Tohru Ichihara

Immunohistochemical localization of CA 19‐9 and CEA in pancreatic carcinoma and associated diseases

The distribution of carbohydrate antigen 19‐9 (CA 19‐9), on pancreatic carcinomas and associated diseases correlated with carcinoembryonic antigen (CEA) localization is described. Immunohistochemical examinations were made on pancreatic specimens from 45 patients with pancreatic carcinoma. In normal pancreatic duct, the antigens were restricted to the luminal surface. In some hyperplastic epithelium, however, they were localized not only to the basolateral plasma membranes but also to the cytoplasm. In neoplastic glands, the antigens were distributed over the entire surface of the cells and in the surrounding stroma adjacent to the basal membranes of the malignant cells. The findings were compatible with previous observations of CEA and secretory component (SC) localization in gastric and colonic mucosa. In addition, the staining intensity of CA 19‐9 in the routine formalin‐fixed and paraffin‐embedded sections was much superior to that of CEA. The relationship between CA 19‐9 and other blood group antigens, such as Lewis a and Lewis b, also was discussed. Localizations of these antigens in pancreatic tissues are useful for the biologic analysis of abnormalities of the pancreatic duct epithelium, and may well facilitate pathologic diagnosis of pancreatic carcinoma.

Clinicohistopathologic and immunohistochemical studies of intrapancreatic development of carcinoma of the head of the pancreas.

Clinicohistopathologic and immunohistochemical studies of intrapancreatic development of duct cell carcinoma of the head of the pancreas to the body and tail were done in 34 cases in which total pancreatectomy accompanied by portal vein resection were performed from July 1981 to June 1987. In studies of hematoxylin and eosin (HE) staining, intrapancreatic development from the head to the body or tail was observed in 14 cases of 34 cases (41.1%). Multicentricity or skip development was observed in two of 14 cases. However, by using immunostaining of carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9) and DUPAN2, small cancer nests surrounded by dense fibrous connective tissues could be easily and accurately diagnosed, and finally, in 25 of 34 cases (73.5%), intrapancreatic continuous development from the head to body or tail was observed. The intrapancreatic development correlated with portal invasion and perineural invasion of carcinoma, hardness of body and tail, obstruction of the main pancreatic duct, and irregular pancreaticogram. The intraoperative quick immunostaining on the cryostat sections, together with HE staining, is useful to determine the intrapancreatic development of the carcinoma. The indication of total pancreatectomy or pancreatoduodenectomy for carcinoma of the head of the pancreas can be determined by these results.

Clinical usefulness of CA-19-9 in pancreatic carcinoma

Preoperative and postoperative serum levels of carbohydrate antigen-(CA)19-9 in 148 patients with carcinoma of the pancreas were studied. All 18 patients with carcinoma of the pancreas of Stage I, II, and III were resectable, and their pre-operative serum levels of CA-19-9 were under 1,344 U/ml. Pre-operative serum levels of CA-19-9 in patients with Stage IV ranged widely between 5 and 32,240 U/ml. The postoperative survival rate was significantly superior in patients (n = 15) whose CA-19-9 pre-operative serum levels were less than 2,000 U/ml compare to those (n = 64) whose levels were over that level. Fifteen resectable patients who showed serum levels of CA-19-9 over 2,000 U/ml pre-operatively died within 2 years postoperatively due to recurrence, especially by liver metastasis in spite of aggressive surgery. Intraoperative quick immunostaining of CA-19-9 and carcinoembryonic antigen (CEA) was useful to diagnose intrapancreatic carcinoma development on frozen sections of cut margin of the pancreas and also useful in abdominal washing cytology combined with conventional staining.

A CASE REPORT OF INTRATHORACIC FOREIGN BODY REMOVED BY THORACOSCOPIC TECHNIQUE

A 17-year-old boy, who had suffered from an injury to his chest three days before, was pointed out right pneumothorax and a foreign body in the right thoracic cavity and refferred to our hospital. His vital signs including respiratory functions were fair and hemothorax was not seen. Emergency operation was done by thoracoscopic technique, which is application of thoracoscopic bulla resection. He had no complications and felt less pain after the surgery. The thoracoscopic procedure has been applied for emergency operation in a few cases. Only three cases including ours have been reported as foreign body removal by thoracoscope. This procedure has many advantages of less surgical stress, less postoperative pain, and minimal cosmetic problems. If the patients general condition permits, this procedure would be the first choice of procedure to remove intrathoracic foreign body.

A CASE OF OBSTRUCTIVE ILEUS CAUSED BY ENDOMETORIOSIS IN THE ILEUM

A 45-year-old woman seen at the department because of a right lower quadrant abdominal pain at menstruation which started about 3 years before. Abdominal X-ray film revealed intestinal obstruction. Obstructive ileus following appendectomy was suspected and the patient was operated on. During surgery, adhesive ileus at the terminal ileum was detected. Ileocecal resection was performed. Pathological diagnosis was made with endometriosis in the ileum, Bowel endometriosis causing intestinal obstruction is rare. It presents difficulty in pre-and intra-operative diagnosis. In a review of the literature, 28 cases including this case have been reported in Japan. It was characteristic of this disease that seven cases (25%) had a previous history of endometriosis, and 14 cases (50%) developed symptoms at menstruations. Those symptoms included abdominal pain, consti-pation, melena, diarrhea, and vomitting. In this case, the patient also complained of abdominal pain and constipation at menstruations. Entertaining of these characteristics, careful attitude for history taking is very important to get the correct diagnosis.