Ryugo Sawada

Globotriaosyl Ceramide and Globoside as Major Glycolipid Components of Fibroblasts in Scirrhous Gastric Carcinoma Tissues

Scirrhous gastric cancer is characteristic in that cancer cells proliferate and invade with prominent fibrosis. To search for the expression of specific carbohydrate chains in scirrhous gastric cancer, we have examined the glycosphingolipid composition of scirrhous cancer tissues (n=10) in comparison with that of non‐scirrhous cancer tissues (n=10) by means of two‐dimensional thin layer chromatography, followed by fast atom bombardment mass spectrometry of the individual glycolipids and immunostaining analysis. The major neutral glycosphingolipids from scirrhous gastric cancer tissues were identified as ceramide monohexoside, ceramide dihexoside, globotriaosyl ceramide (Gb3) and globoside (Gb4), while the major acidic glycosphingolipids were II3 Neu‐Acα‐LacCer, II3 NeuAcα2‐LacCer and sulfatide. Relative concentrations of Gb3 and Gb4 in scirrhous gastric cancer tissues (Gb3+ Gb4=58%) were two times higher than those in non‐scirrhous gastric cancer tissues (29%). Orthotopic fibroblasts cloned from scirrhous gastric cancer tissues showed similar high concentrations of Gb3 and Gb4 to scirrhous gastric cancer tissues. Furthermore, immunohistochemical study revealed that Gb3 and Gb4 were expressed intensely on the fibroblasts. On the other hand, analysis of glycosphingolipids in four scirrhous gastric cancer cell lines yielded the following results. i) The contents of Gb3 and Gb4 were low (6%), compared with orthotopic fibroblasts (62%). ii) Significant amounts of Lea (pentaglycosylceramide) and Leb (hexa‐ and heptaglycosylceramides), which could not be detected in scirrhous cancer tissues, were observed. The results show that the major neutral glycosphingolipids such as Gb3 and Gb4 of scirrhous gastric cancer tissues were derived from orthotopic fibroblasts and not from the cancer cells.

Breast metastasis from EGFR-mutated lung adenocarcinoma: A case report and review of the literature

Although lung cancer rarely metastasizes to the breast, we report a case of breast metastasis from lung adenocarcinoma harboring an epidermal growth factor receptor mutation. This breast metastasis was initially considered recurrent breast cancer and was later diagnosed based on histopathological and molecular examinations as metastasis from lung cancer.

A CASE OF NON-SPECIFIC MULTIPLE ULCER OF THE SMALL INTESTINE

症例は, 23歳,女性.平成11年,十二指腸潰瘍穿通にて広範囲胃切除術施行された.同年,癒着性イレウスの診断にて,癒着剥離術を施行した.この際,回腸末端部より約80cm付近に8カ所の輪状の壁肥厚を認めたため一部を切除した.肥厚部にはびらんを認め,病理学的には非特異的炎症所見のみであった.平成14年8月,突然の下腹部痛が出現し,外来を受診した.受診時,下腹部に強い圧痛を認めたが腹膜刺激症状は認めなかった.腹部CTで小腸の拡張とTargetsign様の所見を認めたため,腸重積を疑い緊急手術を施行した.回腸末端部に8カ所の壁肥厚を認め,それより口側の腸管の拡張を認めたため同部を切除した.切除標本では輪状の潰瘍瘢痕様の病変を8カ所に認め,病理学的には浅い潰瘍形成と粘膜下層の非特異的炎症像が認められ非特異的多発性小腸潰瘍症と診断した.

Usefulness of Intraportal Ultrasonography in Diagnosis of Portal Vein Involvement in Pancreatobiliary Cancer.

膵胆道癌に対し細径超音波プローベを用いて門脈内超音波検査 (intraportal ultrasonography: 以下, IPUS) を行い, 癌の門脈浸潤を中心とした進展度診断への応用を試みた. 対象は膵胆道癌22例で, 経皮経肝門脈造影時に細径超音波プローベを門脈内に誘導し観察した. IPUSでは門脈壁は一層の高エコー帯として描出されるが, 門脈浸潤度診断はその高エコー帯の状態を観察することにより行い, IPUSV0～V3に分類した. 手術時の肉眼所見PV0～PV3と対比したところ18例中17例に一致をみた. 組織学的には, 門脈合併切除症例8例中7例において正診を得た. 門脈内の実質像を2例経験し, 1例は腫瘍栓であったが1例は血栓であった. 以上より, IPUSは膵胆道癌の門脈浸潤度診断に有用であり, 浸潤の有無とともにその程度も正確に診断しえた. しかし門脈内の実質像に対しては診断困難な症例を経験し今後の検討が必要であると考えられた.

Percutaneous Endoscopic Gastrostomy, Duodenostomy and Jejunostomy for Alimentation in Gastrectomized Patients

Percutaneous Endoscopic Gastrostomy (PEG) which can be accomplished with local anesthesia and without the necessity for laparotomy is now gaining popularity as a clinical treatment for patients who have difficulties in swallowing and require long term nutritional support but have an intact gut. A total of 40 patients underwent percutaneous endoscopic placement of a feeding tube in our clinic. They included 37 patients who had had PEG, 1 Percutaneous Endoscopic Duodenostomy (PED) and 2 Percutaneous Endoscopic Jejunostomy (PEJ). Of these patients, 3 had previously had a partial gastrectomy and 1 had had an esophagectomy with esophago‐jejunostomy. Three patients who had undergone a previous partial gastrectomy received different procedures; 1 PEG, 1 PED and 1 PEJ, which were considered to be most appropriate for each patient. One patient with a previous esophagectomy had a PEJ. PEG, PED and PEJ for the patients who had previously undergone a gastrectomy were successfully done with great care. Our experience suggests that PEG, PED or PEJ are rapid, safe and useful procedures for patients who are a poor anesthetic or poor operative risk and can be used even for patients who have undergone previous surgery.