Senji Kanno

Significance of Extensive Surgery Including Resection of the Pancreas Head for the Treatment of Gallbladder Cancer—From the Perspective of Mode of Lymph Node Involvement and Surgical Outcome

The present study aimed to clarify the efficacy of extensive surgery, including pancreas head resection, for more complete lymphadenectomy in the treatment of gallbladder carcinoma. The study involved retrospective analyses of 65 consecutive patients with gallbladder carcinoma who underwent surgical resection between 1982 and 2003. Of these 65 patients, 41.5% displayed node-positive disease and among them 23.1% had positive para-aortic nodes. Of six node-positive 5-year survivors, five underwent pancreatoduodenectomy combined with S4aS5 hepatic subsegmentectomy. The 5-year survival rates were 76.2% for pN0, 30.0% for pN1, 45.8% for pN2, and 0% for pM1[lymph], respectively. Significant differences existed in survival rates. Postoperative recurrence was observed in 24.1% (13/54) of patients who underwent R0 resection. Of the four patients who displayed lymph node recurrence, two had pericholedocal and/or posterior pancreatoduodenal lymph node metastasis at the time of surgery and underwent pancreas-preserving regional lymphadenectomy. These results suggest that extensive resection, including resection of the pancreatic head, is effective in selected patients with up to pN2 lymph node metastasis, as long as complete removal of the cancer can be achieved. Pancreatoduodenectomy combined with S4aS5 hepatic subsegmentectomy should be considered when lymph node metastasis is obvious and the patient is in good condition.

Aberrations of the K-ras, p53, and APC genes in extrahepatic bile duct cancer.

The genetic alterations involved in extrahepatic bile duct (EHBD) cancer are poorly understood. Our aim was to identify aberrations of the K‐ras, p53, and APC genes in EHBD cancer.

Infrequent microsatellite instability in biliary tract cancer

Microsatellite instability (MSI) has been reported in several tumors. However, few reports are available concerning MSI in biliary tract cancers. We investigated MSI and allelic loss at the hMLH1 and hMSH2 gene loci in biliary tract cancers.

Chemical and crystallographic studies on 33 cases of calcium carbonate gallstone (so-called limy bile)

SummaryChemical analyses by atomic absorption spectrophotometry and crystallographic studies by the X-ray powder diffraction method and infrared spectrometry (KBr-disk method) were made on 33 cases of calcium carbonate gallstone or so-called limy bile.Chemically, calcium carbonate was the major constituent, ranged from 33.7 to 91.6% and averaged 77.8%.Crystallographically, calcium carbonate has three different polymorphic crystalline forms; calcite, aragonite and vaterite. In nature the most stable calcite (hexagonal) is most commonly found and aragonite (rhombic) is next. On the other hand vaterite, which is unstable hexagonal modification, rarely occurs in biological systems.But in our gallstone series in man, aragonite was most commonly found, with an occurrence rate of 90.6%, while that of calcite was 62.5%. Even vaterite was found in 28.1%. Moreover three cases contained all three forms of calcium carbonate polymorphs; calcite, aragonite and vaterite. This was a very unusual condition.Some environmental factors controlling the growth of these crystals, such as specificity of the bile, are suggested.

Review of five cases of limy bile--particularly on radiological, chemical and crystallographic studies--.

SummaryIncidence of “limy bile” is relatively rare and only 120 cases have been recorded in Japan so far. The present report is to add five more cases operated on at our clinic. On chemical analysis by atomic absorption spectrophotometry calcium carbonate was the major constituent of solid portion and ranged from 73.5 to 88.5%. On crystallographic analyses, the infrared spectra by means of KBr-disk method gave patterns of calcium carbonate in all the cases, and the X-ray powder diffraction studies disclosed those of aragonite only in cases 2 and 4, and aragonite-calcite mixture in cases 1 and 3. The exact etiology of formation of limy bile in the gallbladder has not yet been understood completely.

Immunohistochemical detection of proliferating cell nuclear antigen and p53 expression in carcinoma of the extrahepatic bile duct.

We used an immunohistochemical method to determine the concentrations of p53 and proliferating cell nuclear antigen (PCNA) to evaluate their usefulness as a predictor of malignancy and examined the relationship between PCNA and p53 in carcinomas of the extrahepatic bile duct (EHBD). Paraffin-embedded specimens from 46 patients were immunostained for PCNA and p53 using PC10 and DO7 monoclonal antibodies, respectively. The PCNA labeling index (LI) was closely associated with the stages of the tumor and depth of invasion (p < 0.05). The cumulative survival rate of patients with a low PCNA LI (LI < 47%) was found to be significantly better than that of patients with a high PCNA LI (LI > or = 47%) in all cases and patients with advanced cancer by univariate analysis (p < 0.05), but PCNA LI was not an independent prognostic factor in multivariate analysis. We detected p53 in 37% of the EHBD cancers. We also found that p53 positivity was not related to the percentage of PCNA-labelled cells or survival. The results suggest that PCNA immunoreactivity may be a useful predictor of malignancy in patients with EHBD carcinomas.

A Case of Nonfunctioning Islet Cell Tumor Assessed Malignancy by Measuring the Nuclear DNA Content with a Flow Cytometer.

症例は60歳男性で集団検診にて肝機能異常を指摘され, 入院精査を受けたところ膵尾部に腫瘤が発見され, 膵尾部腫瘍の診断下に膵体尾部, 脾合併切除術を施行された.臨床的にホルモン過剰生産に伴う症状を呈さず, 組織化学検査でグリメリウス染色, クロモグラニン染色, NSE染色がいずれも陽性であり, 電顕にて内分泌顆粒が証明された.また, 血管侵襲像を認めたため非機能性膵島細胞癌と組織学的に診断された.Flow cytometryにより, 細胞核DNA量解析を行ったところ, 標本採取部位11か所中9か所でDI=1.36のaneuploidyを, 2か所でDI=1.36, 1.55の2クローンが混在していた.DNA ploidyからも病理組織診断が支持された.しかしながら, DNA合成期細胞の割合は小さく, 細胞の増殖能は低いことが示唆された.