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症例は68歳男性で,胃癌に対する幽門側胃切除術後,腸閉塞症を繰り返すため小腸癒着剥離術を施行し,減圧とステント目的でイレウス管を挿入した.術後空腸上部まで引き抜いたイレウス管からの排液が減らないため,イレウス管造影を行ったところ,空腸がトライツ靱帯から約15cm肛門側で完全に閉塞しており,再手術を施行した.その結果同部に順行性三筒性小腸腸重積症が認められた.腸重積症を起こしても腸閉塞の口側の腸管は拡張弛緩しており,嵌入部より口側の腸管がイレウス管で減圧されている場合には,嵌入腸管が虚血に陥らず,腹痛,下血などの特有な症状が認められないことがある.イレウス管を使用しているにも拘わらず,通過障害が遷延する場合には,たとえ腹痛,下血などの症状が出現しなくても腸重積症の合併も念頭におく必要があると考える.

54歳の女性で,平成9年9月5日に胃下部から上部に及ぶ全周性の4型の癌に対して膵体尾部脾合併切除を伴う胃全摘術 (D3), 胆嚢摘除術, Roux-en Y吻合を施行した.総合および病理組織学的所見は, LMU, Circ, 4, T4 (膵被膜), N1, H0, P0, CY0, M0, PM (-), DM (-), porl, sci, INFγ, ly2, v1, stage IIIb, 根治度Bであった.補助化学療法としてMTX-5Fu交代療法を施行後,外来でUFT-Eの経口投与を行っていたが,平成10年7月頃より頻尿,尿失禁の症状が出現した.膀胱壁はびまん性に肥厚し,コンプライアンスが低下し,萎縮性膀胱炎の様相を呈していたが,膀胱鏡下の生検で胃癌からの膀胱転移と診断された.胃癌からの膀胱転移は比較的稀で,播種によるものが多いとされる.手術後血尿や頻尿,尿失禁などの膀胱症状を認めるときは,膀胱への転移も念頭に置き,経過観察を行う必要がある.

A kindred with five members with papillary thyroid carcinoma is reported. The patients were three females and two males. The index patient was a 21-year-old man, whose mother had undergone a surgical therapy for papillary thyroid carcinoma in other hospital 8 years before his admission. In addition his elder brother with papillary thyroid carcinoma visited the hospital. Because of the family history, a screening study for thyroid disease was performed on other six members of the family and revealed that there were two patients with papillary thyroid carcinoma. One was a 49-year-old aunt of index patient and the other was a 79-year-old grand mother. The surgical treatments were performed for four out of these five patients in the hospital. It is believed that total thyroidectomy seems to be the choice of operation for papillary thyroid carcinoma with a familial occurrence. In these cases, however, we employed near total thyroidectomy to prevent from postoperative complications. A family screening study which may permit early detection of the disease should be continued strictly.

A case of benign multicystic mesothelioma is presented. A 41-year-old woman was seen at the hospital because of right lower abdominal pain. A tumor in the right lower quadrant was palpated. Abdominal CT revealed a huge multilocular cystic tumor covering from the subhepatic space to pelvic cavity. The patient was operated on. On gross examination, the cysts measured 17cm in diameter, and weighed 800g, were multilocular and thin-walled, and contained clear and serous fluid. On microscopic examination, the cyst wall was lined by a single layer of cuboidal to columnar cells accompanied by some hobnial-shaped cells, and no evidence of malignancy was found. Immunohistochemical staining has revealed cystoplasmic positivity within the mesothelial cells using antibodies to cytokeratin and vimentin, in addition to negative staining for Factor VIII. Most mesotheliomas of the retroperitoneum are diffuse and malignant, and localized and benign mesotheliomas are rare. Among these benign mesotheliomas of the retroperitoneum, multicystic type is specific and 25% of these mesotheliomas recur even after histologically diagnosed benign and demand a follow-up observation.

A 56-year-old female consulted our hospital because of melena. Gastrofiberscopy indicated a IIc like-advanced type gastric cancer at the cardia, and la lIc type gastric cancer at the angle. Rectalspeculum indicated a type 1 rectal cancer. A total gastrectomy (R2) and low anterior resection were performed. During the follow-up period, a cancer of the right breast was found, and a standard radical mastectomy was carried out. The number of patients with multiple primary cancer is increasing. The present case suggested that we should carefully follow up the patients with malignant tumors, considering a possible occurrence of the multiple cancers.