The Japanese Society for the Study of Postoperative Morbidity after Gastrectomy conducted a nationwide questionnaire survey to clarify the current status of reconstruction after gastrectomy. One hundred and forty-five institutions (66%) responded to the survey. The questionnaire dealt with the reconstruction after a distal gastrectomy, pylorus-preserving gastrectomy (PPG), total gastrectomy, and proximal gastrectomy. The most common method of reconstruction after distal gastrectomy was Billroth I in 112 institutions (74%), and Roux-en-Y (RY) in 30 (21%). Seventy-seven institutions (53%) responded to the PPG questions. The lengths of the antral cuff were widely distributed among the institutions. Segmental gastrectomy was performed by 23 institutions for limited cases. The most common method of reconstruction after total gastrectomy was RY in 138 institutions (95%). Reconstruction with a pouch after total gastrectomy was done in 26 institutions (18%). The most common reconstructions after proximal gastrectomy were esophagogastrostomy in 69 institutions (48%), jejunal interposition in 41 (28%), double tract in 19 (13%) and pouch reconstruction in 6 (7%). Although most Japanese surgeons are concerned about the revised methods of reconstruction and quality of life after gastrectomy, surgeons have not yet reached a full consensus on these issues.

HighlightsA very rare case of large retroperitoneal mucinous cystadenocarcinoma and little-known clinical course of the disease is reported.The disease took unexpectedly aggressive progression despite the small portion of adenocarcinoma for the multiple and large cysts.Informative findings in imaging of primary retroperitoneal mucinous cyst adenocarcinoma, and impressive imaging after recurrence are presented.

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A Peutz-Jeghers P-J type polyp is a hamartomatous polyp that occurs in patients with P-J syndrome, but is rarely found as a solitary polyp in non-P-J syndrome patients 1 . There have been some reports of polyposis and cancerous transformation in patients with P-J syndrome, but few reports of solitary P-J type polyps containing cancer foci 2, 3 . We report here a rare case of a colorectal P-J type polyp showing the hamartoma-adenoma-carcinoma sequence in a non-Peutz-Jeghers syndrome patient. Case ReportA 48-year-old woman was admitted to our hospital for medical examination. Colonoscopy Abstract : Peutz-Jeghers P-J syndrome is an inherited disorder characterized by multiple hamartomatous gastrointestinal polyps, mucocutaneous pigmentation, and an increased risk of both digestive tract and non-digestive tract cancers. P-J type polyps are characteristic of P-J syndrome but rarely present as solitary polyps. Though cancerous lesions frequently develop from polyposis in P-J syndrome, reports of malignancy in solitary colorectal P-J type polyps are rare ; our literature search identi ed only two examples. This report describes a non-Peutz-Jeghers syndrome patient with a solitary P-J type polyp showing the hamartoma-adenoma-carcinoma sequence.

IntroductionOnly 30 cases of non-invasive intra-capsular carcinoma ex pleomorphic adenoma have been reported in the English language literature [1][2][3][4][5] . Here, we report three cases of noninvasive carcinoma ex pleomorphic adenoma and we have carried out a literature survey. Table 1-1, 1-2 Case Reports Case 1A 61-year-old man was admitted to hospital, presenting with a mass in the parotid gland. The prognosis and therapeutic appoach will depend on evidence of capsular invasion. HER-2/neu is a useful marker in the differential diagnosis of pleomorphic adenoma versus noninvasive carcinoma ex pleomorphic adenoma.

1as a premalignant condition of PA. According to their report, atypical PA exhibits at least one of following pathological ndings : hypercellularity, capsule violation, hyalinization, necrosis or cellular anaplasia. However, the immunoreactivity of atypical PA for HER2 / neu, an important immunohistochemical tool for the differential diagnosis of benign PA versus carcinoma Ca ex PA 2, 3 , is still unclear. This study investigated the pathology and HER2 / neu immunoreactivity of atypical PA, compared with Ca ex PA and benign PA. Abstract : Atypical pleomorphic adenoma PA is a premalignant condition of PA, although its immunoreactivity for HER2 / neu, which is a marker for carcinoma Ca ex PA, is still unclear. We investigated the pathology and HER2 / neu immunoreactivity of atypical PA, and compared the results with Ca ex PA and benign PA cases. The mean age of atypical PA was statistically lower and the size tended to be smaller than Ca ex PA. Pathologically, hypercellularity was observed in 10 cases of atypical PA, and 8 cases showed capsule violation. Immunohistochemically, the HER2 / neu positive ratio in hypercellular foci of atypical PA was 40 , signi cantly higher than the ratio in benign PA, and significantly lower than that in Ca ex PA. However, the ratio in capsule violation foci of atypical PA was 0 , as in benign PA. Thus, hypercellularity was considered to indicate greater potential for malignant transformation than capsular violation. Further studies are needed to determine whether atypical PA with HER2 / neu expression undergoes malignant transformation more frequently than HER2 / neu-negative atypical PA.

Here we report a rare case of Trousseau's syndrome in a patient with gastric cancer with multiple intramural metastases and metastasis to the small intestine. A 70 year-old male complaining of appetite loss and weight loss of 7 kg within 3 months was admitted to hospital. Esophagogastroduodenal endoscopy revealed an advanced gastric cancer at the pylorus almost occluding the outlet of the stomach, and multiple ulcerative lesions throughout the stomach. A biopsy showed poorly differentiated adenocarcinoma. The patient underwent total gastrectomy. During surgery, part of the distal ileum was found to be abnormally firm and approximately 1 m of the ileum with the cecum colon was resected. Pathologic examination confirmed poorly differentiated adenocarcinoma at the pylorus and multiple intramural metastases in most other areas of the stomach. Lymph node metastases were confirmed in 12 out of 40 harvested regional lymph nodes including one positive paraaortic lymph node. The resected ileum contained multiple tumors with ulceration. Massive lymphatic invasion in the stomach and the small intestine was observed, which strongly suggested lymphatic spread of the gastric cancer. The patient was discharged on post-operative day 21; however, 2 months after surgery, he developed multiple cerebral thromboembolisms and died 2 weeks later.

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