A Case of Long-Term Surviving AFP-producing Gastric Cancer with Liver Metastases Treated by Three Liver Resections

PIVKA II産生胃癌の報告は稀である.今回肝転移を伴ったPIVKA II産生胃癌の1例を経験したので若干の文献的考察を加え報告する.症例は77歳,男性. 2004年7月の検診で胸部大動脈瘤を指摘され9月10日に当院を受診した. CT検査で胸部大動脈瘤以外に肝S6に腫瘍も認めたため,消化器臓器も精査した.血液検査でHCV抗体陽性を認めるも,肝機能異常は認めなかった.また腫瘍マーカーはAFP, PIVKA IIのみ上昇を認めた.上部消化管内視鏡検査で胃幽門後壁に3型様腫瘍を認め,胃生検検査でAFP産生胃癌と診断された.術前診断はAFP産生胃癌と,転移性または原発性肝癌と考え11月2日に幽門側胃切除術と肝右葉切除術を行った.病理学的診断は胃,肝腫瘍ともに管状組織と胞巣状増殖から構成される腺癌であった.また免疫染色ではAFP, PIVKA II染色ともに陽性であったため, PIVKA IIおよびAFP産生胃癌と診断した.

A case of pivka ii-producing gastric cancer with hepatic metastasis

胸膜肺切除術6例, 骨膜外空気充填術6例, 剥皮術7例の3群を対象とし, 臨床的検討を行った.全例手術は成功した.3群の手術時間と手術出血量, 肺活量と1秒量の術前後変化率, ス澱ア化したH慧ghJones (H-J) 分類の術前後の増減について, 統計学的検定を行った.3群の手術時間, 肺活量の変化率では, 有意差を認めなかった。出血量では, 骨膜外空気充填術群が剥皮術群より有意 (p<0.05) に多量であった.1秒量の変化率では, 胸膜肺切除術群が剥皮術群より有意 (p<0.05) に低下した.スコア化したH-J分類の増減では, 胸膜肺切除術群と剥皮術群が骨膜外空気充填術群より有意 (p<0.05) にH-J分類が改善した.3群間の検討では適用対象は異なるが, 胸膜肺切除術がH-J分類の増減について, 剥皮術は出血量, 1秒量の変化率, H-J分類の増減について優れていた.

https://www.jstage.jst.go.jp/article/jacsurg1992/8/6/8_6_692/_pdf

Pyothorax treatment; a comparison of the clinical value of pleuropneumonectomy, extra-periosteal air-plombage and decortication

A 65-year-old was admitted to the hospital because of dyspnea on exertion. There were previous histories of pulmonary tuberculosis, emphysema and right pneumothorax. Chest X-ray film showed an superior mediastinal tumor. Chest CT, MRI and Ga-scintigraphy showed the tumor originating from the thymus with metastasis to the superior mediastinal lymph nodes. It was difficult to perform transcutaneous needle biopsy and mediastinoscopy based on his radiologic studies. Therefore, surgical extirpation of the tumor was performed by median sternotomy for differential diagnosis. Although the tumor had invaded the right phrenic nerve, the surgery resulted in incomplete resection due to his reduced pulmonary function. The pathological diagnosis was non-Hodgkin lymphoma, diffuse and mixed type. Postoperatively, he received chemotherapy. For mediastinal malignant lymphoma, chemotherapy with or without radiation therapy is the treatment of choice. Surgical resection is rarely performed in the management of these patients. However, surgery should be performed for differential diagnosis, if biopsy is not feasible and the tumor is localized in the anterior mediastinum.

A surgical case of non-hodgkin lymphoma originating from the thymus

https://www.jstage.jst.go.jp/article/ringe1963/55/1/55_1_83/_pdf

A case of dumbbell tumors of type iv according to the eden' classification

症例は58歳の男性で, 32年前に右胸郭成形術を受けている.1994年1月に咳嗽, 膿性痰, 発熱を主訴として, 当院に受診した.胸部X線像上, 右有瘻性慢性膿胸と診断された.一期的根治手術として有茎性大網充填術を行い, 死腔閉鎖のため, 可及的に肋骨後方の骨膜下切除を行った.死腔は遺残したが, 術後6ヵ月経過した現在でも, 瘻症状, 感染症状はなく, 経過良好である.

https://www.jstage.jst.go.jp/article/jacsurg1992/9/2/9_2_212/_pdf

Single-stage omentopexy for chronic empyema with bronchopleural fistula ; a case report

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