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:2019.06.18

助教 /  九州大学病院 消化管外科(1)


総説, 論評, 解説, 書評, 報告書等
1. 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).
2. 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).
3. Shindo K, Aishima S, Okido M, Ohshima A, A Poor Prognostic Case ofMucoepidermoid Carcinoma of theThyroid: A Case Report, Case reports in endocrinology, 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..
4. 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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5. 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. .
6. 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..
7. 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.
8. 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).
9. 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.
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, Surgical Case Reports, 3(1):86(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.

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