From 197'2 to 1985, 40 cases of congenital dilatation of the bile duct (CDBD) were experienced in the department of the authors. Those consisted of 19 cases of anomalous arrangement of the pancreaticobile duct (P-B anomaly), five of bile duct carcinoma, and two of gall bladder carcinoma. In addition, four patients who showed no dilatation of the bile duct in spite of the presence of a P-B anomaly were experienced, and coexistent gall bladder carcinoma was present in three of four cases. The incidence of bile duct carcinoma associated with CDBD is very high. However, coexistent gall bladder carcinoma in CDBD is a new topic, and coexistent intrahepatic bile duct carcinoma in CDBD is extremely rare. This report presents interesting and rare cases of coexistent carcinomas in these anomalies and investigates their carcinogenesis, particularly that of gall bladder carcinoma.Cancer 60:1883-1890, 1987. HE INCIDENCE OF COEXISTENT BILE DUCT carci-T noma in the dilated bile duct of congenital dilitation of the bile duct (CDBD) is very high, but recently coexistent gall bladder carcinoma in CDBD has come into the limelight. Moreover, there are some cases of pancreatico-bile duct (P-B) anomaly without dilatation of the bile duct, even though the former has been considered to be the cause of bile duct dilatation. Among such cases, reports of coexistent gall bladder carcinoma are increasing in Japan. Few reports, however, demonstrate coexistent carcinoma of the intrahepatic bile duct in congenital dilatation of the intrahepatic bile duct.The current report described the study of coexistent carcinoma in CDBD and P-B anomaly relating to the etiology and carcinogenesis of these diseases.From the *Second Department of Pathology, Nagasaki University School of Medicine, Nagasaki, Japan, THamamatsu Medical Center, Hamamatsu. Japan, #Department of Surgery, Ryukyu University School of Medicine, Okin.awa, Japan, and §Nagasaki Citizen's Hospital, Nagasaki, Japan.The authors thank Professor R. Tsuchiya, Department of Surgery, Nagasaki University School of Medicine, for his encouragement and valuable suggestions.Address for reprints: Yasuhiko Sameshima, MD, Second Department of Pathology, Nagasaki University School of Medicine, 12-4 Sakamoto, Nagasaki City, 852, Japan.Accepted for publication April 22. 1987. Case MaterialsFrom April 1972 to December 1981, 36 cases of CDBD were treated in the Surgical Department, Hamamatsu Medical Center, Japan. These consisted of 18 cases of P-B anomaly, four of bile duct carcinoma, and two of gall bladder carcinoma. Four patients who showed no dilatation of the bile duct in spite of the presence of P-B anomaly also were treated, three of which had coexistent gall bladder carcinoma.From April 1982 to December 1985, four cases of CDBD were examined pathologically in the Second Department of Pathology, Nagasaki University School of Medicine, Japan. Among these, there was one case of P-B anomaly and one of coexistent intrahepatic bile duct carcinoma.Among the 40 cases of CDBD and 23 cases of P-B anomaly, ther...

We report a rare case of metachronous and solitary metastasis to the spleen from gastric cancer. A 69-year-old man who had undergone a distal gastrectomy for gastric cancer 48 months earlier was found to have a solitary lesion in the spleen, and an increased serum carcinoembryonic antigen (CEA) level. The patient underwent a laparotomy for suspected metastasis to the spleen. At laparotomy, a tumor was found in the upper pole of the spleen without involvement of other organs, and a splenectomy was performed. Histological examination confirmed that the splenic tumor was a well-differentiated adenocarcinoma similar to the primary gastric cancer. The postoperative course was uneventful and his serum CEA decreased to within normal levels. The patient died of multiple metastases to the liver and peritoneal dissemination 40 months after the splenectomy.

Recently we treated three patients with gallbladder volvulus within a short period. All three patients were examined preoperatively using computed tomography (CT). The first two cases were not diagnosed accurately before laparotomy. A precise diagnosis was made for the third one prior to surgery, based on our former experiences. Typical images, with marked edema and thickened wall of the gallbladder volvulus were shown on CT. We discuss six consecutive cases of the disease experienced at Hamamatsu Medical Center (i.e., the three patients rofed above, and three who did not have preoperative CT).

Typically, the diagnosis of gastric anisakiasis is made at endoscopy with the identification of anisakis larvae. We report a case of gastric anisakiasis presenting as pneumoperitoneum. A 70-year-old Japanese woman was admitted to our hospital with abdominal fullness and pain. Plain chest X-ray in the upright position showed the presence of free gas below the diaphragm. A tentative diagnosis of perforation peritonitis was made and an emergency laparotomy was performed. At laparotomy, a 4 cm, circumscribed red mass was noted on the anterior wall of the upper body of the stomach near the lesser curvature and a partial gastrectomy was carried out. The histological diagnosis showed a foreign body, assumed to be a part of anisakis larvae, seen in the centre of the granuloma. On the serosal aspect, there was histological evidence of peritonitis with fibrin and neutrophils. In addition, an antianisakis larvae immunoglobulin G antibody test was positive. Chronic gastric anisakiasis was suspected because of the presence of eosinophilic granuloma in the resected area and denatured anisakis larvae. Thus, we interpret this case as gastric perforation acutely based on chronic gastric anisakiasis.

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