Publications by authors named "Takashi Nishisaka"

49 Publications

Intussusception caused by small intestine metastasis of malignant pleural mesothelioma: a case report.

J Surg Case Rep 2021 Feb 22;2021(2):rjab003. Epub 2021 Feb 22.

Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, Hiroshima 734-8530, Japan.

Malignant pleural mesothelioma (MPM) is an aggressive form of malignant tumor that originates in the pleural mesothelioma and presents as a local disease in the affected hemithorax. Small intestine metastasis is a rare complication. Herein, the case of a patient with jejunal intussusception caused by small intestine metastasis of MPM has been reported. A 72-year-old man with MPM was admitted to our hospital for abdominal pain. Computed tomography revealed small intestine intussusception. An emergency surgery was performed, and the tumor and intussusception were located in the upper jejunum. Histopathological examination of the resected jejunum revealed that the tumor was a small intestinal metastasis of the MPM from the chest wall. This case showed that MPM may metastasize to the small intestine, and metastatic tumors may cause intussusception.
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http://dx.doi.org/10.1093/jscr/rjab003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7899189PMC
February 2021

Capecitabine Plus Bevacizumab for Cardiac Metastasis of Sigmoid Colon Cancer: Case Report and Literature Review.

In Vivo 2020 Nov-Dec;34(6):3413-3419

Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, Hiroshima, Japan.

Background/aim: Right ventricular cardiac metastasis from colorectal cancer (CRC) is rare and clinically silent. There is no standardised treatment. To date, only twelve cases have been reported in the literature. This is a case report and literature review of right ventricular cardiac metastasis from CRC.

Case Report: A 75-year-old woman with a history of CRC treated with sigmoidectomy followed by liver and lung metastasectomy presented with a right ventricle tumour. Biopsy showed metastatic adenocarcinoma not suitable for resection because multiple lung metastases coexisted. The metastases were controlled for a prolonged duration by chemotherapy with capecitabine plus bevacizumab. According to the review of 13 cases, the median age of metastatic CRC that involves the right ventricle is 71 years and the primary site is half the colon and rectum. Half of cases have non-cardiac metastases at cardiac metastasis diagnosis. Chemotherapy is more suitable than resection in cases with metastases other than heart because resection of the right ventricle has a high risk.

Conclusion: Cardiac right ventricular metastasis from CRC can be controlled by capecitabine plus bevacizumab.
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http://dx.doi.org/10.21873/invivo.12180DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7811651PMC
June 2020

Chronic kidney disease caused by maternally inherited diabetes and deafness: a case report.

CEN Case Rep 2021 May 30;10(2):220-225. Epub 2020 Oct 30.

Department of Nephrology, Hiroshima University Hospital, Hiroshima, Japan.

Maternally inherited diabetes and deafness (MIDD) is a mitochondrial genetic disorder with variable clinical presentations, which can delay its diagnosis. Herein, we report the case of a 57-year-old Japanese man with MIDD who developed chronic kidney disease. He developed proteinuria long before his diabetes and deafness; at the age of 36 years, a renal biopsy showed minor glomerular abnormality and electron microscopy showed mild mitochondrial degeneration in the distal tubular epithelial cells. Twenty years later, a second renal biopsy showed nephrosclerosis with interstitial fibrosis and arteriolar hyaline thickening, despite the absence of hypertension and relatively good glycemic control. Granular swollen epithelial cells were found in the medullary collecting duct epithelium. Electron microscopy showed accumulating mitochondria in podocytes and tubular cells, leading to the diagnosis of MIDD. A muscle biopsy also showed ragged-red fibers, despite the absence of muscle weakness. Mitochondrial DNA analysis revealed an m.3243A > G mutation, and taurine supplementation was initiated. Our findings suggest that mitochondrial dysfunction is mainly associated with progressive renal damage.
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http://dx.doi.org/10.1007/s13730-020-00547-wDOI Listing
May 2021

Recurrence- and progression-free survival in intermediate-risk non-muscle-invasive bladder cancer: the impact of conditional evaluation and subclassification.

BJU Int 2021 Apr 21;127(4):473-485. Epub 2020 Sep 21.

Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan.

Objectives: To assess the change in rates of recurrence-free survival (RFS) and progression-free survival (PFS) based on the duration of survival without recurrence or progression among patients with intermediate-risk (IR) non-muscle-invasive bladder cancer (NMIBC), and to examine the predictive factors for recurrence at different time points by assessing conditional RFS and PFS.

Participants And Methods: A cohort of 602 patients treated with transurethral resection of bladder tumour and histopathologically diagnosed with IR NMIBC was included in this retrospective study.

Results: The conditional RFS rate at 1, 2, 3, 4 and 5 years improved with increased duration of RFS; however, the conditional PFS rate did not improve over time. Multivariable analyses showed that recurrent tumour, multiple tumours, tumour size (>3 cm), immediate postoperative instillation of chemotherapy, and administration of BCG were independent predictive factors for recurrence at baseline. The predictive ability of these factors disappeared with increasing recurrence-free survivorship. Subclassification of these patients with IR NMIBC into three groups using clinicopathological factors (recurrent tumour, multiple tumours, tumour size) demonstrated that the high IR group (two factors) had significantly worse RFS than the intermediate (one factor, P < 0.001) and low IR groups (no factor, P = 0.005) at baseline. This subclassification stratified conditional risk of RFS also at 1, 3 and 5 years, which provides the basis for distinct surveillance protocols among patients with IR NMIBC.

Conclusion: Conditional survival analyses of patients with IR NMIBC demonstrate that RFS changes over time, while PFS does not change. These data support distinct surveillance protocols based on the subclassification of IR NMIBC.
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http://dx.doi.org/10.1111/bju.15209DOI Listing
April 2021

A case of a diverticulum-like giant jejunal gastrointestinal stromal tumour presenting with intraperitoneal peritonitis due to rupture.

Int J Surg Case Rep 2020 1;69:68-71. Epub 2020 Apr 1.

Department of Pathology Clinical Laboratory, Hiroshima Prefectural Hospital, Hiroshima, Japan.

Introduction: Early diagnosis of small intestinal gastrointestinal stromal tumours (GISTs) is difficult. These tumours often present with peritonitis and intraperitoneal bleeding due to rupture. We experienced a case of a tumor that grows to 12 cm asymptomatic.

Presentation Of Case: A 46-year-old man presented with sudden abdominal pain. Computed tomography revealed free air in the abdominal cavity, a 12-cm sized dilatation in the small intestine, and pooled residues. He was diagnosed with perforation of the gastrointestinal tract, and emergency surgery was performed. Inside the abdominal cavity, approximately 500 mL of bloody ascites was observed. A diverticulum-like mass measuring approximately 12-cm long was observed on the jejunum approximately 30 cm from the Treitz ligament. There was a large hematoma inside the mass, and perforation was recognised at the neck of the diverticulum. Partial resection of the jejunum and intraperitoneal drainage were performed. Immunohistochemistry revealed that the tumour was positive for KIT and CD34, and GIST was diagnosed. The patient was discharged on postoperative day 10 without significant complications. The patient did not relapse while taking imatinib as an adjuvant chemotherapy.

Discussion: Gastrointestinal stromal tumours are the most common mesenchymal tumours of the gastrointestinal tract and may undergo increased diverticulum-like growth, as seen in this case. Local resection and proper chemotherapy increase long-term survival, suppress tumour growth, and reduce the risk of relapse.

Conclusion: Diagnosing GIST can be difficult due to the absence of clinical symptoms. It is necessary to ensure local resection and careful long-term follow-up.
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http://dx.doi.org/10.1016/j.ijscr.2020.03.017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7154945PMC
April 2020

Occurrence of Immunoglobulin G4-related Disease during Chemotherapy for Advanced Breast Cancer.

Intern Med 2020 Jul 9;59(13):1649-1654. Epub 2020 Apr 9.

Division of Clinical Oncology, Hiroshima Prefectural Hospital, Japan.

Immunoglobulin G4-related disease (IgG4-RD) is defined as an inflammatory lymphoproliferative disorder. The relationship between malignancies and IgG4-RD remains unclear. We herein present a case of IgG4-RD that occurred during chemotherapy for advanced breast cancer. In this case, it was challenging to determine which of these diseases was responsible for the patient's mediastinal lymphadenopathy. Lymphadenopathy with IgG4-RD was diagnosed by assessing the reactivity to corticosteroids, which were used as premedication in chemotherapy, over time. The administration of prednisolone, which was initiated to treat active IgG4-RD, led to stable systemic therapy for malignancy. It is imperative to assess the disease activity and consider each treatment.
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http://dx.doi.org/10.2169/internalmedicine.3386-19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7402958PMC
July 2020

Genomic Characterization of Non-Invasive Differentiated-Type Gastric Cancer in the Japanese Population.

Cancers (Basel) 2020 Feb 22;12(2). Epub 2020 Feb 22.

Department of Gastroenterology and Metabolism, Institute of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.

Background And Aims: Recent genomic characterization of gastric cancer (GC) by sequencing has revealed a large number of cancer-related genes. Research to characterize the genomic landscape of cancer has focused on established invasive cancer to develop biomarkers for therapeutic or diagnostic targets, and nearly all GC reports have been about advanced GC. The aim of this study is to identify recurrently mutated genes in non-invasive GC and, in particular, the driver mutations that are associated with the development of GC.

Methods And Results: We performed whole-exome sequencing of 19 fresh frozen specimens of differentiated-type non-invasive GC and targeted sequencing for 168 genes of 30 formalin-fixed paraffin-embedded archival specimens of differentiated-type non-invasive GC. We found that TP53 and LRP1 are significantly associated with non-invasive GC. It has been reported that LPR1 is associated with CagA autophagy in gastric mucosa. Therefore, we downloaded RNA sequence data for gastric cancer from the The Cancer Genome Atlas (TCGA) Genomic Data Commons Data Portal and examined the differences in LRP1 gene expression levels. The expression level was significantly lower in cases without LRP1 mutation than in cases with LRP1 mutation. Based on these results, fluorescent immunostaining for CagA was performed for 49 of the above samples to evaluate CagA accumulation within the cancerous tissue. Accumulation of CagA was significantly greater when an LRP1 mutation was present than without a mutation.

Conclusion: These data suggest that LRP1 mutation is an important change promoting the transformation of gastric mucosa to GC early in the carcinogenesis of cancer.
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http://dx.doi.org/10.3390/cancers12020510DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7072322PMC
February 2020

The transition of tissue inhibitor of metalloproteinases from -4 to -1 induces aggressive behavior and poor patient survival in dedifferentiated liposarcoma via YAP/TAZ activation.

Carcinogenesis 2019 Oct;40(10):1288-1297

Department of Oral and Maxillofacial Pathobiology, Basic Life Science, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.

Liposarcoma (LS) is the most common soft-tissue sarcoma. Dedifferentiated liposarcoma (DDLS) shows more aggressive biological behavior than that of well-differentiated liposarcoma (WDLS), so advanced therapeutic agents based on molecular mechanism are urgently needed. Here we show that tissue inhibitors of metalloproteinases (TIMPs) from TIMP-1 to TIMP-4 are differently expressed and regulate yes-associated protein (YAP)/transcriptional co-activator with PDZ binding motif (TAZ) in LS. Database analysis showed high TIMP-1 expression in DDLS patients correlating with poor prognosis, but high TIMP-4 expression in WDLS patients with better prognosis. Stable TIMP-1 knockdown inactivated YAP/TAZ and inhibited proliferation, colony formation and migration in DDLS cells, which was rescued by a constitutive active YAP. However, stable overexpression of TIMP-1 showed the opposite in WDLS cells. Stable TIMP-4 knockdown activated YAP/TAZ and promoted proliferation and migration in WDLS cells, which was suppressed by YAP/TAZ inhibitor (verteporfin) or knockdown of YAP/TAZ. Recombinant TIMP-4 showed opposite results in DDLS cells. These results indicate that dedifferentiation in LS shifts the expression of TIMPs from type 4 to type 1, inducing more aggressive behavior and poor prognosis through YAP/TAZ activation, which can be prognostic markers and therapeutic targets for LS patients.
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http://dx.doi.org/10.1093/carcin/bgz023DOI Listing
October 2019

Lymphoepithelial cyst of the pancreas: A case report and summary of imaging features of pancreatic cysts.

Int J Surg Case Rep 2019 30;55:192-195. Epub 2019 Jan 30.

Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, Japan; Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, Japan.

Introduction: A lymphoepithelial cyst (LEC) of the pancreas is a benign and rare lesion that is difficult to diagnose preoperatively based on imaging studies.

Presentation Of Case: We report a case of a 49-year-old man who presented with weight loss and diarrhea. The serum carcinoembryonic antigen and carbohydrate antigen 19-9 levels were slightly elevated to 6.7 ng/mL (reference value <5.0 ng/mL) and 45 U/mL (reference value <37 U/mL), respectively. Computed tomography showed a large cystic mass with internal septa in the pancreatic tail. The cystic wall and the septa showed enhancement while the cystic contents remained unenhanced. Magnetic resonance imaging (MRI) demonstrated a multiple-ball-like lesion with low signal intensity on T1-weighted image and high signal intensity on T2-weighted image. Diffusion-weighted MRI showed high signal intensity in the central and iso-signal intensity in the peripheral portions of the cystic lesion. The cystic wall and septa showed high signal intensity, and the cystic contents showed low signal intensity on an enhanced MRI. Endoscopic ultrasonography showed a cyst with multiple high-echoic lesions in the pancreatic tail. A mucinous cystic neoplasm and branch duct intraductal papillary mucinous neoplasm were considered among the differential diagnoses, and we performed distal pancreatectomy with concomitant splenectomy and lymphadenectomy for both diagnostic and therapeutic purposes. Histopathological findings revealed that the cystic wall was lined by stratified squamous epithelium, and several lymphoid follicles and a few sebaceous glands were observed within the cystic wall without hair follicles, leading to the final diagnosis of an LEC.

Conclusion: We report a rare case of a pancreatic LEC, which was difficult to be diagnosed and summarize the imaging features of pancreatic cysts to differentiate from the malignancy preoperatively.
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http://dx.doi.org/10.1016/j.ijscr.2019.01.022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6374521PMC
January 2019

Synchronous double primary hepatic cancer consisting of hepatocellular carcinoma and cholangiolocellular carcinoma: a case report.

J Med Case Rep 2018 Aug 18;12(1):224. Epub 2018 Aug 18.

Department of Gastroenterological, Breast and Transplant Surgery, Hiroshima Prefectural Hospital, Hiroshima, Japan.

Background: The incidence of synchronous double primary hepatic cancers is extremely low. Cholangiolocellular carcinoma is also a rare disease.

Case Presentation: A 58-year-old Japanese man was referred to our hospital for the treatment of multiple liver tumors revealed on computed tomography scans. He was hepatitis B and C positive and had undergone hemodialysis for 9 years due to chronic renal failure. Computed tomography scans revealed two hepatic tumors (each ≤ 1.0 cm in diameter) in segments 3 and 7. The preoperative diagnosis was multiple hepatocellular carcinomas. He underwent partial resections of his liver. The resected specimens revealed that the tumors in segments 3 and 7 were well-defined lesions of 8.0 mm and 14.0 mm, respectively. Pathological and immunohistochemical examinations confirmed the tumor in segment 3 to be a cholangiolocellular carcinoma and the tumor in segment 7 to be a hepatocellular carcinoma. Chronic inflammation could contribute to the different types of primary hepatic cancers. It may also give rise to various combinations of synchronous double primary hepatic cancer in patients with chronic liver disease.

Conclusions: We describe the sixth case of synchronous double primary hepatic cancers consisting of hepatocellular carcinoma and cholangiolocellular carcinoma in chronic damaged liver and review the literature. In patients with chronic liver disease, careful surveillance with imaging studies should be mandatory as various types of primary hepatic cancers could develop.
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http://dx.doi.org/10.1186/s13256-018-1762-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6098643PMC
August 2018

A rare case of a spontaneously ruptured secondary hepatic malignant lymphoma.

Surg Case Rep 2018 May 3;4(1):44. Epub 2018 May 3.

Department of Pathology Clinical Laboratory, Hiroshima Prefectural Hospital, Hiroshima, Japan.

Background: Although secondary liver involvement of the lymphoma is common and occurs in 50% of patients with non-Hodgkin's lymphoma, liver tumor rupture in malignant lymphoma is extremely rare. We report a case of a spontaneously ruptured secondary liver involvement of non-Hodgkin's lymphoma that was successfully treated with transcatheter arterial embolization (TAE) to obtain hemostasis, and subsequent hepatectomy and systemic chemotherapy. To the best of our knowledge, this is only the second reported case of a ruptured hepatic lymphoma.

Case Presentation: A 74-year-old man with sudden-onset right shoulder and upper quadrant pain was transferred to our hospital via an ambulance. His vital signs were stable. Contrast-enhanced computed tomography showed a large hypo-enhancing tumor (94 × 81 mm) in the posterior segment of the liver, with intratumoral extravasation and a 12 × 10 mm daughter tumor in segment 5 of the liver. Hemoperitoneum due to rupture of hepatocellular carcinoma with intratumoral hemorrhage was suspected, although the serum alpha-fetoprotein and protein induced by vitamin K absence-II levels were within normal range. TAE was used for hemostasis. Extended posterior segmentectomy including tumor resection in segment 5 was performed on day 23 after embolization. The postoperative course was uneventful. Pathological examination of the resected specimens revealed that the ruptured tumor was diffuse large B-cell lymphoma. Postoperative fluorodeoxyglucose positron emission tomography-computed tomography showed uptake in the left parotid gland, pancreas, and thoracic vertebra. Based on these findings, the final diagnosis was a ruptured secondary hepatic malignant lymphoma. Complete remission was achieved with chemotherapy. He remains alive 30 months after hepatectomy without evidence of relapse.

Conclusions: We report the first case describing a hepatic tumor rupture as the first presentation of a primary or secondary hepatic malignant lymphoma. The patient was successfully treated with TAE, hepatectomy, and subsequent systemic chemotherapy for non-Hodgkin's lymphoma.
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http://dx.doi.org/10.1186/s40792-018-0451-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5934290PMC
May 2018

Significance of lung biopsy for the definitive diagnosis of lung nodules in breast cancer patients.

Mol Clin Oncol 2018 Feb 24;8(2):250-256. Epub 2017 Nov 24.

Department of Surgical Oncology, Hiroshima University Hospital, Hiroshima, Hiroshima 734-8551, Japan.

The aim of the present study was to evaluate the significance of lung biopsy for the modification of the treatment strategy in breast cancer patients who develop lung nodules during follow-up after breast surgery. Of 53 consecutive patients who underwent lung biopsies in two institutions (Hiroshima University Hospital and Hiroshima Prefectural Hospital, Hiroshima, Japan) between 1997 and 2014, 45 underwent lung surgery and 8 underwent percutaneous or transbronchial tumor biopsy for lung nodules developing after curative surgery for breast cancer. The indications for lung biopsy included lung nodules for which a definitive diagnosis was difficult to achieve, and those for which the treatment strategy depended on the pathological diagnosis. The lung nodules were pathologically diagnosed as primary breast cancer metastases to the lungs in 25 (47%), primary malignant lung tumors in 21 (40%) and benign disease in 7 (13%) patients. Among the 25 metastatic patients confirmed by lung biopsy, phenotype discordance was observed in 6 patients (24%). A total of 3 patients with lung metastasis proven to have estrogen or progesterone receptor upregulation by lung biopsy received endocrine therapy. Univariate analysis revealed that patients with metastatic breast cancer confirmed by lung biopsy were significantly younger and had more locally advanced primary cancers diagnosed via clinical and pathological assessment compared with patients with other diseases. Therefore, mastectomy and axillary lymph node dissection were performed more frequently in the metastasis group compared with the others group. Multivariate analysis revealed that mastectomy (P<0.001) and axillary dissection (P<0.001) were independent factors predicting that the lung nodules would be metastases from breast cancer. Lung biopsy in breast cancer patients who developed lung nodules during the follow-up period after breast cancer surgery was crucial for making a definitive diagnosis and modifying the treatment strategy, which may improve the prognosis of breast cancer patients.
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http://dx.doi.org/10.3892/mco.2017.1511DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5774462PMC
February 2018

Primary biliary cholangitis metachronously complicated with combined hepatocellular carcinoma-cholangiocellular carcinoma and hepatocellular carcinoma.

World J Hepatol 2017 Dec;9(36):1378-1384

Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, Hiroshima 734-8530, Japan.

Primary biliary cholangitis (PBC) is a progressive cholestatic liver disease characterized by the presence of highly specific antimitochondrial antibodies, portal inflammation and lymphocyte-dominated destruction of the intrahepatic bile ducts, which leads to cirrhosis. While its pathogenesis remains unclear, PBC that shows histological progression to fibrosis carries a high risk of carcinogenesis; the same is true of viral liver diseases. In patients with PBC, the development of hepatocellular carcinoma (HCC) is rare; the development of combined hepatocellular carcinoma and cholangiocellular carcinoma (cHCC-CCC) is extraordinary. Herein, we report a rare case of PBC metachronously complicated by cHCC-CCC and HCC, which, to the best of our knowledge, has never been reported. We present a case report of a 74-year-old Japanese woman who was diagnosed as PBC in her 40's by using blood tests and was admitted to our department for further management of an asymptomatic liver mass. She had a tumor of 15 mm in size in segment 8 of the liver and underwent a partial resection of the liver. Subsequent pathological findings resulted in the diagnosis of cHCC-CCC, arising from stage 3 PBC. One year after the initial hepatectomy, a second tumor of 10 mm in diameter was found in segment 5 of the liver; a partial resection of the liver was performed. Subsequent pathological findings led to HCC diagnosis. The component of HCC in the initial tumor displayed a trabecular growth pattern while the second HCC showed a pseudoglandular growth pattern, suggesting that metachronous tumors that arise from PBC are multicentric.
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http://dx.doi.org/10.4254/wjh.v9.i36.1378DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5756729PMC
December 2017

Laparoscopic extraction of a giant peritoneal loose body: Case report and review of literature.

Int J Surg Case Rep 2017 24;39:188-191. Epub 2017 Aug 24.

Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, Japan; Hiroshima University, Japan.

Introduction: A peritoneal loose body is a rare finding and is sometimes founded incidentally during laparotomy or autopsy. A giant peritoneal loose body, measuring more than 50mm, is very rare, and only a few cases of laparoscopic extraction of these giant bodies have been reported in the literature.

Presentation Of Case: A 70-year-old man presented for evaluation of urinary frequency. He had no history of previous abdominal surgery or trauma. Computed tomography of the abdomen and pelvis showed a giant oval-shaped mass with calcification of the luminal core, measuring 58mm in diameter. Magnetic resonance imaging revealed a lesion with low intensity in T1-/T2-weighted images. Exploratory laparoscopy was performed. During the procedure, a yellow-white, oval-shaped mass with a "Boiled egg" appearance was discovered in front of the rectum. The mass was freely floating in the peritoneal cavity, without attachment to any intraperitoneal organs. The giant peritoneal loose body was extracted through a small incision, using an enlarged trocar site.

Discussion: Most peritoneal loose bodies are small, not exceeding 2cm in diameter, and are asymptomatic. Only a few cases of giant peritoneal loose bodies exceeding 5cm have been reported.

Conclusion: A giant peritoneal loose body is very rare and laparoscopic extraction was a useful technique. We report a case of a giant peritoneal loose body and review previously published series.
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http://dx.doi.org/10.1016/j.ijscr.2017.08.033DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5575440PMC
August 2017

A case of sclerosing angiomatoid nodular transformation of the spleen with increased accumulation of fluorodeoxyglucose after 5-year follow-up.

Int J Surg Case Rep 2017 21;39:9-13. Epub 2017 Jul 21.

Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, Japan; Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Japan.

Introduction: Sclerosing angiomatoid nodular transformation (SANT) of spleen is a new entity defined as a benign pathologic lesion. Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) shows weak accumulation, thereby ruling out the malignancy in preoperative diagnosis is difficult. Herein, we reported a case of shrinking SANT with increased FDG accumulation during a 5-year follow-up period, which was treated by laparoscopic splenectomy.

Presentation Of Case: A 64-year-old female had been referred to our hospital for the evaluation of a splenic tumor. Initial contrast-enhanced computed tomography (CT) showed a well-defined, and ovoid hypoattenuating lesion, measuring 52mm in diameter in the spleen. Initial PET/CT revealed accumulation of FDG in the tumor (maximum standardized uptake value [SUVmax]: 2.8). The mass was diagnosed as SANT, and the patient was followed-up every 6-12 months for 5 years. Follow-up PET/CT revealed increased accumulation of FDG (SUVmax: 3.5). As it was suspicious considering the differential diagnosis, including malignant lymphoma and inflammatory pseudotumor, she underwent laparoscopic splenectomy. The pathological results showed three types of vessels including capillaries, ectatic small veins, and sinusoids-like vessels, consistent with the features of SANT.

Discussion: A SANT may have features that resemble those of malignancy, including the growing mass and the increase of FDG accumulation.

Conclusion: Although the preoperative diagnosis of SANT is difficult, it is necessary to make a diagnosis of SANT comprehensively, even when accumulation of FDG increased slightly during the follow-up period and suggested the possibility of malignant diseases.
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http://dx.doi.org/10.1016/j.ijscr.2017.07.035DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5545820PMC
July 2017

Identification of DAB2 and Intelectin-1 as Novel Positive Immunohistochemical Markers of Epithelioid Mesothelioma by Transcriptome Microarray Analysis for Its Differentiation From Pulmonary Adenocarcinoma.

Am J Surg Pathol 2017 Aug;41(8):1045-1052

Departments of *Pathology ‡Surgery, Institute of Biomedical and Health Sciences ∥Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University †Department of Clinical Research and Laboratory, Hiroshima Prefectural Hospital #Pathologic Diagnostic Center Inc., Hiroshima, Japan ¶Department of Internal Medicine, Okayama Rosai Hospital, Okayama, Japan §Department of Pathology and Clinical Pathology, South Valley University, Qena, Egypt.

As there are currently no absolute immunohistochemical positive markers for the definite diagnosis of malignant epithelioid mesothelioma, the identification of additional "positive" markers that may facilitate this diagnosis becomes of clinical importance. Therefore, the aim of this study was to identify novel positive markers of malignant mesothelioma. Whole genome gene expression analysis was performed using RNA extracted from formalin-fixed paraffin-embedded tissue sections of epithelioid mesothelioma and pulmonary adenocarcinoma. Gene expression analysis revealed that disabled homolog 2 (DAB2) and Intelectin-1 had significantly higher expression in epithelioid mesothelioma compared with that in pulmonary adenocarcinoma. The increased mRNA expression of DAB2 and Intelectin-1 was validated by reverse transcriptase polymerase chain reaction of RNA from tumor tissue and protein expression was validated by Western blotting of 5 mesothelioma cell lines. The utility of DAB2 and Intelectin-1 in the differential diagnosis of epithelioid mesothelioma and pulmonary adenocarcinoma was examined by an immunohistochemical study of 75 cases of epithelioid mesothelioma and 67 cases of pulmonary adenocarcinoma. The positive rates of DAB2 and Intelectin-1 expression in epithelioid mesothelioma were 80.0% and 76.0%, respectively, and 3.0% and 0%, respectively, in pulmonary adenocarcinoma. Immunohistochemically, the sensitivity and specificity of DAB2 was 80% and 97% and those of Intelectin-1 were 76% and 100% for differentiation of epithelioid mesothelioma from pulmonary adenocarcinoma. In conclusion, DAB2 and Intelectin-1 are newly identified positive markers of mesothelioma and have potential to be included in future immunohistochemical marker panels for differentiation of epithelioid mesothelioma from pulmonary adenocarcinoma.
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http://dx.doi.org/10.1097/PAS.0000000000000852DOI Listing
August 2017

An adult case of lymphangioma of the hepatoduodenal ligament mimicking a hepatic cyst.

Surg Case Rep 2017 Dec 3;3(1). Epub 2017 Jan 3.

Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, 1-5-54 Ujinakanda, Minami-ku, Hiroshima, 734-8530, Japan.

Background: Intra-abdominal lymphangiomas are rare, benign tumors in adults. This report is the third documented case of a lymphangioma originating in the hepatoduodenal ligament that mimicked a simple liver cyst.

Case Presentation: A 50-year-old woman was admitted with a cystic tumor in the right lobe of her liver and underwent laparoscopic excision of the cyst. Operative findings revealed that the cyst had developed in the hepatoduodenal ligament, not in the liver. A small part of the cystic wall remained on the dorsal surface of the hepatoduodenal ligament. Immunohistochemically, the tumor cells stained positive only for D2-40, leading to a diagnosis of lymphangioma (cystic type). Six months later, a cystic tumor recurred and was completely excised via laparotomy. No recurrence was observed after the second operation.

Conclusions: The incomplete excision of the cystic tumor led us to re-operate 6 months after the first operation for the local disease recurrence.
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http://dx.doi.org/10.1186/s40792-016-0280-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5209321PMC
December 2017

Pathological complete response after neoadjuvant chemotherapy for rectal cancer with synchronous multiple liver metastases: a report of an unusual case.

Surg Case Rep 2016 Dec 30;2(1):106. Epub 2016 Sep 30.

Department of Pathology Clinical Laboratory, Hiroshima Prefectural Hospital, Hiroshima, Japan.

Background: Systemic chemotherapy for stage IV colorectal cancer has advanced markedly in the recent years. We report an unusual case of 13 synchronous liver metastases for which a pathological complete response was achieved with neoadjuvant chemotherapy (NAC) consisting of a combination of 5-fluorouracil (5-FU), oxaliplatin, leucovorin (mFOLFOX6), and bevacizumab.

Case Presentation: A 44-year-old man was diagnosed with colorectal cancer with synchronous liver metastases. We resected the primary rectal tumor first. Further, after providing NAC for hepatic metastases, lateral segmentectomy and partial resection of the liver were performed. The subsequent result was compatible with a complete pathological response. The postoperative course was uneventful, and the patient is currently alive 5 years after the first surgery without evidence of recurrence and without adjuvant chemotherapy.

Conclusions: For patients with initially resectable colorectal liver metastases, the survival benefits of NAC are still unclear. We report a rare case of 13 synchronous liver metastatic lesions from rectal cancer with a complete pathological response after neoadjuvant bevacizumab-containing chemotherapy.
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http://dx.doi.org/10.1186/s40792-016-0231-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5042956PMC
December 2016

Comparison of visual assessment and image analysis in the evaluation of Ki-67 expression and their prognostic significance in immunohistochemically defined luminal breast carcinoma.

Jpn J Clin Oncol 2016 Dec 10;46(12):1081-1087. Epub 2016 Aug 10.

Department of Anatomical Pathology, Hiroshima University Hospital, Hiroshima.

Objectives: To compare the Ki-67 labeling index value obtained through immunohistochemistry analysis by human examiners to that obtained from computer-assisted image analysis, and to establish a cut-off value for Ki-67 labeling index for each method in luminal B breast carcinoma.

Methods: Immunohistochemistry analysis for Ki-67 was performed on the formalin-fixed, paraffin-embedded tissue samples from 403 patients with primary luminal breast cancers. Whole slide images were obtained using the NanoZoomer (Hamamatsu Photonics, Hamamatsu, Japan) and thoroughly analyzed using the Definiens Tissue Studio version 1.1 (Definiens AG, Munich, Germany) to detect the percentage of positively-stained nuclei of carcinoma cells.

Results: Although a significant correlation was found between the Ki-67 labeling index obtained by manual assessment and computer-assisted image analysis (Spearman rank correlation coefficient, P < 0.01), the Ki-67 labeling index value obtained by manual assessment was significantly higher than that obtained by computer-assisted image analysis (Wilcoxon signed rank test, P < 0.0001). Disease-free survival was significantly lower in 403 patients with tumors having high Ki-67 labeling index values determined by automated analysis (cut-off value: 11.5%; P < 0.00001) and visual counting (cut-off value: 28.5%; P < 0.00001). Disease-free survival was also significantly lower in 288 patients who received adjuvant endocrine therapy alone having high Ki-67 labeling index values determined by automated analysis (cut-off value: 11.5%; P < 0.0001) and visual counting (cut-off value: 19.7%, P < 0. 0001).

Conclusions: The Ki-67 labeling index values determined by automated analysis and visual counting could equally predict disease-free survival in patients with luminal B breast carcinoma, including those who received endocrine therapy.
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http://dx.doi.org/10.1093/jjco/hyw107DOI Listing
December 2016

[Long-term survival of a patient with stage IV basaloid squamous carcinoma of the esophagus with lung metastases following combined modality therapy].

Nihon Shokakibyo Gakkai Zasshi 2015 Aug;112(8):1503-9

Department of Clinical Oncology, Hiroshima Prefectural Hospital.

A 72-year-old man visited our hospital because of dysphagia and weight loss. He was diagnosed by endoscopy with advanced (stage IV) basaloid squamous carcinoma of the thoracic esophagus. CT and CT-guided tumor biopsy revealed two lung metastases in the right upper and lower lobes, with diameters of 8 and 5 mm, respectively. The primary lesion disappeared after concurrent chemoradiotherapy consisting of 5-FU, cisplatin, and 60-Gy irradiation, which was administered for palliation of obstructive and hemorrhagic symptoms. Subsequently, eight cycles of chemotherapy were administered, resulting in a reduction in size of the metastases. However, multiple cycles of chemotherapy caused prolonged toxicity, and the metastases slightly enlarged during chemotherapy-free periods. Since the number of metastases did not change, stereotactic body radiotherapy was performed, which resulted in disappearance of the lung metastases. Five years following initial diagnosis, the patient has been doing well, with no signs of disease recurrence.
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http://dx.doi.org/10.11405/nisshoshi.112.1503DOI Listing
August 2015

Morbidly obese patient with non-alcoholic steatohepatitis-related cirrhosis who died from sepsis caused by dental infection of Porphyromonas gingivalis: A case report.

Hepatol Res 2016 Mar 25;46(3):E210-5. Epub 2015 May 25.

Department of Gastroenterology and Metabolism, Hiroshima University, Hiroshima, Japan.

Non-alcoholic steatohepatitis (NASH) is associated with increased risks of developing lifestyle-related diseases including type 2 diabetes, cardiovascular disease and cerebral vessel disease. While the two-hit hypothesis and, recently, multiple parallel hits hypothesis of NASH pathogenesis were proposed, further details have not emerged. Recently, dental infection of Porphyromonas gingivalis (P. gingivalis) has been reported as a critical risk factor for NASH progression, which acts as multiple parallel hits to induce inflammation and fibrogenic responses in steatosis. We describe here a 54-year-old woman who died from sepsis and was diagnosed with NASH. Briefly, her body mass index (BMI) at the age of 35 years old had been 25.6 kg/m(2) , but she became obese after withdrawing into her home at the age of 45 years. Severe obesity continued over 19 years without diabetes mellitus. She was admitted to our hospital due to a sudden disturbance of consciousness. On admission, her BMI was 48.5 kg/m(2) . Computed tomography revealed cirrhotic liver with massive ascites, and laboratory data indicated increased inflammatory responses, renal failure and C grade Child-Pugh classification, suggesting the diagnosis of sepsis. Also, severe periodontal disease was present, because the patient's front teeth fell out easily during intubation. Although the focus of infection was not specified, the oral flora Parvimonas micra, a periodontal pathogen, was detected in venous blood. In spite of intensive care including artificial respiration management and continuous hemodiafiltration, she died on the 43rd day after admission. Surprisingly, P. gingivalis was detected in her hepatocytes. This case may represent the significance of P. gingivalis in the progress to cirrhosis in NASH patients.
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http://dx.doi.org/10.1111/hepr.12528DOI Listing
March 2016

IgG4-related pleural disease presenting as a massive bilateral effusion.

J Bronchology Interv Pulmonol 2014 Jul;21(3):237-41

*Department of Internal Medicine, Division of Respiratory and Infectious Diseases, St Marianna University School of Medicine, Kawasaki †Department of Pathology, Hiroshima Prefectural Hospital, Hiroshima, Japan.

A 74-year-old woman with massive bilateral pleural effusion, which was exudative in nature, and with mononuclear cell predominance underwent a pleuroscopy. Parietal pleura were thickened and partly reddish in color. Biopsy specimens taken from the parietal pleura revealed lymphoplasmacytic inflammation with fibrosis. As her performance status rapidly worsened with thoracentesis, we performed bilateral pleurodesis using talc. Pathologic evaluation of the pleural biopsy specimen with immunohistochemical staining revealed 91 IgG4-positive plasma cells per high-power field and an IgG4/IgG ratio of 91%. Thus, the diagnosis of pleuritis from IgG4-related disease was established. Our case suggests that IgG4-related disease is one of the causes of pleural effusion, and it should be included in the differential diagnosis of unexplained pleuritis.
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http://dx.doi.org/10.1097/LBR.0000000000000082DOI Listing
July 2014

A Case of Gingival Metastasis from Rectal Cancer in Which Immunohistochemistry and PET-CT Were Useful for the Diagnostic Procedure.

Case Rep Oncol 2014 Jan 29;7(1):246-51. Epub 2014 Mar 29.

Division of Pathology, Hiroshima Prefectural Hospital, Hiroshima, Japan.

A 50-year-old man was referred to our hospital because of a 2-month history of painful gingival swelling. Histopathological examination of the biopsy specimen showed a metastatic adenocarcinoma, and a chest-abdominopelvic CT showed multiple metastases in the lung, liver, and spleen, but failed to demonstrate the primary tumor. He had never complained of abdominal symptoms, and physical examination did not show any abnormality in the abdomen. However, immunohistochemical staining including caudal-related homeobox transcription factor (CDX-2) of the gingival tumor and PET-CT findings strongly suggested colorectal cancer as the origin. Colonoscopy then revealed a tumor in the rectum, and systemic chemotherapy was started immediately.
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http://dx.doi.org/10.1159/000362185DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3999573PMC
January 2014

Kimura's Disease of the Orbit Successfully Treated with Radiotherapy Alone: A Case Report.

Case Rep Ophthalmol 2014 Jan 13;5(1):87-91. Epub 2014 Mar 13.

Department of Pathology, Hiroshima Prefectural Hospital, Hiroshima, Japan.

We performed radiotherapy in a 28-year-old patient with Kimura's disease of the orbit. Irradiation with 21.6 Gy was administered to the tumor bed with a single dose of 1.8 Gy in 5 weekly fractions delivered via a high-energy linear accelerator (6-MV X-ray). Complete remission of the tumor and improvements in the neurological findings were achieved. Neither tumor regrowth nor late complications were detected up to 84 months after radiotherapy. Radiotherapy is an effective treatment for Kimura's disease of the orbit.
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http://dx.doi.org/10.1159/000360789DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3985780PMC
January 2014

[A case of triple-negative breast cancer responding to multidisciplinary treatment containing bevacizumab].

Gan To Kagaku Ryoho 2014 Apr;41(4):483-6

Dept. of Gastrointestinal, Breast, and Transplantation Surgery,Hiroshima Prefectural Hospital.

We report a case of a 64-year-old woman with Stage IV breast cancer who responded well to chemotherapy containing bevacizumab. She noticed a left breast tumor with acute progression and was diagnosed as having Stage IV, estrogen receptor( ER)(-), progesterone receptor(PgR)(-), human epidermal growth factor receptor 2(HER2)(-)breast cancer (T4cN3cM1[lymph nodes]). She received 5 courses of adriamycin(60mg/m / 2)plus cyclophosphamide(600mg/m2)(AC therapy)and 4 courses of weekly paclitaxel(PTX 90mg/m / 2)plus bevacizumab(AVA 10 mg/m2)as systemic therapy. Computed tomography(CT)and magnetic resonance imaging(MRI)revealed a complete response(CR). After local resection of the breast tumor and radiation to the breast and regional lymph nodes, capecitabine therapy was initiated. Currently, at 5 months after surgery, no new lesion has been detected.
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April 2014

Primary pulmonary mucinous (colloid) adenocarcinoma with postoperative bone metastasis.

Ann Thorac Cardiovasc Surg 2014 4;20 Suppl:677-81. Epub 2014 Feb 4.

Department of Surgery, Iwakuni Minami Hospital, Iwakuni, Yamaguchi, Japan.

We describe rare primary pulmonary mucinous (colloid) adenocarcinoma in an 80-year-old man. Chest computed tomography revealed a lobulated, well-defined nodule with a diameter of 3.2 cm in the right middle lobe. Transbronchial biopsy via endobronchial ultrasound with a guide sheath did not uncover malignancy. Right middle lobectomy proceeded because the tumor was located close to the pulmonary hilum. Macroscopically, the cut surface of the nodule comprised a well demarcated area of somewhat transparent granular aggregates and a yellow-white gelatinous substance. Computed tomography findings of a solitary metastatic lesion in the left fifth costal head 28 months thereafter were consistent with those of a mucin-rich tumor, which was effectively treated by radiotherapy.
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http://dx.doi.org/10.5761/atcs.cr.13-00260DOI Listing
October 2015

Clinical significance of sIL-2R levels in B-cell lymphomas.

PLoS One 2013 13;8(11):e78730. Epub 2013 Nov 13.

Department of Hematology and Oncology, Research Institute Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan ; Division of Molecular Medicine, Aichi Cancer Center Research Institute, Nagoya, Japan ; Department of Cancer Genetics, Nagoya University Graduate School of Medicine at Aichi Cancer Center Research Institute, Nagoya, Japan.

Elevated soluble interleukin-2 receptor (sIL-2R) in sera is observed in patients with malignant lymphoma (ML). Therefore, sIL-2R is commonly used as a diagnostic and prognostic marker for ML, but the mechanisms responsible for the increase in sIL-2R levels in patients with B-cell lymphomas have not yet been elucidated. We first hypothesized that lymphoma cells expressing IL-2R and some proteinases such as matrix metalloproteinases (MMPs) in the tumor microenvironment can give rise to increased sIL-2R in sera. However, flow cytometric studies revealed that few lymphoma cells expressed IL-2R α chain (CD25) in diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma (FL), and most CD25-expressing cells in the tumor were T-cells. Distinct correlations between CD25 expression on B-lymphoma cells and sIL-2R levels were not observed. We then confirmed that MMP-9 plays an important role in producing sIL-2R in functional studies. Immunohistochemical (IHC) analysis also revealed that MMP-9 is mainly derived from tumor-associated macrophages (TAMs). We therefore evaluated the number of CD68 and CD163 positive macrophages in the tumor microenvironment using IHC analysis. A positive correlation between the levels of sIL-2R in sera and the numbers of CD68 positive macrophages in the tumor microenvironment was confirmed in FL and extranodal DLBCL. These results may be useful in understanding the pathophysiology of B-cell lymphomas.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0078730PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3827264PMC
September 2014

Spontaneous regression of primary malignant lymphoma of the prostate.

Case Rep Urol 2013 17;2013:363072. Epub 2013 Sep 17.

Department of Radiology, Hiroshima Prefectural Hospital, 1-5-54 Ujinakanda Minami-ku, Hiroshima 734-8530, Japan.

We herein report a case of primary lymphoma of the prostate, which arose in an 85-year-old male with dysuria. CT and MRI examinations demonstrated a large mass in the prostate. A transrectal ultrasound-guided biopsy of the prostate was performed. The histological examination showed diffuse large B-cell lymphoma. The large lesion in the prostate showed spontaneous regression. Spontaneous regression of primary lymphoma of the prostate has not been reported previously. The spontaneous regression of primary lymphoma of the prostate observed in this patient suggests that observation may represent a viable treatment option following a biopsy that has provided a histopathological diagnosis.
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http://dx.doi.org/10.1155/2013/363072DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3789496PMC
October 2013

Multiple retroperitoneal schwannomas mimicking adrenal tumors.

Case Rep Oncol 2012 May 8;5(2):222-8. Epub 2012 May 8.

Departments of Surgery and Hiroshima Prefectural Hospital, Hiroshima, Japan.

Schwannomas are benign tumors mostly arising from the head and neck. Retroperitoneal schwannomas are rare. Here we report the case of a 68-year-old woman with multiple retroperitoneal schwannomas. An abdominal computed tomography (CT) scan showed 1 non-enhancing mass with a low-density area, 4.6 cm in diameter, in the left adrenal region and another non-enhancing mass with a low-density area, 2.9 cm in diameter, in the para-aortic region. The patient had regularly undergone CT scans for malignant tumor screening in maintenance dialysis patients. Retrospectively, the 2 tumors had existed in the same regions in previous CT scans and had gradually increased in size. The tumors were completely resected. Pathological diagnosis of both tumors was schwannoma. When a CT scan shows a slowly growing retroperitoneal tumor with a low-density area, schwannoma should be considered. If the tumor increases in size, complete resection should be performed for pathological diagnosis.
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http://dx.doi.org/10.1159/000338973DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3369249PMC
May 2012