IntroductionSinusoidal obstruction syndrome (SOS) is a severe adverse event of long-term chemotherapy in patients with colorectal cancer. It usually develops as liver congestion due to diffuse microscopic obstruction in liver parenchyma. In contrast, it sometimes appears as a liver mass occurring with local parenchymal hemorrhaging, and is often misdiagnosed as liver metastasis.Case PresentationA 40-year-old woman with rectal cancer underwent high anterior resection and partial liver resection of segment 7 due to synchronous liver metastasis. She received oxaliplatin-based chemotherapy (mFOLFOX6) as adjuvant chemotherapy for 6 months. A 13-mm irregular low-echoic mass was detected by CT in segment 3 of the liver 12 months after the operation. The mass was again resected as a liver metastasis because it had increased in size. The pathological diagnosis was focal SOS, which showed sinusoidal dilation and congestion by hepatocyte trabeculae in the liver parenchyma.ConclusionsAtypical irregular tumors should be considered as SOS when the patient has received oxaliplatin-based chemotherapy. A qualitative imaging modality diagnosis, such as with diffusion-weighted MRI, is superior to a morphological diagnosis in focal SOS. This imaging modality can prevent unnecessary operations.
Obturator hernia (OH) is a relatively rare disease and there are various surgical procedures for treating it. We report the case of a patient with an OH who underwent laparoscopic-assisted modified Kugel herniorrhaphy. The patient was a 74-year-old woman admitted to our hospital with nausea and abdominal distension. A diagnosis of intestinal obstruction was made because abdominal computed tomography revealed incarcerated right OH. No apparent strangulation findings were observed, and reduction was performed under ultrasound guidance. Laparoscopic-assisted modified Kugel herniorrhaphy for OH was performed. There were no signs of the bowel necrosis. Pneumoperitoneum was temporarily discontinued, and the OH was repaired by the modified Kugel herniorrhaphy. Laparoscopy confirmed that the direct Kugel patch was placed at the appropriate position. Laparoscopic-assisted modified Kugel herniorrhaphy is considered to be safe and useful for patients with OH and is considered as one of the treatment options.
occurred in males and 11 (20%) in females. The frequency of age was the type of normal distribution with the highest in the fifth decade. Sixty percent of the metastases resulted from the left hemisphere, because most of the tumor in the dominant hemisphere were given radiotherapy and/or chemotherapy after the decompressive craniectomy. Except two cases, all of them received various operations, and second or third operation was performed to 28 cases of them. There were two interesing cases of metastases through the ventriculo-pleural shunt. Radiotherapy were carried out to 30 cases (57%) and chemotherapy to 5 cases (9%). One year survival of metastatic cases was 25, which was longer than a mean survival time of glioblastoma multiforme. The favered sites of metastases were, in order of frequency, cervical and mediastinal lymph nodes, lung, vertebral and the other bones, and liver. Also in the operative flap and the dural venous system, which were thought to be passages of all remote metastases, there were foci of metastases in 14 cases. It was possible to classify the pathway of metastasis of glioblastoma multiforme by following types; 1) Hematogenous metastasis through blood vessels of primary tumors.2) Hematogenous metastasis through the dural vein invaded by tumor cells.3) Hematogenous and/or lymphogenous metastasis from infiltrative foci in cranium, cranial soft tissues and the other tissues surrounding central nervous system. 4) Spread through cerebro-spinal fluid. 5) Hematogenous metastasis or dissemination via ventricular drainage tube. Type I of metastasis was scarcely present, and type 3 was seen in almost all of operative cases. Metastasis of non-operative cases was seen to be occurred by type 2 or type 4. Type 5 was important, because in future such a type will be increases according as the therapy for malignant glioma would make progress.
34.Classification of Thalamic Tumor
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