Takao Umemoto

Detection of lymph-node metastases in patients with gastric carcinoma: comparison of three MR imaging pulse sequences.

AbstractBackground: To compare the diagnostic accuracy of magnetic resonance (MR) images obtained with three different pulse sequences for lymph-node metastases in patients with gastric cancer. Methods: T1-weighted spin-echo (SE), breath-hold T2-weighted fast SE, and triphasic gadolinium-enhanced dynamic gradient-recall-echo (GRE) MR images obtained in 16 patients with gastric carcinoma were retrospectively reviewed. Regional lymph nodes were assigned to four different groups, and image review was conducted on a lymph-node group-by-group basis; 64 lymph-node groups were reviewed by two radiologists. Relative sensitivity, specificity, and accuracy were determined based on the findings with definitive surgery and follow-up imaging. Diagnostic accuracy was determined by means of receiver-operating-characteristic (ROC) analysis. Results: Relative sensitivities for lymph-node metastases with T1-weighted SE, breath-hold T2-weighted fast SE, and dynamic GRE images were 61%, 94%, and 59%, respectively. Relative sensitivity with breath-hold T2-weighted fast SE images was significantly greater than that with T1-weighted SE (p < 0.05) and dynamic GRE (p < 0.05) images. Diagnostic accuracy determined by ROC analysis was marginally higher with breath-hold T2-weighted fast SE (area under ROC curve [Az]= 0.87) than with T1-weighted SE (Az = 0.78, p= 0.08) and dynamic GRE (Az = 0.79, p= 0.12) images. Conclusion: Breath-hold T2-weighted fast SE sequence is useful in the detection of regional lymph-node metastases in patients with gastric carcinoma.

A Study of Predicting the New Prognostic Evaluation of Gastrectomized Patients with Cancer of the Stomach Using a Neural Network Model.

1985年から5年間に手術した胃癌411例中, 術後10年以上を経過し, 予後が判明している261例 (Stage I 117例, II31例, III62例, IV51例) を対象に, 胃癌取扱い規約上の予後因子別に単変量解析と多変量解析を行い, 腫瘍マーカーの術前値と術前・後値の変動から治療効果評価法としての有用性を検討した. 次いで, 多変量解析結果から, Stage, 術1か月目のCEA値とIAP値, 術前・後のCEA値変動率差, 治癒切除・非治癒切除, 転移リンパ節個数を入力変数とし, 入力層で9ユニット, 中間層で9ユニット, 出力層を2ユニットの階層型ニューラルネットワークモデルを作成した.本モデルを用いた学習効果は, 学習用症例130例中94例 (72.3%) が正確に応答し, 未知症例では131例中90例 (68.7%) が正確に応答した.以上の結果, ニューラルネットを用いた予後予測は, 治療効果を含めた予測法として有用である可能性が示唆された.

A Case of Villous Tumor of the Rectum with Adenoacanthoma Invaded to the Submucosal Layer Followed by Fuluminant Course by Liver Matastasis.

まれな組織型を呈し, 術後1年で肝転移にて死亡した深達度smの絨毛型直腸癌の1例を経験した. 症例は75歳の女性で, 1990年4月, 肛門出血を主訴として某医を受診し, 直腸腫瘍を指摘され紹介入院となった. 諸検査の結果, 癌合併直腸絨毛腫瘍と診断し, 経仙骨的腫瘍切除術を施行した. 腫瘍は95×88mm大の平板状で, 粘膜層に限局した高分化腺癌が主体であったが, 7mmの範囲で粘膜下層に浸潤し, 癌先進部に腺扁平上皮癌が認められた. また壁在転移リンパ節を認めたため再手術を勧めたが, 患者の了解が得られず, 厳重経過観察とした. しかし, 術後7か月目に強い疼痛を伴う局所再発と肝転移が確認され, 再入院の上後方骨盤内臓摘除術を施行した. 術後2か月目に皮膚転移が出現し, 肝転移巣も急速に増大し, 初回手術から1年後に死亡した. 局所切除が一般化しつつある直腸絨毛腫瘍の中にも, 非常に予後不良な症例が存在することを, 念頭におくべきであると考えられた.

A Case of Subcutaneous Recurrent Pancreatic Cancer Occured from Cancer All Seeding Along the Tract of Catheter Duodenostomy.

極めてまれな再発形式を示した膵頭部癌の1例を報告した.症例: 67歳の男性.主訴: 右側腹壁腫瘤.1990年7月10日, 某医で十二指腸潰瘍にて胃切除術, カテーテル十二指腸瘻造設術を受けた.しかし術後1か月ほどで肝機能障害, 黄疸が出現したため, 当科に紹介された.入院後, PTCD, CTなどの検査により膵頭部癌と診断され, 9月20日, R1郭清を伴う膵頭十二指腸切除術が施行された (stage IV, 相対非治癒切除).腫瘍は十二指腸乳頭部に浸潤していた.退院後, 外来でfollowされていたが, 十二指腸瘻造設部跡に一致して, 有痛性腫瘤が認められたため, 1991年2月28日に腫瘤摘出術が施行された.病理組織検査では高分化型腺癌であり膵頭部癌の皮下転移と判明した.その後徐々に全身状態が悪化して術後1年目に死亡した.本例ではカテーテル十二指腸瘻を介して癌細胞が腹壁にimplantされたと考えられ, PTCD瘻孔を経由して胸壁に再発する場合と同様の機序が推察された.

Evaluation of Preoperative Serum CEA and IAP Levels in the Patients with Colorectal Cancer

The usefulness of the preoerative measurement of serum CEA and IAP level as prognostic factors in colorectal cancer patients was investigated. The cases were divided into negative or positive groups acording to cut off points of CEA of 5ng/ml, IAP of 500μg/ml orIAP of 580μg/ml respectivly. In comparison of survival rates in colon cancer, the groups of CEA negative, IAP500 negative or IAP580 negative were all significantly better than those of positive ones respectivly. But in rectal cancer, only the rate of IAP580 negative one was significantly better than that of positive one. To further investigation of above results, according to the general rules for clinical and pathological studies on cancer of colon, rectum and anus in Japan, distributions of cases by histological backgrounds and by these cut off points were analized. Results were those both in colon and rectal cancer, CEA correlated almost all bacgrounds except histological type and lymphnode metastasis. But IAP500 correlated only operative curability in rectal cancer, and also IAP580 corelated only operative culability in both colon and rectal cancer and lymphnode metastasis in colon cancer.