Akinori Kido

A clinicopathologic study of mucinous gastric carcinoma

A clinicopathologic study of 42 mucinous gastric carcinomas (MGC) and 73 nonmucinous gastric carcinomas (NGC) was done. The tumor was defined as MGC when more than one half of tumor area had mucin pools. The 5‐year survival rate for curatively treated patients was almost the same in MGC (58%) and NGC (56%), and clinicopathologic features, except for lymphatic permeation, showed no significant difference between MGC and NGC. Findings in MGC patients who died of a recurrence within 3 years included total gastrectomy, upper location, large size, infiltrative growth, extraserosal invasion, positive lymph node metastasis, more advanced stage, and a noncurative operation. There was no significant correlation between the degree of mucin content and other data, including the prognosis. Histologically, MGC were divided into well‐differentiated and poorly differentiated types, according to the degree of glandular formation of the tumor cells. In patients with well‐differentiated MGC, the age of onset was older, tumor growth was localized, and there were metastases to the liver. In patients with poorly differentiated MGC, the age of onset was younger, tumor growth was infiltrative, and there was peritoneal dissemination. These results show that the biologic behavior of MGC is similar to that of NGC and that the lesion basically is determined by the histologic subtype, not by the mucin content. Cancer 1992; 69:866–871.

Immunohistochemical expression of β-human chorionic gonadotropin in colorectal carcinoma

The presence of human β-chorionic gonadotropin (HCG) was immunohistochemically studied in 123 cases of primary colorectal carcinoma using the avidin-biotinperoxidase complex method. Positive staining for HCG was recognized in 45 (36.6%) tumors and a statistical difference was observed between the HCG-positive (n=45) and-negative (n=78) groups concerning the frequency of blood vessel invasion in the primary tumor (P<0.01). The prognosis for patients with HCG-positive carcinoma was thus significantly worse than that for patients with HCG-negative carcinoma (P<0.05). A multivariate analysis using the Cox hazards model demonstrated the positive or negative staining of HCG to be one of the independent prognostic factors. The above findings show that, in addition to various other prognostic factors, the HCG staining status may thus also help in determining the prognosis of patients with primary colorectal carcinoma.

Multiple colorectal neoplasms in a young adult with hypogammaglobulinemia. Report of a case.

We report on a 22-year-old man with congenital hypogammaglobulinemia who developed multiple colorectal neoplasms. An immunodeficiency had been diagnosed in the patient since two years of age, and this time many tumors of the sigmoid colon and rectum were detected by barium enema and fiberscopy. Abdominoperineal resection was performed, and the resected specimen revealed 29 polyps, including 9 adenocarcinomas and 20 adenomas. The carcinomas, measuring 0.8 to 11.0 cm in size, showed various depths of invasion, and the adenomas, measuring 0.2 to 1.5 cm in size, showed various degrees of epithelial atypia. DNA analysis demonstrated that the tumors were heterogeneous, showing different DNA index and ploidy patterns. The pathogenetic relation between malignancy and immunodeficiency is also reviewed.

Primary Gas Gangrene of the Pancreas : Report of a Case

Spontaneous gas gangrene of the pancreas, caused by an infection of Clostridium perfringens, is an extremely rare but severe form of acute pancreatitis. A 67-year-old man complaining of severe epigastric pain with diffuse guarding underwent an emergency laparotomy. During surgery, hemorrhagic pancreatic necrosis was observed with a large amount of peripancreatic gas. Cultures demonstrated C. perfringens. The identification of hemolysis and the accumulation of peripancreatic gas on computed tomography, which were both caused by an infection of C. perfringens, led us to make a diagnosis of clostridial infection of the pancreas.

Pulmonary Blastoma in an Adult: A Case with Rapid Progression

A case of biphasic type pulmonary blastoma in a 59-year-old man is reported. Although the tumour was radically resected, there was rapid metastasization to the neck, mediastinum, liver and multiple bones. Despite radiotherapy, the patient died about 14 months postoperatively. Close follow-up and aggressive chemotherapy should be considered for such tumours.

A sweat-gland tumor metastasizing to the axilla: Report of a case

Sclerosing sweat-duct carcinoma is a rare malignancy of the skin. We herein present the case of a 68-year-old Japanese man who developed sclerosing sweat-duct carcinoma 2 years after undergoing local excision of a primary tumor in his right arm. Firm nodules appeared in the right axilla, which were revealed by surgical resection to be metastases. This rare tumor grows slowly but usually metastasizes to the regional lymph nodes, whereupon they are often associated with a poor prognosis. As the effectiveness of chemotherapy and radiotherapy against this neoplasm remains unclear, we recommend that the disease should initially be aggressively treated by surgery, which would also be indicated for any metastatic lesions.