九州大学 研究者情報
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進藤 幸治(しんどう こうじ) データ更新日:2022.05.30

助教 /  九州大学病院 消化管外科(1) 臨床・腫瘍外科


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1. 進藤幸治, 大塚隆生, 中村雅史, 十二指腸乳頭形成術Transduodenal sphincteroplasty, ビジュアルサージカル 消化器外科手術 胆道・膵臓, 85-94, 2019.04.
2. 進藤幸治, 加藤雅人, 縦隔コレステリン肉芽腫の1例, 日本呼吸器外科学会雑誌, 22(1):101-105, 2008.04, 症例は55歳男性、検診における胸写にて異常陰影を指摘され精査加療となった。胸部X線写真、CT,MRI所見上は後縦隔下部に5cm弱の境界明瞭な腫瘤として存在し、内部は液状成分でみたされていた。縦隔腫瘍の診断で、気管支原性嚢胞や奇形腫、神経鞘腫を疑い手術となった。術中所見では、周囲と強固に癒着する腫瘤であり、食道筋層と連続していたため術中診断は食道嚢胞を疑った。この症例に対し胸腔鏡補助下縦隔腫瘍切除術を施行した。術後の病理組織所見では、嚢胞内にはコレステリン沈着と異物型巨細胞が多数みられ、コレステリン肉芽腫と診断された。(著者抄録).
3. 橋健太郎, 進藤幸治, 藤井圭, 笹月朋成, 冨永洋平, 廣田伊千夫, 江口徹, 河野眞司, 相島慎一, 膀胱癌の治療経過中に発生した細胆管細胞癌の1切除例, 日本消化器外科学会, 42(12):1808-1813, 2009.04, 症例は87歳の男性で,表在性膀胱癌のため当院泌尿器科で経尿道的腫瘍切除が行われ,経過観察されていた.2007年1月の腹部造影CTで肝S6に15mmの腫瘤性病変が指摘されたが,血管腫と診断し経過観察されていた.2007年9月の腹部造影CTで肝S6の腫瘤性病変は30mmに増大しており,胆管細胞癌(cholangiocellular carcinoma;以下,CCC)が疑われた.肝腫瘍生検にて中分化型のCCCと診断され,肝S6部分切除を行った.病理組織学的診断では,小型均一な癌細胞が索状から小管腔を形成し互いに癒合しながら増殖する像を呈しており,細胆管細胞癌(cholangiolocellular carcinoma;以下,CoCC)と診断された.術後12ヵ月が経過したが無再発生存中である.極めてまれなCoCCの切除例を経験したので文献的考察を加えて報告する.(著者抄録).
4. 片山直樹, 進藤幸治, 大内田研宙, 森山大樹, 小田義直, 中村雅史, Barrett食道癌に対して施行した術前化学療法が著効し完全奏効となった一例, 臨牀と研究, 97(6):729-735, 2020.04.
5. 久保進祐, 森山大樹, 大内田研宙, 進藤幸治, 長尾晋次郎, 中村雅史, 食道癌手術前処置のグリセリン浣腸による急性腎不全の1例, 日本臨床外科学会雑誌, 82(1):180-186, 2021.04, 症例は56歳の男性で,胸部食道癌手術の前処置としてグリセリン浣腸を行ったところ強い肛門痛と少量の出血をきたした.症状はすぐ軽快したため,予定通り手術室へ搬入した.全身麻酔導入時に少量の赤色尿を認めたが血液検査やバイタルサインに異常を認めなかったため,予定通り手術を施行した.術中尿量は0mLであり,術後も無尿が続いた.急性腎不全と診断し術翌日から持続的血液濾過透析(CHDF),また溶血性腎不全を念頭にハプトグロビンの投与を開始した.術後10日目までCHDFを行い,その後も血液透析を行った.腎機能は徐々に改善し術後27日目に退院し,術後2カ月で腎機能は正常化した.グリセリン浣腸は汎用されているが,その重篤な合併症としての急性腎不全は頻度も低く,十分に認識されているとはいえない.本症例のように重篤な合併症を引き起こす可能性があることを医師だけでなくその他の医療従事者も知っておく必要がある.(著者抄録).
6. Shindo K, Aishima S, Okido M, Ohshima A, A Poor Prognostic Case ofMucoepidermoid Carcinoma of theThyroid: A Case Report, Case Rep Endocrinol, 2012.04, Abstract
Mucoepidermoid carcinoma (MEC) of the thyroid is very rare and low-grade indolent neoplasm. In past reports of the thyroid MEC, only seven cases were described as poor prognosis. A 91-year-old woman presented with a rapidly growing mass of the left upper neck. She was followed thyroid papillary carcinoma (PC) without operation for two years. Fine needle aspiration cytology (FNAC) showed undifferentiated cells. Total thyroidectomy and bilateral neck dissection were performed. In pathological findings, the tumor had two areas of MEC and PC. The boundary of them was mixed. She died of multiple lung metastases only after four months from the operation. We report a rare case of thyroid MEC which had an aggressive behavior and poor prognosis. This case is a precious in that thyroid MEC occurred during observation of PC and suggests a possibility of the transformation from PC to MEC..
7. 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, 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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8. 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. .
9. Shindo K, Ueda J, Toubo T, Nakamura M, Oda Y, Eguchi T, Tanaka M, Primary carcinoid tumor in a retroperitoneal mature teratoma: report of a case, Surg Today, 43(6):694-697, 2013.04, Primary retroperitoneal teratoma in an adult is rare, as is the occurrence of a malignant tumor within a mature teratoma, known as "malignant transformation". A 24-year-old woman was admitted to our hospital for investigation of an abdominal mass. Computed tomography and magnetic resonance imaging revealed a multilocular mass in the right upper abdomen. The tumor consisted of fat, soft tissue, and bone, with a slightly enhanced solid component. The tumor was diagnosed preoperatively as a retroperitoneal mature teratoma with an immature component, and excised. Histologically, it was composed mainly of mature fat, soft tissue, and bone, accompanied by a solid component of prostate-like tissue. In addition, a latent carcinoid tumor was recognized in the middle of the tumor. The tumor was finally diagnosed as a primary carcinoid tumor within the retroperitoneal mature teratoma. The patient has been followed-up for 24 months since her operation without any evidence of recurrence. We report this case to highlight the possibility of malignant transformation in adult retroperitoneal teratoma, even when the preoperative diagnosis is benign mature teratoma..
10. 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, Surg Case Rep, 10.1186/s40792-017-0360-9., 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.
11. Oyama K, Ohuchida K, Shindo K, Moriyama T, Hata Y, Wada M, Ihara E, Nagai S, Ohtsuka T, Nakamura M, Thoracoscopic Surgery Combined With Endoscopic Creation of a Submucosal Tunnel for a Large Complicated Esophageal Leiomyoma, Surgical case report, 10.1186/s40792-020-00854-5, 6(1):92, 2020.04.
12. Tsutsumi C, Moriyama T, Ohuchida K, Shindo K, Nagai S, Yoneda R, Fujiwara M, Oda Y, Nakamura M, Numerous lymph node metastases in early gastric cancer without preoperatively enlarged lymph nodes: a case report, Surg Case Rep, 10.1186/s40792-020-0795-2, 6(1):30, 2020.04, Background: According to the 2018 Japanese gastric cancer treatment guidelines (ver. 5), a reduced extent of lymphadenectomy (D1 or D1+) is indicated for cT1 N0 tumors that do not meet the criteria for endoscopic resection. However, early gastric cancer with multiple lymph node metastases is not unknown, and cases have been reported. We report a case of a patient with early gastric cancer and numerous nodal metastases who underwent laparoscopic proximal gastrectomy based on a preoperative diagnosis of T1 N0.

Case presentation: A 69-year-old woman underwent emergent endoscopic hemostasis for massive hematemesis of the stomach, and endoscopic examination showed ulceration with a visible vessel. Pathological biopsy examination of the ulcer identified poorly differentiated adenocarcinoma with signet ring cells. The patient was diagnosed with early gastric cancer that was not indicated for endoscopic resection because of the ulceration and histological type. Endoscopic ultrasound showed that the third layer was poorly demarcated at the ulcer scar, indicating invasion to the submucosal layer. Computed tomography did not reveal enlarged lymph nodes or distant metastasis. The preoperative diagnosis was early gastric cancer of the fundus without nodal metastasis, and laparoscopic proximal gastrectomy with D1+ lymphadenectomy was performed. The initial postoperative pathological diagnosis was intramucosal carcinoma without lymphovascular invasion; however, the presence of 26 lymph node metastases was revealed unexpectedly. Additional pathological examination of more resected specimens transected every 2-3 mm revealed that only one lesion contained a small number of cancer cells in the lymphatic duct below the muscularis mucosa.

Conclusions: We report a case of early gastric cancer with 26 nodal metastases in which lymph node involvement was not identified prior to surgery. These findings indicate that the extent of lymphadenectomy and the surgical procedure should be carefully decided even in cT1 N0 early gastric cancer when several risk factors for lymph node metastasis are present.
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13. Shindo K, Ohuchida K, Moriyama T, Kinoshita F, Koga Y, Oda Y, Eto M, Nakamura M, A rare case of PSA-negative metastasized prostate cancer to the stomach with serum CEA and CA19-9 elevation: a case report, Surg Case Rep, 10.1186/s40792-020-01074-7, 6(1):303, 2020.04, Abstract
Background: Metastatic cancer to the stomach is relatively rare. Prostate-specific antigen (PSA) is a reliable biomarker used in the screening and management of patients with prostate cancer. However, it is difficult to definitively diagnose a PSA-negative metastatic gastric tumor of prostate cancer because the cancer sometimes resembles primary gastric cancer in clinical images. It is also difficult to distinguish metastatic cancer from primary cancer even in the pathological examination of biopsy samples when the lesion is poorly differentiated adenocarcinoma. There is a possibility that the characteristics of the cancer are changed during treatment such as chemotherapy or radiation therapy. Therefore, careful consideration is required for surgical indication.
Case presentation: A 60-year-old male underwent radical prostatectomy and subsequent radiation therapy for advanced prostate cancer (pT3N1M0) 10 years previously, and hormone therapy was started for metachronous multiple bone metastasis 10 months before. Upper gastrointestinal endoscopy revealed an irregular depressed lesion with a convergence of folds at the greater curvature of the upper gastric body. Biopsy showed poorly differentiated adenocarcinoma that was negative for PSA upon immunohistochemistry. He had high serum carcinoembryonic antigen (CEA) (946.1 ng/ml) and carbohydrate antigen 19-9 (CA19-9) (465.1 U/ml) levels with no elevation of PSA (0.152 ng/ml). The tumor was diagnosed as primary gastric cancer based on the clinical imaging and pathological examination of the biopsy sample including the PSA staining. Based on the diagnosis, laparoscopic proximal gastrectomy with lymphadenectomy was performed. However, pathological examination of the resected specimen revealed poorly differentiated adenocarcinoma that was positive for other prostate markers such as androgen receptor. Thus, the patient was diagnosed with metastasized prostate cancer to the stomach.
Conclusions: We report a case of metastatic gastric cancer of prostate cancer 10 years after radical prostatectomy. In the present case, it was difficult to diagnose a metastatic gastric tumor of prostate cancer preoperatively, because of its resemblance to primary gastric cancer without PSA expression and no serum PSA elevation. Although a rare case entity, it is important to consider the possibility of a metastatic gastric tumor when the surgical indication is determined in cases with another co-existing cancer.
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14. 進藤幸治, 永井英司, 森山大樹, 大内田研宙, 真鍋達也, 大塚隆生, 中村雅史, 胃全摘術後再建:Linear stapler 完全腹腔鏡下 Inverted-T 型 Overlap 法再建, 臨床外科, 72(4):441-444, 2017.04, bstract:<ポイント>食道と空腸を逆T字型になるように吻合することで,共通孔が腹側を向き,縫合閉鎖に有利である.共通孔閉鎖は連続縫合にこだわらず,術者の技量に合わせて結節縫合を適宜採用すること.(著者抄録).
15. 進藤幸治, 永井英司, 大内田研宙, 森山大樹, 真鍋達也, 大塚隆生, 中村雅史, 胃の腹腔鏡下手術 幽門側胃切除術, 消化器外科, 40(3):273-281, 2017.04.
16. 進藤幸治, 大内田研宙, 森山大樹, 中村雅史, 手術手技 腹腔鏡下胃切除におけるポート位置シミュレーション, 手術, 10.18888/op.0000001829, 74(9):1347-1354, 2020.04.
17. 大内田研宙, 進藤幸治, 森山大樹, 中村雅史, 機能的に胃内流入を主経路とする逆蠕動性側々による空腸残胃吻合を用いたdouble tract再建手技, 手術, 10.18888/op.0000002062, 75(2):207-214, 2021.04.
18. Ohtsuka T, Tomosugi T, Kimura R, Nakamura S, Miyasaka Y, Nakata K, Mori Y, Morita M, Torata N, Shindo K, Ohuchida K, Nakamura M, Clinical assessment of the GNAS mutation status in patients with intraductal papillary mucinous neoplasm of the pancreas, Surg Today, 10.1007/s00595-019-01797-7 , 49(11):887-893, 2019.04, Abstract
Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is characterized by cystic dilation of the pancreatic duct, caused by mucin hypersecretion, with slow progression via the adenoma-carcinoma sequence mechanism. Mutation of GNAS at codon 201 is found exclusively in IPMNs, occurring at a rate of 41-75%. Recent advances in molecular biological techniques have demonstrated that GNAS mutation might play a role in the transformation of IPMNs after the appearance of neoplastic cells, rather than in the tumorigenesis of IPMNs. GNAS mutation is observed frequently in the intestinal subtype of IPMNs with MUC2 expression, and less frequently in IPMNs with concomitant pancreatic ductal adenocarcinoma (PDAC). Research has focused on assessing GNAS mutation status in clinical practice using various samples. In this review, we discuss the clinical application of GNAS mutation assessment to differentiate invasive IPMNs from concomitant PDAC, examine the clonality of recurrent IPMNs in the remnant pancreas using resected specimens, and differentiate pancreatic cystic lesions using cystic fluid collected by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA), duodenal fluid, and serum liquid biopsy samples
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