Osamu Tamai

Radiation-Associated Rectal Cancer: Report of Four Cases

Background/Aims: Radiation-associated rectal cancer is a remarkable clinical entity. We demonstrate 4 patients (mean age 68 years, range 63–74) who had undergone pelvic radiotherapy for cervical cancer. We indicate some characteristics of radiation-associated rectal cancer. Results: Two patients had received intracavitary and external pelvic radiotherapy, while the remaining 2 had external pelvic radiotherapy following hysterectomy. The mean total radiation dose was 63 Gy, though radiation dose information was not available for 1 patient. Colorectal cancer developed at a mean time of 20.7 years (range 11–30) after radiation therapy. All patients presented with chronic radiation colitis, and 3 demonstrated abnormal tumor markers. Colonoscopy revealed an ulcerative, localized well-differentiated adenocarcinoma of the rectosigmoid colon in 1 patient, and diffusely infiltrating cancers of the lower rectum, one signet-ring cell carcinoma and two mucinous carcinomas in the remaining 3. One case was stage I, 2 were stage IIIa, and the remaining case was stage IV. Three patients underwent abdominoperineal resection. The remaining patient was felt to be inoperable. The colorectal wall demonstrated the changes of chronic radiation injury. Two patients died within a short time because of their advanced cancers. Conclusion: Radiation-associated rectal cancer has a tendency to be diagnosed in the advanced stage and to have a poor prognosis. A literature review and our case report suggest that since there are no reliable clinical or laboratory indicators of the presence of a curable colorectal cancer in the setting of chronic radiation proctocolitis, surveillance with a colonoscope should be done 10 years after irradiation in patients with previous pelvic radiotherapy.

Analyses of Microsatellite Instability and the Transforming Growth Factor-β Receptor Type II Gene Mutation in Sporadic Human Gastrointestinal Cancer

Microsatellite instability (MSI) and transforming growth factor-beta receptor type II (RII) gene mutation have been reported in many types of tumors and their instance seem to vary among the tumors investigated. To determine the relation between MSI and RII gene mutation in sporadic gastrointestinal cancer development, 21 esophageal, 19 gastric, and 27 colorectal cancers were investigated. The presence of MSI was screened by single strand conformation polymorphism (SSCP) method using six microsatellite markers. RII gene mutations were detected by SSCP method and direct sequencing. MSI was detected in seven of 21 (33.3%) esophageal cancers, three of 19 (15.8%) gastric cancers and seven of 27 (25.9%) colorectal cancers. However, RII gene mutations were observed in only two of seven (28.6%) MSI-positive colorectal cancers. Our data suggest that among sporadic gastrointestinal cancers, colorectal cancers seem to be the most frequent target organ involved in carcinogenesis through RII gene mutation, which thus appears to be related to organ specificity.

Plexiform leiomyoma of the esophagus: A peculiar gross variant simulating plexiform neurofibroma

A plexiform variant of leiomyoma of the esophagus in a 51-year-old woman is reported. The patient was diagnosed with a tumor of the esophagus in an X-ray mass survey of the upper gastrointestinal tract. She was referred to the Ryukyu University Hospital for further examination. She appeared healthy with no complaints. Upper gastrointestinal series revealed an oval, well-defined filling defect in the lower esophagus just above the esophagogastric junction. Endoscopy revealed an undulating bulge covered with normal esophageal mucosa. Endoscopic ultrasonography showed a sharply demarcated hypoechoic mural tumor with internal linear pattern, with no evidence of penetration into the surrounding tissue. These findings were evaluated as consistent with a leiomyoma. Removing the tumor by enucleation was easily accomplished. Unexpectedly, on gross inspection, the tumor was a plexiform type, mimicking a plexiform neurofibroma. Light and electron microscopic examination and immunohistochemistry of the tumor tissue confirmed leiomyoma. Since the enucleation of the tumor, the patient has been free of recurrence and symptoms for 1.5 years at the time of this report.

Morphologic and mucin histochemical analysis of transitional zones in advanced ulcerated colorectal carcinomas : Potential prognostic indicators

Background and Objectives: The transitional zone, which is normal‐appearing mucosa that surrounds a primary colorectal carcinoma, has characteristic histologic features, and an increased amount of sialomucin in the transitional zone have been associated with a poorer prognosis. To clarify the prognostic effects of changes in the transitional zone we studied the transitional zone in cancers of the colon and rectum.

Migrating Site of Bleeding in a Right Colon Demonstrating Angio-Dysplasia following a Segmental Resection of the Colon

Background/Aim: A case of angiodysplasia of the right colon presenting with a migrating site of bleeding following a segmental resection of the colon in a 38-year-old Japanese is herein reported. Methods: The case records of a patient with severe intestinal bleeding and multiple surgeries were reviewed, and then the histologic features were compared with the operative findings. The patient received many units of packed red blood cells and had also undergone three segmental colectomies and most recently a curative ileocolostomy. Despite an exhaustive evaluation, the bleeding sites could not be detected clinically. Results: Ectatic, tortuous submucosal veins were presented in four sections of the colon (cecum, ascending colon and transverse colon, respectively) out of a total of 30 sections that were examined. These veins pierced the proper muscle layer of the colon, but did not traverse the muscularis mucosa. Our case of segmental microscopic angiodysplasia may represent a previously unreported unique variant, because the angiodysplastic lesions were present in the segmental colon and they developed bleeding from the distal remnant colon immediately after each segmental colectomy until an extended right hemicolectomy containing the oral part of the descending colon was done. In spite of the severe bleeding, the mucosa of the colon appeared to be essentially normal during a macroscopic inspection. Conclusion: Gastrointestinal bleeding from angiodysplasia is generally assumed to arise from macroscopically visible vascular lesions within the mucosa. However, angiodysplastic lesions are often unrecognizable and multiple in the gastrointestinal tract, and especially tend to affect both the cecum and ascending colon. When this disease process is recognized, a subtotal colectomy may thus be called for to control bleeding.

Barrett's adenocarcinoma associated with acquired eventration of the diaphragm.

Abstract:We report a rare case of Barretts adenocarcinoma asso-ciated with acquired eventration of the diaphragm in a 71-year-old woman. She initially developed dysphagia and epigastric discomfort in May, 1997. On July 9, she was referred to our Department of Surgery at the Ryukyus University Hospital for thorough examination and treatment. Esophageal adenocarcinoma and eventration of the diaphragm were revealed by exhaustive examinations, including chest X-ray, computed tomography, and magnetic resonance imaging, and proximal gastrectomy with reconstruction of jejunal interposition was performed, on August 8. Histologically, the tumor revealed that the adenocarcinoma arose from short-segment Barretts esophagus (SSBE). It thus appears that eventration of the diaphragm may induce SSBE and Barretts adenocarcinoma. We therefore recommend that periodic examinations of the esophagus and stomach be performed in patients with eventration of the diaphragm. Barretts adenocarcinoma associated with acquired eventration of the diaphragm is reported. Patients with eventration of the diaphragm should undergo periodic examinations of the esophagus and stomach.

Clinical Features of a Resected Cholangiocellular Carcinoma of the Liver in Relation to the Macroscopic Classification

Eighteen cases of resected cholangiocellular carcinoma of the liver were investigated to elucidate their clinical features in relation to the macroscopic classification. The tumors were classified int

Colon Cancer in Pregnancy: Report of a Case and Review of the Literature

A 37-year-old pregnant Japanese woman presented with right upper quadrant pain and pitting edema of the lower extremity. She had become pregnant via intrauterine insemination after a long history of i

Flat-Elevated (de novo) Carcinoma of the Sigmoid Colon with a Pedunculated Muscularis propria Mimicking a Polypoid Carcinoma

A small flat-elevated carcinoma with a pedunculated muscularis propria mimicking an early polypoid carcinoma in a 67-year-old woman is reported. The patient was referred with a diagnosis of polypoid carcinoma of the sigmoid colon. Barium enema revealed an angular polypoid tumor, and endoscopy showed a sessile, plateau-like tumor with a central depression. Endoscopic ultrasonography showed a semilunar tumor with penetration into the muscularis propria, which showed a tent-like elevation. In July 1994, sigmoidectomy with lymph node dissection was performed. Macroscopically, the tumor was 2 cm in size and plateau-like with a depression. Microscopically, the tumor exhibited a plateau-like lesion with an ulcerative change on the surface. The section through the mid-portion of the tumor showed a stalk-like elevation of the inner circular muscle layer with carcinoma infiltration. The lymph nodes were involved by carcinoma. The tumor was a well-differentiated adenocarcinoma with invasion of the muscularis propria and positive regional lymph node metastasis (stage IIIb). The postoperative course was uneventful, and the patient is free of recurrence one year after surgery. This pedunculated stalklike formation of the muscle layer with invasive foci may be produced by peristalsis similar to that of the stalk of polyps.

A Novel Ploidy Typing of Flow Cytometric DNA Histogram for the Detection of DNA Heterogeneity.

Flow cytometry (FCM) によるDNAヒストグラムの新しい分類を行い, 1検体での定量による腫瘍内heterogeneityの検出を試みた. そして, 顕微蛍光測光法 (static cytonuor6 metory, SCM) による成績と比較してその精度を検討し, さらに臨床病理学的所見や予後との関連を検討した. 大腸癌30例を対象とした. コンピューターによるDNAヒストグラムのシミュレーション結果を参考にして, aneuploid patternをcoettcient of variation (CV) 値を示用しAl patternとA2 patternに分類した. Diploid pattem 10例中9例 (90%) がSCMでhomogeneity, A2 pattem 12例中10例 (83.3%) がSCMでheterogeneityを示し, SCMの成績とよく一致した. 肝転移, リンパ節転移はA2 pattem症例に陽性率が高く, 進行度はA2 pattem症例に進行した症例が多い傾向がみられた. 本分類はheterogeneityの検出に有用であり, 臨床病理学的所見との関連を追及するのに有用な分類法であると考える.