Kazuhiro Kume

N-myc oncogene and stage IV-S neuroblastoma : preliminary observations on ten cases

We studied the clinical significance of genomic amplification of N‐myc in Stage IV‐S neuroblastoma, with reference to spontaneous regression. Among 103 neuroblastomas in which N‐myc was measured, ten were Stage IV‐S (eight children were younger than and two were older than 1 year of age). The number of copies of N‐myc was 1 to 3 in five patients, four to ten in one patient, and more than ten in four patients, and the survivors of each group were four, one, and one (recurrent), respectively. Of 41 patients younger than 1 year of age, N‐myc amplification of more than three copies was found only in Stage IV‐S neuroblastoma. Cure with a tendency to regress spontaneously was seen in five of eight patients younger than 1 year of age. However, two patients older than 1 year of age classified as Stage IV‐S (one with N‐myc amplification) died of progressive disease. In two patients (1 and 3 months of age) with a huge hepatic involvement and in whom the tumor had an amplified N‐myc of more than ten copies, tumor regression occurred but there was a relapse to a progressive state later. The overexpression of N‐myc mRNA occurred in nine of ten stage IV‐S tumors and did not correlate with the prognosis. The vanillylmandelic acid (VMA) to homovanillic acid (HVA) ratio was low in tumors with an increased number of copies of N‐myc. Serum lactate dehydrogenase (LDH) levels were increased in Stage IV‐S patients with N‐myc amplification but not in those with regressing tumors and without N‐myc amplification. These data suggest that N‐myc amplification may affect the final outcome in the patient classified as Stage IV‐S, but tumor regression can occur early after birth and appears to be independent of N‐myc amplification.

Malignant Adenomyoepithelioma of the Breast:A Case with Distant Metastases.

Adenomyoepithelioma is thought to be a low-grade malignancy, and cases showing malignant behavior are rare.A massive breast tumor with skin invasion in a 60-year-old woman was diagnosed as malignant adenomyoepithelioma. Despite the tumor size and skin invasion, no axillary lymph node metastases were detected. Light microscopy showed proliferation of tubular structures composed of atypical epithelial and myoepithelial cells and occasional anaplastic cells with mitotic figures extending to the epidermis of the skin.Twenty-four months after the surgery the patient complained of dull pain in the right thigh, and was found to have bone, lung and mediastinal lymph node metastases. There was neither local recurrence nor axillary lymph node metastasis. Subsequent femur fracture was treated by osteotomy. Despite additional chemoradiotherapy, the patient died 43 months after the first operation.Our case and literature review indicated that this tumor tends to show hematogenous metastasis.

Clinicopathologic evaluation of recurrence in early gastric cancer

Five hundred ninety-two patients with early gastric cancer underwent surgical resection from 1970 to 1986 in our hospital, and 13 died from a recurrence of their disease. A careful analysis of these 13 patients suggests that carcinomas which invaded to the submucosa tend to recur more often than those confined to the mucosa. Well differentiated and papillary adenocarcinomas characterized by protruded or elevated lesions tend to recur earlier than poorly differentiated or signet-ring cell carcinomas characterized by depressed or excavated lesions. However, both types recurred from hematogenous metastases, with the liver being the most common site. Therefore, the macroscopic and histological features presently used to characterize early gastric cancer do not provide sufficient information to accurately predict which patients are at most risk for recurrence.

Acquired pseudoobstruction of the colon due to segmental hypoganglionosis

A case of acquired pseudoobstruction of the colon due to segmental hypoganglionosis is reported. The patient became constipated during pregnancy and obstructive symptoms followed. Radiologically, the diseased segment was spastic and the proximal colon was extremely dilated. Microscopically, the involved segment showed marked diminution in the number of intramural ganglion cells and those present showed degenerative changes.

Primary Non-Hodgkin's Lymphoma of the Breast: A Report of Two Cases

Background: Primary non-Hodgkin’s lymphoma of the breast (PBNHL) is a rare neoplasm and PBNHL occuring in a man is extremely rare.Method: We report herein two cases of PBNHL and discuss methods of diagnosis and treatment.Results: The first patient was a 35-year-old woman who presented with an elastic-hard mass in her left breast and adenopathy in her left axillary fossa. Mammography and ultrasonography suggested left breast cancer. Frozen sections demonstrated PBNHL histologically. Quadrantectomy of the breast was performed followed by chemotherapy. The second patient was a 65-year-old man with an elastic-hard mass in his left breast and left axillary lymphadenopathy. Mammography and ultrasonography suggested breast cancer or a soft tissue tumor. Intraoperative histological examination revealed a diagnosis of non-Hodgkin’s lymphoma (NHL). A simple mastectomy and postoperative chemotherapy were performed and the patient had a good prognosis.Conclusion: A multidisciplinary approach including surgery, chemotherapy, and radiotherapy is indispensable in treating PBNHL, after diagnosis by excisional biopsy or aspiration cytology.

Direct Hypogastric Artery Reconstruction for Threatened Lower Limb Ischemia: Report of a Case

Abstract The hypogastric artery is one of the major collateral arteries in aortoiliac occlusive disease. This report describes a case of limb-threatening ischemia caused by acute arterial thrombosis of the right hypogastric artery. The external iliac and distal arteries were obstructed and the hypogastric artery was a major collateral artery. A diagnostic arteriogram taken after intra-arterial thrombolytic therapy revealed a stenotic lesion in the orifice of the hypogastric artery. Open thromboendarterectomy of the hypogastric artery and patch angioplasty, using an expanded polytetrafluoroethylene graft, were performed to salvage the limb. The hypogastric artery was successfully revascularized and ischemic rest pain was relieved.

Prognostic Factors of Chronic Upper Limb Ischemia and Endoscopic Thoracic Sympathectomy

Long-term results of chronic upper limb ischemia and related prognostic factors were evaluated. In addition, the efficacy of endoscopic thoracic sympathectomy was examined. Thirty-one patients with chronic ischemic episodes of 41 upper limbs were reviewed retrospectively. The cause of ischemia included atherosclerosis in 18 limbs, Buergers disease in 16 limbs, and other causes in seven limbs. Thoracic sympathectomy was under taken in 21 limbs, and bypass grafting was undertaken in five limbs. Fifteen limbs were not treated surgically. Of the 21 thoracic sympathectomies, the transthoracic approach was used in 12 and thoracoscopy was used in seven. In addition, an extrapleural approach was used in two cases because of dense pleural adhesion. Compared with open sympathectomy, the intraoperative blood loss, the duration of chest tube drainage, and the complication rate were significantly decreased in the endo scopic group. Recurrence rates for all 41 limbs were 14.5% at 1 year, 19.2% at 2 years, and 30.3% at 3 years. Univariate analysis revealed significantly lower recurrence rates for men, cases caused by Buergers disease, and limbs without contralateral upper limb ischemia. Multivariate analysis also disclosed a significantly lower recurrence rate for limb ischemia caused by Buergers disease. The cause of upper limb ischemia influenced the outcome. In cases of Buergers disease, the recurrence rates were low, and thoracic sympathectomy was effective. Thoracoscopic sympathectomy was safe and less invasive than open sympathectomy and is a valid therapeutic option for treating upper limb ischemia.

Efficacy of Preoperative Computed Tomography for Diagnosing Major Anomalies of the Inferior Vena Cava Associated with Abdominal Aortic Aneurysm

Anomalies of the inferior vena cava are rare but clinically important entities encountered during aortic surgery. Among 92 patients with abdominal aortic aneurysm, two inferior vana caval anomalies, including one case of left-sided inferior vena cava (IVC) and one case of duplicated IVC, were found. Computed tomography with contrast medium showed the presence of inferior vena caval anomalies associated with abdominal aortic aneurysms. Preoperative diagnosis of such inferior vena caval anomalies may reduce the risk of hazardous venous injury. Therefore, computed tomography is useful for routine examination before aortic surgery.

Congenital pyloric atresia —A report of two cases

Two cases of the membranous type of pyloric atresia are described and a review of 99 cases reported in the literature is presented. Excision and incision of diaphragm with pyloroplasty was performed on both cases. The first patient was alive following the second operation of gastroduodenostomy for postoperative stenosis. The second premature patient died of sepsis on the 58th postoperative day.The treatment should be surgical and the operative procedure should be chosen depending on the type of atresia. Excision or incision of the diaphragm with pyloroplasty and gastroduodenostomy are the procedures of choice. Gastrojejunostomy should be avoided because of its high mortality rate.