Fuyo Yoshimi

Postoperative recurrence of hepatocellular carcinoma.

Sixty-nine patients with hepatocellular carcinoma underwent curative hepatic resections as primary cases from 1981 to 1986. Seven patients died in the hospital after operation. The other 62 patients left the hospital and were closely followed for 25 to 78 months. Recurrence of carcinoma became obvious in 41 (66%) of 62 patients. The clinical and pathologic features of these 41 patients were not significantly different from those of the other patients. Recurrent tumors were found in the residual liver in 38 patients (93%), in the bone in 2 (5%), and in the lung in 1 (2%). Recurrence was diagnosed within 1 year, between 1 and 2 years, and more than 2 years after the operation in 22 (56%), 10 (26%), and 7 (18%) patients, respectively. It was difficult to determine the exact time of recurrence in two patients. There was a significant negative correlation between the size of primary tumor and time until recurrence; the larger the primary tumor, the shorter the time until recurrence. Among the 29 patients who underwent local excisions for their primary tumors, 19 recurrences were observed. Eighteen were found in the residual liver, in the same segment as the primary tumor, or in one near it. Larger hepatic resection for primary tumors is thus advocated to prevent recurrence.

Hepatoid adenocarcinoma of the stomach

Although gastric cancer occurs frequently in Japan, few cases of hepatoid adenocarcinoma, a cancer with an extremely poor prognosis, have been reported. Here, we describe a 67-year-old Japanese man referred to our hospital with suspected gastric cancer. Gastrointestinal fiberscopy revealed an elevated lesion with a central depression on the lesser curvature, extending from the antrum to the body of the stomach. On the preoperative examinations, abdominal computed tomography scan, magnetic resonance imaging, and abdominal ultrasonography revealed multiple metastases to the liver and no cirrhotic change. The serum level of alpha-fetoprotein (AFP) was markedly elevated (10,084 ng/ml). After a diagnosis of AFP-producing gastric cancer with multiple liver metastases was made, total gastrectomy, without liver resection, was performed. Microscopically, the tumor showed two main histological features. The main part of the tumor resembled moderately differentiated hepatocellular carcinoma, and the rest showed fetal-type adenocarcinoma. Some parts of the hepatoma-like lesion showed periodic acid-Schiff (PAS)-positive granules. Furthermore, the tumor showed diffuse immunohistochemical positivity for AFP, alpha-1 antitrypsin, and alpha-1 antichymotrypsin. According to these histopathological findings, the tumor was diagnosed as hepatoid adenocarcinoma of the stomach. Although anastomotic leakage occurred postoperatively and the liver metastases have increased in size, the patient remains alive 11 months after the operation. Because of the poor prognosis for this histological type of tumor, accurate diagnosis of hepatoid adenocarcinoma is important, and long-term follow-up is required. We describe this rare case of hepatoid adenocarcinoma of the stomach, and review the literature concerning the clinicopathological aspects.

Internal stenting of the hepaticojejunostomy and pancreaticojejunostomy in patients undergoing pancreatoduodenectomy to promote earlier discharge from hospital

Internal stenting of the hepaticojejunostomy and pancreaticojejunostomy was performed in 11 consecutive patients undergoing pancreatoduodenectomy between July 1992, and July 1994, to promote earlier discharge from hospital. Although minor leakage of the pancreaticojejunostomy occurred in 4 patients, this resolved within a short period and all 11 patients were able to be discharged by the 29th postoperative day in good health and without any intubation. Follow-up abdominal X-ray and computed tomography (CT) scans proved that all 22 of the stenting tubes had spontaneously fallen out by the 176th postoperative day. No complication related to the stenting tubes occurred in any of our patients.

Pancreatoduodenectomy for locally advanced or recurrent colon cancer: Report of two cases

A 66-year-old man, who had ascending colon cancer which invaded the duodenum, pancreas, and superior mesenteric vein, underwent a curative resection including an extended right hemicolectomy, pylorus-preserving pancreatoduodenectomy, and a partial resection of the superior mesenteric vein. The pathological examination revealed adenocarcinoma of the colon, which directly invaded the duodenum and pancreas, thus causing duodenocolic fistula. Tumor infiltration to the superior mesenteric vein was not histologically proven. Two out of 40 lymph nodes were also involved. The patient is still alive and disease-free 37 months after the operation. A 72-year-old man, with a history of surgery two previous times for ascending colon cancer and its recurrence, underwent a third operation including a resection of the former ileocolic anastomosis en bloc by means of a pylorus-preserving pancreatoduodenectomy with a curative intent. The pathological examination revealed adenocarcinoma of the colon, which directly invaded the duodenum and pancreas. Seven out of 31 lymph nodes were also involved. The patient died of recurrence 24 months after the third operation. These two cases demonstrated the usefulness of a resection of the colon en bloc by means of a pancreatoduodenectomy in patients with either locally advanced colon cancer or locally advanced recurrent colon cancer.

Hepatocellular carcinoma with a solitary adrenal metastasis and poor hepatic functional reserve: Report of a case

A 54-year-old man with a 15-year history of liver disease, was found by his family physician to have multiple tumors in the right lobe of the liver and a large right retroperitoneal tumor. He was referred and admitted to our institute where a preoperative diagnosis of liver cirrhosis complicated by hepatocellular carcinoma and probable right adrenal metastasis was made. Because his hepatic functional reserve was so poor, only resection of the right adrenal tumor with a splenectomy for hypersplenism and a cholecystectomy for the prevention of cholecystitis secondary to the scheduled transcatheter arterial embolization was performed. The patient was discharged in good clinical condition 5 weeks after surgery.

Hypermethylation of the Estrogen Receptor Alpha Gene Is Not Related to Lack of Receptor Protein in Human Breast Cancer.

BackgroundExpression and transcriptional activity of genes are regulated by several factors, including DNA methylation. We examined the frequency of DNA hypermethylation at two nucleotide positions, the proximal promoter region (PPR) in exon 1 and the distal promoter region (DPR) in exon 1′ of the estrogen-receptor alpha (ERβ) gene in human breast cancer, and the correlation between ER and progesterone receptor (PgR) status.MethodsThe frequency of hypermethylation of PPR and DPR in 124 breast cancers was examined by the semiquantitative competitive polymerase chain reaction (COM-PCR) assay with restriction enzymes. ER and PgR proteins were analyzed by enzyme immunoassay (EIA; fmol/mg) to determine whether DNA hypermethylation influences the status of either protein.ResultsThere were no significant differences in ER protein status between DNA methylated and unmethylated groups for either PPR (71.2± 190.1 versus 60.7±88.4) or DPR (70.0± 183.6 versus 60.9±89.3). There was a significant difference in PgR protein status between these two groups for PPR (46.8±67.1 versus 169.1±394.9, P<0.01). When one positional methylation was regarded as the criterion for hypermethylation, the frequency of hypermethylation in the ER(+)PgR(−) phenotype was significantly higher than in the ER(+)PgR(+), ER(−)PgR(+) and ER(−)PgR(−) phenotypes (72.7% versus 31.3%, 40.0% and 28.6%, P<0.01).ConclusionsHypermethylation of the 5′-upstream side of the ERα gene did not correlate with lack of ER, but did correlate with lack of PgR, and particularly with the expression of the ER(+)PgR(−) phenotype. We conclude that DNA hypermethylation of PPR and DPR in the ERα gene reflects the expression of the ER target gene rather than the ER gene itself and may account for anti-estrogen resistance in ER-positive breast cancer.

Right aortic arch with left lung cancer: focusing on left recurrent laryngeal nerve

We report a case of a 64-year-old Japanese man with an anomalous right aortic arch who had left lung cancer. We performed lobectomy and mediastinal lymphadenectomy, paying attention to the pathway of left recurrent laryngeal nerve. The left recurrent laryngeal nerve hooked around from the left dorsal to the right ventral part of the left ductus arteriosus, which connected the left pulmonary artery with the aortic diverticulum.

High F-18 fluorodeoxyglucose accumulation in solid pseudo-papillary tumors of the pancreas

We report two cases of young women with a solid pseudo-papillary tumor of the pancreas which having cystic and hemorrhagic components with marked calcification on computed tomography and magnetic resonance imaging. F-18 fluorodeoxyglucose positron emission tomography revealed abnormally increased accumulation of F-18 fluorodeoxyglucose in the pancreas tail tumors, especially in the non-calcified solid portion of the tumors. These patients underwent elective resection of the masses and distal pancreatectomy and were diagnosed with solid pseudo-papillary tumors by histopathological analysis. There was no evidence of distant metastasis on follow-up after surgery and they showed no histopathological findings suggesting malignancy. These cases suggest that solid pseudo-papillary tumor may show high uptake of F-18 fluorodeoxyglucose.

Long-Term Survival After Repeat Resections of Metastases in Liver, Lung, and Stomach from Sigmoid Colon Cancer: Report of a Case

A 74-year-old female patient underwent a simultaneous colectomy and hepatectomy for sigmoid colon cancer and its hepatic metastases. Six months later she underwent a hepatectomy for recurrent hepatic metastases; then 10 months later, a pulmonary resection for pulmonary metastasis; and 24 months later, a partial gastrectomy for gastric metastasis. As of December 2005, at 7 years 6 months after the first surgery and at 4 years after the last surgery, the patient is still alive with a good quality of life and no sign of recurrence.

Fibrolamellar Hepatocellular Carcinoma in a Japanese Man: Report of a Case

Abstract Fibrolamellar hepatocellular carcinoma (FHCC), a rare variant of hepatocellular carcinoma, is becoming more prevalent; however, up until 1999, only 18 cases had been reported in Japan. We recently diagnosed a case of FHCC in a 46-year-old Japanese man who had visited four hospitals before being finally admitted to our department. On admission, he was diagnosed as having multiple liver tumors, with lymph node metastasis and peritoneal dissemination. Both hepatitis B antigen and hepatitis C antibody were negative, and the levels of serum α-fetoprotein and PIVKA-II were within normal limits. Under a provisional diagnosis of atypical hepatocellular carcinoma (HCC), a right hepatic lobectomy with resection of the metastatic lymph nodes and peritoneal dissemination was performed. The histopathological diagnosis made by our pathologist was atypical HCC. He underwent another operation for a recurrence in the left external iliac lymph node. It has been 29 months since his first surgery in this hospital and he is progressing well, which led us to establish the diagnosis of FHCC. Moreover, his serum carbohydrate antigen 125 levels have been well correlated with this condition.