Genichiro Edakuni

Expression of the hepatocyte growth factor/c-Met pathway is increased at the cancer front in breast carcinoma.

Expression of hepatocyte growth factor (HGF) and c‐Met (HGF receptor) has been reported in many neoplasms. We investigated coexpression of HGF and c‐Met to determine the role of the HGF/c‐Met pathway in breast carcinoma, especially at the cancer front. Eighty‐eight cases of carcinoma of the breast were studied by immunohistochemistry and by in situ hybridization for HGF and c‐Met expression. The staining pattern was termed ‘front accentuation pattern’ when it was most conspicuous at the cancer front. HGF and c‐Met proteins were expressed in cancer and stromal cells, with autocrine and paracrine patterns. The front accentuation pattern of c‐Met was observed in cancer cells, but not in stromal cells. The front accentuation pattern was not observed in HGF. Coexpression of HGF and c‐Met at the cancer front was correlated with histologic grade, reduced patient survival and a high Ki‐67 labeling index. Our findings suggest that the HGF/c‐Met pathway acts primarily as a mitogen, especially at the cancer front, in a paracrine manner and affects some clinical factors, including patient survival.

Laparoscopic splenectomy for a giant splenic epidermoid cyst: Report of a case

The use of laparoscopic splenectomy has increased in recent years, primarily for patients with idiopathic thrombocytopenic purpura (ITP). We describe herein the first known case of a laparoscopic splenectomy to be performed in Japan for a patient with a giant splenic epidermoid cyst. A 26-year-old woman presented to our hospital with the major complaint of a feeling of abdominal fullness. Prior to surgery, an ultrasound-guided splenic cyst puncture was conducted for diagnostic purposes as well as to reduce the size of the cyst. The carbohydrate antigen 19-9 (CA19-9) level was found to be elevated in the cystic contents and in the serum. Under laparoscopic guidance, the splenic vessels were ligated using a device for extracorporeal ligation, the divided. After the resected spleen had been placed in a retrieval bag, it was delivered out of the abdominal cavity without fragmentation. Following surgery, the patients serum CA 19-9 level returned to normal. Splenic epidermoid cysts are most often encountered in young women, and laparoscopic surgery to remove cysts of this type is both minimally invasive and excellent from a cosmetic standpoint. Thus, laparoscopic surgery, should be considered as the method of choice for the majority of patients diagnosed with a splenic epidermoid cyst.

Composite glandular–endocrine cell carcinoma of the common bile duct

A rare case of composite glandular–endocrine cell carcinoma of the common bile duct is presented. Histologically, this tumor consisted of adenocarcinoma and small‐cell neuroendocrine carcinoma, with a transition between the two components. The two distinct areas of the tumor were immunohistochemically different, whereas the transitional zone exhibited characteristics of both areas. These features suggest that the tumor arose from a multipotential stem cell. Although it has been reported that the presence of neuroendocrine differentiation in carcinomas indicates a poor prognosis, the patient in the present case was well at the time of writing this report. This may be due to the fact that adenocarcinoma, which characteristically has a low proliferative activity, constituted the majority of the tumor.

A Case of Gastric Malignant Lymphoma Complicated with Gastro-bronchial Fistula during Neoadjuvant Chemotherapy.

胃悪性リンパ腫はそれ自体は比較的まれな疾患であるが, 胃気管支瘻を伴うことは極めてまれである. 今回, 本疾患の1切除例を経験したので報告する. 症例は81歳の女性. 突然の嘔吐と食欲不振を主訴とし, 精査の結果進行大腸癌と胃悪性リンパ腫の合併と診断した. CT検査にて胃の腫瘍は脾臓, 膵臓, 横隔膜への直接浸潤が疑われ, 胃癌取扱い規約によるstage IIIaより進行した症例と判断したため, 大腸癌に対する右半結腸切除術後, 胃悪性リンパ腫に対し術前化学療法を施行する方針とした. 化学療法施行中に胃穿孔を疑ったが, 膿瘍が左横隔膜下に限局化したため化学療法を継続しえた. さらに化学療法を2クール追加後, 上部消化管造影にて胃気管支瘻が判明した. 化学療法施行終了後2週目に待機手術として胃全摘+脾摘+横隔膜瘻孔部合併切除にて腫瘍を切除しえた. 合併症を生じながらも術前化学療法が著効を呈した症例と考えられた.