Sumihiro Matsuzaki

Use of the time–signal intensity curve from dynamic magnetic resonance imaging to evaluate remnant pancreatic fibrosis after pancreaticojejunostomy in patients undergoing pancreaticoduodenectomy†

This study assessed the value of the time–signal intensity curve (TIC) obtained from dynamic magnetic resonance imaging (MRI) in the evaluation of remnant pancreatic fibrosis after pancreaticojejunostomy in patients undergoing pancreaticoduodenectomy.

Mode of Infiltrative Growth of Colorectal Liver Metastases Is a Useful Predictor of Recurrence after Hepatic Resection

AbstractMany studies have been conducted to determine prognosis on the basis of the characteristics of metastatic liver tumor from colorectal cancer. The present study was carried out to determine whether the pathological mode of infiltrative growth (INF) of a metastatic liver nodule is useful in predicting recurrence in the remnant liver after hepatic resection. A total of 42 curative hepatic resections were performed for 37 patients with isolated liver metastases from colorectal cancer. Multivariate analysis (n = 42) showed that number, INF type, and size of liver metastases were statistically significant as independent risk factors. Of these, 28 resected liver metastases (smaller than 6 cm in size or containing fewer than 4 nodules) were classified pathologically into INF alpha or beta types (INF a b; n = 14) and gamma type (INFg; n = 14). Disease-free survival at 5 years was 64% for patients with INF a b type, and 14% for those with the INF g type of liver metastases. Of these, recurrent disease of the liver after hepatic resection was found in 2 (14%) and 11 (79%) patients with INF a b and INF g types, respectively. From these observations, we concluded that pathological infiltrative growth of liver metastases is an informative predictor of disease-free survival and especially of recurrence in the remnant liver.

Small-Cell Carcinoma of the Gallbladder: Report of a Case

Abstract: We report herein the case of an 81-year-old woman in whom a mass in the gallbladder was revealed by an ultra-sound examination conducted as part of a follow-up study for a silent gallstone. The mass showed evidence of invasion into the adjacent liver parenchyma. Under the tentative diagnosis of malignant neoplastic disease originating in the gallbladder, a cholecystectomy with partial hepatectomy was performed. Histological examination of the tumor confirmed a diagnosis of small-cell carcinoma of the gallbladder, which is considered to be a rare type of neoplasm.

Early Pancreatic Cancer

The results of surgical treatment for ordinary carcinoma of the pancreas, even now considered the only means for cure, have been dismal. In order to define early pancreatic cancer, aiming amelioration of surgical results, early pancreatic cancer has been seeked. It may be readily conceivable that the smaller the tumor size, the earlier the lesion. The relationship between tumor size and surgical results was reviewed from the literature, some of which included articles written in Japanese. Tumor size ≤2 cm in diameter is not always an early cancer. Tumor <1 cm could be an early cancer but does not definitely reveal long-term survival. An increase of pancreatic cancer in Japan may be strongly related with the increased elderly population. Small cystic lesions which develop in elderly persons seem to indicate carcinogenesis of ordinary ductal cancer of the pancreas. Carcinoma in situ may be an early pancreatic cancer. Early pancreatic cancer is defined as an intraductal adenocarcinoma without any invasion or with minimal invasion to the stroma, regardless of size or extent of the lesion.

Gastric cancer associated with overexpression of parathyroid hormone-related peptide (PTHrP) and PTH/PTHrP receptor in relation to tumor progression

Parathyroid hormone-related peptide (PTHrP) is involved in cell proliferation in both neoplastic and non-neoplastic tissues. We describe an autopsy case of gastric cancer in a patient who showed serum hypercalcemia and overexpression of PTHrP and PTH/PTHrP receptor in the metastatic tumor cells. The primary gastric tumor was poorly differentiated adenocarcinoma, and multiple metastases were present in the bone, multiple visceral organs, peritoneum, and lymph nodes. PTHrP and its mRNA were detected only in the metastatic tumor cells, but not in primary gastric tumor. PTH/PTHrP receptor was also demonstrated immunohistologically in metastatic tumor cells. This case suggests that the expression of PTHrP is related to tumor progression and the poor prognosis in tumors associated with humoral hypercalcemia.

EXPRESSION OF PARATHYROID HORMONE (PTH)‐RELATED PEPTIDE (PTHrP) AND PTH/PTHrP RECEPTOR IN GIANT CELL TUMOUR OF TENDON SHEATH

The giant cell tumour of tendon sheath (GCTTS) is mainly composed of mononucleated stromal cells (SC) and multinucleated giant cells (GC), so‐called osteoclast‐like GC. It is thought that GC are derived from SC, but their precise relationship is not fully understood. Parathyroid hormone (PTH)‐related peptide (PTHrP) is now considered to be a cytokine for cell differentiation, which may stimulate osteoclast‐like cell formation in haematopoietic cells. Five cases of GCTTS were evaluated immunohistochemically, using a variety of antibodies against PTHrP, PTH/PTHrP receptor, KP‐1 as a histiocytic phenotypic antigen, fibronectin as a fibroblastic phenotypic antigen, and proliferating cell nuclear antigen (PCNA). In situ hybridization and immunohistochemistry revealed that in all cases both SC and GC expressed PTHrP. PTH/PTHrP receptor was observed only in histiocytic SC and GC, but not in fibroblastic SC. Almost all GC showed histiocytic features. PCNA immunoreactivity was detected only in the nuclei of SC, and not in GC. Moreover, SC with PTH/PTHrP receptor immunoreactivity were negative for PCNA. These results suggest that GC are derived from histiocytic SC expressing PTH/PTHrP receptor and losing proliferative activity in the process of transition from mononuclear to multinucleated. PTHrP produced by SC and GC may be involved in the formation of osteoclast‐like cells in GCTTS by acting in an autocrine/paracrine fashion.

The Fas/Fas-ligand system functions in hepatocytes in the early stage of fulminant hepatic failure in rats

Abstract Apoptosis is involved in various liver diseases, but in the case of fulminant hepatic failure (FHF) much remains to be determined. We investigated apoptosis in the remnant liver lobes of FHF rats regarding the Fas/Fas ligand and the TGF- β system. Rats ( n =30) with FHF were euthanized at postoperative 3, 6, 12, 24 and 36 h. Changes in the Fas/Fas-ligand and TGF- β were studied by reverse transcriptase-polymerase chain reaction (RT-PCR) and immunohistochemical staining. Apoptosis was explored using terminal deoxynucleotidyl transferase mediated dUDP-nick end labeling method (TUNEL). Within 6 h, a relatively large number of hepatocytes, mainly in zone 3, were apoptotic. During the same period, the expression of Fas and Fas-ligand mRNA and protein, but not that of TGF- β , were observed and decreased with time. Both Fas and Fas-ligand proteins were present in the hepatocytes in zone 3. These results suggest that the Fas/Fas-ligand system, rather than TGF- β , has a role in apoptosis during the early stages of FHF, possibly through an autocrine loop.

Biliary Inflammation and Biliary Carcinogenesis

Biliary carcinoma has been reported as a late complication of bilioenterostomy. The present study was designed to find out if bilioenterostomy promotes biliary carcinogenesis, and to clarify the relationship between biliary inflammation and biliary carcinogenesis in hamsters. Syrian hamsters were subjected to simple laparotomy (SL), choledochoduodenostomy (CD), or choledochojejunostomy (CJ). All hamsters received subcutaneous injections of the chemical carcinogen, N-nitrosobis(2-oxopropyl)amine (BOP), and were killed 20 weeks after surgery. Neoplastic lesions in the biliary tree were examined histologically, and the presence and degree of cholangitis was evaluated with special reference to the biliary carcinogenesis. The incidence of bile duct carcinoma did not differ significantly among the three groups. However, numerous bile duct carcinomas were recognized in the bilioenterostomized animals, especially in the CJ group. Moreover, there was a significant correlation between biliary carcinogenesis and the presence of cholangitis in the CD and CJ groups, but not in the SL control group. Severe cholangitis was evident in the CJ group, and the number of biliary carcinomas was well correlated with the degree of cholangitis. These findings suggest that the risk of carcinoma in the biliary tract is increased when cholangitis persists after biliary reconstruction.