Undifferentiated sarcoma can result in distant metastasis, and in severe disease, it mostly results in metastasis to the lungs and liver. We treated a patient who had been previously undiagnosed with undifferentiated sarcoma with metastases to the small intestine. We postoperatively discovered a liver tumor in a patient who had undergone surgery for sigmoid colon cancer. Initially, recurrence of the colon cancer was diagnosed, and anticancer treatment (FOLFOX4) was initiated. We later noted a subcutaneous tumor in the right upper arm during the course of treatment and an undifferentiated sarcoma was diagnosed on biopsy. Unfortunately, the patientʼs condition deteriorated and he died. The tumor of the right upper arm was examined during autopsy and found to consist extensively of spindle cells. An undifferentiated sarcoma was diagnosed with no specific cytodifferen-tiation found. The tumor found in the liver and lungs was not metastasis of colon cancer as previously suspected. In fact, cells of the undifferentiated sarcoma were found and metastasis of the undifferentiated sarcoma was diagnosed. Metastasis of the undifferentiated sarcoma to the small intestine was also noted.

症例は42歳の男性で,他院で数年前よりアルコール性慢性膵炎を指摘されていた.食欲不振の精査目的で紹介され,腹部CTで膵仮性嚢胞を認めた.その5日後に発熱を主訴に再来院し,再度胸腹部CTならびにMRI検査を施行したところ,膵仮性嚢胞の急速な増大と縦隔内への進展を認めたため,緊急開腹下に縦隔ドレナージと腹腔内膵嚢胞ドレナージを施行した.縦隔内貯留液のアミラーゼ値は高値であり,膵仮性嚢胞が食道裂孔を経て縦隔内進展したことによる縦隔炎と診断した.25病日に軽快退院し,術後2年の現在も再燃なく外来にて経過観察中である.

症例は62歳,男性.2010年8月に上腹部痛および体重減少を主訴に当院へ紹介となった.胃内視鏡を施行したところ胃角部に3型進行胃癌を認め,生検では印環細胞癌が指摘された.各種検査にて骨・甲状腺への転移を疑われた.甲状腺の穿刺細胞診を行い,免疫組織染色にて検索したところ胃癌の甲状腺転移と診断した.治療を開始したが7カ月後に死亡した.胃癌の甲状腺転移は比較的稀であり,文献的考察を加え報告した.

症例は胃癌，前立腺癌，肺癌の手術歴を持つ80歳の男性．食欲不振と倦怠感を主訴に来院した．CT検査で両側副腎に腫瘤を認めたため，癌の副腎転移再発を疑い，精査目的に入院したが，入院後3日目に死亡した．剖検所見では，癌の再発は認めず，両側性副腎原発悪性リンパ腫による急性副腎不全と診断された．両側性副腎原発悪性リンパ腫はまれであるが，癌の既往を有する患者では，副腎転移再発との鑑別に苦慮すると思われた．

症例は56歳，女性．子宮頸部腺癌IIIb期，傍大動脈リンパ節転移の診断で当院の婦人科外来で，放射線化学療法を施行されていた．2011年7月下旬に，突然の腹痛と発熱を主訴に婦人科を受診した．体温は38.4℃で，腹部全体に圧痛と反跳痛を認めた．血液検査では炎症所見と貧血を認めた．腹部骨盤CT検査で腹腔内遊離ガスを認めたため，消化管穿孔による汎発性腹膜炎と診断し，外科にて緊急開腹手術を施行した．開腹所見で子宮留膿症穿孔と診断した．切除不能の子宮頸部腺癌であることを考慮して，穿孔部を縫合閉鎖し，大網で被覆した．またDouglas窩および子宮内にドレーンを留置した．術後経過は良好であった．高齢でない女性の子宮留膿腫穿孔は珍しいが，子宮悪性腫瘍の治療中に起こりうることに留意すべきである．

症例は63歳，女性． 右腋窩のしこりを主訴に当院の皮膚科を受診した．腫瘤の一部を生検し，腺癌と診断された．潜在乳癌あるいは原発不明癌の腋窩リンパ節転移を疑い，原発巣検索目的に外科に紹介された．胸部CT検査およびFluoro deoxy glucose positron emission tomography（FDG-PET）検査で右腋窩に腫瘤を認めた．諸検査では，明らかな原発巣と考えられる病変を認めなかった．生検後の残存腫瘤切除と右腋窩リンパ節郭清術を施行した．切除腫瘤は免疫組織染色でgross cystic disease fluid protein-15（GCDFP-15）とandorogen reseptor（AR）が陽性であり，アポクリン癌と診断され，さらに腫瘍辺縁に乳管組織を認めたため，副乳内発生が疑われた．リンパ節転移はなかった．術後2年の現在，再発の兆候はない．

We report a case of duodenal hemangioma resection that recurred after endoscopic resection enforcement this time. A 72-year-old woman who had undergone endoscopic treatment (ethanol local injection and demucosation)for duodenal neoplasm was seen in June 2008 for difficulty in breathing. After examining the upper gastrointestinal tract by endoscope,CT,MRI,and duodenography in our hospital,a bleeding tumor was found in the duodenal 2nd portion,but the tumor was large and we judged that endoscopic resection was difficult. We performed a partial resection of the duodenal second portion,after confirm-ing the position of a papillary protruded lesion using intraoperative endoscopy. The surrounding tissue of the duodenum showed extensive scarring from the last ethanol local injection. The pathologic finding of the duodenal neoplasm after the resection was an angiomatous diagnosis. Duodenal hemangioma is a disease with few reports,and is quite rare. A therapy in one report showed excision using an endoscope, but there were no reported cases of duodenum hemangioma that recurred after endoscopic resection enforcement. In this case we experienced a rare resection,so we added discussion from the literature and reported on it here.

今回,子宮および両側付属器摘出術13年後に発症した虫垂子宮内膜症の1例を経験したので報告する.患者は60歳の女性で,既往歴は47歳時に子宮筋腫で子宮および両側付属器摘出術を施行されている.平成20年9月,右下腹部痛を主訴に受診し腹部CTを施行したところ虫垂穿孔を否定できず緊急手術をおこなった.虫垂は発赤し壁肥厚化しており虫垂を根部にて切除した.病理組織学的診断では虫垂は委縮しており,粘膜上皮はほとんど認められなかった.壁には慢性炎症と拡張した腺腔構造を呈する子宮内膜組織が内膜間質を伴って認められた.また免疫染色検査でエストロゲンレセプターが陽性,またプロゲステロンレセプターも一部陽性であり,虫垂子宮内膜症と診断した.虫垂子宮内膜症は通常性成熟期に多く,閉経後は報告例も少ない.さらに,子宮および両側付属器摘出10数年後に発見された報告もなく貴重な症例であると考えられた.

結腸間膜にsporadicな発症を来したintra-abdominal desmoidを1例経験したので報告する. 症例は, 52歳の女性. 43歳時に子宮筋腫の手術歴あり. 2001年9月より, 右下腹部痛が出現し近医を受診した. 腹部CT検査により腹腔内に5×4cmの腫瘤を指摘され, 当科紹介入院となった. 注腸造影X線検査で横行結腸が壁外より圧排を受けていたが, 粘膜面に異常所見は認めなかった. CT, MRI, 血管造影検査から腸間膜腫瘍もしくはSchloffer's tumorを考え, 開腹術を施行した. 開腹所見で腫瘍は横行結腸間膜に存在した. 境界不明瞭で上行結腸と横行結腸への浸潤が疑われたため, 右半結腸切除術を施行した. 病理組織学的所見より, 腫瘍はintra-abdominal desmoidと診断され, 横行結腸筋層への浸潤が認められた.

The chromosome region 17p shows frequently allele losses/mutations in colorectal cancers, and such frequent genetic alterations are a hallmark of the presence of tumor-suppressor gene. The RPH3AL, which is located at 17p13, has been identified from a candidate 17p13 medulloblastoma tumor suppressor locus. The aim of this study was to determine whether it is also altered in colorectal cancers. Mutational analyses of the RPH3AL gene were performed on DNA samples from 50 primary colorectal cancer specimens using polymerase chain reaction-single strand conformation polymorphism, and DNA sequencing. Six missense mutations producing amino acid substitution in coding region of the RPH3AL gene were detected in 50 primary colorectal cancer patients. The RPH3AL gene may play a role as a tumor-suppressor gene in fraction of colorectal cancers, but a minority show RPH3AL gene mutations. Somatic RPH3AL mutations were identified, providing support for an authentic role as tumor-suppressor gene in colorectal cancer, but only in a minority of cases.

胃癌根治手術534例の術後に, 計画的な経過観察を行い診断した再発115例の治療成績を検討した。全例の再発後の生存期間の中央値 (MST) は9.5カ月, 1年生存率は42%で, 再発後2年以上の長期生存が11例に得られた。肝およびリンパ節再発例は, 腹部CTを含む画像診断を用いて, 無症状な時期に診断される傾向にあった。肝単独再発に対する肝動注化学療法例 (n=7), および, リンパ節再発に対する全身化学療法例 (n=23) では, MST, 2年生存率はそれぞれ31.0カ月, 23.4%, および, 13.0カ月, 17.9%で, それぞれ4例, 3例が2年以上生存した。腹膜再発の早期診断は容易でなく, 再発後のMSTは8.7カ月に過ぎなかったが, 4例では, 手術 (腸管減圧手術, 再発巣切除) と全身化学療法, IVHを併用した集学的治療を行い2年以上生存した。以上より, 肝およびリンパ節再発には定期的な画像診断が有用で, 肝動注あるいは全身化学療法が予後向上に寄与することが示唆された。

We have performed interdisciplinary treatment consisting an operation, intraoperative irradiation (IOR), RF-Hyperthermia (RF-HT), and chemotherapy for patients with locally advanced pancreatic cancer. When a higher intra-tumor temperature was achieved during RF hyperthermia, a better tumor response was obtained. We could control the local disease and prolong the survival period of patients with locally unresectable pancreatic carcinomas. Heating by sufficient power of at least 1000W by Thermotron RF-8, and evaluating the treatment by monitoring the tumor temperature during treatment are important when heating pancreatic tumors successfully. Some means we contrived such as tumor exposure just below the abdominal wall by a by-pass operation, reduction of the subcutaneous fatty layer, chilling the body surface with use of crushed ice, anesthesia during the treatment were important for improving the efficiency and safety of this hyperthermia-centered multimodal treatment.

We present a case of myeloblastoma of the breast preceding acute myeloblastic leukemia (AML). A 70-year-old woman was seen at the department because of a tumor of the right breast. On physical examination two elastic hard tumors with a rough surface were palpated in the region c and CD on the right breast. Breast cancer was suspected by mammography and echography. The patient was operated on. Intraoperative pathological diagnosis was solid-tubular carcinoma, so radical mastectomy was performed. The postoperative course was uneventful, but 2 months after the operation, myeloblasts appeared in peripheral blood, and bone marrow examination revealed acute myelocytic leukemia. She was died of acute cardiac failure 4.5 months after the operation. Histological re-examination revealed that the breast tumors were myeloblastoma.

Background. The expression of nm23-H1 and nm23-H2 proteins in 25 hepatocellular carcinomas was studied immunohistochemically.Methods. Tissue specimens were reacted with antihuman nm23-H1 and nm23-H2 monoclonal antibodies (MoAb) (H1-229 and H2-206, respectively) and then stained by the biotin-streptoavidin complex method.Results. Adjacent nontumorous tissues were intensely stained with nm23-H1 and nm23-H2. Of the 25 hepatocellular carcinomas, 60% were positive for MoAb H1-229, and 68% were positive for MoAb H2-206. These immunoreactivities were most common in the cytoplasm of tumor cells. There was no significant correlation between the expression of nm23-H1 protein and tumor size, Edmondson's histopathologic classification, or invasion of the capsule, However, the authors observed an inverse relationship between nm23-H1 expression and intrahepatic metastases of hepatocellular carcinomas. There was no significant correlation between the expression of nm23-H2 protein and clinicopathologic findings. Only a short survival period was observed in patients with hepatocellular carcinoma with reduced nm23-H1 or nm23-H2 proteins.Conclusions. The results suggest that nm23-H1 protein plays a role in the suppression of intrahepatic metastasis of hepatocellular carcinoma and that the combined expression of nm23-H1 is associated with favorable prognosis.