Nobuhiro Suehara

Telomerase activity detected in pancreatic juice 19 months before a tumor is detected in a patient with pancreatic cancer

We report a patient with pancreatic cancer in whom telomerase activity had been detected in the pancreatic juice 19 months before he was diagnosed as having pancreatic cancer. A 61-yr-old alcoholic man complaining of epigastric and back pain was diagnosed as having groove pancreatitis based on the presence of inflammation in the pancreatic head and its extension to the duodenal mucosa with an associated elevated serum amylase level. All imaging modalities showed no sign of a tumor. However, high telomerase activity was detected in the pancreatic juice collected during endoscopic retrograde pancreatography. His symptoms subsided due to abstinence from alcohol. A tumor, however, was recognized on computed tomography 19 months later, at which time the patient immediately underwent a pylorus-preserving pancreaticoduodenectomy. The carcinoma was located mainly in the Santorini duct region. High telomerase activity in the pancreatic juice may precede clinical detection of pancreatic cancer and thus could be a useful early diagnostic marker for pancreatic cancer.

Semi-quantitative analysis of telomerase in pancreatic ductal adenocarcinoma

Using a polymerase chain reaction-based amplification assay, we measured telomerase activity in surgically resected pancreatic ductal carcinomas (n=16 cases) and normal ducts (n=6), comparing findings with the telomerase activity of a human pancreatic cancer cell line, MIA PaCa-2, as a standard, i.e., relative telomerase activity was determined. Telomerase activity was expressed as the equivalent telomerase intensity of the number of cells of MIA PaCa-2 per μg protein of tissue samples. The median value for telomerase activity in normal pancreatic ducts was 0.13 and the 25th and 75th percentile were 0.01 and 0.76. The median value for telomerase activity in pancreatic ductal adenocarcinoma was 34.7 (25th percentile, 4.98; and 75th percentile, 296), significantly higher than that of normal ducts (P<0.001). When the cut-off value was set at 1.0 and 3.0, the telomerase positivity rate of pancreatic ductal adenocarcinomas was 100% and 81.3%, respectively. Telomerase may be a specific marker for pancreatic ductal carcinomas.

Pancreatic tumor formed by infiltration of adult T-cell leukemia cells

SummaryConclusionWe have described a case of pancreatic tumor formed by adult T-cell leukemia (ATL) cell infiltration.BackgroundThe patient was diagnosed as chronic ATL hematologically with the findings of increased number of atypical lymphocytes, ATL cells in the peripheral blood, and positive human T-cell leukemia virus type I (HTLV-I) antibody in the serum. The pancreatic tumor was identified by ultrasonography and computed tomography as a diffusely swollen tumor from the body to the tail of the pancreas. Biopsy specimen confirmed the ATL cell infiltration into the pancreas immunohistochemically, and Southern blot analysis showed the integration of HTLV-I proviral DNA both in the pancreas and in the peripheral blood.ResultsThe pancreatic tumor diminished spontaneously without chemotherapy when ATL cells in the peripheral blood disappeared by spontaneous regression.

Postoperative Follow-Up of Patients with Early Breast Cancer: Reappraisal of Serum Tumor Markers

Abstract The purpose of this study was to determine the most appropriate tests and procedures to detect disease progression effectively during the postoperative follow-up of patients with early breast cancer. We reevaluated our current surveillance protocol which involves the intensive follow-up of 643 patients with stage I disease. With the exception of one case of bone metastasis, all cases of recurrence (97%) were suspected from abnormal results detected during surveillance involving physical examination, serial determination of tumor markers, and chest roentgenography. Among 15 patients with asymptomatic distant metastasis, disease recurrence was suspected in 12 (80%) because of increased levels of serum tumor markers. No disease recurrence was detected by routine complete blood counts or automated chemistry studies alone. Our experience indicates that an effective follow-up regimen for patients with early breast cancer may include careful history-taking, physical examination, and the determination of serum tumor markers every 3–6 months for the first 3 years, then less frequently thereafter, and chest roentgenography every 6 months for 5 years, in addition to annual mammography. Serial determination of the tumor markers tumor polypeptide antigen, NCC-ST-439, and either carcinoembryonic antigen or carbohydrate antigen 15-3, seems to be of value for the selection of patients who should undergo radiologic exploration. The health benefits and cost-effectiveness of a follow-up focused on the measurement of serum tumor markers need to be evaluated in large prospective randomized trials.

Introduction of preoperative instruction video orientation in the intensive care unit: changes in preoperative anxiety levels before and after the introduction of the videos

BackgroundThe surgical treatment of esophageal cancer affects both the physical and psychological condition of the patients, and it is often associated with severe complications after the operation. Education concerning potential postoperative conditions during the early preoperative period might reduce anxiety associated with the operation and allow patients to manage their situation preoperatively. Preoperative instruction video orientation systems (OR) were introduced, and the changes in the patients’ anxiety, the time period after leaving a state of bed rest, and the occurrence of postoperative respiratory complications in the intensive care unit (ICU) were investigated.MethodsSeventeen patients underwent curative surgical treatment of esophageal carcinoma in our institute from February to November, 2008. The original orientation video was introduced on the first hospitalization day, just 1 week before the operation. A questionnaire was administered to the patients on the first day to evaluate the patients’ anxiety using the Hospital Anxiety Depression Scale (HADS) and again on the fourth day before surgery.ResultsHADS score was significantly reduced to 3.9 ± 2.8 after OR from 4.7 ± 2.7 before OR (P < 0.01). The time required to be able to walk was 2.5 ± 0.6 days following the operation. There were no respiratory complications or any episodes of emotional instability in the ICU.ConclusionsThe OR is considered to be effective for the prevention of respiratory complications because it reduces the anxiety in preoperative patients and eases postoperative nursing care (by early ambulation).

Outcomes of endoscopic submucosal dissection and esophagectomy for early and superficial carcinoma of the esophagus

BackgroundEndoscopic resection was recommended as treatment for mucosal epithelium or lamina propria mucosae lesions not exceeding two-thirds of the circumference. The aim of this study was to verify the outcomes of endoscopic resection and surgery for early and superficial carcinoma of the esophagus.MethodsEndoscopic submucosal dissection (ESD) was performed for 56 cases of early and superficial esophageal carcinoma and esophagectomy (OP) for 35 cases, which were enrolled in this study. Treatment-related complications, site of recurrence, and cause of death were compared.ResultsThe complications of ESD were esophageal perforation in six cases (11%). No bleeding and one cicatricial stenosis occurred. The complications of OP were temporary hoarseness in four cases (11%), with aspiration pneumonia in three cases (9%) and anastomotic leakage in two cases (6%), all nonfatal. All early cases of ESD survived without recurrence. One of five cases infiltrating the submucosa had mediastinal lymph node recurrence and died of metastasis to the spinal cord. Nine cases of OP for lesions from the mucosal epithelium to invasion of the upper third of the submucosa survived without recurrence.ConclusionsFor mucosal epithelium or lamina propria mucosae lesions, ESD was the first choice of treatment. For muscularis mucosae lesions, the indication of ESD was allowable. For lesions infiltrating the upper third of the submucosa, one of five cases had lymph node recurrence after ESD, and two cases of radical esophagectomy were alive without recurrence.

Early gastric cancer with diffuse heterotopic gastric glands and granular cell tumors mimicking advanced gastric cancer

Highlights • HGGs are gastric glands that are observed in the submucosa.• Preoperative diagnosis of GC depth or range associated with HGGs is difficult.• Cautious preoperative assessment of GC with diffuse HGGs is required.• Gastrointestinal GCTs are rare and gastric GCTs are seldom seen.• This is the first case report of a patients with gastric GCTs with HGGs and GC.