Kazuo Hirose

Primary mucoepidermoid carcinoma in the thyroid gland. A case report including an ultrastructural and biochemical study.

An extremely rare mucoepidermoid carcinoma of the thyroid gland was found in a 44‐year‐old woman. By light microscopic examination, the tumor consisted of mucous cells and squamoid cells, and was similar to that occurring in any other organs. By electron microscopic examination, the mucous cells displayed prominent mucous droplets, and showed no evidence of colloid production in their cytoplasms. Abundant tonofilaments in aggregates were observed in the squamoid cells. Biochemically, thyroxine (T4) and triiodothyronine (T3) were not detectable in the tissue of this tumor. These findings indicate that this mucoepidermoid carcinoma does not retain the functional properties of thyroid follicular cells; namely, no evidence was found to substantiate a follicular epithelial origin of this tumor.

Ascending colon cancer with hepatic metastasis and cholecystolithiasis in a patient with situs inversus totalis without any expression of UVRAG mRNA: report of a case.

Situs inversus totalis refers to an inverted position of part or all of the viscera, which represents a mirror-image of the normal location, and it is a relatively rare condition that occurs in one in 4 000–8 000 people in Japan. We herein report a patient demonstrating a combination of situs inversus totalis, colon cancer with hepatic metastasis, and cholecystolithiasis, who was treated surgically. We found no expression of UVRAG mRNA in our case, thus suggesting that the UVRAG gene is partly responsible for this condition.

Primary Hepatic Neuroendocrine Carcinoma Coexisting with Hepatocellular Carcinoma in Hepatitis C Liver Cirrhosis: Report of a Case

Abstract.Primary hepatic neuroendocrine carcinoma is an extremely rare tumor of the liver. We herein describe a case of primary hepatic neuroendocrine carcinoma with lymph node metastases, coexisting with hepatocellular carcinoma, on a background of hepatitis C cirrrhosis, in a 72-year-old man. Abdominal ultrasonography and computed tomography (CT) showed a tumor (3 cm in diameter) in Couinauds hepatic segment 8 (S8) with regional lymph node metastases. Whole-body CT, magnetic resonance imaging (MRI), and endoscopy did not reveal primary lesions outside the liver. Feridex MRI and [18F]fluorodeoxyglucose positron emission tomography were strongly suspicious of malignancy. A limited hepatectomy with regional lymph node dissection was performed. Histopathology, immunohistochemistry, and electron microscopy confirmed a diagnosis of primary neuroendocrine carcinoma on a background of liver cirrhosis. A tumor (1.5 cm in diameter) found in hepatic S5 at operation was also simultaneously resected, and histologically diagnosed to be hepatocellular carcinoma. We also review previous reports of hepatic neuroendocrine carcinoma and discuss hypotheses for the histogenesis of these tumors as well as prognostic implications. Given the background cirrhosis and coexisting hepatocellular carcinoma, we speculate that one of the hepatocellular carcinomas underwent neuroendocrine differentiation.

Regional ploidy variations in signet ring cell carcinomas of the stomach

Regional ploidy variations within individual tumors were analyzed by in‐situ cytofluorometry of metaphase cells in Feulgen‐stained paraffin sections, using 45 resected stomachs with early and advanced signet ring cell carcinomas. Aneuploid cells were found in one of 30 early cancers and in eight of 15 advanced cancers, and were almost always accompanied by diploid cancer cells in the mucosal part of the cancers. The diploid and the aneuploid cells were generally found to be distributed in different territories in the mucosa, and aneuploid foci were often included in the diploid area. These findings suggest the diploid origin of signet ring cell carcinomas and the occurrence of aneuploidy during the tumor development. Moreover, the aneuploid cells appeared to infiltrate beyond the mucosa more readily than the diploid cells; most of the aneuploid populations already invaded the extramucosal tissue, and the cancer cells infiltrating in the extramucosal tissue were predominantly aneuploid in six of the nine cancers with aneuploidy. Thus, it appears that the occurrence of aneuploid clones may accelerate the progression of signet ring cell carcinomas from early to advanced stages.

Modified Gluteus Maximus V-Y Advancement Flap for Reconstruction of Perineal Defects After Resection of Intrapelvic Recurrent Rectal Cancer: Report of a Case

Technical advances in myocutaneous flap preparation have resulted in primary reconstruction now being generally indicated for malignant tumors extensively infiltrating the pelvic cavity and perineum. Pelvic tumor resection can dramatically improve the health-related quality of life (QOL) of patients with locally recurrent rectal cancer complicated by infection and pain. However, the removal of a wide area of perineum by these two procedures often leaves a large dead space. A gluteal thigh muscle, rectus abdominis muscle, or pedicle myocutaneous flap is usually made to reconstruct such extensive perineal defects. The subject of this case report was a 76-year-old woman with recurrent rectal cancer in the pelvis after abdominoperineal resection. The large pelvic tumor, which was causing severe pain, was resected and the extensive perineal defects were reconstructed using a modified maximus V-Y advancement flap. The operating time was approximately 30 min, and the pain after surgery was much less severe. Moreover, she could walk the day after surgery and returned to normal daily life without requiring prolonged bed rest. No infection developed in the intrapelvic dead space postoperatively. This technique proved very useful for improving the patients QOL.

Mesenteric Castleman's disease: report of a case.

Abstract.A 77-year-old woman was admitted with intermittent abdominal dull pain. Hypochromic anemia, hypergammaglobulinemia, and elevated C-reactive protein were found in this case. Ultrasonography, computed tomography, magnetic resonance imaging, and angiography indicated either mesenteric leiomyoma or leiomyosarcoma, but no definitive preoperative diagnosis could be established. A surgical resection of the tumor revealed a mesenteric Castlemans tumor with small daughter lymphoid tumors of plasma cell type.

Plexiform Schwannoma of the Small Intestine: Report of a Case

Plexiform schwannoma is a benign peripheral nerve sheath tumor composed exclusively of schwann cells arranged in a plexiform pattern. Most plexiform schwannomas are skin tumors and there has been only one case report of this tumor originating in the colon. We describe herein the first known case of plexiform schwannoma of the small intestine occurring without any relationship to schwannomatosis or neurofibromatosis. A 57-year-old man presented with a short history of abdominal pain, vomiting, and bloody stool after each meal. Jejunography demonstrated multiple nodular tumors in the small intestine. We resected the small intestine laparoscopically. The tumors consisted of multiple white nodules in the submucosal and subserosal layers. Microscopic examination revealed that each tumor was composed mainly of Antony A tissue, compatible with conventional schwannoma. Immunohistochemically, the tumors were positive for S-100, vimentin, and neuron-specific enolase, and negative for HHF35, Α-SMA, and c-kit. No evidence of recurrence has been found in 38 months of follow-up.

The Relationship Between Metastatic Potential and the Expression of Sialyl Lewis A (CA 19–9) and Sialyl Lewis X Antigens in Colorectal Cancer

The relationship between metastatic potential and the expression of sialyl Lea or sialyl Lex antigens was studied in 128 advanced colorectal cancer. Hematogenous metastasis was observed more often in the Grade II-III group of sialyl Lea or sialyl Lex staining than in Grade 0-1. The recurrence rates in the Grade II-III group of sialyl Lex staining was significantly higher than those in the Grade 0-1, and the prognosis in the Grade II-III group of sialyl Lex staining was significantly poorer than that in the Grade 0-1. These results suggested that sialyl Lea and sialyl Lex antigens in colorectal cancer might be involved in the hematogenous metastasis.

DNA Index and p53 Immunoreaction in Colorectal Cancer and Its Relationship to Prognosis

The DNA ploidy pattern and p53 immunoreactivity was studied in colorectal cancers and the results correlate with prognosis. There was no significant correlation between the DNA ploidy pattern and clinicopathological findings. However, patients with aneuploid tumor ran significantly poorer than diploid ones. The 5- and 10-year survival rates were 60.4% and 53.4% for those with diploid tumor. On the other hand, p53 immunoreactivity was found 57.1% of 203 colorectal cancers. The 5-year survival rate was 62.8% of patients with p53-positive tumors, and 74.2% for ones with p53-negative tumors: there was a significant differece between these two groups. We suggest therefore that DNA ploidy pattern and p53 immunoreactivity may possible be a useful prognostic marker of colorectal cancers.

Proper Indication of Gastrectomy for the Gastric Carcinomas with Liver Metastasis

In 36 gastric carcinomas with synchronous liver metastasis, the influence of the degrees of liver metastasis and gastrectomy with lymphnode dissection upon the survival, was studied. In nine gastrectomy-patients who had less than seven metastatic liver tumors and underwent radical lymphadeneetomy, more favorable median survival time and 1-year survival were obtained, 456 days and 67%, than in other 20 gastrectomy-patients who received palliative lympadenectomy regardless of the numbers of liver metastasis, as well as than in the sever, patients who were not resectable.