Hidekazu Sano

Pseudomyxoma peritonei due to mucinous cystadenocarcinoma in situ of the urachus presenting as an inguinal hernia.

Pseudomyxoma peritonei is generally caused by appendiceal and ovarian tumors. Other primary sites have been rarely reported. We describe herein the second reported case of pseudomyxoma peritonei due to mucinous cystadenocarcinoma of the urachus. A 54-year-old man was admitted with a left inguinal hernia that had developed several months prior to his admission. During herniorrhaphy, we found a large amount of gelatinous mucinous material in the indirect-hernia sac and made a diagnosis of pseudomyxoma peritonei on cytological grounds. At re-operation, the origin of the pseudomyxoma peritonei proved to be a ruptured urachal cyst. The urachal cyst and the dome of the urinary bladder were excised. In addition, we removed as much of the gelatinous material as possible. On histological examination, a unilocular cyst was found to consist of noninvasive mucinous adenocarcinoma. We succeeded in removing the rest of the mucinous material by postoperative intraperitoneal lavage with dextran solution, and have observed no evidence of recurrence for 7 years since the operation.

Evaluation of malignancy using Ki-67 labeling index for gastric stromal tumor

AbstractBackground. Assessment of malignant potential in gastrointestinal stromal tumors (GISTs) is still problematic. The maximum tumor diameter and the mitotic index are generally used as an index of malignancy of GISTs. The Ki-67 labeling index has recently been used as an index of cell growth, and the prognosis of GISTs was reported to be significantly poor when the value of this index was 10% or higher. Methods. Clinicopathological and immunohistological factors were analyzed in 15 patients who underwent surgical resection of gastric stromal tumors at our department between April 1997 and July 2002. The patients were divided into “metastasis/recurrence” and “benign” groups. Also, the relationship of changes in the Ki-67 labeling index to the degree of malignancy in recurrent lesions was assessed in an 84-year-old woman who underwent five reoperations because of recurrences in the peritoneum. Results. Significant differences were noted between the metastasis/recurrence and benign groups in relation to the mean maximum tumor diameter (186.7 ± 80.8 mm vs 41.3 ± 22.9 mm), mitotic index (88.3 ± 5.0/50 high-power fields [HPF] vs 3.0 ± 2.9/50 HPF), and the Ki-67 labeling index (11.4 ± 2.5% vs 0.01 ± 0.51%). In the patient who had metastasis to the liver 3.5 years after initial operation and underwent five reoperations before death, the intervals until detection of recurrence tended to be shortened gradually. The Ki-67 labeling index varied with each operation, and tended to be higher at the time of reoperations than at the initial operation. Conclusion. The maximum tumor diameter, mitotic index, and Ki-67 labeling index were useful as an index of malignancy for gastric stromal tumor. The efficacy of surgical resection alone may be insufficient in patients with disseminated metastasis to the peritoneum.

Clinical evaluation of palliative therapy for unresectable primary liver cancer

Ninety‐nine patients with unresectable primary liver cancer were treated with ligation of the hepatic artery (LHA), intra‐arterial infusion chemotherapy (IAIC) or transcatheter arterial embolization (TAE) between 1960 and 1983. A statistical study was made of therapeutic effects and prognosis. The results are as follows: (1) The mean survival time of 14 patients treated with LHA was about 5 months. (2) The survival time of the LHA + IAIC with mitomycin C group was not prolonged as compared with that of the LHA group, but LHA + IAIC with Adriamycin (doxorubicin) group showed a significant prolongation of survival time over the LHA group. (3) In the LHA + IAIC with Adriamycin group, the mean survival time was 12.8 months and the 1‐year survival rate was 37.5%. (4) Factors including age, presence of liver cirrhosis, number of involved segments, and degree of anaplasia graded on Edmondsons criteria did not influence survival time. Cancer 58:329–331, 1986.

Effect of anti-α-fetoprotein serum on human hepatoblastoma

There is no definitive treatment of hepatoblastoma. Except for radical resection, the prognosis of unresectable cases remains pessimistic. Therfore, the development of new anticancer drugs for this tumor is urgently needed. Using the human hepatoblastoma cell line (c-HB-3) we demonstrated that horse anti-α-fetoprotein containing serum suppressed proliferation of the hepatoblastoma cells. This effect was dependent on the duration of exposure and the concentration of anti-α-fetoprotein serum.