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We report a case of squamous cell carcinoma of the gallbladder invading the duodenal bulb. Interestingly, only No.(5) and No.(6) lymph nodes that were regional lymph nodes of the invaded duodenum were positive for carcinoma. A 73-year-old female was admitted to the hospital because of a right hypochon-dric pain. Aspiration cytology showed squamous cell carcinoma. Hepatopancreatoduodenectomy with regional lymph node dissection was performed. The tumor was massive type with a maximum diameter of 10 cm. Histologically, entire the tumor consisted of the squamous cell carcinoma. The tumor was classified to stage IV. The operation resulted in relative non-curative operation. Four months after the operation, the patient died of recurrent liver metastases. It is characterized by that the squamous cell carcinoma of the gallbladder shows an expansive growth pattern with rare lymph node metastasis. However, once squamous cell carcinoma of the gallbladder invades the neighbouring organs like our case, regional lymph node dissection of the invaded organs should be performed. On the other hand, the agreement on the extent of combined hepatic resection is not still reached in the literarure. Further studies are needed to attain the better prognosis.

We report herein a case of malignant Schwannoma of the stomach in a 42-year-old man complaining of anal bleeding who was diagnosed accurately preoperatively by fiberoptic examination. Histopathological examination of the biopsy specimen revealed that the tumor was consisted of bundles of spindle-shaped cells with frequent mitotic figures arranged in palisading pattern. Furthermore, positivity for vimentin and S-100 protein was confirmed immunohistologically. In spite of curative total gastrectomy, liver metastases developed 10 months after the operation. Because of the lack of diagnostic criteria and prognostic indicators, there remain differences in opinions about standard operation for this disease. Metastases were almost always due to hematogeneous in a review of the literature, and lymphogeneous metastases and peritoneal dissemination were seldomly observed. Therefore, adequate removal of the tumor without extensive regional lymph node dissection can be regarded sufficient treatment of the tumor.

A patient with breast cancer without splenectomy associating with idiopathic thrombocytopenic purpura (ITP) was operated on treating with high-dose immunoglobulin therapy (400mg/kg/day) and fresh platelets (10 units/day) for 3 consecutive days pre- and postoperatively. Modified radical mas-tectomy with regional lymph node dissection (R1) was successfully performed without abnormal bleeding during the surgery. Postoperative course was uneventful without serious complications and platelet count was kept at the level around 10, 000/mm3 during the perioperative period. High-dose immunoglobulin therapy with fresh platelet infusion therapy, which can increase platelet count safely and certainly in a short time, may be most appropriate for ITP cases combined with a solid cancer without splenectomy, whereas further consideration regarding the treatment period and dosage may be needed due to the expensiveness, uncontinuanceness and dose-dependency of the drug.

We experienced a rare case of xanthogranulomatous pyelonephritis of abscess type which was difficult to differentiate from renal cell carcinoma. A 48-year-old woman was admitted to the hospital because of fever and lumbago on September 27 1988. From September 25 she had a high fever over 38°C which did not respond to oral antipyretics, and lumbago also occurred. White blood cell count was 10/vision. The patient was diagnosed as pyelonephritis. Abdominal US and CT revealed a mass in the upper pole of the right kidney, measured 4-5cm in diameter, which was irregular in the surface and was relatively isoechoic and isodensity in the inner mass. Renal angiography demonstrated a hypovascular area in the same pole. Right nephrectomy with regional lymph node dissection was performed under a tentative diagnosis of right renal cell carcinoma. The excised specimen macroscopically demonstrated a yellowish mass in the same pole which measured about 5cm in diameter, and microscopically revealed multiple microabscess and epithelioid cell granuloma. The patient was diagnosed as xanthogranulomatous pyelonephritis of abscess type. The patient has been enjoying a disease-free daily life, as of 4 years after the operation.

A 57-year-old female who found having a 18×12×8 cm extramurally growing tumor at the pyloric vestibule was treated with total gastrectomy, pancreatoduodenectomy, combined excision of colon, regional lymph node dissection, and reconstruction surgery according to Child method. In this case, human chorionic gonadotropin (HCG) level was as high as 1, 000 IU/L in the blood or 4, 900 IU/L in urine. Histologically a mixed feature of malignant ciliated epithelioma with adenoma was seen. Ovariohysterectomy was performed, and minute examination of the excised organs could confirm no malignant ciliated epithelioma. the patient was diagnosed as having a primary malignant ciliated epithelioma of the stomach. Though a total of 3 courses of postopertive VAC regimen (oncovine, cosmegen, and endoxan) was carried out, be patient died of hepatic metastasis about 6 months after surgery.A total of 14 cases of primary malignant ciliated epithelioma of the stomach, including this case in Japanese women has been reported up to now. While extramurally growing gastric cancer has been reported in 41 cases. This case is extremely rare in that the tumor is an extramurally growing gastric cancer presenting with a histologic feature of malignant ciliated epithelioma as well as producing HCG.

Questionaire survery was performed for quality of life in patients with gastric cancer who underwent resection of stomach and had no recurrent signs. Chagnes in body weight, amount of ingestion and taste hardly related to postoperative periods, cancer stages and types of operative procedures. Postoperative complaints and morbidity were more frequently observed in patients after major surgery than those after minor one. Frequency of gallstone occurrence after resection of stomach was increased in proportion to the extent of regional lymph node dissection. Almost similar operative procedure was employed for both early and advanced cancers, and entirely no difference was noted in postoperative conditions between them. These results suggest that the quality of life after resection of stomach may be further improved if more curtailed operation is performed for early gastric cancer without spoiling curability.

A 90-year-old woman with carcinoma of the gall-bladder associated with idiopathic thrombocytopenic purpura is reported. A total of 52.5 g of intact γ-globulin (400 mg/kg/day) and 20 Units of fresh platelets were administered preoperatively. Platelet counts increased from 2.3×104/mm3 to 16.9×104/mm3 after treatment. Cholecystectomy with regional lymph node dissection and splenectomy were safely performed, and the postoperative course was uneventful. The association of carcinoma with ITP is rare and only a small number of cases have been reported in the literature. These cases were collected and briefly reviewed.