研究者業績
基本情報
研究分野
1論文
102-
BMC Gastroenterology 22(1) 2022年12月The natural history of intracholecystic papillary neoplasm (ICPN), especially the speed of growth from small benign to a carcinomatous lesion, is quite unrevealed. Here, we report an extremely rare case of ICPN, in which the papillary lesion was observed transforming from small and benign to malignant using abdominal ultrasound (AUS) over 2 years during routine health checks. A 44-year-old man underwent a routine health check-up. The initial AUS showed a small sessile polyp in the gallbladder, which enlarged slightly at the next AUS, a year later. In the third year, the polypoid lesion enlarged markedly, with a maximum diameter of 10 × 9 × 7 mm. Therefore, a laparoscopic cholecystectomy was performed. Microscopically, the 10 mm tumor had intracytoplasmic mucus, and a clear cytoplasm compatible with gastric-type features. Immunohistochemical analysis showed positive staining of atypical cells for MUC6 and PAS. These findings led to the diagnosis of ICPN with high-grade intraepithelial neoplasia of the gastric type. In conclusion, sessile polyps with rapid growth might be a crucial finding in the early stage of ICPN.
-
Heterotopic ossification in primary rectal cancer with squamous cell carcinoma-like differentiation.Fujita medical journal 8(4) 134-138 2022年11月OBJECTIVES: Heterotopic ossification (HO), which occurs when bone tissue forms outside the skeleton, is extremely rare in rectal cancer. Adenocarcinoma is the histological type of all reported primary colorectal cancers with HO. However, in the present case, we observed areas of adenocarcinoma with squamous cell carcinoma-like differentiation. Here we conducted histopathological and immunohistochemical analyses to identify the mechanisms of HO development, to differentiate between adenocarcinoma and squamous cell carcinoma-like phenotypes, and to understand the associated prognostic implications. CASE REPORT: A 62-year-old woman was admitted to our hospital with symptoms of intermittent hematochezia without abdominal pain. Colonoscopy revealed stenosis with a protuberant mass in the rectum. Abdominopelvic contrast-enhanced computed tomography showed irregular wall thickness of the rectum, multiple lymph node metastases, and liver metastases. The rectal tumor exhibited calcified deposits with marked hyperintensity. We then performed Hartmann's operation and D3 lymph node resection. The biopsy specimen revealed tubular and solid adenocarcinoma nests and squamous carcinoma-like components over a necrotic extent without secreted mucin. She received chemotherapy (mFOLFOX6 with bevacizumab) as the first option and is alive 5 months after surgery. CONCLUSION: To the best of our knowledge, this is the first case of heterotopic ossification in a primary rectal cancer with squamous cell carcinoma-like differentiation that was surgically resected. This case suggests that BMP-2 transformed fibroblasts and pluripotent stem cells into osteocytes. We conclude that the squamous cell carcinoma-like lesion was squamous metaplasia of adenocarcinoma.
-
日本消化器外科学会雑誌 55(Suppl.2) 291-291 2022年10月
MISC
452-
Asian J. Endosc Surg 4(3) 143-146 2011年Hepatocellular carcinoma often arises in cirrhotic livers. Patients with severe liver cirrhosis who undergo hepatectomy often develop postoperative liver failure, even if the hepatectomy is limited. Here, we report six patients with severe liver cirrhosis (Child-Pugh B/C and indocyanine green retention rate at 15 min ≥ 40%) who underwent pure laparoscopic hepatectomy. Their perioperative course was favorable and comparable to that of other hepatocellular carcinoma patients with mild-moderate liver cirrhosis. In patients with severe liver cirrhosis, pure laparoscopic hepatectomy minimizes the disturbance in collateral blood and lymphatic flow caused by laparotomy and liver mobilization, as well as the mesenchymal injury caused by compression of the liver. It limits complications such as massive ascites, which can lead to severe postoperative liver failure. Good candidates for the procedure include patients with severe liver cirrhosis who have tumors on the liver surface and in whom adaptation to ablation therapy is difficult and/or who experience local recurrence after repeat treatments. © 2011 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and Blackwell Publishing Asia Pty Ltd.
-
消化器外科 33(9) 1455-1462 2010年8月肝予備能不良症例に対する腹腔鏡下肝切除術について検討した。対象は2005年以降に完全腹腔鏡下肝切除術を行った25例のうち、術前のインドシアニングリーン(ICG)負荷試験15分値で40%異常を示した超高度肝障害5例(男性4例、女性1例・年齢40〜68歳)であった。その結果、周術期経過は、手術時間が2時間20分〜5時間41分(中央値3時間46分)で、出血量は少量〜213ml(中央値100ml)、経口摂取開始日は第2〜3病日、ドレーン抜去日は第4〜6病日であった。また、術当日〜第3病日までのドレーン排液量は279〜1380ml、退院日は第11〜21病日であった。術後合併症は1例に胆嚢炎が認められたが、保存的に軽快した。これらの項目を他の症例(ICG15分値10.1〜27.4%)の10例と比較したところ、両群間に有意差は認められなかった。以上、肝表面で胆管や胆嚢などと接しており局所療法の困難例、数回治療後の局所再発例などの高度肝機能障害例に対する完全腹腔鏡下肝切除術は有用と考えられた。
-
肝胆膵治療研究会誌 8(1) 84-89 2010年8月症例は48歳、女性。人間ドックのUSで膵尾部に大きさ約3cmの腫瘍を指摘された。造影USで腫瘍内部のhoney-comb構造が明瞭となった。ダイナミックCTでは早期から隔壁様構造が淡く濃染された。MRCPでは多房性嚢胞性病変を認め、尾側膵管の拡張を認めた。以上から、膵漿液性嚢胞腺腫と診断し、腹腔鏡下膵体尾部・脾合併切除術を行った。病理組織所見で膵漿液性嚢胞腺腫と診断された。膵漿液性嚢胞腺腫は稀ではないが、主膵管狭窄を呈することは比較的稀であり、若干の文献的考察を加えて報告した。(著者抄録)
-
日本外科系連合会雑誌 35(1) 1-7 2010年2月目的:癌化学療法がE-セレクチンの発現に及ぼす影響と,それに対するシメチジンの抑制効果を前向き試験で明らかにする.対象と方法:胃癌6例と大腸癌8例,合計14例を対象とした.化学療法は経口フッ化ピリミジン系薬剤を使用したレジメンとし,シメチジンは6週間以上併用投与した.経時的に静脈血を採取し,血清中の可溶性E-セレクチン濃度を測定した.結果:可溶性E-セレクチン値は,化学療法単独投与で上昇し(p=0.034),化学療法とシメチジンの併用で低下した(p=0.043).さらに併用後,シメチジンのみ中止すると上昇する傾向にあった(p=0.068).結語:化学療法は血清可溶性E-セレクチン濃度を上昇させ,シメチジンはそれを抑制する効果がある.このことから,シメチジンが化学療法による易転移環境の改善に有用である可能性が示唆される.(著者抄録)
-
日本外科系連合会雑誌 34(4) 556-561 2009年8月目的:GISTの手術症例について診断,治療,予後の特徴を明らかにする.方法:2002年1月から2008年10月の間に手術を施行したGIST 25例の診断,手術,化学療法,予後について検討した.結果:年齢は61.8±13.5歳,男女比は14:11.発生臓器は胃18例,十二指腸・小腸5例,直腸2例で,腫瘍径の中央値はそれぞれ3.4cm,6.5cm,6.8cmであった.術前の組織学的な確定診断は,超音波内視鏡下穿刺吸引生検で7例中6例,通常生検4例中3例において可能であった.胃GIST症例において腹腔鏡下手術では開腹術に比べて出血量が少なく(p=0.004),術後在院期間が短かった(p=0.033).リスク分類は7例(28%)が高リスクであり,高リスク群は4年無再発生存率25.1%と不良であった.結語:胃GISTは予後がよく,術中出血量が少なく術後の早期回復が得られるので,腹腔鏡下手術のよい適応である.(著者抄録)
-
Esophagus 5(3) 149-154 2008年9月Leiomyoma is the most common submucosal tumor of the esophagus, and accurate preoperative diagnosis is difficult. We report herein on two resected cases of esophageal leiomyoma preoperatively diagnosed accurately with endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNAB). The first patient, a 34-year-old man, had complained of dysphagia. Following EUS-FNAB, the pathological diagnosis was leiomyoma. Esophagectomy and reconstruction with a gastric tube were performed because the tumor had almost completely encircled the esophageal wall. The second patient, a 60-year-old woman, had complained of dysphagia. Following EUS-FNAB, the pathological diagnosis was leiomyoma. Enucleation of the tumor was performed because the tumor was not located in the entire circumference of the esophageal wall. The postoperative course of both patients was uneventful, and the final pathological diagnosis of each case was leiomyoma. We conclude that EUS-FNAB is a useful method for diagnosing esophageal submucosal tumors and for selecting an appropriate surgical procedure. © 2008 Japan Esophageal Society and Springer.
講演・口頭発表等
91共同研究・競争的資金等の研究課題
3-
日本学術振興会 科学研究費助成事業 2004年 - 2005年
-
日本学術振興会 科学研究費助成事業 2001年 - 2002年
-
日本学術振興会 科学研究費助成事業 1999年 - 2000年