Takami Fukui

Mixed medullary-papillary carcinoma of the thyroid with lymph node metastases: report of a case.

Abstract We report herein the case of a 77-year-old woman found to have mixed medullary-papillary carcinoma in the right thyroid with lymph node metastases 30 years after a left thyroidectomy. The preoperative values of serum calcitonin and carcinoembryonic antigen (CEA) were high, and fine-needle aspiration biopsy revealed class V, which led us to suspect papillary carcinoma. A right thyroidectomy with dissection of the right neck lymph nodes was performed. Histopathological examination of the tumor specimens revealed gradual borders between medullary carcinoma and papillary carcinoma with positive immunohistochemical staining to calcitonin, chromogranin A, CEA, and thyroglobulin. The serum levels of calcitonin and CEA decreased to normal after the operation. The point mutation of the RET proto-oncogene was found to be negative by a DNA analysis of the peripheral leukocytes. This cancer seemed not to be associated with multiple endocrine neoplasia type 2 syndrome. The presence of both medullary and papillary components in the thyroid with lymph node metastases is rare and may suggest that the tumor had arisen from a common stem cell.

Significance of Apoptosis Induced by Tumor Necrosis Factor-α and/or Interferon-γ Against Human Gastric Cancer Cell Lines and the Role of the p53 Gene

AbstractPurpose. The expression of the p53 gene in target cells plays an important role in the induction of apoptosis by tumor necrosis factor (TNF)-Α and interferon (IFN)-Γ. We herein present a study suggesting the existence of a caspase-independent pathway from p53 via insulin-like growth factor binding protein 3 (IGF-BP3) which acts as an apoptosis induction mechanism. Methods. MKN-45 (wild-type p53) or MKN-28 (mutant-type p53) was cultured with TNF-Α or IFN-Γ either alone or together. After 24 and 48 h, the apoptotic index (AI) was determined by Hoechst staining and then compared. To clarify whether the mechanism of apoptosis is induced by TNF-Α and/or IFN-Γ, apoptosis-related genes were examined by a cDNA on microarray analysis and a Western blot analysis. Results. (1) The AI for MKN-45 increased at 48 h in the presence of TNF-Α or IFN-Γ alone. (2) In the case of combination treatment using TNF-Α and IFN-Γ, the AI for MKN-45 was higher than those in the groups with a single treatment. (3) A cDNA microarray analysis showed that IGF-BP3, the TNF superfamily, and caspase 1 were all upregulated after treatment with the combination of TNF-Α and IFN-Γ. (4) A Western blot analysis of MKN-45 showed a reaction with an anti-IGF-BP3 antibody. Conclusions. These results suggest that the induction mechanism underlying apoptosis induced by TNF-Α and IFN-Γ might therefore involve the caspase-independent pathway via IGF-BP3.

A Study on Four Cases of Simple Ulcer in the Small Intestine Causing Massive Bloody Stool.

下血にて発症する小腸潰瘍はまれな疾患である. 筆者らは, 緊急開腹術にて単純性小腸潰瘍からの出血であることを究明しえた4例を経験したので報告する. 症例は44歳の女性, 65歳の男性, 54歳の男性, 67歳の女性. いずれも主訴は下血. 術前検索で, 胃・十二指腸・結腸・直腸よりの出血は否定. 全例緊急開腹術施行下, 術中内視鏡にて小腸潰瘍よりの出血を確認後, 病巣を含めて腸切除術を施行. 組織学的には, いずれもU1-II～IIIの良性潰瘍で, 単純性小腸潰瘍と診断された. 小腸潰瘍の術前確定診断を得ることは非常に困難である. したがって, 高度な貧血をきたす下血を認めながら, 消化管検査にて原因を究明しえない症例においては, 小腸潰瘍からの出血の可能性も念頭におき, 診断と治療を兼ねた開腹術下小腸内視鏡の施行を考慮すべきであると考えられる.