Tomohiro Toda

Synchronous multiple colorectal adenocarcinomas.

The object of the present work was to characterize clinical features and the quality of preoperative examinations in patients with synchronous colorectal carcinomas, and to compare the incidence of associated benign polyps with our findings in patients with a single malignant lesion.

Endoscopic and pathologic features of Epstein-Barr virus–associated gastric carcinoma☆☆☆★

BACKGROUND Although the presence of Epstein-Barr virus has been documented in approximately 7% of patients with gastric carcinoma, the clinical features of Epstein-Barr virus-associated carcinoma have not been well documented. We studied the histologic and endoscopic characteristics of Epstein-Barr virus-associated gastric carcinoma. METHODS We tested 124 gastric carcinomas from 117 patients using in situ hybridization for Epstein-Barr virus encoded small RNA1. The histologic and endoscopic findings in the Epstein-Barr virus-associated groups and the negative control groups were analyzed and compared. RESULTS Twelve tumors (9.7%) were identified as Epstein-Barr virus associated. These lesions were located mainly in the upper part of the stomach (p < .05) and had a diffuse-type histology (p < .05) compared with those in the control group. Six of seven (85.7%) early Epstein-Barr virus-associated lesions were type 0 IIc (superficial depressed) or a combined type, and 42.9% were accompanied by submucosal nodules of carcinoma with lymphoid stroma. Four of five (80%) advanced Epstein-Barr virus-associated tumors were type 3 (ulcerated without definite limits), thought to be the advanced shape of superficial depressed lesions. CONCLUSIONS Epstein-Barr virus-associated gastric carcinomas often appear as superficial depressed or ulcerated lesions in the upper part of the stomach and have a diffuse-type histology with lymphoid infiltration.

Strip biopsy to treat esophageal granular cell tumor

Esophageal granular cell tumors are rare neoplasms. We successfully treated a 35-year-old Japanese man with an esophageal granular cell tumor without any complications using strip biopsy. Endoscopic ultrasonography revealed a hypoechoic tumor with a diameter of 8 mm that was confined to the submucosal layer. A strip biopsy done with a two-channel endoscope completely resected the tumor. Six months later, no abnormal findings were recognized in the resected area. Therefore we propose that strip biopsy be considered as a viable alternative treatment for esophageal granular cell tumor, depending on the histologic character, tumor size, and depth of tumor infiltration.

A case of postoperative recurrent cholangitis after pancreaticoduodenectomy successfully treated by tract conversion surgery

A 69-year-old man, who had undergone pylorus-preserving pancreaticoduodenectomy (PD) (Imanaga procedure) for duodenum papilla cancer 13 years prior, had a history of repeated hospitalization due to cholangitis since the third year after surgery and liver abscess at the 10th year after surgery. Gastrointestinal series indicated no stenosis after the cholangiojejunostomy. However, reflux of contrast media into the bile duct and persistence of food residues were observed. We considered the cholangitis to be caused by reflux and persistence of food residues into the bile duct. So, we performed the tract conversion surgery, Imanaga procedure to Child method. The postoperative course was good even after re-initiating dietary intake. He was discharged on the 19th day after surgery. He has not experienced recurrent cholangitis for 18 months. For patients with post-PD recurrent cholangitis caused by reflux of food residues like ours, surgical treatment should be considered because tract conversion may be an effective solution.

Ruptured amebic liver abscess.

We treated two patients with a ruptured amebic liver abscess. The diagnosis was made at a relatively early stage and treatment was successful for one patient, but an accurate diagnosis of liver abscess was not made and invasive extraintestinal amebiasis led to multiple organ failure and to death for the other. Neither patient had been outside of Japan, and both were heterosexual. The origins of Entamoeba histolytica infection could not be determined. Though the mortality rate is high in cases of ruptured amebic liver abscess, appropriate management can lead to a good prognosis.

Prediction of Lymph Node Metastasis in Early Gastric Carcinoma by Immunohistochemical Analysis and its Clinical Application.

1986年から1995年に施行した早期胃癌手術326症例のうちリンパ節転移を認めた21例について, ホルマリン固定パラフィン包埋切片を用いてABC法にて癌関連遺伝子であるp53, c-erb B2, cyclin E, CD44について免疫組織学的検討をおこない, その陽性率について対象群40例と比較検討した. p53, cyclin E, CD44のいずれにおいても陽性率は転移群で有意に高率であり, 3遺伝子ともに陽性を示した症例はn (+) 群: 7/21 (33%), n (-) 群: 3/40 (8%) で. n (+) 群で有意に高率であった. さらにcyclin EまたはCD44が強陽性を示した7例は全例がn (+) 群であった. 1996年度の手術症例29例について, 生検標本において転移高危険群と判定した症例は計4例で, n (+) の2例はもれなく含まれていた. 以上より, p53, cyclin E, CD44陽性症例ではリンパ節転移の危険性が極めて高いことを考慮すべきで, 生検組織による術前判定が可能であり, 最適の治療法や術式の決定に活用できるものと考えられた.

Study on Nuclear DNA and Cancer-related Gene in a Case of Early Gastric Cancer Complicated with Virchow Metastasis.

発見時既にVirchowリンパ節に転移を伴い, 術後5か月で癌性腹膜炎にて死亡した早期胃癌症例を経験し, 摘出標本について核DNA解析と癌関連遺伝子発現の検索を施行した.早期胃癌のVirchowリンパ節転移例の報告例は本邦ではわずか5例と稀であり, 癌関連遺伝子の検索が行われた初の症例と考えられる.症例は50歳の女性で, 胃内視鏡にて胃角部前壁の早期胃癌と診断され手術を施行した.入院時に左頸部から鎖骨上窩に小リンパ節を触知し, 術中迅速病理にて転移と診断された.本症例は35×28mm大のIIa病変で癌本体はm層にとどまりながら, sm浅層のリンパ管に著しい腫瘍侵襲を認めた.DNA ploidy patternではaneuploidy patternを示し, 転移抑制遺伝子であるnm23の発現減弱が認められた.またc-erbB-2は原発巣, 転移巣ともに著明な過剰発現を示したが, 転移巣, リンパ管内の癌細胞は原発巣に比して発現が強く, 遠隔転移における関与が示唆された.