Shingo Shima

Adenoid cystic carcinoma of the esophagus: Report of a case and review of the Japanese literature

We report herein the case of a 79-year-old man with adenoid cystic carcinoma (ACC) of the esophagus. The tumor had a polypoid appearance and was covered by thin esophageal mucosa. As the biopsy specimens suggested a diagnosis of poorly differentiated adenocarcinoma, the patient underwent subtotal esophagectomy with reconstruction of the gastric tube via the posterior mediastinum. Histologically, the carcinoma contained basaloid cells, cribriform foci, and a certain amount of eosinophilic hyaline substance. Some of the basaloid cells were stained immunohistochemically for keratin, muscle actin, and S-100 protein, a pattern which was identical to the pattern of immunoreactivity of the myoepithelium. We reviewed 36 other cases of ACC of the esophagus reported in Japan, with special reference to the criteria for histological diagnosis.

Carcinoma within a middle esophageal (parabronchial) diverticulum: A case report and the review of the literature

A case of carcinoma developed in the middle esophageal (parabronchial) diverticulum is reported. In recent literature, 44 cases of carcinoma in esophageal diverticulum were reported. Most of the patients who had carcinoma in a diverticulum have a long-term history of symptom related to diverticula. Prognosis of these patients was poor because the carcinomas were far advanced when they were found. Therefore, the patient with esophageal diverticulum should be checked with esophagogram, esophagoscopy and biopsy, considering the possibility of development of carcinoma. Most of the cases of carcinoma in a diverticulum were treated with diverticulectomy. However, we consider that radical esophagectomy is a better method of treatment.

Immunohistochemical Study of Esophageal Carcinomas Other Than Squamous Cell Carcinoma

It was previously thought that esophageal carcinomas other than squamous cell carcinoma were very rare; for example, Suzuki and Nagayo found 256 (2.1%) of 11,932 resected cases and 360 (7.2%) of 4995 autopsied cases of the esophagus [1]. However, recently some authors have indicated that these tumors were not so rare [2, 3]. We found 29 cases (12.7%) of these carcinomas among 229 resected cases of esophageal carcinoma from 1978 to 1991, we interested the histological origins of the 29 cases (12.7%) of non-squamous cell carcinoma. These tumors were immunohistochemically stained for the purpose of determination of their histological origin and/or differentiation.

Surgical treatment of intra-thoracic esophageal carcinoma infiltrating to the neighboring organs.

他臓器浸潤胸部食道癌52例を対象としてその浸潤臓器別に外科的治療の成績を検討し, 他臓器合併切除の適応につき考察した.1) 大動脈浸潤を伴う13例の1年生存率は23, 1%であり, 気管浸潤を伴う13例の1年生存率は15.4%であった.大動脈・気管への浸潤例では他にも臓器浸潤を伴う症例やリンパ節転移 (n-number) が高い症例が多かった.2) 大動脈浸潤例では癌の浸潤が小範囲に限局し, リンパ節転移がN2以下である症例にかぎり大動脈外膜切除の適応があると考える.気管浸潤に対する気管の合併切除・再建術の適応と手技は今後の問題と思われた.3) 肺や心嚢などへの浸潤例では約半数においてリンパ節転移はn2以下であり, 積極的な合併切除により予後の改善が期待される.

Partial splenic embolization for hypersplenism with liver cirrhosis.

肝硬変に伴う脾機能亢進症10例に対して部分的脾動脈塞栓術 (Partial Splenic Embolization) を施行し, その効果, 肝機能に及ぼす影響, 合併症とその対策について検討した. 血小板数は本法施行後3日目より急激に増加し, 12ヵ月経過後においても9.1±2.7×104/mm3と施行前より有意な上昇が持続した (p<0.05).本法により血小板数の増加を持続的に得るためには脾の50～70%の梗塞範囲が必要であった. 本法は肝予備能の悪い症例やhigh riskの症例に対しても安全に施行することができ, 発熱などの副作用は保存的対処が可能であった. また肝機能に及ぼす影響は一過性であった. 本法の効果が不十分であった症例には反復する必要があると思われた.