Takao Tsumori

Clinicopathologic study of thyroid carcinoma infiltrating the trachea

Eighteen patients (10 women and 8 men), ranging in age from 37 to 80 years, with thyroid carcinoma infiltrating the trachea comprised this series. Eleven had primary and 7 had recurrent cases. Total laryngectomy was performed in 4 patients, and tracheal resection was carried out followed by end‐to‐end anastomosis in 13 patients. In one patient, reconstruction was done with Navilles artificial trachea after tracheal resection. Eleven patients were alive after 1 year and 8 months to 6 years and 7 months after the operation. This result was significantly better than that of a group of ten patients without resection of the infiltrated trachea (seven patients died within 6 months). Thus, combined resection of the upper airway improved the prognosis of advanced thyroid carcinoma with tracheal infiltration. Histologic examination of surgical specimens demonstrated well‐differentiated carcinoma in seven patients, poorly differentiated carcinoma in seven patients, undifferentiated carcinoma in three patients, and squamous cell carcinoma in one patient. The result showed a higher frequency of poorly differentiated carcinoma than in the control group of 70 patients without tracheal infiltration.

Surgical clinicopathologic study of malignant fibrous histiocytoma.

Fifteen men and six women, ranging in age from 20 to 79 years, with malignant fibrous histiocytoma comprised this series. Amputation of the right lower extremity was performed in one patient, wide resection in 7 and marginal excision in 9, respectively. In the other 4 patients, a non-curative resection was carried out. Adjuvant chemotherapy was prescribed post-operatively for 12 patients. Histologic grade of the surgical specimens was Stage I in 3, II in 6, III in 8 and IV in 4. Among fourteen patients living from 10 months to 9 years and 9 months after the operation, the 7 subjected to a wide resection are all disease free. Seven patients died of a local recurrence or a distant metastases. The survival rate of the patients with Stages I, II is significantly higher than those with Stages III, IV. These results show that a wide resection is to be favored and that staging is useful to estimate the prognosis.

Cancer cell emboli in the pectoral lymphatics of patients with breast cancer

In order to investigate the possibility of local recurrence in the pectoral muscles of patients who undergo modified radical mastectomies, the cancer cell involvement of the lymphatics associated with the pectoralis major muscle was studied in 39 patients who underwent a standard radical mastectomy for Stage I–III breast cancer. Cancer cell emboli were found in the transpectoral lymphatics of 2 patients (2/39=5.1 per cent) and in the pectoral fascial lymphatics of 6 patients (6/39=15.4 per cent). Two patients with fascial lymphatic cancer cell emboli were from a group of 14 patients with intramammary lymphatic tumor emboli of a low degree (ly 1). The other 6 patients with cancer cell emboli in either the pectoral fascia or the transpectoral lymphatics were from a group of 11 patients with intramammary lymphatic tumor emboli of a moderate degree (ly 2). There was a significant relationship between the intramammary and the pectoral lymphatic cancer cell emboli (Chi square test: p<0.05). The results of this study therefore indicate that lymphatic cancer cell emboli in the pectoral fascia and muscle are an important risk factor for patients who undergo a modified radical mastectomy.

Clinical assessment of Barrett's esophagus after total gastrectomy.

Barrett様食道は下部食道粘膜が扁平上皮に代わり円柱上皮におおわれた病態である.胃全摘術施行症例に対して内視鏡検査ならびに食道粘膜生検を行った結果, 23例中5例にBarrett様食道の発生が確認された.さらにBarrett様食道は食道炎症例 (23例中13例) にのみ認められた.5例のBarrett様食道上皮は組織学的検索により全例, intestinal typeと診断された.本症の病因は先天説ならびに後天説に大別されるが詳細な発生機序は明らかでない.今回得られた事実より胃全摘術後のBarrett様食道は逆流性食道炎の臨床過程において, 吻合部に隣接する空腸粘膜が口側へ進展したものであることを示唆された.