Masashi Koyanagi

Relationship between postoperative recurrence and expression of cyclin E, p27, and Ki-67 in non-small cell lung cancer without lymph node metastases

Abstract.Background: Cyclin E and p27 play pivotal roles in cancer development and progression. We investigated whether the prognosis in cases of non-small cell lung cancer without lymph node metastases that underwent complete resection could be associated with tissue expression of cyclin E, p27, and Ki-67.nMethods: Tumors from 62 patients at least 5 years after surgery were assessed by immunohistochemistry for expression of cyclin E, p27, and Ki-67. Disease-free survival (DFS) after surgery was used to evaluate disease prognosis. We also investigated the relationship between expression of these factors and postoperative recurrence.nResults: In non-small cell lung cancer, p27-negative expression and pT factor were significantly unfavorable prognostic factors in multivariate analysis. The DFS rate in cyclin E-positive expression was significantly lower than in cyclin E-negative expression. Similarly, p27-negative expression and high Ki-67 expression correlated with a shortened DFS rate. In combinations of expression of cyclin E and p27, the cyclin E-negative/p27-positive group had a significantly higher DFS rate than did the other groups. According to histological type, there were correlations between the risk of postoperative recurrence and expression of these three biological factors, especially in adenocarcinoma.nConclusion: By analyzing the expression of cyclin E, p27, and Ki-67 of tumor cells, it was possible to extract the patient group for whom closer follow-up and postoperative treatment is necessary to improve survival rate.

Cervical cord ependymoma with numerous microrosettes.

Abstract“Microrosette ependymoma,” which is ependymoma with numerous microrosettes throughout the tumor, has rarely been reported. We describe an autopsy case of cervical cord ependymoma with two unusual features: the presence of numerous microrosettes and the formation of trabecular architecture. The tumor originated in the C2 segment of a man aged 23 years and gradually expanded over the following 15 years and 10 months until the entire cervical cord was involved. Beside the low grade of malignancy, the tumor cells exhibited a strong tendency to form microrosettes and trabecular architecture, which formed many perivascular pseudorosettes. The microrosettes mostly consisted of only two or a few more cells, in the absence of large rosettes. Thus the constituent cells were those forming perivascular pseudorosettes. Electron microscopy and immunohistochemistry characterized the ependymal properties of the microrosettes, whose lumina frequently contained fibril bundles similar to those of the Reissners fiber fibrils, in addition to cilia and microvilli. The pathogenesis of the occurrence of numerous microrosettes is unknown; however, a defect in the mechanism of regulation of rosette formation and enlargement is the most likely explanation.

Bleeding Meckel Diverticulum Associated with a Vitellointestinal Artery Aneurysm Found on Preoperative Angiography: Report of a Case

An 18-year-old man was admitted to a local hospital with abdominal pain and bloody stool. Upper and lower gastrointestinal endoscopy failed to show any bleeding sites; however, an angiography of the superior mesenteric artery done on hospital day 4 showed an abnormal artery with an aneurysm, branching from the ileal artery. This artery was thought to be the vitellointestinal artery, a feeding artery of Meckel diverticulum. After embolization, he was transferred to our hospital, where we performed emergency laparotomy with partial resection of the ileum, including a bleeding Meckel diverticulum. Pathological examination revealed ectopic gastric mucosa and peptic ulceration, which we assumed was the origin of the bleeding. The patient had an uneventful postoperative course. Visceral artery aneurysms are rare but important vascular lesions because of their potential for fatal rupture. Although a minimally invasive procedure can be performed for a vitellointestinal artery aneurysm in patients with asymptomatic Meckel diverticulum, we treated our patient surgically because he presented with hemorrhagic shock and had been unresponsive to an H2-receptor antagonist.

A Case of Ascending Colon Cancer Found Out with Spontaneous Bacterial Peritonitis

症例は心房細動とうっ血性心不全の既往がある79歳の男性で, 腹痛を主訴に近医を受診した. 超音波検査で骨盤内に腹水を認めたが, 腹膜刺激症状と炎症所見がなく, 保存的治療を行った. 翌日, 腹膜刺激症状と炎症反応を認め, 当科に入院した. 急性虫垂炎による汎発性腹膜炎を疑い, 手術を行った. 虫垂腫大と骨盤腔内の膿性腹水を認め, 虫垂切除術を行った. 腹水からBacteroides thetaiotaomicronが検出された. 摘出虫垂粘膜に炎症を認めなかった. 高CEA血症と貧血を認めたため, 消化管精査を行い, 上行結腸癌が発見された. 23日目に結腸右半切除術を行った. 腫瘍の穿孔, 膿瘍形成を認めなかった. 腫瘍は高分化腺癌で, ss, n (-), P0, H0, M (-), stage IIであった. 術後経過は良好で, 17日目に退院した. 自験例は心不全による腹水に大腸癌の壊死部または口側の浮腫状の腸管壁からバクテリアルトランスロケーションが起こり, 特発性細菌性腹膜炎を来したと推測された.