Toshiji Motohara

Perineural invasion by ductal adenocarcinoma of the pancreas

The correlation between various levels of perineural invasion by pancreatic carcinoma and the patients prognosis has never been cleared. The authors carried out a histopathologic study of resected pancreatic carcinoma to elucidate the significance of a new histologic finding concerning perineural invasion, which we designated “ntrapancreatic, extratumoral perineural invasion (nex),” and also to determine its predictive value for prognoses of patients after surgical removal of the tumor.

Pure squamous cell carcinoma of the thyroid gland —rreport of an autopsy case and review of the literature—

A rare autopsy case of primary squamous cell carcinoma of the thyroid gland is reported herein. A 61-year-old Japanese woman with a swelling of the left neck underwent surgery and the resulting tumor was histopathologically diagnosed as pure squamous cell carcinoma of the thyroid gland. She had had the nodule for 20 years, and it was histologically diagnosed as having been a well-encapsulated, follicular adenoma. Histopathological observation of the resected glands also revealed the coexistence of pure squamous cell carcinoma, which presumably originated from the adenoma. Postoperatively, an esophagotracheal fistula formed due to local invasion of the tumor cells. The patient’s state gradually deteriorated and she died of severe bronchopneumonia and renal dysfunction, 4 months after the operation. Autopsy revealed no distant metastases, but severe septicemia caused by bacterial infection affecting the systemic organs was found, which presemably resulted in multiple organ failure.

Case of retroperitoneal dedifferentiated mixed-type liposarcoma: comparison of proliferative activity in specimens from four operations.

In a case of retroperitoneal dedifferentiated mixed‐type liposarcoma, a dedifferentiated component was observed in the so‐called mixed‐type liposarcoma consisting of well‐differentiated and myxoid components. The proliferative activity was compared among the different components of the tumor by immunohistochemical study using the proliferating cell nuclear antigen (PCNA) and MIB‐1 monoclonal antibodies. The dedifferentiated component showed higher positivity than the well‐differentiated and myxoid components, and tumor progression was most advanced in the dedifferentiated component. In the chronological examination of each component, the labeling indices of PCNA and MIB‐1 were significantly higher at the third recurrence than in the primary lesion in all types, indicating that the proliferative activity of the tumor cells increased gradually. Considering the surgical treatment of liposarcoma, an extended resection encompassing normal adjacent tissues is required in cases containing the dedifferentiated component in comparison to the cases containing only well‐differentiated or myxoid components. J. Surg. Oncol. 1999;72:32–36.

reconstruction Following Total Laryngopharyngoesophagectomy and Extensive Resection of the Superior Mediastinum

&NA; Our experience with four patients who underwent immediate reconstruction following total Iaryngopharyngoesophagectomy and extensive resection of the superior mediastinum is presented. The reconstructive procedures included free jejunal graft or microvascularly augmented gastric pedicle for esophageal reconstruction, pectoral fasciocutaneous or myocutaneous flap for tracheal reconstruction, and mesenteric flap connected with jejunal graft, omental flap, or pectoral flap for protection of the great vessels and obliteration of the dead space in the cervical and superior mediastinal region. The reconstructive procedures were successful, and no pharyngocutaneous fistula, mediastinitis, or great vessel rupture was noted in any patient. There was one patient who developed lung edema and liver dysfunction postoperatively. Combinations of reconstructive procedures using wellvascularized soft tissues can be expected to provide welltolerated reconstruction following extensive cervical and superior mediastinal resection.

A case of pseudosarcoma associated with type 3 squamous cell carcinoma of the esophagus: report of a case.

A case of a primary esophageal pseudosarcoma associated with an independent type 3 tumor is described herein. A 60-year-old male presented with dysphagia and chest discomfort. A clinical evaluation revealed a type 3 tumor in the middle of the esophagus, which was diagnosed after a biopsy to be squamous cell carcinoma (SCC). A subsequent gross examination of the subtotally removed esophagus revealed a polypoid tumor adjacent to the type 3 tumor. Histologically, the polypoid mass was composed of SCC and mesenchymal components without a transitional zone. The tumor was thus classified as a pseudosarcoma of the esophagus, and was unique in that this appeared to have developed independently from the SCC.

Duodenum-Preserving Resection of the Head of the Pancreas in Patients with Chronic Pancreatitis or Low-Grade Malignancy

Duodenum-preserving resection of the head of the pancreas was performed in 41 patients with chronic pancreatitis and 23 with pancreatic neoplastic lesions. Denervation of the body and tail of the pancreas was added for the patients with chronic pancreatitis. The major advantage of this procedure is that only the small pancreas head is resected, leaving the endocrine and exocrine systems functioning normally. This procedure provides complete pain relief for the patients with chronic pancreatitis; 92% of patients experienced alleviation of pain and no recurrence. Postoperatively, 76% of patients could work well, and 87% maintained their preoperative body weight. Postoperative glucose tolerance test showed 21% of the patients with preoperative diabetic pattern improved to the nondiabetic pattern between 3 months and 3 years after surgery. In 23 patients with pancreatic neoplasms, 22 patients were alive during the follow-up period with no recurrence of the tumor, except 1 patient who died of acute myocardial infarction. We concluded that our procedure allows, patients with chronic pancreatitis to be free from intractable pain and to maintain good endocrine function of the pancreas. Furthermore, this procedure can be applied to patients with low-grade malignant lesions of the pancreas.

A Case of Pancreas Head Carcinoma Associated with Stenosis of the Celiac Axis. The Significance of Intraoperative Evaluation of the Hepatic Artery.

腹腔動脈起始部に正中弓状靱帯による狭窄を伴った膵癌に対し, 電磁血流量計で肝動脈血流量を測定しながら安全に膵頭十二指腸切除術を施行できた1例を報告する.症例は52歳の男性.上腸間膜動脈造影検査で, 膵頭部アーケードが著明に拡張し, 下膵十二指腸動脈, 胃十二指腸動脈を介して肝動脈, 脾動脈が描出された.大動脈造影側方向像で腹腔動脈起始部に腹側からの圧排狭窄を認め, 腹腔動脈起始部に狭窄を伴った膵頭部癌と診断した.術中の電磁血流量計による左肝動脈血流量は正常時20ml/秒, 胃十二指腸動脈遮断時20ml/秒, 総肝動脈遮断時4ml/秒, 胃十二指腸動脈と正中弓状靱帯切離後に26ml/秒であった.腹腔動脈起始部に狭窄を伴った患者の膵頭部切除時には, 肝動脈血流量を測定しながら, 手術操作をすすめることが術後合併症の予防に必須であると考えられた.

A Case of Bile Duct Carcinoma Reconstructed Right Hepatic Artery with Jejunal Artery of the Efferent Limb.

右肝動脈に浸潤した中部胆管癌に対し, 右肝動脈再建を伴った幽門輪温存膵頭十二指腸切除を施行した. 症例は64歳の男性. 閉塞性黄疸で入院した. 経皮経肝胆道ドレナージで, 中部胆管に狭窄を, 血管造影検査で右肝動脈に不整狭窄を認めた. 右肝動脈に浸潤した中部胆管癌と診断し, 膵頭十二指腸切除術を予定した. 腫瘤と右肝動脈は剥離不能であり, 浸潤部を合併切除した. この際, 右肝動脈からの血液の逆流を認めなかった. 胆道再建に用いる挙上空腸脚とともに第2空腸動脈を肝門部に持ち上げ空腸動脈と右肝動脈吻合を施行した. 術後経過良好で血管造影により右肝動脈の開存が確認された. 本例は左右肝動脈の交通が不良であり, 右肝動脈再建の適応と思われた. 挙上空腸脚動脈は胆道再建を伴う胆膵手術時の肝動脈再建の選択肢の1つになりうると思われる.