Desmoid tumor is histologically a benign tumor, however, it is clinically designated as a borderline tumor between benignancy and malignancy because it locally recurs and shows an invasive growth. We report herein a case of mesenteric desmoid tumor invading the transverse colon.
A 61-year-old man was admitted to the hospital because of an abdominal mass in the right lower abdomen. The lesion was suggested to be a tumor originated in the retroperitoneum or mesentery by barium enema, ultrasonography, and computed tomography. A lapalotomy disclosed that the tumor was originated in the mesentery and invaded the transverse colon. We resected the tumor with a part of the transverse colon. The resected mass which was a 5.5×5×4cm white solid tumor was histopathologically diagnosed as intra-abdominal desmoid tumor. This desmoid tumor is thought to develop spontaneously in the patient without history of undergoing abdominal surgery or familial adenomatous polyposis, which is very rare. Further close observation is required because the tumor invaded the transverse colon.

View full abstract

The patient was a 19-year-old female with chief complaints of right upper abdominal pain and fever who was seen by a general practitioner and was prescribed with an antibiotics without improvement but continued aggravation of symptoms. Upon examination she revealed sign of peritoneal irritation on right upper abdomen. WBC count was 9, 900/μl, CRP 13.5mg/dl, normal gastroscopic study, and some ascites around the liver by sonography and CT studies without abnormal findings in the liver and gallbladder. No free air was present in the peritoneal cavity. A laparoscopic examination performed on an urgent basis revealed the presence of peritonitis, ascites and fibrinous adhesions between anterior aspect of the liver and peritoneum. Accordingly, Fitz-Hugh-Curtis syndrome was suspected and a conservative treatment with minocycline hydrochloride was started resulting rapid improvement of symptoms. Later the diagnosis was confirmed by the presence of positive serum Chlamyclia antibody. In case of peritonitis of unknown etiology in a female patient, a laparoscopic study suspecting the presence of this syndrome is important.

View full abstract

A 53-year-old male patient came to our hospital with chief complaint of an indolent mass in his right inguinal area. A diagnosis of right retroperitoneal liposarcoma was made based on image studies. The mass extended from upper portion of the right kidney down to the scrotum, surrounding the right kidney and ureter which were preserved at the time of surgery. The part of the mass in the inguinal area was removed approaching intraperitoneally including the testicle. The resected tumor measured 32×25×8cm, weighing 2, 800gr with the pathological diagnosis of differentiated liposarcoma as the major component. Residual tumor found by CT study done a month after the original surgery was removed from the inguinal area. Retroperitoneal liposarcoma presented as a mass in inguinal area is rare and only 6 cases have been reported in Japan including ours.
Among these, 3 cases needed repeated operations to remove the tumors. We believe a careful check of the content is necessary in case of a inguinal hernia that cannot be reduced manually. At the time of operation, a dual approach from peritoneal and inguinal side is helpful in certain cases.

View full abstract

A 51-year-old woman seen at the hospital because of a inguinal swelling was diagnosed as having intracystic hydrocele of left inguinal hernia and underwent the resection of the hernia sac and hernioplasty using a Prolene Hernia System (PHS). From intraoperative findings, the left inguinal hernia was diagnosed as Gilbert type 2. A grayish white, multicystic lesion about 3cm in diameter was found at the tip of the hernia sac. The cystic lesion was diagnosed pathologically as multilocular mesotherial cyst which was positive for keratin, vimentin, calretinin, and HBME-1. No recurrence has occurred during postoperative 15 months.
Peritoneal mesothelioma found during surgery for inguinal hernia israre, with only 6 cases, including ours, in Japan. When an inguinal swelling lesion can not be reduced manually into the peritoneal cavity, peritoneal mesotherioma should be kept in mind as a possible diagnosis.

View full abstract

The aneurysm of the innominate artery due to blunt trauma is rare. We report a case of traumatic aneurysm of the innominate artery caused by traffic accident. An 18-year-old man suffered a blunt chest trauma from an automobile accident. Chest X-ray revealed left tension pneumothorax. After a chest tube was inserted, the chest X-ray revealed a widening of superior mediastinum. Chest CT showed a mediastinal hematoma. Aortogram revealed aneurysmal dilatation of the proximal innominate artery. Emergency surgery was performed. An aorto-innominate artery bypass with Dacron graft was performed with a 3mm shunt tube. After resection of aneurysm, the intima was found to be completely lacerated. The proximal edge of the aneurysm was identified under partial clamp on the aortic arch. The edge was closed with 4-0 monofilament sutures. Postoperative course was uneventful. Postoperative angiogram revealed good reconstruction of innominate artery.

View full abstract