Papers - MIHARA Hiroshi

十二指腸転移をきたした大腸癌の1例

植田 亮, 細川 歩, 三原 弘, 安藤 孝将, 梶浦 新也, 小川 浩平, 岸 遂忠, 藤浪 斗, 西川 潤, 宮嵜 孝子, 工藤 俊彦, 折原 正周, 杉山 敏郎

腫瘍内科 ( (有)科学評論社 )  2 ( 3 ) 268 - 272  2008.06

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61歳男。3年3ヵ月前にS状結腸癌、右肺転移で手術を施行し、その7ヵ月後と2年後に肺転移で手術を施行した。10ヵ月後に縦隔および腹部リンパ節転移を認めてFOLFIRI療法で腫瘍は縮小したが、3ヵ月後より悪心・嘔吐、食欲不振が持続し、精査加療目的入院となった。肝胆道系酵素、アミラーゼ値の上昇、血清アルブミン値、コリンエステラーゼ値の低下を認め、癌胎児性抗原値の上昇を認めた。上部消化管内視鏡で十二指腸下行脚に結節性の隆起性病変、肛門側に全周性の壁肥厚像、内腔の狭窄像を認め、ガストログラフィンによる十二指腸造影では十二指腸下行脚から水平脚にかけて全周性に壁不整像、狭窄像、可動性の低下を認めた。病理所見では、中分化腺癌の増殖を認めるも、腫瘍は十二指腸粘膜固有の腺管との連続を示さず、周囲の十二指腸の腺管に異常は認めず、CK7陰性、CK20陽性であった。また、リンパ管侵襲を認めた。以上の所見から、リンパ行性の大腸癌の転移と診断した。FOLFIRI療法に抵抗性のため、第3病日よりmodified FOLFOX6療法を施行し、食欲不振の自覚症状は改善し退院した。画像所見の改善を認め、胆道系酵素、血清アミラーゼ値も低下した。

Idiopathic portal thrombosis, improved by conservative management: A case report

Hiroshi Mihara, Seiko Yoshida, Mitsuru Yagi, Hiroyuki Ito, Hiroshi Nanasawa

Japanese Journal of Gastroenterology   104 ( 7 ) 1057 - 1062  2007.07  [Refereed]

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A 40-year-old man complaining of epigastralgia for one week was admitted. Subacute chronic idiopathic portal thrombosis was diagnosed and he improved by anti-coagulation and fibrinolytic therapy. No predisposing factor was identified. As there are many idiopathic portal thrombosis cases in Japan, and there is a possibility that some inherent thrombus predisposing factors are hidden, further study of this condition is necessary.

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Cholangiocarcinoma at the cystic duct discovered by lymph node metastases with clear cell transformation

Kazuto Tajiri, Yukihiro Shimizu, Hiroshi Mihara, Yoshihiro Kawanishi, Tadahiro Orihara, Hiroyuki Takahashi, Shin Ishizawa, Satoshi Kawai, Toshiro Sugiyama

INTERNAL MEDICINE ( JAPAN SOC INTERNAL MEDICINE )  45 ( 18 ) 1045 - 1048  2006  [Refereed]

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We encountered a case with cholangiocarcinoma of the cystic duct, which was first manifested by multiple lymph node metastases with clear cell changes resembling clear cell adenocarcinoma (CCC). Because the clear cell changes were not prominent at the primary site, clear cell transformation might have occurred preferentially at the metastatic lesion in this case. Alternatively, tumor cells with clear cell transformation, found at the primary site, might have high metastatic potential. The patient showed thromboembolism and hypercalcemia as paraneoplastic syndromes at the terminal stage as reported in patients with CCC of the ovary. Those complications might be common biological features of CCC.

DOI PubMed