Nephroblastomatosis (NBM) is a precursor of Wilms tumor. We herein report a case in which Wilms tumor was initially suspected and the affected kidney was removed.The tumor was subsequently diagnosed as intralobar NBM and a favorable outcome was achieved with postoperative chemotherapy. A 2-year-old boy who presented with gross hematuria was found to have an enlarged left kidney with hydronephrosis.Needle biopsy of the left kidney suggested Wilms tumor and left nephrectomy was performed. The tumor was histopathologically diagnosed as intralobar NBM.Although NBM is regarded as a precancerous lesion, a definite treatment plan has not yet been established. In the present case, we used a similar chemotherapy regimen to that for Wilms tumor. Eight years after the completion of chemotherapy, Wilms tumor has not developed or recurred. Appropriate management plans need to be developed by accumulating similar cases.

The first author set up a study group with other members in 2014, aiming to improve multidisciplinary collaboration through reflection and discussions on discomfort ( “Moyatto” in Japanese) while focusing on group members’ experiences at work. One-hour online sessions were conducted monthly with multidisciplinary professionals from several institutions. We reflected on interprofessional collaboration based on Moyatto. This paper describes the history of the study group’s inception and development, the learning process of each session, and the theory as a framework. It also reports on the practice and changes in our study group, concluding that interprofessional collaboration requires first-order reflection within a same-profession group and second-order reflection among diverse professionals.

We developed an educational program on cultural competence for psychiatric professionals. Regarding social justice education that critically questions dominant ideologies, we held weekly 30-minute discussion groups with multidisciplinary professionals. Rather than focusing on a particular culture group, we aimed to realize through critical self-reflection, as advocated by Kumagai and Lypson, that “there is a part of the other that I cannot know,” and named this group the “Discussion Group on Otherness.” Using essays on medical culture written by researchers in the medical humanities as our main teaching material, we discussed what is (or should be) the relevant problem. This article discusses the issues that have emerged so far, the responses to these issues, and future developments.

The Japanese Society of Hepato-Biliary-Pancreatic Surgery launched the clinical practice guidelines for the management of biliary tract cancers (cholangiocarcinoma, gallbladder cancer, and ampullary cancer) in 2007, then published the 2nd version in 2014. In this 3rd version, clinical questions (CQs) were proposed on six topics. The recommendation, grade for recommendation, and statement for each CQ were discussed and finalized by an evidence-based approach. Recommendations were graded as grade 1 (strong) or grade 2 (weak) according to the concepts of the grading of recommendations assessment, development, and evaluation system. The 31 CQs covered the six topics: (1) prophylactic treatment, (2) diagnosis, (3) biliary drainage, (4) surgical treatment, (5) chemotherapy, and (6) radiation therapy. In the 31 CQs, 14 recommendations were rated strong and 14 recommendations weak. The remaining three CQs had no recommendation. Each CQ includes a statement of how the recommendations were graded. This latest guideline provides recommendations for important clinical aspects based on evidence. Future collaboration with the cancer registry will be key for assessing the guidelines and establishing new evidence.

Objective: Combination therapy with glecaprevir and pibrentasvir (G/P) has been shown to provide a sustained virologic response (SVR) rate of >97% in patients with chronic hepatitis C virus (HCV) infection in the first published real-world Japanese data. However, a recently published study showed that the treatment was often discontinued in patients ≥75 years old, resulting in low SVR in intention-to-treat (ITT) analysis. Thus, our aim was to evaluate real-world data for G/P therapy in patients ≥75 years of age, the population density of which is high in “rural” regions.Patients and Methods: We conducted a multicenter study to assess the efficacy and safety of G/P therapy for chronic HCV infection, in the North Kanto area in Japan.Results: Of the 308 patients enrolled, 294 (95.5%) completed the treatment according to the protocol. In ITT and per-protocol analyses, the overall SVR12 rate was 97.1% and 99.7%, respectively. The old-aged patients group consisted of 59 participants, 56 of whom (94.9%) completed the scheduled protocol. Although old-aged patients tended to have non-SVR factors such as liver cirrhosis, history of HCC, and prior DAA therapies, the SVR12 rates in old-aged patients were 98.3% and 100% in the ITT and PP analyses, respectively. Of 308 patients enrolled, adverse events were observed in 74 patients (24.0%), with grade ≥3 events in 8 patients (2.6%). There was no significant difference in any grade and grade ≥3 adverse events between the old-aged group and the rest of the study participants. Only one patient discontinued the treatment because of adverse events.Conclusion: G/P therapy is effective and safe for old-aged patients.

A 55-year-old man visited our hospital for a detailed examination of a gastric submucosal tumor that was first detected 10 years prior. The tumor continued to grow and had developed a depressed area in its center. A histopathological examination of biopsy specimens revealed gastric adenocarcinoma of the fundic gland type (GA-FG). It was diagnosed as T2 based on the invasion depth as determined by white-light endoscopy and endoscopic ultrasonography. A total gastrectomy with lymphadenectomy was performed and a GA-FG in the mucosa and submucosa was confirmed histopathologically. However, there was a gradual transition to an infiltrative tubular adenocarcinoma with poorly differentiated components in the muscular and subserosal layers. Metastasis was identified in a dissected lymph node (LN). This is the first report of a GA-FG progressing to an aggressive cancer with LN metastasis. These findings modify our understanding of the pathophysiology of GA-FG.
Adenocarcinoma* ; Biopsy ; Endoscopy ; Endosonography ; Gastrectomy ; Gastric Mucosa ; Humans ; Lymph Node Excision ; Lymph Nodes* ; Middle Aged ; Mucous Membrane ; Neoplasm Metastasis*

A 74-year-old woman visited our hospital complaining of pain in the left lower quadrant of the abdomen. Physical examination revealed tenderness to palpation without peritoneal signs. Blood test results showed elevated inflammatory response. Both ultrasonography and computed tomography revealed an intra-abdominal abscess containing a foreign body (fish bone) immediately below the left inferior abdominal wall. Lower gastrointestinal endoscopy conducted under fluoroscopic guidance revealed no intraluminal lesion in the colon adjacent to the abscess, and contrast examination also revealed no communication between the colon and the abscess. Fasting and administration of antibiotics did not improve the symptoms. We planned surgical procedure. Partial resection of the sigmoid colon was performed because of the presence of strong adhesions between the colonic wall and abscess. The postoperative course was uneventful, and the patient was discharged on hospital day 12. Histological examination of the resected specimen showed chronic abscess formation, but no communication between the intestinal tract and abscess. Onset was thought to be chronic in this case, because of uncertainty about the history of ingestion of fish bone and failure to verify any communication with the intestinal tract.