I’ve been reading your book and absolutely loving it. I’m a sophomore in college (in the US), and I’m minoring in Japanese. What I find most fascinating about your story is how deeply you were able to assimilate in Japanese society. Do you think opportunities for gaijin, (or at least American gaijin), to receive a seishain have increased since you started working for Yomiuri in 1992? Or is it still a very difficult glass ceiling to shatter? Thank you for your time, please feel free to email me.

-Max

Appendix Cancer in Japan

Shingo Oya,1 Kanji Miyata,1 Norihiro Yuasa,1 Eiji Takeuchi,1 Yasutomo Goto,1 Hideo Miyake,1
Keiichi Nagasawa,1 Yoichiro Kobayashi,1 Terutomo Ito2 and Masafumi Ito3
Departments of 1Surgery, 2Gastroenterology and 3Pathology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan

It is difficult to preoperatively diagnose early carcinoma of the vermiform appendix because of its rarity and few specific
clinical features. In the present study, we report a preoperatively diagnosed mucosal carcinoma of the vermiform appendix.
Key words: carcinoma of the vermiform appendix, early carcinoma, preoperative diagnosis.
INTRODUCTION
Carcinoma of the vermiform appendix is a rare disease, and
it is difficult to preoperatively diagnose it because it has few
specific clinical features. It is correctly diagnosed preoperatively
in 6.6–25% of cases.1–3 Additionally, being diagnosed
at an early stage is extremely rare. Moreover, it can mimic
acute appendicitis because the cancer can cause a luminal
blockage of the vermiform appendix. The diagnostic rate of
this cancer after an operation for appendicitis is reported to
be 0.03–2.2%.4–6 If the appendiceal cancer is misdiagnosed
as benign appendicitis, another operation may needed after
that for the appendicitis. If en block resection cannot be
done, there is a risk of local recurrence. So, it cannot
follow the oncological principle of surgery for cancer.
Therefore, it is important to diagnose it at an early stage for
the optimal treatment of this disease. We present a case of
preoperatively diagnosed early carcinoma of the appendix
vermiformis.
CASE REPORT
A 59-year-old man was admitted to our hospital for additional
studies after occult fecal blood was detected. He had
hypertension but no remarkable family history. He had
neither fever nor abdominal pain. No abdominal mass was
palpable. His laboratory findings at hospitalization were not
remarkable: hemoglobin was 14.9 g/dL, white blood cell
count (WBC) was 6300/mL and C-reactive protein (CRP) was
negative, carcinoembryonic antigen (CEA) was 1.7 ng/mL
and CA19-9 was 7.6 U/mL. Abdominal computed tomography
revealed a 20 mm round mass with contrast enhancement
in the cecum and a swollen appendix (Fig. 1). Barium
enema showed a protruding mass with a smooth surface at
the bottom of the cecum; however, the appendix was not
visualized. Colonoscopy disclosed a tumor in an enlarged,
protruding orifice of the vermiform appendix (Fig. 2). Pathological
examination of the biopsy specimen revealed welldifferentiated
adenocarcinoma. From these findings, we
diagnosed this patient as having a carcinoma of the appendix
vermiformis.An ileocecal resection with lymph node dissection
was carried out. Macroscopic findings of the resected
specimen showed a submucosal tumor located at the root of
the appendix and an enlarged appendiceal orifice.The tumor
was 20 mm and sessile in the resected specimen (Fig. 3).
Pathological examination revealed that atypical columnar
epithelia had proliferated with a papillary or glandular structure,
and the diagnosis was a mucosal well-differentiated
adenocarcinoma without vessel invasion and lymph node
metastasis (Fig. 4).
DISCUSSION
Carcinoma of the vermiform appendix accounts for 0.18%
of all colorectal cancers and 0.1% of excised vermiform
appendices.7,8 The frequency of early carcinoma is approximately