Teiji Matsumoto

UICC and Japanese stage classifications for carcinoma of the pancreas

SummaryThe stage classification (SC) for carcinoma of the pancreas recommended by UICC (UICC-SC) was compared with that of Japan Pancreas Society (JPN-SC) using 229 patients encountered consecutively at the Second Department of Surgery, Nagasaki University School of Medicine over the past 20 yr. By UICC-SC, 51% of the patients belonged to stage IV and 38% to Stage III. By JPN-SC, 82% of the patients belonged to stage IV. Curative resection rates in JPN stage II and III were significantly higher than those in UICC-SC by the chi-squared test. In 60 patients undergoing resectional surgery, postoperative cumulative survival (PCS) curves and rates by each staging criterion (tumor size [T], lymph node metastasis [N], distant metastasis [M], serosal invasion [S], retroperitoneal invasion [Rp], and invasion to the portal venous systems [V]) were calculated by the Kaplan-Meier method. Among these prognostic factors, significant differences in the PCS curves were demonstrated only between Rp(-) and Rp(+), and between V( - ) and V( + ) according to the generalized Wilcoxon’s text. In UICC-SC, the underestimation of these factors leads to a tendency to classify the patients in a less advanced stage than in JPN-SC. JPN-SC is more complex than UICC-SC. Continuing efforts are necessary to establish a more practical, simple, and universal staging system for the disease.

Solid and Cystic Tumor of the Pancreas in an Adult Male

A solid and cystic tumor (SCT) was located at the head of the pancreas in a 43‐year‐old Japanese male, and pancreatoduodenectomy was performed on the suspicion of papillary carcinoma or cystadenocarcinoma of the pancreas. The lesion, which measured 4.5 X 4.5 X 4.0 cm, was clearly demarcated by connective tissue. The cut surface showed solid grayish‐white areas with central cystic degenerative changes. The solid areas consisted of small round cells proliferating in a small solid or a pseudopapillary pattern. The tumor cells partially invaded the surrounding normal pancreatic parenchyma. Immunohistochemical studies revealed positive staining for alpha‐1‐antitrypsin and neuron‐specific enolase, but no staining for known pancreatic hormones. Moreover, ultrastructural studies showed the absence of zymogen granules and the presence of anullate lamellae and neurosecretory granules. On the basis of these findings, a diagnosis of SCT of the pancreas was established. In order to clarify the histogenesis and biological behavior of the tumor, it is necessary to accumulate and analyze similar cases, an endeavor which in turn will contribute to the successful management of this disease. Acta Pathol Jpn 41: 763‐770, 1991.

Caroli’s disease associated with hepatolithiasis: A case report and review of the Japanese literature

SummaryA 27-year-old woman was admitted to Nagasaki University Hospital complaining of abdominal pain and fever. Percutaneous transhepatic cholangiography showed multiple cystic dilatations of the intrahepatic bile ducts without stone formation. The illness was diagnosed as a pure type of Caroli’s disease. No surgical intervention was made. Subsequently, the patient suffered repeated attacks of cholangitis, and six years later, computed tomography demonstrated cystic lesions of both lobes of the liver and stones within the cystic lesions of the right lobe. We collected 62 cases of Caroli’s disease reported in the Japanese literature, including our own case. Among them, cholangitis was found in 43.5%, hepatolithiasis in 30.6%, esophageal varices in 17.7% and cholangiocarcinoma in 8.1%. It is difficult to successfully treat Caroli’s disease involving both lobes of the liver. Long-term repeated cholangitis could lead to fibrosis of the liver, hepatolithiasis, portal hypertension and cholangiocarcinoma. Considering the above-mentioned aspects of the disease, careful follow-up studies are required in each case.

Extended right lobectomy for Caroli's disease: report of a case and review of hepatectomized cases in Japan.

A 27-year-old man was admitted to Nagasaki University Hospital complaining of fever. Percutaneous trans-hepatic cholangiography revealed multiple cystic dilatations of the intrahepatic bile ducts of the right lobe, as well as three obvious cystic dilatations and several small dilatations of the intrahepatic bile ducts of the left lobe. An extended right lobectomy was performed. However, the patient later suffered from repeated cholangitis and required the administration of antibiotics as a result of remnant cystic dilatations and stricture of the extrahepatic bile duct following hepatectomy. A slight enlargement of the remnant cystic dilatations, but no new cystic dilatations, were also recognized in the regenerating liver. We reviewed nine cases of hepatectomy for Carolis disease reported in the Japanese literature, as well as our own case. Among these, four of the seven patients subjected to hepatic resection involving unilateral lobe demonstrated a good recovery. On the other hand, it is difficult to successfully treat Carolis disease involving both lobes of the liver by hepatic resection.

Autotransplantation of the adrenal cortex into the spleen of dogs

The factors involved in regeneration of the autotransplanted adrenal cortex were studied experimentally in dogs. On the basis of a number of conditions necessary for the regeneration of adrenocortical tissue, the dogs were divided into 4 groups according to differences in substitution therapy following autotransplantation. The only group to demonstrate long-term survival received an intermittent substitution of cortisone acetate after the completion of 6 days postoperative replacement therapy. The hormonal functions after adrenocortical autotransplantation were examined in the long-term survivers. The secretory function of adrenocortical tissue after autotransplantation was confirmed by the detection of serum concentrations of aldosterone and cortisol, however, estrogens were not detected in the peripheral blood stream following autotransplantation. The negative response to the synthetic ACTH stimulation test observed in this study was evidence of the functional limitation of regenerated cortical tissue. Clinically, however, the procedure performed in this study will be beneficial for patients with advanced and metastatic breast cancer, not only as a form of surgical hormonal therapy, but also as an effective palliative method of treatment.

Prognosis of Resected Pancreatoduodenal Cancers.

1969年10月より1990年10月までに経験した膵頭領域癌 (十二指腸癌, 原発不明癌を除く) 切除例114例の予後および予後に関与する因子について検討した.症例の内訳は膵頭部癌55例, 乳頭部癌34例, 下部胆管癌25例であり, 平均年齢はそれぞれ64.0±11.7歳, 59.3±12.3歳, 62.1±11.5歳であった.このうち膵頭部癌の予後が最も悪く (p<0.01), 1年生存率は40%, 5年生存率は8%であった.乳頭部癌の予後は膵頭部癌に比べ比較的良好で1年生存率64%, 5年生存率31%であった.しかし進行したstage III以上の症例では予後不良で膵頭部癌とほとんど変わらない生存曲線を示した.下部胆管癌は最も予後良好であり, 1年生存率72%, 5年生存率44%であった.膵頭部癌では予後に最も関与したstage決定因子は膵後組織への浸潤 (Rp因子) であり, 術式では膵頭十二指腸切除術が膵全摘術より予後良好であった (p<0.05).乳頭部癌では膵臓浸潤 (Panc), 十二指腸浸潤 (D), リンパ節転移 (N) の各因子とも予後に関与したが, Panc因子が最も重要であった (p<0.001).下部胆管癌では各stage決定因子の有無で予後に有意差を認めなかったが, 組織学的リンパ節転移 (n) 1, 組織学的膵臓浸潤 (panc) 1, 組織学的十二指腸浸潤 (d) 1, 組織学的胆嚢浸潤 (ginf) 1にとどまっていれば比較的良好な予後が期待された.