Biomedical subjects
Publications and source records attributed to I Yamagiwa.
The association of atresia ani with congenital colonic atresia is extremely rare, with only one such case having been reported up to date. We have recently treated a female infant with atresia ani (covered anus complete) accompanied by atresia of the sigmoid colon, who was managed by three stage surgery.
A 27-yr-old woman with carcinoma developing in the intrapancreatic terminal choledochus 12 yr after the initial excision of giant choledochal cyst with Roux-en-Y hepaticojejunostomy is reported. Despite the generally accepted concept that the presence of bile is associated with malignancy in the remnant biliary ducts after excision of a choledochal cyst, this is the first report of a malignant growth developing in the terminal choledochus which had been free from the bile exposure long after the excision of the choledochal cyst. Long-term follow-up of the patient is advisable even after operation for primary resection of the choledochal cyst.
Histopathologic study was carried out on specimen of extrahepatic biliary system in 23 patients with congenital biliary atresia, and the data were compared with those obtained from a control group of 43 autopsy cases of newborns and infants. In the control cases, accessory tubulo-alveolar glands were observed around the extrahepatic bile duct, and in addition some small ductules were observed in the area of the porta hepatis. In cases of biliary atresia, characteristic findings were histologically detected at each level of the extrahepatic biliary system. In the area of the porta hepatis, there were many epithelial luminal structures in fibrous tissue with inflammatory infiltrates. Near the confluence, the bile duct completely disappeared to be replaced by fibrosis, and in the area between the porta hepatis and the confluence, granulation tissue surrounded by fibrosis was observed. The epithelial luminal structures in the area of the porta hepatis were thought to originate from the bile duct, draining ductules and accessory glands observed in the normal controls. These structures tended to decrease in number with time. In cases possessing a patent common bile duct, the gallbladder showed many mucous glands and no inflammatory changes. On the other hand, in cases with an obliterated common bile duct, the gallbladder showed chronic atrophic cholecystitis without any mucous glands. The pathogenesis remains unknown, but it is thought that this disorder results from non-infectious inflammatory changes initiated near the confluence of the normally developed bile duct.
Because of the rarity of primary duodenal cancer, the coexistence of this disease with gastric cancer is very rare. The case presented herein suffered from two carcinomas of the duodenum and six gastric cancers. The patient was 71-year-old man who underwent subtotal gastrectomy and pancreatoduodenectomy. Pathologic studies showed that all of the gastric and one of the duodenal cancers were limited to the mucosal layer and that the other duodenal tumor invaded to the pancreas. Several cases of double cancers in the duodenum and the stomach have been reported in Japan, and this is first of multiple carcinomas of the duodenum associated with multiple gastric cancers.
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