Kizuku Imanishi

Carcinoembryonic antigen levels of peripheral and draining venous blood in patients with colorectal cancer : correlation with survival

Correlations between preoperative carcinoembryonic antigen (CEA) levels of peripheral (p‐CEA) and draining blood (d‐CEA), the CEA gradient between d‐CEA and p‐CEA (d‐p CEA gradient) levels, and survival after resection of cancer lesions were examined in 94 patients with colorectal cancer. Survival rates of patients with normal p‐CEA and d‐CEA levels and d‐p CEA gradient levels (<5 ng/ml) were significantly better than those of patients with abnormal levels (≥5 ng/ml), and the 5‐year survival rates were, respectively, 62%, 69%, and 72% in the former and 42%, 41%, and 35% in the latter. The differences in the 5‐year survival rates between patients with normal and abnormal d‐p CEA gradient, d‐CEA, and p‐CEA levels were 37%, Z8%, and 20%, respectively. Furthermore, the positive rates of d‐CEA levels (64%) and d‐p CEA gradient levels (48%) were higher than that of p‐CEA levels (36%). However, some significant differences in background variables also were found between the respective groups of patients with normal and abnormal p‐CEA and d‐CEA levels and d‐p CEA gradient levels. These results suggest that patients with poor prognoses are examined more effectively by determining their d‐p CEA gradient and d‐CEA levels than their p‐CEA levels, and that CEA may be expressed as a quantitative sum total of various pathophysiologic variables of patients with colorectal cancer but not as an independent prognostic variable. Cancer 1992; 69:2411‐2417.

Immunohistochemical studies on the main entrance‐route of CA19‐9 into the peripheral venous blood of gastric cancer patients. Correlation with CA19‐9 levels in peripheral and portal blood

The correlation between CA19‐9 levels of portal and peripheral venous blood, and immunohistochemical variables of cancer lesions was examined in 53 gastric cancer patients and eight patients with benign diseases. Immunohistochemically, CA19‐9 was found in 33 (62.5%) of 53 primary lesions. The antigen was found in the cancer cells of invasive lymphatics and node metastases of every CA19‐9 localized cancer, although the cancer cells in veins showed little or no CA19‐9. There was little or no antigen in the cancer cells in veins, lymphatics, or metastases of 20 CA19‐9 nonlocalized primary lesions. Patients with CA19‐9 nonlocalized cancer or with benign diseases showed no elevation of the antigen levels in peripheral or portal blood. CA19‐9 levels of portal blood (mean, 76.4 U/ml; positive rate, 33.3%) were not different from those of peripheral blood (mean, 91.5 U/ml; positive rate, 33.3%). Additionally, the antigen levels of the blood in patients with lymphatic invasion or node metastases were significantly higher than those in patients without the invasion or the metastases, and every patient without the invasion showed no elevation of the antigen. These results suggest that production of the antigen in cancer cells may be a premise of CA19‐9 elevation in peripheral blood and that CA19‐9 may be drained by the thoracic duct of the lymphatic system via node metastases or invasive lymphatics, but not by the hematogenous portal system.

A CASE REPORT OF GASTRIC BENIGN LYMPHOMA

はじめに へ入院した。 1967年に中村がreactive lymphoreticular hyper‐ 入 院時の検査成績 :末浦血には異常は認められず, plasia(以下 RLHと 略)の詳細な報告行って以来, 肝 機能検査においても総蛋白6.4g/dl・アルブミン3.8 本邦においては多数のRLHが 報告されている。その g/di・ A/G比 1.46・総ビリルビン0.7mg/di・ALP 69 大多数は胃痛類似病変の形態をとっている分が,粘 膜 IU/′ 。LDR 1721U/′・GOT 171U/′・GPT 161U/′・ 下腫瘍の形態をとるRLH症 4/11も 散見される。 D。これ γ ‐GTP llIU/′と異常は認められなかった。CEA l.5 らの中 にはreactiveと言 うよ りむ しろprimary ng/ml(正 常値 0~2.5)・α‐fetoprotein(一 )・trans_ tumorと考える方が妥当な症例も存在している。●.最 ferrin 152.2mg/dl(200~400)。fettitin 29.3ng/ml 近著者 らは 胃粘膜下腫瘍 の形態 を とる良性 の (10~ 250)。れ―micrOglobulin l.4mg/′ (0,8~2.4)・ lymphOid tumorous lesionで ,胃 細網細胞系の疾患概 角 antitrypsin 184mg/dl(169~ 326)とtulnor marker 念上極めて重要な位置を占める胃原発の良性 リンパ は ,ぃ ずれも正常範囲内の値を示していた。 腫と考えられる症例を経験したので,若 子の文献的 胃 透視所見 !胃角部小弯側には周辺が軽度隆起し, 考察を加え報告する. そ の中心に淡い陥凹性病変が認められIIattIIc早 期 正.症 例 胃 癌と診断された(写真 1).幽 門前底部には表面平滑 M‐2404(藤○順○,68歳,男 性) で 境界明瞭な類円形の陰影欠損が見られ,そ の十二指 主訴 :右季肋部痛. 腸 球部への脱出像が観察された (写真 2). 家族歴 :母が胃癌にて死亡. 胃 内視鏡検査 i胃角部にHa ttIIc型 早期胃癌 と幽 既往歴 :28歳の時に肝機能障害. 門 前庭部に正常粘膜で被れた隆起性病変が認められ 現病歴 i昭和57年12月20日頃より食事や時間に関係 た 。内視鏡下の生検では胃角部の病巣はGrOup V なく右季肋部に痢痛が出現し,時 々背部に放散してい (paplllary adenocarcinoma)で ,幽 門前庭の粘膜下腫 た。このため,同 月末に近医受診し胃に異常を指摘さ 瘍 部の生検は粘膜のみが採取されておりGroup Iで れ,昭 和58年1月当院内科における精密検査の結果胃 あ った。 癌と胃粘膜下腫瘍と診断されて昭和58年2月 2日当科 以 上の所見より早期胃癌 IIattIIc及び胃幽門部粘 膜下腫瘍の診断のもとに幽門側胃亜全摘術を施行し

A study on risk factors and clinicopathological characteristics of multiple colon cancer with the spocial reference to difference in solitary occurrence.

過去14年間に教室で経験した大腸多発癌18例と単発癌291例を対比し, 多発癌の背景因子と臨床的・病理学的な特徴について検討を加え, 以下の結果と結論を得た.同時性多発癌は14例 (4.8%), 異時性多発癌は4例 (1.4%) であった. 背景因子として, 性・年齢・遺伝性素因並びにポリープ合併頻度が, 癌病巣の臨床病理学的所見として, 発生部位・肉眼型・深達度・組織型において多発癌と単発癌との間に生物学的な差があることを報告した. 同時に大腸多発癌について上のべについても文献的な考察を加え言及した.