Masafumi Morinaga

Quantitative analysis of numerical chromosome aberrations in various morphological types of colorectal carcinomas

Quantitative analysis by fluorescence in situ hybridization (FISH) on thin paraffin-embedded tissue sections, using specific probes for chromosomes 11, 17, and 18 was employed in various morphological types of early and advanced colorectal cancer to clarify tumor cytogenetics. The chromosome index (CI) was calculated as a quantitative measure of the chromosome copy number. Compared with the CI of normal epithelium, the CI of chromosome 11 in villous components of adenomas or polypoid early cancers was decreased, while the CI in flat type or advanced colorectal cancers, conversely, was increased (P<0.05). The CI of chromosome 17 in villous components of adenomas and all cancers was higher than that of normal epithelium (P<0.05), but the differences were not significant. In protruding advanced cancers, the CI of chromosome 18 was significantly decreased (P<0.01) compared to the CI of normal epithelium. There was no significant chromosomal heterogeneity between the superficial and the deepest layer in each cancer. In mucosa adjacent to sessile and flat type cancers, the CI of chromosome 17 was significantly higher than the CI in normal epithelium or adenomas (P<0.05). These results suggest that numerical chromosome aberrations are associated with the histological type of adenoma and the morphological diversity of cancer in the colorectum, and that chromosome 17 abnormality occurs in mucosa adjacent to sessile and flat cancers.

Extended resection for lung cancer invading mediastinal organs

We analyzed 49 patients with non-small-cell lung cancer invading mediastinal organs such as the left atrium (15), superior vena cava (13), trachea (11), aorta (5), thoracic vertebral body (4) and esophagus (1). Lung resection included lobectomy (37), pneumonectomy (8) and limited resection (4). Twenty-seven patients underwent carina- or bronchoplasty. Complete resection was possible in 35 patients. Operative mortality was 12% and overall 5-year survival was 13%. Median survival time was 519 days. Factors significantly affecting survival were the completeness of resection, node status, and histological type. Five-year survival was 18% with complete resection and 0% with incomplete resection (p < 0.0001). Five-year survival for patients with squamous cell carcinoma was 36% and for those with other types of lung cancer, 0% (p < 0.02). Five-year survival for patients classified pathologically as N0 or N1 was 36% and, for those classified as N2 or N3, 0% (p < 0.05). We concluded that aggressive resection for lung cancer invading the mediastinal organs involves a high mortality rate, making selectivity important. Patients undergoing complete resection, classified as N0 or N1, and having squamouse cell carcinoma may benefit most from surgery.

Completion pneumonectomy for recurrent or second primary lung cancer

OBJECTIVE We studied 8 patients undergoing completion pneumonectomy for recurrent or second primary lung cancer. METHODS Subjects were men who averaged 62 years of age. Of these 6 had p-stage I, and 2 p-stage II disease at initial operation. At the second operation, we diagnosed 3 with second primary lung cancer and 5 with recurrent lung cancer. We predicted postoperative pulmonary function by calculating the predicted forced expiratory volume in 1.0 second (FEV1.0) from residual numbers of subsegments after completion pneumonectomy. All predicted FEV1.0 in our 8 cases ranged from 544 to 926 (773 +/- 144) ml/m2. RESULTS Six patients experienced postoperative complications and morbidity was 75%. One patient undergoing completion sleeve pneumonectomy after radiation therapy for local carina recurrence died on 7th postoperative day due to anastomotic dehiscence and pneumonia. Overall operative mortality was 12.5% (1/8). Four remain alive and actuarial 5-year survival was 37.5%. CONCLUSIONS Careful consideration is needed in determining operative indications for completion pneumonectomy for patients after radiation therapy. Patients with recurrent squamous cell carcinoma who have p-stage I disease at initial operation and those with second primary lung cancer and p-stage I or II disease can expect relatively a long-term survival, and we concluded that completion pneumonectomy could be conducted in these cases with a satisfactory prognosis.

Signet ring cell early gastric cancer presenting as an elevated lesion.

SummaryEarly gastric cancer composed of signet ring cell carcinoma is usually present as a depressed lesion and rarely manifests as a protruding lesion. To our knowledge, only eight cases have been reported in the literature. We herein report such a rare lesion which developed in an asymptomatic 55-year-old man.