Tetsutaro Takeda

Prognostic analysis of malignant pleural and peritoneal effusions

A total of 289 cases with malignant pleuroperitoneal effusions were reviewed, and their prognosis were analyzed in relation to the following factors: (1) chronologically divided series; (2) previous tumorectomy of the primary lesion; (3) presence or absence of other metastases; (4) site of effusion; (5) site of the primary lesion; (6) cytologic characteristics of effusion. Prognostic difference among each chronologically divided series was not noticed. Previous tumorectomy slightly improved the patients survival. Other distant metastases had no significant influence on the prognosis. Pleural effusion gave better prognosis than peritoneal effusion. Patients of breast and lung cancer had longer expectancies, contrasting with those of gastric cancer. Formation of large clusters of cancer cells on smear preparations obtained from the tapped effusions was interpreted as a sign of good prognosis. Frequencies of cancer cell and lymphocyte occurrence on smear preparation did not have any relationship with the prognosis. The results showed that some factors of the patients at malignant effusion accumulating stage did contribute a great deal to their prognosis.

Outcomes of 116 patients with hepatocellular carcinoma

We studied the outcomes of 116 patients with hepatocellular carcinoma (HCC) diagnosed in our hospital between January 1980 and August 1992. The patients were divided into groups according to the principal treatment procedure. The 3-year survival rates in the patients treated by percutaneous ultrasonically guided ethanol injection (PEI), operation (hepatic resection), and transcatheter hepatic arterial embolization (TAE) were 90.9%, 53.6%, and 29.0%, respectively. None of the patients treated by oneshot injection of an anticancer agent into the hepatic artery and chemotherapy survived for more than 2 years. The outcomes of the patients treated by PEI and hepatic resection were significantly better than those of the patients treated by the other procedures. There was no significant difference when the patients were stratified according to the year of detection. The 3-year survival rate was 57.3% for 19 patients in whom HCCs were detected during clinical follow-up for chronic liver disease and 17.3% for the other 97 patients. We concluded that hepatic resection in patients with good liver function and PEI for early HCC yielded significantly better survival rates than the other procedures. Moreover, for early detection and treatment of HCC, we recommend clinical follow-up of patients with chronic liver disease.

Clinical evaluation of lansoprazole in the treatment of peptic ulcers : initial healing and prevention of relapse

The clinical usefulness of lansoprazole in the healing of gastric and duodenal ulcers, the S2-stage shift rate (white scarring rate), and endoscopic healing rate with respect to degree of gastric mucosal atrophy were investigated. The subjects were 50 gastric ulcer and 37 duodenal ulcer patients. The endoscopic healing rate in patients with gastric ulcers after initial treatment with lansoprazole was 92% after 8 weeks. The S2-shift rate was 38% after 8 weeks. The 8-week healing rate in patients without atrophy was 100% and with atrophy was 92%, although the difference was not statistically significant. The S2-shift rate in patients without atrophy was 42% and in patients with atrophy was slightly lower, at 37%, although the difference was not statistically significant. The endoscopic healing rate in patients with duodenal ulcers was 93% after 6 weeks, and the S2-shift rate was 59%. It is firmly established that atrophic gastric mucosa shows a reduction in mucosal defense factors. However, lansoprazole achieved good endoscopic healing rates and S2-shift rates even in patients with gastric ulcers with atrophic background mucosa.

Histologic and cytologic studies on atypical epithelial growth of the stomach

SummaryThirty three resected gastric lesions were examined histologically to analyze the relationship between histologie and cytologie diagnoses of the so-called atypical epithelial growth based on biopsy specimens. Of the 33 lesions twenty were histologically verified atypical epithelial growth and the remaining thirteen were, in the same manner, diagnosed with some equivocation as papillary adenocarcinoma. The results of both histological and cytological diagnoses of the biopsy materials from the above mentioned 33 lesions were as follows; for the twenty atypical epithelial growths, 18 were diagnosed as benign, one was as suspicious of malignancy and the other one was as cancer by biopsy histology, whereas these lesions were diagnosed as benign in 16, suspicious in two and cancer in two by cytology; for the thirteen papillary adenocarcinomas, 8 were diagnosed as benign, 4 were as suspicious of malignancy and one was as cancer by biopsy histology. On the other hand their diagnoses were malignant in six, suspicious of cancer in four and benign in three by biopsy cytology. The data indicate that biopsy cytology favors malignancy for atypical epithelial growth and papillary adenocarcinoma when compared with biopsy histology.

Comparative cytological evaluation of renal oncocytoma and renal cell carcinoma in the same kidney.

腎細胞癌と同一腎内に併存した腎好酸性細胞腫について細胞所見を対比し報告した.症例は42歳, 女性, 自覚症状はなく, 人間ドックの超音波検査で右腎の腹側と背側に2個の独立した腫瘤を指摘され, 精査のため入院.画像診断 (CT, MRI, 血管造影) より腎癌が疑われ手術が施行された.右腎腹側の腫瘤は大きさ2.8×2.8cmで, 割面は暗赤色-褐色, 中心部は黒く出血性, 病理組織診断は腎好酸性細胞腫であった.割面擦過で顆粒状の豊富な胞体をもった細胞がシート状で結合性のゆるい集塊として, または孤在性・散在性にみられた.核は直径約8μmで小型, 類円形を基本とし, 2核のものも散見された.顕著なクロマチン増量はみられず, 小さな核小体が1-2個認められた.背側の腫瘤は大きさ1.5×1.5cmで割面黄白色, 腎癌・淡明細胞亜型と最終診断された.割面擦過で得られた細胞の胞体は明るく核は5-10μmと小型であるが, 大小不同がみられ, 類円形のものが多く観察された.

A cytodiagnostic study of urinary bladder carcinomas by squash method.

異型度や浸潤度の異なる膀胱癌10症例について, 膀胱鏡下生検を行い, 同一病変からの採取材料を薄切標本と圧挫細胞診に供して, その診断能を比較検討した.その結果,1) 組織診では薄切標本作製中に膀胱粘膜が剥落したことによる判定不能例が認められた. こうした例では生検圧挫法が癌の検出力において優れていると考えられた.2) 組織学的異型度の判定では, 両者は同等であった.3) 生検圧挫法においても浸潤の有無を判定することは可能であると思われた.以上より, 圧挫法の診断能は薄切標本に匹敵するものであり, 検出力の点では組織診よりも圧挫法がよい成績であった.生検圧挫法では間質浸潤の観察も可能であって, 有力な術前情報を提供するものとして, 今後の臨床応用が期待される.

The availability of silver stain to distinguish mesothelial cells from adenocarcinoma cells in ascites.

体腔液細胞診において, 細胞集塊内の結合組織の存在が中皮細胞の同定に役立つと思われたので報告する.対象は大腸癌症例の腹水24例.内訳は, 細胞診陰性であった16例 (術中採取13例, 穿刺採取3例) と陽性の8例 (術中採取4例, 穿刺採取4例) である.形態的に中皮細胞と判定できる上皮様中皮細胞集塊55個と明らかな癌細胞集塊87個について, Papanicolaou染色標本脱色後, 銀染色を施行し細胞集塊内の線維性結合織の有無を観察した.中皮細胞集塊では, 55個中37個 (67.3%) に線維性結合織を認めた.術中採取に限らず穿刺採取でも高率に線維性結合織を認めた.癌細胞集塊では, 濃染のため判定不能な集塊が32個 (36.8%) あったが, 残りの集塊55個 (63.2%) には, 明らかな線維はみられなかった.また, いずれの集塊でも細胞集塊辺縁が黒く縁どりされたように染まるものが少数みられた.癌細胞か中皮細胞か問題となるような異型細胞集塊の内部に線維性結合織を認めるとき, 中皮細胞である確率がきわめて高く, 癌細胞との鑑別に応用できる所見と思われた.

Cytology of islet cell tumor.

悪性2例を含む4症例の膵ラ島腫瘍について割面擦過塗抹像を検討し, 良・悪性および産生ホルモンにより細胞像に違いがあるか否かについて考察した.症例1では, 細胞は均一散在性, 一部ロゼット様配列を示し, 核は円ないし類円形, 核長径平均8.77±1.07μmであった.クロマチンは顆粒状, 核小体は概して小さいものが1個認められた.細胞質に富み, 核は偏在性であった.症例2は, 症例1と同様の細胞像だが, 核長径は10.26±1.53μmとやや大型の傾向があり, 20μmの大型核もみられた.症例3は, 細胞は散在性から集塊状で, 核は類円形ないし紡錘形であり, 核長径平均は9.89±2.00μmであった. クロマチンは増量し, 核小体は1～2個認められた. 集塊形成細胞の細胞質はライトグリーンに淡染しているが, 散在性のものは裸核状であった.症例4は, 症例3と同様の細胞像を呈したが, 核長径10.63±2.33μmとやや大きい傾向にあった.今回のわれわれの検討の結果からは, 細胞像のみでは良・悪性の鑑別は困難であった. また, 産生ホルモンの違いによる細胞像の差も明瞭ではなかった.

Cytologic study of colorectal adenoma.

宮城県立成人病センターの症例で, ポリペクトミーあるいは手術により摘出され組織学的に大腸腺腫と診断された24例, および腺腫内癌11例について, 大腸腺腫および腺腫部分の細胞所見を検討した.細胞集塊は3つの型に分類することが可能であった. すなわち, 核が細長く著明な多層性重積像を示し, 核の極性が保たれているI型, 部分的に核の軽度円形化と散在傾向があり, 極性に若干の乱れを呈するII型, 核の円形化が著明で散在傾向が著しく, 極性の乱れも著明なIII型である. これらが全例に認められるわけではなく, 大腸腺腫24例中1型のみがみられるもの8例, II型のみ1例, I型とII型が8例, II型とIII型が2例, すべての型がみられるもの5例であった. 大腸腺腫24例での核長径 (μ) は, I型14.6±2.9, II型13.1±2.4, III型12.3±2.7であった. 核長径・核短径比は, I型3.6±1.0, II型2.5±0.7, III型1.8±0.6であった.腺腫内癌11例の腺腫部分にも, 大腸腺腫と同じ1型, II型, III型の細胞集塊がみられた. III型の細胞集塊は全例にみられたが, I型, II型の細胞集塊は症例により含まれていないものもあった. 核長径 (μ) は, 1型16.4±3.0, II型14.0±2.2, III型11.0±1.9であった. 核長径・核短径比は, 1型3.8±1.0, II型2.6±0.5, III型1.6±0.3で, いずれの型も癌を含まない大腸腺腫とほぼ同じ値を示した.以上の結果および胃異型腺腫の細胞像との比較から, 1型の細胞集塊は軽度異型, II型は中等度異型, III型は高度異型と考えられた. 症例としてみれば, 1型のみでuniformな細胞所見を呈するものが軽度異型の腺腫, III型のほかにI型やII型の集塊もみられ多彩な細胞所見を呈するものが高度異型の腺腫, III型がなくII型がみられるもの (1型の有無は問わず) が中等度異型の腺腫と考えられた.

Cytology of noninvasive breast carcinoma.

宮城県立成人病センターで非浸潤癌と組織診断された27例について検討した.乳癌細胞診全体としての成績は, 分泌物では非浸潤癌55%, 浸潤癌51%の陽性率であったが, 穿刺吸引材料では浸潤癌の陽性率88%に対し, 非浸潤癌では48%であった.非浸潤癌細胞の集塊では二層構造の消失が特徴的であった.核は基本的に円～類円形だが, 一部で核不整がみられた.核長径はM・G・G染色で平均12.4μm (±1.3) ～18.1μm (±2.9), Pap.染色で8.7μm (±0.9) ～13.2μm (±1.8) であった.非浸潤癌細胞の大多数は小型核で占められ, M・G・G染色15μm, Pap.染色10μm前後であった.著明なクロマチン増量はなかった.散在細胞は細胞質を保持しているものが多かった.