Faculty Profiles - FUJIWARA Toshiyoshi

MISC - FUJIWARA Toshiyoshi

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A case of primary hepatic solitary fibrous tumor with simultaneous intrahepatic metastasis and pancreatic metastasis

Takashi Kuise, Yuzo Umeda, Hiroshi Sadamori, Susumu Shinoura, Ryuichi Yoshida, Daisuke Sato, Daisuke Nobuoka, Masashi Utsumi, Takahito Yagi, Toshiyoshi Fujiwara

Japanese Journal of Gastroenterological Surgery 47 ( 4 ) 215 - 222 2014

Language：Japanese Publisher：Japanese Society of Gastroenterological Surgery

Solitary fibrous tumor (SFT) is a relatively rare tumor that develops mostly as an intrathoracic lesion related to the pleura. Hepatic malignant SFTs are rare. Here, we present a case of a 56-year-old man with a bulky tumor in the right hepatic lobe. The tumor was found incidentally by abdominal CT as part of an examination for hepatic dysfunction. The definitive diagnosis of SFT was established after liver biopsy, and the patient was referred to our hospital for surgical treatment. At the first visit, imaging studies revealed the primary focus of the malignancy as well as metastatic lesions in the hepatic S2 segment and pancreatic body. The treatment regimen was as follows: after antecedent TAE, primary hepatic and intrahepatic metastatic foci were first resected by extended resection of the two central areas. Nine months later, the pancreatic head tumor was enucleated and distal pancreatectomy was performed to remove metastatic foci including the new lesion on the pancreatic head. Postoperative adjunctive therapy was not administered, and the patient is currently alive without recurrence 22 months postoperatively. To the best of our knowledge, there have only been a few reports on primary hepatic malignant SFTs and this is the only SFT case involving pancreatic metastases reported thus far. This case indicates that total tumor resection allows patients with distant metastasis to achieve recurrence-free survival. Should recurrence occur, we would proactively consider the use of molecular-targeted drugs (approved in 2012), with re-resection in mind. © 2014 The Japanese Society of Gastroenterological Surgery.

DOI： 10.5833/jjgs.2013.0002

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ロボット支援下噴門側胃切除術後のロボットによる体腔内手縫い吻合

西﨑正彦, 黒田新士, 岸本浩行, 野間和広, 香川俊輔, 白川靖博, 藤原俊義

癌の臨床 60 ( 3 ) 311 - 317 2014

直腸癌術後尿管再発の１例

松本聖, 稲田涼, 近藤喜太, 母里淑子, 岸本浩行, 江原伸, 戸田博子, 柳井広之, 永坂岳司, 藤原俊義

癌の臨床 60 ( 5 ) 549 - 554 2014

Language：Japanese Publisher：(株)篠原出版新社

尿管再発は大腸癌において頻度の低い再発形式である。今回直腸癌術後に血尿を契機に発見された左尿管再発を経験したので報告する。患者は80代男性。2007年1月、上部直腸癌に対して低位前方切除術を施行。病理診断にて中分化管状腺癌(pT4aN0M0、pStage II)と診断。2011年9月、血尿を認め、膀胱および左尿管に腫瘍を指摘。膀胱腫瘍に対してはTUR-BTを、また尿管腫瘍に対しては左腎尿管摘出術を施行。組織診断では膀胱腫瘍は、原発性尿路上皮癌と診断。また尿管腫瘍は腸管由来の分化型腺癌を認め、直腸癌の尿管再発と診断。その後、膀胱癌の局所再発および直腸癌の肺・膀胱内再発をきたすも、2012年5月、癒着性イレウスによる嘔吐に伴う誤嚥性肺炎により永眠された。(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2014&ichushi_jid=J00297&link_issn=&doc_id=20141203210011&doc_link_id=%2Fad7gnrsc%2F2014%2F006005%2F011%2F0549-0554%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fad7gnrsc%2F2014%2F006005%2F011%2F0549-0554%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

FDG-PET/CTで再発大腸癌を疑った腹腔内膿瘍の1切除例

母里淑子, 永坂岳司, 稲田涼, 渡邉彩子, 岸本浩行, 近藤喜太, 藤原俊義

癌と化学療法 41 ( 12 ) 1599 - 1601 2014

Language：Japanese Publisher：(株)癌と化学療法社

症例は65歳、男性。腸穿孔を伴う下行結腸癌術後、補助化学療法中にCT、FDG-PET/CT検査にて脾臓・横隔膜にFDGの集積を認め術後再発と診断し、手術を施行したところ、腫瘍再発でなく膿瘍であった。腹膜播種の画像による確定診断は困難であり、特に腸穿孔後は感染性の集積も鑑別する必要がある。臨床的に示唆に富んだ症例を経験したので、文献的考察を含め報告する。(著者抄録)

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Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2014&ichushi_jid=J00296&link_issn=&doc_id=20141217480050&doc_link_id=%2Fab8gtkrc%2F2014%2F004112%2F050%2F1599-1601%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2014%2F004112%2F050%2F1599-1601%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

術前補助化学療法によりpCRが得られた高度進行胃癌の1例

菊地覚次, 香川俊輔, 久保田哲史, 桒田和也, 黒田新士, 西﨑正彦, 田中健大, 藤原俊義

癌と化学療法 41 ( 12 ) 2282 - 2284 2014

化学療法後に切除しpCRを得たStageⅣ胃癌の２例

久保田哲史, 香川俊輔, 菊地覚次, 黒田新士, 西﨑正彦, 藤原俊義

癌と化学療法 41 ( 12 ) 2308 - 2310 2014

分葉膵に付着した消化管重複症

尾山貴徳, 野田卓男, 谷本光隆, 楳田祐三, 藤智和, 八木孝仁, 藤原俊義

小児外科 46 ( 12 ) 1269 - 1273 2014

A Case of Advanced Esophageal Cancer with Pulmonary Hypertention due to Atrial Septal Defect

FUJITA Toshihiko, OHARA Toshiaki, TANABE Shunsuke, NOMA Kazuhiro, SHIRAKAWA Yasuhiro, FUJIWARA Toshiyoshi

Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 75 ( 2 ) 384 - 387 2014

Language：Japanese Publisher：Japan Surgical Association

A 62-year-old man was detected to have advanced esophageal cancer with pulmonary hypertension (PH) due to atrial septal defect (ASD). We planned to perform radical repair of ASD and neoadjuvant chemotherapy before esophagectomy. However, he went into shock with melena by using an anticoagulant before cardiac catheterization. Endoscopic examination showed hemorrhage from the esophageal tumor, which suggested that ASD repair should be preceded by esophagectomy to remove the hemorrhage source. After esophagectomy, circulatory dynamics was unstable. Pulmonary arterial pressure (PAP) temporarily exceeded arterial pressure (AP) with coughing on the second day after the operation. Strict management with infusion and administration of vasopressin led to stable circulatory dynamics. However, unstable dynamics seemed to recur and we decided to repair ASD. Amplatzer Septal Occluder was inserted with intra cardiac echocardiography (ICE) because trans-esophageal echocardiography could not be used. After amplazter insertion, he became in good condition and was transferred to POD another hospital on 20.

DOI： 10.3919/jjsa.75.384

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Other Link： http://search.jamas.or.jp/link/ui/2014159787

Hepatopulmonary syndrome in Japanese liver cirrhosis patients

Hayami Okada, Akinobu Takaki, Takahito Yagi, Tetsuya Yasunaka, Tatsuhiro Gotoda, Hiroki Oe, Kazufumi Nakamura, Shuichi Sato, Hiroshi Sadamori, Susumu Shinoura, Yuzo Umeda, Ryuichi Yoshida, Masashi Utsumi, Daisuke Nobuoka, Yuko Yasuda, Fusao Ikeda, Yasuhiro Miyake, Hiroshi Ito, Toshiyoshi Fujiwara, Kazuhide Yamamoto

Acta Hepatologica Japonica 55 ( 3 ) 143 - 154 2014

Language：Japanese

Hepatopulmonary syndrome is characterized by hypoxemia induced by intrapulmonary vascular dilatations associated with hepatic diseases. We evaluated the frequency and case presentations revealed by general screening before liver transplantation. Sixty-one patients underwent arterial blood gas analysis in both upright and supine positions. Of these, 27 patients (44%) showed Pa0&lt
inf&gt
2&lt
/inf&gt
&lt
80 mmHg and AaD0&lt
inf&gt
2&lt
/inf&gt
&gt
15 mmHg, reflecting intrapulmonary shunting. Four patients exhibited Pa0&lt
inf&gt
2&lt
/inf&gt
&lt
70 mmHg and orthodeoxia, defined as a fall in Pa0&lt
inf&gt
2&lt
/inf&gt
&gt
5% or 4 mmHg in an upright position. Finally, two patients showed hepatopulmonary syndrome, with positive findings on perfusion lung scanning. Both patients with hepatopulmonary syndrome had liver cirrhosis type C with habitual alcohol drinking and smoking. Potential pulmonary shunt patients with Pa0&lt
inf&gt
2&lt
/inf&gt
&lt
80 mmHg and AaD0&lt
inf&gt
2&lt
/inf&gt
&gt
15 mmHg exhibited higher model for end-stage liver disease scores. Care should be taken regarding hepatopulmonary syndrome during liver cirrhosis management in Japanese patients. © 2014 The Japan Society of Hepatology.

DOI： 10.2957/kanzo.55.143

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A patient with primary malignant melanoma of the esophagus who underwent esophagectomy

Maeda Naoaki, Shirakawa Yasuhiro, Koujima Takeshi, Ohara Toshiaki, Tanabe Shunsuke, Noma Kazuhiro, Sakurama Kazuhumi, Fujiwara Toshiyosi

Okayama Igakkai Zasshi (Journal of Okayama Medical Association) 126 ( 1 ) 45 - 48 2014

Language：Japanese Publisher：Okayama Medical Association

We report the case of a 61-old-man with a primary malignant melanoma of the esophagus, an extremely rare and highly aggressive malignancy. He presented with dysphagia, and we performed an upper gastrointestinal endoscopy that detected a tumor in the thoracic part of the esophagus. The biopsy showed malignant melanoma. PET/CT, endoscopy and an esophagogram showed that a 70-mm scaled type 2+1 tumor in the thoracic esophagus and no metastases. We diagnosed a cT3cN0cM0 cStage II tumor. We then performed a subtotal esophagectomy with two-field lymph node dissection and esophagogastrostomy via a retrosternal route. The pathological examination of the resected specimens confirmed that the type 2+1 tumor was PMME (pT2N0M0 pStage II). We administered six courses of postoperative adjuvant chemotherapy with dacarbazine, and the patient has had no recurrence for 17 months after the surgery.

DOI： 10.4044/joma.126.45

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Other Link： http://ousar.lib.okayama-u.ac.jp/52323

Biological Ablation of Sentinel Lymph Node Metastasis in Submucosally Invaded Early Gastrointestinal Cancer

Kikuchi S, Kishimoto H, Tazawa H, Hashimoto Y, Kuroda S, Nishizaki M, Nagasaka T, Shirakawa Y, Kagawa S, Urata Y, Hoffman RM, Fujiwara T

Mol Ther doi: 10.1038/mt.2014.244 2014

縮小手術のコツとピットフォール① 噴門側胃切除術（観音開き法）

西﨑正彦, 黒田新士, 松村年久, 高嶌寛年, 加藤大, 菊池覚次, 桒田和也, 香川俊輔, 藤原俊義

臨床外科 69 ( 13 ) 1464 - 1471 2014