Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVE: The incidence of ductal carcinoma in situ (DCIS) is increasing due to more widespread mammographic screening. DCIS, the earliest form of breast cancer, is non-invasive at the time of detection. If DCIS tissues are left undetected or untreated, it can spread to the surrounding breast tissue. Thus, surgical resection is the standard treatment. Understanding the mechanism underlying the non-invasive property of DCIS could lead to more appropriate medical treatments, including nonsurgical options. DATA DESCRIPTION: We conducted a microarray-based genome-wide transcriptome analysis using DCIS specimens obtained by puncture from surgical specimens immediately after surgery.

DOI： 10.1186/s13104-021-05760-z

PubMed

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本内分泌外科学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Pathological nipple discharge (PND) is a relatively common symptom of breast cancer affecting the nipple. Mammary ductscopy (MD) allows direct visualization of the ductal lumen and collection of a cytological specimen using duct-washing cytology (DWC). Herein, we clarified the diagnostic efficacy of DWC for the detection of breast cancers with PND, compared with fine-needle aspiration cytology (FNAC). METHODS: We retrospectively examined 48 patients with PND who underwent DWC by MD (ductosccopy group; histologically determined by intraductal biopsy [IDB] or surgical specimen). The results of sensitivity and specificity of DWC were compared with that of FNAC (conventional group; histologically determined by core needle biopsy). Clinicopathological factors were compared between the ductoscopy and the conventional groups. RESULTS: Of eight histologically malignant cases in the ductoscopy group, one case was cytologically judged as malignant and three as indeterminate. Sensitivity and specificity of DWC were 50.0% and 82.5%, respectively. Malignant cases were mostly solid papillary carcinomas (SPCs), and benign cases were intraductal papillomas (IDPs). In the conventional group, sensitivity and specificity of FNAC were 88.0% and 38.2%, respectively, and malignant cases were mainly invasive carcinomas of no special type. Tumors in the ductocsopy group had more favorable prognostic features than those in the conventional group. CONCLUSION: DWC has limited diagnostic value due to the high incidence of SPC, whose cytological features are indistinguishable from IDP. As DWC alone may be unreliable, comprehensive examination with IDB and MD findings is recommended.

DOI： 10.1002/dc.24572

PubMed

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：BMC  

Background We suspected that moving a small neodymium magnet would promote migration of the magnetic tracer to the sentinel lymph node (SLN). Higher monitoring counts on the skin surface before making an incision help us detect SLNs easily and successfully. The present study evaluated the enhancement of the monitoring count on the skin surface in SLN detection based on the magnet movement in a sentinel lymph node biopsy (SNB) using superparamagnetic iron oxide (SPIO) nanoparticles. Methods After induction of general anesthesia, superparamagnetic iron oxide nanoparticles were injected sub-dermally into the subareolar area or peritumorally. The neodymium magnet was moved over the skin from the injection site to the axilla to promote migration of the magnetic tracer without massage. A total of 62 patients were enrolled from February 2018 to November 2018: 13 cases were subjected to magnet movement 20 times (Group A), 8 were subjected to 1-min magnet movement (Group B), 26 were given a short (about 5 min) interval from injection to 1-min magnet movement (Group C), and 15 were given a long (about 25 min) interval before 1-min magnet movement using the magnetometer's head (Group D). In all cases, an SNB was conducted using both the radioisotope (RI) and SPIO methods. The monitoring counts on the skin surface were measured by a handheld magnetometer and compared among the four groups. Changes in the monitoring count by the interval and magnet movement were evaluated. Results The identification rates of the SPIO and RI methods were 100 and 95.2%, respectively. The mean monitoring counts of Group A, B, C, and D were 2.39 mu T, 2.73 mu T, 3.15 mu T, and 3.92 mu T, respectively (p < 0.0001; Kruskal-Wallis test). The monitoring counts were higher with longer magnet movement and with the insertion of an interval. Although there were no relationships between the monitoring count on the skin surface and clinicopathologic factors, magnet movement strongly influenced the monitoring count on the skin surface. Conclusion Moving a small neodymium magnet is effective for promoting migration of a magnetic tracer and increasing monitoring counts on the skin surface.

DOI： 10.1186/s12880-020-00459-2

Web of Science

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Language：Japanese   Publisher：(株)篠原出版新社  

Solid Papillary Carcinoma(SPC)の特徴を手術症例と乳管内視鏡施行例を用いて臨床病理学的に検討した。2015年7月〜2019年6月の乳癌手術例389例中、SPCは18例(4.6%)であった。SPCの平均年齢は57.1歳で、分布は若年と高齢の2つのピークを持っていた。診断契機は乳頭分泌10、腫瘤8で、術式は部分切除10、乳房切除8であった。平均浸潤径はSPCが0.24cm、浸潤性乳管癌が1.89cmで、平均進展径はSPCが3.98cm、非浸潤性乳管癌が3.38cmであった。同時期の乳管内視鏡施行例112例中、乳癌は18例で、うちSPCは11例(61.1%)であった。SPCの内視鏡所見は乳管内乳頭腫との鑑別が困難であった。SPCは乳頭分泌で診断されることが多く、乳管内進展傾向が強いが、限局する症例もあるので部分切除も可能である。(著者抄録)

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Language：Japanese   Publisher：(株)篠原出版新社  

乳房部分切除の断端陰性率に影響を及ぼす因子について検討した。2017年4月〜2019年2月に乳房部分切除を施行した原発性乳癌92例を対象とした。病変などの位置情報をもとに水系エマルジョン樹脂塗料で切除範囲の模型を作製し、点墨で使用した。標本上、全切片で断端から5mm以上の距離が確保された場合を陰性と判定した。模型上の病変の数といった情報や臨床病理学的因子と断端陰性率との関連を検討した。断端陰性率は53.3%であった。模型上の病変数の増加とともに、断端陰性率は有意に低下した。組織型や核グレードも断端陰性率に関連した。単一病変の症例比の増加と切除技術向上に伴う単一病変の断端陰性率の向上により、経時的に断端陰性率は上昇した。(著者抄録)

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：(一社)日本内分泌外科学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本内分泌外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：(公社)日本人間ドック学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本胃癌学会  

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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J-GLOBAL

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Language：Japanese   Publisher：(株)日本臨床社  

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Language：Japanese   Publisher：日本臨床外科学会  

症例は40歳,女性.嘔気のため近医を受診し,CTで腹腔内腫瘤を指摘され,精査加療目的に当科紹介.腹部造影CTで胃大彎に接して大網に32mm大および12mm大の連続する腫瘤を認めた.EUSでは内部が均一で血流豊富な低エコー腫瘤を認め,EUS-FNAでリンパ濾胞由来と思われるリンパ球を認めた.GISTまたはリンパ腫が疑われ,腫瘤の確定診断および治療目的にて腹腔鏡下大網腫瘍摘出術を行った.術中所見から腫瘤は胃と連続性はなく,腫瘤とその近傍の腫脹したリンパ節を摘出した.病理組織学的検査でCastleman病と診断され,術後約2年,再発なく経過良好である.Castleman病は腹腔内に発生するのは3.2%といわれ,その中でも大網発生は稀である.今回,われわれは大網腫瘤に対して診断的治療として腹腔鏡手術を行ったCastleman病の1例を経験したので報告する.(著者抄録)

DOI： 10.3919/jjsa.78.602

CiNii Books

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Other Link： http://search.jamas.or.jp/link/ui/2017233545

Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Language：Japanese   Publisher：(一社)日本腹部救急医学会  

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Language：Japanese   Publisher：(一社)日本腹部救急医学会  

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本腹部救急医学会  

A 65-year-old man who had been diagnosed as having hypopharyngeal and esophageal cancer was admitted to the hospital with the chief complaint of dysphagia. The patient received definitive chemoradiotherapy for the hypopharyngeal cancer, and the tumor showed complete response to the treatment. For the esophageal cancer, the patient was treated by right thoracic esophagectomy with gastric tube reconstruction through the intra-thoracic route. The thoracic duct was resected with the esophagus, and the stump of the residual thoracic duct was clipped above the diaphragm. On postoperative day （POD） 9, the chest drainage tube on the right side was removed and oral nutrition was started. However, bilateral pleural effusion was noted on POD 10. Then, chest drainage was performed again, and the drained fluid was milky and white, confirming the diagnosis of chylorrhea. Conservative therapy failed to reduce the chylorrhea. On POD 22, we decided to perform an emergency laparotomy. The lymphatic duct communication with the thoracic duct was detected on the aorta at the upper side of the pancreas, and the root of the lymphatic duct was ligated successfully. The postoperative course was uneventful and the chylorrhea was completely controlled. Then, on POD 12 after the emergency operation, after the patient resumed oral intake, the patient was discharged from the hospital.

DOI： 10.11231/jaem.35.623

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本腹部救急医学会  

症例は82歳,女性。逆流性食道炎のため内服加療中であった。逆流症状増悪,嗄声,咳嗽を自覚,当院受診。外来でショック状態となり集中治療室に入院した。誤嚥性肺炎による急性呼吸促迫症候群と診断され,呼吸器管理,昇圧剤,抗生剤投与などの加療を行った。約1週間で軽快,一般病棟へ転棟した。胸腹部CT,上部消化管造影,上部消化管内視鏡にてIII型食道裂孔ヘルニアを認め,それによる逆流が誤嚥性肺炎の原因と考えられたため,腹腔鏡下逆流防止術(Toupet法+メッシュによる食道裂孔補強)を施行した。術後経過は良好で,術後5日目に退院。入院期間は29日であった。本邦ではまだ腹腔鏡下逆流防止術は一般的ではないが,高齢者で重篤な誤嚥性肺炎を認めたIII型食道裂孔ヘルニア症例において,肺炎治療後すみやかに本手術を行うことは,逆流による肺炎の再燃を防ぐとともに早期の社会復帰を可能にする点で有用であると考えられた。(著者抄録)

DOI： 10.11231/jaem.35.275

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Other Link： http://search.jamas.or.jp/link/ui/2015236680

Language：Japanese   Publisher：日本外科系連合学会  

A 74-year-old woman was admitted to our hospital due to an abdominal tumor and subcutaneous abcess formation at the left lower abdomen. The left hypogastric lateral abdominal skin over the tumor changed into necrosis and ucleration. Computed tomography revealed an abscess in the abdominal wall and contiguous mass to the pelvic tumor. Colonoscopy showed a tumor not entirely visible in sigmoid colon. The stricture was so severe that the fiberscope could not pass through it. We conducted sigmoidectomy (D3) with abdominal wall and skin resection. Resected specimen showed a 80×75mm sized type 5 tumor at the sigmoid colon, and the cut surface of an extra growing tumor. Pathological diagnosis was a well-differentiated adenocarcinoma, and it revealed that the tumor cells and abscess were close to the abdominal wall muscle layer.

DOI： 10.4030/jjcs.40.85

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Language：Japanese   Publisher：Japanese Society of Gastroenterological Surgery  

A 67-year-old man was seen for lower abdominal pain and hospitalized. Pressure pain and a palpable mass were present in the lower left abdomen, and hematology tests showed severe inflammatory signs, with a leukocyte count of 20,600 cells/μl, and C-reactive protein at 14 mg/dl. Abdominal CT showed multiple sigmoid colon diverticula, wall thickening, and increased concentration of adipose tissue in the surrounding area, so a diagnosis of diverticulitis was made, and the patient was admitted to the hospital as an emergency case. Endoscopic examination of the large intestine showed partial circumferential stenosis and edematous changes and reddening on the mucosal surface in the sigmoid colon, and the endoscope could not pass through this region. Biopsy showed no signs of malignancy. Conservative treatment was carried out, but abdominal pain and inflammatory signs recurred, so sigmoidectomy was performed. Histological tests showed type-4 sigmoid colon carcinoma (tub1, SS, and N2). In particular, welldifferentiated adenocarcinoma extended and caused colonic stenosis with marked inflammatory cell infiltration and fibrosis without cancer lymphopathy, so it was thought to be the inflammatory type. A further colectomy was carried out to perform lymph node dissection, and 12 courses of mFOLFOX6 were administered as postoperative adjuvant chemotherapy, followed by monitoring with no signs of recurrence for 18 months. Recurrent diverticulitis should be considered in the differential diagnosis of type-4 colorectal carcinoma.

DOI： 10.5833/jjgs.2014.0148

Scopus

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Language：Japanese   Publisher：Japanese Society for Abdominal Emergency Medicine  

An 82-year-old woman who had been receiving treatment with a proton pump inhibitor for reflux esophagitis was admitted to our hospital for sudden respiratory symptoms. She lapsed into shock at the outpatient department and was admitted to the intensive care unit. She was diagnosed as having acute respiratory distress syndrome due to aspiration pneumonia and received intensive treatment. After recovery, a barium swallow, upper gastrointestinal endoscopy and abdominal computed tomography revealed a type Ⅲ hiatal hernia as the presumable cause of the reflux aspiration pneumonia. Laparoscopic anti-reflux surgery was performed. The postoperative course was excellent and the patient was discharged on postoperative day 5. In Japan, laparoscopic anti-reflux surgery is not commonly performed, especially in older people and high-risk patients. However, some of these patients are good candidates for surgery because the procedure can prevent reflux and the associated complication of aspiration pneumonia. In our patient, we performed the operation soon after she recovered from pneumonia. The prompt treatment shortened her hospital stay and enabled early rehabilitation.

DOI： 10.11231/jaem.35.275

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：一般社団法人 日本消化器内視鏡学会 関東支部  

A 76-year-old man was admitted to our hospital with dyspnea on exertion, diarrhea, and anemia. Abdominal ultrasonography and computed tomography showed a tumor in the abdominal cavity. Capsule endoscopy (CE) and double-balloon enteroscopy (DBE) revealed an elevated mass with an ulcer in the ileum. Histopathological examination showed a spindle-cell tumor, and the spindle cells were immunopositive for c-kit and CD34. Thus, a definitive diagnosis of gastrointestinal stromal tumor (GIST) was made before surgery. After the diagnosis was confirmed by both CE and DBE, single-incision laparoscopic surgery with partial resection of the segment of the small intestine with tumor was performed via a single 2.5-cm umbilical incision. The postoperative course was uneventful. CE and DBE may be useful diagnostic tools in patients with diseases of the small intestine.

DOI： 10.11641/pde.84.1_134

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Language：Japanese   Publisher：日本外科系連合学会  

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Language：Japanese   Publisher：(一社)日本腹部救急医学会  

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Language：Japanese   Publisher：(一社)日本腹部救急医学会  

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Language：Japanese   Publisher：(一社)日本腹部救急医学会  

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会-関東支部  

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Language：Japanese   Publisher：神奈川県医師会  

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Language：Japanese   Publisher：日本医科大学医学会  

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