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The patient was a 43-year-old female who consulted a local physician due primarily to lower abdominal pain. She was referred to our hospital for close evaluation and treatment. Since circumferential cancer was detected in the transverse colon by lower digestive tract endoscopy, the patient was hospitalized for surgical treatment. Transverse colectomy (Cur A) was performed, histopathological examination indicated signet-ring cell carcinoma of the transverse colon, and the lesion was diagnosed as type 4, SS, ly3, v0, n1 (+), Stage III a. Postoperative adjuvant chemotherapy was recommended, but the patient was psychologically unstable and strongly rejected chemotherapy. The patient was periodically followed-up after surgery, but a mass was detected in the left ovary by CT after 1 year and 6 months, and bilateral ovariectomy was performed with a diagnosis of ovarian metastasis. The histopathological diagnosis was signet-ring cell carcinoma, and the ovarian lesions were judged to be metastases of the transverse colon carcinoma. Since the patient did not consent to postoperative chemotherapy, as after the initial surgery, she was followed-up without treatment. She was admitted with ileus due to peritoneal metastasis 4 years and 10 months after the initial surgery, and, despite of the surgery, she died due to carcinoma 5 years after the initial surgery.

Purpose: The purpose of this study was to investigate the pitfalls of using 2-[18F]-fluoro-2-deoxy-D: -glucose positron emission tomography (FDG-PET) for the evaluation of osteoblastic bone metastases in patients with breast cancer by comparing it with (99m)Tc-hydroxymethylene diphosphonate bone scintigraphy., Methods: Among the 89 breast cancer patients (mean age 59+/-15 years) who had undergone both FDG-PET and bone scintigraphy within 1 month between September 2003 and December 2004, 55 with bone metastases were studied. The bone metastases were visually classified by multi-slice CT into four types according to their degree of osteosclerosis and osteolysis-osteoblastic, osteolytic, mixed and invisible-and compared in terms of tracer uptake on FDG-PET or bone scintigraphy and SUV(mean) on FDG-PET. Differences in the rate of detection on bone scintigraphy and FDG-PET were analysed for significance by the McNemar test., Results: The sensitivity, specificity and accuracy of bone scintigraphy were 78.2%, 82.4% and 79.8% respectively, and those of FDG-PET were 80.0%, 88.2% and 83.1%, respectively, revealing no significant differences. According to the CT image type, the visualisation rate of bone scintigraphy/FDG-PET was 100%/55.6% for the blastic type, 70.0%/100.0% for the lytic type, 84.2%/94.7% for the mixed type and 25.0%/87.5% for the invisible type. The visualisation rates of bone scintigraphy for the blastic type and FDG-PET for the invisible type were significantly higher. The SUV(mean) of the blastic, lytic, mixed and invisible types were 1.72+/-0.28, 4.14+/-2.20, 2.97+/-1.98 and 2.25+/-0.80, respectively, showing that the SUV(mean) tended to be higher for the lytic type than for the blastic type., Conclusion: FDG-PET showed a low visualisation rate in respect of osteoblastic bone metastases. Although FDG-PET is useful for detection of bone metastases from breast cancer, it is apparent that it suffers from some limitations in depicting metastases of the osteoblastic type.

We developed a new sheath for selective trans-brachial and trans-femoral arteriography. This sheath has a J-shaped tip and can be inserted by the conventional Seldinger method using a linear dilator. This sheath was particularly useful for abdominal angiography via the brachial artery and pelvic arteriography via the femoral artery.

A 64-year-old women was admitted for the examination of the abdominal mass (5 X 4.5 cm) at porta hepatis with acoustic shadow on ultrasonogram. CT demonstrated peripheral calcification of the mass compressing the portal vein. Left gastric lymph nodes were enlarged and showed ring like enhancement. Those were revealed tuberculous granulomas by the exploratory laparatomy.