Naoki Watanabe

Increased levels of serum leptin are a risk factor for the recurrence of stage I/II hepatocellular carcinoma after curative treatment

Obesity and related adipocytokine disbalance increase the risk of hepatocellular carcinoma. To determine the impact of increased levels of leptin, an obesity-related adipocytokine, on the recurrence of hepatocellular carcinoma, we conducted a prospective case-series analysis. Eighty-five consecutive primary hepatocellular carcinoma patients at our hospital from January 2006 to December 2008 were analyzed. Serum leptin level significantly correlated with Body Mass Index, total body fat, and the amount of subcutaneous fat. They included 33 with stage I/II, who underwent curative treatment. The factors contributing to recurrence of hepatocellular carcinoma, including leptin, were subjected to univariate and multivariate analyses using the Cox proportional hazards model. Body Mass Index (p = 0.0062), total body fat (p = 0.0404), albumin (p = 0.0210), α-fetoprotein (p = 0.0365), and leptin (p = 0.0003) were significantly associated with the recurrence of hepatocellular carcinoma in univariate analysis. Multivariate analysis suggested that leptin (hazard ratio 1.25, 95% CI 1.07–1.49, p = 0.0035) was a sole independent predictor. Kaplan-Meier analysis showed that recurrence-free survival was lower in patients with greater serum leptin concentrations (>5 ng/mL, p = 0.0221). These results suggest that the serum leptin level is a useful biomarker for predicting the early recurrence of hepatocellular carcinoma.

Clinical investigation of upper gastrointestinal hemorrhage after percutaneous endoscopic gastrostomy.

Background:  Upper gastrointestinal (GI) hemorrhage after percutaneous endoscopic gastrostomy (PEG) is sometimes reported as one of the serious complications. Our purpose was to clarify the cause of upper GI hemorrhage after PEG.

Cimetidine and Clobenpropit Attenuate Inflammation-Associated Colorectal Carcinogenesis in Male ICR Mice

Histamine and histamine receptors (Hrhs) have been identified as critical molecules during inflammation and carcinogenesis. This study was conducted to determine the effects of Hrh1-Hrh3 antagonists on inflammation-associated colorectal carcinogenesis. Male ICR mice were treated with azoxymethane (AOM, 10 mg/kg bw, i.p.) and 1.5% dextran sodium sulfate (DSS, drinking water for 7 days) to induce colorectal carcinogenesis. The mice were then fed diets containing test chemical (500 ppm terfenadine, 500 ppm cimetidine or 10 ppm clobenpropit) for 15 weeks. At week 18, feeding with the diets containing cimetidine (Hrh2 antagonist) and clobenpropit (Hrh3 antagonist/inverse agonist) significantly lowered the multiplicity of colonic adenocarcinoma. Terfenadine (Hrh1 antagonist) did not affect AOM-DSS-induced colorectal carcinogenesis. Adenocarcinoma cells immunohistochemically expressed Hrh1, Hrh2, Hrh3 and Hrh4 with varied intensities. Because clobenpropit is also known to be a Hrh4 receptor agonist, Hrh2, Hrh3 and Hrh4 may be involved in inflammation-related colorectal carcinogenesis. Additional data, including the mRNA expression of pro-inflammatory cytokines and inducible inflammatory enzymes in the colonic mucosa, are also presented.

Transcecostomal colonic stent placement after US-guided percutaneous cecostomy.

Colorectal stenting for the treatment of malignant largebowel obstruction is useful for palliation or as a bridge to surgery. 1 It is more difficult to position a stent in the rightsided colon by using a retrograde placement method via the rectum compared with the distal colon. Herein, we present a case involving the successful antegrade placement of a stent in the ascending colon after US-guided percutaneous cecostomy.

Apc-Mutant Kyoto Apc Delta (KAD) Rats Are Susceptible to 4-NQO-Induced Tongue Carcinogenesis

Despite widening interest in the possible association between infection/inflammation and cancer development, knowledge of this issue in relation to oral cancer remains inadequate. This study aimed to determine the susceptibility of Apc-mutant Kyoto Apc Delta (KAD) rats, which are vulnerable to developing inflammation-associated colorectal carcinogenesis, to 4-nitroquinoline 1-oxide (4-NQO)-induced tongue carcinogenesis in order to clarify the role of inflammation in oral cancer. KAD (20 males and 22 females) and F344/NS1c (22 males and 23 females) rats received drinking water with or without 4-NQO (20 ppm) for eight weeks. Histopathological and immunohistochemical analyses of the tongue were performed at week 20. Additionally, the mRNA expression of inflammatory cytokines in the tongue mucosa was determined at week 8. Tongue squamous cell carcinoma (SCC) developed in the KAD and F344/NS1c rats that received 4-NQO. Regardless of gender, the incidence and multiplicity of tongue SCC were greater in the KAD rats than in the F344/NS1c rats. In addition, the multiplicity of tongue SCC in the female KAD rats was significantly greater than that observed in the male KAD (p < 0.01) and female F344/NS1c rats (p < 0.05). The levels of inflammation and the mRNA expression of inflammatory cytokines in the tongue in the 4-NQO-treated female KAD rats were the highest among the rats given 4-NQO. These results show that KAD rats, particularly females, are susceptible to 4-NQO-induced tongue carcinogenesis, suggesting the utility of models employing KAD rats for investigating the pathobiology of oral (tongue) carcinogenesis associated with inflammation.

Primary adenoid cystic carcinoma in the peripheral lung: a cytological, histopathological and immunohistochemical report of two cases

Primary adenoid cystic carcinoma (ACC) of the peripheral lung is a rare entity. Here we report two cases of primary ACC. Case 1 is an 84-year-old male with a past-medical history of cecal cancer presented with a 10 mm left upper lung nodule. Case 2 is a 40-year-old female who presented with 30 mm right upper lobe. Intraoperative (Case 1) and pre-operative (Case 2) histopathologic and cytologic diagnoses were consistent with a primary peripheral lung ACC. An upper lobectomy±mediastinal lymph node dissection was performed and immunohistochemical staining with thyroid transcription factor (TTF)-1, c-KIT and MYB on the excision specimen confirmed our diagnosis.

Preneoplasia and carcinogenesis of the oral cavity

Abstract Oral cancer, ranking sixth in the cancer incidence worldwide, is one of the most common neoplasms. Preneoplastic or premalignant (precancerous) lesions are lesions that can potentially transform into malignancy in a variety of

Primary malignant melanoma of the female urethra: a rare case of cytological observation

We herein report a rare case of primary malignant urethral melanoma developed in an elderly Japanese patient with hypertension, diabetes and hyperlipidemia. An 80-year-old female presented at our hospital with a history of urodynia and perineal pain lasting for several months. Cystoscopy revealed cystitis and urethritis with erosion. At that time, urinary cytology was negative for malignancy, although melanophages were observed. Four months later, lower abdominal computed tomography and magnetic resonance imaging indicated urethral tumors. Urinary cytology subsequently detected malignant melanoma, and a biopsy of the urethra confirmed malignancy. Although inguinal lymph node metastasis was found 16 months postoperatively, the patient has remained free of disease for more than six years after surgery and chemotherapy.

ENDOSCOPIC ULTRASONOGRAPHY-GUIDED GASTROSTOMY TUBE PLACEMENT FROM THE STOMACH

Dear Editor, A 92-year-old woman with severe dementia presented difficulty of oral intake after the treatments of a right femoral neck fracture and severe esophageal ulcer. Percutaneous endoscopic gastrostomy (PEG) was not available, because her stomach had largely ascended in the thoracic cavity. Subsequently, we attempted to place a gastrostomy tube (Ponsky PEG; Bard Access Systems, Inc., Salt Lake City, UT, USA) using the technique of endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA), as shown in Fig. 1.The stomach was pushed downward to the abdominal wall from a subcostal location using an echoendoscope (GF-UCT240-AL5; Olympus Optical Co.,Tokyo, Japan) under fluoroscopic guidance. The interpositioning of the intestine, liver, spleen, and vessels was avoided using the echoendoscope, and we sought an appropriate puncture position using finger indentation from the abdominal wall (Fig. 2).A 19-gauge needle for FNA (Echo Tip Ultra; Cook Endoscopy, Winston-Salem, NC, USA) was used to puncture the abdominal wall, and the loop wire was inserted through the needle from the skin surface side. The needle was withdrawn into the endoscope and pulled out from the mouth with the endoscope. A 20-F gastrostomy tube was positioned by the pull-through technique. We compressed the gastric and abdominal walls between the internal and external bolster of the tube for 7 days until a gastrocutaneous fistula was successfully formed. Major reasons for failure of PEG include a lack of transillumination due to dislocation of the stomach, the anterior interposition of other organs, previous gastric resection, or the inability to carry out endoscopic insertion to the stomach. Chaves et al. reported five cases of EUS-guided PEG in patients lacking abdominal wall transillumination. Their method was to puncture a trocar from the abdominal wall over a 22-gauge needle inserted from EUS. In the present case, the use of a larger-bore puncture needle (19-gauge) Correspondence: Shinji Nishiwaki, Department of Internal Medicine, Nishimino Kosei Hospital, 986 Oshikoshi, Yoro-cho, Yoro-gun, Gifu 5031394, Japan. Email: wakky@nishimino.gfkosei.or.jp

A case of right ventricular bronchogenic cyst with the clinical presentation of cerebral infarction and pulmonary embolism

A congenital malformation of the bronchial tree, known as bronchial cyst, is mostly found in the mediastinum or lung. Intracardiac bronchogenic cysts are quite rare and only two cases of right ventricular bronchogenic cyst have so far been reported. We herein report a case in which a cyst developed in the right ventricle of a 65-year-old Japanese male who presented with aphasia due to cerebral infarction and pulmonary embolism. The cyst was successfully removed and the patient successfully recovered following surgery.