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成人鼠径ヘルニアに対するmesh plug法やProlene hernia systemを用いた手術法(以下mesh法)が本当に簡便で再発率が低いかにつき従来法と比較検討を行った.対象は1984年5月から2002年7月までに当科および関連施設で治療された鼠径ヘルニア患者537症例579病変で,従来法が303症例325病変, mesh法が233症例253病変である.両群間で手術時間は差がなかったが,術後疼痛期間,術後入院期間はmesh法が有意に短く(P

Gastritis cystica polyposa (以下GCP)を伴った残胃初発癌の3症例の経験を報告した.症例1は67歳男性で,胃潰瘍術後30年で吻合部大彎側半周に芋虫状に隆起したGCPと,その大彎線上に中分化腺癌を認め,深達度はseであった.症例2は60歳男性で十二指腸潰瘍術後33年で吻合部ほぼ全周に無茎性に隆起したGCPが存在し,その大彎部分に中分化腺癌,深達度mpを認めた.症例3は36歳男性.胃潰瘍術後24年で吻合部全周および小彎縫合線に沿って脳回転様に隆起したGCPが存在し,吻合縫合両線の交点部に低分化腺癌,深達度mpを認めた.病理組織学的にはいずれのGCPも腺窩上皮の過形成,偽幽門腺の嚢胞状拡張,粘液腺の粘膜下層侵入などの特徴を備えていた.これら3例のp53染色では癌部は全例陽性,非癌非GCP結膜では全例陰性であったのに対し, GCP結膜では粘膜中層に限局して陽性細胞が散見され,発癌との関連が示唆される所見と考えた.

A 49-year-old woman, who had a pectoral muscle preserving mastectomy for a right breast cancer, revealed a swelling of supraclavicular lymph node and an increase in CEA level during clinical observation after the operation. Abdominal ultrasonography showed a mass with heterogenous echo level and 8cm in diameter at the hilum of spleen. So the patient was admitted to the hospital for close examination. Abdominal CT revealed a 14×10×8cm mass in the spleen, which was intensified but showed low density compared with that of parenchyma of the spleen. Abdominal magnetic resonance imaging (MRI) revealed iso-to mildly low signal on T1-weighted image and low signal with a high signal area on T2-weighted images. On Gd-DTPA T1-weighted image, it was a mass showing low signal in an arterial phase but slightly high signal in equilibrium phase. Angiography revealed a hypovascular tumor. Based on these imaging methods, a diagnosis of metastatic splenic tumor rather than primary tumor was made, and a splenectomy was conducted. On the resected material, the spleen was 580g in weight, 10×8×6cm in size, and yellowish white in colour which was sharply demarcated from the normal spleen. Histopathologically, the mass was mainly composed of growth of collagen fiber with infiltration of plasmacytes and lymphocytes, and no angitis nor possible malignant cells were demonstrated. The definite diagnosis of inflammatory pseudotumor was made.

Two cases of retroperitoneal cystic lymphangioma which developed similar symptoms to acute appendicitis at their onsets and were operated on with a diagnosis of appendicitis at the other hospitals are reported. Case 1: A 22-year-old female visited another hospital because of a fever and right lower quadrant pain. Regional tenderness and muscle defense were noted. Leucocytosis was marked. She underwent surgery under a diagnosis of appendicitis but her illness persisted. Later, CT and ultrasonography revealed a large cystic mass in her retroperitoneum. Case 2: A 30-year-old man was seen at another hospital because of right lower quadrant pain when a cystic lesion in the left upper abdomen was confirmed. Eight days later he had a right lower abdominal pain again and was operated on with adiagnosis of appendicitis, but only slight inflammation was noted in his appendex. One month later he again developed severe abdominal pain with peritoneal irritation and bowel paralysis. Both patients were transferred to our hospital and underwent second operation with the diagnosis of retroperitoneal cystic disease. Histological study of the resected specimens revealed cystic lymphangioma.

A 45-year-old woman presented with a left breast mass. The painless solitary tumor was palpated in the A region of the left breast. Ultrasonography revealed an internally isoechoic mass with a regular margin. Mammography visualized a light spherous tumor with a smooth margin. Histopathologically, the excised specimen was 1.5×1.2cm in size and the section was milk-white in hue and hard. At low magnification, the tumor was relatively illdefined and localized but with no capsule. Mild compression of surrounding glandular ducts was also observed. At high magnification, smooth muscle fascicular or nerve fascicular structures were seen surrounding the ducts and framework. A biphasic pattern was clear in the duct itself and neither a cytological heterotype nucleus nor mytosis was seen in the duct and surrounding cells. Muscle-actin and α-smooth muscle actin staining showed strong positive responses in the cyto-plasms of tumor cells in the vicinity of the duct. These findings confirmed that this localized tumor, growing mainly in smooth muscle cells, was a muscular hamartoma.

We have experienced a case of mucinous cystoadenocarcinoma of the vermiform appendix presenting with intussusception. A 56-year-old woman was admitted to the hospital because of a sudden onset of abdominal pain in the right lower quadrant. Ultrasonography revealed a 3×3cm cystic lesion with target like appearance in the ileocecal region. An intussusception of the vermiform appendix brought about by appendical cyst was diagnosed by preoperative barium enema, total colonofiberscope, computed tomography and angiography. Right hemicolectomy with lymph node dissection was performed, because the polipoid lesion in the cyst was suspicious of malignancy. Histopathological examination showed mucinous cystoadenocarcinoma (m, ly0, v0, n0) of the appendix. In this case, abdominal ultrasonography contributed to establish the preoperative diagnosis.

A case of leiomyosarcoma of the stomach in a 79-year-old man in presented here. The patient underwent subtotal gastrectomy for a gastric leiomyosarcoma at another hospital in 1985. At the same hospital be underwent excisions two times for metastases to the mesentery, liver (S3 and S8), and abdominal wall in 1987. Thereafter the patient underwent excisions at the hospital for metastasee to the sigmoid colon in 1990; measenterium in 1991; liver (S8) and chest wall in 1992; liver (S8) in May and the same organ (S2 and S3), mesenterium, and retroperitoneum in July 1993. The patient is alive for 8 years after 7 times operations for metastatic foci following the first operation. When the primary and metastasized lesions were compared for the numbers of karyokinesis and Ag-NORs, the both numbers were higher in the metastatic lesions than those in the primary lesion. These findings indicated that the proliferation activity of the metastatic cells was accerelated.

A 60-year-old female, noted left lower quadrant abdominal pain and genital bleeding, visited a nearly clinic of Gynecology. she was underwent an operation under a diagnosis of adnexal tumor, but was judged to be unresectable. She was referred to the hospital for chemotherapy. CT scan revealed a huge tumor which compressed a kidney, aorta and intestine. Abdominal angiography showed a hypervascular tumor, feeded by right colic artery and ileal artery. On gastrointestinal series and barium-enema, small and large intestines were compressed, without obstruction. From these findings, the tumor was thought to be resectable. The tumor weighed 4800 g and was microscopically diagnosed as malignant fibrous histiocytoma. Further operations of 2 times were necessary in order to resect the local recurrences. It seems that the best treatment option is wide surgical excision because chemotherapy provides little help at present.