Sueharu Iwamoto

Solid-pseudopapillary carcinoma of the pancreas

A case of solid‐pseudopapillary carcinoma (SPC) of the pancreas in a 34‐year‐old Japanese woman is presented. An abdominal ultrasonography revealed a mass, which measured 10 cm in diameter, in the body and tail of the pancreas. The tumor was resected and it was originally diagnosed as a non‐functioning islet cell tumor. One year and five months later, the patient was re‐admitted to hospital, and liver metastasis was confirmed by ultrasonography. The patient died 6 days after the second transcatheter arterial embolization (TAE) required for the metastasis. The autopsy showed small foci of liver metastasis. A retrospective examination of the tumor suggested the diagnosis of SPC because of its characteristic solid and pseudopapillary structures, immunohistochemical findings, and liver metastasis. This case suggests that capsular invasion, specifically found at the surgical margin of the peritoneal side, may be an important pathological finding that is suggestive of malignant potential in solid‐pseudopapillary tumor. If there is such a finding in a surgical specimen, an intensive follow up should be advised to the clinician.

Cytologic findings in noninvasive intraductal papillary-mucinous carcinoma of the pancreas: A report of two cases

BACKGROUND Intraductal papillary-mucinous carcinoma of the pancreas is a new diagnostic term proposed by the 1996 World Health Organization classification of the exocrine pancreas. So far, there have been only a few reports concerning its cytologic findings, especially in noninvasive cases. CASES The clinical and cytohistologic findings in two cases of noninvasive intraductal papillary-mucinous carcinoma of the pancreas were reviewed. Cytologic specimens were obtained from pure pancreatic juice in the dilated main pancreatic duct during the operation (case 1) and during endoscopic retrograde pancreatography (ERP) (case 2). Both cases showed three-dimensionally or individually scattered tumor cells with an increased nuclear/cytoplasmic ratio and prominent nucleoli. CONCLUSION Our cases suggest that pancreatic juice cytology during ERP or surgery is useful in diagnosing pancreatic cancers and that it may detect noninvasive intraductal papillary-mucinous carcinoma of the pancreas.

Fatty replacement of the pancreatic body and tail associated with leiomyosarcoma of the pancreatic head

A case of fatty replacement of the pancreatic body and tall associated with leiomyosarcoma of the pancreatic head is presented. Clinicopathological features as well as differential diagnoses are described with a review of the literature on both leiomyosarcoma and fatty replacement of the pancreas. A possible correlation between the two lesions is also discussed.

Surgical treatment for the recurrence of colorectal cancer

We report the results of a retrospective study conducted on patients who developed recurrence following surgery for colorectal cancer, and present a practical plan to improve the survival rates. Of 974 patients who underwent surgery for colorectal cancer in our hospital during the 20 years between 1974 and 1993, 152 developed recurrence, as local recurrence in 70 (7.2%), as liver metastasis in 47 (4.8%), and as pulmonary metastasis in 35 (3.6%). The number of patients who underwent reoperation or curative resection was 54 (77.1%) and 13 (24.1%), respectively, of those with local recurrence, 16 (34.0%) and 6 (37.5%) of those with liver metastasis, and 6 (17.1%) and 6 (100.0%) of those with pulmonary metastasis. The 3- and 5-year survival rates were 13.4% and 8.9%, respectively, after reoperation for local recurrence, 14.4% and 0%, after reoperation for liver metastasis, and 53.3% and 53.3% after reoperation for pulmonary metastasis. Although evaluation was difficult owing to the small number of patients with lung metastasis, resection of a pulmonary lesion resulted in a good outcome. Furthermore, a significant difference in 3- and 5-year survival rates was observed between patients who underwent reoperation and those who underwent conservative treatment, for whom the survival rates were 0% and 0% following local recurrence, 4.6% and 0% following liver metastasis, and 0% and 0% following lung metastasis, at 3 and 5 years, respectively. These findings indicate that aggressive surgery for recurrence may result in a better outcome.

Forskolin-stimulated adenylylcyclase activity: a marker to assess islet cell viability following cold storage in different solutions and to predict islet cell function following transplantation.

For clinical islet cell transplantation, short-term storage of islet cells is likely to be necessary, and it is imperative that the islet cells be kept as viable as possible during the period. However, there are little data on which preservative solutions are most suitable for the storage of islet cells after isolations or before transplantation. To estimate islet cell viability and transplantation success rate in the present study, adenylylcyclase activity was measured with a rapid new fluorometric assay in rat islet cells prior to transplantation, because cAMP plays an essential role in determining islet β-cell viability and responsiveness to various hormonal stimuli. Adenylylcyclase activity was measured in islet cells stored for different periods of time (0, 3, 16, 24, 48, 96 h) and in different preservative solutions. Approximately 1,000 islet cells from each preservation group using University of Wisconsin (UW) solution were transplanted to streptozotocin-induced diabetes mellitus (DM) rats. Transplant success was evaluated by measuring blood glucose levels. Preoperative adenylylcyclase activity was compared with posttransplant islet cell function. The adenylylcyclase activity of UW solution was significantly higher than that of Euro-Collins solution and lactate-Ringers solution through the different preservation time periods. Preoperative adenylylcyclase activity correlated well with posttransplant islet cell function in a rat model of DM. We conclude that adenylylcyclase activity can be used as a marker to assess islet cell viability as well as differences in preservation media and may predict islet cell transplant success.

Local Recurrence After Local Excision of Early Rectal Cancer

The advantage of local excision for early rectal cancer, excluding fiberscopic polypectomy, is that it allows preservation of the anal function of the sphincter. We treated 75 patients with early rectal cancer and carried out local excision in 29 of these cases during the period from 1974 to 1992. Three of these 29 patients were reoperated upon immediately because of massive invasion to the submucosa at the margin of the removed specimen. Two other cases experienced local recurrences and required additional surgery.

Cryosurgical Treatment For Local Recurrence Of Rectal Cancer

During the last 19 years we have used cryosurgery as part of a multidisciplinary therapy to treat 12 patients with local recurrence of rectal cancer. This treatment was chosen to provide these patients with the palliative benefits of minimal bleeding and to reduce tumor bulk. The survival time following resection therapy in 30 cases after relapse was significantly greater than that for the 12 cases receiving cryosurgical treatment. However, local destruction of the recurring cancer by cryosurgery resulted in effective control of the tumor.

Effect of ATP on antitumor activity of various antitumor drugs in mice tumor cells in vitro.

マウス培養細胞を用い, ATPの癌細胞および正常細胞の増殖, 膜透過性におよぼす影響を検討した. さらに本物質の癌化学療法への応用を目的として, 各種抗癌剤との併用実験を行った. ATPにより, 癌細胞では著明な細胞膜透過性の亢進, cell viabilityの低下がみられたのに対し, 非癌化細胞におけるこれらの変化は軽微で, ATP作用は癌細胞に特異的であった. ATP処理後の癌細胞における各種抗癌剤の抗腫瘍効果は, 5-FU, ADM, MMC, ACNUでは相加的, VCRでは相乗的に増強した. また, 正常細胞に対する抗癌剤の細胞毒性はATPの併用により増強されなかった. これらの結果からATPを用いることにより, 選択的癌化学療法が期待できるものと思われた.