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A total of 160 cases of adenosquamous cell carcinoma of the stomach have been reported in this country so far, but the carcinoma is very rarely detected in an early stage. Our experience with such a case of early adenosquamous cell carcinoma arising in the angular notch is presented here. A 80-year-old man was pointed out an abnormality on X-ray examination of the stomach at a medical checkup, and was referred to the hospital. As a result of close examinations, he was diagnosed as having an early gastric cancer and underwent a partial excision of the stomach. The lesion was 0.8×0.4 cm in size and presented as type IIc. Histopathologically it was adenosquamous cell carcinoma. In a review of the literature, only six cases of early adenosquamous cell carcinoma of the stomach including this case are seen. This case also appeared valuable in terms of etiological discussion of this type carcinoma.

肝原発悪性混合腫瘍に肝細胞癌を併存した極めてまれな症例を経験したので報告する.患者は75歳の男性. 5年前より慢性肝炎にて近医で加療されていたが, 腹部超音波検査で肝外側区域の腫瘤を指摘され当院を紹介された. 腹部超音波およびcomputed tomography検査で肝S3およびS5に腫瘤像を認め, 肝生検でS3の病変は胆管細胞癌, S5の病変は肝細胞癌と診断された. 肝機能を考慮してS3の病変に対して亜区域切除, S5の病変に対しては術後にpercutaneous ethanol injection therapyを施行した. 術後の病理組織学的検討ではS3の病変は大部分が紡錘形細胞を主体とした肉腫成分で, 部分的に肝細胞癌成分と腺癌成分が認められた. 以上より, S3の病変は上皮系および間葉系由来の組織からなる肝原発悪性混合腫瘍と診断された. 成人の肝原発悪性混合腫瘍は本邦報告24例と極めてまれであった.

Recent experience with a case of gallbladder carcinoid with hepatic metastasis coexisting with adenocarcinoma is reported. A 63-year-old woman was admitted to the hospital because of an upper abdominal pain and vomiting. With preoperative imagings including abdominal ultrasonography, endoscopic retrograde cholangiopancreatography, and CT, the patient was diagnosed as having a gallbladder cancer. Extended cholecystectomy including hepatic metastatic lesion was carried out, and an intraarterial catheter was indwelt into the proper hepatic artery. Two bilirubin stones and a 1.5×2.5cm tumor at the fundus of the gallbladder were confirmed. Histopathological diagnosis of gallbladder carcinoid coexisting with differentiated adenocarcinoma was made. And the hepatic lesion was a metastasis from the carcinoid. Post-operative course was uneventful. There has been no sign of recurrence, as of 9 months after the operation. Gallbladder carcinoid is so rare that only 28 cases including this case have been reported in this coutry. The The disease has a poor prognosis and appears to demand treatments according to those for malignant tumors and careful follow up.

This report describes a case of adult ileocolic intussusception of unknown origin that was preoperatively diagnosed. A 56-year-old man was admitted to the hospital because of a sudden onset of pain in the right inguinal region. Plain abdominal X-ray on admission showed multiple fluid levels and dilatated intestines. Abdominal ultrasono-graphy showed target like appearance. From these findings ileus due to intussusception was suspected and the patient was immediately operated on. The operative findings revealed ileocolic intussusception and a tumor of 2cm by 2cm at the ileum outside the intussusception. Then the ileac and colonic segments involved were resected. Histopathological findings for the tumor were consistent with these of submucosal lipoma. In case of adult intussusception some organic changes such as the presence of a tumor are often associated with the intussusception. In that case the leading point is mostly the organic change. But in our patient the lipoma at the ileum was not the leading point. From these observations, it was thought that the intussusception in this case was idiopathic. Preoperative diagnostic ultrasonography appears very useful as a diagnostic measure, because it is not invasive and easy to use.

This paper presents a case of primary ileal undifferentiated carcinoma as well as a clinicopathological study of 95 cases of primary small intestinal carcinoma in Japan from 1965 to 1990. A 63-year-lld man was admitted to the hospital. Laparotomy was carried out under a diagnosis of ileus. A hard tumor was found at the ileum 150cm oral side from the Bauhin. The tumor was polypoid type with the size of 4×3cm. Histological type of the tumor was undifferentiated carcinoma (P0, H0, ss, ly2, v0 n (-), M (-), ). Curative operation was performed. Of 95 cases of primary small intestinal carcinoma, 59 lesions in the jejunum and 33 in the ileum were diagnosed histologically. Sixty-four tumors (69.6%) were found within 49cm from the Treiz and Bauhin. In these parts of the small intestin, well and moderately differentiated adenocarcinomas were dominant (87-88%). And the rate of poorly differentiated adenocarcinomas and undifferentiated carcinomas was only 12 to 13%. On the other hand, the rate of poorly differentiated adenocarcinomas and undifferentiated carcinomas increased to 35.7% in the jejunum and ileum which were over 50cm far from the Treiz and Bauhin. In 13 cases showing preoperative serum CEA level of over 5ng/ml, 9 (69.2%) were non-curatively resected. Five of the 9 cases had peritoneal dissemination, 3 liver metastasis, 2 para-aortic lymph node metastasis, and 2 severe local invasion. So it was suggested that preoperative serum CEA level would be a good marker reflecting the stage of small intestinal carcinomas.

症例は29歳の女性で, 心窩部痛を契機に胃癌が発見されたが, 本症例は生後3か月時に先天性肥厚性幽門狭窄症に対して胃空腸吻合術が行われていた.肉眼的には胃体部のBorrmann 3型であり, 胃切除術が行われたが, 術後の組織検査でow (+) と判明したため残胃全摘術が追加された.胃癌取扱い規約に従って記載すると, 組織学的には低分化型腺癌で, n (-), P0, H0, se, stage IIIであった.胃空腸吻合術後の胃癌の報告は, 本邦では自験例を含めて34例認められるが, これらを集計したところ癌発生部位は吻合部に多いことが判明した.したがって, 胃空腸吻合術後の胃癌の発生に胆汁を含む十二指腸液の胃内逆流が関与しているのではないかと推察された.

During the last 10 years, 35 cases of perforation of the small bowel were treated. 16 cases (45.7%) were due to post operative adhesive ileus, 10 (28.6%) to abdominal trauma and 4 (11.4%) to inguinal or femoral hernia. Operative mortality was 17.1%. Thirty-six hours after operation, mortality was 4.3%, but over 36 hours mortality was elevated to 41.7%. In cases of small bowel perforation due to abdominal trauma and hernia, operations were undertaken sooner than in cases of perforation, due to adhesive ileus. In these cases, prognosis was good. On the other hand, all cases of small bowel perforation due to malignant tumor and mesentery arterial thrombosis died within 30 days of operation; thus the prognosis of these cases was extremely poor. Abdominal free air, leucocytosis (over 10, 000) and muscular defense were decisive factors in undertaking operation. Leucocytosis was found in 51.4% of all cases, and abdominal free air in only 34.3%. On the other hand, muscular defense was found in 85.7%, so that it was necessary to observe the patient's condition, espcially abdominal signs, carefully.

During the last 11 years, 287 patients underwent surgery at Tottori Red Cross Hospital for primary colorectal cancer. They were divided into three groups: Non obstructed and non perforated (group I, n=240), obstructed (group II, n=34), and perforated (group III, n=13). Resectability rates were 90.4% for group I, 70.6% for group II and 92.3% for group III. Curative resectability was 76.3%, 64.7% and 84.6% and operative mortality 3.8%, 14.7% and 7.7%, respectively. Histologically, well and moderately differentiated adenocarcinoam was predominant in the obstructed and perforated groups. By the general rules for clinical and pathological studies on cancer of colon, rectum and anus, si (ai) was 25.0% and P1-3 was 29.4% in the obstructed group. The five-year survival rates of the three groups were 45.9%, 54.0% and 57.7%, respectively. Thus, even with obstructed and perforated colorectal cancer, if the operation was performed curatively, the five-year survival was quite good.

In perforated gastric cancer with peritonitis, it is necessary not only to save the patient's life but also the perform a curative operation. At Tottori Red Cross Hospital, 758 patients received surgery for gastric cancer during 10 years and 9 of them (1.2%) had perforated gastric cancer. Seven of these cases (77.8%) were resectable, but there was a large difference between the macroscopic and histological findings in them. When peritonitis due to perforation was present, the inflammatory changes interefered with accurate diagnosis of clinical stage, and we tended to diagnose more progressively. Histological stage I [n (-), ps (-)] accounted for 42.9%, and two cases of stage I who underwent curative operation were 5-and 10-year survivors. Therefore, the prognosis of perforated gastric cancer that was operated curatively was not poor.

A forign body in the intestine requires surgical treatment only when 1) there is intestinal obstruction due to the foreign body, 2) there is intestinal perforation due to the foreign body and 3) the foreign body may produce a poisonous substance. Seven cases of obstructive ileus due to foreign bodies (ingested foreign bodies: 5, persimmon bezoar: 1, fecaloma: 1) were terated surgically and analyzed clinically. In our cases, 80% of ileus due to ingested foreign bodies occurred at the ileum (within 1 m from ileal valve). Thus, it was considered that the foreign bodies were likely to be incarcerated in the ileum. Moreover, four of the seven patients (57.1%) had undergone laparotomy in the past. Thus, organic intestinal obstacles, such as adhesion and stenosis, are important factors relating to incarceration of foreign bodies in the intestine. Preoperative diagnosis was very difficult, and in many cases, laparotomy had been performed for appendicitis or ileus. This obstructive ileus due to foreign bodies is a blind point for surgical treatment.