Seiji Igarashi

Patterns of recurrence after curative resection of pancreatic cancer, based on autopsy findings

The autopsy findings of patients who died of recurrence after curative resection of pancreatic cancer may afford a reliable guide to increase long-term survival after surgery. Recurrence patterns were analyzed for 27 autopsied patients who had undergone potentially curative resection of pancreatic cancer. The pattern of recurrence was classified as follows: (1) local recurrence, (2) hepatic metastasis, (3) peritoneal dissemination, (4) para-aortic lymph node metastasis, and (5) distant metastasis not including hepatic metastasis, peritoneal dissemination, and para-aortic lymph node metastasis. Of the 27 autopsied patients, recurrence was confirmed for 22 of 24 patients, except for three who died of early postoperative complications. Eighteen (75%) of the 24 patients had local recurrence, 12 (50%) had hepatic metastasis, and 11 (46%) had both. For four patients, local recurrence confirmed by autopsy was undetectable by computed tomography, because the recurrent lesions had infiltrated without forming a tumor mass. Peritoneal dissemination, para-aortic lymph node metastasis, and distant metastasis were found for eight (33%), five (21%), and 18 (75%) of the cases, respectively. Twenty patients died of cancer, but local recurrence was judged to be the direct cause of death of only four. Local recurrence frequently occurs, but is rarely a direct cause of death, and most patients died of metastatic disease. Therefore, treatment that focuses on local control cannot improve the survival of patients with resectable pancreatic cancer, and thus, treatment regimens that are effective against systemic metastasis are needed.

Methylation profile of the MLH1 promoter region and their relationship to colorectal carcinogenesis.

Methylation of the MLH1 promoter region has been suggested to be a principal mechanism of gene inactivation in sporadic microsatellite instability (MSI)–positive colorectal carcinoma. Recently, we have shown a novel methylation profile of the MLH1 promoter region (i.e., full, partial, and no methylation), among which full methylation was strongly associated with MSI. In this study, to confirm whether methylation requires the involvement of both alleles, we studied the MLH1 promoter region concerning the methylation profile and allelic loss. Furthermore, we studied correlations of methylation profiles with genetic alternations such as loss of heterozygosity (LOH) of the TP53 locus and KRAS mutation. Eighty‐eight tumors were classified as full (n = 14), partial (n = 26), and no methylation (n = 48). Full methylation was observed in 78% (14/18) of high‐frequency MSI, in which all CpG sites in the promoter region were methylated. Full methylation differed significantly from partial methylation regarding absence of TP53 LOH (0/12) and KRAS mutation (0/14). In cases with full methylation, we could show biallelic methylation by use of a single‐base nucleotide polymorphism in the promoter. However, this did not accompany LOH of the MLH1 locus. In contrast, there were no significant differences in molecular features between partial and no methylation, except for low frequencies of LOH of the MLH1 locus (P = 0.02). In conclusion, biallelic extensive methylation of the MLH1 promoter region plays a significant role in gene inactivation and is independent of KRAS mutation and TP53 LOH.

Effect of preoperative 5-fluorouracil on apoptosis of advanced gastric cancer

Several studies have reported on apoptosis and the effect of anticancer chemotherapy.

Synchronous colitic cancers and microcarcinoids in a patient with long-standing and extensive ulcerative colitis: a case report and review of the literature.

We report a case of colitic cancer detected by target biopsies at surveillance colonoscopy in a patient with long-standing and extensive ulcerative colitis. At first, the detected colitic cancer was removed by endoscopic mucosal resection as the patient refused surgical resection. However, total proctocolectomy with an ileal-J-pouch anal anastomosis was performed additionally after informed consent had been obtained from the patient, as the resected specimen included invasive cancer histologically. Surprisingly, histologic examination of the surgical specimens revealed another flat invasive colitic cancer and 2 microcarcinoids, which were not detectable by preoperative colonoscopy or by macroscopic investigation of the surgically resected specimen. The occurrence of carcinoid in patients with ulcerative colitis has been reported only sporadically. In addition, coexistence of colitic cancer and carcinoids is extremely rare. Cases of this rare combination reported previously in the English literature are summarized and discussed.

Follicular Hodgkin's lymphoma recurring as nodular sclerosis Hodgkin's lymphoma: report of two cases.

Sir,Follicular Hodgkins lymphoma (FHL) is a form of classical Hodgkins lymphoma. However, little is known about the histological evolution of FHL. Kansal et al.1 reported a case of FHL recurring ...

Marginal zone B-cell lymphoma arising from buccal mucosa resembling inflammatory myofibroblastic tumor of the soft tissue.

We report here a case of marginal zone B-cell lymphoma (MZBL) arising from buccal mucosa resembling inflammatory myofibroblastic tumor (IMT) of the soft tissue. On a low-power field, the lesion is characterized by fibrous granulation tissue and numerous lymphoid follicles with or without atrophic small germinal center. A portion of the lymphoid follicles were surrounded by partial and/or complete thin pale cuff of centrocyte-like (CCL) cells on high power field. The thin rim of the lymphoid follicles contained CCL-cells, plasma cells, cells showing plasma cell differentiation and mature eosinophils. In contrast, the granulomatous areas contained were characterized by haphazardly arranged spindle cells, mature plasma cells, mature eosinophils, small-to-medium lymphocytes and histiocytes. Histologically, IMT was suspected. However, flow cytometry and immunohistochemical study demonstrated a monotypic nature of centrocyte-like cells, plasma cells and their precursor and confirmed the diagnosis of MZBL arising from the buccal mucosa. The differential diagnostic problems between IMT of the soft tissue and classical Hodgkin lymphoma and T-cell lymphoma have been discussed previously. However, the present case indicated that MZBL should be added to the differential diagnosis of IMT of the soft tissue.

Apoptosis and Proliferative Activity of Advanced Gastric Cancer.

術前未治療進行胃癌切除例101例を対象として, 組織学的進行度と腫瘍細胞のS期分画 (S-phase fraction), apoptosis, bcl-2蛋白 (Bcl-2) 発現を検討し, 進行胃癌における増殖活性とapoptosisの関与を検討した.腫瘍細胞のS-phase fraction, apoptosisはflow cytometryによるapoptosis-DNA二重染色により, Bcl-2発現は免疫組織染色にて検討した.S-phase fractionはstage IV症例において高かったが, 他の因子と進行度との関連は見られなかった.apoptosis分画はBcl-2陽性例では陰性例に比べ有意に低く, また組織分化度より見るとBcl-2の発現は未分化型において高率であった.未分化型のS-phase fractionは分化型に比べ高く, S-phase fractionとapoptosis分画の間に逆相関の傾向が認められた.したがってapoptosisそのものは癌進行度との直接関係は認められないが, Bcl-2陽性例では低いことから, 腫瘍増殖を規定する一因である可能性が示唆された.