Tatsuo Hirano

SARCOMA BOTRYOIDES ARISING FROM THE BILIARY TRACT OF CHILDREN — A CASE REPORT WITH REVIEW OF THE LITERATURE

Sarcoma botryoides (embryonal rhabdomyosarcoma) originating from the common bile duct is reported in a 4‐year‐old girl. Grossly, the tumor is characterized by multiple polypoid and grape‐like projections into the lumen of the common bile duct and shows plate‐like thickening of the common bile duct wall. On multiple cut‐sections these polypoid masses are soft and light yellow white except for multifocal hemorrhage. Histologically the tumor consists of undifferentiated mesenchymal cells with a myxomatous appearance; rhabdomyoblasts with varing degree of maturation are scattered here and there within the matrix. These cells are characterized by a strap and racket shape with abundant eosinophilic cytoplasm and elongated cytoplasm with cross striations. The histogenesis of the tumor may be related possibly to an abnormal differentiation of the primitive mesenchymal cells toward striated muscle cells.

Surgical Treatment of Perforated Gastric Cancer

Perforation of the stomach is the most uncommon complication of cancer of the stomach and was found in 9 of 1,620 patients treated over a 23-year period. The 5-year survival rate of 62.8% indicates th

Signet ring cell early gastric cancer presenting as an elevated lesion.

SummaryEarly gastric cancer composed of signet ring cell carcinoma is usually present as a depressed lesion and rarely manifests as a protruding lesion. To our knowledge, only eight cases have been reported in the literature. We herein report such a rare lesion which developed in an asymptomatic 55-year-old man.

Changes in polymorphonuclear leukocyte motility under agarose and luminoldependent chemiluminescence response in patients with gastric cancer

SummaryThis study was designed to assess polymorphonuclear neutrophil (PMN) functions such as motility and chemiluminescence (CL) in fifty gastric cancer patients, as well as to determine the correlation of PMN function with extent of disease and the degree of differentiation of the lesions. Furthermore, the effects of surgery and administration of Mitomycin C (MMC) on PMN functions were studied. In early gastric cancer and Stage I disease, the mean values of chemotaxis and CL were elevated in comparison to controls. As the disease progressed, the PMN function decreased and significant depression was noted in Stage IV cases. With respect to the relationship of PMN functions to the grade of differentiation of cancer, patients with papillary adenocarcinoma had significantly elevated mean chemotaxis in response to one of the chemoattractants, while patients with poorly differentiated and signet ring cell carcinomas had significantly lower chemotactic responses to chemoattractants compared to controls. There were no significant differences in CL according to the degree of differentiation of histologic type. Surgical removal of the tumor resulted in a tendency towards improvement of PMN chemotaxis while postoperative administration of MMC resulted in a decrease, but there were no statistically significant differences between responses before and after surgery. No improvement of the CL response was demonstrated approximately four weeks after surgery.

A Retrospective Clinicopathological Study on Adenocarcinoma of the Upper Part of the Stomach with Special Reference to Lymph Node Metastases

上部胃癌切除294例について, 占居部位・漿膜面浸潤・組織学的壁深達度別に所属リンパ節の転移を検索し, 術式の選択・適応について検討した.切除全胃癌中21.3%を占め, 男女比は2.7: 1, 平均年齢は60.0歳であった.胃癌取扱い規約によれば, Cに限局するものは129例で, 早期癌は15.0%であった.術式は胃全摘214例, 噴切52例, その他28例であった.リンパ節転移は, 早期癌ではn (-) であったが, pmで#2・3に7.7, 30%, ssβで#1・3に40%, #7・9に20%, #6・10・11・13・14に10%, ssγでは#4s・4d・16に37.5, 12.5, 12.5%の転移をみた.Cの漿膜面浸潤と#4d・5・6の転移は, S0S1はn (-) であったが, S2ではそれぞれ2.8, 11.1, 5.6%の転移をきたし, S3では21, 4, 14.2, 7.1%であった.5年および10年生存率は全摘で43.1%, 40.9%, 噴切で32, 5%, 27.5%で, 全摘が優れていたが有意差はなかった.以上より上部胃癌の噴切の適応はS1までのもの, 組織学的にはssγまでにとどまるものである.

The prognostic singnificance of cellular DNA content in colorectal cancer using multivariate analysis.

大腸癌核DNA量の予後因子としての価値を検討する目的で, Coxの比例ハザードモデルにより多変量解析を試みた. 方法はパラフィンブロックを用いたB.Schutteらの方法に準じflow cytometerで核DNA量を測定した. 236例中DNA diploidyは97例 (41.1%) であり, DNA aneuploidyは139例 (58.9%) であった. DNA ploidyは臨床病理学的因子の中で, 壁深達度, リンパ節転移との間に有意差を認め, Coxの比例ハザードモデルにおいては, 回帰係数β値は0.7739危険率0.0033であり, 他の病理組織学的因子に優る有意性が認められた. 以上の結果より, 大腸癌核DNA量は独立した予後因子として有用であることが明かとなった.

Clinical evaluation of neutrophil polarization in surgical patients with gastric cancer.

胃癌患者60例の末梢血好中球polarizationを測定し, 胃癌の病態因子別に検討を加えた.胃癌患者の好中球polarizationは対照群に比べ有意に低下していた.stage IV, n3, 深達度ssで示される進行胃癌患者で有意な低下を認めた.術後感染症合併例では, 他群に比較して差を認めなかった.死亡例では有意な低下をみた.C領域癌, Borrmann 3型癌, por (低分化腺癌) 癌で有意な低下を示した.これらの成績から進行胃癌患者では, 一連の好中球機能の過程で最も初期に位置するpolarizationという機能においてその低下が示され, 担癌患者での好中球機能不全が示唆された.

EVALUATION OF COMPLIAINTS FOLLOWING TOTAL GASTRECTOMY FOR GASTRIC CANCER

胃癌に対する胃全摘術施行例202例について術後愁訴を中心に検討した.1) 本術式は漿膜浸潤を伴うBorrmann3および4型に適応される頻度が高く, 70歳以上の高齢でも症例の生理学的年齢に応じて十分適応できる.2) 再建術式はRoux-Y吻合, 空腸移植, double tractおよびBillrothII法が行われたが1975年以降BillrothII法は行われていない.術式別にみると5年生存率逆流性食道炎・術後下痢・小胃症状の点からは空腸移植, double tractがすぐれていたが, 食事摂取, タンピング症状, 術後体重増加の点ではBillrothII法を除き著明な差はみられなかった.就労状況は空腸移植法ですぐれていた.3) 代用胃としての嚢貯溜能は99mTc-DTPA1.5mciを含んだ試験食による代用胃シンチグラフィーからその有用性がみとめられた.