Nobumichi Takeuchi

Matrilysin gene expression in sporadic and familial colorectal adenomas

We examined the expression of matrilysin mRNA in sporadic and hereditary colorectal adenomas to clarify the role of matrilysin in tumorigenesis. Matrilysin mRNA was not detected in normal colorectal mucosa from patients with either sporadic or familial adenomas. Matrilysin mRNA expression in sporadic adenomas correlated with the degree of dysplasia and the size of the mass, whereas most of the adenomas in patients with familial adenomatous polyposis coli expressed matrilysin mRNA irrespective of adenoma size or degree of dysplasia. Because matrilysin is more likely to be expressed in adenomas with a potential for malignancy, this enzyme may play a role in the malignant conversion of colorectal adenomas. Mol. Carcinog. 19:225–229, 1997.

Gastrointestinal stromal tumor of the stomach with axillary lymph node metastasis: A case report

Gastrointestinal stromal tumors (GISTs) are the most common type of gastrointestinal mesenchymal tumors, although metastasis to the perigastric lymph nodes is relatively rare, compared with liver or peritoneal metastasis. In this report, we describe a case of stomach GIST with a solitary simultaneous metastasis in the left axillary lymph node. A 68-year-old man was diagnosed with a large upper-stomach GIST, and computed tomography and positron emission tomography revealed masses in the left axilla and right mediastinum. We did not detect evidence of metastases to the liver, or other sites including the perigastric lymph nodes, although findings from the surgically resected axillary lymph nodes were compatible with GIST metastasis. Treatment using imatinib markedly reduced the gastric and mediastinal lesions, and this response persisted for 3 years. The patient subsequently experienced rapid growth of the gastric lesion without mediastinal or axilla recurrence, which required palliative surgery. Despite continuing medical treatment (sunitinib and regorafenib), the patient died of liver metastases 23 mo after the surgery. Based on our findings, it appears that the axillary lymph nodes can be a potential metastatic site for GIST metastasis.

Successful choledochojejunostomy for choledochal stricture with preservation of the collateral parabiliary venous system following iatrogenic portal occlusion

We surgically treated a patient with biliary stricture and portal vein occlusion, after operation for gastric cancer with lymphadenectomy along the hepatoduodenal ligament, that had led to choledochal stone formation and a dilatated parabiliary venous system. A 57-year-old man without hepatic dysfunction exhibited hepatic duct dilatation with choledochal stone on ultrasonography and percutaneous transhepatic cholangiography, respectively. Pharmacoportography revealed occlusion of the portal vein and dilatation of the parabiliary venous system. Of various preoperative imaging studies used, enhanced computed tomography was most useful for delineating the surgical anatomy of the hepatoduodenal ligament. Complete preservation of the dilatated vessels, which functioned as the main portal collateral pathway, resulted in a successful choledocho-jejunostomy, with an uneventful postoperative course.

A Case of Ulcerative Colitis Complicated with Rapidly Progressed Sigmoid Colonic Cancer.

30歳の男性.19歳で全大腸炎型の潰瘍性大腸炎と診断されたが症状は乏しかった.1990年8月に行った注腸検査では隆起性病変は認められなかったが, 1991年2月より便柱の細小化と裏急後重が生じ, 下血も認められ, 4月8日に潰瘍性大腸炎の再燃の疑いで緊急入院した.ステロイドの強力静注療法を行ったところ下血は改善したが, S状結腸に全周性の狭窄を認め, S状結腸癌の合併した潰瘍性大腸炎と診断して開腹術を5月11日に施行した.しかし高度の腹膜播種と周囲への直接浸潤により切除不能であった.化学療法と免疫療法を行ったが奏効せず, 術後47日目に呼吸不全で死亡した.発症後10年以上経過した全大腸炎型潰瘍性大腸炎患者に対して1年に1回のcancer surveillanceの施行が推奨されている.しかし本症例はこの方法で早期に癌が発見できたかは疑問であり, 予防的治療も含め症例に応じた対応が必要と思われた.

A Case Report of Leiomyosarcoma of the Residual Stomach Associated with Liver Metastasis.

残胃平滑筋肉腫はきわめてまれな疾患で本邦で16例を数えるのみであり, 肝転移をともなうものはこのうち3例である.症例は60歳, 男性.主訴は心窩部痛で, 5年前に胃潰瘍のため幽門側胃切除術を受けた.上部消化管造影, 胃内視鏡検査, 腹部超音波検査などで残胃粘膜下腫瘍, および肝転移と診断した.残胃全摘, 膵体尾部・脾合併切除, リンパ節郭清, 肝右葉部分切除を施行した.病理組織学的には残胃平滑筋肉腫, およびその肝転移であった.本症例でリンパ節転移は認められなかった.文献によれば残胃平滑筋肉腫16例中2例 (12.5%) にリンパ節転移が認められ, リンパ節郭清の必要性が示唆され, 術式も他臓器浸潤が疑われる場合は合併切除を施行する必要があると考えられた.

A Case Report of Cholecystectomy and Transduodenal-sphincteroplasty for a Typhoid Biliary Carrier.

本邦における腸チフスの発生は減少し年間100人程度になっているが, 現在でも長期保菌者がその感染源となることがある.今回われわれは, 胆道系長期保菌者を外科的治療で治癒せしめた症例を経験した.症例は70歳, 男性.糞便検査でチフス菌の排菌を指摘された.腹部超音波検査, computed tomography検査で胆石が認められ, 十二指腸液検査でチフス菌が検出された.腸チフス胆道系保菌者と診断し胆嚢摘除術, 経十二指腸乳頭括約筋形成術を施行した.術後, 胆汁, 糞便からの排菌は消失した.退院1年後の十二指腸液検査, 糞便検査でもチフス菌の排菌はなく治癒と判定した.胆道系長期保菌者では, 病巣の完全除去, 再発・遺残結石の防止が除菌の成否を決める.そのため, 症例により胆道ドレナージ手術も考慮する必要があると考えられた.