, which was located in the antero-superior segment (S8) of the right lobe, invaded the right hepatic vein...

Portosystemic shunt is a common complication in patients with portal hypertension. Mesenteric varix is one of the collaterals that can cause post-transplant liver dysfunction. In this case report, a 45-year-old woman underwent living relative donor liver transplantation for alcoholic cirrhosis. Although the early postoperative course was uneventful...

A 53-year-old woman with remnant liver metastasis originating from colon cancer was referred to our department. She underwent successful caudate lobectomy combined with resection of the inferior vena cava (IVC), including reconstruction with a pericardial autograft patch. IVC clamping was performed between the IVC below the confluence of the left h...

More than 10 years have passed since hepatic artery resection was first performed for the treatment of biliary tract cancer. The safety of this procedure has been established with the introduction of the microsurgery technique. However, the benefits of and indications for this treatment have not yet been clarified. Twenty-three patients underwent v...

症例は73歳の女性. 1997年12月に右前腋窩部の腫瘤を自覚したが放置していた. 2000年5月になり,同部の腫瘤に疼痛を認めさらに右鎖骨上窩にも腫瘤を自覚し当科に受診した.前腋窩部腫瘤の吸引細胞診の結果class V: adenocarcinomaで,造影MRIでのみ右乳房内に腫瘤を認め潜在性乳癌と診断し定型的乳房切除術+R3リンパ節郭清を施行した。病理組織所見では,原発巣は右乳房CA領域のinvasive lobular carcinomaで一部にsignet ring cellへの脱分化が見られたが,転移巣はsignet ring cellで占められていた. signet ring cellに脱分化し悪性度の高い増殖能を獲得した腫瘍細胞が転移巣で急速に増大したものと考えられた. 2年...

症例は73歳,男性.右季肋部痛で発症し肝右葉に腫瘤を指摘された.画像所見上,肝前区域に表面に癌臍様の陥凹を伴う最大径8cmの腫瘤を認め, dynamic CT,血管造影の所見から, combined typeの胆管細胞癌と診断した.切除標本の組織所見では低分化と高分化の混在する肝細胞癌と診断されたが,腫瘍内にpeliosis hepatisに類似した大小多数の血液腔(peliotic change)を認め,その内腔は大部分が器質化していた.通常,肝細胞癌に内包されるpeliotic changeはdynamic CT,血管造影で持続する濃染像を示すとされるが,本症例ではpeliotic change内の血液の器質化により造影効果を示さず,術前診断を困難にしたものと考えられた.