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Two cases of pancreatic ductal adenocarcinoma with intrapancreatic metastasis

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World Journal of Gastroenterology 2016年第41期22卷 9222-9228页

作者： Yusuke Fujita Minoru Kitago Yohei Masugi Osamu Itano Masahiro Shinoda yuta abe Taizo Hibi Hiroshi Yagi Yoko Fujii-Nishimura Michiie Sakamoto Yuko Kitagawa Department of Surgery Keio University School of Medicine Department of Pathology Keio University School of Medicine

There are no standardized diagnostic criteria for intrapancreatic metastasis of pancreatic ductal adenocarcinoma(PDAC). Here, we report two cases of patients with PDAC who were pathologically diagnosed as harboring intrapancreatic metastasis. In both cases, the main lesions were located in the pancreatic body, and no other lesion was detected preoperatively. The patients were diagnosed with pancreatic body cancers and distal pancreatectomy was performed. Pathological findings revealed microscopic cancer nests, which had connections to neither the main lesion nor the premalignant lesion in the pancreatic tail parenchyma. In both cases, the histological type of the daughter lesion was quite similar to that of the main lesion. Hence, we diagnosed the daughter lesions as metastatic foci in the pancreas. Although intrapancreatic metastasis of PDAC has been regarded as a poor prognostic factor, few reports of intrapancreatic metastasis are available. This article reports two such cases and provides a review of the literature.

关键词：癌胰腺的 ductal 瘤 micrometastasis 复发 Carcinogenesis

First successful perinatal management of pregnancy after ABO-incompatible liver transplantation

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World Journal of Gastroenterology 2017年第3期23卷 547-550页

作者： Hisanobu Higashi Hideaki Obara Kei Miyakoshi Masahiro Shinoda Minoru Kitago Naoki Shimojima yuta abe Taizo Hibi Hiroshi Yagi Kentaro Matsubara Yohei Yamada Osamu Itano Ken Hoshino Tatsuo Kuroda Yuko Kitagawa Department of Surgery Keio University School of MedicineTokyo 160-8582Japan Department of Obstetrics and Gynecology Keio University School of MedicineTokyo 160-8582Japan Department of Pediatric Surgery Keio University School of MedicineTokyo 160-8582Japan

Many papers have reported on pregnancy and delivery after liver transplantation, but there have been no reports on pregnancy after ABO-incompatible liver transplantation. This paper reports the first successful pregnancy and delivery of a newborn after ABOincompatible liver transplantation for fulminant hepatic failure. The patient was a 39-year-old female. She had an ABO-incompatible liver transplantation, donated from her husband, due to subacute fulminant hepatitis of unknown etiology. She was taking tacrolimus, methylprednisolone, and mizoribine orally for the maintenance of immunosuppression at the time of discharge. She was discharged uneventfully on postoperative day 38 without any rejection episodes. At 1 year and 6 mo after transplantation, she indicated a wish to become pregnant. Therefore, treatment with mycophenolate mofetil was interrupted at that time. After two miscarriages, she finally became pregnant and delivered transvaginally 3 years after the transplantation. All of the pregnancies were conceived naturally. The newborn was female with a birth weight of 3146 g; the Apgar scores were 9 and 10. Delivery was performed smoothly, and the newborn exhibited no malformations. The mother and the newborn were discharged uneventfully. We suggest that pregnancy is possible for recipients after ABO-incompatible liver transplantation.

关键词： Pregnancy Liver transplantation Delivery Fulminant hepatic failure ABO-incompatible Living donor

Peritoneal dissemination of pancreatic cancer caused by endoscopic ultrasound-guided fine needle aspiration:A case report and literature review

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World Journal of Gastroenterology 2021年第3期27卷 294-304页

作者： Hideaki Kojima Minoru Kitago Eisuke Iwasaki Yohei Masugi Yohji Matsusaka Hiroshi Yagi yuta abe Yasushi Hasegawa Shutaro Hori Masayuki Tanaka yutaka Nakano Yusuke Takemura Seiichiro Fukuhara Yoshiyuki Ohara Michiie Sakamoto Shigeo Okuda Yuko Kitagawa Department of Surgery Keio University School of MedicineTokyo 160-8582Japan Division of Gastroenterology and Hepatology Department of Internal MedicineKeio University School of MedicineTokyo 160-8582Japan Department of Pathology Keio University School of MedicineTokyo 160-8582Japan Department of Radiology Keio University School of MedicineTokyo 160-8582Japan

BACKGROUND Endoscopic ultrasound-guided fine needle aspiration(EUS-FNA)is a biopsy technique widely used to diagnose pancreatic tumors because of its high sensitivity and specificity.Although needle-tract seeding caused by EUS-FNA has been recently reported,dissemination of pancreatic cancer cells is generally considered to be a rare complication that does not affect patient prognosis.However,the frequency of dissemination and needle-tract seeding appears to have been underestimated.We present a case of peritoneal dissemination of pancreatic cancer due to preoperative EUS-FNA.CASE SUMMARY An 81-year-old man was referred to the Department of Surgery of our hospital in Japan owing to the detection of a pancreatic mass on computed tomography during medical screening.Trans-gastric EUS-FNA revealed that the mass was an adenocarcinoma;hence laparoscopic distal pancreatectomy with lymphadenectomy was performed.No intraoperative peritoneal dissemination and liver metastasis were visually detected,and pelvic lavage cytology was negative for carcinoma cells.The postoperative surgical specimen was negative for carcinoma cells at the dissected margin and the cut end margin;however,pathological findings revealed adenocarcinoma cells on the peritoneal surface proximal to the needle puncture site,and the cells were suspected to be disseminated via EUSFNA.Hence,the patient received adjuvant therapy with S-1(tegafur,gimeracil,and oteracil potassium);however,computed tomography performed 5 mo after surgery revealed liver metastasis and cancerous peritonitis.The patient received palliative therapy and died 8 mo after the operation.CONCLUSION The indications of EUS-FNA should be carefully considered to avoid iatrogenic dissemination,especially for cancers in the pancreatic body or tail.

关键词： Case report Pancreatic carcinoma Endoscopic ultrasound-guided fine needle aspiration Peritoneal dissemination Cancerous peritonitis Biopsy

Colon perforation due to antigenemia-negative cytomegalovirus gastroenteritis after liver transplantation: A case report and review of literature

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World Journal of Gastroenterology 2019年第15期25卷 1899-1906页

作者： Takahiro Yokose Hideaki Obara Masahiro Shinoda yutaka Nakano Minoru Kitago Hiroshi Yagi yuta abe Yohei Yamada Kentaro Matsubara Go Oshima Shutaro Hori Sho Ibuki Hisanobu Higashi Yuki Masuda Masanori Hayashi Miho Kawaida Takehiko Mori Takumi Fujimura Ken Hoshino Kaori Kameyama Tatsuo Kuroda Yuko Kitagawa Department of Surgery Keio University School of Medicine Department of Pathology Keio University School of Medicine Division of Hematology Department of Medicine Keio University School of Medicine

BACKGROUND Cytomegalovirus(CMV) remains a critical complication after solid-organ transplantation. The CMV antigenemia(AG) test is useful for monitoring CMV infection. Although the AG-positivity rate in CMV gastroenteritis is known to be low at onset, almost all cases become positive during the disease course. We treated a patient with transverse colon perforation due to AG-negative CMV gastroenteritis, following a living donor liver transplantation(LDLT).CASE SUMMARY The patient was a 52-year-old woman with decompensated liver cirrhosis as a result of autoimmune hepatitis who underwent a blood-type compatible LDLT with her second son as the donor. On day 20 after surgery, upper and lower gastrointestinal endoscopy(GE) revealed multiple gastric ulcers and transverse colon ulcers. The biopsy tissue immunostaining confirmed a diagnosis of CMV gastroenteritis. On day 28 after surgery, an abdominal computed tomography revealed transverse colon perforation, and simple lavage and drainage were performed along with an urgent ileostomy. Although the repeated remission and aggravation of CMV gastroenteritis and acute cellular rejection made the control of immunosuppression difficult, the upper GE eventually revealed an improvement in the gastric ulcers, and the biopsy samples were negative for CMV. The CMV-AG test remained negative, therefore, we had to evaluate the status of the CMV infection on the basis of the clinical symptoms and GE.CONCLUSION This case report suggests a monitoring method that could be useful for AGnegative CMV gastroenteritis after a solid-organ transplantation.

关键词： Cytomegalovirus gastrointestinal disease Colon perforation Antigenemia negative Liver transplantation Case report

Pre-hepatectomy type Ⅳ collagen 7S predicts post-hepatectomy liver failure and recovery

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World Journal of Gastroenterology 2020年第7期26卷 725-739页

作者： Masatsugu Ishii Osamu Itano Masahiro Shinoda Minoru Kitago yuta abe Taizo Hibi Hiroshi Yagi Ayano Takeuchi Hanako Tsujikawa Tokiya abe Yuko Kitagawa Department of Surgery Keio University School of MedicineTokyo 160-8582Japan Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery International University of Health and Welfare School of MedicineChiba 286-8686Japan Department of Pediatric Surgery and Transplantation Kumamoto UniversityKumamoto 860-8556Japan Department of Public Health Keio University School of MedicineTokyo 160-8582Japan Department of Pathology Keio University School of MedicineTokyo 160-8582Japan

BACKGROUND Liver resection is an effective treatment for benign and malignant liver tumors.However,a method for preoperative evaluation of hepatic reserve has not yet been established.Previously reported assessments of preoperative hepatic reserve focused only on liver failure in the early postoperative period and did not consider the long-term recovery of hepatic reserve.When determining eligibility for hepatectomy,the underlying pathophysiology needs to be considered to determine if the functional hepatic reserve can withstand both surgery and any postoperative therapy.AIM To identify pre-hepatectomy factors associated with both early postoperative liver failure and long-term postoperative liver function recovery.METHODS This study was a retrospective cohort study.We retrospectively investigated 215 patients who underwent hepatectomy at our hospital between May 2013 and December 2016.Early post-hepatectomy liver failure(PHLF)was defined using the International Study Group of Liver Surgery’s definition of PHLF.Long-term postoperative recovery of liver function was defined as the time taken for serum total bilirubin and albumin levels to return to levels of2.8 g/dL,respectively,and the time taken for Child-Pugh score to return to Child-Pugh class A.RESULTS Preoperative type IV collagen 7S was identified as a significant independent factor associated with both PHLF and postoperative long-term recovery of liver function.Further analysis revealed that the time taken for the recovery of Child-Pugh scores and serum total bilirubin and albumin levels was significantly shorter in patients with type IV collagen 7S≤6 ng/mL than in those with type IV collagen 7S>6 ng/mL.In additional analyses,similar results were observed in patients without chronic viral hepatitis associated with fibrosis.CONCLUSION Preoperative type IV collagen 7S is a preoperative predictor of PHLF and longterm postoperative liver function recovery.It can also be used in patients without chronic hepatitis virus.

关键词： Hepatectomy Liver failure Type IV collagen 7S Liver fibrosis Postoperative complications Long-term postoperative liver function recovery

Helicobacter cinaedi bacteremia with cellulitis after ABO-incompatible living-donor liver transplantation: Case report

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World Journal of Gastroenterology 2015年第25期21卷 7911-7915页

作者： Kohei Mishima Hideaki Obara Kayoko Sugita Masahiro Shinoda Minoru Kitago yuta abe Taizo Hibi Hiroshi Yagi Kentaro Matsubara Takehiko Mori Yaoko Takano Hiroshi Fujiwara Osamu Itano Naoki Hasegawa Satoshi Iwata Yuko Kitagawa Department of Surgery Keio University School of Medicine Center for Infectious Diseases and Infection Control Keio University School of Medicine Division of Hematology the Department of Medicine Keio University School of Medicine Department of Infectious Diseases Keio University School of Medicine

Helicobacter cinaedi(H. cinaedi), a Gram-negative spiral-shaped bacterium, is an enterohepatic nonHelicobacter pylori Helicobacter species. We report the first case of H. cinaedi bacteremia with cellulitis after liver transplantation. A 48-year-old male, who had been a dog breeder for 15 years, underwent ABO-incompatible living-donor liver transplantation for hepatitis C virus-induced decompensated cirrhosis using an anti-hepatitis B core antibody-positive graft. The patient was preoperatively administered rituximab and underwent plasma exchange twice to overcome blood type incompatibility. After discharge, he had been doing well with immunosuppression therapy comprising cyclosporine, mycophenolate mofetil, and steroid according to the ABO-incompatible protocol of our institution. However, 7 mo after transplantation, he was admitted to our hospital with a diagnosis of recurrent cellulitis on the left lower extremity, and H. cinaedi was detected by both blood culture and polymerase chain reaction analysis. Antibiotics improved his symptoms, and he was discharged at day 30 after admission. Clinicians should be more aware of H. cinaedi in immunocompromised patients, such as ABO-incompatible transplant recipients.

关键词： Helicobacter cinaedi Bacteremia Cellulitis Liver transplantation Hepatitis C Living-donor ABOincompatible HBc-Ab-positive donor

Decreased incidence followed by comeback of pediatric infections during the COVID‑19 pandemic in Japan

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World Journal of Pediatrics 2022年第8期18卷 564-567页

作者： Cyrus Ghaznavi Haruka Sakamoto Takayuki Kawashima Sayaka Horiuchi Masahiro Ishikane Sarah Krull abe Daisuke Yoneoka Akifumi Eguchi yuta Tanoue Masahiro Hashizume Shuhei Nomura Department of Health Policy and Management School of MedicineKeio University35 ShinanomachiShinjuku-kuTokyo 160-8582Japan Medical Education Program Washington University School of Medicine in St.LouisSaint LouisUSA Department of Global Health Policy Graduate School of MedicineThe University of TokyoTokyoJapan Tokyo Foundation for Policy Research TokyoJapan Department of Hygiene and Public Health Tokyo Women’s Medical UniversityTokyoJapan Department of Mathematical and Computing Science Tokyo Institute of TechnologyTokyoJapan Center for Birth Cohort Studies University of YamanashiYamanashiJapan Disease Control and Prevention Center National Center for Global Health and MedicineTokyoJapan Division of Prevention National Cancer Center Institute for Cancer ControlTokyoJapan Infectious Disease Surveillance Center National Institute of Infectious DiseasesTokyoJapan Department of Sustainable Health Science Center for Preventive Medical SciencesChiba UniversityChibaJapan Institute for Business and Finance Waseda UniversityTokyoJapan

During the coronavirus disease 2019(COVID-19)pandemic,the Japanese government implemented several infection control measures,such as states of emergency(SoE)and school closures,and encouraged universal masking and hand hygiene.Initial activity restrictions and improved hygiene were found to be associated with declines in the incidence of infuenza during the 2019–2020 winter season[1].Prior studies have found that the incidence of seven pediatric infections,such as pharyngoconjunctivitis and varicella,decreased during and after the school closures in Japan[2].As activity restrictions continue to be lifted,there is growing concern that pediatric infections may suddenly return given that the pool of susceptible children increased during the pandemic[3].In this study,we use national infectious disease sentinel data from January 2012 to October 2021 to assess changes in the reported number of pediatric infections in Japan during the COVID-19 pandemic.We hypothesize that the reporting of many infectious diseases decreased during the early stages of the pandemic but ultimately returned to normal when activity restrictions were lifted.

关键词： closure return suddenly

Alcohol,postprandial plasma glucose,and prognosis of hepatocellular carcinoma

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World Journal of Gastroenterology 2013年第1期19卷 78-85页

作者： Hiroshi abe yuta Aida Haruya Ishiguro Kai Yoshizawa Tamihiro Miyazaki Munenori Itagaki Satoshi Sutoh Yoshio Aizawa Division of Gastroenterology and Hepatology Department of Internal MedicineJikei University School of Medicine Katsushika Medical CenterTokyo 125-8506Japan

AIM:To identify factors associated with prognosis of hepatocellular carcinoma(HCC) after initial therapy.METHODS:A total of 377 HCC patients who were newly treated at Katsushika Medical Center,Japan from January 2000 to December 2009 and followed up for > 2 years,or died during follow-up,were enrolled.The factors related to survival were first analyzed in 377 patients with HCC tumor stage T1-T4 using multivariate Cox proportional hazards regression analysis.A similar analysis was performed in 282 patients with tumor stage T1-T3.Additionally,factors associated with the period between initial and subsequent therapy were examined in 144 patients who did not show local recurrence.Finally,214 HCC stage T1-T3 patients who died during the observation period were classified into four groups according to their alcohol consumption and postprandial glucose levels,and differences in their causes of death were examined.RESULTS:On multivariate Cox proportional hazards regression analysis,the following were significantly associated with survival:underlying liver disease stage [non-cirrhosis/Child-Pugh A vs B/C,hazard ratio(HR):0.603,95% CI:0.417-0.874,P = 0.0079],HCC stage(T1/T2 vs T3/T4,HR:0.447,95% CI:0.347-0.576,P 200 mg/dL group"(log-rank test,P < 0.0

关键词： Hepatocellular carcinoma Prognosis Alcohol consumption Diabetes mellitus Postprandial plasma glucose level Initial therapy Local recurrence Survival

Serum Neutrophil Gelatinase-associated Lipocalin(NGAL)Is Elevated in Patients with Asthma and Airway Obstruction

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Current Medical Science 2021年第2期41卷 323-328页

作者： Junichiro Kawagoe yuta Kono Yuki Togashi Mayuko Ishiwari Kazutoshi Toriyama Chika Yajima Hideaki Nakayama Satoshi Kasagi Shinji abe Yasuhiro Setoguchi Deparment of Respiralory Medicine Tokyo Medical UniversityTokyo 160-0023Japan Department of Respiratory Medicine Toranomon HospitalTokyo 105-8470Japan Deparment of Respiratory Medicine Tokyo Medical and Dental UnriversityTokyo 113-8510Japan

Neutrophilic airway inflammation is one of the features of severe asthma.Neutrophil gelatinase-associated lipocalin(NGAL),or lipocalin-2,is a glycoprotein associated with neutrophilic inflammation and can be detected in blood.Recently,blood NGAL levels have been reported to be elevated in chronic obstructive pulmonary disease.However,the clinical significance of serum NGAL levels in patients with asthma has not been elucidated.The aim of this study was to explore the association between serum NGAL level and clinical parameters in patients with asthma.Sixty.one non-smoking people with stable asthma were enrolled in this study.All patients underwent blood ollction and pulmonary function tests.The associations between serum NGAL levels and clinical parameters were analyzed retrospectively.Serum NGAL levels in patients with asthma and obstructive ventilatory defect were higher than those in patients with asthma without obstructive ventilatory defect(76.4±51.4 ng/mL vs.39.3±27.4 ng/mL,P=0.0019).Serum NGAL levels were correlated with forced expired flow at 50%of vital capacity%predicted and forced expired flow at 75%of vital capacity%predicted(r=-0.3373,P=0.0078 and r=0.2900,P=0.0234,respectively).Results of a multiple regression analysis demonstrated that serum NGAL level was independently associated with obstructive ventilatory defect.Serum NGAL levels were elevated in patients with asthma and obstructive ventilatory defect.NGAL may be involved in airway remodeling possibly mediated by neutrophilic inflammation in asthma.

关键词： asthma airflow obstruction neutrophil gelatinase-associated lipocalin airway remodeling