Kiichi Maeda

A clinicopathologic study on multiple gastric cancers with special reference to distal gastrectomy

Simultaneous multiple gastric cancer was seen in 49 (5.8%) of 852 resected stomachs. Patients with multiple cancers were older than those with single gastric cancers (P < 0.01) and the incidence of multiple gastric cancer was significantly higher in male patients than in female patients (P < 0.05). The incidence rates of multiple carcinomas were 9.6% of early gastric carcinomas and 4.0% of advanced gastric carcinomas. With regard to histologic type, the incidence rate of the differentiated type was 71% and the incidence rate of the undifferentiated type was 29%. In 68 serially resected stomachs, 5 (7.4%) new multiple cancers were detected microscopically, whereas 4 (5.9%) had already been diagnosed grossly. The incidence rate of multiple carcinoma increased to 13.2% by this procedure. The cases that were cut serially showed that most of the multiple cancers were located distally from the F‐line presenting the line along which intestinal metaplasia appeared. This study suggests that the surgeon is required to resect the area including the F‐line at the time of distal gastrectomy so as not to leave another cancer in the gastric remnant.

Prognostic significance of expression of thymidine phosphorylase and vascular endothelial growth factor in human gastric carcinoma.

Both thymidine phosphorylase (dThdPase) and vascular endothelial growth factor (VEGF) are well‐characterized inducers of angiogenesis. The purpose of this study was to examine the expression of these antigens and their prognostic significance in gastric carcinoma.

The spread and prognosis of carcinoma in the region of the pancreatic head

Tumor infiltration and prognosis were studied in 73 patients who underwent surgery for carcinoma in the region of the pancreatic head, in order to evaluate the grade of malignancy of pancreatic cancer. Twenty three patients had carcinoma of the head of the pancreas, 16 had carcinoma of the intrapancreatic bile duct and 34 had carcinoma of the papilla of Vater. It was found that the prognosis in carcinoma of the head of the pancreas was not related to tumor size, but to lymph node metastasis and the pancreatic capsular or perineural invasion of the tumor. The poorer prognosis seen in carcinoma of the head of the pancreas could be attributed to the fact that lymph node metastasis and invasion of the pancreatic capsule or nerve plexus occurred much more frequently in this carcinoma than in carcinoma of the other two areas. The 5-year survival rate of the patients with carcinoma of the head of the pancreas was 12.5 per cent, this being significantly lower than that of the patients with either carcinoma of the papilla of Vater (50.0 per cent) or carcinoma of the intrapancreatic bile duct (44.4 per cent). These findings suggest that lymph node metastasis and pancreatic capsular or perineural invasion closely correlate with the prognosis of patients with pancreatic carcinoma.

Management of continuous anastomosis of pancreatic duct and jejunal mucosa after pancreaticoduodenectomy: Historical study of 300 patients ☆

BACKGROUND Pancreaticojejunostomy is the most problematic anastomosis in the reconstruction after pancreaticoduodenectomy. In the past, much of the morbidity and mortality associated with this operation was related to problems with this anastomosis. Recent data, however, suggest that the use of duct-to-mucosa sutures has led to a marked drop in both morbidity and mortality associated with pancreaticojejunostomy. METHODS Among the 300 patients who underwent pancreaticoduodenectomy, including pylorus-preserving pancreaticoduodenectomy, 87 patients underwent traditional pancreaticojejunostomy by invagination of the end of the pancreas into the bowel (group B). Recently three-layer anastomosis was created in 213 patients. The outer layer was created between the pancreatic capsule and the serosa of jejunum. The middle layer was created between the pancreatic parenchyma and the seromuscular wall of jejunum. The inner layer was placed between the pancreatic duct and a small opening in the antimesenteric border of the jejunal mucosa. Among the 213 patients, the inner anastomosis was created with interrupted absorbable sutures (group A1) in 93 patients and continuous absorbable sutures (group A2) in 120 patients. RESULTS The three groups were similar with respect to age, gender, and primary disease. In the anastomosis, the incidence of leakage in group A2 (4.2%) was significantly less than in groups B (17.2%, p < 0.01) and A1 (11.8%, p < 0.05). The operative mortality rates were 3.2% in group A1, 1.7% in group A2, and 5.7% in group B. CONCLUSIONS We recommend continuous anastomosis of the pancreatic duct and jejunal mucosa as a safe procedure after pancreaticoduodenectomy.

Case report of a patient with multiple lesions of the stomach, including multiple cancers and an adenomatous polyp.

This paper describes an unusual case of an 80-year-old man followed up for multifocal gastric cancers. There were three separate polypoid carcinomas and one adenomatous polyp with no sign of malignancy. We measured the DNA content of the gastric cancer and adenomatous cells obtained from endoscopically biopsied specimens. The adenomatous polyp and one of the cancerous lesions showed DNA diploidy. The other two cancerous lesions showed DNA aneuploidy, with different DNA index (DI) values (1.12 and 1.64, respectively). It is considered that the three cancers arose from different stem lines. However, an operation was not performed because the patient refused gastrectomy, and therefore only conservative follow up has been continued. Presentation of this case is followed by a detailed discussion focusing on the possible development of carcinoma in gastric adenomatous polyps in view of the data from the literature.

Clinical experience of biliary tract carcinoma associated with anomalous union of the pancreaticobiliary ductal system

Between 1978 and 1988, 15 patients with gallbladder cancer and 2 patients with bile duct cancer were seen among 49 patients with anomalous union of the pancreaticobiliary ductal system. Radiographic findings revealed two types of this anomalous condition: one in which the pancreatic duct entered the common bile duct(type 1) and one in which the common bile duct entered the pancreatic duct (type 2). In gallbladder cancer, the common bile duct presented no dilatation, or in some patients, mild dilatation, and type-1 anomalous union was frequently found among these patients. In contrast, the two patients with bile duct cancer had cystic dilatation of the common bile duct and type-2 anomalous union. The bile amylase level, which was determined in seven patients, was extremely high in all the patients. Histopathologically, the tumors in most patients showed papillary to papillo-tubular proliferation in the mucosal layer while atypical epithelial hyperplasia was noted in the vicinity of the tumor area. These findings suggest that this congenital anomaly in both ducts results in a loss of the normal sphincteric mechanism of the doudenal papilla, and that chronic relapsing cholecystitis or cholangitis, caused by the reflux of pancreatic juice into the biliary tract, can induced progressive changes to atypical epithelial hyperplasia which may develop into carcinoma.

Intussusception of a mucocele of the appendix secondary to an obstruction by endometriosis: Report of a case

We treated a patient with a complete invagination of the cecum which contained a mucocele of the appendix secondary to an obstruction by endometriosis. Preoperatively, a barium enema showed a crab’s claw-like area without filling in the oral side of the transverse colon. An emergency laparotomy was performed and revealed a mucocele of the appendix to have induced appendicecal invagination; however, no colonic invagination was observed. An appendicecal resection was thus done. Pathologically, the resected specimen was a mucosal hyperplasia with mucin-secreting lesions of the appendix. The theories regarding the pathogenesis of appendicecal mucocele are reviewed and discussed.

Breast Cancer with Endocrine Differentiation: Report of Two Cases Showing Different Histologic Patterns

We report two cases of breast cancer with endocrine differentiation. Case 1 was a 56-year-old woman with a 2-cm tumor in the upper outer quadrant of the right breast and right axillary lymphadenopathy. Excisional biopsy suggested carcinoma and we performed breast-conserving surgery with lymph node dissection. Histologic examination revealed breast cancer with endocrine differentiation resembling small cell carcinoma of the lung, with one nodal metastasis. Case 2 was a 71-year-old woman with a 2.5-cm tumor in the upper outer quadrant of the right breast. Aspiration cytology suggested carcinoma and we performed mastectomy with lymph node dissection. Histologic examination revealed a carcinoid tumor, as one of the breast cancers with endocrine differentiation, but no nodal metastasis. The two patients are now disease-free 26 and 12 months after surgery, respectively.

Myxoid Malignant Fibrous Histiocytoma of the Breast : Report of a Case

Abstract.Malignant fibrous histiocytoma (MFH) is the most common type of soft tissue sarcoma, but it rarely develops as a primary tumor in the breast. Furthermore, no case of the myxoid variant of MFH in the breast has ever been documented. We report the case of a 52-year-old woman with a breast tumor that was immunohistochemically confirmed to be myxoid MFH. She underwent a radical mastectomy and is currently well with no evidence of local recurrence or metastatic spread after 3 years of follow-up.

Spontaneously perforated pyometra presenting as diffuse peritonitis: Report of a case

We report herein a rare case of spontaneously perforated pyometra found in a 72-year-old woman who was admitted to our hospital with abdominal pain and vomiting. A distended abdomen with muscular rigidity, a positive Blumberg sign, and a WBC count of 11,900/mm3 indicated diffuse peritonitis, although a plain abdominal X-ray film revealed no free air in the peritoneal cavity. An emergency laparotomy was performed, which revealed a lot of pus, and perforation in the fundus of a distended uterus. The patient was therefore diagnosed as having suffered uterine perforation associating with a pyometra, and a total hysterectomy with bilateral salpingo-oophorectomy was carried out. Histological examination revealed a pyometra with inflammation and destruction of the endometrium and myometrium, and cervical occlusion with no evidence of malignancy. Postoperatively, the patient developed a subcutaneous abscess and pneumonia, but recovered and was discharged on the 74th day after her operation. Thus, although rare, spontaneously perforated pyometra should be considered when elderly women present with acute abdominal symptoms.