http://hdl.handle.net/10564/1477 2009-12 2026-04-10T15:40:12Z http://hdl.handle.net/10564/1105 タイトル: 第129回奈良医学会 : 学会記事 2009-12-30T15:00:00Z http://hdl.handle.net/10564/1104 タイトル: 胆石イレウスの1例 著者: 中辻, 直之; 八倉, 一晃; 越智, 祥隆; 吉田, 英晃 抄録: Gallstone ileus is a rare complication of cholecystolithiasis. We report a case of gallstone ileus diagnosed preoperatively by abdominal computed tomography (CT). A 57-year-old female was admitted to our hospital due to epigastric pain and vomiting. She had a history of cholecystolithiasis. Abdominal plain X-ray showed niveau and abdominal CT showed the presence of calcification round in shape (20mm in diameter) in the small intestine and cholecystoduodenal fistula. Laparotomy was performed under a diagnosis of gallstone ileus with cholecystoduodenal fistula. At exploration, a stone packed in the ileum 50cm oral from the ileum end was found and a wall-thickened gallbladder was found firmly adherent at the duodenum. We removed the impacted stone from the intestine and performed cholecystectomy and placed an omental patching after trimming the wall of the duodenum to close the cholecystoduodenal fistula. The CT findings allowed a definitive diagnosis preoperatively in this case. 2009-12-30T15:00:00Z http://hdl.handle.net/10564/1103 タイトル: 腋窩に発生したhibernomaの一例 著者: 井上, 和也; 森田, 剛平; 城戸, 顕; 朴木, 寛弥; 笠井, 孝彦; 野々村, 昭孝 抄録: This is a case report of a hibernoma arising from the axilla. The patient, a 54-year-old Japanese man, visited our hospital with the complaint of painless tumor in the left axilla. The size of the subcutaneous tumor was about 7 cm on palpation. On Magnetic Resonance Imaging (MRI), both T1-weighted and T2-weighted images of the tumor were homogenous high signal intensity, so we suspected lipoma. Subsequent MRI examination, however, revealed a non-fat part in the tumor. Because the tumor grew slowly, surgical therapy was performed to rule out malignancy. The resected tumor was 14 × 11 × 6cm in size and exhibited a greasy, brown cut surface. Histopathological examination revealed multivacuolated brown fat cells with granular cytoplasm and small, central nuclei intermixed with ordinary white fat cells. Although brown fat cells somewhat resemble lipoblasts, nuclei of brown fat cells are small, non-atypical and centrally located, and are characteristically distributed evenly through the tumor unrelated to blood vessels. Vasculatures are relatively abundant. No mitosis and atypical cells were detected. On immunohistochemical examination, brown fat cells showed cytoplasmic expression of S-100, and no nuclear expression of MDM2. A diagnosis of hibernoma was made. Correct pathological diagnosis is important to avoid an erroneous diagnosis of well-differentiated liposarcoma because "Lipoma-like" subtypes morphologi- cally bear a striking resemblance to well-differentiated liposarcoma, but hibernoma is a benign tumor that does not recur with complete local excision. MDM2 immunostaining is a useful adjunct in diagnosing well-differentiated liposarcoma. The patient has survived for 3 months since the operation, and shows good QOL under the follow-up. 2009-12-30T15:00:00Z http://hdl.handle.net/10564/1102 タイトル: Colonic adenocarcinomaに発生したcolonic moruleの一例 著者: 殿村, 晴栄; 榎本, 泰典; 山岡, 健太郎; 武田, 麻衣子; 笠井, 孝彦; 野々村, 昭孝 抄録: We report a case of colonic morules with colonic adenocarcinoma. A 69-year-old woman visited our hospital with the complaint of abdominal pain. The examination showed lower abdominal tenderness and muscular guarding. Ultrasonogra- phy and computed tomograpy showed inflanunatory change in the ileocecal region with cecal diverticula and presence of ascites. Surgical therapy was performed under a diagnosis of cecal perforation. The surgery revealed a cecal tumor which had ruptured. Iliocecal resection combined with lymph nodes dissection (D2) and peritoneal lavage was performed. Histopathological examination revealed that the cecal tumor showed well- differentiated adenocarcinoma with morular structures composed of small, oval cells with bland nuclei in a mulberry-like arrangement. On immunohistochemical examination, the morule showed nuclear overexpression of β catenin and CDX2, cytoplasmic overexpression of CD10, and no expression of cytokeratin 20. Correct pathological diagnosis is important to avoid an erroneous diagnosis of adenosquamous carcinoma because morules morphologically bear a striking resemblance to squamous metaplasia but are morphologically and qualitatively quite different from squamous metaplasia. She has survived for 1.5 years since the operation, and shows good QOL under the follow-up. 2009-12-30T15:00:00Z