Motonobu Katano

Increased density and diameter of Lymphatic microvessels correlate with lymph node metastasis in early stage invasive colorectal carcinoma

To determine whether lymphangiogenesis was associated with the development of colorectal carcinoma and whether the mean maximal diameter of lymphatic microvessels (LMMMD) or lymphatic microvessel density (LMVD) is associated with lymph node metastasis in early stage invasive colorectal carcinoma (T1 carcinoma), we used immunohistochemical staining with podoplanin to measure LMMMD and LMVD in intratumoral (LMMMDit, LMVDit) and peritumoral areas (LMMMDpt, LMVDpt) of T1 carcinomas (n=87). By comparing the LMMMD and LMVD in normal large intestine (n=10), adenoma (n=15), and Tis carcinoma (n=15), we found out that the LMVDpt in T1 carcinoma with lymphatic vessel invasion (LVI) was significantly high (P<0.001), and there was a significant decrease in LMMMDpt in T1 carcinoma (P=0.031). Both LMMMDpt and LMVDpt were significantly increased in the T1 carcinomas, with LVI compared with the T1 carcinomas without LVI (P=0.018, P=0.003). Multivariate analysis revealed that LVI and combined greater LMMMDpt and greater LMVDpt were associated with lymph node metastases (P=0.005, P=0.036). These results indicate that lymphangiogenesis might be induced in the surrounding tumor areas of the T1 colorectal carcinoma with LVI; thus, evaluation of the diameter and density of lymphatic microvessels is important in T1 colorectal carcinoma to predict lymph node metastases.

The granulocyte/lymphocyte ratio as an independent predictor of tumour growth, metastasis and progression : its clinical applications

Several investigators have suggested that the granulocyte/lymphocyte (G/L) ratio is a good indicator for the evaluation of the condition of a tumour-bearing host, although its prognotic significance is unclear. To further investigate the clinical applications of the G/L ratio, we injected 1x105 and 1x106 Lewis lung carcinoma cells (3LLc) into the feet of 4-week-old C57BL/6 mice separated into groups A, B, C and D (1x105 cells) and E, F, G and H (1x106 cells). For the observation of tumour metastasis and G/L ratio, the mice in groups A-D were sacrificed on days 11, 14, 17 and 21 after inoculation with the 3LLc cells, and the mice in groups E-H on days 7, 11, 14 and 17. The results suggest that in mice the number of granulocytes increases with time after 3LLc cell injection (P<0.05). We also retrospectively investigated the correlation between G/L ratio, clinicopathologic features and prognosis in 62 patients with gastric carcinoma. There was a significant correlation between the G/L ratio and tumour weight (r=0.746, P<0.05), as well as a significant difference between the G/L ratio and the extent of metastases (P<0.05). Additionally, the G/L ratio was significantly associated with lymph node metastasis and higher tumour stage, tumour progression (P=0.017) and 5-year survival (P=0.013). In conclusion, the G/L ratio is associated with tumour progression and shorter survival. The close correlation between G/L ratio and tumour stage or lymph node status suggests that it could be used to predict tumour metastasis, prognosis and overall survival in patients with gastric carcinoma before they undergo surgical treatment.

Spinal Destruction Induced by Chronic Contained Rupture of an Abdominal Aortic Aneurysm: Report of a Case

We report a case of spinal destruction caused by chronic contained rupture of an abdominal aortic aneurysm (AAA). The patient was a 73-year-old man who had undergone coronary artery bypass grafting, sigmoidectomy for colon cancer, and axillofemoral bypass with AAA resection within months of each other, 3 years earlier. Abdominal computed tomography and magnetic resonance imaging showed destruction of the 12th thoracic and 1st lumbar vertebrae. The possibility of a metastatic spine tumor prompted us to consult the orthopedic surgeons, who recommended a spinal percutaneous needle aspiration biopsy. However, the cardiovascular surgeons diagnosed chronic contained rupture of an inflammatory AAA. The patient gradually improved with antimicrobial treatment, but died of disseminated intravascular coagulation the following year. The definitive diagnosis was confirmed by autopsy. We report this case for its educational value, considering the serious consequences that might have occurred had we attempted to biopsy the lesion.

The Use of Autologous Fibrin Glue for the Treatment of Postoperative Fecal Fistula Following an Appendectomy: Report of a Case

We herein report a case of postoperative fecal fistula following an appendectomy which was successfully treated by the use of autologous fibrin glue. An 82-year-old man had acute appendicitis and underwent an appendectomy. Later, a fecal fistula developed and he underwent drainage treatment twice. After 4 weeks of drainage and during the third recurrence, the remaining fistula was successfully treated using autologous fibrin glue, instead of surgery, due to potential complications and the risks of associated with advanced age. No recurrence has been observed for 5 months. In conclusion, autologous fibrin gluing for fecal fistula was found to be a safe, economical, and effective treatment. A search of Medline from 1980 until 2002 revealed no other report of this treatment for postoperative fecal fistula following an appendectomy.

Inflammatory pseudotumor of the liver in a patient with rectal cancer: a case report

Abstract. An inflammatory pseudotumor of the liver was discovered during a metastatic examination of a patient with rectal adenocarcinoma. Magnetic resonance imaging showed a three-component lesion that infiltrated a large portal vein, and CT arteriography and CT during arterial portography showed a portal obstruction. A histopathological examination proved that necrosis was present in the central zone; infiltration by proliferating connective tissue with chronic inflammatory cells was prominent in the middle zone; and fibrous changes, including pseudo-bile duct proliferation, were present in the peripheral zone. Magnetic resonance imaging revealed both portal infiltration and histopathological features including the above-noted three components. Magnetic resonance imaging is perhaps the most useful diagnostic modality.

Frequencies of estrogen receptor mRNAs splice variants in various human mammary tissues

BackgroundSeveral variant estrogen receptor (ER) mRNAs are present in various cell lines of human breast cancer, and are considered to be one reason for the loss of hormone dependence. The purpose of this study was to assess the ER variants in human various breast tissues, and to investigate the correlation between the expression of ER variants and ER/progesterone receptor (PgR) status.MethodsThe frequencies of 3 ER splice variants (del 2/3, del 5, and del 7) were assessed in 24 benign and 76 malignant breast lesions by the reverse transcription-polymerase chain reaction (RT-PCR) method and compared with histopathological features. ER and PgR proteins were analyzed using enzyme immunoassay (EIA) and immunohistochemical assay (IHA) in 68 cases of cancer to determine whether aberrant variants influence the status of either protein.ResultsDeletions of exons 5 and 7 (del 5 and 7) were more frequent than the deletion of exon 2/3 (del 2/3) in both benign and malignant lesions, and the expression of del 5 and del 7 seemed to correlate with epithelial overgrowth. There was no significant difference between the ER/PgR protein status and the expression of each ER variant in breast cancer.ConclusionsThe expression of ER splice variants is not uncommon in human breast diseases. The abnormal ER structures in this study are not a main factor for tamoxifen insensitivity or an important regulators of PgR expression.

Acute myelogenous leukemia suddenly developing just after surgery for advanced gastric cancer: report of a case.

We report a case of acute myelogenous leukemia (AML) developing just after surgery for advanced gastric cancer, before adjuvant chemotherapy was started. Immature white blood cells were recognized in the peripheral blood from postoperative day (POD) 1. The patient’s clinical status and bone scintigraphy showed no evidence of bone metastasis. Acute myelogenous leukemia was diagnosed by an aspiration biopsy of the bone marrow. If the AML had developed later and had become remarkable during or after adjuvant chemotherapy, the differential diagnosis between de novoand therapy-related leukemia would have been very difficult. Most leukemias that develop during the course of chemotherapy or radiotherapy, or both, are indisputably considered to be therapy-related. Thus, we report the clinical course of this patient with reference to the related literature to warn surgeons of the possibility of this unusual manifestation.

Surgical Management for Villous Tumors of the Rectum

We describe 10 patients with villous tumors of the rectum. Seven tumors showed severe dysplasia but only one invasion of the muscularis propria of the bowel wall. All patients underwent a sphincter-conserving operation. There was one local recurrence which was treated by further local excision. One patient died of other causes, but the remainders recovered.Villous tumors of the rectum, even those showing severe dysplasia, can be adequately treated by local excision because they are adenomas. However, anterior resection is indicated when the tumor is too large for local excision, is located in the upper rectum, or when invasive cancer cannot be ruled out.ZusammenfassungEs werden zehn Patienten mit villösen Rektutumoren beschrieben. Sieben Tumoren zeigten eine schwere Dysplasie, aber nur einer eine Invasion in die Lamina muscularis propria der Darmwand. Alle Patienten wurden einer sphinktererhaltenden Operation unterzogen. Es trat ein Lokalrezidiv auf, das mit einer weiteren lokalen Exzision behandelt wurde. Ein Patient starb aus anderen Gründen, die übrigen erholten sich.Villöse Tumoren des Rektums, auch solche mit schweren Dysplasien, können angemessen mit lokalen Exzisionen behandelt werden, weil es sich bei ihnen um Adenome handelt. Trotzdem ist die vordere Resektion indiziert, wenn der Tumor zu groß für eine lokale Exzision ist, wenn er im oberen Rektum lokalisiert ist oder wenn ein invasiv wachsendes Karzimon nicht ausgeschlossen werden kann.

Multifocal gastric cancer with a variety of histological findings coexisting with hyperplastic polyps: Report of a case

We report a case of multifocal gastric cancer with a variety of macroscopic and histological findings. A 65-year-old woman was admitted with upper abdominal pain. Her familial history was remarkable in that her mother had died of gastric cancer. The hematological and blood biochemical values were normal, but the serum was positive for Helicobacter pylori immunoglobulin G, and the serum pepsinogen test was also positive. Gastrointestinal fiberscopy showed many granulomatous lesions coexisting with pedunculated polypoid lesions and marked atrophic gastritis throughout the stomach. We performed total gastrectomy with regional lymph node dissection. There were four separate cancers and three hyperplastic polyps with entire intestinal metaplasia. The pathological findings of these multifocal gastric cancers varied, with coexisting differentiated and undifferentiated types, and early and advanced types. One of the pedunculated polypoid lesions was accompanied by papillary adenocarcinoma. Although multifocal gastric cancer is not uncommon, the present case is considered an extremely unusual example of gastric cancer.