Kaname Ishii

Detection of sentinel and non-sentinel lymph node micrometastases by complete serial sectioning and immunohistochemical analysis for gastric cancer

BackgroundWe investigated the presence and distribution of the sentinel and the non-sentinel node micrometastases using complete serial sectioning and immunohistochemical staining (IHC), to inspect whether lymph node micrometastases spread to the sentinel lymph nodes first.MethodsA total of 35 patients, who underwent gastrectomy with a sentinel lymph node biopsy for gastric cancer, were enrolled in this study. Total of 1028 lymph nodes of 35 patients having gastric cancer without metastasis of lymph node by permanent section with hematoxylin and eosin staining (H&E) were selected. There were 252 sentinel nodes and the other 776 were non-sentinel nodes. All nodes were sectioned serially and stained alternately with H&E and IHC. Lymph node micrometastases was defined as proving to be positive first either the IHC or the complete serial sectioning.ResultsMicrometastases were detected in 4 (11%) of the 35 patients, 6 (0.58%) of 1028 nodes. Of these 4 patients, 3 had micrometastases exclusively in sentinel nodes, and the other had micrometastasis in both sentinel and non-sentinel nodes. There was no patient who had the micrometasitases only in non-sentinel nodes.ConclusionThese results support the concept that lymph node micrometastasis of gastric cancer spreads first to sentinel nodes.

A new scoring system for peritoneal metastasis in gastric cancer

AbstractBackground. The degree of peritoneal metastasis (PM) of gastric cancer has been classified into four grades (P0, P1, P2, and P3) in the Japanese Classification of Gastric Carcinoma, First English Edition. However, the PM category in this version was so ambiguous in terms of volumetry that it was unlikely to estimate PM status correctly. We have developed a new volume scoring system for PM, modifying Sugarbakers classification. Methods. Eighty-five patients with gastric cancer with PM underwent surgery and/or laparoscopy at our hospital at Kanazawa University between January 1990 and December 2000. The grading (Gr) by the volume scoring system was decided according to the sum of scores for nine (in male) or ten (in female) abdominopelvic regions. These regions included left subphrenics, right subphrenics, left flank, right flank, pelvis, omenta, mesentery, small and large bowels, ovaries (only for females), and other intraabdominal organs. Volumetry for each region was carried out using the following categories: VS0, indicating the absence of cancer in a particular abdominopelvic region; VS1, indicating that tumor nodules are less than 10 mm in diameter; VS2, indicating tumors between 1 and 5 cm in diameter; and VS3, indicating that tumor is more than 5 cm in diameter or that an organ is coated by a mat of tumor (confluent disease). The scores for VS0, VS1, VS2, and VS3 were 0, 1, 2, and 3 points, respectively. Total scores of 1 to 3 were the equivalent of Gr I, total scores of 4 to 6 were equivalent to Gr II, total scores of 7 to 9 were equivalent to Gr III, and total scores of more than 9 were equivalent to Gr IV. Results. There was no significant difference between P1 and P2, or between P1 and P3 in survival curves. But the 50% survival times of Gr I, Gr II, Gr III, and Gr IV were 1.23, 0.66, 0.67, and 0.32 years, respectively. The prognosis of Gr I was significantly better than that of any other grades. Eight of the 28 patients (29%) assessed as Gr I survived more than 2 years, whereas only 2 of the 57 (4%) assessed as Gr II, Gr III, or Gr IV did so. Multivariate analysis by Coxs proportional hazard model revealed that the volume scoring, resection of primary tumor, and resection of peritoneal tumor were independent factors to predict prognosis. Conclusion. These results showed that the volume scoring system was strongly related to the prognosis, and the patients assessed as Gr I had a great probability of cure by surgery.

A Case of Undifferentiated Carcinoma of the Gallbladder Associated with Anomalous Arrangement of the Pancreaticobiliary Duct.

症例は42歳の男性で, 検診での腹部超音波検査にて胆嚢内に隆起性病変を指摘された. 腹部CT検査でも体部中心に不均一にエンハンスされる隆起性病変が認められた. 内視鏡的逆行性膵管胆管造影検査では主膵管と総胆管とが2.5cmにわたり共通管をつくる膵胆管合流異常が認められた. 総胆管は非拡張型であった. 胆嚢内は頸部から体部にかけ陰影欠損像が認められた. 腹部血管造影検査では胆嚢腫瘤部から胆嚢床に一致して腫瘍濃染像が認められた. 以上より膵胆管合流異常を伴う進行胆嚢癌と診断し, 肝S4a+S5+胆摘およびD2郭清術, 胆管空腸吻合術が行われた. 腫瘍は大きさ3.5×2.5cmの結節型腫瘤であった. 病理組織学的には多角形細胞, 紡錘形細胞あるいは多核巨細胞から成る異形度の強い未分化癌と診断された. 免疫組織学的にはEMA, AE1/AE3, CA19-9, CEAで陽性であったが, vimentin, AFPは陰性であった.