Kenji Tsuchie

Granulocyte-colony stimulating factor produced by pancreatic carcinoma

SummaryConclusionA rare case of granulocyte-colony stimulating factor (G-CSF) produced by carcinoma of the pancreas has been reported.BackgroundThis is the first case showing high G-CSF concentration in the aspirated tumor fluid (mucin) at its early stage without leukocytosis.MethodsThe tumor, detected incidentally in a 64-yr-old male, was removed by a distal pancreatectomy. The mass was 7.0×6.5×4.5 cm, and was histologically diagnosed as cystadenocarcinoma with prominent sarcomatous transformation. It was classified as anaplastic carcinoma.ResultsAfter 4 wk of resection, progressive leukocytosis was observed. Seven weeks after the operation, the peripheral leukocyte count increased to 126,000/mL. After 8 wk of resection, the patient died of recurrence. The serum G-CSF concentration was elevated after recurrence. The preserved mucin contained in the cystic components of the resected specimen had a G-CSF concentration higher than 2400 pg/mL. G-CSF is a known cytokine and an etiologic agent in paraneoplastic syndromes. An early diagnosis can, therefore, be made prior to the manifestation of clinical symptoms by the evaluation of the aspirated tumor fluid. This can lead to the prevention of the paraneoplastic syndrome with inhibitory cytokines in future.

Predominance of histamine H1 receptors on liver plasma membrane

We quantitatively determined the receptors for histamine H1, histamine H2, alpha- and beta-adrenergic, prostaglandin E2 and F2 alpha in liver plasma membranes. The number of the receptors was the greatest in histamine H1 receptors (4740 +/- 750 fmol/mg protein) and the second in alpha-adrenergic receptors (965 +/- 16). Although relatively small numbers of the receptors were observed for histamine H2 (116 +/- 11) and prostaglandin E2 (38.0 +/- 8.9), we could not determine the number and affinity of beta-adrenergic and prostaglandin F2 alpha receptors. In contrast to the number of receptors, there was not significant difference in the affinities of receptors for histamine H1, histamine H2, alpha-adrenergic hormone and prostaglandin E2. These results suggest that histamine and its receptor play some role in liver function.

Massive mucinous carcinoma of the breast untreated for 6 years

Abstract. We report a patient with a massive mucinous carcinoma of the breast that had been untreated for 6 years. A 47-year-old premenopausal woman presented with a large right-breast mass. Although she had noticed a lump in the right breast 6 years previously, she had not sought treatment. The tumor had enlarged gradually and become ulcerated. With a diagnosis of advanced breast cancer with skin invasion, she underwent right mastectomy with a free skin graft. No lymph node metastases or distant metastases were detected. The histologic diagnosis of the tumor was pure mucinous carcinoma of the breast with no component of ordinary invasive ductal cancer. She has been well without evidence of tumor recurrence for 7 years after the surgery. The prognosis for mucinous carcinoma of the breast has been recognized as relatively good. The results in our patient are consistent with the biological behavior of this carcinoma.

Chronic pancreatitis at early age of onset presenting interesting findings through endoscopic retrograde pancreatography and chemical analysis of nonopaque pancreatic concretion.

SummaryThis case concerns a 20-year-old male patient with an approximate 10-year history of recurrent and severe abdominal pain radiating to the back. Endoscopic retrograde cholangiopancreatography revealed a short obstructing stenosis of the main pancreatic duct in the head of the pancreas, marked and tortuous dilatation of the prestenotic portion of the main pancreatic duct and its side branches, and a filling defect in the side branch in the body of the gland. Pancreaticojejunostomy was performed to induce decompression of the pancreatic duct. Histology of the pancreas showed advanced chronic pancreatitis. Three nonopaque concretions were obtained at operation. The largest one, which was milky white in appearance and elastic and soft in consistency, proved to be made up of protein. The concretion was rich in acidic amino acids, but poor in basic or aromatic residues. The molar composition of amino acids in the concretion was, in decreasing order, aspartic acid, serine, valine, glycine, and glutamic acid. Powder x-ray diffractometry revealed no crystalline structures.

Small Early Invasive Colon Cancer Near the Splenic Flexure Successfully Diagnosed by Intraoperative Magnifying Endoscopy

Recent improvements in colonoscopy enabled us to make a more accurate diagnosis and to choose an optimal treatment for early colorectal carcinoma. Magnifying endoscopy, although yet to be widely accepted throughout the world, is now routinely performed in Japan to discriminate nonneoplastic from neoplastic lesions [1] and is useful to estimate the depth of invasion in early colorectal carcinoma [2, 3]. In this report we present a case of an early invasive cancer diagnosed by intraoperative magnifying endoscopy. Because routine total colonoscopy failed to determine the malignancy of the lesion because of its location and previous laparotomies, the patient was selected for surgery.