Arichika Hoshino

Rapid-Growing Carcinosarcoma of the Esophagus Arising from Intraepithelial Squamous Cell Carcinoma : Report of a Case

A case of carcinosarcoma arising from the intraepithelial spreading area of esophageal squamous cell carcinoma (SCC) is reported herein. A 64-year-old man was referred to our hospital for investigation of a sore throat and dysphagia. An endoscopic examination revealed a 2. 5-cm polypoid mass in the mid-esophagus. Esophagograms taken 1 month prior to consultation by our hospital and just before surgery revealed marked change within a period of less than 2 months from a 2-cm sessile elevated mass to a 4-cm polypoid mass with a lobular appearance. The resected specimen contained two lesions in the esophagus. The larger one measured 4.0 x 2.0 x 2.0 cm and had a pedunculated polypoid shape, while the smaller one, measuring 1 cm in diameter, was a plateau-type elevated lesion located 3 cm distal from the larger mass. Histologically, the distal smaller lesion was diagnosed as primary SCC associated with a high frequency of intraepithelial spread, while the larger polypoid mass was composed of spindle-shaped sarcomatous cells, arising from the intraepithelial spread of SCC. To our knowledge, this is the only reported case of esophageal carcinosarcoma arising from an area of intraepithelial spread of SCC that showed such surprisingly rapid growth.

Two successful curative operations using stomach-preserving distal pancreatectomy with celiac axis resection for the treatment of locally advanced pancreatic body cancer

Large vessel invasion is a serious factor determining whether an operation for pancreatic body cancer is feasible. The Appleby operation is a radical operation for the treatment of pancreatic body cancer that has infiltrated the celiac axis. Since this procedure includes a total gastrectomy, the operation is associated with a high morbidity, mortality, and deteriorating postoperative quality of life (QOL). We experienced two cases in which radical operations consisting of a stomach-preserving distal pancreatectomy with en bloc resection of the celiac, common hepatic, and left gastric artery were performed. The use of adjuvant chemotherapy in these cases led to a good postoperative QOL.

Complete sequence analysis of rat transferrin and expression of transferrin but not lactoferrin in the digestive glands

Rat milk and digestive juices contain transferrin but not lactoferrin, which is a major iron-binding protein in these secretions of human and mouse. To compare the structure of rat transferrin to that of transferrins and lactoferrins in other species, we isolated a cDNA clone containing the entire coding region of transferrin from rat liver and determined its sequence. The amino-acid sequence of rat transferrin had 69.8% identity with that of human transferrin and 48.8% identity with that of human lactoferrin. Rat transferrin, like other transferrins, had the potential N-linked glycosylation site only in the C-terminal domain, although lactoferrins characterized so far contained the glycosylation sites in both the N- and C-terminal domains. Southern and Northern analyses showed that there was the gene specifically hybridized with the mouse lactoferrin cDNA in rat genomic DNA, but only the transferrin mRNA was detected in mammary gland, submaxillary gland and pancreas of rat. These results suggest that the rat lactoferrin gene is silent in the mammary gland, and transferrin can serve as a functional substitute for lactoferrin in rat.

In situ Gene Transfer and Suicide Gene Therapy of Gastric Cancer Induced by N-Ethyl-N′-nitro-N-nitrosoguanidine in Dogs

Gene therapy could potentially revolutionize the treatment of gastrointestinal (GI) tract cancer. The aim of this study was to establish a practical method of gene transfer which would be applicable to human gastric cancer. Retrovirus or/and adenovirus vectors carrying the lacZ marker gene were transferred in situ by needle through an endoscopic biopsy channel into primary gastric cancer in six male beagle dogs that had been treated with N‐ethyl‐N′‐nitro‐N‐nitrosoguanidine (ENNG). In addition, an adenovirus vector carrying the herpes simplex virus thymidine kinase (Ad.CAGHSV‐TK) gene was introduced in situ into cancer tissues in the stomach of three dog, and the animals were treated with intravenous ganciclovir (GCV). Retrovirus‐producing cells which expressed the lacZ gene were specifically localized to the injection site in the stomach. The lacZ gene was more widely transferred into the tumor by the adenovirus vector than by retrovirus‐producing cells. Improvement of the needle used for gene transfer and the use of multiple injections per tumor led to more diffuse transfer of the vector into the tumor. The Ad.CAG lacZ gene was also transferred into regional lymph nodes of the stomach. Moderate to diffuse degeneration of the primary cancer tissues of the stomach was found after Ad.CAGHSV‐TK/GCV gene therapy. Moreover, almost complete tissue degeneration was observed in the regional lymph nodes of the stomach. An adverse effect of HSV‐TK/GCV gene therapy was acute hepatotoxicity, which was not found after Ad.CAG lacZ gene transfer, but was found after high‐titer Ad.CAGHSV‐TK gene transfer followed by GCV. These findings suggest that in situ gene transfer of a suicide gene followed by prodrug treatment may be applicable not only to primary tumors, but also to lymph node metastases of gastric cancer, though further study of both beneficial and adverse effects is required before clinical usage.

T tube drainage for spontaneous perforation of the extrahepatic bile duct.

Summary Background Spontaneous perforation of the extrahepatic bile duct is very rare. We report a patient with a spontaneous perforation of the left hepatic bile duct who was diagnosed preoperatively. Case Report A 65-year-old woman was admitted to our hospital complaining of a right upper quadrant pain lasting for two days. She was diagnosed as having a perforated bile duct and peritonitis and underwent a laparotomy. After a cholecystectomy, T-tube drainage of the left hepatic duct was performed. The postoperative course was uneventful. The T tube was removed 25 days after the surgery. Conclusions A more noninvasive procedure, such as endoscopic treatment, should play a central role in the management of extra bile duct perforation. For this case, however, we chose to perform a laparotomy based on the patient’s general condition and the presence of peritonitis. T tube decompression is effective and a safe and reliable method. The goal of treatment is to stop the bile leakage, resolve the choledocholithiasis and cholangitis, and reconstruct the bile duct.

Time‐dependent changes in endoscopic findings of intestine in patient with acute superior mesenteric arterial thrombosis after pancreaticoduodenectomy

Superior mesenteric arterial thrombosis (SMAT) is a disorder with high mortality because of extensive necrosis of the intestine.Even if necrosis does not occur, subsequent stricture with sclerosis and the impairment of intestinal absorption are common. We report a case of SMAT in a woman in which time-dependent changes of small intestinal endoscopy could be observed. She had previously undergone anastomosis of the stomach and small intestine during subtotal stomachpreserving pancreaticoduodenectomy. She suddenly developed abdominal pain 10 days after the operation.At 24 h after the onset, she was diagnosed with SMAT, and per-catheteric thrombus aspiration was carried out.After 2 days, endoscopy was carried out for the first time since the onset. The color of the intestinal lumen was cyanotic and dark. A pseudomembrane appearance was observed. Hunter green mucosal nodules were apt to drop off from the wall. Petechial hemorrhages interspersed with pale areas were visible (Fig. 1a,b). Seven days after the onset, the small intestine had a bloody pink color with a wet glossy appearance. After 14 days, the color of the lumen improved significantly. Kerckring folds and local regeneration of the mucosa were observed (Fig. 1c,d). The passage through the intestine was good. After 3 weeks, the patient developed mild stricture(Fig. 1e,f).After 4 weeks, strong stricture was formed with massive sclerosing fibrosis, and Kerckring folds had disappeared. Furthermore, regeneration of the mucosa stopped, and erosive mucosa was seen in the tongue fur (Fig. 1g,h). A contrast examination demonstrated multiple apple-core like lesions throughout the small bowel. After 1 month, no progressive stricture has been observed. This case provides us with interesting endoscopic findings of SMAT in a timedependent manner.