We performed intraoperative peritoneal cytology in 171 gastric cancer patients undergoing curative surgery. Intraperitoneal free cancer cells were demonstrated in almost all patients in whom the area of serosal cancer invasion exceeded 15-20 cm2. In patients with both serosal cancer invasion and free cancer cells the 5-year survival rat was 13% as compared with 85% for patients who had neither, and 40% for patients who had serosal invasion but no free peritoneal cancer cells. Peritoneal metastasis was the most frequently observed recurrence pattern. Therefore, in gastric cancer patients with marked serosal invasion, intraoperative IP administration of cytocidal anticancer drugs should be considered.

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Cytological examination of exfoliated cells in the bile or irrigated fluid from a percutaneous transhepatic choledochal drainage (PTCD) tube and other jaundice-reducing fistula was performed in 59 patients with obstructive jaundice. Malignant cells were found in 22 of 27 patients with choledochal cancer, 50 of 17 patients with pancreatic cancer, 3 of 6 patients with gallbladder cancer, and one of 5 patients with other malignancies. Exfoliated malignant cells were found at a higher rate in the washed fluid of the PTCD tube than in the pure bile aspirated from the PTCD tube. Half of the positive cases were diagnosed as such upon the first cytological examination, and the remaining in second or subsequent cytological examinations. The cytological appearance of cells in the washed fluid or bile reflected the type of cancer cells found by touch-smear of the lesion and also the histological type. This method requires no special technique and facilitates accurate diagnosis in patients with malignant lesion of the choledochal duct.

We report herein the case of a 19-year-old woman, diagnosed as having Klippel-Trenaunay syndrome at the age of 3 years, who presented to our hospital with severe abdominal pain. Abdominal computed tomography revealed splenomegaly, ascites, and paracentesis confirming an intraabdominal hemorrhage. Thus, an emergency laparatomy was performed for a suspected splenic rupture, and 2.5 L of blood was drained from the abdominal cavity. Splenomegaly was confirmed, and a splenectomy was performed. The patient's postoperative course was complicated by disseminated intravascular coagulation, but she recovered and was discharged 3 weeks following surgery. Pathological examination of the spleen suggested that the splenomegaly was caused by high venous pressure due to splenic vein stenosis. To our knowledge, this is the first reported case of Klippel-Trenaunay syndrome associated with marked splenomegaly.

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