Takayuki Amano

Difference frequency laser spectroscopy of the ν1 fundamental band of HOCO

Author Institution: National Research Council of Canada, Herzberg Institute of Astrophysics; Department of Chemistry, Kyushu University

Difference frequency laser spectroscopy of the ν1 band of HOCO

The ν1 fundamental band of HOCO+ has been detected in absorption with a difference frequency laser spectrometer. The molecular constants have been determined for both the ground and excited states. The band origin is found to be 3375.374 26(25) cm−1.

Study of abnormal chromosome regions in esophageal squamous cell carcinoma by comparative genomic hybridization: relationship of lymph node metastasis and distant metastasis to selected abnormal regions

Squamous cell carcinoma of the esophagus (ESCC) has a poor prognosis among digestive tract cancers. Lymph node metastasis and distant metastasis are the major factors determining its prognosis. We used comparative genomic hybridization (CGH) to evaluate primary tumor lymph nodes and metastatic areas from ESCC patients in order to determine the relationship between abnormal chromosome regions and outcome. Tumor tissues and lymph nodes were collected from 51 patients with ESCC, and abnormal chromosome regions were detected by CGH. We searched for regions that were significantly more common in patients with lymph nodes metastases (n>/= 6) or distant metastases, and correlated those chromosomal changes with survival. Regions showing amplification in more than 65% of esophageal squamous cell cancers were as follows: 17q12 (90.2%), 17q21 (86.3%), 3q29 (82.4%), 3q28 (78.4%), 8q24.2 (76.5%), 22q12 (76.5%), 3q27 (74.5%), 8q24.3 (74.5%), 1q22 (70.6%), 5p15.3 (70.6%), 22q13 (70.6%), 3q26.3, 8q23, 8q24.1, 9q34, 11q13, 17p12, 17q25, 20q12, 20q13.1 (68.6%), 1q32, 1q42, and 20q13.2 (66.7%). Regions showing deletion in more than 50% of the tumors were as follows: Yp11.3 (62.7%), 3p26 (56.9%), Yq12 (54.9%), 13q21 (52.9%), 4q32 (51.0%), and 13q22 (51.0%). When Fishers test was used to assess associations of these regions with metastases to lymph nodes, amplification at 2q12-14 (P= 0.012), 3q24-26 (P= 0.005), and 7q21-31 (P= 0.026) were significant. Survival was worse for patients with amplification at all 3 regions. In patients with distant organ metastases, amplification at 7p13-21 was significant (P= 0.008), and survival was worse. Chromosomal amplifications in ESCC at 2q12-14, 3q24-26, and 7q21-31 were associated with lymph node metastasis, while amplification at 7p13-21 was related to distant metastasis. Amplification at these regions correlated with worse survival. Genes involved in the phenotype of ESCC may exist in these regions. Identification of these genes is a theme for future investigation.

Size analysis of lymph node metastasis in esophageal cancer: diameter distribution and assessment of accuracy of preoperative diagnosis

BackgroundIn esophageal cancer, lymphatic spread occurs more frequently and at an earlier stage than in other gastrointestinal cancers, and both preoperative and intraoperative diagnoses of lymph nodes metastases are sometimes incorrect. Our objective was to measure the sizes of lymphatic metastases and to examine the accuracy of clinical diagnosis of lymphatic spread in patients with squamous cell carcinoma of the esophagus.MethodsThe sizes of 320 metastatic lymph nodes of 9254 dissected nodes from 92 consecutive esophagectomy patients over 1 year were measured and compared with the sizes of the actual metastases within the nodes. These data allowed investigation of the correct rate of preoperative diagnosis of lymph node metastasis.ResultsThe mean diameter of the metastases was 4.8 mm, which was significantly smaller than that of the involved lymph nodes. Among the metastatic lymph nodes, 37.2% were less than 5 mm in diameter, and 63.1% of the metastases were less than 5 mm in diameter. The true-positive and true-negative diagnosis rate for all lymph node stations in three fields (neck, thorax, and abdomen) was only 23.2%, and the false-negative rate for diagnosis of lymph node metastasis was 53.7%.ConclusionsTwo-thirds of involved lymph nodes had very small metastases (<5 mm), suggesting that limited confidence should be placed in the preoperative diagnosis of lymphatic spread. Therefore, extensive lymph node dissection appears appropriate in esophageal cancer surgery, given the small sizes of many metastases and the difficulty with preoperative diagnosis.

Subepithelial extension of squamous cell carcinoma in the esophagus: Histopathological study using D2‐40 immunostaining for 108 superficial carcinomas

Squamous cell carcinoma (SCC) of the esophagus occasionally produces subepithelial extension (SEE) in the stroma below the non‐cancerous epithelium. Little information on SEE has been obtained, therefore the purpose of the present study was to carry out a clinicopathological study using D2‐40 immunostaining in 108 cases of superficial (mucosal and submucosal) SCC of the esophagus. SEE occurred in 24 cases (22.2%). The SEE was present in both mucosa and submucosa in 19 cases, but in five cases SEE was located in the mucosa. Lymphatic invasion of tumor cells was well determined on D2‐40 immunostaining. In the SEE group lymphatic invasion was found in 15 cases, and in two cases there was lymphatic invasion in the lamina propria mucosa of the edge of SEE. In the SEE group 23 (95.8%) had infiltrative growth of tumor cells. Lymphatic invasion and growth pattern of tumor cells were statistically correlated with SEE. Lymph node metastases were found in 48 cases, but SEE was not correlated with nodal metastases statistically. In conclusion, esophageal SCC produces SEE from the early stage by infiltrative growth and lymphatic invasion of tumor cells. The detection of lymphatic invasion on D2‐40 immunostaining in the mucosal edge of SEE is useful for evaluation of endoscopic mucosal resection tissue.

A case of pancreatic serous cystadenoma with obstructive jaundice

A 62‐year‐old man with precordial pain and fever consulted a local practitioner. Blood tests revealed jaundice. Acute cholecystitis was diagnosed on ultrasonographic examination, and percutaneous transluminal gall‐bladder drainage was performed. The patient was referred to the Department of Surgery for operation. Imaging studies performed via a drain disclosed compression and stenosis of the lower portion of the common bile duct. A computed tomographic scan showed a multilocular nodule‐like low‐density area measuring 2.0 × 2.0 cm in diameter at the head of the pancreas. Endoscopic retrograde cholangiopancreatography disclosed compression and stenosis of the main pancreatic duct at the head of the pancreas. Angiographic examination revealed encasement of the intrapancreatic branch of the posterior pancreatic arcade, located in the same area as the compression stenosis of the bile duct. The results of imaging studies suggested cancer of the head of the pancreas, and a pancreatoduodenectomy was performed. The resected specimen included a mass measuring 3.5 × 2.7 × 1.7 cm, which was located at the head of the pancreas. On examination of a cut section, the mass was found to consist of small multilocular cysts. The cysts invaded the intrapancreatic bile duct. The histopathological diagnosis was serous cystadenoma.

A CASE OF GROOVE PANCREATITIS WITH DUODENAL STENOSIS

A 58‐year‐old man presented with a 2‐month history of nausea and vomiting. Blood levels of hepatic enzymes and pancreatitis markers were slightly elevated. Hypotonic duodenographic and endoscopic examinations revealed stenosis encircling the descending duodenum. A computed tomography (CT) scan showed inflammatory changes in the head of the pancreas and thickening of the duodenal wall. Magnetic resonance cholangiography demonstrated stenosis of the intrapancreatic segment of the common bile duct and diffuse dilatation of the main pancreatic duct, without irregularity. At laparotomy, microscopic examination of a needle biopsy specimen of the head of pancreas revealed no evidence of malignancy. Distal gastrectomy with Billroth II anastomosis was performed. Microscopically, fibrous thickening of the duodenal wall, serositis and hyperplasia of Brunners glands were found. The presence of duodenal stenosis due to segmental pancreatitis, referred to as groove pancreatitis, was confirmed. The elevated blood levels of pancreatitis markers returned to the normal range 8 months after the operation. Ultrasonic echography and abdominal CT also revealed a marked reduction in dilatation of the extrahepatic bile duct and the main pancreatic duct. In patients suspected of having pancreatic carcinoma or regional pancreatitis, groove pancreatitis should be included in the differential diagnosis.

Relational topographical anatomy between right bronchial artery and thoracic duct

Thoracic duct injury leads to “chylothorax”. We found a close relationship of topographical anatomy between right bronchial artery and thoracic duct from esophageal cancer operations. We retrospectively analyzed topographical anatomy of right bronchial artery and location of thoracic duct in 124 cases operated in 2012. Of 124 cases, we recognized 8 cases of anomalous right bronchial artery. In these cases, the right bronchial artery originated directly from descending aorta without connections with third intercostal artery. When the right bronchial artery has a connection with third intercostal artery, the thoracic duct was located within the loop of the right bronchial artery. However, in these 8 anomalous cases, thoracic duct was located dorsally outside the loop of the right bronchial artery without exceptions. We have to be very careful in exploring the thoracic duct when we notice the anomalous right bronchial artery during esophageal cancer operation.

Utility of weekly docetaxel combined with preoperative radiotherapy for locally advanced esophageal cancer from pathological analysis.

Esophageal squamous cell cancer (ESCC) is a high-grade carcinoma that is treated with multidisciplinary approaches, including chemoradiotherapy (CRT) followed by surgery. Despite some success with these therapies, overall survival remains poor. In order to investigate a newer CRT regimen, we designed a comparative study to evaluate preoperative CRT using docetaxel (DOC) or 5-Fluorouracil and cisplatin (FU+CDDP [FP] therapy) for treatment of resectable ESCC. In a retrospective review of patients with resectable, locally advanced ESCC, 95 patients received preoperative CRT between 2001 and 2007. CRT was administered using either FP (n = 40) or DOC (n = 55). Pathological response and clinical outcomes were compared between the two groups. Hazard ratios and time-to-event analyses were used to assess outcomes; the ratios were controlled by multivariate logistic regression analysis of potential prognostic factors, and survival was presented with Kaplan-Meier curves. In the FP group, a significant curative effect was observed on the basis of pathological examination of postoperative lesions. However, the DOC group presented a significantly better prognosis on the basis of cumulative survival rates. Logistic regression analysis revealed that the presence of five or more lymph node metastases was an independent predictor of reduced survival. Patients with lymph node metastasis exhibited a better prognosis in the DOC group than those in the FP group. Preoperative CRT for locally advanced esophageal cancer using DOC results in similar or better long-term outcomes compared with FP-based CRT. Therefore, CRT using DOC is a promising therapy option for esophageal cancer.

Transthoracic esophagectomy of adenocarcinoma in Barrett’s esophagus in Japanese patients: analysis of localization of lymph node metastases in 19 cases

BackgroundThe incidence of esophageal adenocarcinoma is only 1%–2% in Japan. For this reason, many aspects of this disease have not been clarified, such as its generation, progress, and the potential of malignancy. It is necessary to investigate the strategy for treating this disease.MethodsBetween 1998 and 2008, 19 cases were diagnosed as adenocarcinoma with Barrett’s esophagus and treated with esophagectomy at Juntendo University: 13 cases were early stage and 6 cases were advanced stage. Distribution of lymph node metastasis and prognosis were investigated.ResultsThe incidence of lymph node metastases of adenocarcinoma is statistically lower (15.4%) compared with that of squamous cell carcinoma (SCC) (44.0%) (P = 0.034) when the depth of the tumor is not beyond the submucosal layer. Even in the early stages of adenocarcinoma, positive nodes were found in the lower mediastinum and gastric cardia. In advanced cases, cancer had spread randomly to the upper mediastinum or celiac region. Mean survival time of superficial and advanced adenocarcinoma after esophagectomy was 3,517.5 ± 330.6 and 2,061.4 ± 451.3 days, respectively, whereas that of SCC was 2,794.7 ± 131.0 and 1,669.1 ± 101.5 days, respectively. Overall survival of superficial or advanced adenocarcinoma was better than that of SCC but was not statistically superior.ConclusionsEndoscopic mucosal resection is limitedly proposed for mucosal tumors. Esophagectomy with a mediastinal lymphadenectomy should be conducted for tumors invading the submucosa. An individualized strategy is required that could approach the upper mediastinum based on staging and location of lymph node metastases.