Akiro Shirota

Estrogen and progesterone receptors in gastric cancer.

Cancerous tissue from 86 patients with primary gastric cancer were examined for the presence of receptors for estrogen (ER) and progesterone (PgR). ER and PgR were present in 8 (15.4%) and 5 (9.6%)respectively, of 52 male patients9 (26.6%) and 7 (20.6%)respectively, of 34 female patients, a total of 17 (19.8%) and 12 (14.0%)respectively. One male patient (1.9%) and 4 female patients (11.8%) had both ER and PgR, and 40 male (76.9%) and 22 female patients (64.7%) showed no ER or PgR. The binding activity ranged from 6 to 200 fmol/mg protein for estradiol and from 5 to 58 fmol/mg protein for progesterone. ER‐ and/or PgR‐positive cases were characterized grossly as Borrmann type 4, and microscopically as diffuse type with scirrhous growth pattern. The presence of ER and/or PgR in some gastric cancers indicates the possibility that sex hormonal factors are involved in these tumors.

DYSPLASIA AND RESERVE CELL HYPERPLASIA-LIKE CHANGE IN HUMAN ESOPHAGUS

The esophagus was totally examined in 264 autopsied cases and 61 operated cases, for a total of 325 cases, to clarify the histogenesis of squamous cell carcinoma of the esophagus. Epithelial dysplasia of the mucosa was present in 27% and subclinical carcinoma was found in 2.4%. Hyperplasia of the duct of the esophageal gland proper was present in 34% and dysplasia of the ductal epithelium in 3%. Reserve cell hyperplasia‐like change of the islet of the ectopic gastric mucosa was found in 4% and reserve cell hyper‐plasia‐like change of the esophagogastric junction zone in 13%. Of the seven cases of microcarcinoma, two showed dysplasia and gradual transition and one presented dysplasia and abrupt transition. Another two were considered to have originated in the ductal epithelium. These findings suggested that they could all be the sites of origin of cancer development.

Seedling leiomyoma of the esophagus and esophagogastric junction zone

The esophagus was totally excised for histopathological examination in 276 autopsy cases and 66 surgical cases (total, 342 cases). Leiomyoma of the esophagus was observed in 27 of the 342 cases. The tumors were present in 22 of the 225 male cases and in 5 of the 117 female cases. There were 38 leiomyomas among the 27 cases. Most of the leiomyomas originated in the inner circular muscle. None of the tumors was more than 7 mm. in length. Twenty-five of the 38 leiomyomas were located in the esophagogastric junction zone. Thus, subserial histological examination revealed leiomyomas at a higher frequency than that in previous reports.

Pararectal rhabdomyosarcoma: Report of a case

Primary rhabdomyosarcoma of the alimentary tract is extremely rare, only 11 cases have been reported in the literature. Long-term survival in adults may be possible if the tumor is detected at an early stage even though it is asymptomatic. This highly malignant tumor can be treated by surgical excision, chemotherapy, and irradiation. A 12th case—of stage 1, pararectal, rhabdomyosarcoma—is reported.

[3H]Thymidine autoradiographic and alkaline phosphatase histochemical studies of intestinal metaplasia of the human stomach

SummaryThe relationship between cell proliferation and enzyme activity in intestinal metaplasia of the human stomach was studied using a combined method of [3H]thymidine autoradiography and alkaline phosphatase histochemistry on the same section. Three types of intestinal metaplasia were observed depending on variations in both enzymatic activity and isotope labelling. One type shows alkaline phosphatase-positive cells along the entire length of the glands with [3H]thymidine-labelled cells localized only at the bottom of the glands, resembling the duodenum. In another type of intestinal metaplasia, alkaline phosphatase-positive cells are present on the surface and/or upper half of the glands with mitotically active cells occupying the lower part of the glands. The third variety of intestinal metaplasia is characterized by the absence of alkaline-phosphatase activity and [3H]thymidine-labelled cells present in an extended zone in the lower half of the glands.Differences in labelling patterns of [3H]thymidine and the activity of marker enzyme in various types of intestinal metaplasia seem to reflect variations in cell differentiation during intestinalization of gastric mucosa.

Sequential morphological studies of the esophageal carcinoma of rats induced by N-methyl-N-amylnitrosamine☆

N-Methyl-N-amylnitrosamine was given to male Wistar rats in the drinking water at a concentration of 0.003% for 8 weeks. Three rats were autopsied weekly from the first to the 25th week. The stages of hyperplasia, dysplasia and squamous cell carcinoma in the esophagus were chronologically observed. Hyperplasia and dysplasia were found by the 6th week and continuously observed until the end of the experiment. Early squamous cell carcinomas were found in the 13th week. They showed endophytic or exophytic growths. Histologically, the endophytic growths were well-differentiated squamous cell carcinomas and the exophytic growths were poorly-differentiated. Advanced carcinomas were first found in the 15th week and were almost well-differentiated. Carcinomas were not found in papillomas. The incidence of carcinomas increased with time, being 9 out of 15 rats (60%) in the final 21st through 25th weeks. Lymph node metastasis was found in one rat, killed at the 24th week.

Cytochemical localization of alkaline phosphatase in intestinal metaplasia of the human stomach

SummaryAlkaline phosphatase in the brush border of areas of intestinal metaplasia of human stomach was studied cytochemically. All absorptive cells in the upper part of the villi of the duodenum had strong alkaline phosphatase activity but, in areas of intestinal metaplasia, the metaplastic glands consisted of alkaline phosphatase-positive and negative absorptive cells. Alkaline phosphatase activity was found in tall dense microvilli of absorptive cells in areas of intestinal metaplasia and in the duodenum. However, in some areas of metaplastic epithelium, the activity was very weak in some tall dense microvilli of absorptive cells but strong in those of neighbouring absorptive cells. No alkaline phosphatase activity was found in short sparse microvilli of absorptive cells in areas of intestinal metaplasia. The difference in alkaline phosphatase activity in microvilli of different cells in areas of intestinal metaplasia, which is not seen in the duodenum, indicates abnormal morphological and enzymatic differentiation in intestinal metaplasia.

Recent advance in diagnosis and treatment of cholelithiasis in special reference to ultrasonic tomography

SummaryThe review of 1,041 cases of cholelithiasis operated on during the period of 1935 to 1970 has led to the following conclusion. In diagnosis and treatment of cholelithiasis, careful scrutiny of patient’s history and clinical symptoms and combined use of diagnostic procedures such as cholecystography and ultrasonic tomography are important as well as operative intervention without undue delay. Cholecystography has established itself as the most useful tool in diagnosis of cholelithiasis and has been found to be useful in about three quarter of cases. The presence of intestinal gas in right upper quadrant in duodenum and/or in colon on negative cholecystogram points strongly the presence of acute cholecysttitis and necessitates immediate operative intervention. Ultrasonic tomography has been found to have a great value when cholecystography fails i.e., in case of non-visualisation of biliary tract. Increasing use of these diagnostic procedures in recent years led to the early diagnosis and treatment of cholelithiasis and to a considerable decrease in mortality rate to as low as 1.2 per cent.

Proceedings Of The 21St Autumn Meeting From October 15th-17th, 1979-Maebashi, Japan

When the peripheral blood lymphocytes from patients with various types of hepatitis were stimulated in vitro with liver specific protein, lymphocyte transformation and MIF production were detectable in many cases, especially in chronic active hepatitis. The macrophage activating factor (MAF), a kind of lymphokines, was also detected in the culture medium of activated lymphocytes from patients who showed positive blastogenesis. The activated macrophages by MAF were shown to be cytotoxic to the separated liver cells causing the marked inhibition of albumin synthesis. MAF-containing culture supernatants of these active lymphocytes activated guinea pig macrophages which inhibited the albumin biosynthesis of the isolated liver cells. These observations suggest that the macrophagemediated cytotoxicity may play and role in pathogenesis of chronic active hepatitis.

On the surgical indication in cholelithiasis from the view point of the result in the surgical treatment

On the treatment of gallstone disease, the decision of surgical indication is important from both the medical and surgical viewpoints. Postoperative and non-operative cases, autopsy materials were observed in an attempt to clarify this problem. The postoperative course of 261 cases of cholelithiasis was observed during 2 months to 15 years. It was found that 165cases (63.2%) were in good and 67cases (25.7%) were in fairly good conditions. On the other hand, 12cases (4.6%) were in poor, 10cases (3.8%) were died, and other 7cases (2.75%) were reoperated. Physical examinations and cholecystographies were repeated periodically to detect changes in symptomes and size of gallstones. The 2 months to 15 years follow-up of the gallstone shadow in cholecystography, about 156cases with gallstones treated conservatively, was observed. There was no change in size in 71 patients (45.5%) and enlargement of the gallstones was noted in 51patients (32.7%). In six patients (3.8%) showed diminition in size and 13cases (8.4%) disappeared of gallstone shadow in this series. In 15 patients the gallbladder shadow became negative during this period, and one case (0.7%) among them revealed gallbladder cancer. At autopsy of 304cases with gallstone, 34 (11.25%) had gallbladder and biliary duct cancer, compared with 0.96% in cases without gallstone. According to these data, surgical procedure may be recommended in gallstone patients with complications such as perforation of biliary tract, hepatic dysfunction, repeated cholecystitis and/or cholangitis, pancreatitis and with frequent colicky attack. Moreover, patients with large or many gallstone shadows in cholecystography may be treated surgically. Cases without such complications or severe symptoms, especially asymptomatic cases will be observed their symptoms and repeated cholecystography, and then they will be operated in their deterioration.