Chronic obstructive lung disease (COPD) is a high-risk factor for pulmonary complications in esophageal surgery. We reported a case of esophageal gastrointestinal stromal tumor (GIST) in a patient with severe COPD. Upper gastrointestinal endoscopy and computed tomography revealed a 3×2-cm submucosal tumor at the lower esophagus, and positron emission tomography showed a hypermetabolic mass (SUV(max)=5.6). Forced expiratory volume in 1 second (FEV(1)) was 33.0% of predicted and FEV(1)/forced vital capacity ratio was 40.7%. Taking the patient's lung function into account, we performed a thoracoscopic enucleation for the esophageal GIST while the patient was in a prone position. The postoperative course was uneventful and no significant change was observed in the patient's respiratory condition. Performing thoracoscopic surgery on COPD patients in a prone position is a good therapeutic alternative for reducing the occurrence of pulmonary complications.
A 42-year-old female patient experienced diplopia after two weeks of daily administration of interferon-2b and ribavirin for chronic active hepatitis C. Administration of these drugs had continued further three times a week after that and the diplopia persisted. Since brain MRI and CT angiography did not show any abnormalities, she was referred to our hospital. Neurological examination was negative except for left oculomotor nerve palsy (Fig. 1A). Blood and cerebrospinal fluid examinations and peripheral nerve conduction velocity were normal. Her oculomotor nerve palsy improved promptly after the discontinuation of interferon-2b and ribavirin, and the diplopia completely recovered after three weeks, but a slight left ptosis remained (Fig. 1B). Although interferon may cause neuropsychiatric disturbances, the incidence is quite rare. Only two cases with oculomotor nerve palsy have been reported abroad (1, 2), and this is the first Japanese case induced by combination therapy of interferon-2b and ribavirin.
A 68-year-old man was diagnosed as having advanced sigmoid colon cancer with a bladder fistula. Preoperative neoadjuvant chemotherapy was performed to avoid anterior pelvic evisceration. Since the tumorshrank,totallylaparoscopicradicalresectionwasperformed.Thebladderfistulawasresectedfullthickness,usingbilateralobservationwithalaparoscopeandacystoscope,whichresultedinnegativemargins.Thepathologicalfindingswereadenocarcinoma,T4b,N0,M0,yStageIIc;allsurgicalmarginswere negative. Preoperative chemotherapy made it possible to preserve bladder function, reduce operative stress, and achieve a complete resection. A successful case of conversion laparoscopic surgery for advancedsigmoidcoloncarcinomawithabladderfistulaisreported.
A 71-year-old man who suffered esophageal damage due to an accident approximately 30 years previously complained of dysphagia. Endoscopic examination revealed a whitish papillary tumor in the esophagus. Biopsy results seemed to suggest an extremely well-differentiated squamous cell carcinoma or inflammation, but a definitive diagnosis could not be reached despite multiple inspections. Chest CT showed irregular thickening of the wall of the esophagus and pneumonia by penetration, and PET showed high trace accumulation in the affected area. We decided to operate on the patient due to the possibility of cancer, potential obstruction to the passage of food, and secondary pneumonia. Intraoperatively, the tumor was found to be soft and edematous, and since intraoperative diagnosis of pleural lavage fluid and the LN around the recurrent laryngeal nerve were negative, we performed thoracic esophagectomy without typical lymph node dissection, and reconstruction using a gastric tube. Gross examination of the tumor revealed a warty appearance. HE staining showed that the squamous laminar structure of the esophagus was maintained, although a slight variant form was present. Immunostaining revealed the tumor to be verrucous carcinoma (VC) with a positive reaction of basal layer to p53, p63 and Ki67 as biomarkers. VC is a subtype of squamous cell carcinoma that most commonly occurs in the mouth. We report a rare case of esophageal VC with a review of the literature of similar cases.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.