Kyushu University Academic Staff Educational and Research Activities Database
List of Reports
Ohtsuka Takao Last modified date:2019.06.26

Associate Professor / Department of Surgery and Oncology / Department of Clinical Medicine / Faculty of Medical Sciences


Reports
1. Ohtsuka T, Tanaka M, Is choledochocele innocent bystander or culprit?, Endoscopy, 34:667, 2002.04.
2. Ohtsuka T, Tanaka M, Is choledochocele innocent bystander or culprit?, Endoscopy, 34:667, 2002.04.
3. Ohtsuka T, Yamashita H, Kuroki S, Nakafusa Y, Ohta M, Shinozaki K, Murakami J, Chijiiwa K, Tanaka M, Primary B-cell lymphoma of the breast in patient with smoldering type adult T-cell lymphoma., Eur J Surg Oncol, 22(2):197-199, 1996.04, We report a patient with primary B-cell lymphoma of the breast complicated by smoldering type adult T-cell leukaemia (ATL). A 52-year-old Japanese woman complained of a rapidly enlarging lump in her right breast. She had been diagnosed to have smoldering type ATL since the age of 49. Aspiration cytology and subsequent excisional biopsy revealed B-cell type lymphoma of the breast. A gallium-scintigram showed abnormal accumulation in the bilateral breasts. Radiology was adopted because the lesion was localized only in the breasts and associated with smoldering type ATL. The lesions disappeared after the treatment..
4. Ohtsuka T, Yamashita H, Kuroki S, Nakafusa Y, Ohta M, Shinozaki K, Murakami J, Chijiiwa K, Tanaka M, Primary B-cell lymphoma of the breast in patient with smoldering type adult T-cell lymphoma., Eur J Surg Oncol, 22(2):197-199, 1996.04, We report a patient with primary B-cell lymphoma of the breast complicated by smoldering type adult T-cell leukaemia (ATL). A 52-year-old Japanese woman complained of a rapidly enlarging lump in her right breast. She had been diagnosed to have smoldering type ATL since the age of 49. Aspiration cytology and subsequent excisional biopsy revealed B-cell type lymphoma of the breast. A gallium-scintigram showed abnormal accumulation in the bilateral breasts. Radiology was adopted because the lesion was localized only in the breasts and associated with smoldering type ATL. The lesions disappeared after the treatment..
5. Sato N, Yamashita H, Kozaki N, Watanabe Y, Ohtsuka T, Kuroki S, Nakafusa Y, Ota M, Chijiiwa K, Tanaka M, Granulomatous mastitis diagnosed and followed up by fine-needle aspiration cytology, and successfully treated by corticosteroid therapy: report of a case., Surg Today, 26(9):730-733, 1996.04.
6. Sato N, Yamashita H, Kozaki N, Watanabe Y, Ohtsuka T, Kuroki S, Nakafusa Y, Ota M, Chijiiwa K, Tanaka M, Granulomatous mastitis diagnosed and followed up by fine-needle aspiration cytology, and successfully treated by corticosteroid therapy: report of a case., Surg Today, 26(9):730-733, 1996.04.
7. Yokohata K, Shirahane K, Yonemasu H, Nabae T, Inoue K, Ohtsuka T, Yamaguchi K, Chijiiwa K, Tanaka M, Focal ductal branch dilatation on magnetic resonance cholangiopancreatography: A hint for early diagnosis of pancreatic carcinoma, Scand. J. Gastroenterol., 35(11):1229-1232, 2000.04, A 63-year-old man with a combination of early pancreatic carcinoma and an intraductal papillary adenoma was reported. A pancreatic cyst was detected by chance at the head of the pancreas by computed tomography for a follow-up study of early rectal carcinoma previously operated. Detailed studies by endoscopic retrograde pancreatography (ERP) showed irregular narrowing of the main pancreatic duct at the pancreatic body and magnetic resonance cholangiopancreatography (MRCP) revealed dilatation of ductal branches draining there. Brushing cytology of the pancreatic duct demonstrated cancer cells and total pancreatectomy was performed. Stepwise histo-pathological examinations of the specimen showed two foci of invasive carcinoma in the neck and body and multiple foci of severe dysplasia, some of which contained carcinoma in situ, in the body of the pancreas. The cystic tumor in the head of the pancreas was an intraductal papillary adenoma. In this case, the scrutiny of a pancreatic cyst including MRCP and ERP led to an early diagnosis of pancreatic cancer. Dilatation of ductal branches depicted by MRCP might be a new hint for early diagnosis of pancreatic carcinoma. .
8. Yokohata K, Shirahane K, Yonemasu H, Nabae T, Inoue K, Ohtsuka T, Yamaguchi K, Chijiiwa K, Tanaka M, Focal ductal branch dilatation on magnetic resonance cholangiopancreatography: A hint for early diagnosis of pancreatic carcinoma, Scand. J. Gastroenterol., 35(11):1229-1232, 2000.04, A 63-year-old man with a combination of early pancreatic carcinoma and an intraductal papillary adenoma was reported. A pancreatic cyst was detected by chance at the head of the pancreas by computed tomography for a follow-up study of early rectal carcinoma previously operated. Detailed studies by endoscopic retrograde pancreatography (ERP) showed irregular narrowing of the main pancreatic duct at the pancreatic body and magnetic resonance cholangiopancreatography (MRCP) revealed dilatation of ductal branches draining there. Brushing cytology of the pancreatic duct demonstrated cancer cells and total pancreatectomy was performed. Stepwise histo-pathological examinations of the specimen showed two foci of invasive carcinoma in the neck and body and multiple foci of severe dysplasia, some of which contained carcinoma in situ, in the body of the pancreas. The cystic tumor in the head of the pancreas was an intraductal papillary adenoma. In this case, the scrutiny of a pancreatic cyst including MRCP and ERP led to an early diagnosis of pancreatic cancer. Dilatation of ductal branches depicted by MRCP might be a new hint for early diagnosis of pancreatic carcinoma. .
9. Hirata S, Yamaguchi K, Ichikawa J, Izumo A, Ohtsuka T, Chijiiwa K, Tanaka M, Periampullary choledochoduodenal fistula in ampullary carcinoma, J. Hepatobiliary Pancreat. Surg., 8(2):179-181, 2001.04, Most patients with ampullary carcinoma have obstructive jaundice without cholangitis. We experienced a patient with ampullary carcinoma who presented with obstructive jaundice and cholangitis, probably because of an accompanying periampullary choledochoduodenal fistula. A 77-year-old Japanese man had jaundice, high fever, and upper abdominal pain and was diagnosed, at another hospital, with obstructive cholangitis. On admission to our hospital, his symptoms and signs had subsided spontaneously. Abdominal ultrasonography showed cholecystolithiasis and dilatation of the common bile duct. Duodenoscopy showed an ulcerating tumor at the oral prominence of the ampulla of Vater and a periampullary choledochoduodenal fistula at the bottom of the ulcer. Biopsy from the fistula showed well differentiated adenocarcinoma. With a diagnosis of ampullary carcinoma with fistula formation, the patient underwent pylorus-preserving pancreatoduodenectomy. The diagnosis was confirmed by histology. This communication presents a unique case of ampullary carcinoma that caused obstructive jaundice, which subsided spontaneously but was associated with cholangitis caused by the divergent effects of the periampullary choledochoduodenal fistula formed by the carcinoma. ".
10. Hirata S, Yamaguchi K, Ichikawa J, Izumo A, Ohtsuka T, Chijiiwa K, Tanaka M, Periampullary choledochoduodenal fistula in ampullary carcinoma, J. Hepatobiliary Pancreat. Surg., 8(2):179-181, 2001.04, Most patients with ampullary carcinoma have obstructive jaundice without cholangitis. We experienced a patient with ampullary carcinoma who presented with obstructive jaundice and cholangitis, probably because of an accompanying periampullary choledochoduodenal fistula. A 77-year-old Japanese man had jaundice, high fever, and upper abdominal pain and was diagnosed, at another hospital, with obstructive cholangitis. On admission to our hospital, his symptoms and signs had subsided spontaneously. Abdominal ultrasonography showed cholecystolithiasis and dilatation of the common bile duct. Duodenoscopy showed an ulcerating tumor at the oral prominence of the ampulla of Vater and a periampullary choledochoduodenal fistula at the bottom of the ulcer. Biopsy from the fistula showed well differentiated adenocarcinoma. With a diagnosis of ampullary carcinoma with fistula formation, the patient underwent pylorus-preserving pancreatoduodenectomy. The diagnosis was confirmed by histology. This communication presents a unique case of ampullary carcinoma that caused obstructive jaundice, which subsided spontaneously but was associated with cholangitis caused by the divergent effects of the periampullary choledochoduodenal fistula formed by the carcinoma. ".
11. Nakata K, Ohtsuka T, Sato S, Tanaka M, Shimonishi T, Mori D, Nakafusa, Miyazaki K, Esophageal carcinoma with humoral hypercalcemia and leukocytosis, successfully treated by a two-stage operation:Report of a case, Esophagus, 3:13-17, 2006.04.
12. Nakata K, Ohtsuka T, Sato S, Tanaka M, Shimonishi T, Mori D, Nakafusa, Miyazaki K, Esophageal carcinoma with humoral hypercalcemia and leukocytosis, successfully treated by a two-stage operation:Report of a case, Esophagus, 3:13-17, 2006.04.
13. Kai K, Matsuyama S, Ohtsuka T, Kitahara K, Mori D, Miyazaki K, Multiple inflammatory pseudotumor of the liver, mimicking cholangiocarcinoma with tumor embolus in the hepatic vein: report of a case., Surg Today, 37(6):530-536, 2007.04, A 68-year-old Japanese woman complaining of general fatigue and intermittent high fever was admitted to our hospital. Abdominal ultrasonography showed two tumors in the lateral segment of the liver, with soft tissue in the left hepatic vein that was considered to be a tumor embolus. A diagnosis of cholangiocarcinoma was made based on various radiological and laboratory examinations and therefore a surgical resection was performed. Microscopically, the tumor consisted of inflammatory cells, which had aggressively invaded the hepatic vein and Arantius' duct. The pathological diagnosis was inflammatory pseudotumor (IPT) that had invaded the hepatic vein. Although many cases of hepatic IPT have been previously reported, cases of hepatic IPT massively invading the hepatic vein are very rare as far as we could determine, based on a literature search. We herein report this case and discuss the diagnosis and treatment regarding hepatic IPT with massive venous invasion.

PMID: [PubMed - indexed for MEDLINE]
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14. Kai K, Matsuyama S, Ohtsuka T, Kitahara K, Mori D, Miyazaki K, Multiple inflammatory pseudotumor of the liver, mimicking cholangiocarcinoma with tumor embolus in the hepatic vein: report of a case., Surg Today, 37(6):530-536, 2007.04, A 68-year-old Japanese woman complaining of general fatigue and intermittent high fever was admitted to our hospital. Abdominal ultrasonography showed two tumors in the lateral segment of the liver, with soft tissue in the left hepatic vein that was considered to be a tumor embolus. A diagnosis of cholangiocarcinoma was made based on various radiological and laboratory examinations and therefore a surgical resection was performed. Microscopically, the tumor consisted of inflammatory cells, which had aggressively invaded the hepatic vein and Arantius' duct. The pathological diagnosis was inflammatory pseudotumor (IPT) that had invaded the hepatic vein. Although many cases of hepatic IPT have been previously reported, cases of hepatic IPT massively invading the hepatic vein are very rare as far as we could determine, based on a literature search. We herein report this case and discuss the diagnosis and treatment regarding hepatic IPT with massive venous invasion.

PMID: [PubMed - indexed for MEDLINE]
.
15. Sadakari Y, Miyoshi A, Ohtsuka T, Kohya N, Takahashi T, Matsumoto K, Miyazaki K, Percutaneous Transhepatic Portal Embolization for Persistent Bile Leakage After Hepatic Resection: Report of a Case., Surgery Today, 38(7):668-671, 2008.04, Bile leakage is a relatively common complication after hepatic resection. We report a case of intractable bile leakage after hepatectomy, which was successfully treated by percutaneous transhepatic portal embolization (PTPE). A 58-year-old Japanese man underwent anterior resection of the rectum followed by central bisegmentectomy of the liver (S4 + S5 + S8) for rectal cancer with liver metastasis. Bile leakage from the cut surface of the posterior segment developed on postoperative day 2. Conservative management with simple drainage and ethanol injections into the fistula proved ineffective. Thus, we performed PTPE in the posterior portal branch to eliminate the production of bile from the posterior segment and to block the enterohepatic circulation to that segment. His post-treatment course was uneventful and the bile leakage resolved immediately.


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16. Sadakari Y, Miyoshi A, Ohtsuka T, Kohya N, Takahashi T, Matsumoto K, Miyazaki K, Percutaneous Transhepatic Portal Embolization for Persistent Bile Leakage After Hepatic Resection: Report of a Case., Surgery Today, 38(7):668-671, 2008.04, Bile leakage is a relatively common complication after hepatic resection. We report a case of intractable bile leakage after hepatectomy, which was successfully treated by percutaneous transhepatic portal embolization (PTPE). A 58-year-old Japanese man underwent anterior resection of the rectum followed by central bisegmentectomy of the liver (S4 + S5 + S8) for rectal cancer with liver metastasis. Bile leakage from the cut surface of the posterior segment developed on postoperative day 2. Conservative management with simple drainage and ethanol injections into the fistula proved ineffective. Thus, we performed PTPE in the posterior portal branch to eliminate the production of bile from the posterior segment and to block the enterohepatic circulation to that segment. His post-treatment course was uneventful and the bile leakage resolved immediately.


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17. Hiraki M, Sato S, Kai K, Ohtsuka T, Kohya N, Kitajima Y, Nakafusa Y, Tokunaga O, Miyazaki K, A long-term survivor of alpha-fetoprotein-producing gastric cancer successfully treated by fluoropyrimidine-based chemotherapy: a case report, Clin J Gastroenterol , 2:331-337, 2009.04.
18. Hiraki M, Sato S, Kai K, Ohtsuka T, Kohya N, Kitajima Y, Nakafusa Y, Tokunaga O, Miyazaki K, A long-term survivor of alpha-fetoprotein-producing gastric cancer successfully treated by fluoropyrimidine-based chemotherapy: a case report, Clin J Gastroenterol , 2:331-337, 2009.04.
19. Mori Y, Ohtsuka T, Tsutsumi K, Yasui T, Sadakari Y, Ueda J, Takahata S, Nakamura M, Tanaka M, Multifocal pancreatic ductal adenocarcinomas concomitant with intraductal papillary mucinous neoplasms of the pancreas detected by intraoperative pancreatic juice cytology. A case report
, Journal of the pancreas, 11(4):389-392, 2010.04, CONTEXT: Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas have been detected with increasing frequency as a result of the progression of diagnostic modalities. Recently, invasive ductal carcinoma of the pancreas concomitant with IPMNs has been the focus of attention.

CASE REPORT: We report the case of a 57-year-old man with multifocal ductal carcinomas of the pancreas concomitant with IPMNs detected by intraoperative cytology. During a follow-up for branch duct IPMNs, a stenotic lesion of the main duct in the pancreatic body was found by ERCP, and brush cytology of the stenosis revealed an adenocarcinoma. A distal pancreatectomy was proposed; however, intraoperative pancreatic juice cytology from the pancreatic head also revealed adenocarcinoma, and a total pancreatectomy was finally carried out. Pathological examination of the resected specimen showed multifocal ductal carcinomas and IPMNs in the distal pancreas, and invasive ductal carcinoma in the pancreatic head which had not been detected by preoperative imaging studies.

CONCLUSIONS: Surgeons should be aware of the possibility of multifocal carcinomas in patients with concomitant IPMNs. Intraoperative pancreatic juice cytology should always be performed in order to confirm the absence of carcinoma in the pancreas to be left in place after planned resection.

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20. Mori Y, Ohtsuka T, Tsutsumi K, Yasui T, Sadakari Y, Ueda J, Takahata S, Nakamura M, Tanaka M, Multifocal pancreatic ductal adenocarcinomas concomitant with intraductal papillary mucinous neoplasms of the pancreas detected by intraoperative pancreatic juice cytology. A case report
, Journal of the pancreas, 11(4):389-392, 2010.04, CONTEXT: Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas have been detected with increasing frequency as a result of the progression of diagnostic modalities. Recently, invasive ductal carcinoma of the pancreas concomitant with IPMNs has been the focus of attention.

CASE REPORT: We report the case of a 57-year-old man with multifocal ductal carcinomas of the pancreas concomitant with IPMNs detected by intraoperative cytology. During a follow-up for branch duct IPMNs, a stenotic lesion of the main duct in the pancreatic body was found by ERCP, and brush cytology of the stenosis revealed an adenocarcinoma. A distal pancreatectomy was proposed; however, intraoperative pancreatic juice cytology from the pancreatic head also revealed adenocarcinoma, and a total pancreatectomy was finally carried out. Pathological examination of the resected specimen showed multifocal ductal carcinomas and IPMNs in the distal pancreas, and invasive ductal carcinoma in the pancreatic head which had not been detected by preoperative imaging studies.

CONCLUSIONS: Surgeons should be aware of the possibility of multifocal carcinomas in patients with concomitant IPMNs. Intraoperative pancreatic juice cytology should always be performed in order to confirm the absence of carcinoma in the pancreas to be left in place after planned resection.

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21. Tamura K, Ohtsuka T, Ideno N, Aso T, Kono H, Nagayoshi Y, Shindo K, Ushijima Y, Ueda J, Takahata S, Ito T, Oda Y, Mizumoto K, Tanaka M, Unresectable pancreatic ductal adenocarcinoma in the remnant pancreas diagnosed during every-6-month surveillance after resection of branch duct intraductal papillary mucinous neoplasm: a case report, journal of the pancreas (JOP), 10(14):450-453, 2013.04, Abstract


CONTEXT:

There are few studies regarding the surveillance period and interval of resected or observed branch duct intraductal papillary mucinous neoplasms (IPMNs) of the pancreas in terms of early detection of concomitant pancreatic ductal adenocarcinoma. Despite a strict surveillance protocol, some patients are diagnosed with metastatic distinct ductal adenocarcinoma after resection of IPMN.

CASE REPORT:

We herein report a patient with unresectable pancreatic ductal adenocarcinoma that developed in the remnant pancreas 18 months after resection of branch duct IPMN. Although the patient was surveyed every 6 months after the operation and imaging studies at 6 and 12 months postoperatively demonstrated no evidence of recurrence, invasive ductal adenocarcinoma with liver metastasis appeared 18 months after the operation. The patient subsequently underwent chemotherapy; however, he died 9 months after the diagnosis of metachronous pancreatic ductal adenocarcinoma.

CONCLUSIONS:

In some patients with branch duct IPMNs, 6-month surveillance seems to be insufficient to detect resectable concomitant pancreatic ductal adenocarcinoma. Therefore, identification of high-risk patients who require surveillance at shorter intervals is urgently needed.
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22. Tamura K, Ohtsuka T, Ideno N, Aso T, Kono H, Nagayoshi Y, Shindo K, Ushijima Y, Ueda J, Takahata S, Ito T, Oda Y, Mizumoto K, Tanaka M, Unresectable pancreatic ductal adenocarcinoma in the remnant pancreas diagnosed during every-6-month surveillance after resection of branch duct intraductal papillary mucinous neoplasm: a case report, journal of the pancreas (JOP), 10(14):450-453, 2013.04, Abstract


CONTEXT:

There are few studies regarding the surveillance period and interval of resected or observed branch duct intraductal papillary mucinous neoplasms (IPMNs) of the pancreas in terms of early detection of concomitant pancreatic ductal adenocarcinoma. Despite a strict surveillance protocol, some patients are diagnosed with metastatic distinct ductal adenocarcinoma after resection of IPMN.

CASE REPORT:

We herein report a patient with unresectable pancreatic ductal adenocarcinoma that developed in the remnant pancreas 18 months after resection of branch duct IPMN. Although the patient was surveyed every 6 months after the operation and imaging studies at 6 and 12 months postoperatively demonstrated no evidence of recurrence, invasive ductal adenocarcinoma with liver metastasis appeared 18 months after the operation. The patient subsequently underwent chemotherapy; however, he died 9 months after the diagnosis of metachronous pancreatic ductal adenocarcinoma.

CONCLUSIONS:

In some patients with branch duct IPMNs, 6-month surveillance seems to be insufficient to detect resectable concomitant pancreatic ductal adenocarcinoma. Therefore, identification of high-risk patients who require surveillance at shorter intervals is urgently needed.
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23. Shindo K, Ueda J, Aishima S, Aso A, Ohtsuka T, Takahata S, Ishigami K, Oda Y, Tanaka M, Small-sized, flat-type invasive branch duct intraductal papillary mucinous neoplasm: a case report, Case Rep Gastroenterol. , 9;7(3):449-454, 2013.04, Recent improvements in diagnostic modalities are increasing the frequency of detection of small-sized branch duct intraductal papillary mucinous neoplasms (BD-IPMNs). International consensus guidelines for IPMN recommend surveillance without immediate resection for small-sized (<3 cm) BD-IPMNs without malignant features on imaging. Our patient is the first to have undergone resection of a small-sized BD-IPMN containing invasive cancer, but without malignant features on imaging. We herein report a case involving a 70-year-old man with a small cystic lesion in the pancreas head detected by health screening ultrasonography. Detailed examination revealed that the cystic lesion was a BD-IPMN measuring about 2 cm, with no malignant features. However, cytological examination of the pancreatic juice showed atypical cells with high-grade dysplasia storing intracytoplasmic mucin, indicating malignant BD-IPMN. Pathological examination of the resected specimen showed a BD-IPMN measuring 16 mm with an associated invasive carcinoma that invaded the pancreatic parenchyma over a distance of 11 mm. In this patient, invasive cancer was present within a small BD-IPMN with no high-risk stigmata on imaging. Cytological examination of the pancreatic juice allowed for the detection of pancreatic cancer in such a small-sized IPMN. Although routine endoscopic retrograde cholangiopancreatography (ERCP) with cytology is not recommended in all patients with BD-IPMNs, ERCP may contribute to the detection of small pancreatic cancers in select cases. Accumulation of cases of pancreatic cancer within small BD-IPMNs may help establish the indications for ERCP with cytological examination for the purpose of early detection of small pancreatic cancer. .
24. Shindo K, Ueda J, Aishima S, Aso A, Ohtsuka T, Takahata S, Ishigami K, Oda Y, Tanaka M, Small-sized, flat-type invasive branch duct intraductal papillary mucinous neoplasm: a case report, Case Rep Gastroenterol. , 9;7(3):449-454, 2013.04, Recent improvements in diagnostic modalities are increasing the frequency of detection of small-sized branch duct intraductal papillary mucinous neoplasms (BD-IPMNs). International consensus guidelines for IPMN recommend surveillance without immediate resection for small-sized (<3 cm) BD-IPMNs without malignant features on imaging. Our patient is the first to have undergone resection of a small-sized BD-IPMN containing invasive cancer, but without malignant features on imaging. We herein report a case involving a 70-year-old man with a small cystic lesion in the pancreas head detected by health screening ultrasonography. Detailed examination revealed that the cystic lesion was a BD-IPMN measuring about 2 cm, with no malignant features. However, cytological examination of the pancreatic juice showed atypical cells with high-grade dysplasia storing intracytoplasmic mucin, indicating malignant BD-IPMN. Pathological examination of the resected specimen showed a BD-IPMN measuring 16 mm with an associated invasive carcinoma that invaded the pancreatic parenchyma over a distance of 11 mm. In this patient, invasive cancer was present within a small BD-IPMN with no high-risk stigmata on imaging. Cytological examination of the pancreatic juice allowed for the detection of pancreatic cancer in such a small-sized IPMN. Although routine endoscopic retrograde cholangiopancreatography (ERCP) with cytology is not recommended in all patients with BD-IPMNs, ERCP may contribute to the detection of small pancreatic cancers in select cases. Accumulation of cases of pancreatic cancer within small BD-IPMNs may help establish the indications for ERCP with cytological examination for the purpose of early detection of small pancreatic cancer. .
25. Mizuuchi Y, Aishima S, Hattori M, Ushijima Y, Aso A, Takahata S, Ohtsuka T, Ueda J, Tanaka M, Oda Y, Follicular pancreatitis, report of a case clinically mimicking pancreatic cancer and literature review, Pathology, Research and Practice, 210(2):118-122, 2014.04, We herein present a 71-year-old man who underwent pancreatoduodenectomy with the diagnosis of follicular pancreatitis. We could not completely deny malignancy by a preoperative imaging study. Endoscopic ultrasonography-guided fine needle aspiration biopsy demonstrated clusters of benign acinar cells and no proliferation of atypical lymphoid cells or rich plasma cells. Histologically, the prominent lymphoid follicle formation was seen in an ill-defined mass, 15 mm in size, in the pancreatic parenchyma. Duct-centered fibrotic rims were seen in the pancreatic ducts accompanied by mild fibrotic change between the follicles and obliterative phlebitis. No neoplastic epithelial cells were observed in the resected specimen, and infiltrating lymphocytes did not show any morphological atypia and monoclonal proliferation by immunohistochemical staining with B and T cell markers. In addition, we could exclude IgG4-related disease, because plasmacytic cells were rarely po
sitive for IgG4. Although follicular pancreatitis is rare, this mass-forming inflammatory disease (pancreatitis) should be included in the preoperative differential diagnosis of pancreatic cancer..
26. Mizuuchi Y, Aishima S, Hattori M, Ushijima Y, Aso A, Takahata S, Ohtsuka T, Ueda J, Tanaka M, Oda Y, Follicular pancreatitis, report of a case clinically mimicking pancreatic cancer and literature review, Pathology, Research and Practice, 210(2):118-122, 2014.04, We herein present a 71-year-old man who underwent pancreatoduodenectomy with the diagnosis of follicular pancreatitis. We could not completely deny malignancy by a preoperative imaging study. Endoscopic ultrasonography-guided fine needle aspiration biopsy demonstrated clusters of benign acinar cells and no proliferation of atypical lymphoid cells or rich plasma cells. Histologically, the prominent lymphoid follicle formation was seen in an ill-defined mass, 15 mm in size, in the pancreatic parenchyma. Duct-centered fibrotic rims were seen in the pancreatic ducts accompanied by mild fibrotic change between the follicles and obliterative phlebitis. No neoplastic epithelial cells were observed in the resected specimen, and infiltrating lymphocytes did not show any morphological atypia and monoclonal proliferation by immunohistochemical staining with B and T cell markers. In addition, we could exclude IgG4-related disease, because plasmacytic cells were rarely po
sitive for IgG4. Although follicular pancreatitis is rare, this mass-forming inflammatory disease (pancreatitis) should be included in the preoperative differential diagnosis of pancreatic cancer..
27. Date K, Ohtsuka T, Fujimoto T, Gotoh Y, Nakashima Y, Kimura H, Matsunaga T, Mori Y, Mochidome N, Miyazak T, Oda Y, Tanaka M, Nakamura M, GNAS and KRAS mutational analyses of intraductal papillary neoplasms of the pancreas and bile duct developing in the same individual: A case report, Pancreatology, 10.1016/j.pan.2015.09.013 , 15(6):713-716, 2015.04, Abstract
Intraductal papillary mucinous neoplasm (IPMN) of the pancreas and intraductal papillary neoplasm of the bile duct (IPNB) are considered as counterparts of each other, and it is suggested that these two entities have similar molecular alteration pathways. However, the occurrence of IPMN of the pancreas and IPNB in the same patient is rare. We report a surgical case of a 69-year-old woman who developed invasive IPMN of the pancreas and underwent pancreatectomy, 6 months after hepatic resection of invasive IPNB. Molecular analysis revealed GNAS/KRAS mutation in both invasive IPMN of the pancreas and IPNB. This is believed to be the first case report investigating GNAS/KRAS mutational status in both IPMN of the pancreas and IPNB developing in the same patient, and these two entities may show similar molecular alternations.
Copyright © 2015 IAP and EPC. Published by Elsevier India Pvt Ltd. All rights reserved.
KEYWORDS:
Bile duct neoplasm; GNAS; IPMN; Intraductal papillary neoplasm; KRAS; Pancreas neoplasm.
28. Date K, Ohtsuka T, Fujimoto T, Gotoh Y, Nakashima Y, Kimura H, Matsunaga T, Mori Y, Mochidome N, Miyazak T, Oda Y, Tanaka M, Nakamura M, GNAS and KRAS mutational analyses of intraductal papillary neoplasms of the pancreas and bile duct developing in the same individual: A case report, Pancreatology, 10.1016/j.pan.2015.09.013 , 15(6):713-716, 2015.04, Abstract
Intraductal papillary mucinous neoplasm (IPMN) of the pancreas and intraductal papillary neoplasm of the bile duct (IPNB) are considered as counterparts of each other, and it is suggested that these two entities have similar molecular alteration pathways. However, the occurrence of IPMN of the pancreas and IPNB in the same patient is rare. We report a surgical case of a 69-year-old woman who developed invasive IPMN of the pancreas and underwent pancreatectomy, 6 months after hepatic resection of invasive IPNB. Molecular analysis revealed GNAS/KRAS mutation in both invasive IPMN of the pancreas and IPNB. This is believed to be the first case report investigating GNAS/KRAS mutational status in both IPMN of the pancreas and IPNB developing in the same patient, and these two entities may show similar molecular alternations.
Copyright © 2015 IAP and EPC. Published by Elsevier India Pvt Ltd. All rights reserved.
KEYWORDS:
Bile duct neoplasm; GNAS; IPMN; Intraductal papillary neoplasm; KRAS; Pancreas neoplasm.
29. Shindo K, Nagai E, Nabae T, Eguchi T, Moriyama T, Ohuchida K, Manabe T, Ohtsuka T, Oda Y, Hashizume M, Nakamura M, Successful video-assisted thoracoscopic surgery in prone position in patients with esophageal cancer and aberrant right subclavian artery: report of three cases, Surgical Case Reports, 3
(1):86-86, 2017.04, Abstract
BACKGROUND:
An aberrant right subclavian artery (ARSA) with an associated nonrecurrent right inferior laryngeal nerve (NRILN) is a relatively rare anomaly that occurs at a frequency of 0.3 to 2.0% of the general population. NRILN has been mainly documented in the head and neck region; it has been rarely described in patients with esophageal cancer, especially those undergoing thoracoscopic surgery. Video-assisted thoracoscopic surgery for esophageal cancer (VATS-E) is becoming more widespread as a reliable minimally invasive surgical procedure associated with reduced perioperative complications.
CASE PRESENTATION:
Herein, we report three cases of esophageal cancer with ARSA and NRILN which underwent successful VATS-E. Case 1, a 53-year-old male who had early stage esophageal cancer was performed VATS-E. Upper gastrointestinal (GI) series showed "Bayonet sign" (T1aN0M0, pStageIA in UICC). Case 2, a 75-year-old male who had advanced esophageal cancer was performed neoadjuvant chemotherapy and following VATS-E. This case had right thoracic duct and "Bayonet sign" on upper GI series (T1bN2M0, pStage IIIA in UICC). Case3, a 72-year-old male who had advanced esophageal cancer was performed neoadjuvant chemotherapy and following VATS-E (T3N2M0, pStageIIIB in UICC). All of these three cases were performed VATS-E and discharged without any complication.
CONCLUSION:
VATS-E in the prone position is a feasible procedure that can reduce the risk of complications with an enlarged and clear view, and knowledge of this type of anomaly is very important for surgeons who perform esophagectomy.
KEYWORDS:
Aberrant right subclavian artery; Esophageal cancer; Nonrecurrent right inferior laryngeal nerve; Prone position; Video-assisted thoracoscopic surgery.
30. Shindo K, Nagai E, Nabae T, Eguchi T, Moriyama T, Ohuchida K, Manabe T, Ohtsuka T, Oda Y, Hashizume M, Nakamura M, Successful video-assisted thoracoscopic surgery in prone position in patients with esophageal cancer and aberrant right subclavian artery: report of three cases, Surgical Case Reports, 3
(1):86-86, 2017.04, Abstract
BACKGROUND:
An aberrant right subclavian artery (ARSA) with an associated nonrecurrent right inferior laryngeal nerve (NRILN) is a relatively rare anomaly that occurs at a frequency of 0.3 to 2.0% of the general population. NRILN has been mainly documented in the head and neck region; it has been rarely described in patients with esophageal cancer, especially those undergoing thoracoscopic surgery. Video-assisted thoracoscopic surgery for esophageal cancer (VATS-E) is becoming more widespread as a reliable minimally invasive surgical procedure associated with reduced perioperative complications.
CASE PRESENTATION:
Herein, we report three cases of esophageal cancer with ARSA and NRILN which underwent successful VATS-E. Case 1, a 53-year-old male who had early stage esophageal cancer was performed VATS-E. Upper gastrointestinal (GI) series showed "Bayonet sign" (T1aN0M0, pStageIA in UICC). Case 2, a 75-year-old male who had advanced esophageal cancer was performed neoadjuvant chemotherapy and following VATS-E. This case had right thoracic duct and "Bayonet sign" on upper GI series (T1bN2M0, pStage IIIA in UICC). Case3, a 72-year-old male who had advanced esophageal cancer was performed neoadjuvant chemotherapy and following VATS-E (T3N2M0, pStageIIIB in UICC). All of these three cases were performed VATS-E and discharged without any complication.
CONCLUSION:
VATS-E in the prone position is a feasible procedure that can reduce the risk of complications with an enlarged and clear view, and knowledge of this type of anomaly is very important for surgeons who perform esophagectomy.
KEYWORDS:
Aberrant right subclavian artery; Esophageal cancer; Nonrecurrent right inferior laryngeal nerve; Prone position; Video-assisted thoracoscopic surgery.
31. Ohtsuka T, Tanaka M, Miyazaki K, Gastrointestinal function and quality of life after pylorus-preserving pancreatoduodenectomy, J Hepatobiliary Pancreat Surg. , 13(3):218-224, 2006.04, The pylorus-preserving pancreatoduodenectomy (PPPD) has taken the place of the conventional Whipple pancreato-duodenectomy as the standard procedure for various periampullary disease. With recent advances in surgical techniques and improvements in perioperative management, the number of long-term survivors after PPPD is increasing. As a result, surgeons should pay more attention to the patients' postoperative gastrointestinal function, nutrition, and quality of life (QOL). Gastric stasis, which is a frequent complication during the early postoperative period after PPPD, prolongs the hospital stay and impairs the QOL in the intermediate term. Several possible pathogeneses for this gastric stasis have been postulated; however, the precise mechanism remains unclear. The gastric emptying function gradually recovers to the preoperative level by 6 months after PPPD. Pancreatic functions are likely to be maintained for at least 1 year after PPPD; however, in some cases, they tend to gradually deteriorate over time after the operation, depending on the type of pancreatic reconstruction or the preoperative condition of the pancreas. It is important to note that preoperative and postoperative pancreatic exocrine function strongly influence the postoperative outcome regarding such factors as pancreatic fistula, body weight maintenance, nutrition, and the QOL. The QOL, as assessed by questionnaire, normally returns to the preoperative level within 6 months after PPPD, and this correlates with the changes in gastrointestinal function and nutritional status. It still remains an unresolved question, however, whether the Billroth-I PPPD really leads to better long-term nutritional status, but worse early gastric emptying function, than the Billroth-II type of reconstruction.

.
32. Ohtsuka T, Tanaka M, Miyazaki K, Gastrointestinal function and quality of life after pylorus-preserving pancreatoduodenectomy, J Hepatobiliary Pancreat Surg. , 13(3):218-224, 2006.04, The pylorus-preserving pancreatoduodenectomy (PPPD) has taken the place of the conventional Whipple pancreato-duodenectomy as the standard procedure for various periampullary disease. With recent advances in surgical techniques and improvements in perioperative management, the number of long-term survivors after PPPD is increasing. As a result, surgeons should pay more attention to the patients' postoperative gastrointestinal function, nutrition, and quality of life (QOL). Gastric stasis, which is a frequent complication during the early postoperative period after PPPD, prolongs the hospital stay and impairs the QOL in the intermediate term. Several possible pathogeneses for this gastric stasis have been postulated; however, the precise mechanism remains unclear. The gastric emptying function gradually recovers to the preoperative level by 6 months after PPPD. Pancreatic functions are likely to be maintained for at least 1 year after PPPD; however, in some cases, they tend to gradually deteriorate over time after the operation, depending on the type of pancreatic reconstruction or the preoperative condition of the pancreas. It is important to note that preoperative and postoperative pancreatic exocrine function strongly influence the postoperative outcome regarding such factors as pancreatic fistula, body weight maintenance, nutrition, and the QOL. The QOL, as assessed by questionnaire, normally returns to the preoperative level within 6 months after PPPD, and this correlates with the changes in gastrointestinal function and nutritional status. It still remains an unresolved question, however, whether the Billroth-I PPPD really leads to better long-term nutritional status, but worse early gastric emptying function, than the Billroth-II type of reconstruction.

.
33. Ohtsuka T, Nakamura M, Tanaka M, Superior mesenteric artery-first approach with the first jejunal vein-oriented mesenteric excision in pasncreatoduodenectomy, Surgical Practice, 19(1):29-32, 2014.04.
34. Ohtsuka T, Nakamura M, Tanaka M, Superior mesenteric artery-first approach with the first jejunal vein-oriented mesenteric excision in pasncreatoduodenectomy, Surgical Practice, 19(1):29-32, 2014.04.
35. Ohuchida K, Ohtsuka T, Mizumoto K, Hashidume M, Tanaka M, Pancreatic Cancer: Clinical Significance of Biomarkers, Gastro Intestinal Tumors, 1(1):33-40, 2014.04.
36. Ohuchida K, Ohtsuka T, Mizumoto K, Hashidume M, Tanaka M, Pancreatic Cancer: Clinical Significance of Biomarkers, Gastro Intestinal Tumors, 1(1):33-40, 2014.04.
37. Ishigami K, Nishie A, Asayama Y, Ushijima Y, Takayama Y, Fujita N, Takahata S, Ohtsuka T, Ito T, Igarashi H, Ikari S, Metz CM, Honda H, Imaging pitfalls of pancreatic serous cystic neoplasm and its potential mimickers, World J Radiol , 6(3):36-47, 2014.04, Abstract
The aim of this article is to clarify diagnostic pitfalls of pancreatic serous cystic neoplasm (SCN) that may result in erroneous characterization. Usual and unusual imaging findings of SCN as well as potential SCN mimickers are presented. The diagnostic key of SCN is to look for a cluster of microcysts (honeycomb pattern), which may not be always found in the center. Fibrosis in SCN may be mistaken for a mural nodule of intraductal papillary mucinous neoplasm (IPMN). The absence of cyst wall enhancement may be helpful to distinguish SCN from mucinous cystic neoplasm. However, oligocystic SCN and branch duct type IPMN may morphologically overlap. In addition, solid serous adenoma, an extremely rare variant of SCN, is difficult to distinguish from neuroendocrine tumor.
KEYWORDS:
Computed tomography; Intraductal papillary mucinous neoplasm; Magnetic resonance imaging; Mucinous cystic neoplasm; Serous cystic neoplasm.
38. Ishigami K, Nishie A, Asayama Y, Ushijima Y, Takayama Y, Fujita N, Takahata S, Ohtsuka T, Ito T, Igarashi H, Ikari S, Metz CM, Honda H, Imaging pitfalls of pancreatic serous cystic neoplasm and its potential mimickers, World J Radiol , 6(3):36-47, 2014.04, Abstract
The aim of this article is to clarify diagnostic pitfalls of pancreatic serous cystic neoplasm (SCN) that may result in erroneous characterization. Usual and unusual imaging findings of SCN as well as potential SCN mimickers are presented. The diagnostic key of SCN is to look for a cluster of microcysts (honeycomb pattern), which may not be always found in the center. Fibrosis in SCN may be mistaken for a mural nodule of intraductal papillary mucinous neoplasm (IPMN). The absence of cyst wall enhancement may be helpful to distinguish SCN from mucinous cystic neoplasm. However, oligocystic SCN and branch duct type IPMN may morphologically overlap. In addition, solid serous adenoma, an extremely rare variant of SCN, is difficult to distinguish from neuroendocrine tumor.
KEYWORDS:
Computed tomography; Intraductal papillary mucinous neoplasm; Magnetic resonance imaging; Mucinous cystic neoplasm; Serous cystic neoplasm.
39. Tanaka M, Fernández-Del Castillo C, Kamisawa T, Jang JY, Levy P, Ohtsuka T, Salvia R, Shimizu Y, Tada M, Wolfgang CL, Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas, Pancreatology, 17(5):738-753, 2017.04, The management of intraductal papillary mucinous neoplasm (IPMN) continues to evolve. In particular, the indications for resection of branch duct IPMN have changed from early resection to more deliberate observation as proposed by the international consensus guidelines of 2006 and 2012. Another guideline proposed by the American Gastroenterological Association in 2015 restricted indications for surgery more stringently and recommended physicians to stop surveillance if no significant change had occurred in a pancreatic cyst after five years of surveillance, or if a patient underwent resection and a non-malignant IPMN was found. Whether or not it is safe to do so, as well as the method and interval of surveillance, has generated substantial debate. Based on a consensus symposium held during the meeting of the International Association of Pancreatology in Sendai, Japan, in 2016, the working group has revised the guidelines regarding prediction of invasi
ve carcinoma and high-grade dysplasia, surveillance, and postoperative follow-up of IPMN. As the working group did not recognize the need for major revisions of the guidelines, we made only minor revisions and added most recent articles where appropriate. The present guidelines include updated information and recommendations based on our current understanding, and highlight issues that remain controversial or where further research is required..
40. Tanaka M, Fernández-Del Castillo C, Kamisawa T, Jang JY, Levy P, Ohtsuka T, Salvia R, Shimizu Y, Tada M, Wolfgang CL, Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas, Pancreatology, 17(5):738-753, 2017.04, The management of intraductal papillary mucinous neoplasm (IPMN) continues to evolve. In particular, the indications for resection of branch duct IPMN have changed from early resection to more deliberate observation as proposed by the international consensus guidelines of 2006 and 2012. Another guideline proposed by the American Gastroenterological Association in 2015 restricted indications for surgery more stringently and recommended physicians to stop surveillance if no significant change had occurred in a pancreatic cyst after five years of surveillance, or if a patient underwent resection and a non-malignant IPMN was found. Whether or not it is safe to do so, as well as the method and interval of surveillance, has generated substantial debate. Based on a consensus symposium held during the meeting of the International Association of Pancreatology in Sendai, Japan, in 2016, the working group has revised the guidelines regarding prediction of invasi
ve carcinoma and high-grade dysplasia, surveillance, and postoperative follow-up of IPMN. As the working group did not recognize the need for major revisions of the guidelines, we made only minor revisions and added most recent articles where appropriate. The present guidelines include updated information and recommendations based on our current understanding, and highlight issues that remain controversial or where further research is required..
41. Nakamura M, Miyasaka Y, Sadakari Y, Date K, Ohtsuka T , Comparison of guidelines for intraductal papillary mucinous neoplasm: What is the next step beyond the current guidelines, Annals of Gastroenterological Surgery, 10.1002/ags3.12012, 1(2):90-98, 2017.04, Management of intraductal papillary mucinous neoplasm is controversial, and several guidelines have aimed to establish an adequate strategy for surgical resection and surveillance. We compared various intraductal papillary mucinous neoplasm guidelines and considered new matters that are pivotal for improved treatment of intraductal papillary mucinous neoplasm. We identified and compared 11 published guidelines, three of which were major guidelines that mainly referred to the diagnosis and treatment of intraductal papillary mucinous neoplasm (International Association of Pancreatology 2012 guidelines, European Study Group on Cystic Tumours of the Pancreas 2013 guidelines, and American Gastroenterological Association 2015 guidelines). The main concerns of these three guidelines were indication for surgery and follow up of non‐resected lesions. Among the differences between the three guidelines, the period of surveillance recommended was the most controversial matter. Meanwhile, several nomograms have been proposed to improve the diagnosis of intraductal papillary mucinous neoplasm from the level of experts' experiences to that of rational systems. We discuss the adequate strategy of surveillance for intraductal papillary mucinous neoplasm with and without pancreatectomy and nomograms aiming to predict the risk of malignancy in patients with intraductal papillary mucinous neoplasm..
42. Nakamura M, Miyasaka Y, Sadakari Y, Date K, Ohtsuka T , Comparison of guidelines for intraductal papillary mucinous neoplasm: What is the next step beyond the current guidelines, Annals of Gastroenterological Surgery, 10.1002/ags3.12012, 1(2):90-98, 2017.04, Management of intraductal papillary mucinous neoplasm is controversial, and several guidelines have aimed to establish an adequate strategy for surgical resection and surveillance. We compared various intraductal papillary mucinous neoplasm guidelines and considered new matters that are pivotal for improved treatment of intraductal papillary mucinous neoplasm. We identified and compared 11 published guidelines, three of which were major guidelines that mainly referred to the diagnosis and treatment of intraductal papillary mucinous neoplasm (International Association of Pancreatology 2012 guidelines, European Study Group on Cystic Tumours of the Pancreas 2013 guidelines, and American Gastroenterological Association 2015 guidelines). The main concerns of these three guidelines were indication for surgery and follow up of non‐resected lesions. Among the differences between the three guidelines, the period of surveillance recommended was the most controversial matter. Meanwhile, several nomograms have been proposed to improve the diagnosis of intraductal papillary mucinous neoplasm from the level of experts' experiences to that of rational systems. We discuss the adequate strategy of surveillance for intraductal papillary mucinous neoplasm with and without pancreatectomy and nomograms aiming to predict the risk of malignancy in patients with intraductal papillary mucinous neoplasm..
43. Miyasaka Y, Mori Y, Nakata K, Ohtsuka T, Nakamura M, Attempts to prevent postoperative pancreatic fistula after distal pancreatectomy, Surg Today, 47(4):416-424, 2017.04, Postoperative pancreatic fistula (POPF) is the most frequent and serious complication after distal pancreatectomy (DP) and often leads to other postoperative complications. Numerous studies have been conducted to clarify the risk factors for POPF after DP, and to also determine effective prophylactic treatments. In this article, we review the current evidence on the risk factors for POPF after DP, and also provide new evidence to support the currently implemented prophylactic measures against POPF after DP. The patient-related and surgery-related risk factors and risk factors specific to staplers are discussed. Several studies have suggested that a thick pancreas is a risk factor for POPF using a stapler and that a higher stapler height or pancreatoenteric anastomosis might be useful for preventing POPF when transecting a thick pancreas. Various methods, such as stapler closure, procedures that may be performed in addition to stapler closure, pancreat
oenteric anastomosis, pancreatic transection devices, laparoscopic surgery, pancreatic stenting, stump coverage, and somatostatin analogs, have been tested and in comparison with conventional procedures in case-control studies and randomized, controlled trials. Although some studies have shown the superiority of these methods to the conventional procedures, a consensus on precautionary measures that can be taken against POPF remains to be established. Further investigation is necessary to develop a reliable strategy for preventing POPF and to improve the outcomes of patients after DP..
44. Miyasaka Y, Mori Y, Nakata K, Ohtsuka T, Nakamura M, Attempts to prevent postoperative pancreatic fistula after distal pancreatectomy, Surg Today, 47(4):416-424, 2017.04, Postoperative pancreatic fistula (POPF) is the most frequent and serious complication after distal pancreatectomy (DP) and often leads to other postoperative complications. Numerous studies have been conducted to clarify the risk factors for POPF after DP, and to also determine effective prophylactic treatments. In this article, we review the current evidence on the risk factors for POPF after DP, and also provide new evidence to support the currently implemented prophylactic measures against POPF after DP. The patient-related and surgery-related risk factors and risk factors specific to staplers are discussed. Several studies have suggested that a thick pancreas is a risk factor for POPF using a stapler and that a higher stapler height or pancreatoenteric anastomosis might be useful for preventing POPF when transecting a thick pancreas. Various methods, such as stapler closure, procedures that may be performed in addition to stapler closure, pancreat
oenteric anastomosis, pancreatic transection devices, laparoscopic surgery, pancreatic stenting, stump coverage, and somatostatin analogs, have been tested and in comparison with conventional procedures in case-control studies and randomized, controlled trials. Although some studies have shown the superiority of these methods to the conventional procedures, a consensus on precautionary measures that can be taken against POPF remains to be established. Further investigation is necessary to develop a reliable strategy for preventing POPF and to improve the outcomes of patients after DP..
45. Miyasaka Y, Ohtsuka T, Velasquez VV, Mori Y, Nakata K, Nakamura M, Surgical management of the cases with both biliary and duodenal obstruction, Gastrointest Interv, 7:74-77, 2018.04.
46. Miyasaka Y, Ohtsuka T, Velasquez VV, Mori Y, Nakata K, Nakamura M, Surgical management of the cases with both biliary and duodenal obstruction, Gastrointest Interv, 7:74-77, 2018.04.
47. Ohtsuka T, Tanaka M, Is choledochocele innocent bystander or culprit?, Endoscopy, 34:667, 2002.04.
48. Ohtsuka T, Yamashita H, Kuroki S, Nakafusa Y, Ohta M, Shinozaki K, Murakami J, Chijiiwa K, Tanaka M, Primary B‐cell lymphoma of the breast in patient with smoldering type adult T‐cell lymphoma, Eur. J. Surg. Oncol., 22(2):197-199, 1996.04, We report a patient with primary B-cell lymphoma of the breast complicated by smoldering type adult T-cell leukaemia (ATL). A 52-year-old Japanese woman complained of a rapidly enlarging lump in her right breast. She had been diagnosed to have smoldering type ATL since the age of 49. Aspiration cytology and subsequent excisional biopsy revealed B-cell type lymphoma of the breast. A gallium-scintigram showed abnormal accumulation in the bilateral breasts. Radiology was adopted because the lesion was localized only in the breasts and associated with smoldering type ATL. The lesions disappeared after the treatment.".
49. Ohtsuka T, Yamashita H, Kuroki S, Nakafusa Y, Ohta M, Shinozaki K, Murakami J, Chijiiwa K, Tanaka M, Primary B-cell lymphoma of the breast in patient with smoldering type adult T-cell lymphoma., Eur J Surg Oncol, 22(2):197-199, 1996.04, We report a patient with primary B-cell lymphoma of the breast complicated by smoldering type adult T-cell leukaemia (ATL). A 52-year-old Japanese woman complained of a rapidly enlarging lump in her right breast. She had been diagnosed to have smoldering type ATL since the age of 49. Aspiration cytology and subsequent excisional biopsy revealed B-cell type lymphoma of the breast. A gallium-scintigram showed abnormal accumulation in the bilateral breasts. Radiology was adopted because the lesion was localized only in the breasts and associated with smoldering type ATL. The lesions disappeared after the treatment..
50. Sato N, Yamashita H, Kozaki N, Watanabe Y, Ohtsuka T, Kuroki S, Nakafusa Y, Ota M, Chijiiwa K, Tanaka M, Granulomatous mastitis diagnosed and followed up by fine‐needle aspiration cytology, and successfully treated by corticosteroid therapy: Report of a case, Surg. Today, 26(9):730-733, 1996.04, A 36-year-old woman presented to our hospital with a rapidly growing lump in her left breast. Fine-needle aspiration (FNA) cytology of the mass revealed many epithelioid cells admixed with multinucleated Langhans-type giant cells, neutrophils, lymphocytes, and stromal cells, leading to a diagnosis of granulomatous mastitis. This report describes the clinical course of this patient in whom granulomatous mastitis was successfully treated with corticosteroid therapy. Special reference is made to the usefulness of FNA cytology in the diagnosis and follow-up of this disease.".
51. Sato N, Yamashita H, Kozaki N, Watanabe Y, Ohtsuka T, Kuroki S, Nakafusa Y, Ota M, Chijiiwa K, Tanaka M, Granulomatous mastitis diagnosed and followed up by fine-needle aspiration cytology, and successfully treated by corticosteroid therapy: report of a case., Surg Today, 26(9):730-733, 1996.04.
52. Yokohata K, Shirahane K, Yonemasu H, Nabae T, Inoue K, Ohtsuka T, Yamaguchi K, Chijiiwa K, Tanaka M, Focal ductal branch dilatation on magnetic resonance cholangiopancreatography: A hint for early diagnosis of pancreatic carcinoma, Scand. J. Gastroenterol., 35(11):1229-1232, 2000.04, A 63-year-old man with a combination of early pancreatic carcinoma and an intraductal papillary adenoma was reported. A pancreatic cyst was detected by chance at the head of the pancreas by computed tomography for a follow-up study of early rectal carcinoma previously operated. Detailed studies by endoscopic retrograde pancreatography (ERP) showed irregular narrowing of the main pancreatic duct at the pancreatic body and magnetic resonance cholangiopancreatography (MRCP) revealed dilatation of ductal branches draining there. Brushing cytology of the pancreatic duct demonstrated cancer cells and total pancreatectomy was performed. Stepwise histo-pathological examinations of the specimen showed two foci of invasive carcinoma in the neck and body and multiple foci of severe dysplasia, some of which contained carcinoma in situ, in the body of the pancreas. The cystic tumor in the head of the pancreas was an intraductal papillary adenoma. In this case, the scrutiny of a pancreatic cyst including MRCP and ERP led to an early diagnosis of pancreatic cancer. Dilatation of ductal branches depicted by MRCP might be a new hint for early diagnosis of pancreatic carcinoma. .
53. Hirata S, Yamaguchi K, Ichikawa J, Izumo A, Ohtsuka T, Chijiiwa K, Tanaka M, Periampullary choledochoduodenal fistula in ampullary carcinoma, J. Hepatobiliary Pancreat. Surg., 8(2):179-181, 2001.04, Most patients with ampullary carcinoma have obstructive jaundice without cholangitis. We experienced a patient with ampullary carcinoma who presented with obstructive jaundice and cholangitis, probably because of an accompanying periampullary choledochoduodenal fistula. A 77-year-old Japanese man had jaundice, high fever, and upper abdominal pain and was diagnosed, at another hospital, with obstructive cholangitis. On admission to our hospital, his symptoms and signs had subsided spontaneously. Abdominal ultrasonography showed cholecystolithiasis and dilatation of the common bile duct. Duodenoscopy showed an ulcerating tumor at the oral prominence of the ampulla of Vater and a periampullary choledochoduodenal fistula at the bottom of the ulcer. Biopsy from the fistula showed well differentiated adenocarcinoma. With a diagnosis of ampullary carcinoma with fistula formation, the patient underwent pylorus-preserving pancreatoduodenectomy. The diagnosis was confirmed by histology. This communication presents a unique case of ampullary carcinoma that caused obstructive jaundice, which subsided spontaneously but was associated with cholangitis caused by the divergent effects of the periampullary choledochoduodenal fistula formed by the carcinoma. ".
54. Kai K, Matsuyama S, Ohtsuka T, Kitahara K, Mori D, Miyazaki K, Multiple inflammatory pseudotumor of the liver, mimicking cholangiocarcinoma with tumor embolus in the hepatic vein: report of a case., Surg Today, 37(6):530-536, 2007.04, A 68-year-old Japanese woman complaining of general fatigue and intermittent high fever was admitted to our hospital. Abdominal ultrasonography showed two tumors in the lateral segment of the liver, with soft tissue in the left hepatic vein that was considered to be a tumor embolus. A diagnosis of cholangiocarcinoma was made based on various radiological and laboratory examinations and therefore a surgical resection was performed. Microscopically, the tumor consisted of inflammatory cells, which had aggressively invaded the hepatic vein and Arantius' duct. The pathological diagnosis was inflammatory pseudotumor (IPT) that had invaded the hepatic vein. Although many cases of hepatic IPT have been previously reported, cases of hepatic IPT massively invading the hepatic vein are very rare as far as we could determine, based on a literature search. We herein report this case and discuss the diagnosis and treatment regarding hepatic IPT with massive venous invasion.

PMID: [PubMed - indexed for MEDLINE]
.
55. Sadakari Y, Miyoshi A, Ohtsuka T, Kohya N, Takahashi T, Matsumoto K, Miyazaki K, Percutaneous Transhepatic Portal Embolization for Persistent Bile Leakage After Hepatic Resection: Report of a Case., Surgery Today, 38(7):668-671, 2008.04, Bile leakage is a relatively common complication after hepatic resection. We report a case of intractable bile leakage after hepatectomy, which was successfully treated by percutaneous transhepatic portal embolization (PTPE). A 58-year-old Japanese man underwent anterior resection of the rectum followed by central bisegmentectomy of the liver (S4 + S5 + S8) for rectal cancer with liver metastasis. Bile leakage from the cut surface of the posterior segment developed on postoperative day 2. Conservative management with simple drainage and ethanol injections into the fistula proved ineffective. Thus, we performed PTPE in the posterior portal branch to eliminate the production of bile from the posterior segment and to block the enterohepatic circulation to that segment. His post-treatment course was uneventful and the bile leakage resolved immediately.


.
56. Hiraki M, Sato S, Kai K, Ohtsuka T, Kohya N, Kitajima Y, Nakafusa Y, Tokunaga O, Miyazaki K, A long-term survivor of alpha-fetoprotein-producing gastric cancer successfully treated by fluoropyrimidine-based chemotherapy: a case report, Clin J Gastroenterol , 2:331-337, 2009.04.
57. Mori Y, Ohtsuka T, Tsutsumi K, Yasui T, Sadakari Y, Ueda J, Takahata S, Nakamura M, Tanaka M, Multifocal pancreatic ductal adenocarcinomas concomitant with intraductal papillary mucinous neoplasms of the pancreas detected by intraoperative pancreatic juice cytology. A case report
, Journal of the pancreas, 11(4):389-392, 2010.04, CONTEXT: Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas have been detected with increasing frequency as a result of the progression of diagnostic modalities. Recently, invasive ductal carcinoma of the pancreas concomitant with IPMNs has been the focus of attention.

CASE REPORT: We report the case of a 57-year-old man with multifocal ductal carcinomas of the pancreas concomitant with IPMNs detected by intraoperative cytology. During a follow-up for branch duct IPMNs, a stenotic lesion of the main duct in the pancreatic body was found by ERCP, and brush cytology of the stenosis revealed an adenocarcinoma. A distal pancreatectomy was proposed; however, intraoperative pancreatic juice cytology from the pancreatic head also revealed adenocarcinoma, and a total pancreatectomy was finally carried out. Pathological examination of the resected specimen showed multifocal ductal carcinomas and IPMNs in the distal pancreas, and invasive ductal carcinoma in the pancreatic head which had not been detected by preoperative imaging studies.

CONCLUSIONS: Surgeons should be aware of the possibility of multifocal carcinomas in patients with concomitant IPMNs. Intraoperative pancreatic juice cytology should always be performed in order to confirm the absence of carcinoma in the pancreas to be left in place after planned resection.

.
58. Tamura K, Ohtsuka T, Ideno N, Aso T, Kono H, Nagayoshi Y, Shindo K, Ushijima Y, Ueda J, Takahata S, Ito T, Oda Y, Mizumoto K, Tanaka M, Unresectable pancreatic ductal adenocarcinoma in the remnant pancreas diagnosed during every-6-month surveillance after resection of branch duct intraductal papillary mucinous neoplasm: a case report, journal of the pancreas (JOP), 10(14):450-453, 2013.04, Abstract


CONTEXT:

There are few studies regarding the surveillance period and interval of resected or observed branch duct intraductal papillary mucinous neoplasms (IPMNs) of the pancreas in terms of early detection of concomitant pancreatic ductal adenocarcinoma. Despite a strict surveillance protocol, some patients are diagnosed with metastatic distinct ductal adenocarcinoma after resection of IPMN.

CASE REPORT:

We herein report a patient with unresectable pancreatic ductal adenocarcinoma that developed in the remnant pancreas 18 months after resection of branch duct IPMN. Although the patient was surveyed every 6 months after the operation and imaging studies at 6 and 12 months postoperatively demonstrated no evidence of recurrence, invasive ductal adenocarcinoma with liver metastasis appeared 18 months after the operation. The patient subsequently underwent chemotherapy; however, he died 9 months after the diagnosis of metachronous pancreatic ductal adenocarcinoma.

CONCLUSIONS:

In some patients with branch duct IPMNs, 6-month surveillance seems to be insufficient to detect resectable concomitant pancreatic ductal adenocarcinoma. Therefore, identification of high-risk patients who require surveillance at shorter intervals is urgently needed.
.
59. Shindo K, Ueda J, Aishima S, Aso A, Ohtsuka T, Takahata S, Ishigami K, Oda Y, Tanaka M, Small-sized, flat-type invasive branch duct intraductal papillary mucinous neoplasm: a case report, Case Rep Gastroenterol. , 9;7(3):449-454, 2013.04, Recent improvements in diagnostic modalities are increasing the frequency of detection of small-sized branch duct intraductal papillary mucinous neoplasms (BD-IPMNs). International consensus guidelines for IPMN recommend surveillance without immediate resection for small-sized (<3 cm) BD-IPMNs without malignant features on imaging. Our patient is the first to have undergone resection of a small-sized BD-IPMN containing invasive cancer, but without malignant features on imaging. We herein report a case involving a 70-year-old man with a small cystic lesion in the pancreas head detected by health screening ultrasonography. Detailed examination revealed that the cystic lesion was a BD-IPMN measuring about 2 cm, with no malignant features. However, cytological examination of the pancreatic juice showed atypical cells with high-grade dysplasia storing intracytoplasmic mucin, indicating malignant BD-IPMN. Pathological examination of the resected specimen showed a BD-IPMN measuring 16 mm with an associated invasive carcinoma that invaded the pancreatic parenchyma over a distance of 11 mm. In this patient, invasive cancer was present within a small BD-IPMN with no high-risk stigmata on imaging. Cytological examination of the pancreatic juice allowed for the detection of pancreatic cancer in such a small-sized IPMN. Although routine endoscopic retrograde cholangiopancreatography (ERCP) with cytology is not recommended in all patients with BD-IPMNs, ERCP may contribute to the detection of small pancreatic cancers in select cases. Accumulation of cases of pancreatic cancer within small BD-IPMNs may help establish the indications for ERCP with cytological examination for the purpose of early detection of small pancreatic cancer. .
60. Mizuuchi Y, Aishima S, Hattori M, Ushijima Y, Aso A, Takahata S, Ohtsuka T, Ueda J, Tanaka M, Oda Y, Follicular pancreatitis, report of a case clinically mimicking pancreatic cancer and literature review, Pathology, Research and Practice, 210(2):118-122, 2014.04, We herein present a 71-year-old man who underwent pancreatoduodenectomy with the diagnosis of follicular pancreatitis. We could not completely deny malignancy by a preoperative imaging study. Endoscopic ultrasonography-guided fine needle aspiration biopsy demonstrated clusters of benign acinar cells and no proliferation of atypical lymphoid cells or rich plasma cells. Histologically, the prominent lymphoid follicle formation was seen in an ill-defined mass, 15 mm in size, in the pancreatic parenchyma. Duct-centered fibrotic rims were seen in the pancreatic ducts accompanied by mild fibrotic change between the follicles and obliterative phlebitis. No neoplastic epithelial cells were observed in the resected specimen, and infiltrating lymphocytes did not show any morphological atypia and monoclonal proliferation by immunohistochemical staining with B and T cell markers. In addition, we could exclude IgG4-related disease, because plasmacytic cells were rarely po
sitive for IgG4. Although follicular pancreatitis is rare, this mass-forming inflammatory disease (pancreatitis) should be included in the preoperative differential diagnosis of pancreatic cancer..
61. Date K, Ohtsuka T, Fujimoto T, Gotoh Y, Nakashima Y, Kimura H, Matsunaga T, Mori Y, Mochidome N, Miyazak T, Oda Y, Tanaka M, Nakamura M, GNAS and KRAS mutational analyses of intraductal papillary neoplasms of the pancreas and bile duct developing in the same individual: A case report, Pancreatology, 15(6):713-716, 2015.04, Abstract
Intraductal papillary mucinous neoplasm (IPMN) of the pancreas and intraductal papillary neoplasm of the bile duct (IPNB) are considered as counterparts of each other, and it is suggested that these two entities have similar molecular alteration pathways. However, the occurrence of IPMN of the pancreas and IPNB in the same patient is rare. We report a surgical case of a 69-year-old woman who developed invasive IPMN of the pancreas and underwent pancreatectomy, 6 months after hepatic resection of invasive IPNB. Molecular analysis revealed GNAS/KRAS mutation in both invasive IPMN of the pancreas and IPNB. This is believed to be the first case report investigating GNAS/KRAS mutational status in both IPMN of the pancreas and IPNB developing in the same patient, and these two entities may show similar molecular alternations.
Copyright © 2015 IAP and EPC. Published by Elsevier India Pvt Ltd. All rights reserved.
KEYWORDS:
Bile duct neoplasm; GNAS; IPMN; Intraductal papillary neoplasm; KRAS; Pancreas neoplasm.
62. Ohtsuka T, Tanaka M, Miyazaki K, Gastrointestinal function and quality of life after pylorus-preserving pancreatoduodenectomy, J Hepatobiliary Pancreat Surg. , 13(3):218-224, 2006.04, The pylorus-preserving pancreatoduodenectomy (PPPD) has taken the place of the conventional Whipple pancreato-duodenectomy as the standard procedure for various periampullary disease. With recent advances in surgical techniques and improvements in perioperative management, the number of long-term survivors after PPPD is increasing. As a result, surgeons should pay more attention to the patients' postoperative gastrointestinal function, nutrition, and quality of life (QOL). Gastric stasis, which is a frequent complication during the early postoperative period after PPPD, prolongs the hospital stay and impairs the QOL in the intermediate term. Several possible pathogeneses for this gastric stasis have been postulated; however, the precise mechanism remains unclear. The gastric emptying function gradually recovers to the preoperative level by 6 months after PPPD. Pancreatic functions are likely to be maintained for at least 1 year after PPPD; however, in some cases, they tend to gradually deteriorate over time after the operation, depending on the type of pancreatic reconstruction or the preoperative condition of the pancreas. It is important to note that preoperative and postoperative pancreatic exocrine function strongly influence the postoperative outcome regarding such factors as pancreatic fistula, body weight maintenance, nutrition, and the QOL. The QOL, as assessed by questionnaire, normally returns to the preoperative level within 6 months after PPPD, and this correlates with the changes in gastrointestinal function and nutritional status. It still remains an unresolved question, however, whether the Billroth-I PPPD really leads to better long-term nutritional status, but worse early gastric emptying function, than the Billroth-II type of reconstruction.

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63. Ohtsuka T, Nakamura M, Tanaka M, Superior mesenteric artery-first approach with the first jejunal vein-oriented mesenteric excision in pasncreatoduodenectomy, Surgical Practice, 19(1):29-32, 2014.04.
64. Ohuchida K, Ohtsuka T, Mizumoto K, Hashidume M, Tanaka M, Pancreatic Cancer: Clinical Significance of Biomarkers, Gastro Intestinal Tumors, 1(1):33-40, 2014.04.
65. Ishigami K, Nishie A, Asayama Y, Ushijima Y, Takayama Y, Fujita N, Takahata S, Ohtsuka T, Ito T, Igarashi H, Ikari S, Metz CM, Honda H, Imaging pitfalls of pancreatic serous cystic neoplasm and its potential mimickers, World J Radiol , 6(3):36-47, 2014.04, Abstract
The aim of this article is to clarify diagnostic pitfalls of pancreatic serous cystic neoplasm (SCN) that may result in erroneous characterization. Usual and unusual imaging findings of SCN as well as potential SCN mimickers are presented. The diagnostic key of SCN is to look for a cluster of microcysts (honeycomb pattern), which may not be always found in the center. Fibrosis in SCN may be mistaken for a mural nodule of intraductal papillary mucinous neoplasm (IPMN). The absence of cyst wall enhancement may be helpful to distinguish SCN from mucinous cystic neoplasm. However, oligocystic SCN and branch duct type IPMN may morphologically overlap. In addition, solid serous adenoma, an extremely rare variant of SCN, is difficult to distinguish from neuroendocrine tumor.
KEYWORDS:
Computed tomography; Intraductal papillary mucinous neoplasm; Magnetic resonance imaging; Mucinous cystic neoplasm; Serous cystic neoplasm.
66. Tanaka M, Fernández-Del Castillo C, Kamisawa T, Jang JY, Levy P, Ohtsuka T, Salvia R, Shimizu Y, Tada M, Wolfgang CL, Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas, Pancreatology, 17(5):738-753, 2017.04, The management of intraductal papillary mucinous neoplasm (IPMN) continues to evolve. In particular, the indications for resection of branch duct IPMN have changed from early resection to more deliberate observation as proposed by the international consensus guidelines of 2006 and 2012. Another guideline proposed by the American Gastroenterological Association in 2015 restricted indications for surgery more stringently and recommended physicians to stop surveillance if no significant change had occurred in a pancreatic cyst after five years of surveillance, or if a patient underwent resection and a non-malignant IPMN was found. Whether or not it is safe to do so, as well as the method and interval of surveillance, has generated substantial debate. Based on a consensus symposium held during the meeting of the International Association of Pancreatology in Sendai, Japan, in 2016, the working group has revised the guidelines regarding prediction of invasi
ve carcinoma and high-grade dysplasia, surveillance, and postoperative follow-up of IPMN. As the working group did not recognize the need for major revisions of the guidelines, we made only minor revisions and added most recent articles where appropriate. The present guidelines include updated information and recommendations based on our current understanding, and highlight issues that remain controversial or where further research is required..
67. Nakamura M, Miyasaka Y, Sadakari Y, Date K, Ohtsuka T , Comparison of guidelines for intraductal papillary mucinous neoplasm: What is the next step beyond the current guidelines.
, Annals of Gastroenterological Surgery, 10.1002/ags3.12012, 1(2):90-98, 2017.04, Management of intraductal papillary mucinous neoplasm is controversial, and several guidelines have aimed to establish an adequate strategy for surgical resection and surveillance. We compared various intraductal papillary mucinous neoplasm guidelines and considered new matters that are pivotal for improved treatment of intraductal papillary mucinous neoplasm. We identified and compared 11 published guidelines, three of which were major guidelines that mainly referred to the diagnosis and treatment of intraductal papillary mucinous neoplasm (International Association of Pancreatology 2012 guidelines, European Study Group on Cystic Tumours of the Pancreas 2013 guidelines, and American Gastroenterological Association 2015 guidelines). The main concerns of these three guidelines were indication for surgery and follow up of non‐resected lesions. Among the differences between the three guidelines, the period of surveillance recommended was the most controversial matter. Meanwhile, several nomograms have been proposed to improve the diagnosis of intraductal papillary mucinous neoplasm from the level of experts' experiences to that of rational systems. We discuss the adequate strategy of surveillance for intraductal papillary mucinous neoplasm with and without pancreatectomy and nomograms aiming to predict the risk of malignancy in patients with intraductal papillary mucinous neoplasm..
68. Miyasaka Y, Mori Y, Nakata K, Ohtsuka T, Nakamura M, Attempts to prevent postoperative pancreatic fistula after distal pancreatectomy, Surg Today, 47(4):416-424, 2017.04, Postoperative pancreatic fistula (POPF) is the most frequent and serious complication after distal pancreatectomy (DP) and often leads to other postoperative complications. Numerous studies have been conducted to clarify the risk factors for POPF after DP, and to also determine effective prophylactic treatments. In this article, we review the current evidence on the risk factors for POPF after DP, and also provide new evidence to support the currently implemented prophylactic measures against POPF after DP. The patient-related and surgery-related risk factors and risk factors specific to staplers are discussed. Several studies have suggested that a thick pancreas is a risk factor for POPF using a stapler and that a higher stapler height or pancreatoenteric anastomosis might be useful for preventing POPF when transecting a thick pancreas. Various methods, such as stapler closure, procedures that may be performed in addition to stapler closure, pancreat
oenteric anastomosis, pancreatic transection devices, laparoscopic surgery, pancreatic stenting, stump coverage, and somatostatin analogs, have been tested and in comparison with conventional procedures in case-control studies and randomized, controlled trials. Although some studies have shown the superiority of these methods to the conventional procedures, a consensus on precautionary measures that can be taken against POPF remains to be established. Further investigation is necessary to develop a reliable strategy for preventing POPF and to improve the outcomes of patients after DP..