Tetsuji Uchiyama

Prostaglandin E2 levels and lymphocyte subsets in portal venous drainage of colorectal cancers

Local immunosurveillance may play an important role in the growth and spread of tumors. To investigate the local immune response, we determined prostaglandin E2 (PGE2) levels (n = 23) and lymphocyte subsets (n = 10) in the portal vein draining the tumors of patients with colorectal cancer. PGE2 levels in the portal vein were significantly higher than those in the radial artery. Portal PGE2 levels in patients with advanced stage tumors (Dukes C and D) and lymph node metastases were significantly higher than those of patients with Dukes A and B tumors without lymph node metastases. Moreover, four of the nine patients with portal PGE2 levels greater than 100 pg/mL had liver metastases within 2 years of surgery. There were no differences in lymphocyte subsets between the portal vein and the radial artery. PGE2 levels in the portal vein draining colorectal tumor may thus be closely related to tumor progression and recurrence and may serve as a predictor of tumor recurrence in patients with colorectal cancer.

DNA copy number aberrations associated with the clinicopathological features of colorectal cancers: Identification of genomic biomarkers by array-based comparative genomic hybridization

The aim of the present study was to investigate the chromosomal aberrations that are linked with the crucial clinicopathological features of colorectal cancer (CRC) and its prognosis by array-based comparative genomic hybridization (CGH). Fresh-frozen tumor tissues of 94 cases of CRC were analyzed by using bacterial artificial chromosome (BAC) CGH slides spotted with 4030 human BAC clones, which covered the whole range of the human genome at an average interval of 0.83 mega base pairs. DNA copy number aberrations (DCNAs) were identified in association with clinicopathological features: a gain of 8q24.3 and losses of 9q33.1 and 20p12.2 were associated with lymph node metastasis, gain of 8q24.3 and loss of 9q33.1 with disease stage, gain of 8q21.11 and loss of 10q21.3 with lymphovascular invasion and losses of 3p25.1, 10p15.3, 12q15 and 17p13.1 for venous invasion. These aberrations can be regarded as genomic biomarkers to predict the clinical outcome of patients with CRC, and are expected to serve to individualize the treatment of CRC patients.

The development of a mini-array for estimating the disease state of gastric adenocarcinoma by array CGH

BackgroundThe treatment strategy usually depends on the disease state in the individual patient. However, it is difficult to estimate the disease state before treatment in many patients. The purpose of this study was to develop a BAC (bacterial artificial chromosome) mini-array allowing for the estimation of node metastasis, liver metastasis, peritoneal dissemination and the depth of tumor invasion in gastric cancers.MethodsInitially, the DNA copy number aberrations (DCNAs) were analyzed by array-based comparative genomic hybridization (aCGH) in 83 gastric adenocarcinomas as a training-sample set. Next, two independent analytical methods were applied to the aCGH data to identify the BAC clones with DNA copy number aberrations that were linked with the disease states. One of the methods, a decision-tree model classifier, identified 6, 4, 4, 4, and 7 clones for estimating lymph node metastasis, liver metastasis, peritoneal dissemination, depth of tumor invasion, and histological type, respectively. In the other method, a clone-by-clone comparison of the frequency of the DNA copy number aberrations selected 26 clones to estimate the disease states.ResultsBy spotting these 50 clones together with 26 frequently or rarely involved clones and 62 reference clones, a mini-array was made to estimate the above parameters, and the diagnostic performance of the mini-array was evaluated for an independent set of 30 gastric cancers (blinded – sample set). In comparison to the clinicopathological features, the overall accuracy was 66.7% for node metastasis, 86.7% for liver metastasis, 86.7% for peritoneal dissemination, and 96.7% for depth of tumor invasion. The intratumoral heterogeneity barely affected the diagnostic performance of the mini-array.ConclusionThese results suggest that the mini-array makes it possible to determine an optimal treatment for each of the patients with gastric adenocarcinoma.

A case of hepatocellular carcinoma with tuberculoma within tumor tissue

We made a diagnosis of hepatocellular carcinoma and performed partial resection of the liver in a 72 year-old woman. Granulomas were observed within hepatocellular carcinoma in the surgical specimen. Microscopic findings demonstrated the granulomas particularly within the tumor, and showed that they were composed of epithelioid cells with caseous necrosis. These tuberculomas compressed the tumor cells, and many lymphocytes had infiltrated the tumor around the tuberculomas. The cancer stage of the patient was early and her prognosis is good.

A Case of Circular Giant Leiomyoma in the Esophagocardiac Junction

比較的まれな食道胃接合部に発生した長径13cmの全周性巨大平滑筋腫の1切除症例を経験したので, 8cm以上の平滑筋腫本邦報告例14例と共に文献的考察を加え報告した. 症例は, 45歳のアメリカ合衆国在住の男性パイロットで, 吐血, 下血を主訴とし, 食道胃透視で下部食道の粘膜下腫瘍を疑われ紹介された. 上部消化管透視, 内視鏡にて, 下部食道から噴門部にかけて, 両端の腫大したダンベル状の粘膜下隆起病変を認めた. 腹部CT, MRIでは, 腫瘍は, 食道下部から噴門部にかけて存在し, 境界明瞭, 内部構造均一で, 造影効果はなかった. 手術は, 右開胸開腹による下部食道噴門部切除, 空腸間置術を施行した. 腫瘍は, いびつな大小不同の弾性硬の卵型の充実性集合体よりなり, 大きなものは13.0×8.0×5.0cmで, 病理組織検査で平滑筋腫の診断を得た. 術後経過順調で, 術後15日目に退院し, 現在パイロットに復職している.

Prognostic Features of Colorectal Cancer in the Young Adult

Several prior studies have shown that the prognosis of young adult patients with colorectal cancer is poor. A comparative clinical study was performed in 10 patients diagnosed in the third decade (group A) and 15 patients diagnosed in the fourth decade (group B). The cumulative 5-year survival rate of patients in group A was 32%, with a median survival of 83.7 months. Patients in group B had a 5-year survival rate of 64%, with a median survival of 152.1 months. Moreover, colorectal polyposis was observed in 4 patients (40%) in group A, but in none of the patients in group B. These data suggest that the clinical characteristics of patients diagnosed with colorectal cancer in the third decade were quite different from the characteristics of patients diagnosed in the fourth decade.

An evaluation of hepatic resection for metastasis from the colorectal cancer.

最近の教室における肝切除を行った大腸癌肝転移8例について臨床病理学的に検討を加えた.原発巣の組織はカルチノイドと粘液癌がそれぞれ1例ずつで, あとはすべて分化型腺癌でいずれも進行癌であった. 同時性転移が2例で異時性転移が6例であった. 血中CEAは測定例全例 (5例中5例) が陽性で, ほとんどが20ng/ml以上の高値を示した. なおこの間の肝転移のない大腸癌症例の血中CEA陽性率は41.4%(58例中24例) であった. この血中CEAは肝切除後急速に低下し2ヵ月までに正常域に復した. まだ追跡期間は短いが8例中3例が社会復帰しており, 症例を選べば大腸癌肝転移に対する肝切除は有意義であると考える.