Naoki Futamura

Clinicopathologic significance of sialyl Le x expression in advanced gastric carcinoma

Sialyl Lewis xantigen (SLX) is a carbohydrate antigen that serves as a ligand for selectin, an adhesion molecule expressed on vascular endothelial cells. The expression of SLX in 245 patients with advanced gastric carcinoma was examined immunohistochemically, and its clinicopathologic significance was analysed. We classified the patients with advanced gastric carcinoma into 91 with differentiated type and 154 with undifferentiated type. SLX expressed in 135 of 245 patients (55%), comprising 68 (75%) patients with differentiated carcinoma and 67 (44%) with undifferentiated carcinoma. The positive rate for SLX expression was significantly higher among patients with differentiated carcinoma than among those in undifferentiated carcinoma (P<0.0001). With differentiated carcinoma, the incidence of lymph node metastasis, advanced tumour stage (stage III and IV) and liver recurrence was significantly higher in SLX-positive patients than in SLX-negative ones (P < 0.0001, P=0.0065 and P=0.028, respectively). Moreover, the prognoses were better in patients with SLX-negative tumours than in those with SLX-positive tumours (P = 0.019). With undifferentiated carcinoma, there were no significant correlations between SLX expression and any clinicopathological features or prognoses. The clinicopathologic significance of SLX expression in gastric carcinoma patients depends on histologic type. SLX expression may be of great relevance in predicting liver metastases in patients with differentiated carcinoma.

Clinicopathologic study of primary gastric lymphoma of B cell phenotype with special reference to low‐grade B cell lymphoma of mucosa‐associated lymphoid tissue among the Japanese

Resection specimens from 83 patients with primary gastric lymphoma (PGL) of B cell phenotype at stage IE and at stage IIE, according to the Ann Arbor classification were investigated. Histologically, these lymphomas could be divided into four types: Type I lesions (n=24) were entirely made up of MALT lymphoma; Type II lesions (n=13) were predominantly MALT lymphoma containing one to a few foci of high‐grade B cell lymphoma; Type III lesions (n=22) consisted largely of high‐grade lymphoma with small areas of low‐grade MALT lymphoma; and Type IV lesions (n=24) were pure high‐grade B cell lymphoma, mostly of the large cefi type. All patients had undergone primary gastric resection, and 14 received additional chemotherapy (n=12), or both chemotherapy and radiotherapy (n=2). The survival probability was significantly higher for Types I and II lymphomas than for Types III and IV tumors (P < 0.05 by the generalized Wilcoxon test). According to The General Rules for the Gastric Cancer Study by the Japanese Research Society for Gastric Cancer, the stage of disease showed a clear distinction between each of them (P < 0.01 by the generalized Wilcoxon test). This staging method seemed to serve well as a prognostic indicator. The histological typing of the PGL of the present series also seemed to correlate with the gross appearance, pathologic stage and prognosis. Furthermore, the expression of cyclin D1, bcl‐2 and p53 protein, and PCNA was immunohistochemically investigated in 42 cases of the present series. Most of the low‐grade PGL (Types I and II) had less than 60% PCNA‐positive cells, whereas the high‐grade PGL (Types III and IV) had more than 60% positive cells. In a study for cyclin D1 protein, no cases showed the nuclear staining pattern characteristic for mantle cell lymphoma, and the cytoplasmic staining frequently observed in the node‐based large B cell lymphoma was seldom identified in the PGL. This discrepancy might suggest a lineage difference among the morphologically similar, but site‐dierent, lymphomas. On the other hand, bcl‐2 protein overexpression was almost equal in frequency between the gastric and node‐based high‐grade B cell lymphomas. This is in contrast to the reports from Western countries, in which the majority of high‐grade gastric tumors were bcl‐2 negative.

Primary peritonitis associated with streptococcal toxic shock-like syndrome: report of a case.

Several reports over the past 15 years describe severe group A streptococcal infections causing septic shock, soft-tissue necrosis, and multiple organ failure; a phenomenon known as streptococcal toxic shock-like syndrome (TSLS). However, primary peritonitis associated with TSLS is rare. We report the case of a 40-year-old man admitted with pain in both thighs, hypotension, and severe abdominal pain. His daughter had been diagnosed with streptococcal pharyngitis 3 days earlier. We performed an emergency laparotomy for peritonitis, and culture of the ascites was positive for group A β-hemolytic streptococcus (GAS). Further serotyping of the isolated GAS strain revealed the T-type 22 and the pyrogenic exotoxin gene, spe-C. The criteria for TSLS were clearly met, including the isolation of GAS from ascites, hypotension, liver failure, renal failure, coagulopathy, myositis, and a generalized erythematous macular rash with desquamation.

Dielectric spectrogram for evaluating ischemic microstructural changes of the liver in simple cold preservation.

Abstract.Purpose: Monitoring ischemic liver injury is important in liver transplantation. We previously reported that dielectric properties were correlated with tissue adenosine triphosphate during liver preservation; however, it is unknown what the changes in dielectric properties are based on. Using rats, we studied the relationship between dielectric parameters and microstructural changes in liver tissues during preservation. Methods: We serially measured the percent decrease in conductivity and the percent increase in relative permittivity in rat livers, and determined the areas of cellular and extracellular components using a charge-coupled device microscope and an NIH image. Thereafter, we evaluated the relationship between dielectric parameters and microstructural changes in the liver tissues. Results: A positive linear and exponential correlation was found between the percent decrease in conductivity and the percent decrease in extracellular components (P < 0.01). A positive linear and exponential correlation was also found between the percent increase in relative permittivity and the percent increase in cellular components (P < 0.01). Conclusions: Our results suggest that the serial changes in tissue conductivity and the relative permittivity reflect changes in liver tissue microstructures during cold preservation.

Two Cases of Goblet Cell Carcinoid of the Vermiform Appendix.

今回われわれは虫垂杯細胞カルチノイドの2例を経験したので報告する.症例は46歳の男性と41歳の男性である.2例とも虫垂炎の診断で虫垂切除術を行った.術後の病理検査で虫垂杯細胞カルチノイドと診断されたため, ともに右半結腸切除術を追加した.しかし, 切除標本には腫瘍細胞を認めず, リンパ節転移も認めなかった.2例は術後約2年2か月, 約2年を経過しともに再発の徴候はない.虫垂の杯細胞カルチノイドはまれな疾患である.本邦ではわれわれの症例を含めて31例が報告されている.多くの症例は急性虫垂炎の診断で手術されているが進行した症例では回盲部腫瘍と術前に診断されていた症例も認められる.治療は虫垂切除術のみで経過観察されている症例と回盲部切除術や右半結腸切除術が行われた症例に分けられるが, 転移, 再発を認めた症例が多く, 病期によっては積極的な外科治療が必要と考えられる.