Kiyotaka Yukimoto

Differences in Dihydropyrimidine Dehydrogenase Activities Between Gastric and Colorectal Cancer

We studied the relation between clinicopathological factors and dihydropyrimidine dehydrogenase (DPD) activity in gastric and colorectal carcinomas. Specimens obtained by surgery from 27 gastric and 17 colorectal carcinomas and their normal mucosa were examined. The levels of DPD activity in the gastric carcinomas and their normal mucosa were significantly higher than those in colorectal carcinomas and their normal counterparts, respectively (both Ps<0.0001). The gastric carcinomas had significantly higher DPD activities than their normal mucosa (P = 0.028), but the colorectal carcinomas did not. Among the clinicopathological factors, which included invasion/metastatic status and staging, the only effect was that of the histological differences of gastric cancer on DPD activity. That is, the level of DPD activity of the histologically undifferentiated gastric carcinoma was significantly higher than that of the differentiated type. No prognostic predictive values of DPD were recognized in either gastric and colorectal cancer. In conclusion, the higher DPD activity in gastric cancer than colorectal cancer may be due to the higher DPD activity in the background mucosa of origin, and the higher population of undifferentiated type of histological classification, compared to the colorectal counterparts.

Breast metastasis from EGFR-mutated lung adenocarcinoma: A case report and review of the literature

Although lung cancer rarely metastasizes to the breast, we report a case of breast metastasis from lung adenocarcinoma harboring an epidermal growth factor receptor mutation. This breast metastasis was initially considered recurrent breast cancer and was later diagnosed based on histopathological and molecular examinations as metastasis from lung cancer.

A CASE OF NON-SPECIFIC MULTIPLE ULCER OF THE SMALL INTESTINE

症例は, 23歳,女性.平成11年,十二指腸潰瘍穿通にて広範囲胃切除術施行された.同年,癒着性イレウスの診断にて,癒着剥離術を施行した.この際,回腸末端部より約80cm付近に8カ所の輪状の壁肥厚を認めたため一部を切除した.肥厚部にはびらんを認め,病理学的には非特異的炎症所見のみであった.平成14年8月,突然の下腹部痛が出現し,外来を受診した.受診時,下腹部に強い圧痛を認めたが腹膜刺激症状は認めなかった.腹部CTで小腸の拡張とTargetsign様の所見を認めたため,腸重積を疑い緊急手術を施行した.回腸末端部に8カ所の壁肥厚を認め,それより口側の腸管の拡張を認めたため同部を切除した.切除標本では輪状の潰瘍瘢痕様の病変を8カ所に認め,病理学的には浅い潰瘍形成と粘膜下層の非特異的炎症像が認められ非特異的多発性小腸潰瘍症と診断した.

Percutaneous Endoscopic Gastrostomy, Duodenostomy and Jejunostomy for Alimentation in Gastrectomized Patients

Percutaneous Endoscopic Gastrostomy (PEG) which can be accomplished with local anesthesia and without the necessity for laparotomy is now gaining popularity as a clinical treatment for patients who have difficulties in swallowing and require long term nutritional support but have an intact gut. A total of 40 patients underwent percutaneous endoscopic placement of a feeding tube in our clinic. They included 37 patients who had had PEG, 1 Percutaneous Endoscopic Duodenostomy (PED) and 2 Percutaneous Endoscopic Jejunostomy (PEJ). Of these patients, 3 had previously had a partial gastrectomy and 1 had had an esophagectomy with esophago‐jejunostomy. Three patients who had undergone a previous partial gastrectomy received different procedures; 1 PEG, 1 PED and 1 PEJ, which were considered to be most appropriate for each patient. One patient with a previous esophagectomy had a PEJ. PEG, PED and PEJ for the patients who had previously undergone a gastrectomy were successfully done with great care. Our experience suggests that PEG, PED or PEJ are rapid, safe and useful procedures for patients who are a poor anesthetic or poor operative risk and can be used even for patients who have undergone previous surgery.