Masato Kiriyama

Magnitude of Combination Therapy of Radical Resection and External Beam Radiotherapy for Patients With Carcinomas of the Extrahepatic Bile Duct and Gallbladder

The present study sought to identify the therapeutic efficacy of adjuvant external beam radiotherapy (EBRT) for carcinomas of the extrahepatic bile duct (EHBD) and gallbladder. Twenty-one patients with pathologically verified EHBD carcinoma and 18 patients with gallbladder carcinoma were analyzed retrospectively by Cox regression analysis for predictors of survival. The overall 5-year survival rates after resection were 33% for EHBD carcinoma and 56% for gallbladder carcinoma. The overall 5-year survival rate for EHBD carcinoma was 60% in 8 patients without microscopic residual disease (R0), 15% in 9 patients with microscopic residual tumor (R1), and 0% in 4 patients with macroscopic residual tumor (R2). The overall 5-year survival rate of gallbladder carcinoma patients was also decreased with R status equal to 73%, 40%, and 0% for R0, R1 and R2, respectively. Adjuvant radiotherapy significantly improved the 5-year survival rate in 7 patients with R1 disease of EHBD carcinoma (P= .035), compared with survival in 2 patients who underwent resection alone. However, no significant difference was noted in the 5-year survival rate between the resection plus EBRT group and the resection alone group for gallbladder carcinoma. Multivariate analysis revealed that histopathologic grade (G) was an independent predictor of survival for EHBD carcinoma and that direct invasion of liver parenchyma was a predictor of survival for gallbladder carcinoma. This study suggests that curative resection provides the best survival for patients with EHBD and gallbladder carcinoma, and that radiotherapy may play a beneficial role in controlling local–regional residual EHBD carcinoma tumors. However, new strategies for adjuvant therapy are needed to improve survival in patients with gallbladder carcinoma.

Primary hepatic leiomyosarcoma in a woman after renal transplantation: Report of a case

In contrast to malignant lymphomas or skin cancer, smooth muscle tumors including leiomyosarcoma are rarely associated with transplant recipients. We herein present a 33-year-old woman with end-stage renal disease who received a transplant at 27 years of age. Four years after the transplantation, at age 31, she underwent a mastectomy because of primary right breast cancer, which was found to be a 5-mm-sized mucinous carcinoma with no regional lymph node metastasis. Six years after the transplantation, a liver tumor was unexpectedly discovered. An explorative laparotomy revealed a well-encapsulated tumor occupying the posterior portion of the right lobe of the liver. The patient underwent a posterior segmentectomy. Histologically, the tumor possessed intermingling fascicles of spindle cells with eosinophilic cytoplasm and elongated nuclei. Based on an immunohistochemical examination, the tumor cells were positive for the muscle-associated antibody. In addition, RNA probes for Epstein-Barr virus were negative based on in situ hybridization. The histologic, immunohistochemical findings were considered to be diagnostic for leiomyosarcoma, which is a low-grade malignancy. Two years after surgery, the patient is doing well with no recurrence of liver tumors or breast cancer.

Massive hemorrhage in a patient with intestinal Behçet's disease: report of a case.

Abstract Major gastrointestinal bleeding is a rare manifestation of intestinal Behçets disease. We report herein the case of a 64-year-old man with intestinal Behçets disease complicated by myelodysplastic syndrome who suffered massive hemorrhage. Colonoscopy demonstrated ulceration of the entire colon from the cecum to the rectum, characterized by punched-out ulcers. Angiography demonstrated apparent extravasation of contrast material in the terminal ileum, and embolization was not successful. Continued and massive bleeding necessitated surgical resection of the involved segment of ileum; however, massive bleeding recurred. Re-endoscopy showed oozing hemorrhage from the multiple colon ulcerations. Intra-arterial prednisolone injection therapy was given, following which the melena gradually subsided and completely stopped within a few days.

Protective effect of AA-861 (5-lipoxygenase inhibitor) on experimental acute necrotizing pancreatitis in rats.

SummaryThe effect of the 5-lipoxygenase inhibitor AA-861 on acute necrotizing pancreatitis was studied in an experimental model. Pancreatitis was induced in rats by retrograde injection of 0.4 mL/kg body wt of 6% taurocholic acid into the pancreatic duct. The animals were divided into three groups: control group; administered AA-861 in a single dose of 30 mg/kg; and administered AA-861 in a single dose of 60 mg/kg. The following parameters were examined: serum amylase, lipase, trypsin, blood sugar, and survival rate. Histology of the pancreas was also studied. The serum amylase and lipase activities in groups 2 and 3 were lower than those in group 1 in the early phase after induction of pancreatitis. The elevation of serum trypsin was not suppressed by AA-861. Blood sugar was more efficiently controlled in groups 2 and 3 than in group 1. The survival rates in groups 2 and 3 were better than that in group 1, but there were no significant differences among the three groups. Histologically, massive tissue necrosis with hemorrhage, edema, and inflammatory cell infiltration was prominent in group 1, whereas such changes were obviously suppressed in groups 2 and 3. The results suggest that AA-861 may prove useful in the treatment of acute pancreatitis.

A Study on the Lymph Node Metastases of the Right Side Colon Cancer in Relation to the Location of Cancer and the Arterial Supply.

右側結腸癌109例を対象にリンパ節転移状況を検討し, 以下の結果を得た. 1) 採取リンパ節総数は7,664個, 1症例あたり平均70.3個で, 転移率は49.5%, 転移度は3.4%であった.2) 右結腸への動脈分岐は回結腸, 右結腸および中結腸動脈が独立して分枝する標準型は47w7%のみであった. 3) 肉眼判定と組織学的所見ならびにリンパ節長径と転移度の検討から肉眼判定の困難性が示唆された. 4) 転移率は癌腫部位に関係なく腫瘍近傍リンパ節で最も高く, 次いで中枢側転移が高率で, 主幹動脈に向かう流れが優位を占めた. なお, 腸管軸方向転移は癌腫縁より最長10cmに限られていた. 5) 癌腫部位からみた中枢側転移は盲腸および上行結腸口側1/3の癌では回結腸動脈, 右横行結腸癌では中結腸動脈領城が主で, 他の上行結腸癌では動脈分岐状況に左右され, 3動脈にまたがって転移がみられた. 6) 盲腸および同部の浸潤上行結腸癌の3例で下大静脈前面, 外腸骨動脈周囲リンパ節に転移を認めた. 以上から右側結腸癌に対する郭清術式を考察した.

Criteria of curability in the hepatectomy for hepatocellular carcinoma.

肝細胞癌切除例79例を対象に,肝癌取扱い規約に基づいた切除術式別及び腫瘍進展度の各因子別に予後を検討した.絶対的治癒切除術の生存曲線は相対的非治癒切除術及び絶対的非治癒切除術に比べ,また相対的治癒切除術の生存曲線は相対的非治癒切除術よりも有意に良好であった.腫瘍進展度では,予後に最も影響を及ぼす因子は門脈侵襲であった.相対的治癒切除術の中でも,腫瘍径によってT2となり相対的治癒切除術となった相対的治癒切除A群と,主として門脈侵襲による血管侵襲が陽性であるためにT2となり相対的治癒切除術となった相対的治癒切除B群,及び絶対的治癒切除術とでの予後の検討では,血管侵襲をみない絶対的治癒切除術及び相対的治癒切除A群の予後は血管侵襲を認めるB群よりも良好であった.血管侵襲を認める症例に対する肝切除術では,肝切除単独では治癒治療法にはなり難く,術後の綿密なfollow upとadjuvant chemotherapyの必要性が示唆された.

A analysis of resected hepatic metastases from colorectal cancer.

大腸癌初回手術時肝転移合併切除9例, 再発肝転移切除9例の計18例について検討を加えた.初回手術時肝転移9例中8例がH1で, その個数はすべて単発であったのに対し, 再発例ではH1 6例中4例が多発性であり, かつ腫瘍径も大きい傾向がうかがわれた.切除術式としては, 初回手術時肝転移で部分切除が再発例で系統的肝切除が選択される傾向にあり, その予後は前者の平均生存期間37.3ヵ月以上, 5年生存率50%, 後者の平均生存期間21.3ヵ月以上, 3年生存率50%とかなり良好であった.また2例に5年以上の長期生存例が得られ, 肝転移切除は大腸癌肝転移に対して, 極めて有効であると考えられた.