Hirohide Maruyama

Multiple colorectal carcinomas and colorectal carcinoma associated with extracolonic malignancies

In this study, we analyzed 149 surgical cases of colorectal cancer between January 1983 and August 1989. Thirteen cases (8.7 per cent) of colorectal primary cancer associated with extracolonic primary malignancy of 14 lesions and 10 cases (6.7 per cent) of multiple primary colorectal cancers were included. Among the 14 lesions of extracolonic primary malignancy, there were 6 gastric carcinomas, 2 endometrial carcinomas, 2 urinary bladder carcinomas, and one each in the esophagus, liver, bile duct and jejunum. The second tumor was not detected preoperatively in 3 of 4 cases of synchronous multiple primary colorectal carcinoma. A curative resection was done in 10 (77 per cent) out of 13 cases of colorectal cancer associated with extracolonic malignancy, while 7 (88 per cent) out of 8 cases of multiple colorectal cancers had a curative resection. Nine patients (69 per cent) with colorectal cancer associated with extracolonic malignancy were disease-free for 2 months to 14 years. Seven patients (88 per cent) with multiple colorectal cancers were disease-free for one to 22 years. We recommend, therefore, that in any patient with colorectal cancer, the entire large bowel should be thoroughly searched for any other primary tumors, by taking the existence of extracolonic tumors into account. A curative resection should be performed, and the follow-up period should be life-long.

Efficacy of combination treatment — (TAE with adriamycin and ethanol) — for hepatocellular carcinoma

SummaryAmong 44 patients with hepatocellular carcinoma (HCC), combination treatment with both transhepatic arterial embolization (TAE) and ethanol injection therapy (EIT) was performed in 10 patients. Only two had tumors measuring less than 3 cm in diameter. In all, eight patients had solitary tumors and two had multiple tumors. The tumor was classified as stage I in one patient, stage II in six subjects, stage III in two patients, and stage IV in one subject prior to TAE, but one stage II case was changed to stage III after laparotomy. The clinical stage was I in two patients, II in six subjects and III in two patients. Five patients with tumors of stages I and II achieved either a complete response (CR) or partial response (PR). However, three patients with tumors of stages III and IV showed progressive disease (PD). Thus, the response rate (CR+PR) was 50%. For tumor stages I and II, the 1-, 2-, and 3-year survival values were 100%, 100%, and 83%, respectively. For tumor stages III and IV, the 1- and 2-year survival values were 75% and 25%, respectively. Combination treatment of HCC appears to be efficacious for tumor stages I and II.

Follow-up study of combination treatment (TAE and PEIT) for unresectable hepatocellular carcinoma.

The subjects were 35 patients with unresectable hepatocellular carcinoma. The patients were divided into a transcatheter arterial embolization group (TAE group, 18 cases) and a combination therapy group receiving both TAE and percutaneous ethanol injection therapy (TAE+PEIT group, 17 cases). The 50% survival period was 21.1 months for the TAE group and 37.8 months for the TAE+PEIT group (P<0.05). The longest survival period in the TAE group was 89 months. In the TAE+PEIT group, one patient has survived for 59 months. The actuarial 1-, 2-, and 3-year survival rates for the TAE group were 82%, 45%, and 22%, respectively. For the TAE+PEIT group the rates were 83%, 64%, and 64%, respectively. The TAE+PEIT group showed a significantly higher survival rate in the 895-to 1.074-day period as compared with the TAE groupP<0.05). Overall, the survival rate tended to be higher in the TAE-PEIT group (P<0.1). The therapeutic responses of tumors were measured by the maximal reduction rate within 6 months of TAE and PEIT. In the TAE group, a PR was seen in only four cases. In the TAE+PEIT group, CRs and PRs were achieved significantly more frequently than in the TAE group. When the patients were divided into a responder group (CR, PR, and MR) and a nonresponder group (NC and PD), survival was significantly longer in the responder group. The findings of the present study suggest that the combination therapy was useful for improving the survival of patients with unresectable hepatocellular carcinoma.

PURIFICATION AND CHARACTERIZATION OF A PANCREATIC CANCER‐ASSOCIATED ANTIGEN (PCAA) FROM NORMAL COLONIC MUCOSA

The same antigenic substance as pancreatic cancer-associated antigen (PCAA), sharing an identical immunogenicity with Gelders POA, was isolated and purified from normal colonic mucosa. Purified colonic PCAA (PCAAc) is a glycoprotein with a molecular weight of approximately 600,000; it consists of 30% carbohydrates and 70% peptides, and appears to be an N-glycosidic glycoprotein. Antiserum raised against purified PCAAc showed one fused line with our original anti-PCAA antiserum to ascites fluid from patients with pancreatic cancer and extract from normal colonic mucosa. Circulating PCAAc levels assayed by rocket immunoelectrophoresis showed significant elevation in sera of patients with carcinoma of the pancreas. It is concluded that PCAA might be a new tumor-associated antigen which is produced ectopically during oncogenesis.

DIFFERENTIAL DISTRIBUTION OF THE PANCREATIC CANCER‐ASSOCIATED ANTIGEN (PCAA) AND PANCREATIC TISSUE ANTIGEN (PaA) IN PANCREATIC AND GASTROINTESTINAL CANCER TISSUES

PCAA, a glycoprotein antigen fractionated from the ascites fluid of a patient with pancreatic cancer and sharing an identical immunogenicity with Gelders POA, and PaA, a novel pancreatic tissue antigen, were studied immunohistologically. Serial paraffin sections were prepared from surgical specimens of 11 cases of pancreatic cancer, 15 of gastric cancer, 12 of colonic cancer, and 2 of gallbladder cancer; these were then subjected to immunofluorescence and immunoperoxidase stainings. In noncancerous tissues, PCAA was detected unexpectedly at goblet cells of the whole intestine, but was completely absent in pancreatic tissues, while PaA was not demonstrated in intestinal tissues, but was positive at acinar cells of the pancreas. In pancreatic cancer tissues, PCAA and PaA were detected at apical cytoplasm of cancer cells, although positive cells were in different proportions and had different distributions. PCAA-positive cells were mucin-producing (positive in PAS-alcian blue staining) and were well differentiated histologically, while PaA-positive cells were less differentiated and poor in mucin production. Among 11 cases of pancreatic cancer, both PCAA- and PaA-positive cells were demonstrated in 3 cases, PCAA-positive cells alone were found in 3 cases, and PaA-positive cells alone were seen in 4 cases. In 27 gastrointestinal cancer tissues, PCAA was detected in 7 cases of mucin-producing cancer, and PaA was demonstrated in 2 cases of poorly differentiated adenocarcinoma.

Development of a Gastrojejunocolic Fistula after Gastrectomy for Duodenal Ulcer Perforation.

胃切除後の吻合部潰瘍による胃空腸横行結腸瘻は比較的まれで, 吻合部潰瘍の重篤な合併症の1つであり, 本邦では1931年から1998年まで71例の報告しかない. 十二指腸潰瘍穿孔に対して, 幽門側胃切除術 (結腸後B-II法) 後, 13年を経過して診断された胃空腸横行結腸瘻を経験したので報告する.症例は37歳の男性. 慢性下痢, るいそう, 臀部痛を主訴に入院. 13年前, 十二指腸潰瘍穿孔に対して, 幽門側胃切除術 (結腸後B-II法) の既往がある. 注腸X線検査, 小腸二重造影検査などの結果, 胃空腸吻合部と横行結腸の間に内瘻を認めた. 残胃亜全摘, 横行結腸部分切除術, 全幹迷切術, 胃空腸Roux-enY吻合術を行った. 術後, 慢性の下痢は改善し, 3か月で体重が18kg増加した. 十二指腸潰瘍に対する胃切除後の持続する下痢に対しては, 本症の存在を念頭におき, 早急な診断, 治療が必要である.